Helicopter EMS: Part 2--The HEMS Safety Debate

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."

It is now time to raise a question that is often missed in the HEMS safety debate: Namely, is the industry being unfairly judged because of its high visibility? According to many who work with HEMS, the answer is a definite yes.

"There are a lot of people within the HEMS industry who have been working on making it safer for a long time now," says Ronald Fergie, a director with the National EMS Pilots Association (NEMSPA). "Yet you never see news reports about the hundreds of uneventful flights and the thousands of people who have been safely transported to hospitals by helicopter--just those unfortunate few who have been involved in crashes."

"We have done extensive research on helicopter accidents as part of our ongoing efforts to improve safety," adds Matt Zuccaro, president of Helicopter Association International (HAI). "Despite the impression conveyed in the media, the truth is that the HEMS sector of the helicopter industry is not experiencing a disproportionate number of accidents when compared to other industry segments. It is just that these accidents are so high-profile, the public assumes HEMS operations have the worst accident history, when in reality the personal flying and training sectors account for the majority of helicopter accidents."

Good Business

Despite media musings to the contrary, those who operate HEMS units do care about the safety of their crews and patients. In fact, it would be bad business not to care, because helicopters are expensive--and so are lawsuits over HEMS accidents. At the same time, the truth is that HEMS units often have to work in poor weather and light conditions simply because this is when their services are often required. This is why AAMS' stated objective is to "make medevac transport safer without eroding service to the patients who depend on it as an emergency care safety net, particularly in rural areas," says Mancuso.

At press time, the FAA had recently proposed new rules governing HEMS flights. The impact of such rules and other safety solutions will be covered in the next and final installment of this three-part series.

James Careless is a freelance writer with extensive experience covering EMS issues.