4.3 Transport Vehicle Emergencies
Key Takeaways
- Know the exits, handle directions, and jettison windows before takeoff, and lock every monitor, pump, bottle, and bag so they cannot become projectiles
- Cabin fire, smoke, or an electrical smell is announced to the pilot immediately; fight only a small reachable fire, then prepare for an emergency landing
- In autorotation or a hard landing, stay restrained and silent unless the cabin is on fire; wait for rotor stop before egress unless fire or sinking forces you out
- For ditching, don life vests but do not inflate them in the cabin; for fixed-wing decompression, 100 percent oxygen and a pilot-flown descent come first
- Pilot incapacitation breaks sterile cockpit: in single-pilot HEMS the nurse cannot fly the aircraft and must get a distress call out and prepare the cabin
The flight nurse does not fly the autorotation. The flight nurse does keep the cabin from killing the crew during one. Transport vehicle emergencies are the in-flight and ground-backup failures you have to act on in the next thirty seconds.
Know the exits before the skids leave the ground
Before every takeoff, look at the door you will use, the window that jettisons, the handle direction, and the path the stretcher will take. Secure every monitor, pump, oxygen bottle, and bag. Loose equipment becomes a projectile in a hard landing or a decompression.
| Emergency | Flight-nurse action |
|---|---|
| Cabin fire, smoke, electrical smell | Tell the PIC, don protection, fight only a reachable fire, prepare to land |
| Autorotation or hard landing | Brace, stay silent unless fire, wait for rotor stop unless fire or sinking |
| Ditching | Vests on, uninflated in the cabin; jettison exits; raft after egress |
| Loss of pressurization | 100 percent oxygen, PIC descends, watch Boyle expansion |
| Open door | Tell the PIC, restrain the cabin, do not lean into the slipstream |
| Pilot incapacitation | Break sterile cockpit, radio distress, prepare the cabin; the nurse cannot fly a single-pilot ship |
| Ground collision, fire, or rollover | Restraints first, then egress if fire or drowning |
Cabin fire, smoke, and electrical smell
Treat smoke and an electrical smell as fire until the PIC and you prove otherwise. You do not need the chemistry to act.
- Tell the PIC immediately on the intercom — location, color of smoke, visible flame, and whether the patient is in the smoke.
- Don available smoke goggles or a crew oxygen mask. Give the patient oxygen from a source that is not feeding the fire if you can choose.
- Fight only what you can reach with the cabin extinguisher, aiming at the base, then watch for reflash.
- Electrical fire: isolate the offending device if you can do it without becoming the next ignition source. The PIC will shed electrical buses.
- After a Halon or clean-agent discharge, ventilate when the PIC says the flight path allows it — not by popping a door into rotor wash during an emergency descent.
If the cabin is filling and you cannot put the fire out, prepare for an emergency landing: restraints tight, equipment locked, patient protected, egress path clear.
Autorotation, hard landing, and a field or road
Autorotation is the helicopter's engine-out glide: upward airflow keeps the rotor turning so the PIC can make a controlled descent. The briefing is simple: you brace and stay silent unless the cabin is on fire. Tighten restraints, protect the patient's airway and stretcher locks, and do not stand, grab the cyclic, or open a door in flight. After a hard landing, wait for rotor stop unless fire, then egress as briefed.
An emergency landing on a road or field adds cars, wires, and slope. Once the rotors have stopped, treat it as a new scene: traffic, fuel, and a radio call for a ground ambulance if the aircraft cannot fly again.
Ditching and pressurization failure
Ditching is a planned or forced water landing. Time permitting:
- Life vests on, not inflated in the cabin. An inflated vest can trap you in a flooded, inverted fuselage.
- Know which windows or doors are the water exits. Some must be jettisoned before submersion because water pressure will hold them shut.
- After exit, inflate the vest, board the life raft if one is deployed, and keep the crew and patient together.
- A backboarded, intubated patient is an egress problem you solve in the briefing, not in the water.
Most civilian helicopters are unpressurized. Dedicated fixed-wing ambulances often are pressurized. A sudden decompression or a slower loss of pressurization is a hypoxia emergency first. Don 100 percent oxygen for crew and put the patient on a high-concentration source. The PIC flies an emergency descent. Watch expanding pneumothorax, endotracheal-tube cuff, and intra-aortic balloon helium. Time of useful consciousness shrinks as cabin altitude rises.
An open door in flight is a PIC emergency and a cabin-projectile emergency. Tell the PIC. Do not lean out to close a door against the slipstream unless you are trained on that airframe and the PIC directs it. Restrain the patient and equipment near the opening.
People as the emergency
If the patient arrests, treat them — but do not break sterile cockpit during takeoff, landing, or hover unless the PIC must know ("patient lost pulses, I am starting compressions"). In cruise, say the problem in one sentence and work.
If a crewmember is the emergency — especially pilot incapacitation — break sterile cockpit immediately. In a dual-pilot aircraft, the remaining PIC lands as soon as practicable while you support the incapacitated pilot. In the common single-pilot HEMS cabin, you cannot fly the helicopter. Get a radio call out, treat reversible causes if you can reach the PIC (hypoxia, hypoglycemia), and prepare the cabin for a forced landing.
Ground-backup ambulance emergencies
When the rotor cannot fly, you may finish the transport in a ground ambulance. The same brain applies:
- Collision: restraints first, then scene safety, then patients. Do not exit into traffic.
- Fire: get everyone out, upwind, and use the extinguisher only if the fire is small and blocking egress.
- Rollover: stay belted until the box stops moving unless fire or drowning forces you out; then egress through the new "up" door or window.
Know the exits, lock the equipment, and say the emergency out loud the first time you smell smoke.
The pilot briefs a precautionary ditching with about two minutes of warning. What should the flight nurse do about flotation?
A pressurized fixed-wing cabin suddenly fills with fog and the cabin-altitude warning sounds. What is the flight nurse's first action?
On a single-pilot helicopter in cruise, the pilot slumps over the controls. What is the most appropriate flight-nurse action?