Yet Another Aeromedical Death

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docB

docB

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and there was a copter crash in illinois last night killing 4, including a patient.

i'm in a program with a very active flight program heavily reliant on residents. it was a selling point for where i ended up. i ain't going near that bird now. they are falling out of the sky at an alarming rate.
 
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Mighty Mouse said:
i'm in a program with a very active flight program heavily reliant on residents. it was a selling point for where i ended up. i ain't going near that bird now. they are falling out of the sky at an alarming rate.
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Since we have a very active mandatory flight program as part of our residency I'm interested to see how this affects our recruiting this year. I'm sure it will come up many times.

I'm not sure how many more people are going to have to die to get some change in HEMS operations.
 
crewmaster1 said:
Since we have a very active mandatory flight program as part of our residency I'm interested to see how this affects our recruiting this year. I'm sure it will come up many times.

I'm not sure how many more people are going to have to die to get some change in HEMS operations.
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By all accounts from SDN and people I've talked to, Cinci has somewhat of a mythical reputation in EM. With that said, if I apply to EM (MS3 right now), there's no chance of me applying there because of the mandatory flight time. I've felt that way for a couple of years and it's even stronger now. If they took away the requirement, it would be very attractive.
 
All of these recent accidents have definitely shaken me up a bit... but that being said, I'm still very interested in a few programs that have mandatory flight time, including Cinci. I just think it's a terrific way to learn another aspect of emergency medicine, and I do believe flight makes a difference, at least in more remote or rural areas. Of course, I would be very happy to see increased regulations and safety checks for these choppers - what exactly IS going on lately?
 
I have a feeling this is going to be a heavy issue. I personally don't ever want to fly in one of those. However, I think residents should have the option. I don't think that any resident should be MANDATED to fly. just my .02
 
I definitely understand the worry. But all helicopter agencies are not created equally. For instance, where we fly, we have never had an accident in nearly 30 years. We are in a huge system, 5 birds, and our system is big enough that it does not "rely" on the helicopters for anything more than an ancillary service, and essentially a flying billboard. There are other agencies around us not affilliated with a hospital system like we are, and they are more dangerous. I think it comes down to pilot experience, willingness to stay grounded when weather changes, and willingness to demand that an LZ is safe to land in. I've been on flights where we all decided we just couldn't get in to that shoebox the volunteer firefighters told us was "secure and wide". Secure except for the lines on 3 sides and the tower to the south!! We always make a recon around the LZ and we look hard at whether we can land. On the flight I mentioned we just flew to the local airport and had the EMS crew bring the patient to us. Another thing that also makes a difference in my opinion, and reduces the resident physician's danger is to only fly on scene calls. Now obviously, scene calls are more dangerous LZ's often time, but it limits your totol number of times you get off the ground, and means you are on higher accuity flights. That is how we do it at Geisinger. And in all honesty, we are as essential as we want to be in the bird. Our bird can and will lift off if we can't make it because we are busy in the department. So that boils down to if you really, really don't want to fly, our director is not going to force you to do it. Ultimately you can't force someone to fly and you should not.
 
I have never seen a physician on a chopper what is the need? Where I fly the residents get to fly but they really don't do much, its just more of an observer role and an extra set of hands. We do 75% scene calls, now I can see the need of a physician on our transfers, but why on a scene call? Our average flight time is normally under 15 min..
 
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I think that grounding all ambulances would be tantamount to throwing the baby out with the bathwater. There are certain instances where the most critically ill patients who have an inordinately long transport time certainly are on the benefit end of the risk:benefit ratio involved in air transport. But I do think that there are going to be some major overhauls in the field in regard to short hops and flights in marginal weather.

pseudoknot said:
What BS. They should have grounded the fleet nationwide already (yes, I understand that would be the FAA's call and not NTSB).
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bartleby said:
I think that grounding all ambulances would be tantamount to throwing the baby out with the bathwater. There are certain instances where the most critically ill patients who have an inordinately long transport time certainly are on the benefit end of the risk:benefit ratio involved in air transport. But I do think that there are going to be some major overhauls in the field in regard to short hops and flights in marginal weather.
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That's the crux of the problem though. If we significantly limit helo transports from where we are now it will result in the units spending more time sitting on the group which = not earning money. That would effectively eliminate many of the less busy services. With less services that would increase the response and transport times for many of the calls which would in turn further reduce the effectiveness of the whole service.

