EMS Safety

By Tim McAdams | May 1, 2004
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The Air Medical Physician Assn. reported in 2002 that during the previous five years the helicopter EMS fatal accident rate exceeded that of all other aviation operations. Studies have shown, to no surprise, that human error is the major cause of air medical aviation accidents. Lack of flight experience does not seem to be an issue. According to the AMPA, the average EMS helicopter pilot has 6,307 hr. total, 5,010 hr. in helicopters, and 753 hr. in make and model. Also noted was that only 15 percent of EMS pilots involved in accidents had fewer than 3,000 hr.

However, harder to measure than flight time, but vastly more important to safety, is experience making tough decisions. Perhaps no other segment of aviation is as rich with critical decisions as EMS.

A recent accident in Florida underscores this. On December 16, 2003, a BK117 collided with trees during an inadvertent encounter with instrument meteorological conditions. The helicopter was substantially damaged and the commercial pilot and two paramedics reported minor injuries.


According to the NTSB, the pilot was in visual flight conditions at 1,000 ft. when he went inadvertent IMC. He saw some lights out the left side of the helicopter and started a left turn towards the lights. He slowed the helicopter down, lost sight of the lights, then made a right turn to the south and experienced vertigo. He immediately look down at his flight instruments and observed the artificial horizon was above the horizon and the airspeed was decreasing. He lowered the nose to regain airspeed. The helicopter began to settle and the nose went to the right and down. When he looked back at his flight instruments, the attitude indicator showed the helicopter was inverted and the vertical speed indicator showed a 1,000-fpm descent. He immediately applied cyclic pitch and rolled the helicopter to the upright position and pulled collective pitch to increase power. The helicopter collided with the trees in an upright position and fell to the ground.

The pilot's statement that the aircraft was inverted and descending at 1,000 fpm evidently shows an inability to correctly interpret his instruments. It seems clear that when this pilot encountered instrument conditions, he made several poor decisions and then lost control of the helicopter.

According to the company that employed him, all of its pilots meet the experience requirements for CAMS certification. Also, the company offers one hour of inadvertent IMC training every three months to every pilot. Further highlighting the importance of consistent training is the fact that this pilot did not complete this training for the quarter preceding his accident.

Because of the demanding nature of EMS flying, increasing the frequency and intensity of decision-making training can have a profound effect on reducing accident rates. FlightSafety offers inadvertent IMC training during recurrent instrument and aircraft courses that emphasizes making the correct decisions. According to their Fort Worth, Texas learning center's director of pilot training, Woody Woodruff, few EMS operators take that training. A FlightSafety study of the accident rates of non-FlightSafety trained pilots versus pilots trained in their full-motion simulators found an 80-percent reduction in expected accident rate for the latter group. Obviously, funding for this level of training is the challenge. But the effectiveness of full-motion simulators is hard to dispute.

Despite the fact that flying an EMS helicopter is some of the most demanding work a helicopter pilot can do, pay and benefits are relatively low. The debate on this subject seems to crop up a lot, but in reality will raising compensation levels help the safety problem? I think so. Not that any one individual pilot will fly any safer with a bigger paycheck, but industry turnover will certainly decrease.

I have known many good EMS helicopter pilots who have transitioned to fixed-wing aircraft or left the air medical industry to seek better pay and benefits. Instead of a stepping-stone to a higher paying job, EMS flying could be the career that pilots work hard to achieve. Over time, a low turnover rate will build an experience base of pilots skilled at making the tough decisions uniquely required by EMS flying.

A survey of pilots conducted by the National Emergency Medical Services Pilots Assn. found the No. 1 suggestion to increase safety was to increase the quality and frequency of training. A close second was improving pilots' salaries and benefits. Also high on the list was adding equipment like night-vision goggles.

Unfortunately, all of these strategies require increased funding and the industry must move in that direction. EMS operators and programs should be careful not to let the bidding process and cost pressures take precedence over safety.

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