Special Report: Air Ambulances
Pressure to fly often leads to helicopter crash
When a medical helicopter goes down, there often is more than one cause. Bad risk assessment, insufficient technology, and pilot error can combine to create a tragedy.
Risk managers should remember that medical helicopter crashes are almost always preventable accidents, says transportation accident and liability attorney Jeffrey Kroll, JD, in Chicago.
"Hospitals are putting these pilots at risk, because medical helicopters are not equipped with the kind of technology that can help pilots avoid crashes," he says. "Commercial aircraft have terrain awareness warning systems, military pilots use night vision goggles, and hospitals are asking their pilots to fly into dangerous conditions without this equipment."
Much of the risk comes from the way medical helicopters are dispatched, Kroll says. Rather than an air traffic controller determining whether it is safe to fly, the decision often comes from a 911 dispatcher or a medical professional with no knowledge of risk assessment related to flying conditions. The pilot ultimately decides whether to take off or not, but he or she can be influenced to take unwise risks, he says.
"Take a look at how your flights are dispatched, who makes that decision, and what kind of training they have," Kroll says. "It's not just a matter of saying the patient is injured and then looking out the window to see how hard it's raining. The local airport uses some specific criteria for determining when it's not safe to fly and so should the hospital."
Many civilian emergency air crews also do not have adequate experience to fly the high- risk missions they are attempting, says Don Maciejewski, JD, an aviation attorney with the Jacksonville, FL, law firm of Zisser Robison and a former Army helicopter pilot. Some of the missions, often in poor weather and difficult terrain, would challenge even highly experienced military pilots, he says. The crews often feel pressured to fly against their better judgment, Maciejewski says.
"The hospital says, hey, we're paying insurance, maintenance fees, crew fees; why not use the helicopter? If they have the asset, they feel like they have to use it," he says. "There's a level of prestige associated with using these aircraft, and that clouds the judgment of when it is appropriate to use them. It's one thing to use the helicopter on a bright, clear afternoon when there are no particular hazards, even if it's not really necessary, but it's different to do that at two o'clock in the morning in bad weather."
Night vision goggles, which allow pilots to see terrain in the dark and in bad weather, can greatly improve safety, and nearly all helicopter pilots say they want them, Kroll says. But only about 25% have them, he says, mostly because they cost about $120,000 for the equipment and training.
Another risk is that many medical helicopters are flown by only a single pilot. Maciejewski calls that a recipe for disaster. Without a co-pilot, the pilot can become "task overloaded" by trying to fly the aircraft, talk on the radio, navigate, keep track of the patient's status, and many other tasks.
Steve Marks, JD, an attorney with Podhurst Orseck in Miami and one of the nation's leading aviation attorneys, says you should look for crews that are experienced specifically in medical flights and not simply helicopter flying. The medical missions can be much more challenging, and the very nature of flying a medical helicopter is different, he says. Most pilots are used to flying in a relatively calm environment with few distractions. But a medical helicopter can be full of distractions and stressors.
There also is the additional hazard of people entering and departing a helicopter in dangerous conditions, Marks says. This is a risk that people do not generally encounter in commercial aviation, so it is easy to overlook in medical helicopter programs.
"I had a case in which a woman was decapitated because the helicopter had landed on uneven ground, and the rotors were lower than she expected," Marks says. "Everyone who will be around the helicopter has to be trained in these hazards. It is so easy for people to be focused on their patient or other tasks and walk right into a dangerous situation."
When a medical helicopter goes down, there often is more than one cause. Bad risk assessment, insufficient technology, and pilot error can combine to create a tragedy.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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