The crash Thursday morning of an emergency medical helicopter in Tennessee is another tragic reminder of the crisis in medical aviation. Three people were killed when a Eurocopter AS350 operated by Hospital Wing crashed near Brownsville, Tennessee after delivering a patient in Jackson. While the crash happened shortly before 7:00 a.m., the bulk of the flight occurred during what is considered "the backside of the clock" the hours between ten p.m. and six a.m.. This is the most dangerous time to fly by helicopter medivac. Nearly half of all the EMS helicopter crashes take place on the backside of the clock.
This statistic comes from the Comprehensive Medical Aviation Services Database (CMAS) which was compiled by Dr. Patrick Veillette and myself. Fatigue is a pervasive problem in these accidents, according to Dr. Veillette, a commercial pilot and former EMS pilot. The situation seems to be getting worse. "In just the last 8 years there have been 48 accidents that occurred on the back side of the clock."
Reviewing the so-far-incomplete details of the accident, it appears notably and tragically typical. The aircraft had already delivered the patient and was returning to base, there was bad weather in the area and the flight was being conducted under visual flight rules, without the assistance of enhanced visibility instruments. Our database shows these are the consistently reoccurring factors in helicopter medivac accidents.
What's so frustrating is that it is no mystery how to make air ambulances safer. When EMS helicopters are required to carry two pilots and equipment to help them fly in limited-visibility conditions safer flights will result.
Since 1987, nearly half of the EMS helicopter accidents occurred either at night or in weather that obstructed the pilot's vision. Our statistics also show that people are twice as likely to die in limited-visibility accidents as in those occurring in good weather during the day. Considering the layers of risk in reduced-visibility flights, one would expect operators of air ambulances to make sure their aircraft are equipped to fly in these conditions. But only a small portion are equipped with enhanced-visibility systems.
The EMS helicopter industry has boomed from a few hospitals in Colorado in 1972 to a multi-million-dollar business which operated nearly half a million flights in 2009. This phenomenal growth has been based on a disturbing business model; fly the helicopters as inexpensively as possible - meaning one pilot and a minimum of safety equipment - even though these are inherently more hazardous missions. As one EMS pilot told me, "If they knew what I knew, even the nurse and paramedic wouldn't get on board."
In a study of turbine engine airplane accidents, a noted aviation research company Robert E. Breiling Associates of Florida, concluded that single-pilot flights are riskier than those with two pilots. The statistics show the risk of a fatal accident is 3.7 times greater with a single-pilot. In publishing these findings, AOPA Pilot magazine wrote "single-pilot operations create higher workloads and greater demands on pilot skill when the chips are down and stress levels run high."
Flying a helicopter - any helicopter- is not like flying an airplane. The pilot is busy from start to finish. To an already higher workload and often under time pressure the EMS pilot has additional concerns, a 24/7 flight schedule, a lack of a weather information for the route or destination, operations in and out of non standard landing zones including rooftops, highways and parking lots and flights that take them through obstacles and obstructions.
It is this last factor that makes the need for two pilots most obvious. Of the accidents over the past 20 years, one in of three - involved the aircraft hitting something. With the exception of a pilot-check ride in Michigan in May 2007, all the others were operated by a single pilot. Medical helicopters in Canada and air rescues conducted by the U.S. Coast Guard already require two-pilots. What do they know that America's air ambulance operators do not?
When it comes to making air-ambulance flights safer, the elephant in the room is money. Nobody wants to talk about it because to do so would be to puncture the myth that no expense is too high when it comes to rescuing those in need.
Bringing complicated medical equipment and highly trained professionals to the skies is already an expensive undertaking. Most EMS helicopter companies are businesses with bottom lines to consider. Often a hospital contract will go to the company that offers the lowest bid, which is why additional equipment and doubling of pilots is such a hard concept to sell.
It is imperative that the industry equip all EMS helicopters for reduced visibility conditions and put two qualified pilots in the cockpit to fly them. It's expensive. But once again, investigators have been called to the scene of the crash that is a tragic reminder of the alternative.