HEMS - Regulations and saving life

[Oogle]

Re: HEMS Scenes safety

I myself do not see a problem with hot-loading or un-loading or patients or survivors if you have sufficient crew guards in place. On some rare occasions (medical considerations), the doctor or paramedic will ask not to shutdown. I have done this for many years using AS350, BO105, BK117 and Bell 412 with no dramas.

The biggest problem is that, for some reason, people seem to think that they have to rush around when the engines are running. No matter how much you ask/tell people to slow down, they still insist on running around.

[Flying Lawyer]

HEMS safety: Statements issued by FAA and NTSB

Issued by the FAA yesterday.


January 24, 2006


EMS Helicopter Safety
Helicopter Emergency Medical Service (HEMS) operations are unique due to the emergency nature of the mission. In August 2004, the FAA initiated a new government and industry partnership to improve the safety culture at EMS operators and recommend short- and long-term strategies for reducing accidents. While the FAA has not ruled out proposing new or changing existing rules, the agency has prompted significant short-term safety gains that do not require rulemaking. The FAA’s immediate focus has been on:

• Encourage risk management training to flight crews so that they can make more analytical decisions about whether to launch on a mission.
• Better training for night operations and responding to inadvertent flight into deteriorating weather conditions.
• Promote technology such as night vision goggles, terrain awareness and warning systems and radar altimeters.
• Provide airline-type FAA oversight for operators. Identify regional FAA HEMS operations and maintenance inspectors to help certificate new operators and review the operations of existing companies.

Background

There are approx. 650 emergency medical service helicopters operating today, most of which operate under Part 135 rules. HEMS operators may ferry or reposition helicopters (without passengers/patients) under Part 91.

The number of accidents nearly doubled between the mid-1990s and the HEMS industry’s rapid growth period from 2000 to 2004. There were 9 accidents in 1998, compared with 15 in 2004. There were a total of 83 accidents from 1998 through mid-2004. The main causes were controlled flight into terrain (CFIT), inadvertent operation into instrument meteorological conditions and pilot spatial disorientation/lack of situational awareness in night operations. Safety improvements are needed.


FAA Oversight
The FAA inspects HEMS operators, but is prompting changes beyond inspection and surveillance. Rather, the FAA is moving to a risk-based system that includes the initiatives outlined below which focus on the leading causes of the HEMS accidents.


FAA Actions

• In August 2004, the FAA established a task force to review and guide government/industry efforts to reduce HEMS accidents. The FAA most recently met with HEMS operators on October 18, 2005.
• On January 14, 2005, the FAA hosted a meeting with EMS industry representatives to discuss safety issues and gain feedback. Representatives from the Association of Air Medical Services, Helicopter Association International, the National EMS Pilots Association and several operators attended.
• On January 28, 2005, the FAA published a notice that provides guidance for safety inspectors to help operators review pilot and mechanic decision-making skills, procedural adherence, and crew resource management practices. It includes both FAA and industry intervention strategies (Notice 8000.293 Helicopter Emergency Medical Service Operations).
• On August 1, 2005, the FAA issued guidance to inspectors to promote improved risk assessment and risk management tools and training to all flight crews, including medical staff (Notice 8000.301 Operational Risk Assessment Programs for Helicopter Emergency Medical Services).
• On September 22, 2005, the FAA issued guidance to HEMS operators to establish minimum guidelines for Air Medical Resource Management (AMIRM) training. The training focuses on pilots, maintenance technicians, flight nurses, flight paramedics, flight physicians, medical directors, specialty team members (such as neonatal teams), communications specialists (dispatchers), program managers, maintenance staff, operational managers, support staff, and any other air medical team members identified by specific needs (AC No. 00-64 Air Medical Resource Management).
• On September 27, 2005, the FAA issued a notice to inspectors to provide guidance for special emphasis inspection programs (Notice 8000.307 Special Emphasis Inspection Program for Helicopter Emergency Services). During summer 2005, FAA safety inspectors met with EMS operators to review their Operations Specifications (OpSpecs) for EMS VFR weather minima. Changes to those minima, including the level of lighting for night operations, are in the final stages of development.
• On January 24, 2006 the FAA issued a handbook bulletin to inspectors describing acceptable models for CFIT Avoidance and Loss of Control (LOC) Avoidance Programs. The bulletin contains information for inspectors to provide to HEMS operators for developing LOC/CFIT accident avoidance programs and clarifies existing guidance (HBAT 06-02 Helicopter Emergency Medical services (HEMS) Loss of Control (LOC) and Controlled Flight Into Terrain (CFIT) Accident Avoidance Programs).
• On January 24, 2006 the FAA issued revised guidance to inspectors regarding HEMS OpSpecs, amending the Visual Flight Rule (VFR) weather requirements for HEMS operations (HBAT 06-01 Helicopter Emergency Services; OpSpec A021/A002 Revisions).
• Members of the aero medical and rotorcraft industries continue to work with the FAA through the Part 135/125 Aviation Rulemaking Committee to recommend changes to Part 135 (general aviation) segment of the industry.
• The helicopter industry recently formed the International Helicopter Safety Team (IHST) to gather data and draft strategies to reduce helicopter accidents globally by 80 percent by 2015. The effort is modeled on the Commercial Aviation Safety Team (CAST) which has achieved a significant reduction in the commercial fatal accident rate in the United States. Members include the FAA, European Aviation Safety Agency (EASA), Transport Canada, the International Civil Aviation Organization (ICAO), and industry representatives.
• The FAA’s Flight Standards Service formed a task group this month to focus on the large HEMS operators that support a variety of medical organizations throughout the United States.

