2009

2009 saw a full programme of meetings, Spring, Autumn, a fly-out, gliding and a trip to France.

Spring Meeting:   Saturday 28th February 2009, London.

Theme:  Aeromedicine – the choice of challenges for 2009.

Venue:  Royal College of General Practitioners, London.

Report,  by Peter Anderson.

We thank Jeremy Radcliffe for the general organisation, Raj Bansal for arranging the civilian lectures, and Claire McCready who arranged the RAF lectures.

President Gordon Williams welcomed all and introduced new member Dr. Neil Wilson.  After the lectures, we regrouped at 7pm for a truly excellent Association Dinner, provided by the College Staff, who received well deserved thanks from President Gordon Williams.

Lecture 1: The Manchester Air Disaster of 1985, by Paul Cook.

Paul Cook was formerly a Chief Superintendent with Greater Manchester Police, and held a PPL for many years.  He is internationally known as an expert on drugs and organised crime.  He lectures worldwide on these matters. (See www.paul-cook.net.)

He was involved both in the immediate policing of the 1985 incident at Manchester, and in the subsequent enquiry into this disaster which killed 55 of the 137 on board.

The Boeing 737-200 was on the take-off run on runway 24, with a very light headwind (270/05 knots).  At 127 knots there was a very loud bang. The crew could not determine the cause, but instruments showed left engine failure followed by a fire warning.  In accordance with practice at the time and ATC instruction, after slowing, the aircraft was turned off the runway and stopped.  At that time only a right turn was available.

There was an apparent left engine fire, which turned out to be due to disintegration of number 9 combustion chamber, with high speed debris penetrating the wing fuel tank, resulting in a deluge of fuel onto the hot engine causing a severe and unstoppable fire.

Videos and photos showed smoke and flames affecting the right side of the aircraft, with relatively little effect on the left.  The right rear door and shute were rapidly deployed but were not used. Another door/chute jammed due to a design fault, subsequently altered by the manufacturer. Inside, passengers struggled to get out, piling up and obstructing each other as they tried to get through a 27″ bulkhead (domestic doors are 31″ wide).  Despite the very prompt attendance of the emergency services, 55 died of burns or inhalation of toxic substances, all in a very short time.

Paul described the considerable difficulties experienced subsequently due to interference from the press, politicians and clergy, problems establishing a mortuary and obtaining medical and dental records for identification purposes.

Initially the Air Accident Investigation Board did not consider that the very light wind was a factor, but Mr. Cook and his Fire Brigade colleague thought otherwise.  They arranged a test fire at a disused airfield in similar weather conditions, filming the flames and smoke from various angles.  This showed conclusively that even a light wind has a very significant effect on the direction and spread of flames and smoke.

This was accepted by the AAIB, and with the benefit of this previously unknown knowledge, it became apparent that had the aircraft stayed on the runway, the wind would not have blown flames and smoke under the fuselage, with likely much more successful evacuation of the aircraft.

Subsequently, recommended procedures were revised, along with floor lighting for guidance and revised internal aperture widths.

Lecture 2: The future of UK GA and European Rules, by Martin Robinson.

Martin Robinson is Chief Executive Officer of the Aircraft Owners and Pilots Association (AOPA) UK.  He is also Deputy Vice-President of the International AOPA which has 33 European offices and 23,000 individual members.  He is Secretary General of the European GA Safety Foundation, and GA member of many important working groups.  He is an active pilot with UK and US licences.

He tries to co-ordinate European rule making with global plans in Montreal in relation to General Aviation.  This is all flying apart from commercial and military.  Thus GA includes business, sport, recreation, aerial work, air taxi, law enforcement and ambulance work.

AOPA tries to present aviation to the wider world to attract new people, for instance a presence at the Boat Show which has 120,000 visitors.  He reminded us that Europe is 4% larger than the USA, with 100 million more people, with an massive economic value in the various sectors of GA, all of which need to pull together.  He noted the regrettable trend for regional airports to price out GA.

He feels that the European commission is sympathetic to GA, but that EASA is overdoing maintenance rules, for example flight training will be auditable every 2 years at considerable cost, but the UK alone is required to recover expenses.  EASA does not have the data to assess the impact of their GA rulings since all their data is IFR sourced.

Licencing may become:

  1. Restricted recreational, within 50km of base, GP medical.
  2. Leisure, within EU States, passengers, GP medical which may reduce initial costs and encourage newcomers.
  3. Full PPL, more training, heavier aircraft, may progress to instructor, Class 2 medical needed.

