Since 1991 there have been 127 accidents involving helicopter emergency medical services (HEMS) operations, according to Helicopter Association International (HAI). Ninety-six of these were a direct result of pilot error, which can be broadly characterized as poor pilot technique; lack of situational awareness; loss of control; poor aeronautical decision-making; controlled flight into terrain, water or objects; or a combination of these.

As the number of accidents involving HEMS aircraft has increased in recent years, the industry has come under scrutiny from the FAA, the public and itself. Every accident involving a HEMS aircraft becomes headline news, particularly if fatalities are involved. Of the 127 accidents since 1991, 49 resulted in fatalities to 128 people.

“In actuality, more accidents in the helicopter community are experienced during personal flights, instructional flights or a host of other activities than during medical flights,” HAI emphasized. However, since the nature of HEMS operations is supposed to be the heroic saving of life, rather than the taking of life, they attract much attention when they come to grief.

[Regardless of HAI’s assertion that there are fewer fatal accidents in the HEMS sector than in other helicopter ops, according to statistics compiled by Robert E. Breiling Associates, turbine HEMS has a worse fatal accident rate per 100,000 hours than all other turbine helicopter ops combined, at 1.75 versus 1.18. –Ed.]

Of the accident total, 109 were caused by some failure in human factors, which includes not only pilot error but also improper maintenance or quality assurance, inadequate crew or ground coordination and perhaps inadequate supervision.

HAI has issued a “white paper” outlining its views on safety involving rotary-wing EMS operations. Titled “Improving Safety in Helicopter Emergency Medical Service (HEMS) Operations,” the paper represents what HAI calls “a balanced approach” to HEMS safety that serves the interests of the entire helicopter air medical industry while recognizing that HEMS operations are conducted under a variety of circumstances. The paper maintains that enhancing the safety of HEMS operations requires a multi-faceted approach adopted by the industry rather than regulated by the government.

HAI president Roy Resavage has encouraged all operators in the air medical industry to “use this white paper and other similar documents to review their current operations and institute the recommended program changes that are applicable to their specific environment and scope of activity.”

Since January, HAI, along with other representatives of the helicopter emergency medical services industry, has been working closely with an FAA internal HEMS task force exploring possible interventions to reduce accident rates.

As a result of the task force deliberations, and in conjunction with input from the industry, the FAA has issued two notices to POIs providing guidance for HEMS operations.

The first, Notice 8000.293, focused on reviewing pilot and mechanic decision-making skills, procedural adherence and crew resource management, along with numerous recommendations on training and equipage. The second, Notice 8000.301, encouraged the use of risk-assessment tools in HEMS operations and offered examples of industry-developed threat-ssessment tools. HAI has endorsed both of these notices.