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NTSB says EMS accident rate is too high

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Old 31st Dec 2011, 22:18
  #141 (permalink)  
 
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Statistics can explain almost any side of an argument. Many have mentioned the tempo of US HEMS operations. Unless you have lived within our system it is hard to grasp the magnitude of what actually transpires each and every day and evening. At AMC alone there is an aircraft airborne with a patient continuously 24/7. For the most part the decisions to transport do not reside with the aircrews but with hospital staff and first responders. It is kind of a, you call, and we haul system. As such, the final responsibility for the actual conduct of flight resides with the PIC. He or she is given a whopping 3-5 minutes to decide GO versus NOGO.
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Old 1st Jan 2012, 00:12
  #142 (permalink)  
 
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Has this, non fatal, accident been missed?
Helicopter Crashes Near Rock Springs - The Rocket-Miner

Helicopter Crashes Near Rock Springs

ROCK SPRINGS: No one was injured in a helicopter crash north of Rock Springs early Tuesday evening. At the scene, Sheriff Rich Haskell said Undersheriff Craig Jackson was on Yellowstone Road about 3 miles north of the city when he saw a helicopter circling west of the roadway around 6 p.m. He then observed the helicopter drop straight to the ground from a relatively low altitude.  Jackson investigated and found the craft to be a Guardian Flight helicopter with five people aboard, none of whom were patients. None were injured in the crash. Haskell said federal officials are being notified and will be in charge of the investigation. He said he planned on releasing additional information on Wednesday.
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Old 1st Jan 2012, 09:34
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Its not on the NTSB website. Thats one way to reduce the accident rate.
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Old 1st Jan 2012, 12:57
  #144 (permalink)  
 
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Rock Springs

http://www.faa.gov/data_research/acc...a/J_1214_N.txt

Passengers of downed helicopter identified - The Rocket-Miner

ROCK SPRINGS -- The pilot and passengers of the Guardian Flight helicopter that crashed near Rock Springs on Tuesday have been identified.

Sweetwater County Sheriff Rich Haskell said Calvin Cannon of Rock Springs, 45, was piloting the craft. Max Calnin, 28, Robert W. Moses, 58, Robert B. Moses, 33, and a 13-year-old boy Haskell declined to identify, were the passengers. A press release said none were patients and the flight was not believed to involve a medical transport.

Around 6 p.m. Tuesday, Undersheriff Craig Jackson was on Yellowstone Road about 3 miles north of Rock Springs when he saw the helicopter, a Bell 407, circling west of the roadway. He then observed the craft drop straight to the ground from a relatively low altitude.

No one was reported injured. A range of emergency services providers responded to the crash, including the Sweetwater County Sheriff's Office, Sweetwater County Fire District No. 1, Wyoming Highway Patrol, Sweetwater Medics and Sweetwater County Search & Rescue.

Haskell said investigators from the Federal Aviation Administration and National Transportation Safety Board are en route to Rock Springs to begin their investigation. Meanwhile, county detectives and deputies are conducting a preliminary inquiry and gathering information to be submitted to federal authorities.


The flight was a non-HEMS
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Old 2nd Jan 2012, 13:12
  #145 (permalink)  
 
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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!
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Old 2nd Jan 2012, 14:34
  #146 (permalink)  
 
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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.
My highlights in the quote......where is it written that the mission statement for HEMS...Helicopter EMS...is to "SAVE" lives?

My intent is to throw out a challenge to anyone in the Helicopter EMS business who thinks their express reason for being is "SAVING" lives!

I would submit...that kind of mindset is what kills Helicopter EMS crews.

I also will accept that lives are saved by the application of professional skills, protocols, and use of hi-tech equipment in the provision of the service Helicopter EMS crews are there to provide....that being the provision of safe, timely, efficient medical transportation of injured, ill, or hospitalized people.

Am I the only one who thinks that way?

Taken from the Air Methods Web site.....again...high lighting is mine.

Air Methods' mission is to provide safe, professional air medical transportation services, products, and systems with the highest level of quality and integrity. We are dedicated to providing excellent service to our customers, a fulfilling work environment for our staff, responsible membership in the medical aviation community and a reasonable return on capital to ensure long-term economic viability and healthy growth.

Last edited by SASless; 2nd Jan 2012 at 17:05.
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Old 2nd Jan 2012, 16:41
  #147 (permalink)  
 
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SASless

Well if your only comment on my post is quibbling with my use of the term "saving lives" do I take it that you are broadly in agreement with the rest of it?

By saying "saving lives" I did not mean that was the only justification for use of HEMS. Other valid reasons would include for example improving the prognosis post serious injury and reducing expensive hospitalisation. Or, for those paying themselves and not by other's taxes, simply having a faster more comfortable transfer to hospital.

The vastly higher cost of HEMS compared with road ambulances certainly needs compelling justification if it is to be paid for by the public and not the end user. And of course making a significant contribution to the saving of lives must be a major reason.

