Editor's Note:The death toll from the Flagstaff, Ariz., crash reached seven with the death of registered nurse James Taylor, 36, who died July 4. This story has been updated to reflect that.
Despite the alarming number of U.S. air ambulance crashes in the first half of 2008which have claimed 17 livesseveral healthcare providers say the benefits of air medical services still outweigh the risks involved.
National Transportation Safety Board officials continue to investigate the accidents, including the most recent one on June 29, when two helicopters approaching 263-bed Flagstaff (Ariz.) Medical Center collided in midair and led to the deaths of seven people. Given the pending investigations, no one knows yet what caused the most recent crashes, although a few experts have cited human error. Meanwhile, as emergency physicians, flight directors, paramedics and hospital administrators await the NTSBs findings, they are far from discontinuing a service that was developed from advances made during the Vietnam War and that they consider a vital component of the nations healthcare system today.
Proof of this can be found in the Flagstaff tragedy. In that crash, one of the helicopters was operated by privately held Classic Helicopters, Woods Cross, Utah, while the other was with Guardian Air Transport, a division of Flagstaff Medical Center. Flagstaff contracts with Englewood, Colo.-based Air Methods Corp. for all aviation services for Guardian, including the Federal Aviation Administration license, pilots and maintenance. Shares of Air Methodswhich traded as high as $59.50 per share in November 2007hit a 52-week low of $23.70 on July 2 before closing at $24.47 per share on July 3. After voluntarily suspending flights after the accident, Guardian Air resumed healthcare missions two days later, showing Flagstaffs support for air medical services in spite of its recent loss and renewed risk.
And in Grand Rapids, Mich., the Spectrum Health system issued a written statement about the value of air medical services a month after an Aero Med helicopter crashed at the systems Butterworth campus helipad. Aero Med Spectrum Health is a full-time, physician-staffed medical transport program that serves West Michigan. No one died in the May 29 accident.
Spectrum Health views air medical transportation as a service to the community, the statement said. Spectrum Health is proud of Aero Med and how it works with emergency responders throughout the region to improve the quality and timeliness of care.
Experts said the air medical services sector in the U.S. began at 263-bed St. Anthony Central Hospital in Denver, which says it launched the nations first emergency medical transport system 36 years ago. Since then, air medical transport has evolved into an industry that flies about 500,000 helicopter emergency medical service missions and between 100,000 and 150,000 airplane medical flights each year, according to the Association of Air Medical Services. In a February 2007 report, the Government Accountability Office said that there were 89 air ambulance accidents between 1998 and 2005 (resulting in 75 fatalities and 31 serious injuries), which represents nearly 40% of the total air ambulance accidents since 1972.
But the absence of some data prevents the GAO from calculating if the rate of accidents has risen. During the eight-year period we examined (1998 through 2005), 89 air ambulance accidents occurred, but a lack of data about the number of flights or hours flown prohibits us from calculating whether the rate of accidents has increased, decreased or remained the same over this period, the report said.
The report also showed that the number of accidents tripled to 18 in 2003 from six in 1998, and then declined to 12 and 11 in 2004 and 2005, respectively. Since the start of this year, there have been 10 air ambulance accidents (See chart), and all 16 fatalities have occurred in helicopter emergency medical service, or HEMS, crashes, the NTSB reports.
The spate of accidents is likely something of an aberration, but it has to be viewed in the context of increasing exposure to risk of helicopter EMS providers and pilots as the number of HEMS increases, said Mark Greenwood, an Aero Med flight physician who also has a law degree. I think this exposure to risk is the result of the for-profit, nonhospital-operated aircraft.
The GAO report said available data from 2003 to 2005 showed the number of helicopters involved in air ambulance operations increased by 38% to 753 from 545, while the number of locations from which they operated grew by 30%. And while the report said data are not available on the number of stand-alone and hospital-based operators, researchers found most of the growth in operations since 2003 has been in airports and stand-alone helipads, rather than hospital-based operations.
Industry sources indicate that this growth has produced more competition in certain areas and potentially led to such unsafe practices as helicopter shoppinga continued search for air ambulance service by emergency medical service dispatchers until an operator agrees to accept a flight, the report said.