Deadly Cost of Helicopters Swooping In to Save a Life

[catskills]

Washington Post Articles on Helicopter Accidents.

If your read the time line article for Trooper 2 accident, patients would have arrived at the Level 1 Trauma center at the same time for both land ambulance and air helicopter ambulance. Given the bad weather conditions why do most state protocols allow helicopter transports in this scenario? :angry: IMHO state protocols need to be changed to allow land ambulances to transport to level 1 trauma centers even when the transport is out of that ambulance's normal operating boundary.

:usa:

 

[VentMe∂ic]

Very sad story.

 

[catskills]

Yes very sad but there is a lot of room for improving safety for eveyone involved.

Here are some quotes from one of the articles.

Yet as crashes and deaths have mounted, top executives at the Federal Aviation Administration and its parent agency, the U.S. Transportation Department, have acted as partners with the industry, issuing reams of voluntary safety advisories with little follow-up. The FAA has sent poorly trained inspectors to monitor operators and used fines and penalties as only a last resort.

The number of fatal flights has risen sharply, closely tracking the rapid growth of what is now a $2.5 billion industry. Nearly half of all deaths have occurred in the past decade. In 2008, the deadliest year ever, 23 crew members and five patients were killed.

What began almost four decades ago as a way to save lives is now one of the most dangerous jobs in America -- deadlier than logging, mining or police work -- with 113 deaths for every 100,000 employees, The Post found. Only working on a fishing boat is riskier.

The director of the helicopter program for which Palcic flew called these lucrative patients "golden trout" and pushed pilots to reel in as many as possible. When pilots balked at flying in bad weather, he called them sissies and second-guessed them, records and interviews show.

For reference >> NY State Guidelines for Helicopter Utilization Criteria for Scene Response.

 

[paramedichopeful]

Washington Post Articles on Helicopter Accidents.

If your read the time line article for Trooper 2 accident, patients would have arrived at the Level 1 Trauma center at the same time for both land ambulance and air helicopter ambulance. Given the bad weather conditions why do most state protocols allow helicopter transports in this scenario? :angry: IMHO state protocols need to be changed to allow land ambulances to transport to level 1 trauma centers even when the transport is out of that ambulance's normal operating boundary.

:usa:

The only thing I can say is that I am touched. Situations like these are not generally understood by the average person. But to someone who is a member of the EMS family (yes, it IS a family), it is a great loss. Also, it is a chance to learn and improve. Once we know what went wrong with the scenario, we can improve on current practices/procedures to make things a little bit safer. I know thsi isn't the place to ask it, but I will anyway. Why don't we have a fallen EMT/Medic memorial? We have fire, military, and police memorials (which all those branches deserve) but nothing for EMS. Shouldn't EMT's/Medics be allowed to honor their fallen brothers and sisters as well? I wanna hear what everyone else thinks about this.

 

[ffemt8978]

I know thsi isn't the place to ask it, but I will anyway. Why don't we have a fallen EMT/Medic memorial? We have fire, military, and police memorials (which all those branches deserve) but nothing for EMS. Shouldn't EMT's/Medics be allowed to honor their fallen brothers and sisters as well? I wanna hear what everyone else thinks about this.

Please start a separate thread for that so that this one doesn't get threadjacked.

 

[MSDeltaFlt]

Washington Post Articles on Helicopter Accidents.

If your read the time line article for Trooper 2 accident, patients would have arrived at the Level 1 Trauma center at the same time for both land ambulance and air helicopter ambulance. Given the bad weather conditions why do most state protocols allow helicopter transports in this scenario? :angry: IMHO state protocols need to be changed to allow land ambulances to transport to level 1 trauma centers even when the transport is out of that ambulance's normal operating boundary.

:usa:

That is the question, catskills. One that is being addressed.

 

[paramedichopeful]

Please start a separate thread for that so that this one doesn't get threadjacked.

will do. yes, this thread needs to stay on topic

 

[usafmedic45]

Why don't we have a fallen EMT/Medic memorial? We have fire, military, and police memorials (which all those branches deserve) but nothing for EMS.

Not to derail but I would like to point out there is no need for another thread as there are already memorials for fallen EMS workers (http://www.nemsms.org/) and one in the works for the aeromedical losses in particular (http://www.airmedicalmemorial.com/)

 

[Mountain Res-Q]

Truely SAD!