These measures are UK led.

Mr. Robinson feels that commercial airlines should fund their own operations since GA pays plenty in taxes.  There are 30 billion Euros available for modernization of European skies.  We must ensure that GA freedom of movement remains, though likely transponders will become mandatory.  “See and Avoid” will prevail, especially as ATC shortage means that controllers, busy with IFR traffic often cannot cope with VFR traffic.

Infringements occur at all levels of competence, mostly due to poor pre-flight planning: study the maps, get Notams or free-phone (0500 354 802) for temporary restrictions, Red Arrows etc. and remember that LARS is replaced on March 12th 2009 by “ATSOCAS” – “Air Traffic Services Outside Controlled Air Space”.  Learn the four levels of service that will be available then.

Anti-terrorist moves: 300 police officers are being trained for GA procedures, and new forms will soon be available, with risk of severe disapproval if you do not comply.  Also possibly 100% passport checks, but perhaps with text option with unique number to ease the procedure.

AOPA successes include stopping VFR fees, halting severe increase in Avgas duty, and preventing a charge for “radio frequency use”.  IMC Rating may become a European stepping stone to a full IR, if not the CAA should have an opt out clause.  Interestingly, Japan may introduce a similar rating.

In conclusion Martin again emphasized the importance of all pre-flight checks, and regretted the loss of a level of safety from the loss of PPL instructors.  Perhaps the rule makers should recall that the Ark was handled by amateurs, the Titanic by professionals!

Lecture 3: Can Doctors learn from Aviation’s human factors training? by Professor Brian Ellis.

Brian Ellis was Consultant Urological Surgeon at Ashford and St. Peter’s Hospitals from 1983 until late 2007.  He now consults in Primary Care and is a Visiting Professor and Honorary Clinical Tutor.  He was an early advocate of clinicians’ use of diagnostic ultrasound and regularly runs courses for other Urologists.  He has always been passionate about patient safety, and has implemented “Human Factors” training for senior staff.

Professor Ellis reminded us that NHS litigation was negligible before the 1970s, but now is a major and expensive item.  The cost in 1999-2000 was £386 million.  Mistakes happen.  Errors are inevitable, ranging from the trivial to those causing death.  The important point is that ALL should be noted and analysed in order to understand the evolution of errors.  This is necessary so that staff can be trained to understand the basics of “human error”.

Safety in aircraft and hospital has similar needs, good, well maintained equipment, and good crews/staff.  But stopping here overlooks human factors.  Aviation and Surgery have a common evolutionary pathway: in early days, unreliable equipment, poor maintenance systems, inadequate training, knowledge base and skills.  An extreme example is Galen’s anatomy text, based on monkey anatomy.  It was used for centuries until Vesalius, in the sixteenth century risked the wrath of the righteous and commenced human dissection.

Now both disciplines have good equipment, good maintenance, good understanding and training.  Important aspects of “human factors” are situational awareness, risk management, communication, feedback, behavioural patterns, leadership, fellowship and motivation.  Captain Sullenberger, who recently landed an ailing Airbus on the Hudson River, is a shining example of excellent “human factors” input, this from a man who sets up and runs crew resource management courses.

Human factors leading to disaster can be acts of omission, commission or bad communication.  There is always an “error chain” leading to, for examples, shutdown of wrong engine (Kegworth 1989) and removal of wrong kidney (Llanelli 2000).  Another example, failure of computer programming so that the extra drag of wheels stuck down, was not taken into account for fuel requirement prediction, and an aircraft ran out of fuel.

The “Herald of Free Enterprise” maritime disaster was caused by ignoring check lists already in place.  Intrathecal Vincristine was given due to a series of human errors which surely should be avoidable.

Errors arise with teams of different skills, complex tasks, non-obvious situations, hierarchical and transnational cultures, budgets, time pressures and expectations.  Medical Team Resource Management should address all these components, in all areas; theatre, radiology, intensive care and ward.

Good TRM and leadership should give good improvement, though it is difficult to prove absolutely.  A questionnaire study showed that most felt this would be so, especially if senior management attended!

Professor Ellis felt courses probably have helped, but since he was unable to make them compulsory, there was an element of preaching to the converted, with those really needing the advice staying away.  There is a tendency to keep quiet about incidents, to regard a report as a threat. Apathy, and a feeling that useful inputs are not appreciated, these negative elements of course not helping safety.

