By Paul Mazurek
Last weekend, I was enjoying dinner with my significant other and her family, who I had recently met. As we talked, I was asked the standard “get to know you” question: “So, what do you do for a living?” As I am very proud of what I do, I was more than happy to answer this question. When I did, the woman across the table from me mentioned that she had a very good friend who was an air medical transport provider. He was killed in a helicopter crash several years ago, leaving behind a wife and small children. I expressed my condolences as my heart sank below my diaphragm, as it always does when I hear about another EMS helicopter crash.
While I don’t believe in coincidences, I was also recently asked by the editorial staff of EMS1.com to provide my perspective on current recommendations released by the NTSB regarding EMS helicopter safety. As someone who works for two air medical programs and spends a great deal of his time in the air, I certainly have my own opinions.
Motivation, Dialogue, and Assessment
In February of this year, the NTSB held a four-day public hearing in order to learn more about the HEMS industry in an attempt to examine the factors that lead to medical transport helicopter crashes1. Last year was described as “the deadliest year for HEMS operations” with eight crashes that killed 29 people.2
The role of the NTSB is to investigate civilian transportation accidents in the United States and determine probable causes. Through field investigation, fact-finding missions and public hearings, recommendations are made to federal regulatory agencies and congress in order to improve safety in the American transportation system.
At the hearing, 41 witnesses were called from all corners of the air medical transport industry including clinicians, helicopter manufacturers, communications specialists, pilots, inspectors, hospital administrators and insurance experts. The hearing focused on several issues, including:
• Flight operations, policies, and procedures
• Growth of the HEMS industry and its potential impact on safety
• Training
• Oversight (company-wide and governmental)
• Technologies inside and outside of the cockpit that may enhance safety
• Quality assurance
After four days of testimony by key experts in their respective fields and discussion of topics ranging from weather, reimbursement structures, simulator training, and technology to a comparison of the Canadian HEMS model (which serves 21 million people with 20 aircraft)2, the board spent the next several months analyzing the data and processing the information received. Their conclusions and recommendations were released September 1 of this year in the form of a public meeting.3 The results of witness testimony and the safety recommendations issued can be found in the aviation section of the NTSB Web site (http://www.ntsb.gov).
One Air Medical Provider’s Perspective
In analyzing the NTSB’s conclusions, it is important to first understand that change is inevitable. The NTSB has made its recommendations and modifications of current equipment; procedures and practice are forthcoming.
The fact of the matter remains that there is a vast percentage of the public that is looking for someone or something to blame for our recent safety record in HEMS. The industry has fallen under much scrutiny, and rightfully so. Our job is to safely transport patients and people are becoming more and more skeptical of helicopters. There are outcries that there is no place for helicopters in critical care and emergency transport (that’s a completely different topic of discussion, and I welcome anyone else to author a column on it).
As for the upcoming changes, there is one unavoidable truth: If I want to continue to work in this field (which I do), I am going to have to embrace whatever changes are required of me. This I have no control over, not that I want it.
There is, however, plenty that I as an air medical transport provider can do right now to improve my chances of making it to the ground safely each and every time I go up. While not all inclusive, these are my basic “recommendations:"
• Read the NTSB recommendations for yourself. Discuss them with your teammates and get a feel for where you currently fall short. Discussing safety is one of the first steps to practicing it.
• Learn as much as you can about the technology that is recommended to help keep aircrews safe if you are not currently implementing it.
• Don’t take it personally when the pilot tells you to tighten your chinstrap, wear your gloves, or quiet down while you are in a “sterile cockpit” situation.
• On that same note, don’t be afraid to offend anyone who is falling short with their responsibilities with respect to crew safety.
• Formulate and foster good communication skills with your entire crew. Know your role in an emergency and be prepared to do your share to get home safely. If you act like “talking cargo,” you will be treated as such.
• Understand that stowing your equipment for flight is not a suggestion.
• Simulators or no simulators, train as a crew in the aircraft. Know where the emergency procedures are kept and know your primary and secondary egress routes.
• If you are too tired or too sick, don’t go up. Who are you benefiting at that point?
• Create and maintain a safe forum to discuss concerns as a team. Every program has it as its policy but is it really there?
• Look out for each other.
Conclusion
Intuitive? Obvious? Stuff that you have heard many times before? Probably. In light of what is happening in HEMS, a little repetition to reinforce these principles can’t hurt. It is all part of our recurrent safety training. I have played “Air Medical Safety Jeopardy” along with everyone else who has attended safety training. I can quote key regulations in the FAR manual that affect me. I can escape an aircraft filled with “canned” smoke. I can even discharge a halon fire extinguisher. The question is, what am I doing every single shift to take care of myself and help take care of the people that I fly with?
Everyone has their reasons for doing this job. Most of it revolves around the strong desire to help people. While there are inherent risks, no one expects to die while doing this job. Provider models, reimbursement rates, competition, and the number of helicopters within a 25-square-mile radius should have no bearing on how we perform our jobs when the rotors start turning.
I and a number of people that I know within the air medical transport industry have lost colleagues. My short answer to the question, “What do you think about the latest NTSB recommendations?” Whatever keeps me going home after my shift is over.
References
1. EMS Public Hearing Announcement: Safety of Helicopter Emergency Medical Services (HEMS) Operations. February 3-6. www.ntsb.gov. Accessed 21 September 2009.
2. National Transportation Safety Board. Public Hearing: Helicopter Emergency Medical Services. February 3-6, 2009. www.ntsb.gov. Accessed 21 September 2009.
3. National Transportation Safety Board. Public Meeting of September 1, 2009: Four Safety Recommendation Letters Concerning Helicopter Emergency Medical Services. www.ntsb.gov. Accessed 21 September 2009.