IMHO... I am equally saddened by the attitude that dirrects the use of helicopters in emergency services... I can not speak specificlly to medical helos... but being in SAR, I have a pretty solid grasp seeing as how we utalize medical, LEO, Fire, Forest Service, and SAR helos...

IMHO, people are too quick to call the helo becasue they view them as the end all be all of rescue/medical evac... Don't get me wrong, they are a great asset in the right circumstances... but they are also dangerous, so their use need to be justified. In SAR we are told to be helicopter conservative. Anylize the situation and made a desision that you can stand by when requesting the use of a helo.

We had a call several months ago where Fire and Forest Service jumped the call and ordered a LEO helo for a rescue (something we did not want)... a rescue for a twisted ankel that could have been carried out 1 mile to a boat for a three mile trip across a lake... instead, they tried to short haul the person out... only the FFs are not trained to do so. So the LEO pilot had to hover and spend 20 minutes instructing the FFs on how to hook the rigging up. Plus, there would be no rescuer accompanying the pt.! Plus, they wanted to short haul the pt. dirrectly to the ambo and set the pt. down on a dock that could not be secured on a weekend! It was a BAD DEAL! And we said as much, and then reduced our liabilty and hightailed it out of there. ALL FOR A TWISTED ANKLE... If something bad had happened (pt paniked and fell, FFs screwed up the rigging, the helo had a malfunction, etc...) could they have looked back and be able to justified the use of the helo, a helo that could have been better used elsewhere...

On the other hand, I love when I get to jump on our helo... it is fun and (can be) more effective if used correctly... ^_^ But a SAD deal here... I feel the pain of it...

 

[VentMedic]

On the other hand, I love when I get to jump on our helo... it is fun and (can be) more effective if used correctly... ^_^ But a SAD deal here... I feel the pain of it...

One of the issues I have with the Maryland system is that they only fly one medic on board and may have to take a ground crew member. In Trooper 2, I believe the EMT who died was a volunteer who also probably thought it was really cool to take a flight.

Those of us who do this professionally know the risks and many have made some preparation as far as insurance and family expectations. It is a risk we take being well informed, trained, and educated for. This volunteer may not have even considered the dangers of getting into a helicopter in heavy fog.

Lee County EMS' MedStar(FL) also went down this week and I can say that is one very lucky crew to have escaped with their lives. The patient was also not critical but someone decided the location warranted a helicopter. After the helicopter crashed I would bet they had to drive the patient to the hospital.

 

[usafmedic45]

One of the issues I have with the Maryland system is that they only fly one medic on board and may have to take a ground crew member.

I agree that there needs to be a dedicated two person team in the back as dictated by the CAMTS standards, but the presence of a second pilot on board is going to be far more important from a safety aspect than the presence of a second dedicated crew member. If they had to chose between the two (for reasons of weight for example), the better bet would be a second pilot with a single medic. There's a very good reason why it's illegal in many countries to operate a commercial helicopter in instrument conditions with a single pilot and it all boils down to safety. The same policy is in place for US military helicopter operations as well with a couple of exceptions.

BTW, I'm speaking as someone who rode several times with the pilot who died on Trooper 2 during interfacility transfers while in the military. I considered Stephen a friend and still get a little angry every time I hear the Maryland authorities try to whitewash the system flaws and abuses that lead to his death and those of the others aboard.

In Trooper 2, I believe the EMT who died was a volunteer who also probably thought it was really cool to take a flight.

That she was. There was actually comments in the articles about the discussion among the EMTs who was going to get to ride along to the hospital.

 

[Mountain Res-Q]

One of the issues I have with the Maryland system is that they only fly one medic on board and may have to take a ground crew member. In Trooper 2, I believe the EMT who died was a volunteer who also probably thought it was really cool to take a flight.

Those of us who do this professionally know the risks and many have made some preparation as far as insurance and family expectations. It is a risk we take being well informed, trained, and educated for. This volunteer may not have even considered the dangers of getting into a helicopter in heavy fog.

Lee County EMS' MedStar(FL) also went down this week and I can say that is one very lucky crew to have escaped with their lives. The patient was also not critical but someone decided the location warranted a helicopter. After the helicopter crashed I would bet they had to drive the patient to the hospital.

