US EMS Pilots Are Not Very Innovative

[SASless]

As a general thought and based upon nothing particular, I have come to the conclusion American EMS pilots as a group are thicker than two short planks.

While considering the results of a bit of research and review of accident reports of fatal accidents over the past ten years or so....it became glaringly obivious EMS pilots are not innovative at all in the way they find to kill themselves and their crews.

One continues to see the same causes repeated over and over. I will admit every now and then a crew finds a new twist to an old trick and does themselves in with a bit of flair but that is just window dressing.

Is it just me or does the American EMS industry need to look for new, different, and better ways of doing themselves in or should we rely on the well known, proven devices that have sustained the industry all these years.

Practice sure seems to make perfect as evidenced by this year alone.:(

[hostile]

SASless:
"Is it just me or does the American EMS industry need to look for new, different, and better ways of doing themselves in..."

No, it is not only you. Simply answer is...... YES. Something should do and fast. I hope that all parts have a plans to go forward to solve this problem. Like I said some earlier discussion, everybody who are involved with EMS operations need to be a part of new culture.

Waiting for it.

Hostile

[hostile]

This comment is from latest crash news:

"The Safety Board is very concerned with the increasing number of these EMS helicopter accidents," said Robert Sumwalt, the NTSB's vice chairman. "We have had too many of them. The number is increasing. We need to do something about it. We need to do something about it right now."

Hope this kind of thoughts waking up.

Hostile

[KRB]

Is it just me or do the Americans tend to rely on technology too much instead of better training & heaven forbid a second pilot in the cockpit. I would be shocked to find a program in the States that doesn't fly IFR single pilot.

Would also be interested to see if the for profit companies have the higher accident rate as oposed to the operations that are not for profit.

[SASless]

Yahoo! (http://cosmos.bcst.yahoo.com/up/player/popup/?rn=3906861&cl=9973458&ch=4226722&src=news)

The link takes you to a video on this topic produced by CNN.....and notes that an NTSB study suggests 29 of 55 fatal EMS helicopter crashes were "preventable".

What happened to the industry proclamation of reducing the accident rate by 80% over a ten year period? Must have been all talk based upon this year's death toll.

[Revolutionary]

KRB, prepare to be shocked: there's at least one dual-pilot IFR EMS aircraft in the US that I know of: A PHI-operated S76 in New Orleans. And no, an over-reliance on technology is not one of the main problems: I can't think of any other industrialized nation that has such a large proportion of hand-me-down Astars and clapped-out LongRangers masquerading as EMS aircraft. Almost all EMS operations are for profit by the way, and even the ones that claim not to be (such as the Maryland State Police) still have to justify their budget to some corporate or government overlord.

Sas is right; it's (almost) always the same storyline:

1. Night
2. Marginal weather
3. ?
4. CFIT

Boring!

[Shawn Coyle]

I would also suggest that training has a lot to do with it.
Minimum required training for Part 135 is 5 hours on type, and that's all most folks get. No simulators for most of the machines (or at least no reasonably priced, easy to get to simulators). The result is that folks with complex, all-electric helicopters don't know and understand things like the AFCS / autopilot.
Next, there is no good IFR training in a non-IFR helicopter unless you go to a lot of trouble to put in vision-blocking equipment. Foggles just don't cut it when there are chin windows and side windows that go down below waist height.
And there is no such thing as night VFR unless you're over a built-up area.
I could go on, but these are just two of the things that should be re-considered for improving safety.

[Vertolot]

I think Shawn Coyle said it very good:

THERE IS NO SUCH THING AS NIGHT VFR....Specially in too marginal weather conditions....!!

[Phil77]

eddie,
I believe that most flights resulting in an accident have been launched while marginal/unstable weather already prevailed or was to be expected (by the use of the pilots interpretation skills of weather systems).
Only to pick the most recent in Maryland: all evening long the ceilings where low (marginal or at the limit for most operators as I learned in another thread here): BKN008. Agreed, with a big high pressure system overhead it may be reasonable to expect that the conditions will remain stable, but with a tropical system offshore, throwing clouds, rain and thunderstorms at you, it is a huge gamble compared to your nice, clean cold front coming at you at x kts.

I can only guess what led to the go/no go decision, but dare 'em if somebody told the pilot the nature of the emergency...

Scenario: "Multiple casualties of teenagers in a car pileup" - figure in the father of a teenage daughter being the pilot who has to make a go/no go decision!
Or put yourself in the shoes of a young father who has been told there is a newborn in a live threatening situation!

You see where I'm getting: PEER PRESSURE!

Maybe most EMS pilots can (or claim to) deal with the burden of too much information provided to them, but I can blame no pilot literally being forced to fly through the tactics of unnecessary information given to him; be it because of greed or carelessness.

[What Limits]

Now we are getting to the crux of the matter.

Its not peer pressure, its self-induced.

Why would anyone try harder for a newborn/teenager/adult/old person?

When I was doing EMS my responsibility lay with myself and the crew in that order. If the weather was good enough I would go, if it wasn't I wouldn't.

My mantra is: It is better for 1/2/3 people not to survive the accident than for 4/5/6 to die in the helicopter crash.

