Helicopter operators flying air medical operations have always had a keen interest in safety, but a spike in accident and fatality statistics in the last five years has intensified concern throughout the industry. Representatives from a number of helicopter EMS task forces gathered in Dallas recently to discuss procedures for improving the safety of their operations.

In the last five years U.S. helicopter operators have formed a number of task forces to establish common goals and procedures and advocate operational rather than mandated changes. The most effective coalition has been the Air Medical Service Accident Analysis Team (Amsat), founded five years ago by the Association of Air Medical Services (AAMS).

After an Amsat meeting at Addison Airport, FlightSafety International (FSI) hosted about 60 air medical operators at its Dallas/Fort Worth International Airport facility to discuss the industry’s safety future.

The meeting was the brainchild of Terry Palmer, an FSI fixed-wing instructor who saw the need for air medical operators to develop and agree on solutions.

While the annual accident and fatal accident numbers for EMS operators constitute a large proportion of rotary-wing accidents, they are only a fraction of the aviation-wide total. The FAA, however, favors developing and suggesting strategies specifically for EMS helicopter operations.

The agency has distributed to inspectors Notice 8000.293 (“Helicopter emergency medical services operation”), which outlines background, intervention strategies, action and tracking. In addition, the agency is expected to distribute an Advisory Circular on Air Medical Resource Management (AMRM) this month.

The number of air medical flights has doubled since 1990 and such missions now constitute a large percentage of total helicopter operations in the U.S., with 660 rotary-wing aircraft logging more than 300,000 flight hours annually, according to Matt Rigsby of the FAA’s Operational Safety Rotorcraft Standards Office.

But, he added, rising costs in the EMS market will probably influence spending on future equipment and personnel. “Single-engine IFR is where it’s headed,” he said.

With more equipment–specifically avionics–than ever, yet another new discipline has emerged: automation management. The distractions of multiple instruments and systems for navigation, communications and hazard warning have the potential to cause serious problems, said Larry Mattiello, president of Aero Insurance.

Another pitfall in air medical operations is that some EMS pilots exceed their own limits and safety parameters because of their perception that they must complete a mission at all costs. “We need to keep the pilots separate [from the medical personnel],” he emphasized.

Operational Changes

Mattiello, an HAI board member who is also active on the association’s safety and insurance committees, is a passionate–and often outspoken–supporter of training.

“You think training is expensive?” he asked the group. “Try an accident! Forget rates: talk about our goal as insurance professionals–accident prevention. If we don’t have to pay claims–great! If we’re wrong about [our risk judgment of] you, we will all share the cost.”

Mattiello emphasized that his industry’s support of simulator-based training, as well as an increased input of operational data from customers and manufacturers, will help accomplish accident-prevention goals.

“For example, we’re working hard so that every underwriter is promoting the use of night vision goggles (NVGs) by the time the 2006 HAI Convention is held here in Dallas,” he added.

Another group devoted to enhancing EMS safety is the Commission on Accreditation of Medical Transport Systems (CAMTS), a peer-review group created in the 1980s to improve both safety and patient care. The organization developed safety guidelines for its members, but it does not set standards, according to Eileen Frazer, a former EMS flight nurse and CAMTS executive director.

CAMTS’ guidelines give full weight to training all crewmembers–both aviation and medical–and set weather turndown limits. Currently there are 111 EMS services accredited in the voluntary self-policing program, which operators fund for three-year accreditation.

Improving the Helicopter EMS Safety Record

At the Dallas event, a roundtable session gave operators the opportunity to air their concerns and to propose some workable solutions. One topic of discussion was the difficulty of hiring and qualifying ex-military EMS pilots for single-engine or single-pilot operations because the pilots typically have a multi-engine, dual-pilot background.

Both large and small operators would like to decentralize training and hold some or all of the courses at their home base. Without recertification under FAA Part 142, a simulator must remain in one location, but FSI and others have indicated that at least part of a training course could go on the road.

Several operators pointed out that there is no simulator training available in the U.S. for Eurocopter products. FlightSafety answered that there must be cooperation between the training company and the manufacturer and suggested that much of the pressure must come from customers.

Action Items

Before the group adjourned, it drew up battle plans and appointed a 12-member working group (at www.airmed safety.com) that will communicate what attendees determined to be the important action items:

• disseminate information through Amsat;

• develop tools to increase the quality of pilots and require EMS certification;

• investigate whether the FAA can certify sims and training universally rather than one program at a time;

• institute a risk-management checklist matrix: CAMTS, AMSAC (the Air Medical Safety Advisory Council) and the FAA;

• shift to human factors situational training;

• adapt training to fit current needs: automation, NVG, night, IMC and scenario-based; and

• stress single-pilot resource management.

“The suggestions were awesome,” Palmer said, “and everyone wants to do it again. FlightSafety has agreed to have this again next year and will host the Amsat meeting as well.”

In addition, she said the company is at work on EMS training programs specifically for pilots and/or medical personnel to fulfill the applications outlined in last month’s AMRM Advisory Circular.