Weather

On March 21-23, the FAA in cooperation with the University Corporation for Atmospheric Research (UCAR) will host a government/industry HEMS Weather Summit in Boulder, Colorado. The purpose of the summit is to identify the HEMS-specific issues related to weather products and services. Attendees will explore possible regulatory improvements, weather product enhancements, and operational fixes specific to HEMS operations. Invitees include the National Weather Service, National Center for Atmospheric Research, Helicopter Association International, American Helicopter Society International, Association of Air Medical Services, National EMS Pilots Association, National Association of Air Medical Communications Specialists, manufacturers, and many HEMS operators.

Night Vision Goggles
The FAA has a solid record of facilitating safety improvements as well as new technologies for EMS helicopters, including certification of Night Vision Goggles (NVGs). Since 1994, the FAA has worked 28 projects or design approvals called Supplemental Type Certificates (STCs) for installation of NVGs on helicopters. This number includes EMS, law enforcement and other types of helicopter operations. Of the 28 projects, the FAA has approved approximately 15 NVGs for EMS helicopters. The FAA initiated and wrote (in coordination with RTCA) the minimum standards for NVGs/cockpit lighting. Technical Standard Order (TSO) C164 was published on September 30, 2004 referencing RTCA document DO 275 Minimum Operational Performance Standards (MOPS), published October 12, 2001. The FAA has hosted workshops to help applicants work with the FAA to obtain NVG certification. One set of NVGs costs approximately $7,000 and an operator must carry multiple sets per flight. Certification is just one step. The operator must also have an FAA-approved training program for using NVGs.

Flight Data Recorders
Flight Data Recorders (FDRs) are not required for HEMS operations. FDRs offer value in any accident investigation by providing information on aircraft system status, flight path and attitude. The weight and cost of FDR systems are factors. Research and development is required to determine the appropriate standards for FDR data and survivability in the helicopter environment, which typically involves substantially lower speeds and altitudes than airplanes. Funds are currently best invested in preventive training.

Terrain Awareness Warning Systems
The FAA supports the voluntary implementation of Terrain Awareness Warning Systems (TAWS) and did consider the possibility of including rotorcraft in the TAWS rulemaking process. Through this process, however, the FAA concluded that there are a number of issues unique to VFR helicopter operations that must be resolved before the FAA considers mandating the use of TAWS in this area, such as modification of the standards used for these systems. For example, helicopters typically operate at lower altitudes so TAWS could potentially generate false alerts and “nuisance” warnings that could negatively impact the crew’s response to a valid alert. TAWS application to HEMS would require study of TAWS interoperability within the lower altitude HEMS environment, and possibly a modification of TAWS system standards.

###

Any thoughts by those in the industry?



FL

[Setpoint99]