[Phil77]

...just to be clear: I don't think it is about prioritizing one human being over the other - at least not obvious - and there are certainly clear thinking minds out there; but I think it is very likely that one's decision becomes clouded if he/she can directly relate to the victim/patient and come to the wrong conclusion about staying on the ground or not.
I guess you could call that "self induced" but I think its preventable.

[qwagga1]

I have found on many occations that pilots think that they can push the limits because they are going to save a life. When asked what do they think saving a life is worth... as far as your crew and self is concerned, I tend to get the answer of "what do I mean"!!!! It is difficult for young pilots to see the difference between sound planning and a poor decision making as three quaters of the time older pilots that tend to set the example:ugh::ugh: tend to get away with marginal decisions due to their vast experience levels to fall back on.
EMS pilots is a amazing bread of people..:D.. if that is what you do because you believe in it. For that I take my hat of to all of them. However too many young pilots see it as a hour building exercise, when not having a call for a couple of days and then a call comes in with the weather conditions, night, ect. being marginal, too many EMS pilots will do this call because it might be his only flight for a week.
I think a lot of accidents/incidents could have been prevented if the general mindset of EMS pilots was that of saving a live while preserving that of his crew.

For those in the game good luck and you can not always save a life.....even if all of us would like to.

SAS I certainly agree with you and wish I had a solution. But must admit that I find the general EMS pilot has a lot of inovation as far as their ability to select landing areas ect is concerned, But they do make the same errors over and over through out the world as far as planning and pushing the limits is concerned.

[ATPMBA]

A couple of thoughts -

EMS industry seems to be looking like the US Airmail in the early days.

METARS and area forecasts do not cover local WX. How about if we had something like an AWOS machine attached onto cell towers then a better WX picture can be developed. That would be a huge investment so another solution could be to have weather spotters. These could be fligjht students, retirees, bored houswives who get some training in WX observations and feed it into the internet and is it made available to EMS pilots. Volunteers can be motivated by some simple rewards and recognition.

When I hear, "we got to land because of weather", that is a flight that should have never started.

[TheVelvetGlove]

Many of us are flying non-stabilized aircraft at night out here. 407's, 206's and a few others, are never equipped with an autopilot or SAS. So, I would put equipment at the top of the list (to include NVG's), and more IFR and IIMC training a close second.

The problem with EMS in the USA is that probably more than 90% of it is conducted by corporate operators who do not receive any subsidies at all from the government- so everything is profit driven... the bean counters pretty much run the industry. This also creates pressure to fly.

Weather reporting and forecasting in many areas is still either absent or grossly mis-forecast; most pilots have to rely on whatever personal insights they have about the weather patterns in their local area, because the NOAA and NWS still appear geared towards our higher-flying fixed-wing brothers. It would seem that weather close to the ground is something that they don't fully appreciate, unless it is tied to an instrument approach.

Since operators end up having to comply with insurance company requirements, maybe the quick route to change with insurers upping the equipment and training requirements before they will write insurance to HEMS operators. If the accidents keeps happening, this will eventually happen (someday), I think.

I am fortunate that I work for a company that utilizes NVG's and that never frowns or inquires about why I turned a particular flight down. But I still don't have the aircraft that I believe we should all be flying: SPIFR, NVG's, and plenty of recurrent IIMC and IFR training to keep the skills fresh.

[hostile]

Pressure from customers,

That might be the bigger issue than pressure from company. Especially if you have patient on board. How easy is to cancel the flight when you already made decision to go. In these cases pilots need all possible support to make right decisions. That support should be come from company, customer, doctors, etc. Not only company. This needs operational procedures and experience. Those pilots, who already have experience, need to share this atmosphere for all.

Weather sources might be somewhere incomplete. In those areas pilots needs to put more time to be sure where they are planning to go. Also might be good idea think kind of "backup" plan, if it is more lousy than expect. World most difficult maneuver with EMS helicopter - 180 degrees turn back or even land as soon it is safe.

This all should be written in company's procedures, like I believe they are some kind of way. Problem is how to handle this.

[Troglodita]

I think I'm losing the plot here!

IFR - flying under instrument flight rules at all times - ending up with an ILS/GPS/VOR approach to a published destination.

VFR - in visual contact with and able to fly safely with reference to the ground at all times!

Accidents due to: - being able to do neither!

Call me a deluded fool!

Trog

[alouette3]

The problems of the US EMS industry have been discussed here very often.The solution maybe in everybody (the pilots. middle managers,company and the FAA) making a concerted effor towards ensuring/enhancing the three 'T's : Training ,Technology and Temperament.
Most issues are already in the procedures:for instance, in my company, the comm.spec.( dispatcher) does not indicate the nature of the flight until the pilot has made the go/no go decision. That should alleviate most of the emotional decisions. But,since good news does not travel by helicopter, the pilots are already hardwired to make an emotional decision(if I don't go somebody is going to die---maybe I can go up and take a look).And this is further compunded when the patient is already on board. I don't know if it even possible to train or regulate that pressure out of the guy. It is easy to say it is no different from hauling cargo.But we are human and that is what makes it hard to put it into practice.
In the case of the most recent crash there was no economic pressure either. It was a State funded unit. Maybe , the fact that they had all got a lot of bad press in the recent past had a bearing on the thought process of the managers and the pilot---we will never know. But, in this case, it certainly debunks the theory that twin engines, SPIFR capable helicopter and pilot will fix all the problems.All the bells and whistles did not prevent this from happening. So where do we go from here?
Meanwhile, there is an agency working towards eliminating sleep for the night duty pilot to prevent "sleep inertia". The tragedy is they are powerful enough to succeed.
Maybe it is time for me to pull out and dust the old resume-----.
Alt3.

