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Another AeroMedical Crash
Started by EMRaiden
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I have to agree with stopping aeromedical transport. I can't even think of one trauma victim I've seen who survived BECAUSE he/she was taken by helicopter. In contrast, 80% of the patients that arrive by helicopter are open fractures, or chest/abd trauma with stable vital signs that could have come by ground ambulance.
In addition to the crash today, there was another crash heading toward Prescott on Friday: http://www.allheadlinenews.com/articles/7011410769
Fortunately, no one was killed in that one.
Fortunately, no one was killed in that one.
I'm not saying stop it all together.....there's good uses for aeromedical transport, but I'll agree that it's over-used most of the time. I think that it needs to be grounded much as say, the entire fleet of specific military aircraft after several incidents, where they do a 48 hour ground hold, and force the industry to re-evaluate safety, and usage, etc. This many crashes in a single month scare me.
I've gotta ask...what is stopping these services from changing their policies?
Airevacs should only occur from both mechanism AND/or physical findings that make them unstable, and only when there is a CLINICALLY (not statistically) significant reduction in transport time.
I doubt it's money that stops them....at least around here, I'm pretty sure that the several medevac companies are beginning to lose money on overall transports due to higher fuel prices. It's more about prestige for the institution.
Simple. $$$. It costs $$$ to have aeromed services ready to go and they don't make anything if they are not transporting. If you run an aeromed service you'd rather have your crew transporting than sitting on the ground. Now I'm not saying anyone wants to endanger their crews for non-indicated transports but they do tend to allow the sending entities (small hospitals, EMS, etc.) to be quite conservative.
The fact that they exist perpetuates their use. I frequently get patients sent by rural clinics for chest pain that would have come in code 2 by ground ambulance but the clinic docs are afraid that if by chance the patient did get worse enroute during the 2 hour drive they would be held liable for not flying them. Devensive medicine kicks in and viola, $9000 dollar helo ride. If there were no helo service, they would code 2 ground those guys without a second thought.
Excuse me. I have a helicopter landing now with a transport from an outlying hospital of a non-intubated tylenol OD who already got NAC. Reason for transfer and helo transport? "The patient has a toxic Tylenol level."
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That's ridiculous! Most acetaminophen overdoses are stable enough to be admitted to the floor and have no reason to be flown into a receiving hospital unless they're in fulminant hepatic failure and a transplant is in the works.
That makes sense now. Our air evacuation system here is integrated into our EMS service, and they are only activated under strict criteria. Perhaps the states need to introduce legislation and control who is allowed to fly and when?
I know I have gotten dinged before for mentioning it, but...
I do 'EMS' in about a month for a couple weeks and can opt out of flying and do ground only. This latest certainly seals the envelope on what I'll be doing.
I do 'EMS' in about a month for a couple weeks and can opt out of flying and do ground only. This latest certainly seals the envelope on what I'll be doing.
At this point, I suspect that the future life saving/improving capacity lost due to
doc & nurse deaths >>>lives saved or improved from air transpo
doc & nurse deaths >>>lives saved or improved from air transpo
I have to disagree about using aeromedical simply for "mechanism".
Many times I've seen patients rushed in by helicopter, who were A&O, had minimal complaints and no obvious injuries. When I ask the medics why they transported the patient via air, they stated "due to mechanism" or "damage to vehicle".
I can see completely eliminating them in some areas, but in super rural areas I think they still are a necessity. New Mexico is a weird place anyway, but UNMH is the only Level 1 trauma center in a HUGE state. I know my insurance says I only get the plane, they won't pay for a helicopter.
But then, as this last one was in Flagstaff, it makes me question the rural sentiment. Flagstaff itself is not particularly rural, but that hospital serves another expansive rural area.
But then, as this last one was in Flagstaff, it makes me question the rural sentiment. Flagstaff itself is not particularly rural, but that hospital serves another expansive rural area.
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I think you would meet vehement resistance from people who get off on wearing flight suits.
Hey GV
I think you misread what I said. Mechanism AND physical findings are both required for an airevac here, or sometimes physical findings alone. I agree 100% that mechanism alone is never sufficient to request airevac.
Hopefully they are only a minority of people when compared to all of the voting public (including us) who are against it.
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I'm glad somebody else finally said this. I'm in IM not EM and 2 of my last 3 months have been crit care and I've seen an enormous waste of resources on air transport of clearly not critical patients just b/c it was available. Two stand out in my mind quite clearly.