Now I personally think that would be the way to go. Limit helo to those for whom there is really significant benefit such as critical trauma with > 1 hour transport by ground. As I've mentioned before the existence of helos propagates their use as transferring hospitals fear repercussions from patients going bad enroute and having to justify not using it. Limiting helo transport for those patients would help.

Now that creates more problems. First, in a transfer situation you've got a doctor who is saying (justifiably or not) that helo is required. Second, from the safety standpoint, eliminating transfers is taking out the safer component of the service. Landing at hospitals with established LZs is safer than landing on scenes. So stopping transfers is addressing the wrong end of the equation.
 
Greg Henry presented an article at ACEP this week that showed discontinuation of a helicopter service was not associated with an increased trauma mortality. The study was in Journal Trauma out of UTMB-Galveston.

I think we need analyze this issue further because it seems like the benefits don't out weigh the risks and costs.
 
I had a pilot's license during college, and in general our view of those lifeflights, both helicopter and otherwise was not good. We basically felt that those pilots were pushing the envelope a bit too much. Despite the skill and dedication, the aircraft were often flying in unsafe or questionable conditions, and the generally rushed nature of the flight made things even more worse. I knew one pilot who refused to take off because he told them 'if we leave, we'll all die in this weather.' They fired him, and he was happy to leave.

Don't get me wrong, I appreciate what they do, and I've seen them save lives, but there's no way you would get me on one of those flights.
 
I was going to try to set up a flight during fourth year, but now I'm not so sure. Feel like maybe I should give FAA/NTSB a few years to get their stuff together and try to fly in residency once everyone has night vision, new rules etc.
 
hmm. I'm supposed to get to fly next week.
 
i've flown heli's for 23 years and now i have retired from flying. if i ever get the bug to fly again i go watch the u-tube videos on crashes.

they're great machines for a specific purpose, but there is always the risk. flying at night is asking for trouble. the accident occurred at about 2AM. the pilot in the reno area accident apparently called out a mayday just prior to going in. it sounds like he was doing an autorotation. perhaps he ran out of fuel (happens to the best pilots-that's how gary powers died). the post crash fire, though, argues against fuel starvation. that was an AS350, french machine, used to be called "falling stars" until they ironed out the engine bugs.

looking at the crash scene photos i guess that he missed the flare at the bottom and took off his tail, then rolled up. at night you cannot judge heights well, and if you don't start your flare at the right altitude, you will hit hard.

i doubt if night vision goggles will help. they will probably just increase the accident rate by luring pilots into situations that they would have avoided.
look at the army's experience with night vision goggles.

if you want to be safe, never fly at night. never fly in marginal visibility.
 
Mighty Mouse said:
and there was a copter crash in illinois last night killing 4, including a patient.

i'm in a program with a very active flight program heavily reliant on residents. it was a selling point for where i ended up. i ain't going near that bird now. they are falling out of the sky at an alarming rate.
Click to expand...

yeah, i'm on my EMS rotation now and (prior to these recent accidents) opted out of the helicopter ride-alongs. my utmost respect and appreciation for those who fly.
 
paiute said:
i've flown heli's for 23 years and now i have retired from flying. if i ever get the bug to fly again i go watch the u-tube videos on crashes.

they're great machines for a specific purpose, but there is always the risk. flying at night is asking for trouble. the accident occurred at about 2AM. the pilot in the reno area accident apparently called out a mayday just prior to going in. it sounds like he was doing an autorotation. perhaps he ran out of fuel (happens to the best pilots-that's how gary powers died). the post crash fire, though, argues against fuel starvation. that was an AS350, french machine, used to be called "falling stars" until they ironed out the engine bugs.

looking at the crash scene photos i guess that he missed the flare at the bottom and took off his tail, then rolled up. at night you cannot judge heights well, and if you don't start your flare at the right altitude, you will hit hard.

i doubt if night vision goggles will help. they will probably just increase the accident rate by luring pilots into situations that they would have avoided.
look at the army's experience with night vision goggles.

if you want to be safe, never fly at night. never fly in marginal visibility.
Click to expand...

