NTSB says EMS accident rate is too high

[rotornut]

Board: Lives lost 'needlessly' in medical helicopter crashes - CNN.com

[Shawn Coyle]

Does that mean if you crash your EMS helicopter there may be a chance that it was not 'needless'?
Hard to show how you can crash and the crash be needed?
Sigh.

But in a more serious vein - they're right. Some of these crashes do raise the question of 'what are we trying to do?' and are we always doing it in a seriously professional way?

[WhirlwindIII]

Shawn

... "what are we trying to do" ...

Seriously, that has to be the ground zero question HEMS needs answered!

WIII

[MightyGem]

NTSB says EMS accident rate is too high

They should read Pprune. They would have found out ages ago.

[Furia]

I cannot agree more with the idea that the accident rate is TOO HIGH.
However on the article mentioned above they make too much enphasis on the use of NVG while we all know that the main cause of accidents in EMS either night or day is unintended flight into IMC conditions.

I believe that all pilost flying by night must have a current IFR ticket and if possible all HEMS ops during night time should be made with 2 pilots so if you encounter IMC condiions one of them that should be focusing on instruments all the flight should take control of the aircraft and inmediately gain altitude above the MSA of the area.

Helicopters for such operations must be fully IFR and must be adequately equiped with appropiate technology to lower the workload imposed on a HEMS crew flying by night and that encounters inadverted IMC conditions.

Operators must train regularly their crew to face the nightmare posibility of encountering IMC conditions by night at low leve and must make sure all crews are trained to transition safely into IFR.

Of course this also implies properly trained dispatchers that know what icing conditions are so no night flights are performed if marginal weather conditions are present along a low freezing level.


NVG are a very big help but will not navigate IFR through the clouds. They are better for obstacle avoidance and for take off and landing operations.
However the only way to avoid the too common accident involving inadverted IMC is a proper and safe transition to IFR.

[CYHeli]

Go - No Go

Would the ability to say "No." be the hardest thing in aviation?
I'm not an EMS pilot, but whether it is charter ops or EMS or airwork, saying "No, I'm not doing that." is the hardest thing, but it should happen.
I think it gets even harder when you fly all the way there and have a look and then make the decision, no it's not safe, time to go home.
We as pilots need to know that the boss/bean counters will support us when we are in the air and change our minds based on what we see, or can't see as the case may be.
It doesn't matter what the task is, we should be confident that the boss will respect our decisions.

The last time I felt safe saying "no" was when someone else booked a photo job for our R22. I turn up at the end of a 40 min ferry flight to find the photographer is 130 kilos! I said "No" and they had to find another photographer PDQ. They were told about weight issues and would still have had to pay for that ferry, but how often are we afraid to say "No."? And push on to get the job done.
All the best gear in the world will not overcome the fact we need to train management (and the client) that some times, some jobs are not going to happen.
And that's okay.

[JimL]

It is not correct to imply that nothing is being done.

Before effective action can be taken, it is first necessary to establish the root causes of the accidents. Once the causes have been established (and it is not as simple as it first appears), they can be addressed.

As will be seen, the causes will be many and varied; there will be clusters and trends, and this is where systematic measures will have the best chance of success (single accident mitigation achieves only a 'sticking-plaster'/'band-aid' effect).

Here is an extract from the latest IHST Newsletter:

http://ihst.org/images/stories/docum...wsletter-3.pdf

The OSI-HEMS Team
By Ira Blumen
“Opportunities for Safety Improvement in Helicopter EMS”

(OSI-HEMS) is a research project that has brought together aviation and medical experts to undertake the most comprehensive review of U.S. HEMS accidents to date. A root cause analysis is being conducted on an estimated 120 HEMS accidents dating back to 1998. Through this research and analysis, concrete recommendations will be made to compare the potential benefits, cost, effectiveness and feasibility of various factors that can prevent HEMS accidents or reduce the impact of accidents.

Key to the experimental design and analysis of our data (the HEMS accidents) is the scope, strength and experience of the research team that has come together. Bringing together such a team was one of the goals established by theoriginal core group that set out to develop this project. It was concluded that the best way to attract the support, knowledge and expertise that we needed to undertake and complete this research was to invite participation from throughout the air medical community. Air medical associations, aviation operators and manufactures were approached and the response was overwhelming. Our research team has now expanded to over 40 aviation and air medical professionals, with an average of 25 individuals present at each meeting. Our team currently represents:

Associations
- Air & Surface Transport Nurses Assoc (ASTNA)
- Air Medical Physician Assoc (AMPA)
- Air Medical Safety Advisory Committee (AMSAC)
- American Assoc for Respiratory Care (AARC)
- Assoc of Air Medical Services (AAMS)
- Commission on Accreditation of Medical Transport Services (CAMTS)
- Helicopter Assoc International (HAI)
- International Assoc of Flight Paramedics (IAFP)
- National Assoc of Air Medical Communication Specialists (NAACS)
- National EMS Pilots Assoc (NEMSPA)

