Like the
rest of the
country, we
were deeply
saddened by
the fatal
collision of
two
emergency
medical
services
(EMS) Bell
407
helicopters
on June 29
in
Flagstaff,
which killed
seven. But,
as one of us
is a former
Chairman of
the National
Transportation
Safety Board
and the
other an
aviation
reporter who
closely
follows the
industry, we
were not
shocked by
the
catastrophe.
After all, this tragedy came on the heels of the June 8th crash of another Bell 407 in Huntsville, Texas, which killed all four passengers aboard. And less than a month before that, on May 10th, an EMS-operated Eurocopter EC 13 crashed at La Crosse, Wis., after dropping off a patient, killing the pilot, a surgeon and a nurse. That is 13 deaths in less than two months. And while this period has been especially bad, it was anything but unforeseeable.
EMS helicopters — often proclaimed "angels of mercy" — are among the most dangerous aircraft in the skies today. While this decade has seen a decline in major airline crashes, it has seen an increase in EMS helicopter fatalities, with a worst-ever record of 18 killed in 2004. This year's count: 16 deaths, with six months remaining. Clearly, things are getting worse, not better.
Rather than answers to the problem, the FAA offers excuses. It stated in a press release after the Flagstaff collision that "[EMS] operations are unique due to the emergency nature of the mission." What the FAA needs to ask itself is whether this "unique" situation justifies a fatal accident rate that is 6,000 times that of commercial airliners. In the face of this safety crisis, the FAA's response has been to simply "encourage risk management" and "promote [safety enhancing] technology such as night vision goggles, terrain awareness and warning systems and radar altimeters." This "encouragement" is noticeably lacking the vigor we've seen the FAA use recently to force major airlines to maintain acceptable safety standards.
In our view, the disparity between the standards we take for granted as passengers aboard an airliner and those required of EMS helicopters is caused primarily by the unfortunate overlap of what should be two distinct safety cultures: that of medicine and that of aviation. The two cultures are similar in their gravity — after all, human error in either can cause serious injury or death — but their accident rates are drastically different: the U.S. Institute of Medicine estimated in 2000 that up to 98,000 people died of medical error in the United States each year, the equivalent of three jumbo jets crashing every four days.
This is not to say that aviation always gets it right and medicine always gets it wrong; there are many reasons why management of human error is more difficult in the operating room than in the air. However, the potential for human error is recognized in aviation and efforts are made to design systems and procedures to minimize it. This process now needs to be applied to EMS operations.
While some may argue that EMS missions are inherently more dangerous than those of airliners, we believe that danger is being unnecessarily exacerbated by their proximity to medicine. For instance, in many counties, a 911 operator — who has no aviation experience or expertise — acts as the sole dispatcher for a flight, without real-time weather reports at his/her disposal or any awareness of terrain difficulties. Making dispatch the responsibility of a 911 operator is simply irresponsible. Similarly, often when a road ambulance would be sufficient a helicopter is sent instead. While the medical personnel making these decisions understandably put a high premium on the time-saved by helicopter transport, they do not incorporate into their decision the added risk that occurs each time a helicopter leaves the ground. EMS flights should thus be used only when absolutely necessary, as was the intention when they began flying rescue missions to remote locations in 1972.
The underlying principle that should govern EMS operations is simple: when a patient is evacuated by helicopter, there should not be additional risk of injury or death because of shortcomings in the safety culture associated with these operations.
— Jim Hall was Chairman of the National Transportation Safety Board from 1994 through 2001. He is the managing partner of Hall & Associates LLC, a crisis management and government relations firm and serves as counsel to Nolan Law Group. — David Evans is an air safety consultant with Nolan Law Group and editor of Aviation Safety & Security Digest.
After all, this tragedy came on the heels of the June 8th crash of another Bell 407 in Huntsville, Texas, which killed all four passengers aboard. And less than a month before that, on May 10th, an EMS-operated Eurocopter EC 13 crashed at La Crosse, Wis., after dropping off a patient, killing the pilot, a surgeon and a nurse. That is 13 deaths in less than two months. And while this period has been especially bad, it was anything but unforeseeable.
EMS helicopters — often proclaimed "angels of mercy" — are among the most dangerous aircraft in the skies today. While this decade has seen a decline in major airline crashes, it has seen an increase in EMS helicopter fatalities, with a worst-ever record of 18 killed in 2004. This year's count: 16 deaths, with six months remaining. Clearly, things are getting worse, not better.
Rather than answers to the problem, the FAA offers excuses. It stated in a press release after the Flagstaff collision that "[EMS] operations are unique due to the emergency nature of the mission." What the FAA needs to ask itself is whether this "unique" situation justifies a fatal accident rate that is 6,000 times that of commercial airliners. In the face of this safety crisis, the FAA's response has been to simply "encourage risk management" and "promote [safety enhancing] technology such as night vision goggles, terrain awareness and warning systems and radar altimeters." This "encouragement" is noticeably lacking the vigor we've seen the FAA use recently to force major airlines to maintain acceptable safety standards.
In our view, the disparity between the standards we take for granted as passengers aboard an airliner and those required of EMS helicopters is caused primarily by the unfortunate overlap of what should be two distinct safety cultures: that of medicine and that of aviation. The two cultures are similar in their gravity — after all, human error in either can cause serious injury or death — but their accident rates are drastically different: the U.S. Institute of Medicine estimated in 2000 that up to 98,000 people died of medical error in the United States each year, the equivalent of three jumbo jets crashing every four days.
This is not to say that aviation always gets it right and medicine always gets it wrong; there are many reasons why management of human error is more difficult in the operating room than in the air. However, the potential for human error is recognized in aviation and efforts are made to design systems and procedures to minimize it. This process now needs to be applied to EMS operations.
While some may argue that EMS missions are inherently more dangerous than those of airliners, we believe that danger is being unnecessarily exacerbated by their proximity to medicine. For instance, in many counties, a 911 operator — who has no aviation experience or expertise — acts as the sole dispatcher for a flight, without real-time weather reports at his/her disposal or any awareness of terrain difficulties. Making dispatch the responsibility of a 911 operator is simply irresponsible. Similarly, often when a road ambulance would be sufficient a helicopter is sent instead. While the medical personnel making these decisions understandably put a high premium on the time-saved by helicopter transport, they do not incorporate into their decision the added risk that occurs each time a helicopter leaves the ground. EMS flights should thus be used only when absolutely necessary, as was the intention when they began flying rescue missions to remote locations in 1972.
The underlying principle that should govern EMS operations is simple: when a patient is evacuated by helicopter, there should not be additional risk of injury or death because of shortcomings in the safety culture associated with these operations.
— Jim Hall was Chairman of the National Transportation Safety Board from 1994 through 2001. He is the managing partner of Hall & Associates LLC, a crisis management and government relations firm and serves as counsel to Nolan Law Group. — David Evans is an air safety consultant with Nolan Law Group and editor of Aviation Safety & Security Digest.