EMS Helo Regs May Help
You may recall an iconic photo that circulated a few years, a low-angle aerial shot depicting a freeway choked with traffic at a dead standstill. At the front of that bottleneck was a small fleet of emergency vehicles circled wagon-like around an EMS helo, strobes flashing, rotor spinning.
The viewer couldn't help but perceive the scene as an airborne angel of mercy snatching yet another life back from the mortal abyss. From the picture alone, you'd have no way of knowing that the trip to the trauma center—if it was even needed—might be nearly as risky as the car trip that precipitated the scene in the first place. If that's a bit of an exaggeration, the fact that the airborne EMS industry has a less than-stellar-safety record certainly isn't.
The FAA finally got busy and this week and announced new proposed regulations intended to reduce the risk of EMS crashes. Specifically, helos will be required to have H-TAWS and radar altimeters and pilots will have to be instrument rated and thus better equipped to survive a VFR-into-IMC encounter. Moreover, EMS operations will have to conduct their operations under FAR Part 135, not Part 91.
That's all good stuff and probably minimal. I'm actually a little surprised that these requirements aren't already in place. I'm skeptical that it will do much to improve the accident rate, however. And as far as for-hire flights go, the EMS rate is awful. Accurate rate data is hard to come by, but the GAO estimated that in 2008, the EMS fatal rate was 1.8/100,000 hours of flight. That's worse than GA's rate of 1.3, which is itself unenviable. If the scheduled airlines had a rate like that, they'd kill hundreds of people a year. To be fair, the better way of assessing EMS risk might be on a per operation rather than a per hour rate, but that data doesn't seem to exist.
Although I'm generally skeptical of this level of regulation moving the accident rate much, it actually might have some effect if 135 regs reduce the number of missions. The accident rate is poor in part because of the very nature of the operations EMS helos do. They fly into unknown landing zones night and day and even a mile of vis is just poor weather. They fly at low altitude, often without benefit of the instrument flight plans that help keep airline travel safe and many landings are at urban LZs, not airports. But the larger issue is that they are probably overemployed, used in circumstances where ground transport might have been a little slower, but would have been less expensive and safer. They are often used when the patient isn't critical enough to require rapid transport.
In a July 2006 article in Air and Space magazine, Dr. Bryan Bledsoe related the experience of a 63-year-0ld heart patient ordered to another hospital via EMS. No one questioned the use of the helo, but the patient never made it to the other hospital. The aircraft crashed enroute due to a known faulty altimeter, according to the NTSB. The crew was too badly injured to help the man and he strangled to death on a restraining strap.
Bledsoe reported that research data has revealed that patients rarely benefit from the rapid transportation that EMS provides and given the considerable crash risk, they may actual suffer from it. There are at least 800 EMS helos in the U.S.—more in the Phoenix area alone than in all of Canada. Why? Bledsoe says its because the air ambulance industry pushed federal regulators to increase Medicare payments for EMS operations and, accordingly, the industry expanded. So, perversely, just as EMS was helping to run up the deficit it was exposing patients who probably didn't need the service in the first place to more risk.
As all of us well know, this is the way government and private industry work together in this country, occasionally to the detriment of the sorry, beleaguered taxpayer. I'm all for things that increase employment in aviation and sell more aircraft, but I refuse to be a stooge and accept the notion that if it flies, it must be good. As in all things, I'd argue for responsible use rather than building a fleet on the government gravy train.
That's not to say there's no need for EMS. The vital services it provides have saved many lives, getting patients to the trauma center within that golden hour that so improves survival chances. If I were stranded on some mountain somewhere fading from a heart attack or an injury, I'd welcome that flap of EMS rotors. But on a rainy night on the interstate, I might be more inclined to ride the big red bus.