I can see your point. Anyone who is going to be on a helo needs to know what they are getting in to... it really is not all fun and games... it is dangerous and needs to be considered...

On the other hand, I am aware of the risks, and do take it seriously... My time on helos is limited to when I am needed on one, and the thought of being on that machine scares me to death, but (having acknowledged the risks and being educated in helos - to an extent) I will step up because It is needed and because, honestly, how can you say no to the experience?

I was called up on Thursday AM, in fact, and told that the helo was doing up in 30 minutes, they needed a medical geek on board because it sounded like this lost guy might not be really lost, but hurt... 2 hours in the air on a Llama searching at 7500 feet in a protected wilderness... god I love it... stills scares me to death... BTW... no medical need... just someone who got lost in an area where getting lost doesn't seem possible... LOL

 

[spisco85]

If money wasn't an issue I would push for better helicopters were the weight of the patient and equipment wouldn't be an issue (blackhawks), TWO pilots on every helicopter, better instruments including FLIR, how about a crew chief to assist the pilots?, and two of whatever kind of medical provider the system wants.

As much as we don't want a military-esque EMS world we should take into consideration what they do and how they do things ESPECIALLY when it comes to helicopter medevacs.

 

[usafmedic45]

If money wasn't an issue I would push for better helicopters were the weight of the patient and equipment wouldn't be an issue (blackhawks), TWO pilots on every helicopter, better instruments including FLIR, how about a crew chief to assist the pilots?, and two of whatever kind of medical provider the system wants.

Well, if money was not an issue (in the sense of profits at least) most areas would not have helicopters since they don't need them. That is what a lot of people seem to miss out on- not only these crashes happening because the companies (or the state in the case of the Trooper 2 fiasco) are cutting corners in the name of profit, expediency or both but they are happening on needless flights that offer no benefit to the patient in any tangible form. As one of my physician friends who has a radio show likes to say "Where is the outrage?".

As much as we don't want a military-esque EMS world we should take into consideration what they do and how they do things ESPECIALLY when it comes to helicopter medevacs.

I guarantee if the Army helicopter safety guys were given the lead in the investigation and the rulemaking process for HEMS, this issue would have been resolved already. Hell has no minion quite so nasty as an Army crash investigation team when they think you're hiding something. I'd love to see a couple of my friends from Fort Rucker get ahold of the profiteers at AirEvac Lifeteam.

 

[Flight-LP]

The problem is a double edged sword. Yes, the underpowered single engine airframes do need to go. I can tell you first hand that a Bell 206 L-4, with the C-30 conversion, is still subpar for summer scene flights in Texas. All too often they are maxed to 104% torque, if not overtorqued. This is also under normal operating circumstances with less than max fuel, a lighter patient, and a non obese flight crew (which seems to be a dying breed these days!). The 407 and A-star are much better, but neither can accomodate a second pilot, so you can scratch that idea.

Get into your better platforms such as the BK-117 / EC-145, EC-135, S-76's etc. and you have some room to play. I'm currently flying in a BK-117b2 and can fly a 5 person crew, plus a neo isolette (330#), and an hour and a half of fuel in the heat of the Houston summer without an issue.

It gets back to 2 items, government regulation and money. The areas that can truly benefit from a helo (i.e. the rural environment with excessive transport distances) are the ones that will never get them because operators do not want to foot the bill for the under and uninsured. The FAA has been slow to respond to change. The evidence is right under their nose courtesy of the NTSB, but I truly wonder what involvement the private sector has through aviation PAC's? Either way, until better regulation occurs, greedy private firms will continue to provide half a$$ed service with volume over quality, forcing other services (including the few remaining legacy programs) to up their game to stay competitive. This is where corners get cut and lives get lost.

 

[usafmedic45]

The 407 and A-star are much better, but neither can accomodate a second pilot, so you can scratch that idea.

No, you need to scratch those helicopters. If they can't do the job safely, they don't need to be utilized in this role.

Either way, until better regulation occurs, greedy private firms will continue to provide half a$$ed service with volume over quality, forcing other services (including the few remaining legacy programs) to up their game to stay competitive. This is where corners get cut and lives get lost.

Agreed.

The FAA has been slow to respond to change.

