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"medical" helicopters are noisy, unnecessary, overused, expensive, and unsafeMarch 17 2005 at 6:27 AM
Johnny Bob (Login jbob)
from IP address 22.214.171.124
--There have been 4 fatal crashes so far this year, and this is still only
--Medical helicopter crew/pilots have a 40% chance of dying in a crash after
20 years at 20 hours per week.
[because online newspaper articles disappear, it is copied below...]
Safety record of air ambulance industry under scrutiny
Friday, March 04, 2005
By Kevin Helliker, The Wall Street Journal
For weeks now, federal regulators have been investigating the safety record
of the air-ambulance industry, which has experienced four deadly crashes
But an increasing body of evidence suggests there is a larger question to be
asked about emergency-medical air transports: Do they benefit most patients?
The conventional wisdom is that air ambulances save the lives of patients
who are too critically ill to withstand a slower ride in a ground ambulance.
Yet some observers of the industry say medical air transports actually save
very few lives -- while costing as much as 10 times more than ground
ambulances. A number of published studies including research at Stanford
University and the University of Texas, show that the flights often
transport minimally injured patients when ground transport frequently could
get them to a hospital faster, and with less risk to others.
"In 20 years of experience in urban critical-care helicopter transport, I
can count on the fingers of one hand the number of times I thought flying a
patient to the hospital made a significant difference in outcome compared to
lights and siren," says David Crippen, an associate professor of critical
care and emergency medicine at University of Pittsburgh Medical Center.
Inspired by images of helicopters evacuating wounded soldiers in Vietnam,
the air-ambulance industry took root in the 1970s and has grown steadily
ever since. The industry fleet has nearly doubled since 1997, and patient
transports are rising an estimated 5 percent a year, according to Tom Judge,
president of the Association of Air Medical Services, a trade group.
The current probe of this year's fatal crashes, begun in January, comes as
the industry has drawn increasing scrutiny over not just safety, but also
efficacy and possible overuse. Also in January, the journal Prehospital
Emergency Care published an abstract reporting that a study of 37,500
helicopter-transported patients determined that two of three had only minor
injuries. One of four had injuries too minor to require hospital admission.
"The evidence says too many patients are being flown, and yet they keep
flying more," says Bryan Bledsoe, a physician who co-authored the
Prehospital Emergency Care abstract.
Among other recent research critical of air-transport use, Stanford
University trauma surgeon Clayton Shatney conducted a study of 947 patients
flown to Santa Clara Valley Medical Center and concluded that helicopter
service potentially saved the lives of only nine of them -- while
potentially serving as detriment to five who could have arrived faster by
ground. Travel by helicopter often is slower in urban situations, in part
because of a lack of places to land. "In multicasualty situations, it has
not been uncommon that ground ambulances arrive before an airship with
patients from the same event," says the Stanford study, published in 2002 in
the Journal of Trauma, Injury, Infection and Critical Care.
To be sure, there are situations where there is little debate that medical
air transport has clear benefits, such as in rural areas where patients must
travel long distances quickly. Some smaller hospitals that fly patients to
bigger facilities say they must err on the side of caution with a patient
they aren't equipped to handle themselves. And there is research that shows
a value for patients. A 2002 study, conducted by an air medical service in
Boston compared patients flown with patients driven and showed a 24 percent
survival benefit among the most seriously injured who were flown. "That's an
enormous benefit," says Mr. Judge of the Association of Air Medical
The cost of air ambulances varies -- generally from $5,000 to $10,000 a
trip, and sometimes as much as $25,000, according to industry experts. That
is typically five to 10 times as much as ground ambulance. But ground
transportation also can be not just less expensive, but faster: A 1995 study
of air transport of potential organ donors in Houston, conducted by trauma
surgeon Christine Cocanour, found that 27 of 28 would have arrived faster by
Air-transport industry leaders, including Stephen Thomas, a physician and
associate medical director of Boston MedFlight, an emergency medical
air-transport service, attribute the high rate of minimally injured patients
to the difficulty of conducting accurate injury assessments at the scene of
accidents -- especially considering that such calls often are made not by
physicians but by paramedics and even police.
But the majority of air transports occur not from accident scenes but from
hospitals, according to the Association of Air Medical Services and others.
Frequently, doctors at a smaller hospital assess and stabilize patients
before dispatching them to larger medical centers.
Insurance companies -- which often must pay for the costly transport -- say
they are reluctant to second-guess the decisions of these doctors, who may
view air transport as the least-risky choice for both the patient's health
and the hospital's liability.
Consider the decision on Jan. 11 to fly Ryan Memering out of Memorial
Hospital of Carbon County in Rawlins, Wyo. Mr. Memering had two fractured
vertebrae and a deep gash inside his mouth from a car accident. Doctors at
Carbon County made the decision to fly him to a larger trauma center in
Casper, 120 miles away.
