‘Letter War’ Rages While Helicopter Ambulances Continue to Crash

The “letter war” between the two agencies is not improving safety, but it is proof of the old adage that three inches of flame will shield one’s derriere from accountability.

Case in point: the recommendations issued in 2006 to improve the safety of medical evacuation flights, especially those flown by helicopters. The National Transportation Safety Board (NTSB) issued four recommendations. Taken as a group, they are classified RED by the NTSB – for unacceptable response – because the Federal Aviation Administration (FAA) is progressing slowly in implementing them. Progress may be lagging but, boy, the FAA has issued pages and pages of bland assurances to the NTSB that the situation is in hand.

That is debatable. Helicopter emergency medical services (HEMS) flights are falling out of the sky with appalling regularity, killing patients, pilots, nurses, and other people aboard or on the ground.

While helicopter ambulances continue to crash, the FAA dithers.

While helicopter ambulances continue to crash, the FAA dithers.

Here is the record for the past three years:

HEMS Accidents2008 to Present
DateLocationOperatorCasualties
5 Feb. 2008South Padre Island, TXMetro Aviation Inc.3 fatal
10 May 2008La Crosse, WIAir Methods Corp.3 fatal
21 May 2008Hiram, GAOmniflight Helicopters Inc.None
29 May 2008Grand Rapids, MIAero Med Spectrum Health2 serious injuries
30 May 2008Pottsville, PALehigh Valley Medevac3 minor injuries
8 June 2008Hunstville, TXPHI Inc.4 fatal
27 June 2008Ash Fork, AZPHI Inc.3 serious injuries
29 June 2008Flagstaff, AZAir Methods Corp.7 fatal
29 June 2008Flagstaff, AZClassic Helicopter Lifeguard7 fatal
31 Aug. 2008Greensburg, INAir Evac Lifeteam3 fatal
27 Sept. 2008District Heights, MDMaryland State Police4 fatal1 serious injury
15 Oct. 2008Aurora, ILAir Angels Inc4 fatal
22 Feb. 2009Cave Creek, AZPHI Inc.None
2 July 2009Loris, SCOmniflight Helicopter Inc.None
17 Aug. 2009North Captiva Island, FLLee County Division of Public SafetyNone
22 Sept. 2009Page, AZOmniflight Helicopters Inc.None
24 Sept. 2009Tucson, AZAir Methods Corp.None
25 Sept. 2009Georgetown, SCCarolina Life Care3 fatal
22 Oct. 2009Lythe, CATristate Careflight LLCNone
14 Nov. 2009Doyle, CAMountain Lifeflight3 fatal
25 Dec. 2009Decatur, TXAir Evac EMS Inc.None
17 Jan. 2010Reno, NVAir Methods2 serious injuries1 minor injury
5 Feb. 2010El Paso, TXSouthwest Med Evac3 fatal
11 Feb. 2010Cheverly, MDMaryland State PoliceNone
25 March 2010Brownsville, TNHospital Wing3 fatal
2 June 2010Midlothian, TXCareFlight2 fatal
Total for the 29 month period: 26 helicopters banged up or destroyed49 fatalities

8 serious injuries

4 minor injuries

Basically, about two people per month are killed or injured in HEMS flights. The total, 61 dead and injured, exceeds the 50 or so persons on board a regional airliner; and no matter how the calculation is done, being aboard a Part 135 HEMS flight is considerably riskier to life and limb than being a passenger on a Part 121 airliner. The HEMS accident rate is fuzzier, because unlike for airliners, we don’t know how much air time the HEMS industry logged. Suffice to say, though, if Part 121 airliners were crashing at a rate of about 0.90 per month – as are the evacuation helicopters – the airline fleet would be grounded. In this case, HEMS flights are still conducted despite the grim recent record of broken aluminum and shattered bodies.

Now consider the FAA’s pallid response to the NTSB’s 2006 recommendations.

A-06-12, Require operators to conduct all EMS flights with medical personnel on board in accordance with commercial flight operations. The FAA stated in March 2010 that, because an IFR [instrument flight rules] flight provides guaranteed obstacles clearance, continuous radio communication with air traffic control, and radar contact, this option provides a HEMS operator with an equivalent level of safety to that of a Part 135 [air taxi] visual flight rules flight. The only problem here is that despite three pages of back-and-forth letters between the NTSB and the FAA, the fact remains that the NTSB’s word – “require” – has not been acted upon. The NTSB characterizes the FAA response to this recommendation as “OPEN – Unacceptable Response.”

A-06-13, Require EMS operators to develop and implement flight risk evaluation programs. The industry had a 94% compliance with risk assessment; FAA is working on a Notice of Proposed Rulemaking (NPRM) to make risk assessments a requirement. Despite promises to issue the NPRM in January 2010, it has yet to be issued. For its slow rate of progress, the FAA response is categorized by the NTSB as “OPEN – Unacceptable Response.” Note that its been four years since the recommendation and an NPRM has yet to be issued; after the NPRM is issued, the FAA will have to consider all comments before issuing a final rule. Action on this recommendation is at least two years away.

A-06-14, Require formalized flight following and dispatch procedures including up-to-date weather. The FAA’s May 2008 publication of Advisory Circular (AC) 120-96, “Integration of Operations Control Centers [OCC] into Helicopter Emergency Medical Services Operations,” only partially satisfied the NTSB recommendation, as an AC does not “require” implementation. The FAA promised an NPRM by January 2010; no such document has been found on the Federal Register. Only because an AC has been issued, the NTSB classifies the response to this recommendations as “OPEN – Acceptable Response.”

A-06-15, Require EMS operators to install TAWS [terrain alert and warning systems]. The latest FF response is dated April 2009, promising to complete work on an NPRM by January 2010. It appears that much was promised by January 2010, none of which was delivered. The NTSB said, “FAA initiated rulemaking process, but little progress has been made.” The recommendation was classified, “OPEN – Unacceptable Response.”

All four recommendations are still “OPEN” and only in one was the response deemed “Acceptable” because a non-mandatory AC was issued. A literal reading of all four recommendations, each of which contains the word “require,” indicated nil progress.

Let us consider just one of the accident flights in the table above: the 8 June 2008 nighttime crash at Huntsville, TX, of the PHI Bell 407. TAWS might well have alerted the pilot to his dangerous proximity to ground. The NTSB issued a recommendation for TAWS two years before the accident.

In February 2009 the NTSB held a three-day hearing on the safety of HEMS flights. After this 3-day conclave, 21 additional recommendations were issued. None of them has been fully implemented. These recommendations were issued right in the middle of the three-year record of HEMS flight accidents in the table above.

The NTSB must be into self-flagellation, issuing 21 additional recommendations on top of the four languishing above.

But this commentary isn’t about the NTSB. It’s about the dismal record of the FAA at stemming the continuing mayhem in helicopter ambulance flights. If the FAA’s job is to protect the flying public – in this case patients strapped to a gurney, and the pilots and flight nurses sent to rescue them – the agency has been a dismal failure.

One thing is evident: had the FAA spent a little less time sending letters to the NTSB explaining why progress was difficult and time-consuming, it might have freed up a few bureaucrats to actually solve the problems.