Despite what some others may think, statistics must be the key to steering the evolution of safer US HEMS operations. Of course the information needs to be critically examined, for undoubtedly misleading conclusions can readily be promoted, but that's normal.
There is no doubt the scale of the US HEMS operation is huge - 850 helos flying around 400,000 hours per year. With major operators like Air Methods and Omniflight, the vast majority of flights are no doubt very professionally run and perfectly safe. However being a HEMS crew still rates as about the most risky occupation in the US, with a fatality rate of 113/100,000 employees, twice that of general aircrew.
It is widely known that the FAA and the NTSB are concerned about the high accident rates. Accidents are much more likely at night and mainly due to CFIT, LOC in IMC or hitting obstacles. But it also seems that the response from the NTSB and FAA shows concern but perhaps not sufficient urgency for action. Recommendations have been mainly for more training, better flight planning, radalts, NVGs and an autopilot if two pilots are not carried. All in an indeterminate timescale. In reviews readily available, it is interesting that there is precious little mention of the benefit of IFR twin use, even at night, albeit it a cost. Indeed it is hard to even find any mention of the number of IFR twins versus VFR singles utilised by HEMS business.
And business it clearly is. Since funding for many flights has been provided by Medicare (quoted at around $20k per flight) there has been a dramatic increase in the EMS helicopter fleet. Which the industry understandably says means better response times. Interestingly the amount paid by Medicare to the operators seems to be fixed. So if you operate a B206 you make a lot more profit than an EC135 or A109, for example.
It is clear from the posts on this forum that there is great support for not changing regulations to mandate use IFR twins, as used exclusively in Europe. This is entirely understandable - the cost increases would undoubtedly reduce the US EMS fleet significantly with the loss of jobs, though a requirement for two pilots may compensate for this, to an extent. Furthermore the current evidence does indicate that mechanical (eg engine) failure is a minimal cause of accidents. Having said that, as has been mentioned here, it is not so much the second engine but the IFR capability and redundancy that comes hand in hand that is the big advantage, especially for the more hazardous night flights.
However the US might actually be able to do us in Europe a huge favour here. There is no doubt European aviation is stifled by extensive regulation. Excessive, maybe. US HEMS ops experience is huge -much greater than we have. From comments on this forum, there seems to be a dominant US perception that use of single engine VFR helos for night EMS is fine, subject to implementation (eventually) of the kind of recommendations the NTSB make - particularly IMC training, TAWS/radalt, NVGs, autopilot. If well equipped singles are indeed safe enough, with such a scale of operations in the US, using twins and singles at night as well as day, compelling evidence should be able to be provided to support the approval of suitably equipped singles for IFR operations in both the US and Europe. If the data and statistics were solid, a lot of money could be saved. And again, the unique scale of US EMS ops should provide the evidence.
The problem is, it doesn't seem to. I have found no statistics to compare US single with twin EMS accident rates. Because perhaps the data doesn't exist. It needs to be though. If it does I'd like to see it. Surely there should be a logging system for all flights, which would include single/twin, IFR/VFR, day/night, duration, safely completed/risk factors/accident etc. The results would be fascinating, and provide much needed facts to supplement opinion.
Of course the Canadians would say they know the answer already. In nearly 250,000 flight hours since 1977 they have never had an EMS accident. But there again, they do only operate IFR twins with two pilots, and only use pre-surveyed sites at night. And with just 20 or so aircraft the pool is a fraction of that of the US, though rates should be comparable.
I suspect fewer Canadians get the benefit of a HEMS service as a result of a more expensive and limited service. But there again, what percentage of US HEMS flights are critical for life saving? What data is there on this? The US HEMS business is clearly a delicate balance between providing a huge ($2.5bn) industry that employs people and buys helicopters and parts etc, and one that cost-effectively saves lives.
Despite a number of requests on this forum, no-one has cited any detailed statistics to shed light on this issue. Maybe they do not exist. Cynics might say that a big part of the reason why is that some don't want to risk any awkward conclusions compromising the scale of a big industry.
Now clearly I've just very quickly tried to understand more about the issues as a European, non-HEMS ops pilot in order to constructively progress the debate. I look forward to comments from those with more direct knowledge!