Three helicopter crashes in Arizona in just a few days this past week give me cause for concern about the procedures and safety measures in the medical aviation transport sector of our field.  That brings the total deaths in 2008 to 16, a number just two deaths shy of the record.  Worst of all, the year is just half over.  Are we to expect another 12 to 16 deaths in the second half of the year?

The most recent and surely most devastating crash involved two helicopters which collided with patients on board killing six and severely injuring a flight nurse on one of the choppers and also some responders on the ground. The helicopters were 1 mile from their destination hospital when they crashed. The wreckage started a brush fire on the ground where the other responders were injured.

I found this other story from earlier this week detailing another EMS aviation accident. Luckily, no one in this accident died although one of the providers on board was seriously injured. The helicopter was landing in the Arizona desert to pick up a patient from a motorcycle accident when it crashed.

Some pilots speculate the latter chopper's pilot may have experienced a "brown out" from the dust raised during the landing, causing him to lose site of landmarks on the ground and become disoriented.

These and other recent EMS aviation transport disasters in the U.S. underline the need for more oversight on a largely unregulated segment of the aviation industry. Because these services are often excused from some safe flying restrictions because of the "Emergency Nature" of their purpose, these helicopters and planes fly in conditions that might be avoided by other aircraft.

I know that we sometimes tread a thin line with safety when working with patients but our own safety has to be the primary concern. If conditions aren't safe for ground EMS to approach a violent patient we don't approach. We wait for the situation to clear, regardless of the severity of the emergency.

In the private, air ambulance sector, that does not necessarily hold true.

What happened to safety first?

The truth of the matter is that these services are profit makers for their health systems, bringing in many more dollars than the transport fees charged to the patients. In fact, when you add up the critical care, advanced surgical interventions, and recovery and rehab fees these patients are worth hundreds of thousands of dollars apiece!

I have talked to some local flight nurses and paramedics about how the safety processes work. It is often left up to the crews to determine if they think it’s safe enough to fly in questionable weather. A single dissenting vote and the helicopter stays on the ground. In the face of $100,000+ in lost income, though, I wonder if there isn’t some amount of pressure from above when a crew repeatedly opts for their own safety instead of taking a questionable transport call.

Public service air ambulance services like the Maryland State Police med-evac helicopters have an excellent safety record. Why? According to a good friend of mine, a retired MSP paramedic, it's because they have hard and fast rules on safe weather conditions. They don't violate these rules and remain grounded until the weather clears.

Putting these rules in place for other, commercial services would go a long way to keeping some of our best and brightest EMS and nursing providers alive and able to care for many more patients. The time has come to institute a study of the safety and efficacy of these programs in the face of the lives of the providers on board. While the National Transportation Safety Board (NTSB) and the Federal Aviation Administration (FAA) will certainly investigate the causes of both of these crashes, their results will be on individual events and not necessarily be used to report on broader trends. This is surely what is needed in this arena as more hospitals and services begin to enter this lucrative medical transport business.

It’s about saving lives (our own included), and not the money!