An accident this week in Arkansas has boosted to 21 the number of people that have been killed so far this year in medical helicopter and plane crashes, renewing concerns about the safety of such operations.
An Air Evac Lifeteam helicopter crashed Tuesday near Scotland, Ark., killing the pilot, a nurse and a paramedic. It was the fourth fatal accident this summer: A medical helicopter crash in Tucson, Ariz., killed three people on July 28; a crash near Kingfisher, Okla., on July 22 killed two people and seriously injured a third, and an air ambulance plane crashed July 4 in Alpine, Texas, killing five.
"This is very alarming," National Transportation Safety Board member Robert Sumwalt said in an interview. "The safety board continues to be very concerned about the safety of this industry."
The number of deaths represents a sharp spike from last year, when only six people were killed in one plane and nine helicopter accidents. There were 28 people killed in 2008 in EMS helicopter crashes — the most medical helicopter fatalities in any year, according to NTSB records dating back to 2000. There were 31 people killed in 2004 in a combination of medical helicopter and plane accidents, the most deaths in a year in the air medical industry in the last decade, NTSB records show.
The increase in accidents and fatalities reflects, in part, the growth in the emergency medical transport industry, which took off in the early 1980s. Today, there are about 800 helicopters and about 150 planes, according to an industry trade organization.
Sumwalt said he is concerned that the Federal Aviation Administration hasn't implemented numerous NTSB recommendations aimed at increasing the safety of the air medical industry. The board made a series of recommendations to the FAA in 2006, and then moved the recommendations to their "most wanted list" of safety improvements in 2008. Last year, Sumwalt chaired a three-day public hearing on the issue. That resulted in about 30 more recommendations.
FAA officials told Congress in April 2009 that the agency would propose new regulations addressing the safety issues by early this year.
"We have worked very hard to make sure the proposed rule responds to all the issues important to air ambulance safety, and we expect to publish the rule very soon," FAA spokesman Les Dorr said.
The board wants the FAA to require EMS helicopter operators to install Terrain Awareness Warning Systems (TAWS) on helicopters. The system warns pilots when helicopters are in danger of crashing into the ground, mountains or tall buildings. The board has pointed to several crashes that happened at night or in poor visibility that might have been prevented if the helicopters had had the warning systems.
Another recommendation is that EMS flights that carry only medical personnel, like the one in Arkansas, to follow the more stringent safety rules that apply to flights carrying patients and organs for donation. An NTSB study of 55 emergency medical helicopter or plane crashes between January 2002 and January 2005 found that 10 crashes involving the transport of medical personnel only could have been prevented if the more stringent rules had been followed.
NTSB also wants a formal evaluation be conducted before an EMS flight to determine if the flight is too risky. Fifteen of the 55 crashes could have been prevented if such an evaluation had been made before takeoff, the board said.
The causes of the most recent accidents haven't yet been determined "so it would be premature to say these accidents would have been prevented by the NTSB recommendations," said Dawn Mancuso, executive director of the Association of Air Medical Services, which represents more than 80 percent of the industry.
The industry has "come a long way" in the year and a half since the NTSB hearing, Mancuso said. About 40 percent of EMS helicopters are now equipped with the terrain warning systems, with most of the equipment installed during that time, she said.
But the fact that 60 percent of EMS helicopters don't yet have the warning systems shows the industry can't be counted on to voluntarily implement safety recommendations, Sumwalt said.
The proposal the FAA is working on will include requirements for the terrain warning systems and flight risk evaluation programs, Dorr said.
National Transportation Safety Board www.ntsb.gov
Federal Aviation Administration www.faa.gov