From a safety perspective, last year was not a good year for the air medical sector. A spate of fatal accidents has led to much media speculation about the safety record of U.S. air ambulances and even the medical benefits of using them so (apparently) freely. It has also further tarnished a deteriorating rate apparent in statistics from previous years.

At least 37 people died in 12 medical helicopter and airplane crashes in 2004, according to the NTSB. Only seven died in 2003. “We’re paying attention to this and it’s of extraordinary concern to the Board,” said NTSB chairman Ellen Engleman Conners.

As usual, few common factors are evident in the incidents. There are plenty of potential culprits–human factors, lack of instrument ratings or simulation training, aircraft not fitted with obstruction warning devices, too-low weather minimums, technical failures–but accidents happen as a result of a combination of factors. Throwing money at any one, or even all of them, will not cause the accident rate to fall magically to zero. There are risks inherent in flying aircraft close to the ground, especially if the pilots are not familiar with the terrain and responding to accidents related to bad weather.

It would seem worthwhile, therefore, to conduct a root-and-branch analysis of helicopter EMS accidents, to identify the chain of events leading up to them and propose intervention strategies that are both feasible and effective in removing (or at least minimizing) future risk. The process of risk analysis should refine solutions into categories, ranging from those that are relatively practical and valuable to carry out to those that are difficult to execute and of marginal worth.

The EMS community has already done just that and has published the findings. In April 2000, in response to a similar spike in the number of accidents during the previous three years, the industry convened a summit in Dallas to identify ways to prevent future accidents.

Organized by the Association of Air Medical Services (AAMS), the series of meetings was headed by Richard Wright Jr., then chairman of HAI, and attended by representatives from Sikorsky, air medical operators (such as Air Methods, Careflite and Omniflight) and organizations such as the National EMS Pilots Association (NEMSPA). The group formed the Air Medical Service Accident Analysis Team (Amsat).

Implementing the Recommendations
Unfortunately, AIN was unable to identify any organizations that have formally embraced Amsat’s strategies (see sidebar) since their publication. HAI president Roy Resavage, AAMS president Tom Judge (also executive director of Lifeflight of Maine), Air Methods senior vice president Neil Hughes and summit chairman Dick Wright all used the same phrase in conceding to AIN that the document was “probably gathering dust on a shelf somewhere.”

That’s not to say that nothing has been done. Many operators– especially the larger ones that now make up 75 percent of U.S.-based air medical programs–have enhanced their training programs and installed radar altimeters.

The FAA is also in on the act. A draft notice instructs its operations inspectors to “request helicopter EMS operators to review their pilots’ and mechanics’ decision-making skills, procedural adherence, crew resource management and professionalism.” It also “encourages helicopter EMS operators to promote and maintain pilot ‘soft skills’ as the first line of defense–and sometimes the last–against accidents caused by lapses in human performance.”

But these changes are not nearly enough to deflect the wave of criticism that would come the industry’s way should the public learn that the industry had a chance to put its house in order five years ago–and failed to take it.

Judge was candid about the level of participation throughout the EMS community. He conceded that “Not enough has been done. It’s amazing to note the number of people who haven’t even read the report. We should have had more representation from the smaller operators and challenged the industry as a whole to adopt our recommendations.”

The FAA does not come out of this entirely blameless, either. According to Judge, the agency regularly “throws down the gauntlet” at the helicopter EMS industry with numerous proposals for regulating safety. However, “during its one and only meeting with industry, [this past] January, I brought up the fact that the study had been done under the auspices of the FAA’s ‘Safer Skies’ initiative. No one was aware of it. [Safer Skies more or less died out when the top representatives of the FAA, Mike Gallagher, and industry, Jack Olcott (of NBAA), retired at about the same time.] With my prompting, the FAA and AAMS have brushed the dust off and are now looking at the recommendations that came from this study.”

Safety Task Force
The FAA has formed a task force to address the problem and has held a public meeting with major operators, HAI, AAMS, the NTSB and NEMPSA. HAI was planning to meet with the agency at the end of last month to discuss the next step. The NTSB is also conducting an independent study, as are the CEOs of the helicopter EMS operators.

Judge said that the 2000 summit was not a total failure. “In addition to the study came the CEOs’ operators forum and particularly Amsac (air medical safety advisory council), which has attracted a lot of smaller operators and begun to share with its members the data it collects. But we are now under renewed scrutiny and there remains a great deal to be done. It requires concerted action,” he noted.

To restore credibility in the sector, observers note, Amsat’s work needs to be turned into a formal plan of action, suitably budgeted, scheduled and implemented. Interested parties need to be informed about the formal plan at all stages: when it is in place, when it is being implemented and when the process is complete.

Rolling out such a plan will present a significant challenge and will put a drain on industry resources, but it is only a matter of time before customers–and the communities they serve–begin to demand it.