The number of people seriously injured and killed in helicopter air ambulance crashes has been well documented. In one 10-month period alone between December 2007 and October 2008, there were 13 helicopter air ambulance crashes which resulted in 35 deaths. There are around 75 air ambulance companies operating more than 1500 helicopters in the U.S. Citing cost factors, many air ambulance services have resisted both industry-wide and FAA proposals calling for enhanced use of safety equipment and other regulatory measures. Of the 27 fatal medical air ambulance helicopter crashes between 1998 and 2004, 21 were at night and often in bad weather conditions.
Much of the mission incentive has an economic basis. A typical medical air ambulance transport costs at least several thousand dollars, and in some circumstances, may run up to $25,000.00 or more. This is five to ten times greater than the cost of a traditional ground ambulance. Private health insurance plans and even some public ones such as Medicare cover at least part of these costs. Given that there are about 400,000 medical helicopter flights annually, that amounts to a great deal of funding both for the helicopter operator and the hospital. A number of mission-specific measures should be taken to address the serious risks inherent in helicopter air ambulance operations.
The NTSB has long proposed a flight risk evaluation program for air ambulance operators specifically including consideration of weather, visibility and the prospect of unfamiliar or unsafe landing sites. The NTSB convened a public meeting on September 1, 2009 to further advance its safety recommendations concerning helicopter emergency medical services. In laying out these proposals, the NTSB noted that there was pressure to conduct these operations in less than ideal weather conditions. As a result, many of the NTSB’s safety recommendations address enhanced pilot training and risk assessment measures to reduce the number of flight missions undertaken in dangerous operational environments. This push by the NTSB was precisely responsible for the stricter flight rules finally implemented by the FAA in late 2014.
As part of the risk assessment procedure, the NTSB recommended using a more formal dispatch approach which would include an evaluation of the current weather information and assistance to the pilot in assessing some of the other flight risk decisions. Many studies have determined that helicopter air ambulances are not always the best means of transporting patients and in many cases are not even necessary. In many instances the patient’s injuries are relatively minor and ground transportation would have resulted in arrival at the hospital faster than via helicopter transport.
On far too many occasions helicopter air ambulances have taken on a mission in weather conditions not suitable for flight. Many traffic-related accidents and resultant trauma are caused by poor weather conditions such as fog, heavy snow or rain or thunderstorm and lightning conditions. These conditions are potentially as hazardous for helicopters as for on-ground vehicles. In such a scenario, the hospital facility must elect to send the on-ground ambulance rather than to risk the safety of the pilot, crew and potentially the patient to a helicopter crash.
Given the number of night missions routinely flown by air ambulance helicopters, additional safety devices such as terrain awareness and warning systems (TAWS) should be required. All air ambulance operators should also be required to equip their helicopters with night vision goggles (NVGs) which substantially enhance the pilot’s ability to visualize obstacles and maneuver around them in low light and dark conditions.
Night vision technology has long been used by military helicopter pilots and is capable of providing pilots with the equivalence of 20/20 vision in the dark. The use of NVGs would not require any modification of the aircraft structure but would require some additional pilot training as to their appropriate use. A recent survey conducted by the National EMS Pilots Association found overwhelming support for use of NVGs. The addition of NVGs for all air ambulance helicopters in this country would have a marked impact on reducing helicopter crashes for these types of flight missions. The NTSB has been at the forefront of recommending safety improvements for air ambulance helicopters for many years.
Enhanced helicopter pilot training would have immediate impact on reduction of accidents. The FAA has considered and should now implement far more rigorous testing for air ambulance helicopter pilots to make sure that these pilots can operate the aircraft in sub-par weather conditions which have led to many helicopter accidents. This should be interconnected with the flight risk assessment program before each and every flight. If the flight risks are too high such as where the potential landing zone poses undue risks or the weather is of poor visibility, the flight should not be undertaken. There is a great disparity in the required pilot experience among air ambulance operations. The Mayo Clinic requires helicopter pilots to have 5,000 hours of experience while other operators require only a minimum of 1,500 hours of flight time. This disparity should be minimized, in favor of more pilot experience across the board.