All I know is when you have a flat in a rotor wing, there is no where to pull over!....
Seriously, rotors are extremely dangerous. Tower wires, heavies (other big aircraft), fence posts, geese, etc... It is a known fact, when you crash your lucky if you die.. if it is a short lift off or decent, you might get lucky with only a broken back and fractured ankles. Then as well, look at tail rotor incidences...
What is ironic, most assume you spend most of your time taking care of the patient in the helicopter... in reality, very little assessment and treatment is performed in the air. ( remember you can't hear, and probably only are able to reach & get to the chest area) One must be continuously looking for hazards, and other aircraft.... safety is the main goal, patient care is second...
R/r 911
Not to mention always looking up front to make sure your 70ish year old pilot is still breathing!
Yea, its funny that most people think there is this high level of trauma care that occurs in the helicopter. To expand on what rid was mentioning, a typical flight will go something like this..................
1. Land (hopefully with minimal damage to the helo).
2. Immediately get out and stop some dumb volunteer firefighter from running into the rotors.
3. Drag said firefighter back to his truck and put him in time out.
4. Make contact with patient and ground EMS crew. Receive report, maintain airway as needed, insert chest tube and/or perform any invasive procedure as needed, establish our baseline vitals, get demographics, transfer pt. to our equipment, place hearing protection on pt.
5. Kick out the additional firefighters who insist on helping the already 4 people in the back of the ambulance just so they can be near the helicopter.
6. Drag said firefighters back to the truck to join their buddy in time out.
7. Either insert transport flat under pt. or transfer pt. to helicopter stretcher (depends on type of helo).
8. Move to helicopter with too many people including the aforementioned firefighters who are supposed to be in time out.
9. Stop same firefighter from again walking into the rotors, send him back to time out (3rd time, he's on his own. Damn thats going to be a painful lesson!)
10. Secure pt. in helicopter.
11. Get everyone other than the flight and medical crew away from the helicopter.
12. Perform final walkaround.
13. Put pt. on vent, pump, and additional monitoring as required.
14. Ignore pt. for a couple of minutes while we prepare to lift and depart the LZ.
15. Stop, get out and tell the firefighters that they do not need a charged hose line 3 feet from the helicopter as it is about to lift.
16. Get back in helicopter and depart LZ.
17. Glance at pt. to make sure they are still alive, take a pulse to confirm.
18. Continue to ignore pt. as we watch for VFR traffic in the area as we are flying too low to be picked up on radar by ATC.
19. Repeat 17 and 18 until arrival at destination.
20. Land (again hopefully with minimal damage)
Seriously though, yes rotor based EMS is significantly more dangerous than ground based EMS. The sad part is that most of the increased dangers are caused by EMS personnel not knowing when it is and is not appropriate to fly patients. Too many crews fly pts. based off of MOI, which has been proven to be an insufficient method of assessment. Your only benefit from a helicopter is time, not necessarily better care (unless your a BLS service in which case you should consider a better source of ALS care that reduces the increased mortality of the flight crews). This especially holds true for some for-profit based helicopter systems. There are a couple of companies that I wouldn't send my worst enemy's dog with..............
Another factor is the type of helicopter. I see so many Bell 206's flying in EMS. Yes it is the safest helicopter in the world, but it is a horrible EMS platform. Minimal load capabilities, minimal fuel capabilities, and slow. Plus if your trying to operate in the mountains, forget it. Higher altitudes = an increase in density altitude which the 206 cannot afford to compensate for.
Then you bring in the factor that most companies operate in visual conditions only. Bad weather, no helicopter. Provide IFR capabilities and you not only increase contingency operation possibilities, but you also can then file IFR, even its clear blue and a million, and be guaranteed ATC priority handling and radar coverage.
Honestly, the way to bring down the risk would be to increase education to the clients (i.e. ground EMS and hospitals), provide 2 pilots in a twin engine aircraft, have IFR capabilities, and provide NVG's for night operations. Then increase the required amount of crew resource management training for the flight and medical crews. The risk reduction would be quite significant!
