Aviation Experts See 'Appalling' Spike in Helicopter Ambulance Crashes

[scubanurse]

Aviation Experts See ‘Appalling’ Spike in Helicopter Ambulance Crashes

By Jane Norman, CQ HealthBeat Associate Editor

Aviation safety experts at a House hearing on Wednesday slammed an “appalling” spike in crashes of helicopters delivering emergency medical services, and said the number of air ambulances has increased during the past few years due in part to higher reimbursement rates from Medicare for independent operators.

Between December 2007 and October 2008, there were 13 accidents involving medical helicopters resulting in 35 fatalities, according to a report by the aviation subcommittee staff of the House Committee on Transportation and Infrastructure. It was the greatest number of accidents in any 11-month period. Between 1998 and 2008, there were 146 accidents and 131 fatalities.

Air ambulances provide urgent care for victims of serious accidents or life-threatening events such as cardiac arrest or stroke, and also carry patients between hospitals. Often they fly at night and in difficult territory. While air ambulances can be fixed-wing aircraft or helicopters, about 74 percent are helicopters, according to a report presented at the hearing by the Government Accountability Office (GAO).

Gerald L. Dillingham, director of physical infrastructure issues for the GAO, said at the aviation subcommittee hearing that the air ambulance operations generally are either hospital-based or stand-alone commercial operations, but the big growth has been in the latter. In 2003, the first year data was available, the Association of Air Medical Services reported 545 helicopters in use, but that number grew to 840 by 2008, he said.

Dillingham said the growth in the number of stand-alone providers has spurred competition in some areas, and interviews by the GAO determined that the increase is linked to the development of a Medicare fee schedule for ambulance transports, “which has increased the potential for profit-making.” The fee schedule, mandated by Congress, was implemented gradually beginning in 2002. Since January 2006, 100 percent of payments for air ambulance services have been made under the fee schedule, he said, in contrast to partial payments in the past. Reimbursement is provided only if a patient is actually transported.

Robert Bass, testifying on behalf of the National Association of State Emergency Medical Services Officials, also linked the rise in the number of for-profit medical helicopters to the increase in Medicare reimbursements. “We began to see a shift from mostly nonprofit, hospital-based or government providers to for-profit operators of independently based helicopters, which then consolidated into large national or regional companies,” said Bass, who directs the emergency medical services system in Maryland. He said Texas now has 90 medical helicopters, while Pennsylvania has 62 and Florida has 61.

More helicopters is not always good — “in many cases it simply meant more helicopters on top of each other in an unregulated, competitive and potentially dangerous environment,” said Bass, posing a “significant” challenge to state EMS systems trying to integrate helicopter emergency services.

The National Transportation Safety Board (NTSB) held four days of hearings on medical helicopter safety earlier this year and board member Robert L. Sumwalt III told subcommittee members there have been an “alarming” and “appalling” number of fatalities. He said that “as a result of the lack of timely and appropriate action by the FAA,” the NTSB made four recommendations for action and added them to its “Most Wanted List of Transportation Safety Improvements” in October.

John M. Allen, director of flight standards service for the FAA, told subcommittee members that the agency has just initiated rulemaking to improve standards for operations of emergency medical helicopters, a process that likely won’t be concluded until 2011. The agency will seek to include a requirement that helicopters carry technology that alerts pilots to potential collisions with the ground or an obstacle, deemed an important development.

Allen said the agency has been successful with voluntary compliance as well. But witnesses at the subcommittee hearing disagreed over whether federal legislation also is needed to curb crashes, injuries and deaths.

The situation is complicated by the layers of regulation governing the operation of the medical helicopters, with the FAA overseeing air safety and states regulating provision of medical care, including the medical training and qualifications of the health professionals aboard medical helicopters. States cannot regulate air carrier routes, rates or services under airline deregulation laws.

Some states want a greater hand in helicopter regulation, arguing that states regulate ambulances on the ground and should in the air as well, said Subcommittee Chairman Jerry Costello, D-Ill. “I have concerns about allowing states to separately regulate helicopter EMS services,” he said.

Legislation has been introduced by Rep. Jason Altmire, D-Pa., (HR 978) that would allow state regulation beyond what’s currently permitted, including coordination of helicopter medical services as part of the state emergency medical services system and requirements for medically necessary equipment on board. “Patients are being harmed and put at risk every day by a broken air medical system that is supposed to protect them,” said Altmire, a member of the subcommittee.

