Costs hurt helicopter ambulance safety

Helicopter setting off on a rescue mission


Renita Jablonski: The National Safety Transportation Board usually focuses on commercial airline crashes. This week, they've been looking at air ambulances. In question are companies that send out choppers to rescue people and airlift them to a hospital. Jill Barshay has this look at how medicine and business collide.

Jill Barshay: As fans of the TV show MASH know, medical evacuation has been around for over half a century. But it's only recently grown to a $2.5 billion civilian business.

In the last 10 years, the number of helicopter ambulances has doubled, but the number of accidents has skyrocketed. Last year, 28 people died in medivac crashes.

Thomas Judge: This has everybody's attention. We have an accident set of numbers that's completely unacceptable.

Thomas Judge runs a nonprofit medical evacuation program in Maine. He says it's not clear what's causing all these accidents, but he believes money is a factor. Helicopter companies charge $10,000 or more for each mission. If they don't pick up patients, they don't get paid.

Judge: They're under pressure to find, you know, flights because the revenue for the system is based on flights. That now we're making a decision that's not based on medicine, we're making a decision that's based on business.

Business concerns are also why many firms are not buying costly safety equipment.

Dr. Kevin Hutton is with the Association of Air Medical Services, the industry trade group. He says helicopters are expensive, and profit margins are thin.

Dr. Kevin Hutton: Any time we adapt, any time we add a safety technology, any time we do anything that's going to cost us additional money, we have no way of getting reimbursed for that right now.

Dr. Hutton predicts new safety costs will force air ambulance companies to retreat from some rural communities. If that happens, it could affect the health of people who live in small towns. Many of their hospitals don't have neurosurgeons or cardiac specialists, and they rely on air ambulances.

In New York, I'm Jill Barshay for Marketplace.

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sir , could i know the cost new helicopter ambulance

I fly for a community based air ambulance service in west Texas where it gets real dark at night. We have all sorts of obstacles like wind farms under construction without obstruction lighting, the usual antennae, mountains and black holes. Add to that strange weather and crop duster pilots and it gets dicey. However, safety is not a gizmo or another dash mounted display or warning tone that corporate can use as a sales tool. Sales, or flight numbers come from the field where the skids meet the pads. Our safety record is the fact that we are there. Most of the crashes are pilot error and preventable. The workload in the cockpit is sufficient to keep the pilot busy and some internal procedures are annoying as well as distracting so the addition of faux safety devices will only add to the time the pilot spends inside the cockpit instead of outside. I am a well trained NVG pilot and instructor and I shudder at the thought of goggling up everyone to lower our turndown rate. I have always said that if you can't fly without goggles you shouldn't be flying at night at all. It takes a pretty good night pilot who is comfortable and confident to become a goggle student let alone a good goggle pilot. Lets not fall victim to kneejerk reactions to accident rates that are not necessarily growing when compared to the growth of the industry.

For those of you have and have not read the NTSB reports, the number of fatal crashes per 100,000 hrs of fly time is down considerably from a decade+ ago. With more flights, come more accidents due to normal statistics.

In order to remain relevant and responsive to the needs of their customer base, air ambulance programs, like any EMS provider, must draw their core operating philosophies from the symbiotic cultures of health care and public safety.

Add in the highly regulated, standards and credentials based world of aviation, and you have an industry that at times feeds on itself trying to survive, and do so responsibly and safely.

A profit motive is incompatible with the essential mission of public safety. This carries over to EMS agencies, and thus to air medical programs.

In order to remain responsive to their communities and their mission, flight programs must therefore eschew revenue considerations in favor of a service model that emphasizes service and safety.

I am an EMT-B (B for basic) for a rural volunteer ambulance service in SW Colorado with a 2 hour ground transport to a hospital from our local clinic. One of the best things that I can hear after transporting a seriously ill patient to the local clinic is that the helicopter is on the way. It's the care flight helicopters that give us any hope of a quick trip to higher level care for anybody in our area unfortunate enough to have had a serious injury or illness. Having a bad trauma injury, stroke or heart attack when the helicopter can't come (such as bad weather or dispatched to somewhere else) is more than bad luck, it can be fatal.

If that helicopter option went away, it would be sad news for everybody.

Tom Judge runs a very respected HEMS service in Maine, in fact was the HEMS service of the Year in 2008. As far as the comments about NTSB findings. Yes most of the accidents in 2008 were caused by pilot error, but that starts with the decision to fly. How many of these crashes happened after another service turned down for weather? There is some pressure for teams to fly, to stay open. I'm personally glad I fly for a not-for-profit, hospital based and sponsored Critical Care Team.

Air ambulances are like most things in medicine, too many procedures/people/ambulances = not enough treatments/patients/transports to support the infrastructure. On the other hand, lack of procedures/people/ambulances leads to increased mobidity/motality of patients. So realistically air ambulances are one cog in the wheel of medicine that needs to be present. We have to make them as safe as what we can afford, utilize them when appropriate, and maintain enough of them to handle the needs of the patients while maintaining the skills of those working on them. Larger and more sophisticated helicopters do offer some advantages to their air crews that smaller, simpler helicopters don't have. The number one reason though behind failure, is our failure as air crews to appropriately monitor our own utilization and when (even if the patient does "need our services") to refuse the mission when it is unsafe to perform. I have no doubt that we cannot always prevent all helicopter accidents just the same as we cannot prevent all of any type of aviation accident if we still fly. What we can do though is mitigate our exposure and risk. As far as those areas that do not have large populations of people, that is exactly what air medical helicopters and airplanes are for. To bring you highly skilled clinicians in a vehicle that can bring you back to some tertiary center for your care.

I must say after reading I disagree and agree with some of it. After carefully reviewing the NTSB reports, a majority of med evac crashes are deemed pilot error. I cannot vouch for what type of experience Mr. Judge has in the nations med evac service, but I cant tell you that the two largest med evac compainies in the world are on the up and up with safety proceedures. We do not go looking for flights, nor do we base flight acceptance on the patient. His words are reckless and quite out dated. There are only a few devices on a helicopter that would prevent some, but very few of these unfortunate crashes. They are expensive, they are worth the money though. To state that money is the cause of these accidents is foolish and uneducated. Most of these crashes are the cause of a simple pilot error, and most pilots I know put the lives of the crew, themselves, the patient, all of our families and friends.....before someone elses money.I have lost great friends to helicopter crashes. Think before you speak.....

How many more lives have to be lost before someone finally says enough is enough? If you have the money to open a new base, you have the money to purchase equipment and aircraft that have the latest and greatest equipment to ensure crew and patient safety. Too many lives have been lost. ENOUGH IS ENOUGH!

If the $ margins were that slim there wouldn't have been the explosion in the number of Airmedical companies....people only open and remain open airmedical where they are making money....ask any commmuntiy who needed the service, used to have it and lost it. So that argument is BS. Maybe those who don't feel they can afford the safety measures for their staff need to be the ones who start going on each and every flight they sendout because if its safe enough for your staff to go day in day out, regardless it should be the same for the shareholders/managers/owners-


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