The first was billed as a "fulminant hepatic failure, transferred for transplant eval." Now...she'd been in-house for 3 days and just now they decided she was fulminant. Secondly, she was at a hospital that, at rush hour is 45 min away. From the time she was signed out to me by the transferring doc, it took almost 2 1/2 hours for her to get there.
The second was an NSTEMI, real EKG changes and Trop elevation but chest pain free after nitro and metop in the ED but choppered up from 4h (drive) away just to sit in the unit overnight and get cathed in the AM.
Just 2 examples of many of the "well, we can so we should" mentality that exists WRT air evac/transfer.
Sounds like the crap I saw in Maryland all the time. The most egregious example was one where I saw them aeromedically transport someone from a crash scene that was 2 minutes by ground (literally in sight of) the trauma center. The reason? The patient had to be extricated and had bilateral femur fx's. To paraphrase the medic, they would get "written up" by their medical director if they didn't call for the helicopter.
As someone who currently works on aviation safety research looking primarily at injury patterns and how to make crashes more survivable, I am truly bothered by aeromedical crashes and the refusal to adhere to safety recommendations. Some of the "outlandish" (to use the term I heard come from the mouth of the person in charge of safety for AirEvac Lifeteam a couple of years ago) suggestions:
-Not flying for non-critical cases
-Proper maintenance
-Mandating use of night vision and radar altimeters,
-Not taking off in weather that I would hesitate to drive in
-Landing only on predesignated sites
Honestly, the only way these programs will be reigned in (short of the FAA actually pulling their heads out of their collective asses and doing something drastic) is if the EMS medical directors begin to discourage their providers from calling for helicopters for anything but the most time sensitive situations. The services (all with the same medical director) I spent most of my time as an EMS provider in mandated that if we called for a helicopter we were held to account for that decision. If you made a habit of requesting the helicopter for marginal cases or did it for something blatantly non-indicative of a need for aeromedical transport, you could be suspended and/or terminated.
The trauma decision tree was modified with the 2008 protocol roll-out. There was an emphasis on Category C and especially D patients to make sure that when we send them to a trauma center, 80% of the time there will be nothing wrong.
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Just to play devil's advocate:
How does the death rate compare between aeromedical transport and regular ambulance transport? There have been a couple of recent helicopter crashes, but when compared to the number of flight operations that occur without incident it is a very small percentage. Sending someone from Hospital A to Hospital B on an ambulance with lights and sirens poses a significant risk of death as well, but is that risk more or less than the risk of a helicopter crashing?
Is the uneasiness about aeromedical transport safety a result of the actual risks, or is it more a result of anecdotal stories coupled with the "unnaturalness" of flying (this is the reason people are deathly afraid to fly in an commercial jet, but will drive on an interstate without hesitating)?
How does the death rate compare between aeromedical transport and regular ambulance transport? There have been a couple of recent helicopter crashes, but when compared to the number of flight operations that occur without incident it is a very small percentage. Sending someone from Hospital A to Hospital B on an ambulance with lights and sirens poses a significant risk of death as well, but is that risk more or less than the risk of a helicopter crashing?
Is the uneasiness about aeromedical transport safety a result of the actual risks, or is it more a result of anecdotal stories coupled with the "unnaturalness" of flying (this is the reason people are deathly afraid to fly in an commercial jet, but will drive on an interstate without hesitating)?
part of the problem is that even though there are a lot of ambulance crashes, many of them are survivable. Wheras if your chopper hit power lines or falls off the roof you have a low low chance of making it out alive. Also I think it is pretty well accepted that there is a lot more risk from each hour in the air than each hour on the road. Too tired to look for it now, but I'm sure that if you break it down in terms of fatalities/100,000 hours flight time v fatalities/100,000 hours road time you can see why people are nervous.
I'm still thinking about doing some flight time. I figure my chances of being in crash are pretty low during a week or two. (Though the equation is very different if you are considering being a flight medic for 10 years)
I'm still thinking about doing some flight time. I figure my chances of being in crash are pretty low during a week or two. (Though the equation is very different if you are considering being a flight medic for 10 years)
The numbers do not compare well at all (there is actually a publication coming out in the next few months regarding this that I am aware of). You are talking an increase in frequency of fatal injury that is several fold that of ground transport. This is all the more unacceptable given the lack of benefit from helicopter transport in all but a very select few situations.
