The Deadly Cost of Swooping In to Save a Life The director of the helicopter program for which Palcic flew called these lucrative patients "golden trout" and pushed pilots to reel in as many as possible. When pilots balked at flying in bad weather, he called them sissies and second-guessed them, records and interviews show.
Palcic, 63, was just two minutes into the flight of AIRHeart-1 when his crew radioed a dispatcher that he was turning back because of the thunder and lightning.
Moments later, Palcic's helicopter banked in clouds and plunged 700 feet into shallow waters, killing him, a flight nurse and a paramedic. A woman who lived nearby recalled that the vibration shook candlesticks out of their holders.
For the medical helicopter industry, it was the fourth fatal crash that year -- part of a legacy that has claimed the lives of 211 crew members and 27 patients since 1980 and injured many others, The Washington Post has found.
The number of fatal flights has risen sharply, closely tracking the rapid growth of what is now a $2.5 billion industry. Nearly half of all deaths have occurred in the past decade. In 2008, the deadliest year ever, 23 crew members and five patients were killed.
Some calamities were the result of pilot errors. But many were predictable, pilots and safety experts say, and could have been prevented with stronger oversight and better technology.
"We've been killing ourselves the same way for 20 years," said veteran pilot Ed MacDonald. "There's not a whole lot new about these crashes."
What began almost four decades ago as a way to save lives is now one of the most dangerous jobs in America -- deadlier than logging, mining or police work -- with 113 deaths for every 100,000 employees, The Post found. Only working on a fishing boat is riskier. The rate for airline pilots is 80.1.
In the 37 years helicopters have been used to transport patients, pilots and crews have died in an almost unfathomable array of crashes. In the past two years alone, medical helicopters have dropped into pitch-black oceans, plummeted to the ground after losing rotor blades, smacked into mountains and collided in clear blue desert skies.
Yet as crashes and deaths have mounted, top executives at the Federal Aviation Administration and its parent agency, the U.S. Transportation Department, have acted as partners with the industry, issuing reams of voluntary safety advisories with little follow-up. The FAA has sent poorly trained inspectors to monitor operators and used fines and penalties as only a last resort.
"I'd rather use a carrot than a hammer," said John M. Allen, the FAA's director of flight safety standards. "It's not like we do nothing and then smack them with a rule."
Allen said the agency has to balance business and safety. "Even one crash is too many," he said. "But there's a fine line on how far does government go to impact business."
Private, for-profit companies dominate the industry, with about 830 medical helicopters vying for patients. The number of aircraft has doubled every decade since 1980, leaving some firms with fleets as large as those of US Airways or JetBlue. Yet medical helicopters are permitted to operate without basic safety features that commercial flights must carry, such as black box recorders, collision-avoidance systems and radar altimeters.
Unlike an airliner, a medical helicopter does not fly a direct route from one airport to another, seamlessly tracked by radar. Most flights are at low altitude. There might or might not be an established landing zone.
Because of their low flight paths, helicopters are especially vulnerable to rapid changes in weather. Most flights are made under visual flight rules, with the pilot using his eyes to pick through clouds and around obstacles, and often are to out-of-the-way accident scenes. Unlike commercial airline trips, only a fraction of helicopter flights are conducted under instrument flight rules, which make it easier to travel in inclement weather.More than half of fatal crashes occur at night, but only one-third of medical helicopter pilots are equipped with night-vision goggles to help them avoid power lines, towers and other obstructions.
Industry officials are well aware of the risks, noting in public statements that medical flights are inherently dangerous. They emphasize the thousands of patients they safely transport each year and the many lives that have been saved. They also say helicopters are critical in rural areas.
Although the industry has not advocated for a specific federal safety requirement, companies have made individual improvements and supported voluntary guidelines, said Christopher Eastlee, a spokesman for the Air Medical Operators Association.
The accidents last year "lend themselves to safety concern in the industry, but I don't think that translates into a safety problem," said Eastlee, whose group represents more than 90 percent of the industry, which is dominated by five private companies and dozens of smaller programs.
Industry officials have been slow to adopt safety technologies until recently and urged more studies, citing the expense and readiness of the equipment. Operators also have successfully sued state regulators who tried to restrict the number of helicopters in their areas based on a community's medical need.
In effect, the FAA and Transportation Department treat the companies the same as low-fare carriers to Disney World, contending that a deregulated, unfettered market will drive down costs through competition.
The model hasn't
worked.
In Kentucky, "all of a sudden, the skies were almost black with helicopters," recalled Brian K. Bishop, a former regulator.
With a population
of 4.2 million,
Kentucky has 26
medical helicopters
-- more than many
nations. Canada,
which is about nine
times as large with
a population of 33
million, has 20. It
has never suffered a
fatal crash.
The idea that helicopters can be used to swiftly transport critically injured patients to trauma centers and other hospitals grew from the experience of surgeons and pilots during the Vietnam War.
"What we learned was if we got to them quickly enough and got them to the right people, we could save lives," said MacDonald, a Dustoff pilot in Vietnam who flies a medical helicopter in New Mexico. "When we came back, we took a look around and said, why aren't hospitals doing that here?"
It didn't take long for hospitals and private operators to catch on. In 1980, there were about 40 medical helicopters in the United States. In 1990, there were about 225. Today, there are more than 800. Texas alone has 67. Arizona has 54. Pennsylvania: 45.
Virginia has 24; Maryland, 17; and the District, 5.
Operators say the extraordinary rate of growth reflects "pent-up demand" for the services, especially in rural areas without trauma centers. But as with many expensive technologies, the increase appears to have as much to do with making money as with medicine. Complaints about overuse are common, with patients walking off helicopters with sprained ankles or being discharged within a few hours from emergency departments.
"A patient flown in by helicopter can mean thousands of dollars in downstream revenue" once the patient is admitted to a hospital, said Paul A. Taheri, a doctor who co-wrote a 2003 study on the subject. "That fact is not lost on hospital administrators."
A helicopter also helps to burnish the image of a hospital as a lifesaving facility.
"They're like flying billboards," says Thomas P. Judge, executive director of LifeFlight of Maine, a statewide program with two helicopters. "It's the equivalent of a medical centerfold. It's sexy advertising."
In the late
1990s, Congress
prodded Medicare,
the nation's largest
insurer, to change
its formula for
paying for
helicopter
transports. In 2002,
Medicare boosted its
reimbursement rates
and started paying a
50 percent premium
for rural flights.
The spigot of new
money expanded the
market for private
operators, who
responded by opening
scores of
free-standing bases
miles from
hospitals. Medicare
payments soared,
increasing 434
percent in seven
years, to $220
million last year.