Table 1 Output from the safe job analysis

1

Reconnaissance

Reconnaissance

Loose objects above the accident site

Personnel moving above the accident site. Risk of falling rocks

Length of static rope selected is too short

May pose a risk to the helicopter

Rock falls can pose a danger to the helicopter. Can lead to personnel injury and material damage

May cause climbers to be unable to drag the HEMS rescuer to the accident site (it will be too heavy)

Thorough reconnaissance during ROPE. If there is a rappelling rope down to the accident site or there are other loose objects above the accident site, the helicopter crew must make sure that they have been secured

Thorough reconnaissance during ROPE. Make sure that there are no personnel above the accident site. Risk assessment of the mountain/terrain quality.

Thorough reconnaissance during ROPE

Clarification in the procedure: during reconnaissance one must also assess whether any rappelling rope used by climbers to get to the accident site must be removed or secured before an offset technique operation

*Other hazards and barriers to prevent them occurring are covered by existing procedure(s)

2

Leaving the rig site and arrival at the scene (approach)

The HCM attaches the offset throw line to the central loop of the climbing harness

The HCM forgets to attach the offset throw line in the central loop of the climbing harness

Time delay in mission. It will take longer before the rescuer can start preparing the patient for evacuation

Covered by existing checklist (SIST).

*Not found expedient to specify this in the procedure. Hazard identified is more of theoretical interest

Last check, SIST, is carried out

The SIST check is not carried out or certain elements of the SIST are forgotten

Can contribute to additional consequences for the rescuer and patient, i.e., insufficient safety barriers

Procedure and training state that the SIST check shall be carried out. Experience shows that SIST is always carried out

Already implemented in the procedure

The helicopter is positioned as close to the accident site as possible. The maximum throw length is approximately 15 m

The helicopter’s positioning is too far from the accident site. Throw length will be more than 15 m

Unable to access accident site

Thorough reconnaissance and assessment of throwing distance during ROPE. One should not try to gain access with a throw line if the throwing length exceeds 15 m

Already implemented in the procedure

Hand signal “hold height” is given, and the HCM prepares the offset throw line. The ideal throwing position is 5 m above the accident site

Throwing position is more than 5 m above the accident site

May contribute to more failed throws. Longer time before the HCM can access the accident site. May result in the rescuer not arriving at the scene of the accident

Thorough reconnaissance and assessment of throwing distance during ROPE

Clarification in the procedure about why the ideal throwing position is 5 m above the accident site. Clarification could contribute to a better understanding of what is an ideal throwing position. More focus among the crew members regarding what is the ideal throwing position will then be achieved

The offset throw line is thrown to the injured person who has received a brief in advance or to climbers involved. The climber holds the telescopic pole out to the side as an aiming point for the throw line

Personnel at the scene of the accident are not informed about what will happen when using an offset throw line

Climber loses the telescopic pole

Lost communication with the wireless intercom radio (Polycon MP50)

The climber keeps the telescopic pole pointed at the HCM and not out to the side

Personnel not secured at the scene of the accident. Can lead to unprovoked fall injury

Telescopic pole falls to the ground. Risk of material and/or personal injury

Loss of communication between the HCMand the helicopter

May contribute to more failed throws. Longer time before the HCM can access the scene of the accident. May result in the HCM not arriving at the scene of the accident

The helicopter crew shall have had telephone contact with personnel on the accident site before using the offset throw line. If there is no contact, the HCM can use the telescopic pole or wait until trained and briefed personnel have arrived at the accident site

Telescopic pole shall be attached with a weak link to the rescuer or a fixed object

Test of communication before the operation is started. Bring a back-up Polycon in the helicopter. Tetra handsets are carried by HCM

Brief climbers before assignments. It is important to explain why the telescopic pole should be held out to the side as an aiming point for the throw line

Covered in current procedure

Covered in current procedure

Clarification in the procedure that Tetra radio must be carried by the HCM. This is particularly important, as lacking or incomplete communication between the crew members can be particularly critical with the offset technique, as the HCM is connected to the helicopter during the entire rescue mission and, in some situations, connected at the same time to both the mountain and the helicopter via the double attachment procedure

Clarification in the procedure on whether the communication test must be carried out before the rescue operation is started

Clarification in the procedure as to why the climbers should hold the telescopic pole aimed at the HCM and not out to the side. Clarification could contribute to a better understanding of this point for the crew members. More focus among the crew members regarding what is the ideal position for the telescopic pole will then be achieved and passed on to the climbers. Without clarification in the procedure, this point could fall out of the brief with climbers; the result could often be that the climbers tries to catch the rope and thus holds the telescopic pole straight towards the HCM. More difficult to establish contact with the HCM and the scene of the accident then

HCM throws the line and misses. If the line misses on the first attempt, the line is coiled into bays and a new throw is made

Unable to throw offset throw line

Offset throw line gets attached unintentionally to a fixed object

Unable to access accident site

Helicopter accidentally attached to a fixed object

Thorough reconnaissance and assessment of throwing distance during ROPE. One should not try to gain access with an offset throw line if the throwing length exceeds 15 m

Weak link at the end of the telescopic pole that breaks at 70 kg

Thorough briefing of the personnel at the scene of the accident. Weak link that breaks at 70 kg. A knife or scissors must be available and ready at the accident site

Clarification of why the throw length should not exceed 15 m. A clarification in this area will contribute to more awareness of the recommendation in the procedure