Oh, it's not the rank and file at the FAA holding this up. I've already seen off the record drafts of the potential regulations and if the suits at the top can get their testicles to descend long enough to pass them, we can pretty much kiss a lot of the corner-cutting operations out there goodbye in a very short timeframe.

The evidence is right under their nose courtesy of the NTSB, but I truly wonder what involvement the private sector has through aviation PAC's?

You can bet your posterior the AAMS is fighting against regulation tooth and nail despite the fact that in doing so they are turning their backs on the very people they technically represent. Likewise, I've heard from contacts I have at the FAA that the major companies (PHI, AirEvac Lifeteam and several others) are already trying to persuade the Administration that the industry can truly reform in terms of a self-regulation.

 

[catskills]

Likewise, I've heard from contacts I have at the FAA that the major companies (PHI, AirEvac Lifeteam and several others) are already trying to persuade the Administration that the industry can truly reform in terms of a self-regulation.

I just hope the folks in the fancy offices pulling in 6 figures don't buy it.

The other problems are state protocols when a Medevac is warranted. If you look at these protocols they would be called in a lot more than they are today. When medevacs swoop into local fire houses for a training drill, they do a power point presentation to point out when to call them.

The real problem is local doctors do not want to be called out to the local ER. A a 30 YO in an MVA that is stable with strong vitals and possible midshaft femur fracture should not have to be flown out to a level 1 trauma center in my opinion. I have seen this happen recently when a few years ago they would take the patient to the local regional hospital. Just a few months ago the local regional hospital now has orthopedic surgeons on call at a cost of 100,000 per month. Having a regional hospital with more ER services, will also reduce medevac transports.

As you can see we can't place all the blame on the medevac companies. Its protocols for entire health care system of local ground ambulances, dispatchers, regional hospital, as wells as medevacs...........

We got lots of problems with health end to end patient care. A Pt with a bleeding spleen is stuck in a small hospital whose ER consists of a full time PA with an MD on call. By the time the PA determined the Pt had the bleeding spleen it may be snowing hard and no medevac transport to a level 1 trauma center is possible and no ambulance service will transport. The nearest level 1 trauma center is 60 minutes away even in bad weather. We need ambulances that are willing to transport on the ground longer distances. Here is an idea. What about a team of doctors from the level 1 trauma center that are willing to drive in a snow storm to the ER where the patient is. Medevacs are not the silver bullet in all cases.

Medevacs are like an over prescribed pain killer. They are very addicting to the health care system. IMHO

 

[Flight-LP]

The other problems are state protocols when a Medevac is warranted. If you look at these protocols they would be called in a lot more than they are today. When medevacs swoop into local fire houses for a training drill, they do a power point presentation to point out when to call them.

As you can see we can't place all the blame on the medevac companies. Its protocols for entire health care system of local ground ambulances, dispatchers, regional hospital, as wells as medevacs...........

Actually, yes you can place the blame on them. They can refuse to fly. Many programs do it, some will even get on scene and tell a ground crew or hospital to send them by ground as they do not meet the appropriate criteria.

State protocols are **** and they need to go. Most are antinquinated documents older than Rid and Vent put together (good 'ol early morning pre-coffee jab). They are not up to date on evidence based medicine, they are way too generic, and all too often seen as the bible of EMS with no variance allowed.

As a flight medic, I can attest it will be a cold day in he!! before some pencil pushing politician at a state capital tells me when I will or will not fly a patient. Fortunately, Texas doesn't operate that way and my particular program is dedicated to our hospital system which can and does refuse flights that are not medically necessary.

Reducing individual medic's making an ignorant call to fly (i.e. off of mechanism alone) is great and all, but as long as you have state protocols telling you absolutes in an "individual mileage will vary" world, the problem will continue.

Steve - I think we see eye to eye on most of these issues. However, I do not see the need to sacrifice patient care by eliminating a provider in all areas. Nor do I see eliminating the single side loaders as a feasible solution (with the strong exception of the 206). The 407 and A-star both are sufficiently powered. With the addition of good CRM, NVG's, TCAS, recurrent training, an effective operational control center (OCC), multi-provider communication in the case of flight aborts, and a few other tweaks here and there, I think those programs can be safe and effective. Looking at the recent statistics, few show that the aircraft is the issue. Most are direct failure on the part of the pilot and bad decision making. I have yet to see any accident in recent history caused by a failure of the company's in place prevention plans. Its always weather, hazardous attitudes, or just plain bad decision making.