Great post. We always said that helicopters don't fly, they just beat the air into submission. I'll stick to planes where at least there's a potential for gliding.
 
helicopters glide too, it's called autorotation. pilots practice it regularly. no one with common sense would fly a heli if it weren't possible to autorotate (glide without engine power). planes, however, will stall: look at the you tube videos. the heli main blade can stall also: that's usually fatal unless you're within 10 feet of the ground. all aircraft are dangerous, though it is known that heli's have a higher crash rate.

your HEMS pilot should be glad to demo an auto for you next time you go up. it's a good learning experience and is probably the safest configuration in heli flight.
 
paiute said:
helicopters glide too, it's called autorotation. pilots practice it regularly. no one with common sense would fly a heli if it weren't possible to autorotate (glide without engine power). planes, however, will stall: look at the you tube videos. the heli main blade can stall also: that's usually fatal unless you're within 10 feet of the ground. all aircraft are dangerous, though it is known that heli's have a higher crash rate.

your HEMS pilot should be glad to demo an auto for you next time you go up. it's a good learning experience and is probably the safest configuration in heli flight.
Click to expand...

That's true but you have a lot more options gliding in a fixed wing aircraft compared to a rotorcraft. Autorotation is like partially controlled falling while once you trim to best glide in an airplane you usually have miles of controlled flight to look for a clearing. Stalling is a result of inappropriately increasing your angle of attack which is bad during an unpowered situation.
 
Scary stuff. Safety must be the first priority in operating a medical helicopter program. I have to say, flying in our BK117s with dual engines provides some reassurance!
 
I remember looking at occupational fatalities back in residency and HEMS was up there with coal-miners. It was good training, and there are ways to manage the risk (only flying under VFR conditions, blinding pilot to patient situation, any member can scrub the mission, dual-engines, maybe night-vision). But there is a risk, and there may not be the benefit to offset that risk. In three years of flying, I think I only made a significant difference in 2 patients. And both of them were intrahospital transfers during which flying actually lengthened the time of transport.
 
Not to belittle the significance of these accidents, but it's hard to measure just how safe (or unsafe) flying in these EMS helicopters are, unless you look at the data across the board, analyzing the total # of flights vs. the accidents/injuries/fatalities. For example, when talking about the safety of flying by aircraft...

"Air travel, despite the rash of safety incidents surrounding Qantas, has never been safer.

By any measure, travellers are far safer in the air than driving to the airport, according to Boeing and the US National Safety Council.

Every day, six million people are in the air and they're 22 times safer than being on the road, the council says.

In fact, in a typical six-month period in the US, 21,000 die on the roads, which equates to the total loss of life in commercial airline accidents since 1960.

Since 1960, air safety has soared from 45 fatal accidents per million departures to less than one today as the industry learns from accidents, engines become more reliable and cockpit technology enters the computer age."

I'd be very interested in seeing such "risk adjusted" data for these EMS helicopters, based on the total number of flights nationwide vs. those w/ accidents/injuries/fatalities.
 
These statistics are pretty well known by everyone, but I'd love to sit down one day and compare the risks after excluding fatalities related to alcohol, excessive speed, dangerous driving, fatigue, inattention, etc.

I think after all that the risks would still be higher, but not quite as dramatic.
 
FDNewbie said:
Not to belittle the significance of these accidents, but it's hard to measure just how safe (or unsafe) flying in these EMS helicopters are, unless you look at the data across the board, analyzing the total # of flights vs. the accidents/injuries/fatalities. For example, when talking about the safety of flying by aircraft...

