Medical helicopter crashes spur new safety recommendations: Federal proposal includes improved pilot training, flight data monitoring
David Dykes
Greenville Online - October 1, 2009

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As federal investigators continue their search for the cause of a medical helicopter crash in South Carolina last week, there is renewed concern about an industry that has grown rapidly in recent years, and the safety of the emergency flights.

The crash near Georgetown on Friday killed all three people on board and occurred three weeks after federal safety officials called for more steps to minimize the risk of such accidents.

Last year was the deadliest on record for helicopter emergency medical services, or HEMS, with 12 accidents and 29 fatalities, according to the National Transportation Safety Board.

As a result, the NTSB said it placed the issue of medical helicopter operations on the agency's “most wanted” list of transportation safety improvements.

The federal safety agency has issued 19 recommendations regarding medical helicopters, including 10 proposals to the Federal Aviation Administration to address improved pilot training and analysis of flight, weather and safety data.

Medical helicopters are used regularly across the Upstate to transport seriously injured patients. The aircraft enable emergency crews to conduct flights quickly in different environments, but federal officials say those operations are riskier than other types of commercial flight operations.

Industry officials say the helicopters play an often life-saving role in the nation's health-care system, particularly in rural areas. The industry's primary goal is to ensure safe flights for the more than 400,000 patients transported each year, the officials say.

In 2004, an air ambulance carrying a three-member crew and a female patient crashed into Sumter National Forest near Newberry. All four were killed.

The NTSB determined that accident's probable cause was “the pilot's failure to maintain terrain clearance as a result of fog conditions,” according to an agency report.

“A contributing factor was inadequate weather and dispatch information relayed to the pilot,” NTSB investigators said in the report.

Early stages

An official with the NTSB said this week it likely will be several months before the agency knows what caused the Eurocopter AS-350 B2 helicopter to crash Friday night near Georgetown after dropping off a patient in Charleston about two hours earlier.


The pilot, flight nurse and flight paramedic were killed.

Peter Knudson, a spokesman for the NTSB, said the agency hopes to issue a preliminary report next week.

The report won't contain any analysis or conclusions, only factual information from the investigator about weather conditions at the time of the accident or crash-scene observations, Knudson said.

“We're really in just the fact-finding phase at this point,” he said. “There's so much data and information yet to be gathered.”

Knudson, who recently returned from the crash site, said the helicopter “was burned up pretty badly.”

“It was not recognizable as a helicopter other than to see a few parts and the blades,” he said.

The NTSB issued its recommendations for medical helicopters as a result of recent accident investigations and testimony at a four-day public hearing from expert witnesses representing medical helicopter operators, manufacturers and hospitals.

Agency officials made their recommendations to the FAA, other federal agencies and 40 government-operated or public HEMS systems.
Pilot training

The NTSB's five recommendations for public operators included improved pilot training and flight data monitoring. The agency also called for use of autopilots and night-vision imaging systems.

The NTSB also recommended limiting Medicare payments for emergency flights to operators who meet new safety standards.

“The pressure on HEMS operators to conduct their flights quickly in all sorts of environments makes these types of operations inherently more risky than other types of commercial flight operations,” said NTSB Chairman Deborah A.P. Hersman.

Those operators need “every available safety tool to conduct these flights and to determine when the risk of flying is just too great,” Hersman said.
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The Association of Air Medical Services, a trade group representing the air and critical-care ground medical transport industry, said it welcomed the NTSB's recommendations. The association said it has “diligently worked” with its members, the FAA and other organizations on voluntarily developing many of the improvements.
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A further consideration, however, is making sure adequate time is allowed for implementing the changes and budgeting the costs, association officials said.

Among the proponents of helicopter use is Dr. Martin Lutz, medical director of emergency services at Greenville Hospital System University Medical Center, which receives 40 to 45 trauma flights every month.

The flights are operated primarily by an air ambulance company that teams up with medical centers and emergency service providers, he said. The hospital system's physicians are heavily involved in training and education of the company's staff, he said.

