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3.9 Assisting the Crew
3.9.1 After the helicopter has landed, do not approach the helicopter. The crew will approach you.
3.9.2 Be prepared to assist the crew by providing security for the helicopter. If asked to provide security, allow no one but the crew to approach the aircraft.
3.9.3 Once the patient is prepared and ready to load, allow the crew to open the doors to the helicopter and guide the loading of the patient.
3.9.4 When approaching or departing the helicopter, always be aware of the tail rotor and always follow the directions of the crew. Working around a running helicopter can be potentially dangerous. The environment is very noisy and, with exhaust gases and rotor wash, often windy. In scene operations, the surface may be uneven, soft, or slippery which can lead to tripping. Be very careful of your footing in this environment.
3.9.5 The tail rotor poses a special threat to working around a running helicopter. The tail rotor turns many times faster than the main rotor, and is often invisible even at idle engine power. Avoid walking towards the tail of a helicopter beyond the end of the cabin, unless specifically directed by the crew.
NOTE.
Helicopters typically have doors on the sides of the cabin, but many use aft mounted “clamshell” type doors for loading and unloading patients on litters or stretchers. When using these doors, it is important to avoid moving any further aft than necessary to operate the doors and load/unload the patient. Again, always comply with the crew’s instructions.
3.10 General Rules
3.10.1 When working around helicopters, always approach and depart from the front, never from the rear. Approaching from the rear can increase your risk of being struck by the tail rotor, which, when at operating engine speed, is nearly invisible.
3.10.2 To prevent injury or damage from the main rotor, never raise anything over your head.
3.10.3 If the helicopter landed on a slope, approach and depart from the down slope side only.

Federal Aviation Administration Twentieth Edition
3.10.4 When the helicopter is loaded and ready for take off, keep the departure path free of vehicles and spectators. In an emergency, this area is needed to execute a landing.
3.11 Hazardous Chemicals and Gases
3.11.1 Responding to accidents involving hazardous materials requires special handling by fire/rescue units on the ground. Equally important are the preparations and considerations for helicopter operations in these areas.
3.11.2 Hazardous materials of concern are those which are toxic, poisonous, flammable, explosive, irritating, or radioactive in nature. Helicopter ambulance crews normally don’t carry protective suits or breathing apparatuses to protect them from hazardous materials.
3.11.3 The helicopter ambulance crew must be told of hazardous materials on the scene in order to avoid the contamination of the crew. Patients/victims contaminated by hazardous materials may require special precautions in packaging before loading on the aircraft for the medical crew’s protection, or may be transported by other means.
3.11.4 Hazardous chemicals and gases may be fatal to the unprotected person if inhaled or absorbed through the skin.
3.11.5 Upon initial radio contact, the helicopter crew must be made aware of any hazardous gases in the area. Never assume that the crew has already been informed. If the aircraft were to fly through the hazardous gases, the crew could be poisoned and/or the engines could develop mechanical problems.
3.11.6 Poisonous or irritating gases may cling to a victim’s clothing and go unnoticed until the patient is loaded and the doors of the helicopter are closed. To avoid possible compromise of the crew, all of these patients must be decontaminated prior to loading.
3.12 Hand Signals
3.12.1 If unable to make radio contact with the HEMS pilot, use the signals in FIG ENR 6.2.8.
FIG ENR 6.2.8
Recommended Landing Zone Ground Signals

3.13 Emergency Situations
3.13.1 In the event of a helicopter accident in the vicinity of the LZ, consider the following:
3.13.1.1 Emergency Exits:
 a) Doors and emergency exits are typically prominently marked. If possible, operators should familiarize ground responders with the door system on their helicopter in preparation for an emergency event.
 b) In the event of an accident during the LZ operation, be cautious of hazards such as sharp and jagged metal, plastic windows, glass, any rotating components, such as the rotors, and fire sources, such as the fuel tank(s) and the engine.
3.13.1.2 Fire Suppression:
 a) Helicopters used in HEMS operations are usually powered by turboshaft engines, which use jet fuel. Civil HEMS aircraft typically carry between 50 and 250 gallons of fuel, depending upon the size of the helicopter, and planned flight duration, and the fuel remaining after flying to the scene. Use water to control heat and use foam over fuel to keep vapors from ignition sources.
　
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