NTSB calls for stricter regulation of air ambulance flights

The links to the NTSB report described in the following press release are at:
Synopsis: http://www.ntsb.gov/publictn/2006/SIR0601.htm
PDF and PPT presentation files:
http://www.ntsb.gov/events/2006/EMS/presentations.htm
FOR IMMEDIATE RELEASE: January 25, 2006 SB-06-04
NTSB CALLS FOR STRICTER REGULATION OF AIR AMBULANCE FLIGHTS
Washington, D.C. - In a special report adopted today, the National Transportation Safety Board called for the Federal Aviation Administration to impose stricter requirements on all emergency medical services flights.
The NTSB undertook the special report after investigating fifty-five EMS accidents in the three-year span between January 2002 and January 2005. "The very essence of the EMS mission is saving lives. Operating an EMS flight in an unsafe environment just makes no sense," commented NTSB Acting Chairman Mark Rosenker.
During the study the Board found that while carrying patients or organs, EMS flights are required to operate in accordance with 14 CFR Part 135 regulations. However, when positioning flights are conducted without patients on board, they are permitted to operate under the much less stringent provisions of 14 CFR Part 91. The Board noted that thirty-five of the fifty-five accidents occurred on positioning flights with medical crewmembers, but no patients,on board.
Part 135 and Part 91 requirements differ significantly regarding weather minimums and crew rest requirements -- two key factors found in the EMS accidents investigated by the Board. The Board concluded that the safety of EMS operations would be improved if the entire EMS flight plan operated under Part 135 regulations and recommended that the FAA require all emergency medical services to comply with Part 135 regulations during the conduct of all flights with medical personnel on board.
The Board's investigation also examined the decision-making process of EMS operators when evaluating the potential risks of a flight. Weather, nighttime flight, spatial disorientation from the lack of visual clues, pilot training and experience, and pressure to take the flight are all risks associated with the EMS mission. Safely operating in this high risk environment calls for the systematic evaluation and management of the risks. However the Board found that none of the operators involved in the highlighted accidents had an established aviation risk evaluation program at the time of the accident. Therefore the Board recommended that the FAA require EMS operators to develop and implement flight risk evaluation programs.
In conjunction with the lack of risk evaluation programs, the Board's investigation revealed that many EMS operators lack a consistent, comprehensive flight dispatch procedure to assist pilots in determining the safety of a mission. Currently most EMS operators are notified of an assignment by the local 911-dispatch system or emergency hospital staff. Because most hospital staff and 911 dispatchers do not have aviation expertise, they are not aware of flight requirements, particularly requirements for nighttime flight or adverse conditions. This information is critical and can help avoid accidents. The Board asked the FAA to require EMS operators to use formalized dispatch and flight following procedures that include a dispatcher with aviation experience, up-to-date weather information, and assistance in flight risk assessment decisions.
Finally the report reviewed several technologies that can assist in flight operations - terrain awareness warning systems (TAWS) and night vision imaging systems (NVIS). Controlled flight into terrain is a common factor in helicopter EMS accidents that could be alleviated by the use of TAWS. The investigations of seventeen of the fifty five accidents determined that TAWS might have helped pilots avoid terrain. The Board recommended that the FAA require the installation of terrain warning systems on all EMS aircraft.
In addition to TAWS, the Safety Board found that some EMS operators were using NVIS to enhance a pilot's ability to avoid terrain. The Board determined that if used properly, NVIS could help EMS pilots identify and avoid hazards during nighttime operations. However, because NVIS are not feasible in some situations such as populated areas with ambient light or numerous streetlights, the Board did not make a recommendation on this subject.
In its action today, the Board also adopted final reports for seven EMS accidents highlighted in the safety study. A synopsis of the report that includes the conclusions, and recommendations can be found on the Board's website, www.ntsb.gov. Briefs of the individual accidents, including probable cause statements, will be available on the website, on Friday, January 27.
Media Contact: Lauren Peduzzi
[phone]
[email protected]

[Setpoint99]

NY Times article on the NTSB report

Here is the NY Times article on the NTSB report:

January 26, 2006
Report Faults Rules and Judgment in Crashes of Air Ambulances

By MATTHEW L. WALD
WASHINGTON, Jan. 25 — Air ambulance crashes killed 54 people, most of them pilots, paramedics and nurses, in a three-year period ending in early 2005, according to a special study by the National Transportation Safety Board.

The report, which was approved by the board on Wednesday, concluded that pilots were not good at analyzing risks and that the rules are too lax for flights that are not carrying a patient or a donated organ.

Helicopters and planes used as ambulances fly under airline-type rules when carrying a patient or organs. But if they are on their way to a pickup, they fly under rules that apply to private planes, which do not limit how many hours a pilot can work and allow flights in worse weather. Three-quarters of the accidents occurred under those rules.

"It seems like a ridiculous paper loophole that needs to be closed," said one member of the board, Debbie Hersman. "You've got one, two or three medical personnel on board, and they have organs in their bodies. They're just as important cargo as an organ for transplant."

Investigators also supported a formal program of "flight risk evaluation," in which the pilot and possibly a second expert would dispassionately score each mission, based on weather conditions, time of day and other factors. Of the 55 accidents, 13 might not have occurred if such evaluations had been done, they said.

While the number of crashes is up, including nine more crashes killing eight people since the end of the study, the rate of accidents is uncertain because of difficulties in determining the number of flights. According to the Federal Aviation Administration, there are about 650 emergency medical service helicopters; an industry group estimates there are more than 750.

According to investigators, there were no accidents among "public use" aircraft, including those flown by police and fire departments. Government agencies tend to have dispatchers trained to obtain weather data and discuss conditions with the pilot, investigators said, adding that professional dispatching might have eliminated 11 of the 55 crashes.

For example, a helicopter sent for a passenger in Newberry, S.C., in July 2004 ran into trees and crashed shortly after picking up the patient. The pilot, who was dispatched by a 911 operator, did not know that before he accepted the job that three other helicopter companies had turned it down because of weather conditions. Everyone on board died.

Kitty Higgins, named to the safety board this month, referred to the problem as "helicopter shopping."

The safety board investigators said accidents could also be reduced by use of night-vision equipment and terrain warning systems.

