Med copter deaths intensify calls to enforce safety rules

Minutes before midnight on Oct. 15, a medical helicopter was flying 1-year-old Kirstian Blockinger to Children's Memorial Hospital in Chicago. The baby was having seizures, and there was no room at a hospital closer to her home in rural Leland, Ill.

The helicopter crashed, killing the infant and all three crew members.

Investigators say preliminary evidence suggests the Air Angels Inc. craft hit the ground after clipping a radio tower support wire.

These fatalities raise to 28 the number of victims from seven fatal medical helicopter crashes this year. This surpasses the previous high of 18 deaths in 2004, according to National Transportation Safety Board data. Since December 2007, 35 people have died in nine emergency copter crashes.

As a result of the tragedies, federal officials and the medical community are reexamining the issue of EMS helicopter safety -- pondering the same questions: Why is this happening? What can be done?

"It's absolutely heartbreaking," said Robert Sumwalt, a board member of the NTSB. "Our mission is to try and improve safety in transportation, and here we've found an area where lives are needlessly being lost."

In October, the NTSB questioned why the Federal Aviation Administration had not implemented four recommendations that the board made in 2006. The NTSB has placed improving the safety of EMS flights on its annual "Most Wanted" list of safety improvements.

The NTSB recommends all medevac operators:

• Use increased weather-minimum and pilot-rest duty requirements on all medically staffed flights.
• Use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight-risk assessment decisions.
• Install helicopter terrain awareness and warning systems and train flight crews to use them.
• Develop and implement flight-risk evaluation programs and training procedures, and consult with others trained in EMS flight operations when weather risks reach a predefined level.

FAA spokesman Les Dorr cited the rule-making process as a big reason why no regulations have been put in place. The agency has opted to encourage voluntary changes by flight operators to adhere to the recommendations. It also urges use of other safety measures, such as night-vision goggles.

"Certainly, we don't disagree with the need to improve safety," Dorr said. "We feel like rule making that would result in mandates is one way to do things, but certainly not the only way, and seldom is it the fastest way."

The agency hopes to unveil technical standards for helicopter terrain awareness and warning systems in January 2009 -- a key step toward mandating use of the devices, according to Dorr.

The FAA hosted a meeting about medevac safety in October, trying to seek immediate measures that can be taken voluntarily. The NTSB will conduct a public hearing on the issue Feb. 3-5, 2009, in Washington, D.C.

One solution gaining popularity among EMS pilots is the use of night-vision goggles, which illuminate landing zones and obstacles that might otherwise go unseen in the darkness.

"I've flown probably 34 of my 38 years without them, and the difference is literally night and day," said EMS pilot Ed MacDonald, a retired military pilot who flies for PHI Air Medical Group in New Mexico and is the safety committee chair of the National EMS Pilots Assn.

The problem is money. The goggles cost about $10,000, and at least two would be needed on board. The aircraft would also have to be retrofitted to accommodate the goggles, and the crew trained in using them.

In seeking solutions, aviation experts said this year's fatal crashes cannot be lumped into one category, can't be solved simply through FAA mandates, and probably are a spike rather than a trend.

"The accidents are still under investigation, but ... if you look at the accidents this year and say, 'Where's the common thread?' there isn't one," Dorr said. "It's a unique set of circumstances for each accident. So, that makes it difficult to shoot a silver bullet at the problem and say, 'This will fix it.' "

For instance, it was a clear and sunny day in June when two medevac choppers heading to the same medical center in Flagstaff, Ariz., collided midair, killing seven people.

"There's just no explanation for that," said Ira Blumen, MD, medical and program director of the University of Chicago Aeromedical Network and a past president of the Air Medical Physician Assn. "None of the [NTSB] recommendations would have prevented that accident, as best I understand."

Different ways to transport patients

Another common question: Are medevac flights ordered too often?

There are slightly more than 750 medical helicopters flying-- roughly double the number 10 years ago.

Studies have shown that use of helicopters for trauma patients helps just a small number of patients, and a sizable number of EMS doctors call for air transport when the situation might not require it. A study in Annals of Emergency Medicine in 2000 looked at 3,408 patients with penetrating trauma in Pennsylvania during an eight-year span. It found the patients transported by helicopter had longer transport times and no significant difference in mortality compared with those transported by ground ambulance.

Yet, emergency medical directors aren't ready to ground their helicopters just yet.

"Sometimes [helicopter transports] might be unnecessary, but you may not know that until the patient arrives," said Michael Eng, MD, a heart/lung transplant surgeon at Loyola University Medical Center in Chicago. "There is no absolute whether somebody needs it or not."

He said both safety and the patient's needs must be considered.

"The people who question whether people need to be on helicopters or not ... if it were them or one of their loved ones [injured], they would want the best chance for a good outcome they could have," he said. "Having a helicopter available has undoubtedly saved lives."