Helicopter EMS: Part 2--The HEMS Safety Debate

Medevac crashes draw lots of press--but do they tell the full story?

When helicopter EMS (HEMS) accidents occur, they typically get a lot of attention from the media.

There are a few reasons for this. First, the media always seek stories that include fatalities and serious injuries. When a HEMS mission results in a "flight into ground" incident--a crash, in layman's terms--death and serious injury are common. Second, serious air crashes of any kind are usually guaranteed media coverage because the public is interested in such stories. Third, a HEMS crash attracts media and public attention simply because of the implicit tragedy in such mishaps. "The tragedy of any medical helicopter crash is that the pilot and healthcare workers are all there for one reason: to safely transport patients to a hospital or other medical facility," says www.helicoptercrashes.com, a HEMS lawsuit website operated by the Willis Law Firm in Houston. "But some are wondering how 'safe' helicopter medevac really is."

Given the Willis Law Firm's interest in HEMS lawsuits, their doubts about helicopter medevac safety come as no surprise. But HEMS safety is a genuine public issue that is being widely debated for one very simple reason: Medical staff and patients are dying.

"In 2008, HEMS experienced a significant increase in the number of accidents and fatalities associated with helicopter medical transport," says Dawn Mancuso, executive director and CEO of the Association of Air Medical Services (AAMS). "There were seven fatal crashes and 28 deaths that year. In contrast, there were two fatal crashes in 2009, in which six crew members were killed." More recently, pilot Kenneth Robertson, flight nurse Kenneth Meyer, Jr. and flight paramedic Gayla Gregory died in August when their Air Evac Lifeteam helicopter crashed near Clinton, AR.

What is causing these crashes? "Recent studies reveal that the majority of accidents occur in low light and changing weather, and that no service model, category of operator [for-profit, not-for-profit, civilian or government] or geographical area is immune to accidents," Mancuso says. "Therefore, to reduce this tragic accident rate, it is imperative that our industry continue to adopt appropriate safety measures, particularly with regard to nighttime and changing weather situations, and that more funds be dedicated to aviation infrastructure improvements for helicopters.

"While addressing technology is important, we also must not forget human factors, which to date remain largely unexplored," she adds. "To that end, AAMS has initiated a Safety Management Training Academy, which is now entering its second year, and we also have instituted Vision Zero, a program dedicated to creating a 'culture of safety' through education, awareness and vigilance. In addition, AAMS' partner, MedEvac Foundation International, is funding pilot-fatigue and other studies, and is working with crash survivors on culture-of-safety issues."

Relative Risk

Although HEMS crashes occur in all kinds of situations, it is generally accepted that single-pilot aircraft operating under VFR (visual flight rules) conditions are more at risk than double-pilot IFR (instrument flight rules) aircraft. The reasons are self-evident: A single pilot has more work to do than a two-person team, while an aircraft that is not equipped with ground detection and night vision goggles has less information to work with during stormy, foggy and low-light flying conditions.

The National Transportation Safety Board (NTSB) has identified single-pilot crews and VFR-only flying as factors that can contribute to HEMS accidents. But the NTSB's findings, based on the hearings it held in 2009, point to other factors as well. According to a synopsis issued by that agency (available online here), today's HEMS pilots require more training in dealing with unexpected visibility-limiting changes in the weather. They could also benefit from having auto-pilots installed in single-pilot aircraft, flight recorders to allow more detailed investigations of accidents, night vision goggles for night flights, and "a safety management system program that includes sound risk management practices."

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