A spokeswoman for the Federal Aviation Administration, Alison Duquette, said that the technology was not well suited to helicopters because they sounded false alarms frequently at low altitudes, which is where helicopters often fly.

A spokesman for the industry, Thomas P. Judge, a paramedic in Maine and the previous president of the Association of Air Medical Services, said that risk management programs would be helpful, but that applying airline rules to all flights would not. For example, Mr. Judge said, the airline rules require that before departure, the pilot receive a weather report on the destination from a source approved by the F.A.A. But the destination might turn out to be an isolated area for which no weather report was available.

[tottigol]

Both the FAA and the NTSB are still largely missing the point, and while proposing all EMS operations to be ruled by Part135 is one small step in the right direction, empowering dispatch officers with "aviation knowledge" shall only create a sharper divide between the medical and the aviation side of the operation.
The FAA and the NTSB, fail to acknowledge that the so called "Aeromedical" industry is a huge money maker, and that is not a real emergency service; those two factors, added to the fact that most medical "crews" are typically the "customer to be pleased" by the pilots as "company representative" pose the greater unrecognized hazard to this particular branch of the helicopter industry, at least considering the way "HEMS" operation are conducted in the USA.
Any pilot who has been flying in this industry for at least five years has been second guessed more than once with regards to weather conditions necessary for dispatch and recovery (and if they say no, they are lying to themselves).
NVGs systems, EGPWS, Radar Altimetres are only palliatives and do not make up for a system that should allow for UNBIASED and UNCHECKED go/no go decisions by the flight crew; just imagine you are flying a US Pt.135 twin engine commuter and weather at your destination is below mins for the flight, yet your flight attendant or better yet one of your PASSENGERS wants to go regardless, becuse otherwise the "other" fly-by-night Airlines would garner more recognition and market share; what would you as a pilot do? You would say no, and if they insisted you'd probably notify the federal Authorities about this individual, right?
Imagine now that the same individual OWNS the airline you are flying for and that he/she threatens you with termination if you do not make that flight, forcing you to uproot your family and move to another city to find work. How would you go about it?
THAT is the nature of the beast and THAT is the problem that both the FAA and NTSB fail to recognize (partly because is out of their jurisdiction).
A way around this are FDRs and CVRs, another way around this would be increase the disciplinary capabilities of pilots, by actually creating a program that "de facto" renders medical passengers as crew members thus subject to disciplinary action by the pilot.
One more thing is for the FAA to be forthcoming with the development of a much more complete network of ASOS/AWOS3 or whatever the next generation of Automated WX reporting stations will be, to allow for precision WAAS supported GPS approaches even into locations lacking an airport, but that would be useful to serve one or more rural USA community.
With the current proposed rulemaking or these determinations that are still shy of it, the FAA is demonstrating a refusal to tackle the issue in its own half (a European Football term) and are just attempting to cure the simptoms rather than the cause (a medical term).

[SASless]

Pilot Input to FAA rules about HEMS

A poster named Cactusrotor asked me to place his post on Rotorheads...seems he was unable to get himself registered today.

There has been a great deal of criticsim of the recent NTSB reports that made the news last week. I also know that some of you have some strong opinions concerning the FAR 135 for HEMS, that we live and die by. The process for changing the FARs or MMEL's is very much cut and dry. The FAA, the manufactures and the operators get together in what ever combination is required, and come up with reccommendations that the FAA may or may not put into effect. Even tho' it is advertized that hearings or meetings are going to take place, for the most part we, the line pilots and technicians have little or no voice in the matter. So here is your chance. Post your concerns here, or e-mail your thoughts and concerns, any and all suggestions are welcome.

I assume he will be providing the responses to a friendly ear at the FAA or NTSB. There was an earlier effort to do the same by a Maryland State Police Pilot that seemed to be productive.

[Revolutionary]

One thing I did like about the NTSB report is the suggestion that dispatch could play an expanded role in supporting the pilots in the field, both before and during a flight. Wouldn't it be nice if the dispatcher had the weather resources and knowledge to actually make a preliminary judgement about the feasibility of a flight request before passing it on to the pilot? Or if the dispatcher was shrewd enough to ask the requesting agency if they've been turned down by another program already if he suspected a case of 'helicopter shopping'? Or if the dispatcher would give you comprehensive inflight updates on weather forming ahead on your route of flight? I'm not suggesting that we offload our responsibility for the safe conduct of the flight to the dispatcher, just that dispatchers can provide us with more backup than simply rattling off the scene location and ground contact.