He concluded with a delightful slide reminding us to always to expect the unexpected – a slide of Father Christmas being pitched into the snow because his reindeer were distracted by a real “tart” of a reindeeress!

Lecture 4: Analogies between the Operating Theatre and Aviation Environments by Professor David Mendelow.

Professor Mendelow has worked in Newcastle since 1987, being Professor of Neurosurgery since 1992.  His earlier training was in South Africa, Edinburgh and Glasgow.  He has a PPL with around 750 hours, and has shares in a Bulldog and a Twin Comanche; clearly a man of good taste and discrimination.

Operating theatre and aviation environments have similar problems, both low- and high-tech.  For example, distractions, sudden unexpected developments, personal limitations, fitness, and routine repetition. Abnormal anatomy could equate to bad weather.  Maintainance issues are broadly similar.

Comparable errors could be: wrong patient / wrong airport, wrong site / wrong runway, wrong side / wrong circuit, wrong X-ray / wrong approach chart.  Technique and judgement affect both areas.

Some excellent guidelines need considerable resources.  Newcastle needed £500,000 to institute NICE guidelines on head injury, mainly early transfer to a Neurosurgical Unit, this halved mortality and much reduced morbidity.  The use of check lists put up in theatre gradually declined, though WHO Surgical Safety Checklists are now mandatory.

High-tech items: GPS (Global Positioning System) can be compared to IGS (Image Guidance System).  The use of IGS dramatically improves, for example, the initial success rate for insertion of a ventricular drain but both systems demand careful use and understanding, and have the capacity to seriously mislead the unwary.  Hands up all those who knew that there is a button which if pressed transposes a CT scan.  (Why fit such a recipe for disaster?)

Competence comparisons: Aviation has regular checks and medicals, in surgery revalidation is coming.  Surgeons however tend to work when ill, but pilots do not.  Preparedness and personality are problems in both areas, and are difficult to define and supervise.

Both disciplines need adequate training, revalidation, check lists, limitations of pressure, an adequate, easy to use error reporting system, good resources, and very careful selection with regard to ability and personality.

In conclusion, realize these things; errors are inevitable, reporting should be easy, the need for check lists, brief / debrief, work-load, distraction, all these factors are important.

Lecture 5: Typhoon – The Aeromedical Challenges by Wing Commander Nic Green

After a period of hospital medicine, Wg. Cdr. Nic Green joined the RAF in 1990, and is based at RAF Henlow.

The Typhoon is a product of four nations, UK, Spain, Italy and Germany. The UK is the lead in assessment and sorting of Aeromedical problems.  In overall competition the Typhoon is second only to the greatly more expensive American Raptor, being Generation 4.5 compared to the 5 of the Raptor.

The Typhoon is a highly maneuverable, hugely powerful device, being computer controlled, this prevents limits being exceeded.  This gives relatively carefree handling.  The aeromedical issues include high altitude, rapid climb and descent, very high G force, disorientation potential, thermal and survival problems.

The challenges are to achieve a working compromise between protection and practicality.  The methods hinge on progressive release to service of items, with gradual expansion of the performance envelope.  This requires working very closely with industry to provide rapid prototyping and testing for performance and repeatability.  Testing is on bench, in chamber and centrifuge and with Hawks, which are cleared to 9.5G, and have 16 channel data recording and video.  Each type of protection required has to be clearly defined and integrated with other gadgets of protection, and optimized by going round in circles looking for perfection.

Typhoon performance is remarkable.  Very modest runway requirement (1,500 feet), off the ground in 7seconds, 450 knots over the end of the runway, 2.5 minutes (150seconds) to 35,000 feet at Mach 1.5.  Agility? How about from 1G to 9G in ONE second!!

Altitude.  At 40,000 feet, should cabin pressurization fail, even breathing 100% oxygen is not enough, so pressurized breathing is used, with automatic tightening of the mask.  This blows up the thorax, with risk of pneumothorax or embolism, which is countered by a chest compressive garment, which has to be integrated with other survival requirements. Surprisingly, pressure breathing is not inspiration triggered, this is very uncomfortable.  60,000 feet is the limit, but most unpleasant.  The “Space Suit” idea is no good, too restrictive and too long to get into.

G-Force.  4.5 G can cause fainting.  AVM Bill Stewart demonstrated in a Fairy Battle that the effect of 6G can need 30 seconds to recover competence after G-force is normalized.  Often “grey-out” (retinal ischaemia) gives some warning, but at 8G+. eye and brain go together, i.e. sudden unconsciousness.

