Global Doc: Submersion

Author: Dr. Vincent DeGennaro Jr. ’02

The plastic frame quickly rolls over, and I’m suddenly upside down, strapped onto a chair, inside a plastic cage, underwater in a pool. Water fills my ears and nose and a panic rolls up in my throat. I’ve observed the escape procedure in video a half dozen times. I’ve practiced it myself, but above water and sitting upright. The muscle memory just isn’t there yet; my brain has to tell my hands to perform each step. Hurrying will only make things worse, causing fumbling of the hands or tangling with the seat belt straps. Time now to think clearly, act deliberately, all while the oxygen is consumed, slowly at first, but faster as the seconds tick by.

I am no Houdini. A warm terror jolts through all of my limbs. Why did I agree to this?

In order to fly over water safely, passenger helicopters have two options. One is to fly a certain altitude so that if the engines stop working, the pilot can auto-rotate (basically gliding) to land on terra firma. The farther out over water, the higher the helicopter must fly in order to ensure that it has enough altitude to auto-rotate and direct the craft to cover the horizontal distance to the shore. Since helicopters are limited in the safe altitude that they can climb to, pilots can generally only fly short distances off shore in this scenario. The second option involves equipping the craft with flotation devices along the skids, the metal support beams that the helicopter lands on. For this to be an option for Haiti Air Ambulance, the crew must be trained in emergency underwater egress from a submerged helicopter.

In case of an emergency over water, the pilot will auto-rotate as much as possible until at a low enough altitude to deploy the floats. At higher altitudes, the bulkiness and drag off of the deployed floats can affect the agility of the falling helicopter so the pilot waits until under a hundred feet or so to deploy them. Despite the floats, helicopters are top-heavy because of the rotor blades and tend to tip over in water, meaning that the crew must learn how to extricate themselves from an upside-down, submerged helicopter.

Underwater, I run through the steps in my head from start to finish before moving. The order of steps matters. Undoing the seat belt before opening the door will leave you floating aimlessly in the cabin. Removing the anchor hand from the door frame will also remove your ability to determine which way to egress from the sinking craft. In the dark of the ocean, upside down and with inner ears filled with water, proprioception — the brain’s ability to determine where the body is in space — is disoriented.

The training instructor was a helicopter pilot in the Navy and has trained helicopter staff from all over the U.S. The underwater egress training is the industry standard for programs that operate near large bodies of water. The simulated helicopter cabin is made of white plastic PVC piping for the four walls, complete with a helicopter seat and shoulder harness belt. Typically, the instructor brings the simulated cabin in pieces and assembles it on-site, but we had to build the unit in its entirety in Haiti. After a lecture and watching videos that included helicopter water landings and crashes, we hit the pool at the crew house.

While underwater, I’m disoriented and strapped to a cage. Think of the steps, I remind myself. Left hand grasps under the seat to keep the body from floating away. With the right hand, unbuckle the seat belt and free the right arm from the shoulder strap. Keeping the left hand secured under the seat, open the door with the right hand and push it clear of your path. Free the left arm from the shoulder strap while holding the door frame with the right hand. Always keep one hand on a point of reference. Once free of the straps, use both arms to push out the door and free of the sinking vessel.

Simple enough, but underwater, upside down in the dark, many things can go wrong, especially after your helicopter just crashed into the sea. Several of the Haitian staff members do not know how to swim. They’ve only been submerged in water a handful of times in their lives. Despite this, they all bravely were dunked in the underwater cage several times, because without completing the underwater egress training, staff members are not permitted to fly on over-water missions. As they struggle free of the simulated helicopter structure, all became tangled in the seat belts or the plastic piping. Some needed a half-dozen attempts to perform the procedure correctly, but all were ultimately successful.

Haiti is situated on one half of the island of Hispaniola and is shaped like a backwards “C.” Port-au-Prince is situated at the apex of the island and the island spreads out northwest and southwest from the capital. In order to reach the tips of the C, the helicopter previously had to trace the shore line, increasing transit time, critically important in emergency situations. Once the craft that is equipped with floats, the pilot can now choose to fly over the water and decrease the distance and time a flight will take.

In addition, there are three smaller islands that belong to Haiti with populations who must travel by boat to seek medical care. Now, emergency medical care is nonexistent on the three islands. Two of them could be potential tourist attractions in the near future. Having access to these islands with an emergency medical helicopter increases the potential for tourism and provides better safety for the local populations. The third and most populated island, La Gonâve, is one of the poorest parts of Haiti and due to the geography, has very limited access to medical care. With the addition of the floats and the trained crew, Haiti Air Ambulance will be able to serve the islands with emergency care, and may be able to bring staff to the islands for clinics more regularly.

A few moments of terror underwater, and I’m free of the simulated sinking vessel. We’re now trained for all the remote possibilities. Why did we agree to this? So that Haiti Air Ambulance can serve everyone in Haiti, including those separated from us by water.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.