Everyone mourns the loss, and once everyone attends funerals and puts their black ribbons away they go back to business as usual and don't even pay attention to when an initial report, let alone the final report comes out. There's enough information out about this incident, to include the weather conditions, to understand what the situation likely was.
CANMAN is 100% right. Now is the
only time to talk about this, because the reality is that this is the only time that people are actually paying any attention.
We are closing in on 20 years since I started in HEMS, and I can tell you that it is the same movie being played over and over again:
- A HEMS crew makes a poor decision(s) and crashes as a direct result of their poor decision(s)
- Everyone is shocked and in mourning.
- No one is allowed to discuss it bluntly because "the NTSB report isn't even out yet", so "let's just honor them and mourn right now. Let's not speculate, mmmkay?"
- Crew is described by everyone as heroic and highly skilled and dedicated, and no one even thinks about being critical of their decisions
- FlightWeb gets blacked out, everyone changes their profile pic to the death wings, everyone goes to the memorials and talks about safety.
- We say that we have new guardian angels now and that the crew was heroic and died doing what they loved, "so others may live", and other sappy, meaningless things to make us feel better about the senselessness of it.
- A week later, websites go back to their normal color, profile pics get changed back, and everyone not personally impacted by the crash forgets about it
- Months later the NTSB report comes out and confirms what everyone knew. Everyone pauses for a moment and makes some cursory statement about "safety first - we need to stop these tragedies", and then goes back to doing things the exact same way.
Rinse and repeat. Over and over and over.
So let's dispense with the political correctness this time, and have an honest discussion about what is happening in the HEMS industry. I think this is especially important for everyone who is interested in HEMS as a career, but it's also important for anyone in EMS or any other part of public safety.
I started in HEMS in 1999. Back then most HEMS was provided by hospital-based programs that made little money on them, and some community based ones which tended to be non-profit and thus also made little money. There may have been some programs that made money on HEMS transports, but for the most part it just wasn't profitable and really was viewed as a service to the community, not unlike a volunteer ambulance service that exists in an area where no paid services are available. Most areas had only one HEMS program available so there was little competition between programs.
Fast forward to late 2002, when CMS authorized a nearly 500% increase in reimbursement rates for HEMS transports. That changed
everything about the industry. Seemingly overnight, established programs doubled or tripled the number of helicopters in their fleet. "Community based" programs were popping up in rural areas everywhere. The number of medical helicopters available in the US went from something like 350 in the early 2000's to over 1000 in 2010. Less experienced pilots, paramedics, and nurses - who never would have been hired before the expansion - were now finding HEMS jobs without much trouble. Average patient acuity seemed to go way down in many places, as patients were being "flown" routinely who no one would ever have thought about calling a helicopter for before 2002. Thanks to a convoluted interpretation of the Airline Deregulation Act of 1978, states had very little control over the HEMS industry. That's how the industry came to look like it does today.
About the accidents. Here is the thing: we know
exactly what causes a large majority of HEMS crashes....it is not some mystery that is yet to be solved. Anyone who asks "why does this happening" is simply not paying attention. Probably 90% or more of civilian HEMS crashes in the US follow a nearly a nearly identical pattern: the crew takes off at night (when vis already sucks) in weather that they shouldn't be flying in, figuring that they'll be fine (and
usually we are). But this time they don't handle the poor visibility as well as they hoped they'd be able to, and it kills them. Thats all. If you want to analyze these things to the nth degree you can read all the minute details in the NTSB reports, but "they crashed because they couldn't see where they were going because visibility was poor" accurately summarizes almost all of those reports.
These crews (and I mean in general terms - not singling out anyone) made a careless choice that they knew they shouldn't make, and they suffered the consequences that they knew they might suffer. It's not that different than getting in your ambulance and driving the whole way to a call well over the speed limit and barely even slowing down for intersections. That's not a perfect analogy but I think you get the point. It's not heroic or selfless - it's careless.
Why do smart, well-trained people keep making the same mistakes that they've seen kill other people? The answer to that question isn't
quite as cut-and-dry as the last one, but we have a pretty good idea how it works. There's a whole Human Factors / Crew Resource Management industry built around this and HEMS crews spend lots of time in classes and reading articles about this very topic.
The folks who teach CRM and make money off it make it complicated, but the main ingredients to this crap sandwich are
overconfidence and
feeling pressured to fly, seasoned with plenty of
that won't happen to me. You know the weather is marginal or worse and you know that you really shouldn't take off. However, you've flown this route before, you think you can avoid the worst of the low vis, and if worse comes to worse, you know you are well trained in how to handle an inadvertent IMC. That's the overconfidence part. The pressure to fly part is more insidious and even less apparent, but just as much of a factor, if not more so. It comes both from the fact that most HEMS programs are corporate, for-profit businesses that have to do a certain amount of transports just to stay in business. Each base is generally competing for transports with other HEMS programs, or even with other bases within the same program. There are only so many transports to go around, so the reality is that you can only turn down your slice of the pie so many times before everyone else eats it. Of course everyone says "I never feel pressured to fly" and "I don't factor that stuff into my decisions at all", but it is very naive to think that your bases transport numbers aren't in the back of everyone's mind pretty much all the time.
Programs have no incentive to do what
really needs to be done in order to stop this from happening, because those things mean fewer transports, and thus less profit. I mean sure, they'll provide the crews with NVG's and make them attend CRM every year, and they'll tell the crews that they'll never question a weather turn-down and that they don't want to crews to ever feel pressured. And those are good things, but they aren't sufficient. The programs will do those things and then turn around and hire minimally experienced pilots to staff helicopters at a new base right in the backyard of an existing program, and they'll market to the local EMS agencies about how important "The Golden Hour" and "Critical Care In the Air" is to patient outcomes. That the HEMS industry refuses to take the steps necessary to curb unnecessary transports is actually pretty sick, given the obvious ramifications.
Why do the med crews put up with it? Cuz flight suits. Cuz they don't know any better, cuz they don't pay attention. Cuz everyone thinks they are special and different. "Well,
our program isn't like that" thinks every flight nurse and flight paramedic who reads a critical appraisal such as this. "
Our management really does put safety first.
We really do have a huge impact on the outcomes of the patients we fly, so it's important that we get to every transport that we possibly can. We're different than all those other programs". Because
we are an exception, because
that will never happen here, so we have permission to not really take this stuff that seriously. I mean sure, it's serious, and we'll pay attention to it, but it doesn't
really apply to us, because we are different.
Let's not kid ourselves. The reality is that we aren't saving lives any more on helicopters than we are on ground ambulances. We're just spending a hell of a lot more money and looking cooler in the process. Yes, the patients are sicker, but the difference is not as great as you might imagine, nor is our ability to really doing anything about it. At the end of the day, all we are really doing is looking cool, having fun, making a lot of money for the corporations who own the programs that we work for, by flying people who could usually go by ground much more cost-effectively and perhaps even much more safely.
The bottom line is that we all really need to stop viewing these crashes as some romantic, selfless sacrifice that we all hate, but that has to happen occasionally in order to save lives. It isn't that at all - it's actually senseless and even purposeless. We aren't heroes - we are just workers. We didn't
sacrifice ourselves when we crashed and died - we screwed up, plain and simple. We aren't dedicated and selfless, we are stupid and egotistical.
That last part might sound a little harsh, but maybe part of the reason we keep making the same mistakes is because we refuse to call a spade a spade.