Like JBar stated, the problem is that a ground ambulance crash is often survivable, since most are medium to low velocity impacts. Most helicopter crashes are high energy events and often followed by a fire that tends to further reduce survivability. In my research database (aviation safety), we have 9 or 10 helicopter accidents (I don't have the data open at the moment) accounting for maybe 20 deaths represented thus far and ~20% of deaths are the result of either burns, smoke inhalation or a combination of the two.
Like JBar stated, the problem is that a ground ambulance crash is often survivable, since most are medium to low velocity impacts. Most helicopter crashes are high energy events and often followed by a fire that tends to further reduce survivability. In my research database (aviation safety), we have 9 or 10 helicopter accidents (I don't have the data open at the moment) accounting for maybe 20 deaths represented thus far and ~20% of deaths are the result of either burns, smoke inhalation or a combination of the two.
There was a study that came out several years back (I believe out of the Hopkins public health division) that stated that in a 20 year career as a flight paramedic one would basically have a 50/50 shot of being involved in a crash producing at least serious injury. I do not recall the specific details or the citation, as I simply saw this during a presentation on aeromedical safety (or more correctly, lack thereof) at a conference.
As someone who flew aeromedical missions in the Air Force, I can state that you would NEVER find me flying for a civilian operation. This is the one of the things that will be a deciding factor in where I will apply for residency should I decide to pursue EM.
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deleted109597
More people die every year in box crashes than helo crashes. However, box crashes don't get the publicity.
Actually you're not correct. According to the National EMS Memorial Service website, in 2007, there were only three deaths among EMS personnel responding in ground ambulances. However, I do not know how accurate this is. However, it would seem to be in keeping with the CDC data that was published in February 2003 which stated: "This report documents 27 ambulance crash-related fatalities among EMS workers over a 10-year period."
By comparison, figure that there are (according to the American Ambulance Association):U.S. Ambulance Statistics
Number of Ambulance Services 15,276
Number of Ground Ambulance Vehicles 48,384
Number of EMS Personnel 840,669*
*- This would likely include most if not all of the persons involved in aeromedical operations with the exception of the pilots
A much higher percentage of people involved in aeromedical transport die annually than the percentage of persons who are killed or even critically injured in ground transport. You figure there are 800 aeromedical helicopters in the US, assuming 3 crew members and three shifts, that's 7200 people. When you lose between 30 and 50 of them in a good year, something is seriously screwed up.
The number isn't anecdotal, and if you do a little Googling, you'll actually find the statistics. I did a year or so ago and didn't have any problem finding it.
The number of helicopter crashes in the air medical industry is markedly higher than helicopter crashes for civilian passenger carriage or personal helicopters. Likewise, the fatality rates (both a case fatality rate and absolute number of fatalities) is significantly higher in the air medical industry than in ground ambulance transportation industry.
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deleted109597
That kind of defies the study published by ACEP in 2002 that shows
Occupational fatalities in Emergency Medical Services: A Hidden Crisis said:
Of course, this was an estimate based on all of the data they had, but the data mining took 4 years, so they didn't just make the numbers up.
A different study by the same MD shows
Using that data, there are 850 serious bus crashes (with injury or death) every year. This year we are talking about 4-5 helo crashes. You are much more likely to die in a helo crash, but you are more likely to crash in a bus (but not die). However, if you're the guy bouncing around in the back, all crashes feel pretty bad.AN OPTIMAL SOLUTION FOR ENHANCING AMBULANCE SAFETY: IMPLEMENTING A DRIVER PERFORMANCE FEEDBACK AND MONITORING DEVICE IN GROUND EMERGENCY MEDICAL SERVICE VEHICLES said:
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You missed the part where that first article included persons struck by vehicles while on scene.
You can't use that data to support your argument because of the methodological flaws. That is the danger of simply data mining for statistics, particularly across numerous data sources.
Try more on the order of 10-12 per year on average. By my count, we have had 7 so far this year with 16 fatalities. Most of those (13) have been in the past two months.
