The safety of emergency medical services operations became a greater national priority last week when the National Transportation Safety Board added EMS flight operations to its federal most wanted list of safety improvements for 2009.
Created in 1990, the most-wanted list is intended to raise public awareness and support for transportation safety issues. The other items added for next year include restricting the use of cell phones by motor-coach drivers and requiring electronic onboard recorders for all motor carriers.
Although the board has issued recommendations to improve EMS safety, the Federal Aviation Administration has not implemented the changes, the NTSB said in a news release on Oct. 28. In the last 11 months, there have been nine EMS accidents resulting in 35 fatalities.
The most recent accidents happened in Prince Georges County, Md., on Sept. 27 and in west suburban Chicago on Oct. 15. In the first, one patient survived and another patient and three rescue workers were killed as a Maryland State Police helicopter transported victims of a traffic accident. In the second, a helicopter crashed en route to Chicagos Childrens Memorial Hospital crashed and killed three crew members and a 13-month-old child.
In January 2006, the NTSB sent the four recommendations to the FAA. One was that all EMS operators must comply with certain federal code specifications (known as part 135, this code refers to for-hire flights) during all flights with medical personnel onboard. A second said operators must develop and implement flight-risk evaluation programs that include training all employees involved in the operation as well as developing procedures that support the evaluation of flight risks and consulting with others trained in EMS flight operations if the risks reach a defined level. The board also said operators must use dispatch and flight-following procedures that include up-to-date weather information and assistance in flight-risk assessment decisions. And finally, all operators must install terrain awareness and warning systems, or TAWS, on their aircraft and provide adequate training to ensure that flight crews are capable of using the systems to safely conduct EMS operations.
In response, the FAA said it agrees with those recommendations.
Its important to recognize that we agreed with the safety intent of those four recommendations, said Les Dorr, spokesman for the FAA. Our feeling is that making rules whichbecause of the nature of the federal rulemaking process for every regulatory agencycan sometimes take time. We feel rulemaking is one way, but certainly not the only way, and seldom is it the fastest way.
In the past four years, Dorr said, the FAA has worked with operators of helicopter emergency medical services to encourage them to adopt better policies, decisionmaking processes and new safety technology, such as night-vision goggles. In June, the FAA issued a news release listing 17 actions the agency has taken on the leading causes of HEMS accidents (July 7, p. 6).
East Texas Medical Center in Tylerwhich loses about $500,000 in revenue each year to operate Air One, its air medical services systemis evaluating whether it will equip its helicopters with night-vision goggles, according to Art Chance, vice president of operations. But the goggles are a hot item and are hard to come by, Chance said, adding that it would cost East Texas about $50,000 to equip each of the hospitals helicopters. East Texas has four helicopters, including one that is on reserve in case one of the other vehicles is damaged.
Of the NTSBs safety recommendations, East Texas has three of the four in place, Chance said. The only one it does not use is the TAWS system. Milton Geltz, managing director of Shreveport, La.-based Metro Aviation Inc.which contracts with East Texas Medical Centersaid the FAA is currently working on an HTAWS system for helicopters. The FAAs Dorr said the agency is developing a technical service order for HTAWS based on recommendations it received in March of this year from RTCA Inc., formerly known as the Radio Technical Commission for Aeronautics, a private, not-for-profit organization that develops consensus-based recommendations regarding communications, navigation, surveillance, and air traffic management system issues, according to its Web site. A technical service order, or TSO as it is called, is required before the agency can mandate any new rules, Dorr explained.
Although Metro Aviation has not had accidents with East Texas Medical Center, the company operated one of the air ambulances that crashed earlier this year. On Feb. 5, a helicopter registered to Harlingen Community Emergency Care Foundation, doing business as Valley AirCare, and operated by Metro Aviation, approached South Padre Island to pick up a patient when it crashed into the water, killing three, according to a preliminary report from the NTSB. Currently known as South Texas Emergency Care Foundation, the foundation provides ground ambulance service to the Rio Grande Valley of Texas, and Valley AirCare is its air medical division. Although the accident rate this past 11 months has been clearly unacceptable, Geltz said, the number of missions is huge. In the case of Metro Aviation, the company is responsible for 2,800 flights a month, Geltz said.
Meanwhile, the NTSB continues to investigate the recent spate of crashes. Ted Lopatkiewicz, a spokesman for the NTSB, said there will be a public hearing about the crashes early next year, most likely in February. Until then, there has not been more information available on the causes of those accidents.
All of the accidents are under investigation, said the FAAs Dorr. What Ive been told is if you look at the accidents and you look at the common denominator, there isnt one. Its a set of unique circumstances.