[WhirlwindIII]

HEMS flies 24/7/365, any place, any time, point to point, etc. Seems the Coast Guard is the only other operator in the states to do that - of course they have two pilots (no shocker there), great training (to include extensive IFR), good equipment, high standards, and then they just go get the job done - with rarely an accident.

US HEMS needs two pilots, proper equipment, full IFR, great training, and a drastic reduction of distractions - but it will take a mandate from government types to get it done though I doubt any will have anything to do with exposing themselves to this trail.

My guess is that what is going to happen is more strict criteria by which HEMS aircraft are dispatched, thus reducing the number of flights, total risk volume, and total number of operations remaining financially viable all leading to a reduction in the total number of accidents to the point where the concern disappears from societies' radar.

When this happens politicians and all the other industry hangers-on and pundits will point to their great success in sorting multiple variables; albeit we'll be no better off as the real accident rate will remain the same.

[imabell]

customer pressure ?????? i don't think so,
the customer is probably unconscious in the back, on their way to hospital then they are dead.

[IHL]

The Ontario Government (Canada) has contracted EMS helicopters for more than 35 years and have not (hopefully never) had patient or pilot killed in that time. They presently operate 11 S76 aircraft with 2 crew.

They have contracted Bell 212 aircraft in the past and have ordered 10-12 AW139 to commence operations in 2010. For the most part they operate in very remote areas with few facilities, their secret is 2 IFR rated pilots on all operations, simulator training and sticking to the regulations.

They did have an accident in December 2007. No patient on board- some serious injuries to the crew though.

On the fixed wing side they have had a couple of serious ones with fatalities.

[zalt]

Customers = hospitals

[hostile]

Good job, Ontario. Keep on going!:ok:

[Darren999]

Our program does not inform us to what we are flying to. We are informed its a scene, but no further info. As to what was mentioned earlier the pilot always would push harder if there was say, a baby dieing on the side of the road for instance, and unfortunatly accidents happened. We are remeinder over and over again, we do not save lifes. We transport for A to B safely.

My personal feeling is that I am going to fly a box of rocks. Therefore, what would I do for a box of rocks.... my 2 cents..

[ron-powell]

I’ll digress for a moment. This year in U.S. HEMS:

Wisconsin – fatal at night
Texas – fatal at night
Arizona – brownout at night, lucky to be alive
Arizona – fatal midair in broad daylight
Indiana – catastrophic (?) failure broad daylight
Maryland – fatal at night

I’m disregarding the day accidents here:

Some aircraft were basic single engine, some twins. Some with NVGs, some without. Just guessing if any had terrain awareness. All probably had some sort of operational control oversight. A multitude of other factors they all faced – crap weather knowledge between reporting points, crew issues, patient issues, fuel issues, etc.

So, where’s the “get out of jail free” answer to these night crashes? The “when everything the pilot has done is by the book and it still breaks bad”, where’s his/her out? We don’t have one.

My answer is this: Give me a tool so, that no matter what stupid decision I make before or after takeoff concerning weather, I can SEE WHERE I’M GOING. Everything else is a bandaid.

[griffothefog]

Back in the 80's when we were pioneering Hems in the UK, pilots were selected based on experience, hours and skill. All were IFR qualified, but tasking was 99.9% day only...... no accidents :=

Today, I would strike a guess that several of the above have changed significantly :{

Its a no brainer for me. Before Hems, the various health authorities coped without us and when we came along were welcomed by the same as a very useful tool to be utilised during the day. The only trip I ever made at night was IFR from an RAF base to an international airport with ILS landing.

IMHO, it should be taken out of our hands...

[Dream Land]

These crews are quite unique and very aggressive to complete the job, it's hard to completely squash the "white knight syndrome' from their personality,these people are extremely dedicated to help people in need, I think it's imperative that pilots understand their ultimate responsibility to conduct the flight in safe conditions ONLY, often times two pilots operations are nixed to accommodate a family member, wrong priority but ultimately they are trying to market the service and be profitable.

[helmet fire]

Not very Innovative?
:8 good wind up.

There is no doubt that the recent accident is tragic loss, and it is also another accident that has happened before, and will reflect yet another that is bound to happen again soon. There are no new accidents [Old Jungle Saying]

What I find increasingly frustrating is all the calls for radical overhaul and complete system change based on one element of an occurrence. Read old mate Dr Reason and his Swiss cheese model to begin the journey of just how many elements are actually involved from the pilot and his shortcomings (always first and loudest here amongst his "peers") right through to the company culture and even the FAA (oversight or regulatory issues removing the oversight due to "public use", etc).