I do agree it is optimal to have two, but you and I both know it it will not happen in our lifetime with the opposition out there. God, I pray I am proven wrong, but not optimistic. All we can do in the meantime is control the aspects we have direct control over and the biggest one is flying unneccesarily with low acuity patients that need to go by ground. there is a strong shift towards that goal, hopefully it will keep up!

 

[Sasha]

What a sad thing. Helicopters seem to be dropping like rocks. How many HEMS crashes has there been this year alone?? Seems to be popping up in the news section every couple of weeks.

 

[MSDeltaFlt]

Actually, yes you can place the blame on them. They can refuse to fly. Many programs do it, some will even get on scene and tell a ground crew or hospital to send them by ground as they do not meet the appropriate criteria.

State protocols are **** and they need to go. Most are antinquinated documents older than Rid and Vent put together (good 'ol early morning pre-coffee jab). They are not up to date on evidence based medicine, they are way too generic, and all too often seen as the bible of EMS with no variance allowed.

As a flight medic, I can attest it will be a cold day in he!! before some pencil pushing politician at a state capital tells me when I will or will not fly a patient. Fortunately, Texas doesn't operate that way and my particular program is dedicated to our hospital system which can and does refuse flights that are not medically necessary.

Reducing individual medic's making an ignorant call to fly (i.e. off of mechanism alone) is great and all, but as long as you have state protocols telling you absolutes in an "individual mileage will vary" world, the problem will continue.

Steve - I think we see eye to eye on most of these issues. However, I do not see the need to sacrifice patient care by eliminating a provider in all areas. Nor do I see eliminating the single side loaders as a feasible solution (with the strong exception of the 206). The 407 and A-star both are sufficiently powered. With the addition of good CRM, NVG's, TCAS, recurrent training, an effective operational control center (OCC), multi-provider communication in the case of flight aborts, and a few other tweaks here and there, I think those programs can be safe and effective. Looking at the recent statistics, few show that the aircraft is the issue. Most are direct failure on the part of the pilot and bad decision making. I have yet to see any accident in recent history caused by a failure of the company's in place prevention plans. Its always weather, hazardous attitudes, or just plain bad decision making.

I do agree it is optimal to have two, but you and I both know it it will not happen in our lifetime with the opposition out there. God, I pray I am proven wrong, but not optimistic. All we can do in the meantime is control the aspects we have direct control over and the biggest one is flying unneccesarily with low acuity patients that need to go by ground. there is a strong shift towards that goal, hopefully it will keep up!

I do not believe that MOI alone is a good enough reason to call for a flight with a few exceptions (rollover ejections is about the only one). I never have even before I flew. It requires the medic to actually assess their patient; to put their hands on them, expose them, palpate them, and actually know what's going on with their pt. I have hardly ever needed a scene flight as a ground medic. Why? Because after I assessed my patients, I found that the flight wasn't warranted.

I've given some of those power points as a flight medic. Still do. All they are saying, even with the forementioned MOI, is that these are a list of criteria where corporate has authorized us to go ahead and launch. That's about it, in a sales pitch tone of voice. My company will never say, "You have no choice but to call us for these listed reasons. Period. Without question." That's just not in the policy. If you need an aircraft, call an aircraft; whichever one you want by whichever method they use. If you think you might need an aircraft, put them on standby by whatever method they use if they allow it. If you don't need the aircraft, call them off. It's as simple as that. If that crew gets all upset, let 'em.

Speaking as someone who has been through a crash, I can whole-heartedly attest to you that, yes, even the 206 is capable. I don't like the 206. It is minimally powered. I would much rather fly in 407's. I've flown in 222's for another comany. Not practical for scene flights, but do-able. But the 206 can get most of the jobs done. Where it can't get the job done, the answer is simple: don't go.

It wasn't the 206 that almost killed me. It wasn't the 206 that broke my neck and shattered my back. It wasn't the 206 that caused me to relearn how to walk again. My pilot was faced with a situation where he had 2 options for getting out. He should have chosen the other one. Seeing me injured like that broke his heart and was killing his soul. He is my pilot. He is my friend. And he will never let that happen again. I bet my life on it. And I do each and everytime I get back in the aircraft with him.