Just one more but this is a really good article.

[Just Plain Ruff]

EMS Helicopter crashes. This is a great article. Might just make us re-evaluate the general use of helicopters for transporting. This article has far reaching consequences and may lead to a revamping of when to call a helicopter.

http://www.alea.org/public/safety/files/20...ident_Study.pdf

[Ridryder 911]

First, yes there are too many crashes and deaths. Second, one needs to be aware of what FAA interprets and defines what "crashes" and "incidents" etc.. You might be surprised what a crash is defined as.

I have to admit, it is a cut throat business. Very competitive and most of the time not nice to each other, except when one crashes or tragedy occurs. This business, is very costly and the pressure to fly in unsafe conditions is sometimes pressured to the pilots and crews. I was fortunate, we had a vote on every mission.. anyone had any ill feeling or uneasiness, the mission was scrubbed.... period. No questions, or harassment was to occur. The same as the pilot was never given details of the dispatch (such as infant, child or mother.. etc..) to persuade the pilot or crew to take the mission.

Air EMS is over abused, and with the increase in ground responses, and less number of EMS units responding in urban and rural areas, I believe you will see more. This decreases the "out of town" truck, and the patient is delivered to the metro area in about half the time. However; I realize, that this study as well as Medicare and insurance companies are evaluating the necessity and payment structure along with this.

Time will tell.. we will see some major changes in the future regarding the need and use of air transport, respectively so.

[whit72]

They are a life saver for us ......well for the pt. We have a pretty bad stretch of highway that runs thru are city. On occasion we have called them a couple times a week. They are wonderful, professional, and always ready to answer any questions we might have. I do agree though that sometimes it seems as if some crews will fly in conditions where others wont. Sometimes its a toss up as to whether they are flying or not. They have actually asked if we would like to do a ride along someday. Great people. Its sad when you here of these crashes. Are their guidelines they follow or is it totally up to the crew, as to when they fly?

[flight-lp]

It is completely up to the crew. The old saying rings true, "three to go, one to say no!", meaning that any one crew member can say no and that is that, period, they do not fly. I actually didn't read the study itself, the conclusion said it all, further statistics over the upcoming year will be needed to see a change in trend or associated aspects that decrease or increase accidents. Personally, I think people who have no clue about aviation, i.e. doctors and medical researchers, need to remain out of the realm of accident statistics. The NTSB and FAA do a fine job of telling us what we do wrong! I think that time will tell, many programs will go under over next couple of years, especially with further state and federal medical cutbacks. I think only programs who watch their bottom line and operate with financial efficiency will survive. Again, time will tell.........

[TerrfyinFlyinSrvc]

Great article. While I'm new to EMS, I've spent a lot of time around aircraft/airports.

#23% had fewer than 100 hours in the type of aircraft flown.

That surprised me. Time in type is a big crash factor across all of aviation. A lot more IMC sim time would probably help considerably. The full-motion simulators can give you years worth of experience in a few weeks and simulate conditions no one could fly in and live through.

#Most EMS helicopters have a single pilot.

Darkness is tough enough. Single pilot IMC is a tremendous workload under the best of situations. In an EMS situation, you are really asking the pilot to be a 5 handed monkey.

Night vision would help, but these also can have issues.

#Thirty-three crashes (19%) involved post-crash fire; 76% of these 33 crashes were fatal.

Better tanks needed. Also there is a lot of research going on for less volatile fuel. Also better cabins. Energy absorption in aircraft has come a long way. Gear should be strapped down to at least a 20g limit before it comes loose.

Something they didn't touch on is better selection of landing sites. This might help some.

Additionally, light discipline on the ground needs to be rigorously enforced, esp at night and in IMC. Any lights not being used to mark the lz should be extinguished. Esp light-bars and spotlights. Big vertigo factors there.

Just my 2 cents, neal

[Ridryder 911]

Yeah, like Pilots really care what a Doc says, when it comes to their livelihood. There is already sometimes friction between med crews and the pilot. Now this.

I do agree this needs to be VERY closely monitored, and yes, there is a ton of abuse going on, as well as flight services "popping up" every where. I know in my state alone we went from 3 five years ago to 9 or 10 now. It sometimes like vultures overhead, to see who gets the next flight...

R/r 911

[kevkei]

Our system here utilizes a pilot and a co-pilot. No if's, and's or butts.

[flight-lp]

Great article. While I'm new to EMS, I've spent a lot of time around aircraft/airports.

#23% had fewer than 100 hours in the type of aircraft flown.

That surprised me. Time in type is a big crash factor across all of aviation. A lot more IMC sim time would probably help considerably. The full-motion simulators can give you years worth of experience in a few weeks and simulate conditions no one could fly in and live through.