I think the system needs more governmental regulation. One major issue is the business aspect of operating a helo program, even a university helo program. When a smaller outside facility calls for a helicopter, if your company says we don't think that patient needs a helo, send them by ground. That doc is going to say fu and call another company. Next time when they do have a sick pt, they won't be calling you either. So, by trying to do the right thing you just shoot yourself in the foot from a business aspect. However, it is still your responsibility to protect your crew, but inter-hospital transfers are not as high-risk in relation to scene flights, so it is a bit easier, I think, to take the borderline patients. If we have some set of guidelines making the patient either meet criteria for flight or not this will help reduce the competition between companies related to who they accept for transport. Another issue is that many of the smaller hospitals don't accurately recognize what is going on with the patient and the condition they reported to us is worse than they recognize, so sometimes the patients billed as borderline end up much sicker than recognized....so sending helo in some of the borderline cases can be in the patient's best interest. Granted many times it is the other way around where they are not as sick. Another issue with ground transport of patients is the liability of events enroute. If your mother was the patient with a NSTEMI with EKG changes, enzymes, and CP would you want her to develop a STEMI or VF 1/2 through the 4 hour ground trip while they are in the middle of the countryside between 2 cities? Or in a helicopter that is 1/2 between the two cities (15-20 minutes) from the cath lab. Physicians take a risk when they transfer patients between two facilities, this is why the patient signs a consent form. To some degree sending patients by helo is defensive medicine. That still doesn't make it right, but we have to change the practice of a lot more people than just the EMS folks and medical directors of the EMS people.
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deleted109597
Uh, dead is dead, regardless of how it happens. Just because you are standing next to the box when a truck runs into it doesn't make you less dead than you being in it.
7 helo crashes this year? You're going to have to label those for me. Iowa, Detroit, Arizona (x2), and one more that I can think of offhand.
+Wisconsin
You're talking about two different things. Although both are tragic, one is a death related to the transport and one is a death related to on-scene safety. The deaths and accidents from helicopter crashes do not include on-scene fatalities caused by medical workers being struck by cars. On-scene safety is another issue. Let's keep the focus on transport safety, which is deaths and injuries from crashing the ambulance or crashing the helicopter.
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FAA Press Release:
For Immediate Release
June 30, 2008
Contact: Alison Duquette
Phone: (202) 267-3883
EMS Helicopter Safety
Helicopter Emergency Medical Service (HEMS) operations are unique due to the emergency nature of the mission. In August 2004, the FAA initiated a new government and industry partnership to improve the safety culture at HEMS operators and recommend short-and long-term strategies for reducing accidents. While the FAA has not ruled out proposing new or changing existing rules, the agency has prompted significant short-term safety gains that do not require rulemaking. The FAA's immediate focus is:
Encourage risk management training to flight crews so that they can make more analytical decisions about whether to launch on a mission.
Better training for night operations and responding to inadvertent flight into deteriorating weather conditions.
Promote technology such as night vision goggles, terrain awareness and warning systems and radar altimeters.
Provide airline-type FAA oversight for operators. Identify regional FAA HEMS operations and maintenance inspectors to help certificate new operators and review the operations of existing companies.
Background
There are approx. 750 emergency medical service helicopters operating today, most of which operate under Part 135 rules. HEMS operators may ferry or reposition helicopters (without passengers/patients) under Part 91.
The number of accidents nearly doubled between the mid-1990s and the HEMS industry's rapid growth period from 2000 to 2004. There were nine accidents in 1998, compared with 15 in 2004. There were a total of 83 accidents from 1998 through mid-2004. The main causes were controlled flight into terrain (CFIT), inadvertent operation into instrument meteorological conditions and pilot spatial disorientation/lack of situational awareness in night operations. Safety improvements were needed.
FAA Oversight
The FAA inspects HEMS operators, but is prompting changes beyond inspection and surveillance. Rather, the FAA is moving to a risk-based system that includes the initiatives outlined below which focus on the leading causes of the HEMS accidents.
FAA Actions
In August 2004, the FAA established a task force to review and guide government and industry efforts to reduce HEMS accidents.
On January 14, 2005, the FAA hosted a meeting with HEMS industry representatives to discuss safety issues and gain feedback. Representatives from the Association of Air Medical Services, Helicopter Association International, the National EMS Pilots Association and several operators attended.
Decision-making skills: On January 28, 2005, the FAA published a notice providing guidance for safety inspectors to help operators review pilot and mechanic decision-making skills, procedural adherence, and crew resource management practices. It includes both FAA and industry intervention strategies (Notice 8000.293 Helicopter Emergency Medical Service Operations). These principles were reinforced in the "Safety Alert for Operators" (SAFO) 06001 issued on January 28, 2006.
Risk assessment programs: On August 1, 2005, the FAA issued guidance to inspectors promoting improved risk assessment and risk management tools and training to all flight crews, including medical staff (Notice 8000.301 Operational Risk Assessment Programs for Helicopter Emergency Medical Services).
