HEMS crash statistics

[ExpatMedic0]

Hey guys, I can't help but look at the news and see we have a HUGE number of HEMS crashes in the USA. I have a theory we may have more than any other modern western country in the world per captia, by a lot. I have been searching pubmed and other sources but have been unable to come up with any recent retrospective data to validate my theory. Any opinions or thoughts?

 

[chaz90]

I don't know any numbers, but based on the size of the country, I have a feeling we do way more flights than anyone else. Distance isn't as great a factor across much of Europe and population centers of Asia, and neither Russia nor Africa have the economic means to have robust HEMS components.

 

[STXmedic]

Usafmedic, now banned, had studies and stats galore on that topic. You may still be able to get in contact with him through katgrl2003. That may be more tedious than what you were hoping for, though.

 

[FiremanMike]

This is a topic that can and does quickly become quite heated and filled with personal opinions and attacks. I would encourage you to invest a few hours and look up NTSB reports for HEMS crashes and really look closely at the causes of these crashes.

 

[ExpatMedic0]

Check this out, shows that even on a "per mission" basis we have around 4 times higher the amount of HEMS crashes, and way more if you go on the hour statistics. I just found this interesting because at the UMBC CCEMT-P course in Baltimore we analyzed the risk of HEMS in the USA and some of the statistics where pretty staggering, theory's in class ranged from overuse of HEMS, to profit and the american healthcare system, to night missions, to all sorts of stuff.

https://www.google.com/url?sa=t&rct...WNT7as-75PvG7UaLg&sig2=El20qBjnePAJx0jynH3A3g

 

[Carlos Danger]

HEMS is vastly over-used in the US. Many/most areas have far more helicopters than they need and see far more utilization than is necessary. I am not intimately familiar with HEMS utilization in Europe or elsewhere, but my impression is that on the whole it is much more conservative.

After spending 12 years in the industry in 3 different programs across 5 different states, my opinion is that there are basically two categories of crashes in American HEMS:

1) The ones that are, for lack of a better term, statistically "bound to happen"
2) The ones that happen ultimately (mostly) because of business pressure

The first category are the ones that, while technically probably not "unavoidable", are unfortunately just going to happen occasionally. Things like mechanical failure, un-forecast rapid weather deterioration, etc. These are a pretty small percentage of American HEMS crashes, and I would suspect the rates are similar to elsewhere in the world.

The second category is a result of complex factors, and is largely what sets American HEMS apart from it's counterparts elsewhere. For various reasons (the persistent myth of the "golden hour", pressure to keep your base's flight numbers up so it doesn't close and you don't all lose your jobs, pressure to get back to base after a late night transport even though the weather isn't the best, etc.), pilots and crews just keep making poor decisions about when to accept flight requests. It doesn't help at all that in an attempt to keep cost down and profits up, many operations use the most affordable airframes and a minimum of equipment (NVG's, IFR, etc.) and currency training, but the bottom line in the vast majority of HEMS crashes is the crew was out flying in weather they should never have been flying in.

As far as firm statistics, they are available from several sources but suffice it to say that there are W-A-Y too many crashes, and it is a result of W-A-Y too many helicopters and the pressures that result from that. That is really all there is to it.

 

[triemal04]

Let's see...

Almost exclusively run as for-profit businesses...check.
Based on an inherently expensive business model...check.
Require a (relative to the type of business) large amount of paying customers to be profitable...check.
Generally fly in single engine, underpowered airframes that are far from ideal...check.
Almost always fly with a single pilot...check.
Often only allowed to use VFR and don't have NVG...check.
Rarely if ever have any medical launch criteria...check.
Rarely if ever turn down calls for anything other than serious weather concerns...check.
No oversight for how many services may operate in a given area...check.
No requirements for when/where a buisness is started except for having startup money...check.

I don't know...sounds like a recipe for a perfectly safe, properly used business to me.

 

[TheLocalMedic]

Until I see numbers that support any of these hypotheses I cannot comment other than to say; I don't know that I can agree with you.

Yes, helicopters crash. Yes, sometimes it seems as though it is happening far too often. But these air services generally do their utmost to assure the safety of their patients, crew and equipment. Do you think it would serve them well to have shoddy equipment and just let their aircraft crash willy nilly without a second thought? Certainly the crew is concerned about their own safety, and companies certainly don't count a downed aircraft as just the cost of doing business.

This past year has seen several crashes, but that may be nothing more than a statistical anomaly or perhaps more likely an intensified media focus on such events. While the US may have/utilize more aircraft than other areas, I really don't think that we have a higher crash rate by ratio.

 

[FiremanMike]

People love to cite profit status, airframe, number of engines, over utilization, and a whole host of other irrelevant factors. I implore you all to read the NTSB reports on HEMS crashes. What you'll find is pilots and crew making poor judgement calls and ending up dead. When you go IIMC and make immediately poor control inputs to try and fix things, it doesn't matter how many engines you have. When you aren't paying attention and clip wires or hit trees, it doesn't matter if you're in a 206 or an ec145. When you decide to try and beat the storm and then get struck in freezing rain or lightning, it doesn't matter if you have 1 pilot or 15 pilots.