[fishboy]

Weather

Gathering weather info is one thing, but making any kind of "go" decision about the flight should be ruled out immediately. You would have to bear in mind that this person would not be on the flight and could very well be a "company man". The dispatcher would then be in a position to apply considerable pressure for a pilot to accept a job he would normally turn down. PLEASE, we must not go down this road.
If the weather is below certain set limits I agree he should be able to say "no" to a flight, but he should never be able to say "yes" to a flight.
In-flight weather updates would be great

[Revolutionary]

Yes, I meant the judgement on the part of the dispatchers to say 'no' to a flight request before it even reaches the pilot, not to accept a flight on the pilot's behalf. It seems that sometimes, even when you're 'red', dispatch still relays flight requests just to see if maybe you can do it after all. What I am thinking of is more along the lines of what AEL is now doing: they have a pilot in the comm center at all times (either a retired guy or a guy who's lost his medical or someone who just doesn't like to fly anymore) who collects and relays weather data, info on TFR's and restricted areas and anything else a pilot in flight may need, and generally covers the back of the guy in the air. Now that's helpful.

[SASless]

This is as good a place to put this as anywhere....

Some reports suggested there was a lot of fog around at the time of the crash.

Good news is all survived the crash of the PHI EMS Bell 206 in Indiana this morning at about 0200 CST.

[havoc]

PHI Indiana

Local TV video can be found on this homepage link:

http://wthr.com/


Crew is doing ok, all hospitalized.

[havoc]

EMS from a Lawyers perspective

This is from the journal for the Association of Trial Lawyers of America. I deleted the reference notes but they may viewed at thsi link:

http://www.emsresponder.com/article/...tion=1&id=3012


JUSTIN T. GREEN, a former Marine Corps helicopter pilot, is a partner at Kreindler & Kreindler in New York. He thanks Christine Negroni, his firm's lead investigator, for her valuable assistance with this article.


