In March of this year, a pilot, flight nurse and flight medic answered the ultimate call of service as they boarded Haynes Ambulance LifeFlight medical helicopter at Troy Regional Medical Center in Southeast Alabama. The flight staff was on its way to assist an automobile accident victim who had a broken leg and was unconscious. The helicopter went to the crash site, picked up the victim and resumed its flight. They were to transport him to a hospital in Montgomery. At 12:17 a.m., the helicopter was reported missing. The darkness, rain and fog hampered the search for the downed flight, which wasn’t discovered for seven hours. Four lives were lost when the helicopter crashed in a heavily wooded area.
Approximately four months following the fatal LifeFlight crash in Alabama, four more lives were claimed when a Cal-Ore Life Flight crashed on a rural northern California mountainside just after midnight. In September, a North Memorial Health Care helicopter crashed near Alexandria, Minn., just after 2 a.m., critically injuring the three flight staff on board who were returning to their base after transporting three patients to a local hospital.
These examples depict the significant risks helicopter emergency medical services (HEMS) personnel face every time they respond to an emergency. The HEMS industry dates back to World War I, and the Journal of Emergency Medical Services (JEMS) reports that the industry has grown rapidly. By 2014, there were more than 1,500 helicopters in the industry, which is nearly double the amount of helicopters in service in 2008. JEMS estimates that HEMS transport more than 400,000 patients each year in the U.S. Although it has increased access to emergency medical services, the industry’s growth has also outpaced its ability to provide an infrastructure for acceptable safety regulations.
Analyzing data from HEMS accidents in the United States from 2006 to 2015, Aerossurance estimates that a HEMS crash occurred in the U.S. every 40 days for the last 10 years. A spike in the number of air medical transport crashes in 2008 claimed 29 lives in 12 crashes, including a midair collision. The tragic year prompted a four-day National Transportation and Safety Board (NTSB) hearing in February 2009. Robert Sumwalt, an NTSB Board Member, recalls that the agency issued 21 safety recommendations based on hearing testimony and information from other sources highlighting safety concerns of the HEMS industry.
In February 2014, the U.S. Department of Transportation (DOT) Federal Aviation Administration (FAA) incorporated the NTSB’s recommendations in its new, stricter flight regulations and procedures, decades overdue, for the helicopter segment of aviation. Many of the new rules were aimed at addressing the major causes of HEMS accidents. The Air Medical Physician Association analyzed HEMS accidents that occurred over a 20-year period and determined the leading causes for most accidents included the time of day, environmental factors (such as weather conditions, flight altitude and geographic location) and time pressure due to the patient’s condition.
The new regulations required improved pilot training, the collection and analysis of flight, weather and safety data, and the use of dual pilots and autopilots. However, as Sumwalt surmises, more steps can and must be taken, including:
• requiring pilots to conduct more scenario-based training in simulators or flight training devices;
• using night vision imaging systems;
• incorporating a safety management system;
• mandating that all helicopters be equipped with autopilots and that all pilots are trained to use the autopilot; and
• developing a low-altitude airspace infrastructure.
Dallas Emergency Medicine resident, Dr. Brandon Morshedi, MD, DPT, NREMT, offers even more practical recommendations from his experience and work with HEMS and first responders. Dr. Morshedi explains that pressure to fly, even when conditions are bad, is due to the nature of the industry (the desire to save the most critically ill or injured patients) coupled with the financial incentives of an unregulated and lucrative business.
Dr. Morshedi urges HEMS flight staff to critically evaluate the time advantage of the air transport versus ground transport. The staff should also objectively evaluate the patient’s condition using evidence-based guidelines to determine the likelihood of the services improving the patient’s condition. Dr. Morshedi advises that only the pilot should make the decision to launch and, in order to remain objective, the pilot should not have any knowledge of the patient’s condition. Additionally, Dr. Morshedi encourages:
• continuous pilot training;
• increased funding for more FAA inspectors;
• implementing “severe and stiff” consequences for companies and operators who violate regulations; and
• regulating a fee structure that rewards quality care and appropriate operation of air ambulance services.
While the cost of implementing more life-saving regulations will likely be substantial, it cannot compare to the crashes that are prevented or the lives saved. Maximizing safety is important to the HEMS flight crews as well as the patients who entrust them with their lives.
If you need more information on this subject contact Mike Andrews at 800-898-2034 or by email at Mike.Andrews@beasleyallen.com.
Sources: Dothan Eagle, CNN, Twin Cities Pioneer Press, Journal of Emergency Medical Service (JEMS), Aerossurance, Propilot Magazine, and emDocs,
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