Everyone seems to have an opinion on what it will take to reduce accidents in EMS. There have been NTSB hearings and front page newspaper articles discussing the issue. What strikes me is that you rarely hear from the pilots. It is the pilots who are crashing aircraft, not FAA inspectors, medical program managers, or journalists. As a former EMS line pilot, here’s my wish list to improve safety.
• Equipment and technology. What I always hear about is hardware. In no particular order, here are a few items: NVGs, GPS moving map, XM satellite weather, IFR capability, robust OEI performance and H-TAWS. Can you transport patients safely with a barebones, single-engine helicopter while unaided at night? Some operators do it, but no one should be surprised when accidents happen. Whether you fly a patient in a Eurocopter EC145 or a Bell 206, your reimbursement is the same. Not all operators will voluntarily install this equipment, so it comes down to the FAA requiring specific equipment. But there is more to improving EMS safety than improved equipment.
• Operational control still needs improvement. From pilot training to operational issues, medical managers exert their influence on aviation ops. Since they are the customer, it’s hard for aviation vendors to ignore a program manager’s desires. Hospital management decides issues from what aircraft to buy to who should be the lead pilot. It is good to see FAA step up enforcement of operational control in the last few years, but I was surprised by the number of medical folks who gave testimony during the NTSB hearings. I can’t imagine FAA consulting airline frequent flyers as to whether TAWS should be installed or what kind of training airline pilots should receive. Imagine pilots attending hearings on what protocols hospitals should use! The air ambulance community needs a fundamental shift in who makes the transportation-related decisions.
• Training. Cost is a major factor in EMS contracts. One way to reduce cost is to reduce training to the bare minimum. Computer training systems (CTS) is the standard for pilot recurrent training, but every pilot I know treats CTS as a joke. CTS allows a check airman to give a pilot his annual checkride in one afternoon. No need for table talk, you have your CTS completion printout.
As much as I think that the sole use of CTS is a travesty, the check airman I’ve encountered in EMS were excellent. In my experience, five blade hours was the max for initial training of a VFR PIC in a specific model. Check airman just don’t have the luxury of spending time with pilots to cover all areas in-depth. After initial training, it is only a checkride every 12 months. Then consider that most pilots do not attend any simulator training. Even if no simulator currently exists for a specific model of helicopter, it would still be beneficial to perform basic emergency procedures and instrument tasks in a simulator. If FAA mandated simulator training for EMS pilots, you would see simulators being built for every helicopter in the field. Mandate it and someone will build them. Almost all EMS programs are flown single-pilot. Pilots are human and will always make mistakes. Ask yourself why there are two pilots required for airline flights. It isn’t because an airplane is harder to fly than a helicopter—the second pilot is there to increase safety. EMS programs try to do it on the cheap by having the paramedic ride up front to “help” the pilot. Same deal with Air Medical Resource Management. Instead of medical folks being taught aviation skills, we just need another pilot in the aircraft. FAA could mandate two-pilot cockpits in EMS and I believe that alone would cause the accident rate to plunge.
I’m lucky I didn’t kill myself the first couple of years in EMS. I was a low-time helicopter pilot and a few years of seasoning with an experienced pilot would have been safer. I say this as someone who had already flown airplanes single-pilot under Part 135. Conversely, toward the end of my time in EMS, I could have benefited from flying with another pilot to prevent complacency. Requiring two pilots, better equipment, and thorough training may cause numerous bases to shut down due to increased cost. If there are a few less operators, a helicopter will still be there for Grandma Betty to get to the ER. It’s also true that smaller helicopters would be essentially shut out of EMS flying. Despite flying a Bell 206 for a few years, I still feel that larger aircraft, which could carry the latest safety technology and two pilots, is a better choice for EMS operators. At the top of my wish list is a mandate for two-pilot operations. Fly Safe!