When Rescue Is Too Risky: Medevac Flights Too Often Endanger the Lives They Were Dispatched to Save
JUSTIN T. GREEN
Trial
On the night of September 9, 2002, an emergency medical services (EMS) helicopter went out of control and crashed into a South Dakota bean field. Investigators determined that pilot error caused the crash because the pilot's deficiencies--especially in night flying--were well documented. (1) In fact, his employer (a leading EMS company) previously grounded him from night missions because he was not capable of flying safely at night.
So why was the pilot flying on the night of the crash? After the employer's safety manager identified the pilot's night-flight problems and the base manager wisely restricted the pilot from flying night missions, the employer's chief pilot overturned the decision and cleared the pilot to fly at night. The pilot crashed the helicopter on his fourth night mission.
The company's decision to clear the pilot for night flight after it had identified his serious deficiencies is typical of endemic safety problems in the EMS industry. Despite the company's denial, it appears that the decision was made for business purposes--so the company could schedule more night missions, putting profits over safety.
The EMS industry--which is now largely populated by private, for-profit companies--operates on narrow profit margins and has not invested properly in safety. By failing to hire trained and experienced pilots, who command high salaries, or equip and maintain aircraft, the industry has not served its aircrews and passengers well.
EMS aviation is some of the most dangerous nonmilitary flying in the United States. According to the U.S. Bureau of Labor Statistics, "aircraft pilot" is among the most dangerous of all professions, (2) but EMS aviation is in its own class--with a crash rate closer to that of combat flying than commercial aviation.
In the past five years, more than 10 percent of air ambulance helicopters crashed, a total of 84 accidents resulting in 60 deaths. (3) If patients knew of these lethal statistics, many probably would choose not to fly in EMS planes and helicopters.
The National Transportation Safety Board (NTSB)--the independent agency of the federal government that investigates civil aviation and other transportation accidents in the United States--attributes many EMS crashes to pilot error. But a pilot is only as good as his or her aircraft, which must be properly equipped and maintained. Aircraft manufacturers, maintenance companies, and operators must understand the unique risks involved in emergency medical aviation and work to avoid them. To date, the industry has failed to live up to its responsibilities.
Victims of EMS accidents often have difficulty obtaining justice because workers' compensation usually provides immunity to the operating company against claims by crew members and their families. However, aviation disasters usually have more than one cause, and trial attorneys who zealously investigate a crash often find other potential defendants.
Unique hazards
Many risk factors contribute to high EMS accident rates.
The flight environment. Emergency flights are often made into ad hoc landing zones and in hazardous conditions, including bad weather, high altitude, and rough terrain. Night flying and flying in "instrument meteorological conditions" (IMC)--where the pilot cannot see enough visual cues outside the aircraft to fly and must rely on instruments--are common on EMS missions. These conditions greatly increase accident rates. Poor visibility induces pilot vertigo and increases the chance of crashing.
Over the last six years, 13 percent of fatal EMS helicopter accidents involved pilots inadvertently flying into weather conditions that required them to rely on their instruments to navigate. (4) Flying in bad weather, regardless of the time of day, exposes a pilot to all the dangers of night flying and introduces other hazards, such as icing, snow, severe winds, and lightning. (5) Fatal accident rates increase by nearly two-thirds at night and triple in weather conditions requiring instrument flying. (6)
The pilot's training, judgment, and experience. A general pilot shortage has prompted some EMS operators to hire inexperienced pilots and send them on missions well beyond their capabilities. For example, many EMS pilots are not instrument-rated (certified to fly when weather conditions restrict visibility, using instruments only) but are required to fly in poor weather and at night, (7) when they are more likely to encounter serious flight hazards and have to rely on instruments.
Some EMS pilots may be influenced by a hero mentality: They may believe that completing a flight is critical to the survival of their passengers and continue missions that they should cancel. Even experienced EMS pilots can succumb to this thinking and fail to weigh the risk of delayed medical treatment against the risks of continuing into worsening weather or attempting dangerous landings. (8)
The aircraft's suitability, condition, and outfitting. Medical emergency aircraft must be capable of handling hazardous conditions, such as high-altitude flight and landing at dangerous sites. EMS aircraft should be outfitted and certified for instrument flight and equipped with modern devices--such as night-vision systems and power-line-detection systems--that mitigate the limited visibility of weather and night flying in bad weather and at night.
Hitting power lines, telephone wires, and other objects has been the leading operational cause of fatal EMS helicopter accidents in thelast decade. (9) Power lines and wires are difficult to see in flight; detection systems pro vide audio and visual warnings to the pilot when an aircraft is flown too close to them. (10)
The EMS industry has dropped the ball on safety. While limited visibility and weather are recognized as leading factors in fatal accidents, the Association of Air Medical Services has made no recommendation to its 300 members on the use of night-vision goggles or a requirement that EMS pilots be instrument-rated. (11)
In addition, the helicopter air ambulance service industry increasingly uses single-engine aircraft, which increases the risk that an engine malfunction will result in a catastrophic accident. (12) And most of the helicopters used in EMS flights are not equipped with available safety mechanisms such as power-line warning systems.
Economic pressures. In the nonprofit, hospital-based model of a decade ago, medical centers controlled air medical services, including the aircraft and flight crew. (13) But the EMS industry now predominantly consists of for-profit companies with large capital investments,including aircraft and equipment purchases or leases, repair and maintenance costs, medical and aviation personnel staffing, and crew training. If economic pressures force cost-cutting measures, safety often suffers.
EMS operators may buy or lease cheap aircraft that have fewer safety features than more expensive models do and fail to purchase necessary, but costly, safety devices. Aircraft maintenance is also expensive, and a plane or helicopter grounded for maintenance is not earning money for the company. This creates tremendous financial pressure to ignore or put off necessary aircraft maintenance. Also, many companies refuse to pay for comprehensive safety and training programs. "Multiple safety layers don't exist," said one former EMS pilot. (14)
Financial incentives also can result in risky flights. Often, operating companies are not paid unless they complete missions, and many send their aircraft on missions where there is insufficient medical need for air transport. A January 2005 study, for example, found that of 37,500 patients transported by helicopter, two-thirds had only minor injuries. One of four had injuries too minor to require hospitalization. (15)
Lack of government oversight. There are 350,000 helicopter and more than 100,000 fixed-wing EMS flights in the United States each year,(16) which means an EMS aircraft takes off on a mission every 90 seconds on average. Most aviation in the United States is highly regulated, but air-medical transport is an exception.
The Federal Aviation Administration (FAA) has not sufficiently addressed the safety problems in EMS aviation. EMS aircraft operate under different flight rules depending on the phase of flight, and EMS operating companies set their own standards for pilot qualifications and decide what safety equipment will be installed on their aircraft.
Currently, EMS flights may begin--without passengers--under Federal Aviation Regulations (FAR) part 91 rules, which allow flight even if weather conditions are not good enough for passenger-carrying commercial operations (governed by FAR part 135 rules). (17) Once a patient is collected, the mission becomes a part 135 flight, so if the weather has not improved at the evacuation scene, pilots are forced to choose between flying back without the patient or breaking FAA regulations and completing the mission.
The practice of flying out in bad weather and hoping for the best has been identified as an ongoing problem by both the FAA and the NTSB, which proposes that medical flights be considered FAR part 135 flights from the time they are dispatched.