Lutz knows firsthand the risk of helicopter flights.

During medical training in Ohio several years ago, he was aboard a helicopter that encountered wind shear as it was landing. The aircraft dropped 40 feet suddenly, damaging the fuel tank and causing a fuel leak.

“It was hard enough to jolt us,” Lutz said. “It was hard enough to all of a sudden feel like you're on a rollercoaster.”

The helicopter wasn't carrying a patient and no one aboard was hurt, Lutz said. He continued to fly afterward, Lutz said.

“I think it's an important piece of emergency medicine,” he said. “There's tremendous risk and I understand that.”
Accident rate

Dawn Mancuso, executive director of the air medical services trade group, told The Greenville News that the industry's accident rate last year “was far from what we wanted it to be.”

“We were doing much better this year,” she said.

Last week's crash in South Carolina was the industry's first fatal accident this year, she said.

“Safety is always a concern whenever you have a medical intervention of any kind, and air-medical transport is exactly that,” she said.
(4 of 4)

The association has initiated a “Vision Zero” program to create a “culture of safety” for its members through steps promoting education, awareness and vigilance.
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Crew members in last week's crash near Georgetown flew for Omniflight Helicopters Inc., a Texas-based provider of air medical services throughout the United States.

Company officials and NTSB investigators said the helicopter took off from the Charleston airport about 11:08 p.m. Friday and crashed approximately 22 minutes later.

The aircraft was headed to Conway, where it was based, company officials said.

The company said it was working closely with the NTSB as investigators try to determine the accident's cause.

In the Newberry incident five years ago, NTSB investigators said a single-engine emergency medical services helicopter was destroyed after it crashed into trees about 5:32 a.m.

In their report establishing the accident's probable cause, the investigators said mist and light fog prevailed in the area of the accident site.

Before takeoff, the pilot performed a weather check, according to the NTSB. He departed from Spartanburg Regional Medical Center about 5:02 a.m. to aid an injured woman on Interstate 26.

The NTSB report said the helicopter arrived at the accident scene and landed on the interstate highway near a rest stop about 5:23 a.m. The helicopter departed the scene about 10 minutes later, flying toward the national forest located north of the interstate, the report said.

A witness reported the helicopter made no abrupt maneuvers and the engine “didn't sound like it was missing, sputtering, or any other kind of power loss,” according to NTSB investigators.

He reported the helicopter was “flying level” as it descended into the trees, and that the helicopter's searchlight was on and that fog and mist were visible at treetop level, investigators said.

Three other EMS helicopter operators, according to the NTSB report, had turned down the mission, including one who had attempted it but returned because of fog conditions.

However, the accident pilot wasn't informed that other pilots had declined the mission because of fog, the report said.

The Association of Air Medical Services, a trade group representing the air and critical-care ground medical transport industry, said it welcomed the NTSB's recommendations. The association said it has “diligently worked” with its members, the FAA and other organizations on voluntarily developing many of the improvements.

A further consideration, however, is making sure adequate time is allowed for implementing the changes and budgeting the costs, association officials said.

Among the proponents of helicopter use is Dr. Martin Lutz, medical director of emergency services at Greenville Hospital System University Medical Center, which receives 40 to 45 trauma flights every month.

The flights are operated primarily by an air ambulance company that teams up with medical centers and emergency service providers, he said. The hospital system's physicians are heavily involved in training and education of the company's staff, he said.

Lutz knows firsthand the risk of helicopter flights.

During medical training in Ohio several years ago, he was aboard a helicopter that encountered wind shear as it was landing. The aircraft dropped 40 feet suddenly, damaging the fuel tank and causing a fuel leak.

“It was hard enough to jolt us,” Lutz said. “It was hard enough to all of a sudden feel like you're on a rollercoaster.”

The helicopter wasn't carrying a patient and no one aboard was hurt, Lutz said. He continued to fly afterward, Lutz said.