But the bill met with resistance from the Air Medical Operators Association, which represents those who operate medical helicopters. Craig Yale, vice president of corporate development for Air Methods Corporation, said the bill would undermine federal aviation law without justification, and could limit access to air medical services. Yale said operators are committed to safety and members of his association must agree to meet safety standards under development by the association. The most significant change in the air medical industry in the last three years has been an increase in the use of night-vision goggles, he said, and that developed outside of any regulatory pressure.

Allen of the FAA and Christa Fornarotto, acting assistant secretary for aviation and international affairs at the Department of Transportation, also said in a joint statement that “the FAA does not believe that new safety legislation is needed at this time” because of the voluntary compliance and ongoing rulemaking. A second bill, HR 1201, introduced by Rep. John Salazar, D-Colo., would place additional requirements on operators and the FAA.

I don't have a link as this was sent to me in an e-mail sorry...

[VentMedic]

Sometimes it is hard to regulate stupid.

Night vision goggles unused after 4 years

Last updated on: 4/8/2009 6:40:03 PM by Kara Kenney

http://www.nbc2investigators.com/articles/...d=28034&z=5

LEE COUNTY: Lee County EMS spent $59,000 on night vision goggles that experts say reduce crashes and save lives, but NBC2 discovered despite purchasing the goggles four years ago, they are still setting on a shelf unused.

In a life or death emergency, Lee County's MEDSTAR can make the difference, but flying medical helicopters comes with a risk.

In 2008, 14 medical choppers crashed killing 28 people and injuring 9.

In the bulk of the accidents, the pilots were not wearing night vision goggles, equipment experts say reduces crashes.

Lee County MEDSTAR bought night vision goggles nearly four years ago.

According to invoices, they spent $23,056 on two pairs back in 2005.

Then in October 2008, they spent $35,845 to outfit the aircraft for the goggles.

That's a total of $59,000.

The goggles have never been used.

NBC2: You're still not using them. What has taken so long?

Rick O'Neal: It hasn't taken so long, it's a matter of perspective.

O'Neal is the manager of air operations for MEDSTAR. He says in 2005, Lee County had the money for the goggles, and they were available.

"That's why we bought the goggles when we did because the war in Iraq and Afghanistan was pulling all the night vision goggles. We knew we wouldn't be using them when we bought them. But we also knew that if we didn't buy them we may not be able to buy them in the future," said O'Neal.

And as for why they waited years to outfit the helicopter, O'Neal says the county had a hard time finding a company that could do the work.

"When we bought the goggles there was no one in the nation that could modify our aircraft-- so we knew we'd be waiting," said O'Neal.

We called the Federal Aviation Administration who told us Lee County hasn't even applied to use the goggles. FAA approval is required when transporting patients.

NBC2: Why haven't you applied to the FAA to use these goggles?

O'Neal: I don't know what you mean when you say apply to the FAA. Certainly we have talked with the FAA. The FAA is aware of this, and they're working with us daily.

To get FAA approval, the county has to submit a written plan on how they'll use them. The county says they have one, but wouldn't give us a copy.

NBC2: Why haven't you submitted it yet?

O'Neal: Because we haven't gotten everything together where we should be ready to submit it. There's a lot going on. I think we're right on schedule where we should be.

O'Neal points out MEDSTAR already has a night vision enhancement system which is similar to night vision goggles, except the camera and screen are fixed. That means pilots are limited in what they can see at night.

Lee County EMS says having both the night vision enhancement system and the goggles will keep patients safe.

"Combining the two is going to give us the ultimate in safety and that's our goal," said O'Neal.

We asked O'Neal if the purchase of the night vision goggles was a good use of tax dollars.

"Absolutely. It was the right purchase at the time and the right thing today," said O'Neal.

Lee County EMS estimates pilots will be using the night vision goggles within the next 6 months.

They bought 2 pairs in case one pair breaks during flight.

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This was just released:

HEMS: Industry Risk Profile

http://www.flightsafety.org/pdf/HEMS_Indus...isk_Profile.pdf

Edited April 22, 2009 by VentMedic