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When rescue is too risky: hazardous medevac flights too often endanger the lives they were dispatched to save. Crashes usually have more than one cause, and a thorough investigation will often reveal more than one responsible party.

Article Excerpt
On the night of September 9, 2002, an emergency medical services (EMS) helicopter went out of control and crashed into a South Dakota bean field. Investigators determined that pilot error caused the crash because the pilot's deficiencies--especially in night flying--were well documented. (1) In fact, his employer (a leading EMS company) previously grounded him from night missions because he was not capable of flying safely at night.

So why was the pilot flying on the night of the crash? After the employer's safety manager identified the pilot's night-flight problems and the base manager wisely restricted the pilot from flying night missions, the employer's chief pilot overturned the decision and cleared the pilot to fly at night. The pilot crashed the helicopter on his fourth night mission.

The company's decision to clear the pilot for night flight after it had identified his serious deficiencies is typical of endemic safety problems in the EMS industry. Despite the company's denial, it appears that the decision was made for business purposes--so the company could schedule more night missions, putting profits over safety.

The EMS industry--which is now largely populated by private, for-profit companies--operates on narrow profit margins and has not invested properly in safety. By failing to hire trained and experienced pilots, who command high salaries, or equip and maintain aircraft, the industry has not served its aircrews and passengers well.

EMS aviation is some of the most dangerous nonmilitary flying in the United States. According to the U.S. Bureau of Labor Statistics, "aircraft pilot" is among the most dangerous of all professions, (2) but EMS aviation is in its own class--with a crash rate closer to that of combat flying than commercial aviation.

In the past five years, more than 10 percent of air ambulance helicopters crashed, a total of 84 accidents resulting in 60 deaths. (3) If patients knew of these lethal statistics, many probably would choose not to fly in EMS planes and helicopters.

The National Transportation Safety Board (NTSB)--the independent agency of the federal government that investigates civil aviation and other transportation accidents in the United States--attributes many EMS crashes to pilot error. But a pilot is only as good as his or her aircraft, which must be properly equipped and maintained. Aircraft manufacturers, maintenance companies, and operators must understand the unique risks involved in emergency medical aviation and work to avoid them. To date, the industry has failed to live up to its responsibilities.

Victims of EMS accidents often have difficulty obtaining justice because workers' compensation usually provides immunity to the operating company against claims by crew members and their families. However, aviation disasters usually have more than one cause, and trial attorneys who zealously investigate a crash often find other potential defendants.

Unique hazards

Many risk factors contribute to high EMS accident rates.

The flight environment. Emergency flights are often made into ad hoc landing zones and in hazardous conditions, including bad weather, high altitude, and rough terrain. Night flying and flying in "instrument meteorological conditions" (IMC)--where the pilot cannot see enough visual cues outside the aircraft to fly and must rely on instruments--are common on EMS missions. These conditions greatly increase accident rates. Poor visibility induces pilot vertigo and increases the chance of crashing.

Over the last...

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