Helicopter operators (currently 10 different 135 certificate holders)
- Air Evac Lifeteam
- Air Methods Corporation
- CareFlite (Dallas/Fort Worth)
- EraMed
- Intermountain Life Flight
- Med-Trans Corporation
- Metro Aviation
- Omniflight Helicopter, Inc
- PHI Air Medical
- REACH

Manufacturers
- Bell Helicopter
- American Eurocopter
- Turbomeca USA
-Federal Aviation Administration Aviation training
- FlightSafety International Aviation insurance- AirSure Limited

Members of the research group first met in early 2007 and the first “working” team meeting took place in January 2008. We anticipate continuing our work through the summer of 2009.

Editors note: due to recent events in the HEMS community, the IHST will be working with Dr. Ira Blumen, a well known HEMS accident analyst. His team is using a process similar to that developed by the US JHSAT team. The IHST plans to use the recommendations developed by Ira's team to form a HEMS specific implementation team late in 2009.

Jim

[Devil 49]

Yes, too many accidents in US EMS. Would somebody please post a US EMS accident rate? I suspect there is no sound statistical means to assess our accident rate, and I'm convinced that were there such it would be heavy on pilot error.
It's not a single/twin issue, you don't have to go very far into the history to see twins involved.
It's not a VFR/IFR issue, see previous.
It is a day/night issue- NVGs and scheduling.
It's a training issue, night training especially.
It's a managerial issue: all give safety lip-service, but often fail when the almighty dollar becomes an issue.
It's a regulatory issue. EMS is not just 'unscheduled fly-for-hire', and that is obvious to everybody flying the line. There are industry specific Parts for Ag and External work- EMS needs one too.
Finally- I'm coming around to the conviction that this is a single-pilot issue above all else. Pilots who can do this well by themselves are a minority and the safety advantages of a 2-pilot crew are inarguable.

[hostile]

Now whole case seems much better. Hopefully, and I am sure that OSI-HEMS team take care of this with good results. Good thing is that all parties are involved. Wishing them all best.

Mean while, fly safely out there.

Hostile

[alouette3]

Devil 49 et.al.
Agree that there should be a separate part for the industry. I have a sneaky feeling in the gut that if somebody with a super computer were instantly able to compare Part 135 Fixed Wing ops.(Freight, Charter,etc.) with Fixed Wing EMS ops. the crashes in the latter would exceed those in the former.
Maybe it is just an EMS issue-----.
Alt3.

[maxvne]

NTSB should insist on more experience and training for US EMS operators and crew to help stop these needless accidents

[The Nr Fairy]

NTSB can't insist - my understanding is their role is the same as that of our own AAIB in that they investigate, make findings and can make safety recommendations.

Only the FAA can regulate but, if the point you're trying to make is that the act needs cleaning up, then if the industry gets in there first with a proper "code of conduct" including equipment, training and flight decision criteria - which overrides commercial interest, then they're ahead of the game. However, the words "commercial interest" are the killer

[helisteve]

How about raising the night VFR min and doing away with the "competition" model for ems work

[slgrossman]

I think everyone here has identified a bit of the solution. The difficult part is implementing it in an environment that's governed almost solely by profit. On the one hand we want to make transport by HEMS safer, while on the other, we are reluctant to regulate someone out of business.

There are business models that work well in terms of profit, and there are those that work well in terms of safety. Occasionally, they are found in the same operation. But by the same token, the absence of accidents does not necessarily imply the presence of safety.

For years we've attempted to solve the problem with incremental measures, focusing on the proximate cause of the latest accident. It's time to look at broader solutions from a "systems" perspective.

Starting from the top:

1. How do we determine that a program is necessary in the first place? Will the community really be better served or is this just a business opportunity? Perhaps the "certificate of need" process needs to be more realistic.

2. How do we fund the service? Does the call volume directly affect the program's survivability? Is there pressure (real or perceived) to keep the "numbers" up?

3. Are the aircraft and crews equipped and trained to be able to surmount the challenges of the operating environment right up to the point of clearly defined mission abort criteria? Once a mission reaches an abort criterion is there a safe alternative?

4. Is the program staffed sufficiently and scheduled properly so as to prevent fatigue-related deficiencies in performance and judgement?

For years we've left it to the operators to make these decisions. Isn't it funny how they can always find a way to justify their operation, in spite of common sense. I think increased government regulation in these areas is the only measure that will ultimately produce an improvement in the the safety record of the HEMS industry.

-Stan-

[widgeon]

model time regime fatal cause
bell 206 day departure 3 wire ?.
bell 407 day approach 4 mid air
bell 407 day approach 3 mid air
bell 407 night en route 4 cfit ?
ec 135 night en route 3 cfit ?
as 350 night approach 3 water
bk 117 day en route 4 water
bell 206 night at scene 3 mech failure
27

others in same period 32

From NTSB site total Helicopter incidents year ending oct 11.
26 occurances , 8 EMS .

