EMS Helicopter Safety: Can New Rules Save Lives?

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Ross D. Franklin / AP

National Transportation Safety Board and Federal Aviation Administration workers survey the damage left by the crash of two medical helicopters in Flagstaff, Ariz.

Wayne Kirby's last helicopter mission came on a warm and moonless night in South Texas on June 8, 2008. A few scattered clouds floated 1,200 ft. above the Huntsville International Airport. The sky was clear for miles. But just south of town, a low cloud swept in over Sam Houston National Forest. The fog already had thwarted another helicopter pilot who had tried to fly a patient from Huntsville Memorial Hospital to Houston. Blinded by the fog, that pilot was forced to turn around and abort the mission. Ninety minutes after that, Kirby was asked to fly the same patient to Houston.

He knew about the first, failed mission. But he couldn't see the cloud, which lingered in a gap between airport weather stations. Kirby decided it was safe to launch. He flew his bright yellow Bell 407 helicopter to the hospital, picked up the patient, and took off for Houston at 2:46 a.m. Two minutes later, Kirby was flying 600 ft. above dense forest at 122 m.p.h., near the spot where the first pilot aborted. Kirby lost radio contact with the hospital in Houston. His helicopter dropped suddenly, to 100 ft. Its rotor sliced into thick pine trees. The cabin smashed into three pieces and landed upside down, drenched in jet fuel. Kirby, the patient and two medical crew members died. (See a story about water landings.)

The crash was a tragedy. It was not a surprise. Helicopter ambulances were a huge step forward in trauma care when the industry started in the early 1970s. But even as the fleet more than tripled in size, from 200 helicopters in 1988 to around 665 today, safety problems festered. On average, five EMS helicopters crashed every year between 1988 and 1997, according to new research by Dr. Ira Blumen, director of the University of Chicago Aeromedical Network. The average has doubled to more than 12 crashes per year since 1998. The past 15 months have been the deadliest yet: there have been 18 helicopter-ambulance crashes since October 2007, including 11 fatal accidents that left 36 people dead. "The current accident record is unacceptable, and it has to improve," says Robert Sumwalt, vice chairman of the National Transportation Safety Board, which investigates air crashes.

Beginning on Tuesday, Sumwalt will lead four days of hearings in Washington into the medical-helicopter industry, the longest inquiry in the board's history. The hearings will be the title fight in a long-simmering argument over medical-helicopter crashes and how to prevent them. The Federal Aviation Administration (FAA), which has sole power to regulate helicopter flight, and the Association of Air Medical Services, the industry's main trade group, maintain that most accidents have nothing in common, making it difficult for the FAA to impose tough safety rules. "Each accident has a different set of facts that leads up to it," says Peggy Gilligan, the FAA's top safety official. "The data supports that if standards are being met, these operations can fly safely." (Read a first-person story on riding in an EMS helicopter.)

Wayne Kirby followed the standards, yet he and three passengers still died. Many aviation-safety experts believe such crashes do follow a pattern, one that looks a lot like Kirby's last flight: pilots launch in flyable conditions, only to be confronted midflight by unexpected foul weather, darkness and terrain that they are unequipped to handle. "The FAA says they need to study the situation some more," says Vernon Albert, one of the industry's top safety experts. "That's garbage. They need to get off their butts." (See a story about surviving disasters.)

When was the last time you shuffled off a commercial airliner and saw just one pilot in the cockpit? Probably never. Federal rules require two pilots for every airline flight, and all airliners must be equipped with GPS, weather-tracking and collision-avoidance systems. Airliners fly predetermined routes, usually on autopilot, and always land at airports. When the weather turns cloudy or the night turns dark, airline pilots have the training and equipment to fly using just their instruments. "You wouldn't get onto an airliner that can't fly through clouds," says Drew Ferguson, lead pilot for Metro Life Flight, which operates EMS helicopters for MetroHealth, the public hospital in Cleveland. "What we do is more dangerous than flying a commercial airliner, no question."

Unlike airliners, medical helicopters are unstable aircraft that require constant input from the pilot. They often land in remote desert canyons, on freeways and in muddy farmers' fields, places without precise approach paths, powerful weather-tracking systems or even lights. "In a medical helicopter, you're basically an on-demand taxi," says Blumen, who recently completed a study of 264 medical-helicopter accidents stretching back to 1972.

Even though they fly in more challenging conditions, medical-helicopter pilots are not required by the FAA to be trained to fly using only their instruments. In any case, most helicopters lack the necessary technology. So when a helicopter pilot flies into a cloud and can't see out his windows, it is — by definition — an emergency. The pilot must simultaneously descend until he can see lights on the ground, toggle multiple radio frequencies to inform nearby planes and airports that he is flying blind, maintain control of a twitchy aircraft in conditions he is not trained to handle, over terrain he does not know and cannot see. When flight nurses have nightmares, this is the picture on the backs of their eyelids.

"You try driving your car, talking on your cell phone, adjusting your radio and drinking a Coke in a thunderstorm," says Kevin High, manager of the trauma program at Vanderbilt Medical Center in Nashville and president of the Air & Surface Transport Nurses Association. "Now do it in a helicopter that doesn't have advanced avionics because the company doesn't want to spend the money. That's how you get into trouble."

These troubles are not new. The National Transportation Safety Board first investigated the medical-helicopter industry's crash epidemic in 1988. It found that low visibility, often caused by bad weather, accounted for 61% of all crashes. "Weather-related accidents are the most common and the most serious type of accident experienced by EMS helicopters," the report found, "and are also the most easily prevented."

However, not much prevention has happened since 1988. Variations on a simple chain reaction — where pilots fly without instruments in low visibility or at night, lose their bearings or make bad decisions, and crash into terrain — caused 80% of all helicopter-ambulance accidents reviewed by the Congressional Research Service in 2006. "The same accidents keep happening over and over," says Stacey Friedman, founder of Safemedflight.org, which advocates for crash victims' families. Her sister Erin Reed was a nurse who died in a medical-helicopter crash in Puget Sound in 2005.

Some regulators and industry leaders believe this is an oversimplification. As the FAA's Gilligan points out, a number of EMS programs that fly beefy, dual-pilot helicopters with sophisticated safety technologies have crashed, while other programs flying small, single-pilot helicopters with nothing more advanced than radio altimeters have perfect safety records. "When we introduce new technology, we want to solve the problem," Gilligan says. "But we have to be very careful not to introduce new risks."

Asked what's causing so many helicopter crashes, Dawn Mancuso, CEO of the Association of Air Medical Services, says, "I wish I had the answer to that question, because we would have fixed it by now."

See pictures of the plane crash in the Hudson River.