"Air travel, despite the rash of safety incidents surrounding Qantas, has never been safer.

By any measure, travellers are far safer in the air than driving to the airport, according to Boeing and the US National Safety Council.

Every day, six million people are in the air and they're 22 times safer than being on the road, the council says.

In fact, in a typical six-month period in the US, 21,000 die on the roads, which equates to the total loss of life in commercial airline accidents since 1960.

Since 1960, air safety has soared from 45 fatal accidents per million departures to less than one today as the industry learns from accidents, engines become more reliable and cockpit technology enters the computer age."

I'd be very interested in seeing such "risk adjusted" data for these EMS helicopters, based on the total number of flights nationwide vs. those w/ accidents/injuries/fatalities.
Click to expand...

But the issue of whether aeromedical helicoptor flights are any more or less safe then other helicopter flights is irrelevent. Aeromed flies for different reasons and in different environments so the comparison doesn't mean anything. One of the most important questions is if aeromed leads to better outcomes at all.
 
FDNewbie said:
Not to belittle the significance of these accidents, but it's hard to measure just how safe (or unsafe) flying in these EMS helicopters are, unless you look at the data across the board, analyzing the total # of flights vs. the accidents/injuries/fatalities. For example, when talking about the safety of flying by aircraft...

"Air travel, despite the rash of safety incidents surrounding Qantas, has never been safer.

By any measure, travellers are far safer in the air than driving to the airport, according to Boeing and the US National Safety Council.

Every day, six million people are in the air and they're 22 times safer than being on the road, the council says.

In fact, in a typical six-month period in the US, 21,000 die on the roads, which equates to the total loss of life in commercial airline accidents since 1960.

Since 1960, air safety has soared from 45 fatal accidents per million departures to less than one today as the industry learns from accidents, engines become more reliable and cockpit technology enters the computer age."

I'd be very interested in seeing such "risk adjusted" data for these EMS helicopters, based on the total number of flights nationwide vs. those w/ accidents/injuries/fatalities.
Click to expand...

The correct way to look at it is the accident rate per #flight hours though you can also 'slice the bread' by #missions. This has actually not been studied/published in the US. Perhaps surprising given it costs 10 times as much as ground transport while providing few proven benefits, but nothing in this crazy money wasting system surprises me anymore. The only study done on this recently was on the German system and that showed conflicting data depending on how you sliced it. What we need is a larger study encompassing all of US HEMS to have enough power to draw valid conclusions. Unless the FAA/NTSB undertakes this, I doubt this can be done by a private group/individual given the reluctance of private HEMS operators to cooperate.

Edit: so speaking of the NTSB, I came across this after a little Googling. I still don't see it on pubmed, but it's a very informative lecture given by someone who has studied HEMS for a while; good stuff. Page 33 seems to answer your question.
 
Last edited:
willow18 said:
The correct way to look at it is the accident rate per #flight hours though you can also 'slice the bread' by #missions. This has actually not been studied/published in the US. Perhaps surprising given it costs 10 times as much as ground transport while providing few proven benefits, but nothing in this crazy money wasting system surprises me anymore. The only study done on this recently was on the German system and that showed conflicting data depending on how you sliced it. What we need is a larger study encompassing all of US HEMS to have enough power to draw valid conclusions. Unless the FAA/NTSB undertakes this, I doubt this can be done by a private group/individual given the reluctance of private HEMS operators to cooperate.

Edit: so speaking of the NTSB, I came across this after a little Googling. I still don't see it on pubmed, but it's a very informative lecture given by someone who has studied HEMS for a while; good stuff. Page 33 seems to answer your question.
Click to expand...
Yea that presentation sure did seem to have some good data...thanks!
 