Hospital officials in Rawlins say that ordering the air transport was a
clear-cut decision: Though the 45-bed rural hospital has a small
intensive-care unit, it lacks full-time specialists for higher-level acute
or trauma care. "Any time you have something out of their scope of practice,
that's a liability for anyone. Do you want to take that risk?" asks Candace
Hofmann, the hospital's ambulance director.
The plane dispatched to retrieve Mr. Memering attempted to land in the dark
at Rawlins Municipal Airport. It crashed three miles away, killing three of
four crew members on board. Not until the next day did Mr. Memering get
flown to the Casper hospital, where doctors performed no surgery and
released him in four days. "The staff there said Rawlins had panicked
basically," says Serena Memering, the patient's wife. Her husband, she says,
"feels guilty that three people died because of this. In my opinion, it was
a waste of lives."
The Rawlins crash represented the third fatal accident of an air ambulance
during the first two weeks of 2005, prompting federal regulators to open a
Safety experts say the industry's crash record is less a threat to patients
than to crew members, who if they worked 20 hours a week for 20 years would
face a 40 percent chance of being involved in a fatal crash, according to
Johns Hopkins University epidemiologist Susan Baker, a professor in the
Johns Hopkins Bloomberg School of Public Health who has studied the
industry. Possible outcomes of the federal probe include a requirement that
pilots wear night-vision goggles. The four fatal crashes so far this year of
air ambulances have killed six crew members and one patient.
Patients can end up paying for helicopter transport that wasn't medically
necessary. After 9-year-old Tyler Herman fell and broke his jaw in the wilds
of Arizona, doctors at a community hospital decided the boy should fly to
Phoenix to undergo plastic surgery for a gash on his face. During the flight
he was well enough to sit up and remark on the scenery. Upon arriving in
Phoenix, he waited nearly 20 hours to undergo surgery. "We could have driven
him there in four hours," says Sharon Herman, the boy's mother. Her
insurance didn't cover air transport, leaving the Hermans with a bill for
On its own, the air ambulance doesn't appear to be a huge money maker.
Earnings at the industry's largest player, Air Methods Corp., climbed to
$5.1 million from $3.4 million during the five years ended in 2003. But a
2003 Journal of Trauma study conducted by the University of Michigan Health
System, which runs a flight service, found that flown-in patients had better
insurance and generated significant "downstream revenue" because the
patients developed a relationship with the hospital and often returned years
Respond to this message Author Reply Johnny Bob
HELICOPTER = D A N G E R !!! (more links)
March 19 2005, 7:09 AM
They're not something we want flying low over our residential neighborhoods many times every day. It just doesn't make sense anymore. Their proponents will now have a much harder time justifying it with their usual narrowminded contrived tearjerker sob stories. This should become obvious if you will read some of the links below, particularly the first one...
Safety record of air ambulance industry under scrutiny
This makes 5 medical helicopter crashes in 2005 in the US
Medical helicopter crashes since 1990
Cause of Copter Crash Unknown
(Potomac Case Latest of Many Medical Flight Accidents, NTSB Says)
Fatal Helicopter Crash Under Investigation (Patient Dies in Crash...)
Medical helicopter crashes, killing one
4 killed in Texas medical helicopter crash
Copter crash kills 3
(Bayflite medical crew slams into radio tower.)
Investigators reach remote Nevada site of medical helicopter crash
The cost-effectiveness of air medical helicopter crash survival enhancements...
SEND THE WHIRLYBIRD....(crashed)
Three killed in crash of medical helicopter in southwest Georgia
Killed in the line of duty...
First NTSB report on helicopter crash is out
Air Ambulance Operations: Enhancing Public Safety or Causing Unnecessary Tragedy
BehindTheMedspeak: Medical Helicopters Crash Too Often
(partway down the page)
Air Ambulances Are Under Fire
Report: Air Ambulances Often Slower Than Counterparts On Ground
Do air ambulances save lives?
4 Killed in Regional One Helicopter Crash
N601RX A109K2 - NTSB Preliminary Accident Report
Helicopter Crash Litigation
Medical helicopter crashes - Lynnville Indiana
more to come...
Respond to this message Johnny Bob
another fatal Air-Evac helicopter crash...
March 20 2005, 1:39 PM
This fatal crash is the eighth Air-Evac helicopter accident since 2001. You can read the February 27, 2005 newspaper story at the link below:
These helicopters are dangerous! They should not be allowed to fly low over our highly populated neighborhoods in Mt Vernon IL several times a day. It's not safe!
[because online newspaper stories disappear frequently, it is copied below...]
More Flights, More Crashes
By Don Dailey
The Morning News
ROGERS -- The fatal crash this week of an Air Evac helicopter in western Benton County was the company's eighth accident since 2001, but its safety record mirrors the industry as a whole.
Andy Arthurs, Air Evac Lifeteam director of base operations, said the increase in the number of accidents correlates to the increase in the number of flights by the company's aircraft.
"A small company may fly 4,000 hours a year," Arthurs said. "Air Evac in 2005 will fly 35,000 hours a year."
The entire air medical industry has seen its accident rate increase each year beginning in the late 1990s, an increase that has drawn the interest of the Federal Aviation Administration.