There are very many calls for the introduction of two pilots above, but guess what folks, there have been many two pilot EMS accidents. Talking world wide here. Do we drag up each of the two pilot accidents and use them as emotive calls to ban all two pilot ops? Why not?

Unfortunately as we muse so emotionally over the risks and the tragedies and the complete uselessness of HEMS we are perpetrating the long held and cherished view of HEMS that exists amongst the general public: it is dangerous and needs to be re-evaluated! Don't kid yourselves, the medical fraternity in the US is bristling with opponents to HEMS and see another great topic with which to over dramatise in order to get published and gain significance. And they read these sorts of threads searching for justification.

In an email chain that is going around work at the moment between the aviation and medical side (I bet we are not the only ones) a doctor recalled a statistic that puts this argument into perspective, and is worth repeating here:
28 people have died so far in USA HEMS in 2008. There is an enormous amount of soul searching and arguing and calls for bans and statements of irrelevance, etc, etc, etc. Meanwhile, medical dramatists have said that more than 170,000 will die as a result of medical system errors. Are we gaining perspective? That is about 6 Jumbo Jets per week spearing in without public outcry or demands that the system be stopped!

In a book that I highly recommend to all you bored touring pilots when you next get on the plane, go read "Risk: the Money, Politics and Science of Fear". It reveals that in the year following Sept 11 2001 when everyone was so scared of flying due to the terrorist attacks that 1595 MORE Americans dies in road accidents that year (on top of the steady average). Although flying, even with terrorists about, is far safer than driving, the emotive reporting of the deaths that day completely over took logic and resulted in the needless deaths of 1595 Americans.

That fear is creeping into the prevalent discussions surrounding the MSP and other recent US HEMS accidents. That is not to say that we cannot discuss the factors and examine ways to reduce the occurrences (indeed that process is precisely why we are SO safe now), rather that we should keep perspective and educate outsiders as to the ACTUAL safety of our industry.

That way we might just be around long enough as an industry to help keep the US annual death toll on the roads from again climbing above 50,000 by providing the rapid medical interventions necessary.

For those of you non pilot types searching for meaning in all these accidents, don't risk driving to work today, give the local helicopter company the pleasure of reducing your risks considerably and flying you there!!:)

[helodpe]

For how much longer is the FAA and the US EMS industry going to keep their heads buried in the sand on this safety issue?

31 DEAD IN THE LAST 12 MONTHS

[Jim Dean]

Good post Helmet Fire and quite agree. We musn't ignore it but let's keep it in perspective. Chicken Little is alive and well out there, remember Y2K, and global warming will probably end up in the same way.:)

[SASless]

HF,

Ah what the heck....it was only 30 people...what the Hell?

Kill 30 people in eight crashes on the North Sea.....what kind of outcry and outrage would be heard?

Kill 30 people at eight school shootings....what kind of outcry would you hear?

Kill 30 squaddies in eight training accidents....what kind of outcry would you hear?

Helmet Fire you have the makings of a GOM helicopter company manager with that kind of attitude....but then we must put things into perspective mustn't we?

All this is just the cost of doing business.....right?

[hostile]

SASless, keep muddle this anthill. Best results comes when situation is mature. Something need to be do anyway. 30 dead people is not a answer for this problem. If we would like to compare for these deaths something, we have to compare it a similar operations in worldwide. In every countries more people died in car crash than aviation.

All participants need to get together to build new safety culture whole EMS operations. How?, it depends to target, which should be 0.

[500e]

As I understand the debate the bean counters in the main do not put up enough money for on going training Ifr Nvg etc so you have older helios flown by some pilots with lower hours?
Now where have I heard a simular argument "CRAB":suspect:

[helmet fire]

SASless, NEVER in my post do I say anything about ignoring or trivialising the "30" whom have died this year in US HEMS, not for that matter the hundreds over the years in HEMS world wide. These are people who have lost their lives in the service of others and should be remembered as such regardless of the circumstances. Not one of them goes out on the mission with intent to die, they go out with intent to save.

If I could, I would reach through the cyberspace and buy you a beer.

I was, and am, concerned and the "outcry" that occurs after such accidents. We perpetuate that emotive reaction each time we call for X or Y based on a single element of a single accident. I believe it is our place in this industry to explain the VERY HIGH safety levels of HEMS to those outside our domain to alleviate their reaction to the "outcry" that is generated almost entirely by the media.

At the end of the day in the world of media, 40,000+ road deaths are inconsequential to the excitement that can be generated by the stringing together of some helicopter accidents to show an imminent and dangerous threat that MUST be immediately stopped. Only we as an industry stand between that assumption and a call for a more realistic reaction.

We dont even know why the MSP accident happened and we are posting comments like banning HEMS, banning night HEMS, banning Single Pilot HEMS, etc, etc. These reactions from within our industry are amplified outside it, and the call for perspective is drowned out.

The reason our industry is so safe is that we rationally investigate such accidents in detail, analyse the findings and compare trends. Then we can make rational adjustments to the system to improve safety, and so on. Let that process continue.

Sven: the comparison would be more valid per patient intervention rather than per hour. For example, if comparing ambulance transport V helicopter for patients, a per hour representation is not really valid because helicopters are often used over far greater distances than road ambulances -so is it a fair comparison. You may be interested to know that one of our doctors has done such an analysis and helicopter patient transfer (day and night) is safer PER PATIENT than road ambulance under lights and sirens.

