Medical Transport: Safety Versus Mission
It’s a foggy, rainy night and you’re the pilot of a life flight helicopter, relaxing, when the phone rings. It’s an auto accident 25 mi away. You check the weather, check the route of flight, check with your team and after all preflight mission planning is completed, you launch toward the accident site. The aircraft arrives at the destination, your patient is loaded into the aircraft and the aircraft departs for the hospital. Along the way, you realize the weather is deteriorating and you need to alter your destination and route of flight. You radio ahead to alert the authorities of the change when your aircraft disappears from radar and radio communication. Two hours later, the aircraft wreckage is found in the woods with four fatalities. This is exactly what happened on Sept. 28, 2008 to a Maryland State Police medevac aircraft. So, what went wrong?
This kind of scenario of high-risk flying plays itself out everyday in general aviation. Aviation emergency medical services (EMS) can be proud of its accomplishments and has made many improvements through the years, but accidents still occur. Why do we repeatedly have the same accidents? How do we lower the risks of aircraft mishaps within this very dangerous profession?
I investigated several aviation EMS accidents where the aircraft managed to arrive at the accident site in bad weather without incident but crashed on the return flight to the hospital. Are we pilots less aware of our site or is it a sense of urgency to help save a life on the return flight?
According to the National Transportation Safety Board (NTSB) accident database, there were five medical transport accidents involving six fatalities since 2005 including the most recent in September. The probable causes varied but included a maintenance issue, pilot error, and inadequate operator training. What can we control?
Let’s start with the command climate. What is the relationship between the hospital and operator? The hospital is in the business of making money and if the aircraft does not fly, no revenue is generated. This puts unnecessary pressure on the crew to accomplish the mission and satisfy the client. How does this affect the crew’s decision-making process? Do medical operations personnel have too much of a role in flight operations?
Several years ago, I flew for a medical evacuation company in N.J. Prior to this, the New Jersey State Police operated two S-76 medical aircraft. This operator was very anxious to fly as many flights as possible to establish themselves in this new market. The oversight for the program was operated out of Allentown, Pa. more than 100 mi away. There were times where flights were cancelled due to weather when the office in Pa. would question our weather decisions and claimed their radar indicated sufficient weather for flight. We would explain the current conditions at our location and disregard any comments. The director’s office would try to place "command pressure" and encourage pilots to fly in marginal weather. As a control measure, a common agreement among flight crews is understood that all members have to agree to fly. If one does not agree, the flight is cancelled.
Many operators do not have an active safety program. A good safety program is essential in conducting safe operations in EMS operations.
What about systems safety? I flew an aircraft where the FM radios were not user-friendly and they were placed next to the collective on the center console. This forced the pilots to have their heads in the cockpit too long. The constant switching of radio frequencies and/or inputting new frequencies were difficult, but a must, for communicating with ground rescue personnel.
How are these aircraft maintained? The aircraft that crashed on Sept. 28 was more than 19 years old. According to published reports, a recent state legislative audit faulted the police agency for failing to document maintenance needs and costs for its fleet of 12 twin-engine helicopters. Many EMS operators do not have a mechanic on station but rather rely on one that "floats" in the general area until needed. This is not the best practice.
Is there a difference between state- owned EMS programs and ones operated by private owners? Yes, I believe there is. Because of the stability of government-operated programs, pilot retention is greater and funding is not normally an issue. There is no "command pressure" to fly and earn revenue. This is a major difference within the EMS community. I also believe the safety standards are higher with the state run programs.
I understand that the EMS industry is attempting to please their customer, the hospital, but our customers must understand why it is important to allow the crews to make the final decisions. The EMS business is very risky and mistakes are non-forgiving. Make the right decisions.