SKY Anxiety by ProQuest

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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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