As federal regulators work on new provisions to improve the safety of air ambulances, some healthcare experts question whether the government is doing everything it can to prevent more medical transport accidents, which have sharply increased in recent years.
Air ambulance debate heats up
Actions contemplated to curb increase in accidents
Some government officials and lawmakers believe that more aggressive actions are needed to improve the safety of medical transport. The urgency was underscored in testimony on Capitol Hill and in a new assessment released by the Flight Safety Foundation that outlined the 26 greatest risks facing the helicopter emergency medical services industry, and steps that industry and regulators could take to mitigate these risks.
In addition, several bills have been introduced in Congress to improve the safety of medical transport, including a bill by Rep. Jason Altmire (D-Pa.) that would provide states with additional authority to regulate intrastate helicopter medical services.
The increase in accidents involving medical air transport operations is alarming and unacceptable, Robert Sumwalt, board member of the National Transportation Safety Board, testified last week before the House Aviation Subcommittee. Last year was the deadliest year on record for the air ambulance industry, where a total of 13 accidents and 29 fatalities were reported. There has been only one accident so far this year, according to the NTSB.
One of the more dramatic 2008 incidents took place in June, when two air ambulances collided in midair while approaching the Flagstaff (Ariz.) Medical Center helipad (July 7, 2008, p. 6). Both helicopters were destroyed, and all seven people aboard the two aircraft were fatally injured, according to the NTSB. Flagstaff Medical Center declined to comment for this story.
Hospitals have often been blamed at least in part for the problems, but many are undoubtedly aware of the importance of air ambulance transport and the role medical evacuation helicopters play in saving lives.
Texas Health Resources depends on the air ambulance service to pick up and deliver patients safely from one facility to another, said Lillie Biggins, vice president of clinical operations at 603-bed Texas Health Harris Methodist Hospital Fort Worth. It is always a sad situation when a unit goes down with fellow caregivers who have committed their lives to helping others, Biggins said.
Many believe that regulatory intervention is long overdue. The helicopter emergency medical service, or HEMS, industry suffers from a lack of structure or governance, not to mention the fact that reimbursement for these services is poor, said Bob Wolin, a partner with the Baker Hostetler law firm in Houston, highlighting some of the biggest risks cited in the Flight Safety Foundations report.
Were having more accidents today because theres no one comprehensive regulator, said Wolin, who has worked with a number of hospitals and HEMS services.
But federal aviation officials dont want any more congressional intervention. Given the voluntary measures already being implemented by the industry, in addition to rulemaking efforts under way at the Federal Aviation Administration to improve safety, regulators believe the issues outlined in these bills are already being addressed, said Christa Fornarotto, the Transportation Departments acting assistant secretary for aviation and international affairs.
To improve air ambulance safety, the FAA should fully address guidelines issued by the NTSB in 2006, said Gerald Dillingham, director of physical infrastructure issues with the Government Accountability Office, at the hearing. The FAA says it will be proposing new regulations by the end of 2009 or early 2010.
Hospitals in the meantime could do their part to help reduce accidents by establishing better communication with the operators of these flights, Wolin said.
Many hospitals engage in helicopter shopping, where they keep dialing various HEMS operators until someone takes the flight. Sometimes the helicopter operator will feel the pressure to take the flight even though it may not be safe, or they need the revenue, Wolin said.
Wolin suggested that hospitals have specific protocols for when an operator turns down a flight for safety reasons. As an example, the emergency department or other staff that requested the flight but had it rejected should be required to tell the next operator that the flight had been turned down by someone. This type of disclosure could prevent more helicopters from venturing into bad weatherand endangering its occupants, he said.
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