...Once again, think hard before calling for the helicopter. I know people disagree but no way could you put me on one of those vomit buckets with a propeller for a living... JMHO
 
Sorry, referring to the previous articles..... but the statement still stands. One of my partners took me in his airplane and I was stuck between vomiting, SVT, and pure hysteria. Needless to say our "flight" didn't last long. :scared:
 
TysonCook said:
Sorry, referring to the previous articles..... but the statement still stands. One of my partners took me in his airplane and I was stuck between vomiting, SVT, and pure hysteria. Needless to say our "flight" didn't last long. :scared:
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Some got it, some don't. ;)
 
Apollyon said:
The incident docB referenced was a fixed-wing plane crash.
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I haven't seen numbers on it, but I'd bet the odds of dying from a crash are still higher in fixed-wing vs ground transport. I don't know the details in this case, but it seems it was a man with a hip fx; the trip would've been 3 hours by ground transport.

I love anything that flies and would've loved to spend all my time up there if it made a real difference, but the sad fact is that most HEMS flights are a waste and probably unethical as well given the risk vs benefit ratio.
 
I've been a pilot for 15 years, and I'm married to an EM riesident.

FDNewbie said:
I'd be very interested in seeing such "risk adjusted" data for these EMS helicopters, based on the total number of flights nationwide vs. those w/ accidents/injuries/fatalities.
Click to expand...

Helo EMS is the deadliest segment of aviation in the USA outside of Alaska. Cropdusters have a better safety record.

Fixed wing EMS is much better. Roughly on par with other passneger charter flying, far better than driving.


The best thing Docs can do is not allow your staff to "shop around" for a company that will push the weather. If I know that you will call another comapny if I refuse to take a flight, then I might be pressured to fly in more marginal weather where most of these accidents happen.

Fortunatly it's rare, but docs and patient families still argue with pilots about wether they can fly a trip safely or not. As much as it pains me to refuse to transport a patient, I'm not going to put 4 lives at risk to try to save one.
 
If YOU could die from putting in a chest tube, you'd think a lot harder about whether the patient actually had to have it, wouldn't you? What about if you, your nurse, your tech and the janitor could die from it? Think about that the next time you call for a chopper.
 
And another. My brother used to fly with these people. Too close to home.

Eagle Med

FAA: 2 killed in Okla. medical helicopter crash

(AP) – 30 minutes ago

KINGFISHER, Okla. — Authorities say at least two people are dead after a medical helicopter crashed in a central Oklahoma field.

Federal Aviation Administration spokesman Lynn Lunsford says the Eagle Med helicopter had left Oklahoma City's Integris Baptist Medical Center and was on its way to pick up a patient when it crashed about 8 p.m. Thursday.

Lunsford didn't know the helicopter's destination. It crashed near Kingfisher, which is about 50 miles northwest of Oklahoma City.

Lunsford says he doesn't know how many people were on board the aircraft but that another medical helicopter had been dispatched to the scene.
Click to expand...

Updated info:

KINGFISHER — Two people were killed and one injured this evening when a medical helicopter crashed four miles south of Kingfisher, the Oklahoma Highway Patrol reported.

It was an Eagle Med test flight, said Sgt. Denise Robinson. She said three people were aboard the helicopter.

Kingfisher County Emergency Management Director Steve Loftis says the helicopter went down about four miles south of Kingfisher.

Federal Aviation Administration spokesman Lynn Lunsford says the Eagle Med helicopter left Oklahoma City's Integris Baptist Medical Center and was on its way to a hospital in Okeene when it crashed about 7:30 p.m. four miles southeast of Kingfisher.

Lunsford said the injured person was being airlifted by to Oklahoma City on another medical helicopter.

Read more: More
Click to expand...
 
My sister (a fellow flight nurse) and her husband (firefighter who drives EagleMed ambulances on his days off) were good friends with the crew. The pilot and nurse on flight were killed and the paramedic was thrown 50 yards from the wreckage where he was seen waving for help by a nearby local working on his land; He is in critical care with severe spinal injuries among other trauma.
 
The "air ambulance" crash into lake Michigan today was a private plane ( owned by a construction company) which was taking a patient to Mayo. Tragic just the same
 
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