The Excessive Risk in Air Rescue

Fri, Jan 30, 2009 — James E. Hall

Safety Issues

Like the rest of the country, I was deeply saddened by the fatal crash of an emergency medical services (EMS) Eurocopter Dauphin II helicopter on September 28 in Maryland which killed four and left another in critical condition. But as a former Chairman of the National Transportation Safety Board, this trend is anything but shocking.

James E. Hall

James E. Hall

This crash is the latest in a line of tragic of EMS crashes this summer, with a June 29th a collision of two EMS helicopters near Flagstaff, AZ, which killed 6 and a Bell 407 crash on June 8th in Huntsville, TX, which killed all four passengers aboard. And less than a month before that, on May 10th, an EMS-operated Eurocopter EC 13 crashed at La Crosse, WI after dropping off a patient, killing the pilot, a surgeon and a nurse. This latest tragedy brings the tally up to 17 deaths in less than five months. And while this period has been especially bad, it was anything but unforeseeable.

EMS helicopters – often proclaimed “angels of mercy” – are among the most dangerous aircraft in the skies today. While this decade has seen a decline in major airline crashes, it has seen an increase in EMS helicopter fatalities, with what was a worst record of 18 killed in 2004. The count this year: 20, with three months remaining. Clearly things are getting worse.

Rather than answers to this problem, the FAA offers excuses. It stated in a recent press release that “[EMS] operations are unique due to the emergency nature of the mission.” The agency needs to ask itself is whether this “unique” situation justifies a fatal accident rate that is 6,000 times that of commercial airliners. In the face of this safety crisis, the FAA’s response has been to simply “encourage risk management” and “promote [safety enhancing] technology such as night vision goggles, terrain awareness and warning systems (TAWS) and radar altimeters.”

This “encouragement” is noticeably lacking the vigor we’ve seen the FAA use recently to force major airlines to maintain acceptable safety standards. Rather than regulating an industry that has a demonstrated history of carrying out unsafe operations, the FAA seems content with offering a do-it-yourself program of oversight.

In my view, the disparity between the standards we take for granted as passengers aboard an airliner and those required of EMS helicopters is caused primarily by the unfortunate overlap of what should be two distinct safety cultures: that of medicine and that of aviation. The two cultures are similar in their gravity – after all, human error in either can cause serious injury or death – but their accident rates are drastically different: the US Institute of Medicine estimated in 2000 that up to 98,000 people died of medical error in the United States each year, the equivalent of three jumbo jets crashing every four days.

This is not to say that aviation always gets it right and medicine always gets it wrong; there are many reasons why management of human error is more difficult in the operating room than in the air. However, the potential for human error is recognized in aviation and efforts are made to design systems and procedures to minimize it. This process now needs to be applied to EMS operations, with the FAA taking a leading role.

The underlying principle that should govern EMS operations is simple: when a patient is evacuated by helicopter, there should not be additional risk of injury or death because of shortcomings in the safety culture associated with these operations. I would hope that this year’s deadly spell of EMS accidents will cause the FAA to realize just how grave a safety threat EMS operations pose to their passengers. Once it does, these tragedies will not have happened in vain.

Byline: James Hall was chairman of the National Transportation Safety Board from 1994 through 2001. He is managing partner of Hall & Associates LLC, a crisis management and government relations firm.

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