Air Medical Resource Management (AMRM): On September 22, 2005, the FAA issued guidance to HEMS operators establishing minimum guidelines for Air Medical Resource Management (AMRM) training. The training focuses on pilots, maintenance technicians, flight nurses, flight paramedics, flight physicians, medical directors, specialty team members (such as neonatal teams), communications specialists (dispatchers), program managers, maintenance staff, operational managers, support staff, and any other air medical team members identified by specific needs (AC No. 00-64 Air Medical Resource Management).
Special emphasis inspection program: On September 27, 2005, the FAA issued a revised standards for inspection and surveillance of HEMS operators, with special emphasis on operations control, risk assessment, facilities and training, especially at outer locations away from the certificated holder's principal base on operations.
FAA establishes new office: In December 2005, the FAA's Flight Standards Service's Air Transportation Division established the new Commuter, On Demand, and Training Center Branch (AFS-250) to work Part 135 and Part 142 policy issues.
Loss of Control (LOC) and Controlled Flight Into Terrain (CFIT): On January 24, 2006 the FAA issued a handbook bulletin to inspectors describing acceptable models for LOC and CFIT avoidance Programs. The bulletin provides inspectors with information to provide to HEMS operators for developing LOC/CFIT accident avoidance programs and clarifies existing guidance (HBAT 06-02 Helicopter Emergency Medical Services (HEMS) Loss of Control (LOC) and Controlled Flight Into Terrain (CFIT) Accident Avoidance Programs).
HBAT 06-01 & OpSpec A021: On January 24, 2006 the FAA issued revised guidance to inspectors regarding HEMS OpSpecs, amending the Visual Flight Rule (VFR) weather requirements for HEMS operations, including consideration of the adverse affects of reduced ambient lighting at night and mountainous terrain (HBAT 06-01 Helicopter Emergency Services; OpSpec A021/A002 Revisions).
Guidance to Part 142 training centers: On February 24, 2006, the FAA issued a Notice to Training Center Program Managers assigned to oversee Part 142 training Centers advising them of recent changes to HEMS operations and training standards (Notice 8000.317, Operator Training Provided by Part 142 Training Centers for Helicopter Emergency Medical Services.)
Public HEMS operators: On March 2, 2006, the FAA issued guidance to inspectors on the surveillance and oversight of public aircraft operators for HEMS operations (Notice 8000.318 Public Helicopter Emergency Medical Services (HEMS) Operations).
Terrain Awareness and Warning Systems (TAWS): On June 27, 2006, at the FAA's request, RTCA, Inc. established a Special Committee to develop Helicopter Terrain Awareness and Warning System (H-TAWS) standards. These standards will be used to develop FAA requirements for H-TAWS systems, installation and operations.
Aeronautical Information Manual: In August 2006, the FAA revised the Aeronautical Information manual (AIM) to provide guidance to pilots on assessing ambient lighting for night visual flight rule (VFR) operations and for off-airport/heliport landing zone operations.
Aviation Rulemaking Committee (ARC): The FAA is currently reviewing the 140 recommendations made by the Part 135/125 ARC. We have begun rulemaking on many issues which pertain to HEMS operations and training. Examples of the areas considered for change are: weather requirements for IFR flight, medical personnel as crew, IFR landing minimums, instrument flight competency, etc.
International Helicopter Safety Team (IHST): The helicopter industry has formed the IHST to gather data and draft strategies to reduce helicopter accidents globally by 80 percent by 2015. The effort is modeled on the Commercial Aviation Safety Team (CAST) which has achieved a significant reduction in the commercial fatal accident rate in the United States. Members include the FAA, European Aviation Safety Agency (EASA), Transport Canada, the International Civil Aviation Organization (ICAO), and industry representatives.
Surveillance of large HEMS operators: The FAA's Flight Standards Service established a task group to focus on the certification and surveillance requirements for large HEMS operators that support diverse medical programs throughout the United States. The group's findings resulted in the increase in the cadre of inspectors assigned to HEMS operations.
Operational Control Centers: On May 5, 2008, the FAA's Flight Standards Service issued an advisory circular (AC 120-96) highlighting the "best practices" for use by HEMS operators in establishing their control centers and training their specialists.
