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helicopter safety Cover report by John Erich, Associate Editor As the crashes keep coming, what can we do to utilize helicopter EMS resources more safely? Over the last 12 months, the fatal EMS helicopter crashes have come in rapid succession. First were Whittier, AK, and Cherokee, AL, last December, respectively killing four and three. Then South Padre Island, TX, in February and La Crosse, WI, in May, three each. Huntsville, TX, in June, four more. Two collided in Flagstaff, AZ, that same month, claiming seven, then another fell in Burney, IN, in August, taking another three. Finally, as this story neared completion in late September, a Maryland State Police medevac crashed in suburban Washington, DC, killing four. That’s eight accidents and, pilots But as all the metrics climb— want to help people.” and patients and crew, a total of 31 aircraft, missions, ﬂight hours, Certainly, EMS can ill-afford to lose dead in the last year. It could have crashes and deaths—it becomes those. been worse—another half-dozen increasingly worth doing. events saw everyone emerge alive. “At this year’s National EMS ‘NOT WELL DONE’ It’s easy, if natural, to ask Memorial in Roanoke, half the people As recently as 2002, researchers what equipment or practices inducted were air medical people,” with the University of Chicago might help reduce the spiraling notes Texas emergency physician Aeromedical Network calculated the yardsticks of air-medical crashes Bryan Bledsoe, DO, FACEP, perhaps number of medical helicopters in and fatalities. It’s harder to look at the most prominent critic of the the U.S. at around 400. Today, that’s the proliferating use of helicopter accelerating use of HEMS resources doubled. EMS (HEMS) resources and try to (not all were killed in 2007). “The Some reasons for that growth are decipher the optimum balance of ﬂight paramedics and ﬂight nurses, clear. The population’s greying. Rural beneﬁt, risk and safety, and the they’re the victims in this. And those hospitals and EDs have closed. Top most likely path to achieving it. are smart, dedicated people who just trauma resources and specialty care 38 NOVEMBER 2008 EMS www.emsresponder.com helicopter safety are consolidated. The importance of was a patient in need. But the nonlife-threatening injuries. timely interventions in situations longer answer also involves things “You always want to err on the like stroke and cardiac arrest is ever like indications and procedures for side of caution, but we’re ﬁnding more widely reﬂected in protocols and air-medical use, ﬁnancial realities, rates that are ridiculously high,” practice. Even in urban areas, trafﬁc restrictions on oversight and the Bledsoe says. “In our study, two out congestion and overstretched ground overall design of communities’ of three, by all objective criteria, had resources may sometimes make emergency response networks. minor injuries. These people get an ﬂight a faster option. Concomitantly, “Right now, we don’t have a $8,000 helicopter ride, then they’re total EMS ﬂight hours have risen thoughtfully designed system,” says not even admitted to the hospital. steadily in the U.S., from fewer than Tom Judge, executive director of Is our prehospital assessment so 200,000 in 1998 to more LifeFlight of Maine and past president poor that we can’t even begin to “The than 400,000 in 2006. of the Association of Air Medical judge who might even need hospital In terms of relative Services (AAMS). “It’s not unlike admission?” safety, at least until this many other things in medicine. It’s Casting a wide net is important, of year, things have been not well-integrated into EMS. There course; you wouldn’t want to miss question improving. Reviewing a needs to be more medical oversight any patient air resources might help. decade’s worth of accidents and oversight of use, and making
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