The standard 5 bladder anti-g trousers are inadequate.  To counter high G-force, new Full Cover Anti-G Trousers (FAGT) have been developed here, (there were 12 prototype variations) and attract world-wide interest. G-force also affects blood pressure and breathing, and the positive pressure breathing for G protection comes in at 4G, to a maximum of 60mm Hg above ambient at 9G.  The main benefit is to maintain blood pressure to prevent GLOC (G-Loss Of Consciousness), the help with breathing is a bonus.  All this has to fully integrate with survival gear, liquid cooled vest, be reasonably comfortable and allow adequate movement.

Headgear produces problems, since there is a danger of too much weight causing neck injury under high G.  It needs to accommodate head up display, night vision kit, mask and sealing kit, communications, and be stable under high G.  Also to be considered, the time it takes a pilot to dress. Overall, a surprising number of inter-related problems to assessed and solved.

Lecture 6: Typhoon, – The Operational Aircrew Challenges by Pilots Rich Wells and Steve Pook, No. 3 Aircrew, RAF Coningsby

RAF Coningsby in Lincolnshire employs 2,500 personnel, houses the Battle of Britain Memorial Flight, and is home to the Typhoon Operational Evaluation Unit, with 2 Squadrons and 50 pilots A unit is planned for Leuchars in 2010.  Quick Reaction Alerts are a current priority, with a noticeable increase in prowling, possibly intruding activity.  There are always two fully armed aircraft ready to be in the air quickly.

The Typhoon has performance much superior to most others, with extreme agility and very high thrust-to-weight ratio.  It has good endurance at high altitude, with superb cruise capability.  At 40,000 feet at 0.9 Mach it uses less fuel than at ground idle.  It can go from low level 200 knots to Mach one in 30 seconds with reheat, and in quieter times goes from sub-sonic to super-sonic without reheat.

Take-off can be under seven seconds from less than 1,400 feet of runway. Weapon load is up to 6,000 pounds at 5.5 G limit, cruising at 0.9 Mach. Extra tanks are an option.  It can carry the load of three Tornados.  Without load the G limit is 9.

The man – machine interface is of interest.  There are three screens with overlay capability for maps, radar, etc, presented in a way to give best situational awareness and to reduce workload.  There is “Voice Input” from “Bitching Betty”, and they can talk back.

Pilot personal equipment was discussed, with Steve Pook modestly strutting the catwalk to display his undergarments and putting on the layers of kit.  We saw, or were told of; insulating underclothes, which will later have a cooling vest, fireproof long johns, full dry suit (a big survival aid in cold water), full cover G trousers and G socks, jacket with compressive bladder to counteract positive pressure ventilation, and helmet, with night vision kit, the latter weighs 2kg.  They felt, at times, that there was too much protection!

Each pilot is on call for rapid departure around three times per month. Whilst on call he will constantly wear as much of the kit as possible, to minimize time dressing when responding urgently.  We were relieved (so to speak) to hear that the facility exists to have a pee in the air or on the ground.

A most interesting talk, difficult to adequately convey in words, it needed a video to do it justice.

Easter Fly-out:  Saturday 11th April 2009, Yorkshire.

Sherburn-in-Elmet airfield.

Early June Fly-out:   2009, Perth.

We joined the Scottish Aeroclub for their Open Day and scenic flying. Perth Airport, Scotland.

11th-14th June 2009, Association des Médecins Pilotes.

A goodly number of BMPA members joined up with our French counterparts for “Le Découverte de l’Alsace Authentique and again enjoyed their generous hospitality.  The meeting was based at Colmar with arrivals by air at Colmar Houusen Airport.  We visited to the beautiful town of Eguisheim where we had wine tasting and lunch.  The following day, we had a guided tour of Strasbourg which included a boat tour and cathedral visit where we saw the famous astronomical clock.

After lunch we toured by coach some extremely beautiful towns and villages in the area between Strasbourg and Mulhouse, including Itterswiller, Dambach la Ville, Riquewihr and Kaysersberg.  The Gala Dinner was at the Michelin-starred “Rendez-vous de Chasse”.

18th July 2009, Shenington.

Gliding in a relaxed and friendly atmosphere.

4th-6th September 2009, Shrewsbury / Cosford / Sleap.

This weekend included, amongst other things the new ‘cold war’ display at Cosworth and the National Trust house at Attingham Park.