In the early days of civilian EMS helicopter activities it was comparatively easy to identify that aviation operators were creating many of their own safety problems by promoting their product as a function of trying to fulfill sometimes excessively optimistic marketing promises through consequently intensified operational heroics. This translated into “getting the patient flown, no matter what.”
Today’s safety issues, however, are less obviously generated, existing in a relatively refined environment of aviation and medical operational specialties and stemming from what must be described as a widened pattern of somewhat complex human cause factors. The AAMS Conference at the end of 2002 was treated to a meaningfully helpful analysis of poor safety performance statistics at that time, developed by the University of Chicago’s Aeromedical Network, and UCAN was able to isolate the following realities, which continue as accepted elements in safety performance today:
•Takeoffs and landings, or departure and terminal flight segments, have traditionally been envisioned as the most dangerous flight mission phases, but it turns out that en-route phases, over the years, are statistically more dangerous. Even though we understand that en-route phases are artificially weighted in significance by their consumption of more raw time in any mission profile than other flight phases, it would seem that static cruising flight in helicopters should be relatively uneventful. Yet 36 percent of major accidents occur in this phase, eclipsing departure segments, destination maneuvering and scene operations. Cruise flight, it turns out, is the flight phase during which most POOR OPERATIONAL DECISIONS are made.
• Night flying is more dangerous in EMS helicopter aviation than daylight operations. As a consistently evident general statistic, less than 40 percent of all flights are accomplished at night, yet more than 50 percent of recorded accidents occur in darkness. Of accidents eventually classified as weather related, more than 85 percent occur as night operations.
• Human errors and deficient personnel performance factors, especially for pilots, are involved in nearly 80 percent of all mishaps. Chief among these human failings is faulty in-flight decision making; the dominant example of which entails incorrect decisions to continue into deteriorating weather, often driven by the perception of mission urgency. Disregard for program weather minimums before takeoff is far less a problem than the temptation to press on during en-route phases when weather can actively deteriorate. Accordingly, IFR qualification and competency, so that recovery from inadvertently encountered weather can be reliably accomplished, is shown to be irreplaceably valuable to safe EMS flight operations, as is regular program review of correct prioritization between mission urgency and conservative aviation discipline.
• Pilot experience levels are a clearly identifiable factor. Surprisingly, relatively junior pilots, below 3,000 hours of flight experience, and relatively senior pilots, having recorded over 6,000 hours, are statistically less accident-prone than those middle seniority pilots of between 3,000 hours and 6,000 hours. (Most Vietnam-era pilots, traditionally comprising the majority of EMS operations in years past, usually show more than 6,000 hours of experience. That group, interestingly, will be concluding its participation over the next few years, a math reality that is certain to affect fleet average pilot experience levels.)
• Crew coordination demands, to include multiple radio use workload, traffic avoidance in high density airspace, and task interruption due to frequently required multi-tasking, particularly when compounded by marginal weather and poor visibilities, can compromise safety margins dramatically. Recently introduced technological innovations, such as NVG equipment, can provide improved safety performance in peripheral ways, but these additions to the working environment also represent ancillary layers of operational complexity, along with increased opportunity for distraction from fundamental decision-making, and they cannot eliminate the most dangerous elements that continue to contaminate EMS safety performance.
These days we are not seeing the horrific accident rates which plagued EMS helicopter operations during the early 1980s, nor are we enjoying the relatively safe halcyon days of the middle 1990s, when EMS activities had matured and the number of substantively experienced participants matched the volume demands of the time. Our safety challenge today consists mainly of hiring, training and correctly using high quality pilots, who can deliver superior judgment and effective leadership.