As I said at the bottom of the last one, if you really believe the risk of HEMS so unsupportable, you had better fly to work every day and use a helicopter to drop your kids off at school!:}

Now we have some perspective, lets examine the outcomes from the MSP accident (and those of the other ones) and discuss the ramifications of those. In an emotive way of course, and preferably involving red wine!:ok:

[SASless]

"We" are not talking about binning Helicopter EMS.

"I" am talking about growing weary of reading of people killing themselves and their patients....the very ones they claim to "saving"....and doing so with great frequency using the same tired old methods and devices.

"I" am saying the helicopter EMS industry is remaining rock solid in clinging to the tried and true methods of doing themselves in and not seeking new and innovative methods.

"I" am saying each life lost is a tragedy.

"I" am saying they are not heroes for killing themselves....very much the opposite.

"I" am saying they are more times than not....."suicidal" for taking the risks they do in the pursuit of "saving" lives.

"I" am saying it takes a "hero" to stand up and refuse to play the role of sacrificial lamb in this slaughter....and there are damn few heroes about.

"I" am saying the bureaucrats count their annual bonus while pointing out all the 'bureaucratical" reasons effective changes have not been made....all the while people are dying as a result.

"I" am saying the pursuit of the almighty dollar, one more run, a shorter response time, a cheaper operation, going when another crew turned the flight down, and a host of other vile reasons are the motivation for these suicides.

Sane people would not take these risks.

Smart people would figure out the odds and decide they favor the house rather than the player and get out of the game.

Reading about how gallant the dead crew was....how dedicated they were to saving lives....makes me want to throw up!

We are talking about the slow, lame, sick, and stupid of the herd. It is nature's way of thinning the herd in action.

I am suggusting the herd has to evolve or it will surely become extinct either through attrition or some cataclysmic event similar to the demise of the dinosaurs.

As a very astute fellow named Nick Lappos once said....."The more effort and time you spend proving there is not a problem is indicative of how bad the problem is." (or words very similar to that).

American helicopter EMS has a life threatening problem...lives are being lost...and most everyone is trying to invalidate or mitigate that proposition.

That suggests to me how pervasive the problem really is. The American Helicopter EMS industry refuses to embrace reality. They give mere lip service only otherwise they would be standing on some big gray metal government desks demanding action from the bureaucrats, hospitals, insurance companies, and every agency or group that could provide some assistance in seeking out the new and innovative cures to the problems.

Nick Lappos asked what kind of R&D projects we wanted to see. How many American EMS pilots pitched their Tuppence into his hat?

[griffothefog]

HF,
Your passionate plea for debate and discussion are noted.... But, your arguments about stats in the industry and how its easier to get killed walking down the sidewalk etc.. sound as contrite and blunt as the bean counters excuses for lack of funds and hence the under development of our industry as a whole. If you want to look at stats, good luck because there are people out there that do nothing but, and can convince even the blind that they can see!! It doesn't matter how passionate we feel about HEMS, the facts not stats are clear. Most accidents are caused by poor judgement and decision making at night...
Nobody wants HEMS banned, but until we have found a solution to all this carnage, I believe night EMS should be suspended at least. :(

[havoc]

Too Much Risk in Air Rescue

By Jim Hall
Thursday, October 2, 2008; A23



Like many Americans, I was deeply saddened by the crash of an emergency medical services Eurocopter Dauphin II helicopter last weekend in Prince George's County that killed four people and left another person in critical condition. But as a former chairman of the National Transportation Safety Board (NTSB), I was not shocked.

EMS helicopters are among the most dangerous aircraft in the skies. While major airline crashes have declined over the past decade, EMS helicopter fatalities have increased. Until this year, the worst annual record belonged to 2004, with 18 killed. So far in 2008 there have been 20 deaths. Clearly, things are getting worse.

Sunday's crash brings the national death toll of EMS helicopter crashes in just the past five months to 17. On June 29 two EMS helicopters collided near Flagstaff, Ariz., killing six. A Bell 407 crash on June 8 in Huntsville, Tex., killed all four people aboard. On May 10, an EMS-operated Eurocopter EC 13 crashed at La Crosse, Wis., after dropping off a patient; the pilot, a surgeon and a nurse were killed. While this summer has been especially bad, these tragedies were anything but unforeseeable.

I fear that as the facts of this accident emerge, it will be revealed that the crash stemmed from ignoring lessons previously learned. Local authorities say that the helicopter lacked a terrain awareness and warning system (TAWS), something aviation experts have deemed crucial to flying safely in difficult conditions. The NTSB has stated that the pilot operating the helicopter was the sole pilot, which meant he had to work the radio while maneuvering the aircraft. He had tried twice to radio for help because of the severe fog that day. Such conditions -- a solo pilot flying a helicopter in inclement weather -- are some of the worst a pilot can face, yet EMS pilots are required to operate in them all the time.