Every time there's a crash, the human factor continues to be ignored in favor of hating on companies, medically unnecessary flights, single pilot, NVG, etc.. Again, it's quite easy to look up NTSB reports, I really encourage it.

 

[ExpatMedic0]

While the US may have/utilize more aircraft than other areas, I really don't think that we have a higher crash rate by ratio.

Did you see the retrospective study I posted with crash ratio's? Yes we have 4-10 times the crash ratio of every other modern country in the world that was studies. See link above, but feel free to post other studies and statistics here with links.

 

[Tigger]

Did you see the retrospective study I posted with crash ratio's? Yes we have 4-10 times the crash ratio of every other modern country in the world that was studies. See link above, but feel free to post other studies and statistics here with links.

Do we think this rate is a result of poor regulation/oversight that allows poor crew decisions resulting in the acceptance of flights that should not be taken?

Or is it all the "medically unnecessary" flights?

I tend to think towards the former. A medically unnecessary flight should not increase the risk of helicopter flight. Thousands of people are flown every day on helicopters who don't, strictly speaking, "need it." It's a convenience thing. The difference is that these companies are held to the same standards as airlines, because that's what they are. There is no reason areomedical providers should not be subjected to the same to the same standards.

I'd also hazard a guess (and I am not sure how to confirm other than by saying every helicopter service I've ever dealt with says it's true) that often times near if not more than half the flights flown are from hospital to hospital. That takes out the whole "uncontrolled landing area" reason for danger on many flights. Even where I am now we rarely fly from someone straight from the scene, we'd rather go to predetermined landing spots that the pilots have already been too, or better yet, lighted helipads that all five fire districts have set up at their stations.

 

[Carlos Danger]

A medically unnecessary flight should not increase the risk of helicopter flight.

You are right, a medically unnecessary flight is not in itself any riskier than a medically necessary one.

The problem is that willingness to fly patients who will not benefit allows "justification" for services and bases that aren't really needed. Those bases come to exist, and then need to keep their flight numbers up in order to stay in business. Pressure to do so both directly and indirectly results in pressure to fly in conditions that are unsafe. This is the direct cause of the majority of crashes in American HEMS.

And of course there is the issue of simple probability: we know that, even if everything is done 100% right, some crashes will still happen, because helicopter operations carry an inherent level of risk. The more flights you do, the higher the probability of eventually experiencing one of those events. Why worsen those odds by flying people who will not benefit? All it does is expose people to risk and expense unnecessarily. It's like driving L&S every time you have a patient on board; we stopped doing it because it clearly doesn't help and only increases risk.

I am of the opinion that more government regulation is not necessary; what is necessary is finding a way to significantly reduce the number of medically unnecessary flights. When these programs stop being paid for unnecessary services, they'll stop providing it. Bases will close and the stronger programs will remain. Competition will decrease, programs will have less incentive to take risk, and the problem will essentially be fixed.

I think with the overall picture of healthcare economics being what it is, we are heading in that direction right now.

 

[Rialaigh]

Until I see numbers that support any of these hypotheses I cannot comment other than to say; I don't know that I can agree with you.

Yes, helicopters crash. Yes, sometimes it seems as though it is happening far too often. But these air services generally do their utmost to assure the safety of their patients, crew and equipment. Do you think it would serve them well to have shoddy equipment and just let their aircraft crash willy nilly without a second thought? Certainly the crew is concerned about their own safety, and companies certainly don't count a downed aircraft as just the cost of doing business.

This past year has seen several crashes, but that may be nothing more than a statistical anomaly or perhaps more likely an intensified media focus on such events. While the US may have/utilize more aircraft than other areas, I really don't think that we have a higher crash rate by ratio.

I hate to tell you but well run companies know exactly how many flights need to happen at what profit margin to cover a crash that kills x number of people at the average settlement for these types of deaths....it may not be heart warming but it is just good business.


I am not as concerned about crash rate per ratio as long as it isn't absurdly bad compared with other HEMS countries. However total crash rate due to accepting flights for total crap calls is a much more fixable and concerning statistic.

 

[ExpatMedic0]

I am not as concerned about crash rate per ratio as long as it isn't absurdly bad compared with other HEMS countries.

That is the problem, it is!

 

[Rialaigh]

You can only get a crash rate so low for necessary flights. However the crash rate that we should be looking to achieve for unnecessary flights should approach 0...because we should be looking to eliminate those flights all together, that is a much more easily fixable problem

 

[Summit]

Usafmedic, now banned, had studies and stats galore on that topic. You may still be able to get in contact with him through katgrl2003. That may be more tedious than what you were hoping for, though.

I linked usafmedic to this thread.