Weather
In March 2006, the FAA and the University Corporation for Atmospheric Research hosted a weather summit in Boulder, Colorado to identify the HEMS-specific issues related to weather products and services. Attendees explored possible regulatory improvements, weather product enhancements, and operational fixes specific to HEMS operations. Attendees included the National Weather Service, National Center for Atmospheric Research (NCAR), Helicopter Association International, American Helicopter Society International, Association of Air Medical Services, National EMS Pilots Association, National Association of Air Medical Communications Specialists, manufacturers, and many operators.
As a result, the FAA funded the development and implementation of a graphical flight planning tool for ceiling and visibility assessment along direct flights in areas with limited available surface observations capability. Its use improves the quality of go/no-go decisions for HEMS operators. The tool was fielded in November 2006. The response from the users continues to be very favorable (Notice 8000.333, HEMS use of the aviation digital data service experimental HEMS tool).
Night Vision Goggles
The FAA has a solid record of facilitating safety improvements and new technologies for EMS helicopters, including certification of Night Vision Goggles (NVGs). Since 1994, the FAA has worked 28 projects or design approvals called Supplemental Type Certificates (STCs) for installation of NVGs on helicopters. This number includes EMS, law enforcement and other types of helicopter operations. Of the 28 projects, the FAA has approved approx. 15 NVGs STC's for EMS helicopters. The FAA initiated and wrote (in coordination with RTCA) the minimum standards for NVGs/cockpit lighting.
Technical Standard Order (TSO) C164 was published on September 30, 2004 referencing RTCA document DO 275 Minimum Operational Performance Standards (MOPS), published October 12, 2001. The FAA has hosted workshops to help applicants work with the FAA to obtain NVG certification. One set of NVGs costs approx. $7,000 and an operator must carry multiple sets per flight. Certification is just one step. The operator must also have an FAA-approved training program for using NVGs.
The FAA has revised the NVG guidance in the Operations Inspectors Handbook, Order 8900.1. Produced using considerable industry input, the revision includes the establishment of a cadre of NVG national resource inspectors (Notice 8000.349, Night Vision Imaging Systems).
Flight Data Recorders
Flight Data Recorders (FDRs) are not required for HEMS operations. FDRs offer value in any accident investigation by providing information on aircraft system status, flight path and attitude. The weight and cost of FDR systems are factors. Research and development is required to determine the appropriate standards for FDR data and survivability in the helicopter environment, which typically involves substantially lower speeds and altitudes than airplanes. Funds are currently best invested in preventive training.
However, the FAA is studying alternatives to expensive and heavy airliner-style FDRs, especially in light of the relatively low-impact forces in most helicopter accidents. By establishing a standard appropriate to the helicopter flight envelope, the FAA may be able to make meaningful future FDR rulemaking efforts.
Terrain Awareness Warning Systems
The FAA supports the voluntary implementation of Terrain Awareness Warning Systems (TAWS) and did consider the possibility of including rotorcraft in the TAWS rulemaking process. Through this process, however, the FAA concluded that there are a number of issues unique to VFR helicopter operations that must be resolved before the FAA considers mandating the use of TAWS in this area, such as modification of the standards used for these systems. For example, helicopters typically operate at lower altitudes so TAWS could potentially generate false alerts and "nuisance" warnings that could negatively impact the crew's response to a valid alert. TAWS application to HEMS would require study of TAWS interoperability within the lower altitude HEMS environment, and possibly a modification of TAWS system standards.
At the FAA's request, RTCA, Inc. established a Special Committee (SC-212) to develop H-TAWS standards for use in future FAA rulemaking projects. The final report was delivered to RTCA in March 2008. Those standards are being reviewed by the FAA's Aircraft Certification Service for the development of an HTAWS technical standards order.
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This is a very good article about HEMS safety from the FAA: http://www.ntsb.gov/publictn/2006/SIR0601.pdf
-Lacrosse, WI
-Grand Rapids, MI
-Flagstaff, AZ
-Another one in Arizona that resulted in serious injuries just a couple of days prior to the Flagstaff incident
-Sam Houston National Forest, TX
-South Padre Island, TX
-Another I don't call the location of
There was an additional incident due to probable mechanical failure in Pottstown, PA in May 2008 and a non-fatal crash in Deland, Florida in January.