Rather than answers, the Federal Aviation Administration offers excuses. A recent FAA news release stated that EMS "operations are unique due to the emergency nature of the mission." The agency needs to ask itself whether this "unique" situation justifies a fatal accident rate that is 6,000 times that of commercial airliners. In the face of this safety crisis, the FAA's response has been to "encourage risk management" and "promote [safety-enhancing] technology such as night vision goggles, terrain awareness and warning systems (TAWS) and radar altimeters."

This "encouragement" is noticeably lacking the vigor we've seen the FAA use recently to force major airlines to maintain acceptable safety standards. Rather than regulating an industry that has a demonstrated history of carrying out unsafe operations, the FAA seems content with offering a do-it-yourself program of oversight.

I have long subscribed to Thomas Jefferson's theory of governance: "The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government." Sadly, our government does not consistently endorse this philosophy, but, as Sunday's tragedy shows, instead allows a series of accidents to occur without any regulatory response.

This trend is unacceptable. Many of us working in aviation safety have long advocated requiring two pilots for EMS flights, night-vision goggles, and terrain awareness and warning systems. Rather than simply "encouraging" these crucial safety measures, the FAA must demand them. I hope these tragedies have not happened in vain. This year's deadly spell of EMS accidents should cause the FAA to realize just how grave a safety threat EMS operations pose to their crews and passengers.

The writer was chairman of the National Transportation Safety Board from 1994 through 2001. He is managing partner of Hall & Associates LLC, a crisis management and government relations firm.

[alouette3]

I love the way he parks the whole mess at the doorstep of the FAA.They, in turn, will say that the fault lies with the operators who want to make a quick buck. The operators will in turn say that they are doing everything the FAA wants them to do. Anything more (two pilots, twin engine etc etc) will mean a lot of the companies will be out of business and government should not control the free market blah,blah,blah. And so it goes on and on ad infinitum, ad nauseum.:{
The historical enmity between the NTSB and the FAA is as well known as the joined-at-the-hip-partnership between the FAA and the operators.That will not change.:ugh:

Alt3.

[Devil 49]

One would have work hard to fairly apportion blame for problems in the EMS industry:
First, the FAA for regulating EMS as "just another phase of the Air Taxi industry". No magic risk assessment grids, no matter how many check lists are required, EMS isn't just another air charter, even when the pilot's isolated from the medical side. This is more like "Dustoff" of 40 years ago, and the accident pattern shows it.
Next, the industry- using the air taxi minimums as official endorsement of minimum requirements. Part 135 training doesn't amount to a good introductory course for the job. What's done is done half-arsed. I can't think of a single time that memorizing a filter bypass pressure differential was applicable in the real world, much less the knowledge that a dog's digestive juices are twice the strength of a humans' (actual test subjects).
In all fairness, I have to admit that EMS pilots contribute their fair share to the problem, and pay for it.

Better training. Better scheduling. Better support. NVGs.

[imabell]

sasless has been voicing his concerns and those of others on this forum for quite a few years now and all his posts send the same message. fix it.

in fact he has been a lone voice on this issue.

whenever he states the blatantly obvious, most of us refuse to see the usual causes and want to defend the pilots as having done no wrong. while we keep on thinking like that these results will continue to happen

we have in the past had problems in australia, 11 ems accidents over a period of years, nowhere near the terrible rate in the us. ems here seem to have changed our attitudes or culture or what ever it is that leads to these accidents. touchwood we can stay that way.

sometimes i personally feel that it is difficult to relate these problems to the word "accident".

these accidents are avoidable, fix the problems or risk losing the valuable services of helicopters and crew.

[WhirlwindIII]

My 2 cent opinionated ramble.

Everything starts at the top, with leadership.

HEMS has no top!

What we do have is the paralyizing confusion and obfuscation of competing alphabet and standards groups (in which I include Congress, FAA and NTSB) who toss about reccomendations and administrative input as if they know something special and are doing something worthwhile to eliminate the accident rate. All that results from their wanderings and machinations is minimal progress and bickering within industries' ranks.

The death of common sense and current fascination with time-consuming data, technology, committees, and process is going to do us very little good in the short term, where accidents are happening. Without one clear leader (i.e. ONE real human being) to make sense of all this and bring it all together to identify solutions it is pretty obvious progress is not in our future.

The question is how do we find that individual and get them going? They DO exist.

[jolly girl]

I keep thinking about IHL's post (#21?).

How is it that the same industry can have one operator that can go 35 years with no fatals, but have another that (according to SASless) can be expected to have a fatal on average every13 months?

Surely there is more than SPVFR at play...

[SASless]

Whirlwind,

I would suggest that "one person" is each of us.

Each one of us should be brave enough to say "NO!" when exposed to an unreasonable risk, bad procedure, bad policy, or wrong headed decision.

Major changes come from many small changes.

We have to risk our jobs at times to do this.

We risk our lives otherwise, so the choice should be easy, even though in reality it is just the reverse.

If pilots would begin to support one another in refusing to accept the existing situation and work together towards improving the standards, policies, procedures, and demanding.....yes...demanding the operator change regardless of the "minimum" standards now being embraced then the whole EMS industry will benefit immediately.

If you employer puts you at risk by providing you a single engine helicopter with minimum instrument flying equipment, demands you fly over dark terrain at night, refuses to provide NVG's, refuses to put autopilots on the aircraft, and expects you to fly in marginal weather....REFUSE TO VIOLATE PART 135 REQUIREMENTS FOR VFR FLIGHT. Stay over a well lighted area....and stay out of marginal weather at night.

