Putting newborns and children at risk

NSW Ambulance is replacing NETS current two-pilot system with a single pilot operation – a move which experts say will endanger staff and critically ill patients.

NETS transports babies and children who are critically ill and injured with a specialist neonatal and paediatric team who safely transport these sick or injured infants/children between hospitals using road, fixed and rotary wing vehicles. NETS is not a dedicated helicopter service – NETS chooses the vehicle based on the child’s needs first and foremost.

Pre-hospital specialists move children from the home or roadside to the nearest hospital. Should the infant or child’s needs overwhelm the rural, regional or metropolitan hospitals, NETS Specialists provide intensive care stabilisation and expert escort to the tertiary or quaternary specialist neonatal or paediatric facility.

The Neonatal Paediatric Emergency Transport Service NSW (NETS) has used a dual pilot operation, without incident, since NETS began flying infants and children in 1989.

According to NETS State Director Andrew Berry, the dual pilot mode offers ‘airline’ standard pilot redundancy and Crew Resource Management.

“It was particularly important to NETS because of the typically long distance and long duration nature of NETS’ missions. Such missions, which test the boundaries of what a helicopter can do, require careful and complete planning – something much safer and more efficient with two pilots working together than one alone.”

NETS currently uses helicopters provided by CareFlight, however from 2017 this mode of transport will be contracted to Toll Logistics.

At present, Careflight offers two dedicated NETS helicopters manned by two pilots, however the Toll contract will drop this to one helicopter available to NETS manned by one pilot and a winching paramedic. A winching paramedic is not required during the inter-facility transport of critically ill and injured infants and children.

According to AMA (NSW)’s Hospital Practice Committee member, Dr Kath Browning Carmo, there are proven safety advantages to having two pilots – a system that is used by most services around the world.

“This disregards NETS’ needs as an Interfacility service that often flies longer distances that require more planning and pilot input to the flight,” she said.

“Health is funding this helicopter which is an advanced machine – an AW139 that is recommended as a two pilot operation and this is largely adhered to in the USA and in Europe. The manufacturers recommend the AW139 is operated by two pilots. When you compare flying hours, NETS does over half the helicopter work in NSW however it is being reduced to a third of the resources. We will have access to a helicopter following consultation with adult ambulance approval and if the helicopter is deemed available.”

To manage this loss of pilot, NETS’ highly skilled neonatal and paediatric staff will not only be responsible for the critically ill infant/child, they will also be expected to function as crew and manage aviation responsibilities. All staff on a helicopter are responsible for safety, however previously NETS staff focused on the infant/child and were deemed “medical passengers”. Now they are expected to train further to be able to function as “medical crew”.

“This puts at risk the safety of NETS staff and also the critically sick and injured infants and children that are moved around the state on up to 500 flights per year,” Dr Kath Browning Carmo said.

The AMA (NSW)’s Hospital Practice Committee will be writing a letter to NSW Ambulance in support of retaining the two pilot system. dr.