The FAA has not promulgated necessary regulations, but has issued only recommendations to the industry on EMS flight crew and management training. (18) These were prepared with substantial industry input and influence, and the industry has resisted new recommendations in the form of safety requirements that would reduce its profit margins. The FAA currently is working on additional recommendations in the form of nonmandatory advisory circulars for the industry. (19)
The NTSB has recognized the dangers of EMS aviation and is considering recommendations--of which the FAA and EMS industry should take note--about the following:
* night-vision goggles and training in their use
* ground-collision warning devices
* flight-data and cockpit-voice recorders;
* more standard rules on training, night operations, and limited-visibility conditions
* inadequate training of pilots, aging equipment, and vague rules for flights in limited-visibility conditions.
Until the industry and government take the necessary steps to safeguard EMS crews and passengers, plaintiffs and their attorneys must use the civil justice system to deter the wrongful conduct that takes so many lives.
Complex claims
EMS aviation cases present difficult challenges. Most crashes have more than one cause and more than one responsible party. Multiple plaintiffs and third-party actions can make cases even more complicated.
A perfect example of this complexity is reported in Walker v. Messerschmitt Bolkow Blohm GMBH. (20) In that case, a BO-105 helicopter crashed on an EMS training flight, killing three crew members. The helicopter was seen flying over one of the airport's runways when it suddenly banked hard to the right, pitched downward, and crashed.
Representatives of the decedents' estates brought a claim against the manufacturer. The owner, North Central Texas Services, and the operator, Lone Star Helicopters, intervened to recover for the loss of the aircraft, and the manufacturer counterclaimed, seeking indemnity or contribution. Not surprisingly, the manufacturer claimed that pilot error caused the accident.
The manufacturer ultimately settled with the plaintiffs, and the case proceeded to trial to determine the relative responsibility of the manufacturer, the owner, and the operator. Lone Star Helicopters and North Central Texas Services intervened to recover for the total loss of the helicopter. The manufacturer filed a third-party complaint against the pilot. The manufacturer also counterclaimed against Lone Star Helicopters and North Central Texas Services, seeking indemnity or contribution on grounds that the pilot's negligence caused the accident. The jury found that the helicopter was defective and that the manufacturer was negligent in designing and manufacturing it. It also found the pilot negligent.
In this case--typical of one with more than one cause and more than one responsible party--the plaintiffs, who probably could not sue the operator, were successful with their claims against the manufacturer. Ultimately, both the operator and manufacturer were held liable.
Not all victims in EMS crashes have the same legal options, and you need to approach cases differently depending on whom you represent. The issues involved in a passenger's case are unlike those involved in a crew case.
Passenger cases. The family of a passenger killed in an EMS accident has a uniquely strong case. The passenger is a victim who can't have contributed to the crash, and the law favors his or her family's claim. Even tort "reformers" recognize the special status of these passengers. The leading piece of aviation law tort "reform," the General Aviation Revitalization Act of 1994, exempts suits "if the person for whose injury or death the claim is being made is a passenger for purposes of receiving treatment for a medical or other emergency." (21)
Most important, workers' compensation law almost never bars passengers from suing potential defendants. A passenger can sue the pilot and the pilot's employer, while EMS pilots and crew usually cannot sue their employer.
Crew cases. Operating companies that employ EMS flight crews and their families are protected by workers' compensation laws in most jurisdictions. The operator is responsible for aircraft selection and equipment, pilot hiring and training, and mission assignment, and is legally responsible for the errors of its pilots. Yet, even when the operator is clearly at fault, it often enjoys immunity from employee suits.
The voluntary settlement insurance that many operators carry is a further complication. This insurance provides coverage for settlements that the operator can offer to the families of its employees killedin a crash. This is a terrific benefit in pure pilot-error cases, where the victim's family may have no other options, but it can complicate the case if the surviving family intends to bring claims against the aircraft manufacturer or other defendants.
These settlements come with strings attached. The operator will ask that the victim's family sign releases indemnifying it if it is later sued in a third-party action brought by a defendant (such as the aircraft manufacturer), that has been sued by the family. The releases may even require the settling families to pay for the operator's legal defense. If your clients are asked to sign such a release, scrutinize the language and negotiate the terms so that family members do not sign away their rights.
Proving the case
Even before discovery, it is relatively easy to determine safety problems concerning the pilot, operating company, and aircraft. The NTSB maintains comprehensive and searchable databases of accidents. (22) The FAA holds a vast amount of information regarding service difficulties of the aircraft, maintenance performed, pilot qualifications, and other issues. Filing a Freedom of Information Act (FOIA) request with the FAA (23) produces this information relatively quickly, and much of it is now posted on the Internet.
While it's easy to blame the pilot for a crash, you should be sureto pursue all factors contributing to it. Often, a full investigation will show that an accident attributed to pilot error actually was the result of a mechanical failure. In discovery and at trial, focus on the following:
The manufacturer's marketing and sales documents, and correspondence between the manufacturer and the EMS operator. These documents mayprovide a basis for misrepresentation and warranty claims. EMS operators often purchase or lease aircraft for use in a particular flight environment, such as at high altitude. Documents about the suitability of the aircraft for these environments may be crucial evidence to establish the manufacturer's liability.
Evidence of the hospital's involvement. If the crash occurred at ahospital landing zone, problems with the zone may make the hospital liable to the victims. For example, the hospital may be liable for negligent selection of the EMS operator. (24) In certain circumstances, the hospital should be liable for requesting EMS air transportation when the patient's condition did not require it.
The EMS operator's financial records. These will tell you how muchmoney the operator spends on safety, including flight training. Theywill also reveal how the operator makes money, which may speak to its motives for scheduling a mission.
The EMS operator's flight mission records. These will show why the operator sends its crews on missions and may demonstrate a history of pushing missions that were not necessary based on the passenger's medical condition. These records should also provide information regarding the crew's flight experience.
The operator's training records. These will reveal whether the operator has complied with FAA recommendations and employed reasonably safe practices. Test whether the training reported in the records ever took place by comparing it with the number of hours flown on the training flights. You may find that too much training was purportedly accomplished in too little flight time.
Also look for whether the operator overused simulators to complete necessary training. While simulators are important training tools, there is no substitute for actual flight time. Operators tend to rely too much on simulators to save flight costs.
Correspondence between the operator and the FAA. As government oversight of the industry increases, communications may reveal that an operator's shortcomings have come to the FAA's attention. Independently seek from the FAA, via FOIA, all documents relating to the operator.
Aircraft records. These will reveal whether the aircraft was properly equipped for its missions. Was it instrument-certified? Did it have power-line-avoidance equipment? Was it properly equipped for nightflying? The records will also show whether the aircraft received appropriate maintenance. You may find a history of a relevant defect that the operator, maintainer, or manufacturer failed to correct.
The operator's accident/incident history. Many operators have terrible safety records. Look beyond major crashes, because relatively minor incidents or difficulties may prove to be important evidence.
The pilot's logbooks and training records. Here you'll find a pilot's qualifications, flight time, training, and experience, which willshow whether he or she should have been flying the aircraft at all.
A plaintiff lawyer must approach an EMS crash case from every angle. When a lawsuit determines all the causes of an EMS disaster and holds liable those who are responsible, it sends a strong message to the industry.
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[B Sousa]