#Most EMS helicopters have a single pilot.

Darkness is tough enough. Single pilot IMC is a tremendous workload under the best of situations. In an EMS situation, you are really asking the pilot to be a 5 handed monkey.

Night vision would help, but these also can have issues.

#Thirty-three crashes (19%) involved post-crash fire; 76% of these 33 crashes were fatal.

Better tanks needed. Also there is a lot of research going on for less volatile fuel. Also better cabins. Energy absorption in aircraft has come a long way. Gear should be strapped down to at least a 20g limit before it comes loose.

Something they didn't touch on is better selection of landing sites. This might help some.

Additionally, light discipline on the ground needs to be rigorously enforced, esp at night and in IMC. Any lights not being used to mark the lz should be extinguished. Esp light-bars and spotlights. Big vertigo factors there.

Just my 2 cents, neal

Most services are single pilot VMC services. IMC + HEMS = bad outcome. Personally, I do not believe that any service should be flying in night IMC, much less with a single pilot. If the visibility is reduced, there is a reason why, usually associated with weather that is not condusive with the aerodynamics of flight. Plus if the minimums are below a companies VMC standards, then IFR capabilities aren't going to help much with scene flights or interfacility flights into smaller hospitals that lack an instrument approach. The only place it is remotely helpful is at your larger medical facilities that do have a published FAA approved non-precision approach. Then you run into the problem of having your heliport on top of a hospital. If your hospital helipad is 400 feet above the ground and your instrument approach calls for 800 feet minimum ceiling, then you have to have 1200 feet of visibility from the ground which is HIGHER than required for VFR flight. It makes no sense what so ever and will not improve the core safety issue associated with HEMS crashes.....

[TerrfyinFlyinSrvc]

Most services are single pilot VMC services. IMC + HEMS = bad outcome. Personally, I do not believe that any service should be flying in night IMC, much less with a single pilot. If the visibility is reduced, there is a reason why, usually associated with weather that is not condusive with the aerodynamics of flight. Plus if the minimums are below a companies VMC standards, then IFR capabilities aren't going to help much with scene flights or interfacility flights into smaller hospitals that lack an instrument approach. The only place it is remotely helpful is at your larger medical facilities that do have a published FAA approved non-precision approach. Then you run into the problem of having your heliport on top of a hospital. If your hospital helipad is 400 feet above the ground and your instrument approach calls for 800 feet minimum ceiling, then you have to have 1200 feet of visibility from the ground which is HIGHER than required for VFR flight. It makes no sense what so ever and will not improve the core safety issue associated with HEMS crashes.....

You raise some great points. Besides the economic factors, I think the improved avionics, egps, taws, etc is driving some of the risk taking. Some of the gear can seem so smart, you start to fly stupid. Additionally, I think there is a tendency for the crew to push the limits a bit, just because of mindset. If the phone be ringin', somebody be needin'.

"Helicopter EMS programs could benefit from decision protocols such as that used by the Coast Guard, in which high-risk flights require command endorsement, a role that could be met by a helicopter EMS safety officer"

The Coast Guard idea ain't bad (although those guys fly in weather that'd find me huddled in the basement corner). But the helicopter EMS safety officer gotta be a guy who can say "we no fly" with absolute economic impunity. The crew can still say "no go" and it sticks. But also if the SO says "no go", then its no go even if the crew wants to go.

"I think only programs who watch their bottom line and operate with financial efficiency will survive."

That is a fact. The money that you have to spend to fly both legally and safely makes an addiction to strippers and crack look like a prudent investment strategy.

"It makes no sense what so ever and will not improve the core safety issue associated with HEMS crashes."

Since you are at the sharp end of the stick, I'd really like to hear yr thoughts on yr biggest safety concerns and the biggest changes you'd make if you could. In fact, I like to hear from any flying ems folks.

neal

[flight-lp]

Well, human error is the culprit over 90% of the time, usually from over stretching either the aircrafts ability, the weather, or a combination of both. Rarely is it a non human catastrophic event. Bottom line is people need to put emotion aside and think a little clearer. I do not care how sick or injured someone is, if the weather is not condusive for air operations, we do not go PERIOD! Ground EMS will have to improvise, adapt, and overcome. One dead or dying person does not justify the increased risk of 3 others joining him because they made a bad decision to fly in bad weather. I value my life and will not end it voluntarily to attempt to save someone elses when there are other medical options available. They may not be as good as the optimal level of care, but its better than killing another HEMS crew and adding one more mark to the NTSB statistics. If more people had this mentality, then I believe the statistics will improve.........

Other improvement items would include an increase in the use of risk assessments, updated weather observation capabilities for remote area, and continued crew resource training..................