According to National Transportation Safety Board records, the helicopter crash near Cherokee City north of Siloam Springs that killed a Texas man being flown from a vehicle accident was the second crash in four months of an Oklahoma-based Air Evac aircraft and crew.
Robert Arneson, 71, did not survive the combination of automobile and helicopter crashes. Helicopter pilot Dennis Enders, 53, of Broken Bow, Okla., was in serious condition Saturday at Northwest Medical Center of Washington County in Springdale. Paramedic Clayton Bratt, 56, of Hulbert, Okla., was in fair condition Saturday in the same hospital. Nurse Dee Ann Miller, 40, of Bentonville, was in fair condition Saturday in the surgical intensive care unit of Northwest Medical Center of Benton County in Bentonville.
The crash was the eighth accident since 2001 involving an Air Evac helicopter. Before 2001, Air Evac had only four accidents dating back to its beginning in 1985.
In terms of the number of aircraft, Air Evac is one of the top five air medical services in the country, according to Dawn Mancuso, spokeswoman for the Association of Air Medical Services in Alexandria, Va., a leading industry group.
The company operates in portions of 11 states and has a fleet of 43 aircraft. There are seven Air Evac bases in Arkansas.
Calls for Air Evac flights have probably not increased in Northwest Arkansas cities, said Sam Clardy, Springdale Fire Department Battalion Chief and Lowell Fire Captain. The distance to the hospital is too short for a helicopter to help, he said.
"But out in the rural part of the county, you get more flights," Clardy said. "It's a lot farther to the hospital from there."
People who have a membership with Air Evac also are more likely to be air-lifted, Clardy said.
Arthurs said the company owns the world's third largest fleet of Bell 206 LongRanger helicopters, the workhorse of the air medical service industry.
According to Robert E. Breiling, a Florida-based consultant who analyzes business aircraft accidents, in 2003 -- the latest year for which statistics are available -- the accident rate across the helicopter EMS field was 7.45 per 100,000 flight hours, lower than the rate in the 1980s, but much higher than it was in the mid-'90s.
In 2003, according to the National Transportation Safety Board, Air Evac experienced two accidents with no injuries, one of which was a training flight, resulting in an accident rate for the company of 6.30 accidents per 100,000 flight hours.
"I believe that we are as safe as anybody in the industry," Arthurs said.
Air Evac helicopters have been involved in five fatalities since 1985, although not all have been the result of a crash. A security guard was killed in 2001 when he walked into the moving tail rotor of a helicopter at a hospital in Quincy, Ill.
Last week's crash was the first Air Evac fatality in the state, but it was the fourth accident in Arkansas for the company's helicopters, including one in 1998 in Springdale that injured three crew members.
Air Evac is in good standing with the state, according to David Taylor, director of the EMS and Trauma Systems Division of the Arkansas Department of Health. There has been one complaint against Air Evac lodged with the Health Department, Taylor said, but it did not involve a safety issue.
Shawn Rogers, emergency medical services director for the Oklahoma State Department of Health, told the Oologah, Okla., newspaper last week that Oklahoma is closely watching Air Evac because of the two latest crashes.
The first definitive study of the air medical service industry was done in 1988 by the National Transportation Safety Board and found the accident rate between 1982 and 1986 to be 13.42 crashes per 100,000 flight hours.
Pilots were taking off in marginal conditions -- bad weather or at night -- and taking unnecessary risks, the study found. The industry began rigorous self-regulation and the accident rate was reduced to 3.14 per 100,000 flight hours.
The Federal Aviation Administration watched as the rate of accidents for helicopter emergency medical service began to rise from its low point in 1996. By August 2004, the accident rate had risen to its highest in 17 years and the agency decided to take action, said Roland Herwig, an FAA spokesman in the agency's Oklahoma City office.
"We formed an FAA and industry and operator task force, the people who build, people who fly (helicopters)," Herwig said.
In January, the FAA's task force found many of the same accident-causing factors found in the 1988 study were causing the recent upswing in accidents.
Most of the accidents were caused by pilots flying in bad weather and at night.
"The FAA got the task force together and saw risk management was a lot of it," Herwig said.
The FAA recommendations for the industry included providing risk-management training for flight crews, better training on flying into weather or at night and better technology such as night vision goggles.
Arthurs said Air Evac participated with the task force and agreed the recommendations are good ones.
However, he said the company hasn't specifically acted on the recommendations because it already has a rigorous training program in place.
"We actually almost every month improve our pilot training," Arthurs said.
Arthurs acknowledged the company must make flights in order to stay in business, but like most other helicopter emergency medical service companies, Air Evac attempts to insulate pilots from market pressures by giving them the last word on whether to fly.
When a call comes in requesting Air Evac service, pilots make decisions based only on flying conditions. They are not given details of the medical situation, whether it is a major trauma at a highway accident or a short hospital-to-hospital transfer flight, Arthurs said.
That prevents flight crews using potential patients' medical conditions as a factor when deciding whether to fly in marginal conditions, Arthurs said.
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