No Question that EMS in general is a Gold Mine to The Lawyer Industry. The "I gotta go no matter" has killed more than its fair share and EMS is growing rapidly. More folks in the chain are going to have to be willing to say NO more often.

[paco]

That's an interesting point about going out as Part 91 and returning Part 135 - in the UK, if a passenger is going to be on board at any stage, the whole flight is PT.

The other interesting point is the old chestnut about twins being inherently safer, but we all know the arguments for and against on that one. However, if the jury thinks they might be, then it ought to be considered.

Phil

[MightyGem]

Currently, EMS flights may begin--without passengers--under Federal Aviation Regulations (FAR) part 91 rules, which allow flight even if weather conditions are not good enough for passenger-carrying commercial operations (governed by FAR part 135 rules). (17) Once a patient is collected, the mission becomes a part 135 flight, so if the weather has not improved at the evacuation scene, pilots are forced to choose between flying back without the patient or breaking FAA regulations and completing the mission.

A case for the medical team to be classed as passengers perhaps, as here in the UK. Then the stricter weather limits would apply for the whole flight.

[havoc]

Overall message

A plaintiff lawyer must approach an EMS crash case from every angle. When a lawsuit determines all the causes of an EMS disaster and holds liable those who are responsible, it sends a strong message to the industry.

The whole story wraps around this message, from all the other points the lawyer is not sending any message to the industry. He merely is telling how to capitalize tha maximum amount of money from the incident for whom ever becomes his client.

The industry lawyers should take note and close the loop holes, implement better accountablility and safety procedures. There is a laundry list of things to do but it boils down to $$$.

[SASless]

Don't We Wish!

When a lawsuit determines all the causes of an EMS disaster and holds liable those who are responsible, it sends a strong message to the industry.

Why is it the "plaintiff's lawyer" has that role to play? Reckon there are more than a few folks making like cats covering scat when these things happen?

I don't ever recall anyone standing up and admitting having played a role in causing one of these accidents but I do remember a lot of folks that are darn quick to point the finger at the pilot, especially when that pilot is not around to defend himself.

[tottigol]

CVRs and FDRs ought to be considered as defensive items by the Industry's lawyers, even before being accident investigative tools, and as such ought to be installed in all EMS helicopters. Of course in the cases where occurrences like WX busting happen routinely could be further investigated by locating MANDATORY WX reporting at all EMS helicopter bases.
Regarding the article I concur with Havoc (I believe) as it concerns itself mainly with finding the best way to squeeze blood out of a rock.

[havoc]

Maui Fixed wing nurses refuse to fly

Maybe I should be come a "consultant" since former pilots now lawyers have more then their 2 cents to add. I guess we eat our own.

This article was a result of the fatal crash a few days ago.


http://www.honoluluadvertiser.com/ap...WS01/603110333

[Geoffersincornwall]

TOTIGOL

The prospect of FDRs offers the prospect of a technique employed in the offshore world called HOMP (FOQA or FD Analysis). There are some good CAA papers on the subject (www.caa.co.uk - look under publications for HOMP.

This process allows analysis of FDR info to determine the parameters used by the pilot during the flight. It has been used very effectively and without prejudicing the relationship between employer and pilot - read up on it. It's compelling stuff

G