“I think it's an important piece of emergency medicine,” he said. “There's tremendous risk and I understand that.”
Accident rate

Dawn Mancuso, executive director of the air medical services trade group, told The Greenville News that the industry's accident rate last year “was far from what we wanted it to be.”

“We were doing much better this year,” she said.

Last week's crash in South Carolina was the industry's first fatal accident this year, she said.

“Safety is always a concern whenever you have a medical intervention of any kind, and air-medical transport is exactly that,” she said.
(4 of 4)

The association has initiated a “Vision Zero” program to create a “culture of safety” for its members through steps promoting education, awareness and vigilance.
Advertisement

Crew members in last week's crash near Georgetown flew for Omniflight Helicopters Inc., a Texas-based provider of air medical services throughout the United States.

Company officials and NTSB investigators said the helicopter took off from the Charleston airport about 11:08 p.m. Friday and crashed approximately 22 minutes later.

The aircraft was headed to Conway, where it was based, company officials said.

The company said it was working closely with the NTSB as investigators try to determine the accident's cause.

In the Newberry incident five years ago, NTSB investigators said a single-engine emergency medical services helicopter was destroyed after it crashed into trees about 5:32 a.m.

In their report establishing the accident's probable cause, the investigators said mist and light fog prevailed in the area of the accident site.

Before takeoff, the pilot performed a weather check, according to the NTSB. He departed from Spartanburg Regional Medical Center about 5:02 a.m. to aid an injured woman on Interstate 26.

The NTSB report said the helicopter arrived at the accident scene and landed on the interstate highway near a rest stop about 5:23 a.m. The helicopter departed the scene about 10 minutes later, flying toward the national forest located north of the interstate, the report said.

A witness reported the helicopter made no abrupt maneuvers and the engine “didn't sound like it was missing, sputtering, or any other kind of power loss,” according to NTSB investigators.

He reported the helicopter was “flying level” as it descended into the trees, and that the helicopter's searchlight was on and that fog and mist were visible at treetop level, investigators said.

Three other EMS helicopter operators, according to the NTSB report, had turned down the mission, including one who had attempted it but returned because of fog conditions.

However, the accident pilot wasn't informed that other pilots had declined the mission because of fog, the report said.

The association has initiated a “Vision Zero” program to create a “culture of safety” for its members through steps promoting education, awareness and vigilance.

Crew members in last week's crash near Georgetown flew for Omniflight Helicopters Inc., a Texas-based provider of air medical services throughout the United States.

Company officials and NTSB investigators said the helicopter took off from the Charleston airport about 11:08 p.m. Friday and crashed approximately 22 minutes later.

The aircraft was headed to Conway, where it was based, company officials said.

The company said it was working closely with the NTSB as investigators try to determine the accident's cause.

In the Newberry incident five years ago, NTSB investigators said a single-engine emergency medical services helicopter was destroyed after it crashed into trees about 5:32 a.m.

In their report establishing the accident's probable cause, the investigators said mist and light fog prevailed in the area of the accident site.

Before takeoff, the pilot performed a weather check, according to the NTSB. He departed from Spartanburg Regional Medical Center about 5:02 a.m. to aid an injured woman on Interstate 26.

The NTSB report said the helicopter arrived at the accident scene and landed on the interstate highway near a rest stop about 5:23 a.m. The helicopter departed the scene about 10 minutes later, flying toward the national forest located north of the interstate, the report said.

A witness reported the helicopter made no abrupt maneuvers and the engine “didn't sound like it was missing, sputtering, or any other kind of power loss,” according to NTSB investigators.

He reported the helicopter was “flying level” as it descended into the trees, and that the helicopter's searchlight was on and that fog and mist were visible at treetop level, investigators said.

Three other EMS helicopter operators, according to the NTSB report, had turned down the mission, including one who had attempted it but returned because of fog conditions.

However, the accident pilot wasn't informed that other pilots had declined the mission because of fog, the report said.