Three people including two Mayo Clinic workers were killed in a Mayo Clinic helicopter crash in Florida on Monday. The cause of the crash and names of the victims are still unknown. But the accident will likely increase the already growing scrutiny on using helicopters for the transport of medical personnel.
The aircraft used in this flight was from a private service and is used for everything from emergency medical services to firefighting to corporate transportation. It’s been identified as a Bell 206. That’s not unique to healthcare, but it’s also not the “air ambulances” the public associates with medical transport.
It’s been an intense 18 months for the practice of using helicopters for healthcare. Medical helicopter pilots were labeled as flying the “most dangerous missions in aviation” and the “most dangerous profession in America” in a July 2010 article in Popular Mechanics. Some states were using helicopters unnecessarily, the article found, and they have fewer equipment requirements and poorer protocols — around things as pedestrian as weather checks — than other kinds of flights.
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Part of the reason for the dangers were from an early era as the practice grew. As of mid-2010, the fatal accident rate on medical helicopters was 1.18 per 100,000 hours. Meanwhile, the rate for all general aviation and air taxi flights is 1.13 per 100, 000 hours, according to the Federal Aviation Administration. For helicopters specifically, the rate can vary between 1 and 1.94 per 100,000 hours.
But there remains a consensus that, in general, helicopters used for medical purposes are not safe enough. The National Transportation Safety Board earlier this year said current helicopter EMS accident records are unacceptable.
More specifically, there’s a big difference in how safe one helicopter is to another. The NTSB pointed out that no matter the cost and makeup of the helicopter — a $800,000 single-engine model versus a $12 million twin-engine autopilot air ambulance — Medicare reimbursement is the same.
Monday’s Mayo Clinic organ transplant flight accident is different than many medical flights. But that won’t stop the safety debate from restarting. And even these flights aren’t without challenges. According to the Associated Press, a surgeon and an assistant flying to pick up a donor heart died in 1990 crash in New Mexico. In 2007, a twin-engine plane transporting a set of lungs crashed into Lake Michigan.
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Key questions to be answered about any medical helicopter accident will involve:
- equipment for the pilots
- whether the pilots had scenario-based simulator training and if they had instrument proficiency training
- the kind of autopilot and navigation equipment on the helicopter
It’s unclear what’s happened at the FAA in the past year. The Popular Mechanics article and intensified scrutiny around air ambulances triggered both voluntary safety measures and federal rule proposals. More helicopters came with helmets equipped with night vision goggles, for example. A rule proposed by the FAA in 2010 received final comments in January of this year. It included requirements around pre-flight checks, minimum weather requirements and training — some of which a trade association had already required or implemented.
But the FAA regulation bogged down — due in part to partisan issues around the FAA — and the rule has not yet been implemented.
