EMS Helicopter Safety: First, Do No Harm
By Scott Spangler on February 26th, 2009A confirmed rotorhead, I recently invested some unexpected free time looking into the NTSB’s public hearing on Safety of Helicopter Emergency Medical Services (HEMS) Operations. I didn’t have the time to watch four days of video available, so I settled for the executive summary in the NTSB’s Special Investigation Report on Emergency Medical Services Operations, which includes four safety recommendations.
Now at the top of its Most Wanted List of Transportation Safety Improvements, what attracted the NTSB’s attention were the 41 HEMS crashes, 16 of them with fatal consequences, between January 2002 and January 2005. The report said HEMS flight time grew from 162,000 hours in 1991 to an estimated 300,000 hours in 2005. And so did the accident rate, from 3.53 accidents per 100K to 4.56. Last year was the worst on record. Four of the 35 fatalities perished when an independent medevac helo hit a guy wire on a 734-foot radio tower near Aurora, Illinois, one VFR night last October. The patient was 13 months old. The company suffered its first fatal accident in 2003, and this one put it out of business.
The NTSB report never said it directly, but I inferred that the medevac pilots were seen as cowboys, riding to the rescue on rotary wings no matter what. Or maybe I’m oversensitive and took the NTSB’s four recommendations the wrong way. What do you think? 1. Conduct all medical flights in accordance with Part 135 regulations. 2. Develop and implement flight risk evaluation programs. 3. Require formalized dispatch and flight following procedures that include current weather. 4. Require terrain awareness and warning systems (TAWS) on all EMS helicopters.
To get some perspective, I called the local air medicine program, ThedaStar, which is just up the road at Theda Clark Medical Center in Menasha. There I met Flight Nurse Pam Hillen, who’s been flying ThedaStar since it first took wing in 1986, and Ron Ries, a high-time pilot who launched his helo career with the Army and still flies Blackhawks for the Guard. Making it clear that they could only speak for how ThedaStar operates, Hillen said the patient’s condition is not a factor in the go/no-go decision. Why? The first rule of medicine, she said, is “First, do no harm.” Last year ThedaStar flew 498 patient missions, and didn’t launch on another 300, mostly because of weather.
Theda Clark owns its helicopter, a Eurocopter EC 135, and the staff of eight, six flight nurses and two flight paramedics, work for the hospital. In rotating 24-hour shifts, two of them are on duty 24/7/365. The four pilots, who work 12-hour shifts, and two mechanics, seven on and seven off, all work for PHI Air Medical, which holds the hospital’s operational contract.
To fly, all members of the crew, the single pilot and two flight nurses, must give the thumbs up. One no-go scrubs the mission. But this comes after the pilot complies with PHI Air Medical’s Enhanced Operational Control (EOC) program. The foundation is online, a screen that lists all the PHI Air Medical operations. If the box is green, conditions are good to go. Yellow, call the EOC, and Red, stay put. Just a few clicks provides the pilot different layers of detailed information.
One component is the EOC risk assessment matrix, which assigns numeric values to static risks like aircraft equipment and crew currency, and dynamic risks like weather, airspace, destination terrain, and time of day. If the total is 10 or less, they are good to go. If it’s 16 or higher, it’s an automatic no-go.
When the score is between 11 and 15, the pilot calls the EOC command center to discuss the flight, Ries said. At the center senior EMS pilots continually update the weather that’s fed online to their single-pilot operations at hospitals nationwide. The EOC guys are good, too, Ries said. Just last week they turned down a flight on a perfect full-moon night, because the EOC learned that fog was drifting toward and around the accident site.
Anyway you look at it, said Ries, “I’m spoiled.” He flies VFR Part 135 in a helicopter equipped (including weather radar and radar altimeters) for IFR. Flying to a scene, one of the nurses rides left seat as another set of eyes. At night, both wear night vision goggles, which PHI added to the crew equipment last year. And they have the new ANVIS-9 goggles, which he likes better than the ANVIS-6 he flies with in the Guard, because they don’t have as much “visual noise” when flying over cities.
There’s no denying that air medical is a business, Hillen said, and that “customers” shop different operators to find the best price or one who will fly when others won’t. “When you’re responsible for someone’s life, there’s no room for cowboy medicine.”
But given the HEMS accident statistics, this is obviously not a universally held–and adhered to–belief. Ultimately, equipment and procedural requirements can only do so much to improve safety. As a trusted friend, who happened to be a helo flight instructor told me, safety really depends on “the nut who holds the stick,” and you only have it “when he parks his ego at the door.” A good lesson for us all, no matter what we fly. — Scott Spangler
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March 4th, 2009 at 5:44 pm
NorthStar MediVac in NJ flew me out of a field on a CAVOK day after a student induced incident!
I don’t remember the flight, but we all made it safely to Morristown Memorial
April 17th, 2009 at 10:41 pm
As you mentioned in the article ultimately the person holding the stick is responsible.
All the procedures in the world won’t stop someone who for whatever reason continually executes bad judgment.
Maybe, if there is a problem, it lies is the background/experiences of some of there pilots and not in the procedures and I would think not in the entire HEMS pilot population.
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