HCM must have access to two offset throw lines If one accidentally gets stuck and is cut with a knife or scissors, the rescuer will be able to gain access to the accident site with a second offset throw line

Physician reports: “Rescuer throws the line”. “Rescuer hit/missed”

Lack of notification from the physician, or insufficient notification

The pilot has a different situational awareness from the rest of the helicopter crew. May cause injury to the HCM

Thorough brief of the offset technique before a mission. Also, clarification of how the physician reports to the pilot

Covered by existing procedure

When a connection has been established, with the offset throw line between the HCM and climber, the climber pulls in the slack on the line and drags the rescuer to the scene of the accident. The hand signal “down” is used by the rescuer to position the helicopter down. A calm descent is of importance

Personnel at the accident site lose the offset throw line

Excessive load on the offset throw line. Weak link breaks

Personnel at the accident site are unable to drag the HCM to the scene of the accident

The rotor disk can hit the ropes that climbers has used to rappel down to the accident site. This can happen in situations where the rappel ropes stand out from the rock wall due to an overhanging rock wall

Loss of contact with the accident site

Loss of contact with the accident site

HCM unable to access accident site

Helicopter crash

There must have been radio contact with personnel at the scene of the accident before the offset technique is initiated. A plan is briefed for what to do if the HCM misses with the throw line ◊ HCM coils up the throw line and throws again

HCM physically holds his hand on the knot where the weak link is. This will reduce the physical load on the weak link

Do not descend with the helicopter too quickly so that the burden on personnel at the accident site becomes too great. Strive for the HCM to be a little over height when he is guided to the scene of the accident

Thorough reconnaissance of climbers rappel ropes and an assessment of whether they should be removed before the approach and offset technique are initiated

Covered by existing procedure

Covered by existing procedure

Covered by existing procedure

Clarification in the procedure about the importance of assessing whether the climbers rappel ropes should be removed before approaching the patient in the reconnaissance phase

3

Preparation of the patient

The HCM evacuates the patient in their own harness, or climbers must have prepared the patient according to written procedures

HCM detaches from the static rope

Loss of contact with the helicopter and the possibility of evacuating from the scene with the helicopter

A thorough brief and a procedure which states that the HCM must not disconnect from the static rope

Covered by existing procedure

Topography and rock formations at insertion points determine whether there is a need to use the double attachment procedure

The helicopter is unable to maintain a steady hover while the HCM is connected to a fixed object during the double attachment procedure

The consequences can be critical for the HCM but can also be insignificant. The consequences depend on whether the helicopter descends or ascends

Thorough reconnaissance and assessment of the length of the static rope before the mission. Test of communication equipment. Tetra radio is brought along by the HCM

Covered by existing procedure

The HCM either leaves the offset throw line at the scene of the accident or packs the line in the throw line bag

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4

Leaving the scene and evacuation, underslung, by the helicopter to the rig site (departure)

The HCM uses the “Positioning Sign” to position the helicopter if necessary. The static rope must be tight, to avoid snagging of the rescuer and patient, approximately 0.5 m slack

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If a double attachment must be used on patients or climbers, this is done in accordance with procedure

Unintentional double attachment of the helicopter

Personnel or material damage

Thorough brief of double attachment procedure before mission. Annual recurrency training

Covered by existing procedure(s).

HCM performs “SIST” check

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Covered by existing procedure.

HCM signals “up” when everything is ready. Evacuation from the scene of the accident can be planned and carried out in accordance with two options:

1. The HCM and patient carry out a controlled pendulum from the scene of the accident. The physician reports “Rescuer clear of the ground” as they leave the scene of the accident. This option is recommended with a triangle harness or when using the patient’s own harness.

2. The climber who is left at the scene uses a short tag line with a free-running Munter hitch for a controlled extrication. This is to reduce the pendulum movement. Recommended when using a rescue stretcher.

Helicopter ascends too fast.

Too much slack in the static rope and a fall from the accident site.

Departure from the scene of the accident is done with the help of a climber, but where climber does not use a thigh short tag line

HCM and patient depart unintentionally from the accident site. Contact with terrain or obstacles.

Static fall in the static rope.

Uncontrolled use of the short tag line, which can result in consequences for both the rescuer and the patient.

Thorough reconnaissance during ROPE and briefing of procedure.

Aim for a maximum of 0.5 m of slack on the static rope. AAK Safety has carried out tests which show that there is no need for additional fall arresters at the static rope as there are enough dynamics in the rope system as of today.

Thorough brief on the offset procedure to climbers before missions and explanation of why the short tag line is used.

Clarification in procedure regarding why a slow ascent.

Clarification that one should aim for a maximum of 0.5 m of slack on the static rope. This is to prevent the HCM from being inadvertently lifted out of the scene of injury or a static fall in the static rope.

Covered by existing procedure.

5

Evacuation of climber(s)

There must be a plan for the retrieval of climbers, including a helicopter-independent plan.

*Same as when evacuating a patient with the offset technique

*Same as when evacuating a patient with the offset technique

*Same as when evacuating a patient with the offset technique

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If the patient’s condition is not time-critical, then the climbers can be evacuated using the offset technique. The physician on duty assesses this based on the patient’s condition.

If the patient’s condition is critical/urgent, treatment and transport have the highest priority. Climbers moves to the same point they were inserted, waiting to be picked up at a later time. Alternatively, a rappel out of the wall