If you filter out turbine accidents only 8 of 11 turbine fatal accidents were EMS. And 100% of twin.

Aviation Query Results Page

[WhirlwindIII]

Lot of good replies.

As to root cause analysis that is something that should have been ongoing such that we don't have years of delay while a few folks fiddle with stats to come up with some sort of conclusion/s, which may or may not have any implementable elements.

My frustration is that Common Sense has taken a back seat to what can be done right now - such as requiring all EMS pilots to at least gain and maintain 135.297 IFR status, irrespective of the helicopter they fly, so they might have the confidence to climb in to the weather when required in order to avoid dangerous CFIT situations.

[Jackonicko]

So are we saying that the problem is systemic, that the interests of safety have been overridden by commercial concerns for too long, and that the HEMS industry remains too governed by profit?

Are some HEMS programmes really established more to generate profit than to serve a real need in the community?

Do funding arrangements rely too heavily on call volumes, putting too much emphasis on operators to ‘keep the numbers up’, and on pilots to press on (perhaps into deteriorating conditions) and to avoid mission aborts?

Is there sufficient incentive for operators to train crews to the best possible standard, to acquire the most suitable aircraft, and to equip them properly?

Are the HEMS programmes adequately resourced to ensure proper engineering, and to avoid the inevitable penalties that arise when crews are over-worked, over-stretched or simply tired?

[Devil 49]

Yes, I think systemic failure is an accurate assessment of fault.

Starting at the top of the ladder, the FAA believes that EMS is just another helicopter charter. It isn't. To get the helicopter EMS job you have to have significant night experience, which most Part 135 operations avoid. Example- In 13 years in the Gulf of Mexico, I did 2 night flights as a VFR pilot, and the company tried to avoid those two flights. Night flight just isn't commonplace air taxi operation, not to mention 24/7 operations.
Often, air taxi's allowed to "take a look" and/or land short of destination. That was a mixed blessing, in that I learned weather very well as an air taxi pilot by flying into it at minimums well below my present weather minimums. Most EMS operations want to be reasonably certain of getting the patient to the receiving hospital, so "taking a look" doesn't happen.
On the subject of nights and regulations, it's stupid to pretend that "10 hours of uninterrupted rest" adequately addresses the pilot's condition going from a day assignment to a night shift. Yet, it's not uncommon (and perfectly legal) for a pilot to work a day shift, sign out at 2000 hours, take 24 hours off, and sign in the next night at 2000 hours. That's a major sleep and circadian disruption, it's well known that that affects mentation- and it's not addressed in training, policy or regulation.

EMS companies generally don't exceed the letter of the law. They act in the real world of 'profit equals existence'. If you don't make money, you don't exist for very long. The industry does pretty well within those limits, with these exceptions:
Scheduling, scheduling, scheduling!;
NVGs are decades over-due;
And training is done on the cheap and treated as a necessary evil, mandated by government. The training department can be a major asset in driving quality and safety, but not when it's scattershot by a very few overworked pilots, and especially not when done by 'management' types intent on enforcing the 'book' and all it's failings.

Pilots aren't blameless in any of this.

[Gomer Pylot]

As stated above, the NTSB has no regulatory power of any kind. They just investigate accidents and make recommendations, which the rest of the world is free to ignore, and generally does.

The FAA has been very reluctant to regulate operators - see the Eclipse soap opera, detailed in the current issue of AIN. HEMS in the US is a commercial operation, and few officials are ready to use socialist-seeming regulation to force anything on the operators. In the US, anyone with some capital is free to try to make more by any legal, or even illegal, means, and if someone gets hurt or killed, that's regrettable, but just part of the cost of doing business. I don't expect much regulation in the short term, and perhaps more deregulation, especially if the Republicans can maintain their current Congressional seats and McCain can manage to win. McCain has historically been hell-bent on deregulation, especially for the industries he's been paid to help. A little bribery goes a long way with politicians, and it's totally legal in the US, as long as you call it a campaign donation.

If the Democrats win big, there might be some tightening of the rules, but I don't foresee all that much, because they can be bought just like any other politicians, and we have the best government money can buy.

[busdriver02]

I don't think the crew rest issue mentioned above has much to do with it.

I do think NVGs would help, I sure as hell am not comfortable flying without them at night to an unimproved LZ.

But if the presumption that inadvertent IMC is the real killer, I think flying dual pilot would probably be the most expediant "fix."

Why am I so inclined to buy that answer? Well everyone I fly with is fully instrument capable, the aircraft I fly is a very good IFR platform, and I still cringe at having to fly in the weather. I don't do it very often, and I imagine most helo drivers don't do it very often, even when rated to do so. I'm ok with having to do it, mainly because if I'm the pilot on the controls, I can focus on just flying, while the non-flying pilot does all the "thinking."