Thursday, January 29, 2009


There have been joys too great to be described in words, and there have been griefs upon which I have not dared to dwell; and with these in mind I say: Climb if you will, but remember that courage and strength are nought without prudence, and that a momentary negligence may destroy the happiness of a lifetime. Do nothing in haste; look well to each step; and from the beginning think what may be the end."
- Edward Whymper, who made the first ascent of the Matterhorn with six others in 1865.
On the way down, four of his companions fell to their deaths.

July 27, 2007 over north central Phoenix.
Click Play:

This incident was investigated by the National Transportation Safety Board, which released its' findings yesterday. Among other things, the NTSB cited the practice of allowing news helicopter pilots to also act as reporters while airborne, while also having to focus on monitoring other proximal air traffic, communicating with local air traffic controllers, etc.

Reading the details of NTSB reports is entertaining and informative for me, and the Phoenix incident was no exception. The detailed transcript of the recorded audio aboard both helicopters, as well as the transcript of the air traffic control radio activity, illustrated to me a highly complex and somewhat chaotic situation, with as many as six media helicopters coming into the area of a police pursuit.

While the loss of life is truly unfortunate here, it's also very fortunate that the two helicopters that collided crashed into a park, and not into the street, houses, a school, etc.

The NTSB's announcement dovetailed with the announcement yesterday that two Denver TV stations will start sharing one helicopter for airborne reporting. While the arrangement between KMGH and KUSA has been largely attributed to economic conditions in the broadcast news 'industry', the arrangement seems to be a prescient one in relationship to the potential risks involved, as evidenced by the misadventure in Phoenix.

Having worked with EMS helicopters for many years in an urban setting, I can attest to the complex nature of putting several aircraft into a relatively tight section of airspace. Speaking with the pilots afterward, I heard many accounts of the numerous conversations required with air traffic control, the responders on the ground, their own dispatch (me), and internally with the flight crew.

One particular incident in the Pittsburgh area comes to mind. Our flight program had been requested to the scene of a serious car accident west of the city, immediately adjacent to Pittsburgh International Airport. By 'immediately adjacent' I mean that the accident scene, and the golf course at which we were requested to land, was at the end of one of the active runways.

After paging out the flight, the duty pilot came into our office, and said two words. The first was "where"? I pointed to a large wall map of the metro area, showing the country club across the highway from the end of Runway 28L/10R at PIT. He said one other word - an expletive recently popularized by Governor Blagojevich of Illinois - before heading out to the aircraft.

After returning, he relayed to me how many people he had to talk to aside from me; Pittsburgh approach control, PIT control tower, and the public safety units coordinating the landing zone on the ground. After landing he was contacted by the departure controller, inquiring when he might be departing the area. Upon lifting off with the crew and patient, he saw why; the active runway had been closed because of the emergency activity in the area, and there were at least 6 commercial airliners waiting to take off.

The safe conduct of aviation-related activities is dependent upon strict adherence to rules, practices, and policies defined by the Federal government and the carriers themselves. This is combined with the extreme skill, knowledge, and judgment exercised by pilots and other flight crew members.

There is a routine to safe flying, but in my opinion there is nothing 'routine' about the flying business, especially when combined with the equally complex and somewhat symbiotic disciplines of health care and public safety.

Airborne EMS, especially when utilizing helicopters, has been glamorized in the media, largely due to the obvious visual production values associated with their use (I can't get enough of watching them, even after all these years), and the manner in which their use has been portrayed in news accounts, movies and TV, and the marketing product of the health care providers involved.

Truth be told, Helicopter EMS is by no means a philanthropic enterprise. It is a profitable venture for the aviation companies that operate the aircraft, and an effective marketing tool for the health care facilities that affiliate themselves with them.

Helicopter EMS is also fraught with risk, and the trade is plied by personnel who are comfortable with the risks involved, perhaps too comfortable at times. Unfortunately, the accident rate for these aircraft has increased drastically over the last two years, to the point that the NTSB is holding four days of public hearings next month to figure out why, and what can be done to improve the safety record of these flights.

As many of us in public safety are aware, helicopter accidents are by no means limited to urban areas. One of the more tragic (and therefore headline-grabbing) incidents involving Helicopter EMS occurred in June of last year over Flagstaff, Arizona, when two medical helicopters collided in mid-air and crashed, killing a total of seven people. Both aircraft were en route to Flagstaff Medical Center when the crash occurred.

Concerns over air medical safety aren't new; Our congressman John Salazar co-sponsored a bill in 2007 that would have established minimum safe weather conditions and other factors under FAA regulations that govern Helicopter EMS operations. That bill didn't go anywhere, for whatever reason.

With the NTSB's very public focus on the industry, as well as increasing media attention as a result of the aforementioned production values, the various trade organizations that represent numerous components of the air medical industry are gearing up to offer testimony at next month's hearings.

The organization presenting air medical service providers has issued a comprehensive position paper that includes several recommendations for safer operations in and around rural airports, as well as suggestions for changes in regulatory structure and internal flight program policies designed to optimize operational efficiency, and thereby improved safety.

These include addressing the clinical appropriateness of a patient's condition for an expensive and potentially risky helicopter ride, along with an identified trend among some health care facilities of attempting to secure air transport for a patient after another air medical service has determined that weather or other factors preclude the safe conduct of such a flight. This practice is known as helicopter shopping.

One thing that I have no doubt about is that helicopters are cool. That being said, the fascination with the utilization of helicopters, whether for informing the public or transporting the critically ill, must be tempered with the realization that lots can, and probably will, go wrong.

The application of best practice thinking (technology, processes, people) along with a responsive regulatory environment, will go a long way to assuring safer and more efficient operations, to the benefit of those in the air and on the ground.

I'll be watching the NTSB hearings next month with interest. Have a great day.

1 comment:

Anonymous said...

Today, Congressman John Salazar will be reintroducing legislation in the 111th Congress, titled the Air Medical Safety Act. A bill number has yet been signed (formerly known as H.R. 3939). I have a pdf of the new bill being dropped if you are interested.
On a side note, I enjoy your insight & perpsective regarding air medical transport, especially given your role in the communication center.