Hospitals

On the heels of Mayo Clinic crash, a brief on medical helicopter safety

Mayo Clinic procurement technician David Hines and cardiovascular surgeon Dr. Louis Bonilla were doing what […]

Mayo Clinic procurement technician David Hines and cardiovascular surgeon Dr. Louis Bonilla were doing what they do every day — procuring an organ to save a patient’s life — when they lost their own lives in an early morning helicopter crash on Monday, says one colleague in tribute videos posted on the hospital’s blog.

Because the crash started a fire that destroyed 85 percent to 90 percent of the aircraft, the National Transportation Safety Board says it could take six months to a year to complete the investigation to determine the cause and conditions of the accident, which also killed pilot E. Hoke Smith.

Although the men were part of a charter mission to procure an organ, as opposed to the emergency medical rescue of a patient, the Mayo Clinic crash brings to the forefront some important safety issues that surround air medical services in healthcare.

A 2010 article in Popular Mechanics pointed to the dangers in medical helicopter safety, following some high-profile helicopter EMS crashes and a transplant mission accident that killed six people in 2007. The number of fatal helicopter EMS accidents nearly doubled between the mid-1990s and mid-2000s, and the accident rate among HEMS missions is above the rate for all general aviation flights.

To put the Mayo crash in context, we talked to Tim Pickering, the president of the Association of Air Medical Services, a nonprofit trade organization that supports providers of air and surface medical transport systems. He explained some concerns from the AAMS’ perspective, including a lack of development and support in low-altitude aviation operation and a general lack of data about HEMS and charter flight accidents.

Q: What are the differences between “air ambulances” for EMS use and regular charter helicopters, like the Bell 206 involved in the Mayo crash?

Physically, they differ only in the fact that an AAMS helicopter would be specifically equipped to transport a patient. Otherwise, they could be identical aircraft and equipment, just purposed for different missions. They both operate under Federal Aviation Administration regulations part 135, which gives whoever operates the aircraft the requirement of having an air carrier certificate.

Q: Are there general requirements that pilots and medical helicopters must meet in order to contract with hospitals?

Other than the requirements under FAA’s regulations that anybody operating and renting or leasing an aircraft have an operating certificate under part 135, I don’t know of any federal or state requirements for medical pilots and medical helicopters to contract with a hospital.

Q: Do most hospitals contract with aviation companies for helicopter services?

Many hospitals that use helicopter EMS will contract with aviation companies to lease the required part 135 air carrier certificate, but there are some hospitals that have chosen to own an aircraft and establish and own their own air carrier certificate, and thus they inherently become an aviation company as well. A lot of it would vary around economics, but a lot of it also might vary on whether a hospital felt it wanted to have more ability to control the specifics of the aviation side.

Q: Why are things like flight data recorders and filing a flight plan not required for emergency air operations?

Helicopter EMS operations do file flight plans under part 135 requirement. They’re generally not flight plans with air traffic control centers; they’re local flight plans through their communications coordination or operational control centers. Flight data recorders are not required for certain types of aircraft based on operating weight and their use, so it’s not just HEMS aircraft that do not have them. They are heavy and weight is a concern.

The FAA considers operations in HEMS to be similar to general aviation operations, thus the FAA hasn’t invested in and hasn’t begun any real development in support of what’s called the low-altitude infrastructure — that is, the requirements for below the 5,000-foot area, which most HEMS operate in. AAMS has called for and lobbied for FAA investment in this area, including weather reporting, regulating meteorological powers and communications capabilities.

Q: What poses the biggest problem for EMS pilots? Lack of equipment? Flying and landing in hazardous conditions? Feeling rushed?

Many folks who operate HEMS aircraft in the last five to seven years have voluntarily made huge financial investments in improving equipment in the fleets. They’ve added things such as night-vision goggle systems, helicopter warning systems and improved their flight following and risk-assessment systems, and all of this has been developed generally without regulatory requirement.

Ultimately, the real problem comes down to human factors of decision-making and we believe that’s what contributes to the majority of today’s accidents. Why did a human make a decision at a particular point in time to do something that ultimately led to an incident or accident? The NTSB has added human factors into its accident investigation process, looking at fatigue issues. You may be aware of the well-publicized airline part 121 rules on pilot fatigue, and we believe those kinds of requirements will come down to our part 135 air carrier operations.

Q: Do doctors/surgeons typically go on the kind of trips like the Mayo one (to retrieve organs)?

AAMS doesn’t know what a typical medical crew component of a transplant service is. We know in the past, like in a recent accident with the University of Michigan, their transplant team had several physicians on that aircraft. We do know that some AAMS members use a helicopter simply as a means of expeditiously transporting the physical organ, not a team to get the organ.

Generally, it’s hard for us to know because there’s no data. That’s one of the big things that the FAA acknowledges and the NTSB has planned out — there’s a dearth of accurate data collection for helicopter EMS and the charter industry. Who’s doing what? Where? How? Under what conditions? We hope that FAA’s rule-making role will mandate more data collection.

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