Improving air ambulance safety
By Dorothy L. Tengler

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The medical helicopter safety record is troubling. Although air ambulances are supposed to save lives, often the crew and patients find themselves in great danger. Reports of medical helicopter crashes are all over the news.


Do you think air ambulances should be state-regulated?
  • 1. Yes
  • 2. No

As early as 2003, a study examined 47 United States air medical helicopter accidents for a five-year period with an increase in the number of accidents during the study period. In 2009, air ambulance helicopters were deemed to have the worst fatal crash record in aviation history, and their crews were slated as being the most likely to die on the job. Often, entire crews are lost.

According to many, the risk is unacceptable, and relatives of crash victims have demanded that the Federal Aviation Administration (FAA) take action to reduce the death toll.

Since 1988, the National Transportation Safety Board (NTSB) has known that most fatal medical helicopter accidents happen when the pilots unexpectedly encounter poor visibility or bad weather. Since then, the board has urged the FAA to require improved safety equipment on medical helicopters.

Many air medical organizations have been voluntarily implementing safety culture changes for years, including new technology, addressing the human factors, incorporating comprehensive safety management systems and more.
Since 1988, the National Transportation Safety Board has known that most fatal medical helicopter accidents happen when the pilots unexpectedly encounter poor visibility or bad weather.

But there remains little oversight of medical air transport services in the U.S. The FAA has limited jurisdiction over such services. For the most part, the NTSB accident reports evaluate mechanical, environmental and human factors involved in such crashes. But the board, for example, does not delve into the question of whether air transport was better than ground transport.

In 2010, the FAA developed several policies or policy changes that they want both public and personal air ambulance services to help implement. Some of these required programs include:
  • Risk assessment and decision skills
  • Work and rest guidelines and restrictions
  • Guidelines on Lack of Control (LOC) together with Controlled Flight Into Surfaces (CFIT)
  • Installation of Data Recorders and devices that track particulars on a flight
  • Integration of an Operation control Center
  • Use of radar altimeters
  • Surfaces Avoidance and Warning Process (TAWS) equipage
Recently, Dr. Mike Abernethy, a flight physician in Wisconsin was interviewed about his passion — air ambulance safety and how it can be improved in the U.S. and abroad. Abernethy admits the industry has had problems and does not have definitive regulations. He says air ambulance safety issues are multifaceted.

Abernethy certainly agrees with others who have questioned whether an air rescue is always necessary and believes we need to look at appropriate air utilization versus ground rescue utilization, medical training requirements, and safety issues, such as night-vision goggles.

In an effort to look into all deaths involving air ambulance from Jan. 1, 2006 to Dec. 21, 2012, the Ontario Ministry of Community Safety and Correctional Services systematically identified and reviewed all known cases in which operational issues related to the air ambulance transport may have caused or contributed to death. The expert panel identified eight themes and made recommendations in the following areas:
  • Decision-making (5 recommendations)
  • Response process (5 recommendations)
  • International transports (1 recommendation)
  • Communication (4 recommendations)
  • Aircraft/equipment (5 recommendations)
  • Staffing (1 recommendation)
  • Paramedic training/education/certification (1 recommendation)
  • Investigation/quality assurance (3 recommendations)
By its nature, air ambulance rescue is unique. The FAA, operators and the medical community all play a vital role in promoting a culture that is safe, ensuring the safety of passengers, flight crews and medical professionals on these flights. Hopefully, air ambulance safety will improve; time will tell.

Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, primary and review manuscripts, and pharmaceutical sales training materials.