Air Ambulances

Apparently it’s a slow news day at CNN, which is quoting a USA Today article about the “surge in crashes” which is “scarring” the air ambulance industry.

As usual, it’s clear the pieces were written by people with little if any aviation experience. They’re unbalanced and sensationalized.

It’s an undeniable fact that air ambulance service is responsible for saving thousands of lives each year. It’s also a fact that every time one of those helicopters goes out on a mission, they’re landing in an area which was not designed for helicopter operations.

These pilots have to avoid powerlines, buildings, trees, cars, and set that thing down in the tightest of spots, often in poor weather. They’re landing on this untested surface for the first time. Then they have to take off again at maximum gross weight with the rotor wash from their aircraft bouncing off the surrounding surfaces, fight the weather and then land — often at night — on a small concrete pad at the top of a building. For those of you who’ve never been on top of a building, it’s windy up there and you can’t see very well because there are few peripheral references with which to judge your altitude.

News flash: it’s risky.

CNN and USA Today show no recognition of that fact, choosing instead to take the whole industry to task because this activity doesn’t have the same safety record as an airliner.

Its study found that more than 10 percent of the U.S. air ambulance helicopter fleet crashed during that time, a proportion that would have translated to 90 jetliner crashes if applied to commercial airlines.

CNN didn’t read the USA Today article very well. If they had, they’d realized that if 10 percent of the commercial airliner fleet was 90 aircraft, the implication is that there are approximately 900 jet airliners in the United States. This is wrong. There are nearly 10,000 jetliners in active use according to the FAA registry. Note also that this FAA statistic does not include jetliners that are in storage, so the “fleet” that USA Today refers to is undoubtedly much larger.

When a news publication makes a mistake like this, it puts their entire argument at risk. To an aviator, this kind of thing is akin to reading that there are only 23 states. It raises a red flag and says “whoever is telling you this doesn’t know what they’re talking about.”

After reviewing hundreds of pages of documents and interviewing dozens of pilots, aviation experts, federal officials and executives with the companies that operate the flights, USA Today concluded that air ambulance companies and the Federal Aviation Administration have failed to impose safety requirements that might have saved lives.

What they’re not saying is that “imposing safety requirements” would also cost lives. The very lives that air ambulances exist to save, thereby defeating their whole raison d’être. USA Today seems to be in favor of having the go/no-go decision made by someone other than the pilot.

Patrick Veillette, a former emergency medical pilot who has written several studies of air ambulance accidents, says the lack of emphasis on safety regulations, equipment and training is “setting the pilots up.”

Veillette now flies a business jet. He says the contrast between that type of flying and the air ambulance world is stark. In a jet, air traffic controllers guide him away from hazardous conditions. His cockpit is equipped with the latest safety devices, including one that sounds an alarm if he strays too near to the ground. A company dispatcher won’t allow him to take off unless conditions are safe.

For the air ambulance industry, “these multiple safety layers don’t exist,” he says.

Additional training is one thing. You can never have enough training. Even a review of regulations might be worthwhile.

But with due respect to Mr. Veillette (by all accounts a well respected aviator), how are air traffic controllers supposed to provide information on hazardous conditions? ATC has no weather information that isn’t already available to the pilot. Low weather conditions keep ATC too busy to take on this sort of task anyway. They may provide it on a workload-permitting basis, but it’s not something you can count on. Even if you could, radar coverage frequently doesn’t extend to the low-level areas where rotorcraft fly.

A ground proximity warning system would only be an annoyance to a helicopter which typically flies just a few hundred feet off the deck. And the dispatcher idea doesn’t translate. It works well for a Part 135 charter, but air ambulances must operate on smaller margins. The smaller those margins get, the harder it would be for a dispatcher to make an effective go/no-go decision.

As the guy with his neck out there on the line, I can appreciate Mr. Veillette’s concern about the industry. Even so, I oppose any attempt to take authority or responsibility away from the pilot-in-command, which USA Today rightly credits for the majority of accidents. It’s the one area where we are in agreement.

The newspaper’s analysis of almost 30 years worth of accidents shows that 82% of fatal crashes were caused by human error — almost all by pilots.

What USA Today isn’t telling you is that this statistic is as applicable to general aviation as it is to air ambulance service. The Air Safety Foundation reports consistently show that the vast majority of accidents are attributable to pilot error rather than mechanical failure. It’s true for privately operated light aircraft, for airliners, and for charter operations. Why should air ambulances be any different?

This statistic only proves a) that aircraft are reliable, and b) that the best safety device in any aircraft is a well trained pilot.

  1 comment for “Air Ambulances

  1. August 4, 2005 at 12:00 am

    The CNN piece sucks, as do many CNN pieces.
    But the crux of what they are saying is true……

    I started flying helicopters in the EMS role in 1986.
    The Industry exploded in 1987.
    New services, scrapping to compete with established providers, contributed to one of the most terrible years I can remember.
    CBS and ABC both did investigative reports on EMS ops that year.

    Generally, EMS helicopters crash because the PIC is trying to be a hero…….go out and save a life, even though the weather is marginal/IMC.

    You can only do that so often before Murphy catches up with you!

    I think the terrible statistics this year will moderate. But the FAA is getting pressure from the NTSB to look into training and procedures…….not altogether a bad thing.

    Your description of scene landings was pretty good. Add to it the fact that we are being assaulted by four or more radio receivers…..talking to our dispatchers……to the on-scene commander…… the hospital………and sometimes ATC, and you can imagine the chaos we face when trying to land “on the centerline, between the wires!

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