Helicopter EMS Safety Draws Sharper Scrutiny

ACEP News 
June 2009

EMS HelicopterA new report from the Flight Safety Foundation identifies 26 systemic risks involved in helicopter medical evacuation.

FAA to Address Safety Concerns

By Mary Ellen Schneider
Elsevier Global Medical News

With eight fatal accidents in 2008 and the release of a comprehensive new report, the safety of air ambulance helicopters is fueling debate among health care providers and the aviation industry--and drawing intensified scrutiny from federal lawmakers and regulators.

The report from the Flight Safety Foundation identifies 26 systemic risks involved in helicopter medical evacuation, and cautions that the current medical reimbursement model is no longer sufficient to cover the cost of operating or upgrading helicopter air ambulances.

Another factor that could jeopardize the safety of helicopter air ambulance flights is the "lack of clarity" about the roles of federal, state, and county agencies in overseeing helicopter emergency medical services. In addition, safety management systems are only beginning to be introduced to the industry, the report's authors found.

The report, "Helicopter Emergency Medical Services (HEMS) Industry Risk Profile," was published in April by the Flight Safety Foundation, a nonprofit organization dedicated to improving aviation safety.

A recent spike in accidents involving helicopters used in medical evacuation has made improving safety a hot topic among physicians, industry, Congress, and regulators. From 2002 to 2007, there were 26 fatal accidents involving helicopter emergency medical services, an average of 4.3 accidents per year. There were also 59 nonfatal accidents, an average of 9.8 per year. In 2008 alone, however, there were eight fatal and five nonfatal accidents with air ambulance helicopters.

"I don't believe that the current risk profile should be tolerated or is acceptable," said Kimberley Turner, CEO of Aerosafe Risk Management, the risk and safety management firm that produced the report for the Flight Safety Foundation. "The question is, how do you reduce the risks so that it gets to that level of tolerance that people are comfortable with?"

The industry needs to differentiate the acceptable level of "inherent risk" due to the nature of the job, versus unnecessary risks, she said.

Regulators Spurred to Action

As part of the ongoing risk assessment process, several industry organizations have agreed to develop a detailed "action plan" outlining the voluntary steps they will take to address some of the systems issues identified in the initial report.

That detailed plan is expected to be developed this summer, Ms. Turner said, with periodic reassessments being conducted.

While much of the current risk assessment report focuses on areas that can be addressed voluntarily by the industry, regulators are also taking a closer look at air ambulance helicopters.

The Federal Aviation Administration (FAA) announced in April that it plans to begin the rule-making process to address Helicopter Terrain Awareness and Warning System standards, radar altimeters, operational control centers for helicopter air ambulance operators with more than 10 aircraft, and risk management programs.

The FAA also wants to change the terminology used in the industry from helicopter emergency medical services to "helicopter air ambulance."

The switch in terms could help convey the idea that helicopter transport is simply another method of transport, unlike other air emergency services such as search and rescue or emergency evacuations, according to the FAA.

Currently, it can be difficult to determine which patients are the most severely injured at the scene of an accident where there is limited equipment to assess patients, said Dr. Steve Andrews, associate medical director for North Memorial Ambulance Service in Minneapolis, Minn., and chairman of the American College of Emergency Physicians' Air Medical Transport Section.

While there may be a certain amount of "overtriage," he admitted, there currently isn't a better mechanism for screening those people.

The Centers for Disease Control and Prevention and the National Institutes of Health have funded studies aimed at developing a more exact method for identifying the severity of injuries at an accident scene, to allow first responders to better gauge which patients should be transported by helicopter.

"But we don't have those answers right now," he said.

ACEP is working on updating its air medical guidelines, including the indications for which patients would benefit from air medical transport.

ACEP will review the new literature and update its existing recommendations, Dr. Andrews said. n

The complete risk assessment report is available online at

www.flightsafety.org/pdf/HEMS_Industry_Risk_profile.pdf.
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