7 people killed in a day mid-air crash, in, or very near an airport traffic area;
3 crew die in what appears to have been a structural failure, also in day light- these are very unusual occurrences. They're no less of concern because of their exceptional nature.
Next, 4 fatalities colliding with a tower that, from what I hear, was a known en route hazard. To me, also unusual- except that most wire strikes occur with known obstacles.
Then, Texas/ PHI, Wisconsin/ Air Methods, and the Maryland State Police accidents- 11 lives lost. These fit the stereotype EMS night and weather crashes, except that I think we're missing the forest for the trees in our analysis. These aren't as easily classified as 'night VFR into IMC':
The PHI pilot was an IFR captain in the Gulf for years. He never struck me as a 'cowboy' and his professional skills should have been adequate to the task;
MSP's Trooper 2 seemed to be doing the right things when the flight came to grief;
I know very little about the Wisconsin crash, except that it was an Air Methods EC 135. That airframe is often employed in my company as SPIFR platforms. I don't know if it was an IFR program.
So- Night and day; single and twin; VMC and IMC; VFR and IFR platforms; the one thing missing is two pilot crews. I think it's reasonable that the common element is the human factor. That's the issue that needs to be addressed.
Pretending that EMS is just an on-demand charter is short-sighted. In EMS we have an aviation decision to make, but a responsibility to the patient that over rides all when evaluating a flight- you have to know with reasonable certainty that at the very least, you will get the patient the receiving facility without undue hazard- or you're not doing the job hired for, period. The most conservative response is the best choice for all. When I have doubts, I have no doubts, and no option but to decline.
I shouldn't need a risk assessment matrix or operational control center to know that the proposed flight is not certain- the facts speak for themselves. Muddling the decision allows more flights and more revenue, but dilutes responsibility. EMS is not combat, there are options besides accepting dispatch or proceeding into unfavorable circumstances. Risking 4 to possibly help 1 is very bad math. There's no such thing as “taking a look” or “giving it a shot”, those are excuses for poor decision making.
We in US EMS do the hardest part of our job when we're at our worst, a sweeping generalization- most programs swap mid-hitch, day to night duty, with a 24 hour break between day and night shifts. Circadian rhythm, sleep patterns and rest, all are supposedly covered by the umbrella regulatory requirement for “10 hours of uninterrupted rest”.
Pilots are not blameless in this, I've heard professional pilots say bald-faced that they had plans for the day between two night hitches that meant they wouldn't be sleeping. I've heard of relief pilots reporting for night duty with the plan to sleep because they hadn't done so that day.
NVGs are slowly coming to the fleet. With aided vision, a pilot can see and avoid, almost as well as on a day flight. Right now, at typical unaided night visual acuity ranging from 20/200 to 20/400, we see by using counter-intuitive techniques and crappy lighting. Often, we don't see issues at all until we're in the cloud, hit the hill or the tower. Most pilots I know don't cruise that low at night. I wonder if the CFIT incidents aren't descents to regain contact, a very bad choice.
I'm not an equipment guy, this is all about decisions, how and why they were made, and the planning that results in the flight completed. Throw equipment, procedures and regulations at the problem and it'll have some impact- reducing flights, but not accident rates. More complications means more opportunity for mistakes as the root cause isn't addressed- the human factor.
I'm especially not a fan of IFR as a safety solution. Yes, I've been IIMC, but never had to continue IMC- a return to better weather or a precautionary landing works. Besides, the weather's VFR or better 95% of the time. Do I wish for full IFR capability? Sure. I also wish Carmen Electra would drop by, but I'm not building a business plan around that possibility.
Add that in our area, the average leg length is twenty-two minutes. By the time I check, plan, and fly, the patient could be transported by ground. Which is the case now, because I don't go.