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deleted109597
I tend to count all of the "preventable" causes of death the same. I don't count scene run MI's, because those are likely the same risk between the two groups, although aero-staff are generally more fit and less likely to have these problems. However, to me, someone dying because they were standing around near the truck when it got hit is due to the same kind of preventable error as someone dying as a helo is landing. Scene safety is scene safety, be it powerlines or trucks. It just so happens that they often take more effort making the scene safe for the helo, because the risk is higher. They don't often cordone off the road just for a bus, but they do for a bird. Maybe this too should be looked into.southerndoc said:
No, it's not the same. By the time most air medical personnel arrive on scene, the patient has usually been extricated (at least in my experience) and is already in the back of an ambulance. Therefore, you don't have air medical personnel standing on the side of the road as often.
Landing the helicopter is part of the transport. Likewise, parking the ambulance is part of the transport. If the ambulance is struck while parking, then that's covered in our discussion. If the paramedic is struck while extricating the patient, then that's inherent scene safety that's not included in the discussion.
Needing somebody on-scene for treatment is not the discussion. If you eliminate the helicopter, you still need someone on-scene to extricate the patient. You still need a responder. It's the mode of response for transport that is in question -- ground v. air.
This is where you depart from the accepted practices of injury pattern research.
Not according to the pile of autopsy data that I'm wading through. There is about the same rate of coronary artery disease as we see in a general population.
Actually this is a practice on the interstate and highway in the jurisdiction I used to run in as an EMS provider. We would routinely shut down the next lane over from the vehicle for any call alongside the road or on the road. If there was an extrication needed, we frequently pulled an engine company across both lanes and block the road completely. Of course, this was a rural area so it wasn't like we had "rush hour" to contend with. But I do know of several other agencies that engage in very similar practices.
That being said, I would also like to point out that the choice of a non-predesignated landing zone for a helicopter often is not as thorough as you would like us to believe. Given the staunch defense you are giving to aeromedical operations in trying to paint them somehow in a less hazardous light, I wonder about your own leanings on the matter. The last time I saw someone dance around the issue and try to smokescreen this much was the medical director for one of the national companies during a rather heated discussion.
Like it or not, regardless of any comparison to ground fatalities or anything else, aeromedical evacuation is an extremely hazardous operation that simply has little to no place in the trauma system in most areas due to the risk and the lack of appreciable benefit. At very least, severe and binding restrictions on their operation should be put in place to prevent operators from engaging in what is tantamount to a game of Russian roullete.
If this does not cease, some attorney is going to figure out that aeromedical transfer or scene response is not supported by the literature and when one of these birds goes down, he (or she) will convince the families of the crew (and/or) to go after the company operating the helicopter and anyone involved in arranging the transfer. I think this is likely to be the way the services are finally reigned in for good.
I'm highly critical of HEMS safety, and I'm a self-proclaimed helicopter junky. I love them. I love to fly. I think it's cool when you land in a helicopter in the middle of an interstate. I love the smell of jet fuel, I love the feeling of the vibrations on final approach, I love the sound of a helicopter as it comes in on final approach, I love the feeling of vertical takeoff.
However, even I, probably one of the biggest helicopter fanatics on SDN, recognize the dangers associated with helicopter EMS. I don't downplay those risks. To do so would be foolish.
However, even I, probably one of the biggest helicopter fanatics on SDN, recognize the dangers associated with helicopter EMS. I don't downplay those risks. To do so would be foolish.
Agreed. I think helicopters are awesome, and have flown on civilian aeromedical missions a few times. Despite the "cool" factor, we must remain cognizant of the proper role and proper operation of these aircraft.
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deleted109597
Uh, I didn't say it was thorough. Usually it is just something flat, hopefully away from powerlines, and bigger than the rotors.
Well, I didn't rank any places that require you to fly, I won't fly and never will unless as a patient, and I think the whole system needs an overhaul. I'm not trying to downplay any risks of helo transport, I'm trying to enlighten people on the risks of EMS, because those guys are out there dying too, they just aren't on the national news.
Does your data say anything about the non-flying EMS? All I was trying to point out is that of EMS staff that I have seen in my smaller, more rural southern locales (n=6-7), helicopter crews are skinny, and ground guys are generally less so.
Hopefully is the keyword in many areas. I think there should be a limitation of "scene" responses to sites that are predetermined if they are deemed to be absolutely necessary at all.
Remember that weight is not an absolute predictor for CAD or SCD nor does it say anything about physical fitness. You are likely seeing a false impression because of the selection of persons who might the height and weight criteria to function as a flight crew member. This would tend to exclude your normal large and burly guys that are involved in firefighting and, almost by default, EMS.
