Helicopter air ambulances continue to suffer accidents with monotonous regularity in spite of the industry’s best efforts to get that number to zero. The helicopter operators, the customers, the FAA, and the NTSB are all looking hard at what can be done to get the risk out of air medical operations. In mid-2009 the NTSB published 19 recommendations focused on the Board’s analysis of accident/incident data. 14 recommendations were made to federal alphabet agencies (the FAA, CMS-Center for Medicare and Medicaid Services, and the FICEMS- Federal Interagency Committee on EMS) and 5 to the community of helicopter operators. It is important to note that the NTSB has no authority to force any of these agencies or the operators to adopt those recommendations.
Early in my aviation career I was employed in the helicopter air taxi business and remained so for nearly 15 years. Helicopter EMS became our biggest market, in fact we eventually divested the company of all non-EMS operations. We began with one air medical base in 1982 and added more every year; a sister company was doing the same, we in the East and they in the Midwest. Eventually the two companies became one and shortly thereafter we acquired a competitor of equal size and grew to number two nationally in terms of the number of EMS bases, aircraft, pilots, and technicians. Over those years I served in all of the operations positions- Chief Pilot, Director of Operations, and VP/General Manager. The point here being that my experience allows me to offer meaningful comments on the air medical business, even after an absence of a decade and a half.
During that period of rapid growth we had crashes, too. During my years with the company we suffered a total of 4 accidents with 10 fatalities. Interestingly, none of these were related to weather conditions, which seem to be a leading cause of accidents especially when combined with flying in the dark. One of our aircraft went down due to fuel starvation, another had an in-flight fire*, and the third and fourth were involved in CFIT (controlled flight into terrain) episodes. In one CFIT event the pilot made a high-speed steep turn at an impossibly low altitude, and the main rotor came in contact with the ground. In the second case the aircraft contacted the ground at cruise speed in an area of gradually rising terrain.
(*Suspected but never proven conclusively. The crash occurred at the end of an unsuccessful autorotation at night.)
I’d like to think somehow we could have avoided these horrible mishaps. I spent a lot of time after each one looking at the conditions and circumstances preceding it- I wasn’t alone- everyone in the company did the same. Each of us within our particular aviation disciplines looked for ways to make improvements to flight safety and then took the steps we thought appropriate. In my area pilot training continually improved- more hours, night training, instrument training, and scenario-based training. Pilot selection became more rigorous. An EMS manual, a specialized guide for our pilots intended to supplement our General Operations Manual was introduced.
In response to our efforts, not just our company but for the EMS business overall, the accident rate did improve in the late 1980s and early 1990s. I left the business in 1993 and safety statistics were trending upward for air medical programs. At the time there were approximately 180 hospital bases and 250 helicopters nationwide (all operators). For a couple of years those numbers remained constant but the end was coming for the established business model in which a hospital contracted with a helicopter operator to supply an on-site helicopter, pilots, and a technician. The hospital then crewed the back end of the helicopter with its own doctors, nurses, or paramedics/EMTs and sent the patient a bill for the air ambulance care and transport. It was worth it since the potential profit to be made from a gravely ill or injured patient could run into six figures. But by now that market segment had matured- hospitals wanted to reduce their financial committment and the associated risk. Helicopter operators wanted bigger profits in a market segment where for too long competition made it hard to make any money.
To Be Continued.
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