You all do it....violate the requirement for adequate surface lights to control the aircraft without reference to instruments....I know I did sometimes. Why ever take that risk particularly in marginal weather.

Just say "NO!".

That one step alone would go a very long ways towards reducing the death toll we experience right now....and have ever since EMS helicopters started flying.

It sounds simple....why cannot EMS pilots do that?

If you are reading this and willingly fly over those dark holes in the terrain....why can you not find another lighted route to your destination or refuse to take the direct...dark...deadly path?

[WhirlwindIII]

All,

I would suggest that "one person" is each of us. Yes, to a point. What is additionally required is that we, each of us, recognize this situation is not being addressed excepting by a lot of alphabet groups and administrators who haven't one single clue about reality, just their concept of reality via whatever statistics they fuddle around with at the occasion of discussion - there needs to be a "gate-keeper" to all their well-intended convolution. That "gate-keeper" can get them on track - and it is not the IHST, or HAI, or any of those fascinated with process and data etc. It takes a leader!

Each one of us should be brave enough to say "NO!" when exposed to an unreasonable risk, bad procedure, bad policy, or wrong headed decision. In the company I work for the easiest way to the dole is not to say no, or fail to listen when a crewmember says enough, is enough. No courage required. It is really fun to say no, and then move on, knowing everyone is alive and well - of course the patient might still be in the dumps but better one in the dump, than four!

Major changes come from many small changes. True, but it is a LOT faster coming about when one conductor stands before the orchestra - orchestrating those small changes.

We have to risk our jobs at times to do this. Certainly a consideration, best handled by saying little, and lighting one's employer's imagination with the consequences of mucking about with professional employees who do know how to use the phone, the internet, the ........ it does work, but it has to be very subtle.

We risk our lives otherwise, so the choice should be easy, even though in reality it is just the reverse. The most important person on the aircraft is the pilot - if he or she, sitting on the pointy end, makes it home in one piece there is a lot of probabilty all others will as well. That alone makes it a joy for me to say no! I love it.

If pilots would begin to support one another in refusing to accept the existing situation and work together towards improving the standards, policies, procedures, and demanding.....yes...demanding the operator change regardless of the "minimum" standards now being embraced then the whole EMS industry will benefit immediately. Again, the company I work for will literally fire anyone, throughout the organization, who considers behaving unprofessionally - of course those who work for Brand - X might be interested in what you advocate (which is excellent in the short run), or come work with us. The minimums are when one stops flying, not when one starts to do so.

If you employer puts you at risk by providing you a single engine helicopter with minimum instrument flying equipment, demands you fly over dark terrain at night, refuses to provide NVG's, refuses to put autopilots on the aircraft, and expects you to fly in marginal weather....REFUSE TO VIOLATE PART 135 REQUIREMENTS FOR VFR FLIGHT. Stay over a well lighted area....and stay out of marginal weather at night. True. Ignominious defeat is the act of doing oneself in (however couched), with all good intent, but lacking in results. Not getting the job done via crashing, is just that. Sad stuff, but it happens in this very very immature industry purportedly led by mature leaders - not! In the US all the do-gooders inside the beltway literally have their eyes in the headlights, and not on the real ball - the ball they need to follow - the leader who can put it right. We need to find that silver bullet, and he/she does exist! The Warren Buffet of our problems.

You all do it....violate the requirement for adequate surface lights to control the aircraft without reference to instruments....I know I did sometimes. Why ever take that risk particularly in marginal weather. Nope - not a chance, and I mean it. Or, Yup, you're absolutely right.

Just say "NO!". Then walk away and watch the idiots banter! I once had an argument with a fellow about whether the aircraft was in service, or not. I told him it was my neck, not his, and if he wished to see his on the line, it was a phone call away - never heard from him again. The power of suggestion - it was delivered with a soft and gentle inherited English accent, just for effect. Good stuff.

That one step alone would go a very long ways towards reducing the death toll we experience right now....and have ever since EMS helicopters started flying. True - but the interesting thing appears the illusion of being pushed may be more bound in folks knowing they are doing the right thing - albeit with the wrong instrument, wrong qualifications, wrong skill sets/s - like a deer in the headlights. It takes leadership to keep them safe, from the top. The blood is on the hands of our so-called leaders, and some are starting to realize it.

It sounds simple....why cannot EMS pilots do that? Because they can't see the end of time - that just happens to be shortly around the corner.

If you are reading this and willingly fly over those dark holes in the terrain....why can you not find another lighted route to your destination or refuse to take the direct...dark...deadly path? Absolutely. I remember in RVN telling guys to stay a little closer to efficient transport routes so if the world turns sour at least they'll be able to thumb a ride, or confiscate a vehicle - lot better than crashing in the jungle! Different time, different hole, but the same ADM conundrum.

Like Nick would say - 'the more you have to convince yourself there is no problem, the more it comes to light there is' - or something like that. Problem solving ALWAYS distills down to the simplest of things - in this case it is the need for a single leader.

Thanks for your time!