To say that HEMS crews who believe they are saving lives are a liability to themselves is one of the most ridiculous things I've read! Many people have to work professionally knowing their services could influence life or death - just ask the SAR boys or surgeons, for example. I'm sure Crab feels quite able to rescue people and save lives without taking silly risks!
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Old 2nd Jan 2012, 17:11
  #148 (permalink)  
 
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Rotorspeed,

I have yet to see such a well balanced post such as yours on this forum.Typically, it is a US Vs Europe discussion, with both sides defending their point of view vociferously.So, well done and thank you.
I am afraid that statistics you ask for probably do not exist.I think that is intentional. Most operators would like the status quo to persist.In fact, a Chief Pilot of a major EMS company is on record stating that twins/IFR capable helicopters don't necessarily enhance safety and cost way more to operate than the revenue they generate.Lawmakers who want to fix things are in the grip of lobbyist and the lobbyists work for the operators,not the patients or the folks generating the revenue.And so, the drumbeat carries on-----.
But, as a current EMS pilot, I will endorse what SAS less says.Right from the very beginning of an EMS career ,we are indoctrinated to beleive that we are NOT in the life saving business.We are not SAR.We are transportation on demand. It just so happens that the folks we transport are in need of medical help.Since most pilots are human enough to be pressurized into thinking otherwise, policies have been put inot place to take the emotion out of the picture. Ultimately, it is the pilot himself who has to make the call.If he puts that additional "white knight syndrome" pressure on himself, he will be guaranteed to make decisions that put people at risk.
Alt3.
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Old 2nd Jan 2012, 17:13
  #149 (permalink)  
 
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rotorspeed,

I very much agree with your post....in content, tone, message, and style.

The "Life Saving" mentality I refer to is the unhealthy one...the one where when the Tone goes on the pagers...the "Type A's" charge forth to challenge Death and steal victims from the Grim Reaper....no matter the risk to themselves as after all...they are "Heroes" when they smack ol' Mother Earth at near Warp Speed one dark night in really ugly weather.

That excludes a great number of folks who are quite professional...dedicated to serving their fellow Man the best they can but in a logical, professional, safe manner.

Anyone experienced in the Helicopter EMS business knows exactly what kind of folks I am talking about.

As Alouette correctly states....the aviation folks tend to be more in tune with the mission statement than the medical crews riding in the back of the cab. Granted they are far more exposed to the part of the task that would give them that feeling while the Flight crew(s) are more removed from the hands on part of the medical mission.

You want to become very unpopular amongst medical folks....publically state that position and find out how quickly your stock falls with the med crew! Far more than a few pilots learned that the hard way....and once the Med Crew decides to run you off....you might as well pack your bags because the Operator shall invariably put the contract far above standing behind the pilot. (Unless there has been some Lightning strikes I have not heard about!)
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Old 2nd Jan 2012, 18:08
  #150 (permalink)  
 
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I would also imagine that pro rata, the US accident rate seems higher because they fly inexorabily more ems trips than the europeans. Add to this the American way of doing things (which is not right nor wrong, simply "different");
then it might be that their safety record is on a par.
I simply find that the accidents - when they do happen, seem to be easily avoidable
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Old 2nd Jan 2012, 18:43
  #151 (permalink)  
 
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Some fairly recent IHST statistics.....

http://www.ihst.org/portals/54/ihss/...1_Overview.pdf
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Old 2nd Jan 2012, 20:11
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There are controlled studies on secondary transfers. They reduce mortality by 50%. Primary missions suffer from very little published data but what there is suggests a system crewed by doctors prevent death in serious head injuries only. So it is true they don't in general save lives.

It is not the same as being a surgeon. As a surgeon I can do anything within the limits of my equipment without any consideration except for my patient. As a pilot the need is for me to not use my equipment because of the addition of weather.

When I started in the US I actually had an experienced Nam pilot respond to my flight request with 'Nope not with this weather......is it serious?'

As a result my system has always operated a Chinese wall where the pilots don't know the medical indication and the medical crew don't know the met. And if one of my doctors even jokingly criticised a pilot he would be fired on the spot.

Sadly in the US some doctors still believe they are god although in fairness the driving force for helicopters is not the medical profession but the finance directors of the hospitals who need the ability to get high revenue patients in adequate numbers to fund regional services
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Old 2nd Jan 2012, 21:16
  #153 (permalink)  
 
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Alouette3

Thanks for your comments. I certainly have respect for both US and European operations, and constructive debate may benefit both, long term. Your comments ref statistics - or lack of them - in the US don't surprise me!

SASless

Pleased we are converging on a common understanding of the issues here.

And both; I respect your comments ref pressure on some pilots if they are too focussed on the life saving element. It would be nice to think they would be professional enough not to be influenced, but alouette3 at least is at the coal face and SASless has loads of experience, so I'll take your points. I guess with far less regulational constraint than in Europe there is more scope for subjective go/no go decisions and therefore opportunity for the overt Type As, as you say SAS, to sometimes take too big a risk to try and save a life.

