How EMS Workers Can Improve Air Ambulance Safety

By Chair Jennifer Homendy

Adapted from i-Chiefs magazine, originally published Feb 2021

Imagine for a moment that you’re an emergency medical services (EMS) worker.

You’re assisting a patient who requires transport to another facility. You decide to request a helicopter air ambulance (HAA). How do you pick the safest HAA operator?

In a perfect world, all companies would conduct a risk assessment before accepting the flight request to ensure everyone’s safety. They would consider factors such as weather, flight conditions, and which pilot is on duty. How — and if — those risks are assessed and mitigated can determine whether the medical transport flight you’re requesting is safe…or leads to tragedy.

Three years ago, we launched to a crash involving a medical transport flight where this scenario played out. Based on our investigation, we’ve learned that there are steps EMS workers and, indeed, anyone requesting air medical transport can take to improve safety.

Photograph of helicopter before crash (Source: The Columbus Dispatch)

Remembering Zaleski, Ohio

On January 29, 2019, a patient at Holzer Meigs Emergency Department in Pomeroy, Ohio, required transport to another hospital, located approximately 70 nautical miles away in Columbus. The emergency room technician contacted three helicopter air ambulance companies to help move the patient.

The first company immediately declined the flight request due to icing probability and snow squalls. The second company stated they would call back after conducting a weather check. Before hearing back, the emergency room technician reached out to a third company, Survival Flight, which quickly accepted the request. The second company then called back to decline the flight due to weather-related safety concerns.

Three Survival Flight crew members, the pilot, flight nurse, and flight paramedic departed for Pomeroy to pick up the patient. About 22 minutes into the flight, the pilot encountered two snow bands that decreased her visibility. The pilot attempted a maneuver to escape from the inadvertent instrument meteorological conditions (IIMC), in keeping with standard operating procedures, but did not maintain altitude. Tragically, the Survival Flight helicopter crashed into forested terrain near Zaleski, Ohio. All three crew members died.

What Went Wrong?

The NTSB was called in to investigate. Our investigation revealed numerous safety deficiencies that we can learn from. Here’s what went wrong.

Lack of comprehensive and effective flight risk assessment and risk management procedures. This means the pilot was unaware that other operators had refused to accept the flight due to weather concerns.

The lack of both a positive safety culture and a comprehensive safety management system (SMS). The casual behavior of Survival Flight management regarding risk assessment and safety programs was not indicative of a company with an established SMS program, which operators use to evaluate and address risk, as well as their pilots’ skills and flight behavior. The NTSB has long advocated for the adoption of a SMS in all flight operations. Indeed, this recommendation is so important that it has been associated with several issues on our Most Wanted List of Transportation Safety Improvements over the years.

Need for flight data monitoring (FDM) programs for HAA operators. Although the Federal Aviation Administration (FAA) requires helicopter air ambulance operators to have FDM recorders installed, it does not require that operators use the recorders and the data collected. But an FDM program that is part of a broader SMS has great potential to identify risky situations and make changes before a crash occurs. For example, an FDM program would have allowed Survival Flight to identify deviations from normal operations and potential safety issues.

Lack of HAA experience for principal operations inspector. The investigation revealed the FAA principal operations inspector assigned to oversee Survival Flight’s operation was unaware of deficiencies that were later identified in Survival Flight’s flight risk assessment.  

Lack of accurate terminal doppler weather radar data available on the HEMS (helicopter emergency medical services) Weather Tool. The current version of the HEMS Weather Tool does not incorporate terminal doppler weather radar data to display precipitation. As a result, the pilot could not tell if there were gaps in the data or if there were, in fact, no precipitation.  

Lack of a flight recorder. If a recorder system that captured cockpit audio, images, and parametric data had been installed, it would have enabled NTSB investigators to reconstruct the final moments of the crash and determine why the pilot did not maintain the helicopter’s altitude and successfully exit the IIMC encounter.

How You Can Promote Safe Air Medical Transports

Don’t underestimate the “power of the purse” to encourage the safest operating practices when selecting an air ambulance operator: only give your business to operators that take safety seriously. Here are some practical steps that can help you make an informed decision:

  • Vet the companies in your area before you need air transport. Consider selecting a company that has earned accreditation from a respected third party. For example, the Commission on Accreditation of Medical Transport Systems (CAMTS) accredits medical transport organizations that pass their audit and agree to abide by certain best practices, which are usually more stringent than those required by regulations. It’s important to note that most helicopter air ambulance programs in the United States are CAMTS-accredited; in fact, the U.S. Department of Defense requires CAMTS accreditation for civilian contracts. Despite this being the “gold standard” for auditing and accrediting helicopter air ambulances, Survival Flight was not CAMTS accredited.
  • Meet the helicopter air ambulance companies that serve your area. Some offer a shadowing opportunity for EMS workers. Ask the crew members you meet how they determine which flights to accept.
  • Do some research. Find out which operators have shown a commitment to the highest levels of safety by obtaining FAA approval for an SMS program and have an FDM program that regularly evaluates data collected to identify and address flight safety issues. While HAA operators are not yet required by FAA to have either, some have implemented these measures voluntarily. Your patients and crews deserve the safety benefits that accompany SMS and FDM programs.

Finally, never hesitate to reevaluate the necessity of air transport as weather conditions change, especially when other helicopter operators turn down the same request due to weather or other safety concerns.

Do it not just for your patient, but for the helicopter crew. Do it to honor the lives lost in Zaleski three years ago.

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