Just checking. I agree that there are risks in ground-based EMS that need to be addressed. However, the use of accurate information to do so without unnecessary clumping of injury types and circumstances is also paramount.
Transported a stemi yesterday from outside hosp to cath lab at the different hospital....was giving report to the cardiologist and he was like "yah, I already saw her at the other hospital." I'm pretty sure he doesn't have lights and sirens in his car and he was waiting for us when we arrive by helicopter! I almost asked why he just didn't throw a monitor in his beemer and drive her over cause he'd double his profit, but I figured he wouldn't find this very funny. I agree these are the situations that need to be re-evaluated for helo transport, but again it is pretty low risk flying interfacility in the daytime with good weather. I think most crashes are related to scene flights (accurate?).
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Amen to that(modification of the trauma decision tree, that is). You know, there's several local medical directors who have taken their paramedics to task for flying patients who are within thirty minutes of a trauma center. MIEMSS is taking a long, hard look at helicopter transports, but you can imagine the political wrangling involved when dealing with things like the State Police and publically funded aeromedical transport problems. I'm not suggesting that politics trump safety; however, the issue of aeromedical transport spans across a wide variety of domains in addition to that of patient safety....
What's that noise? Oh, never mind.. its just troopers 2 and 8 inbound with another "mechanism" MVC patient. 🙂
-P
Well, since no one mentioned this w/specificity yet, I'll copy an older post I made on a 'different' site:
Ironic that just this past week a major news story has come out highlighting one such problem facing civilian air ambulance crews due to our current involvement overseas and why this may be happening more often.
I, of course, have no idea if this contributed in any way to this particular sad loss, (and clearly as I SDN post now we know it wasn't)but if you read the full article it states something like the lack of these visual aids contributed to at least >13 of evac crashes in the one recent year they have current #'s for.
Perhaps the industry may be a victim of unintended consequences?
Interesting read and an issue of great concern to those in the community.
http://www.contracostatimes.com/search/ci_9477534
(Full disclosure, I actually am a military flight nurse so no ulterior motives w/this one....)
Ironic that just this past week a major news story has come out highlighting one such problem facing civilian air ambulance crews due to our current involvement overseas and why this may be happening more often.
I, of course, have no idea if this contributed in any way to this particular sad loss, (and clearly as I SDN post now we know it wasn't)but if you read the full article it states something like the lack of these visual aids contributed to at least >13 of evac crashes in the one recent year they have current #'s for.
Perhaps the industry may be a victim of unintended consequences?
Interesting read and an issue of great concern to those in the community.
http://www.contracostatimes.com/search/ci_9477534
(Full disclosure, I actually am a military flight nurse so no ulterior motives w/this one....)
👍 Same here.
Part of the reason we see so many crashes with urban Medivac and news choppers is that in both of these situations you're going to be taking on additional risk to expidite travel. Whether it is a less-than-thorough pre-flight check, reduced traffic/situational awareness during travel, or the danger inherent to landing on a highway with light poles, the fact is the risk is inherently high.
I'd like to point out that there are two numbers we are looking to minimize here. The first is transport related fatalities (the actual COUNT of people who die as a result of aeromedical transport) while the second is the generalized statistical risk of a crash (crashed flights / count of flights).
So the question is: Is is better to reduce the RISK associated with medical transport or the FATALITIES associated with medical transport.
Simply reducing the number of Medivac flights will reduce the number of fatalities but will not change the overall flight risk for the better. One could even argue that by reducing the number of flights, the risk of a crash INCREASES due to reduced flight crew experience and preparedness. In this case, we are reducing fatalities, but increasing risk.
On the other hand, implementing the various FAA and NTSB recommendations discussed earlier on in this thread would reduce the risk of a crash, and consequently, the number of crash related fatalities. In this case, we are reducing BOTH numbers.
I think it would be more prudent to place emphasis on reducing the risk involved with aeromedical transport, and at the same time the number of fatalities, than just the number of fatalities with an resultant increase in risk.
Of course, part of managing risk is risk avoidance, so a measured reduction in flight operations by means of stricter medivac request guidelines may, of course, be part of the overall risk managment plan, but I think it is important that flight operation managers consider flight reductions as one of part of a multi-faceted solution.
sm plane crash today with angel flight.
http://http://www.foxnews.com/story/0,2933,402202,00.html
http://http://www.foxnews.com/story/0,2933,402202,00.html