Homonculus; no big deal, but I still think the surgeon parallel has some relevance. There can still be pressures to expedite procedures to minimise operation duration. Having said that, the presentation of error is not as dramatic as a helo accident, I grant you!
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Old 2nd Jan 2012, 22:19
  #154 (permalink)  
 
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The Rock Springs accident was not HEMS.... there is more than meets the eye to this... from another site:

In one of the early articles on the crash an online newspaper, Rocketminer.com listed the names of the people onboard (excluding a 13 year old boy).

Doing a FAA database search of those names shows that the man who the police listed as "piloting the craft" only had a mechanic's A&P ratings - no pilot certificate. One other guy onboard matched a name in the database for an older guy (age 58) who had a private rotorcraft certificate but whose current "FAA-address" is in Miami. The name of another man (age 28) also does show up. He lives in Denver and has a bunch of fixed-wing ratings (including ATP) - but no rotorcraft.

What the hell was going on here?! Did a non-rated mechanic have some friends/relatives who were fixed-wing pilots visiting and want to take them up and show them all the bells and whistles of their new helicopter? And did they go up with him under the assumption that he was rated?

No wonder the accident doesn't show up in the NTSB files yet. There may have been as many as two "real" pilots onboard (albeit not rotorcraft rated) in addition to the non-rated guy at the controls. The FAA is probably STILL sitting around trying to figure out who and how to violate over this one. But rest assured, violations are coming!

See for yourselves at the archived story:
Passengers of downed helicopter identified - The Rocket-Miner
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Old 2nd Jan 2012, 22:58
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Repetition & Boredom

I would like to begin by saying that this has been one of the best forum discussions I have participated in. More discussion groups like this consisting of professionals from around the world can and will effect change in the long term.

On another note, to follow up on SASless’ point concerning Life Saving Type “A” pilots, I believe that in many instances just the opposite may be a factor. Many operations here in the US have pilots that have been located in one position at one base for as long as 20 years. Boredom and complacency builds as veteran pilots routinely fly repetitive routes both day and night. As confidence builds, a pilot’s perceived ability to cope with more demanding conditions grow as well. This can lead to a point where an experienced pilot may back, he and his machine, into a corner.
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Old 2nd Jan 2012, 23:14
  #156 (permalink)  
 
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Gordy,

A bit of snooping and it appears the aircraft belongs to an outfit based in Salt Lake City but does business in Alaska. The few places I looked show no public record for the actual names of the owners or head of Ops. I did find some names of folks in the Dispatch Center.

The company maintains a web site for those that are interested.


I did find this facebook reference to Guardian Flight in Rock Springs.

https://www.facebook.com/note.php?no...81344665214562
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Old 3rd Jan 2012, 00:27
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Looks like Rock Springs will be interesting.

Talking of US data there was a study done by NYU and published in Aviation Psychology and Applied Human Factors that looked at 4,755 helicopter accidents (all types of operations) from the NTSB database. The researchers compared the underlying causes and also the factors that differentiate daytime and nighttime helicopter accidents.

The number of fatal accidents occurring at night was reported as significantly higher than during the daytime. The combination of night flights and adverse weather conditions is shown to be particularly fatal in accidents.

If it is economics that drives the use of singles it is a pity that a well equipped IFR certified machine means a twin, irrespective of the pros and cons of engine number. I may have missed it here but oddly lack of weather data is also commonly raised as a reason to stay low and fly VFR.

The NTSB meeting on HEMS IIRC threw up many issues with the US HEMS business model. Yet it does feel that many are arguing for the status quo of special VFR, or at least NVIS assisted VFR, for purely economic reasons. Yet there are indications that HEMS is being used in the US for cases that in Canada, Europe, Australia etc would not justify a helicopter (the Maryland State Trooper accident for example), surely a waste of resource that if addressed would allow improvements in equipment, training etc.
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Old 3rd Jan 2012, 18:42
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As this source states:

...since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions. And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.

The EMS Helicopter Industry's Business Model Leads to Unnecessary Crashes : Aviation Law Monitor


More on "Golden Hour" and Other Myths from the EMS Helicopter Industry explains:

The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.

"Golden Hour" and Other Myths from the EMS Helicopter Industry : Aviation Law Monitor
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Old 3rd Jan 2012, 19:38
  #159 (permalink)  
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...since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions.
There's no incentive in that equation for me to ever accept a flight. Eleven years, I've never had that decision questioned.
Take this to the bank, too: Crashes kill pilots, and in 43 years I've buried a fair few comrades. Kinda focuses my attention each and every time.

And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.
Ah yes, that nasty profit motive... You either believe in fairies or you don't.

More on "Golden Hour" and Other Myths from the EMS Helicopter Industry explains:

The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.
I'm not competent to discuss 'the need for EMS helicopters' or the 'Golden Hour", I'm just a pilot. I would guess that the on-scene medical professionals directly responsible for the call and the insurance companies and government agencies that bear the costs of EMS have a better perspective. And, more objective than the source cited by "Shell Management".

Last edited by Devil 49; 3rd Jan 2012 at 19:44. Reason: Redirect to the issue
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Old 3rd Jan 2012, 19:43
  #160 (permalink)  
 
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Best advice for dealing with SM....."Consider the Source...ad ignore the Coment!"
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