[anartificialhorizon]

Health Blog : A Rash of Medical Helicopter Crashes Brings Call for Reform (http://blogs.wsj.com/health/2008/10/29/a-rash-of-medical-helicopter-crashes-brings-call-for-reform/)

Quite astounding statistics.

I am surprised this has been allowed to accumulate to this level. One of latest crashes involved 3 staff and a one year old girl they were transporting. Very sad.

Hopefully the latest recommendations will bring some changes and less accidents.

[pattern_is_full]

The proximate causes have been the usual suspects: WX, terrain, night. No mechanical failures of the type that have plagued, e.g. Qantas for whatever reasons recently.

Statisticians will point out that a "clumping" of events is actually usually a sign of randomness rather than a sign of causality.

The NTSC statement implies that there have been more EMS flights in total (some, they say, unnecessary), and again, if one crash in a hundred flights is normal, then 3x the flights will result in 3x the crashes. Normal statistics.

In short, there may be no "why" in terms of an external factor, just chance, influenced by a larger number of rolls of the dice (flights).

The NTSC suggestions are primarily restrictions that would both reduce flights in iffy conditions and also the overall numbers of flights ("Can this be done with ground transport instead?") which may well be effective in the roll/dice sense, but also likely will affect bottom lines for the services that are private.

The most recent (3 crew/1 child/Aurora IL) was to a hospital at which I used to work, so it cut a bit closer to home than usual. I also live under the approach path to a nearby hospital, so the pictures fall off the walls some nights when the crews are doing approaches (practice or for real).

[edit] @tottigol(below) Hee-hee! I see your point. But I'm not one! My post and the one above it were 'imported' from a different thread, which may make them look a little displaced.

There probably is some "use-it-or-lose-it" pressure as mentioned below, affecting go-no go decisions.

[tottigol]

Spoken like a true EMS manager.

[WhirlwindIII]

Question: Rash of EMS crashes in the US. Why?

Answer: Rushing to do too much, with too little, 24/7/365!

[Dan Reno]

The rumur in these parts is helos are involved in a 'make work' push. Either make use of them or they may go away. So, to justify their being, previous patient transfers via ground are being handed over to helos and none life-threatening injuries previously delivered to ERs by ground are being flown in. Simply, more flights means more chances for accidents.

[IHL]

SB-08-51 (http://www.ntsb.gov/Pressrel/2008/081110.html)

Washington, DC - The National Transportation Safety Board will hold a public hearing on the safety of Helicopter Emergency Medical Services (HEMS) operations. The three-day hearing will begin on February 3, 2009, at the NTSB's Board Room and Conference Center, 429 L'Enfant Plaza, S.W., Washington, D.C.

Helicopter EMS operations provide an important service to the public by transporting seriously ill patients or donor organs to emergency care facilities. The pressure to safely and quickly conduct these operations in various environmental conditions (for example, inclement weather, at night, and unfamiliar landing sites for helicopter operations) has the potential to make HEMS operations more at risk than normal passenger carrying operations.

"We have seen an alarming rise in the numbers of EMS accidents and the Safety Board believes some of these accidents could have been prevented if our recommendations were implemented," said Member Robert Sumwalt, Chairman of the Hearing. "This hearing will be extremely important because it can provide an opportunity to learn more about the industry so that possibly we can make further recommendations that can prevent these accidents and save lives."

The NTSB issued a Special Investigation Report on EMS Operations in January 2006. The report involved the analysis of all EMS-related aviation accidents that occurred from January 2002 through January 2005. There were a total of 55 accidents that occurred during this 3-year window; 41 helicopters and 14 airplanes. These accidents killed 54 people, and seriously injured 19. Analysis of the accidents indicated that 29 of 55 accidents could have been prevented with corrective actions identified in the report.

However, over the past 11 months the Safety Board has investigated nine fatal EMS Accidents with a total of 35 fatalities. In 2008 alone there have been 7 fatal accidents with 28 fatalities. This is a drastic increase in accidents since the Special Investigation Report and therefore has prompted the Safety Board to examine this issue in greater detail by holding this hearing.

There will be witnesses from all EMS communities including pilots, medical personnel, managers, and FAA. The issues that will be discussed during the hearing include:

Operational Structure and Models
Flight Operations
Aircraft Safety Equipment
Training
Oversight
The hearing will be webcast. An agenda and webcast details will be posted on the Board's website, National Transportation Safety Board (http://www.ntsb.gov), when available.

# # #

Media Contact: Keith Holloway
202.314.6100
[email protected]





NTSB Home | << Back to Press Releases Page << | News & Events

[rotorfan]

As I was shaving this morning, an advertisement on the radio nearly made me gash my neck. A local HEMS operation (run as a non-profit by a consortium of hospitals, I believe) runs an occasional ad urging the listener to pay a flat-rate annual fee that will cover the cost of an EMS transport that they might need. An insurance of sorts. But, I was surprised when this ad went on to tell how the pilots are now flying with NVGs to make their ops safer.

rf

[bandit19]

The US is vast country (UK is roughly the size of Colorado) and don't forget Alaska. The sheer volume of Med Evacs per year, although untracked, would be far higher then anywhere else on the planet. Just wanted to put it in perspective.