Two nurses were among experts who testified before the National Transportation Safety Board’s four-day hearing on helicopter EMS safety, which was prompted by a record year in helicopter EMS accident fatalities.
“The take-home message for nurses here is we need to be engaged,” said Kevin High, RN, president of the Air & Surface Transport Nurses Association and trauma program manager for Vanderbilt LifeFlight, Nashville, Tenn. “We’ve got skin in this game. Nurses are losing their lives in the line of duty.”
High was one of the nurses who answered questions from the board of inquiry Feb. 3-6. in Washington, D.C.
“What I wanted them to know is this is a multi-factorial problem,” High said. “All week, what I kept hearing over and over again is, ‘There’s no silver bullet and no one thing that’s going to make [accidents] stop.'”
The hearing was held to learn more about helicopter EMS operations so the NTSB can better evaluate the factors that lead to accidents and recommend safety improvements to the Federal Aviation Administration, which oversees the field. The issues discussed included operational structure and models, flight operations, aircraft safety equipment, training, and oversight.
“I don’t think the solution to the problem can be found inside the industry alone,” High said. “I think whatever [the NTSB] comes up with, not everybody is going to like it. I think it will probably be some type of compromise. [But] I’m not worried about it. Inaction would worry me.”
The NTSB added helicopter EMS safety to its Most Wanted List of Transportation Safety Improvements in October, along with a list of recommendations: Conduct all flights with medical personnel on board in accordance with charter aircraft regulations. Develop and implement flight risk evaluation programs. Require formalized dispatch and flight-following procedures, including up-to-date weather information. Install terrain awareness and warning systems on aircraft.
Accident StatisticsKevin High, RN
Each year about 400,000 patients and transplant organs are safely transported via helicopter EMS, according to Robert L. Sumwalt, chairman of the board of inquiry. “In the last six years, we have seen 85 HEMS accidents, resulting in 77 fatalities,” Sumwalt said in his opening statement at the hearing. “In calendar year 2003, we saw 19 accidents and seven fatalities; in 2004, there were 13 accidents with 18 fatalities; 2005 had 15 accidents and 11 fatalities. In 2006, 13 [helicopter EMS] accidents occurred with a total of five fatalities. In 2007, there were 11 accidents with a total of seven fatalities. However, 2008 was the deadliest year in HEMS on record, with 13 EMS helicopter accidents, and 29 fatalities.
“The Safety Board is concerned that these types of accidents will continue if a concerted effort is not made to improve the safety of emergency medical flights,”Sumwalt said.
Ira Blumen, MD, professor of medicine, medical director and program director, University of Chicago Aeromedical Network, testified there were 131 fatalities in 146 helicopter EMS accidents between 1998 and 2008, 77% of which were due to human error.
There were 668 dedicated helicopter EMS units from 21 companies in operation in 2008, Blumen said.
Kevin Hutton, MD, testifying on behalf of the Association of Air Medical Services, said growth in helicopter EMS use is spurred by: rural level of care requirements; increased time-dependent care; consolidation and critical care regionalization; increased patient destination legislation; limited or no rural ground transport capability; malpractice lawsuits; decreased local specialty capability; growth and consolidation of providers (economies of scale); and more consistent reimbursement.
Hutton is CEO and chairman of Golden Hour Data Systems Inc., which provides air medical and ground transport services, integrated computer-aided dispatch, clinical charting, and other services.
Focusing on SolutionsEileen Frazer, RN
Nine states require that helicopter EMS programs be credentialed by the Commission on Accreditation of Medical Transport Services, based in Anderson, S.C. Eileen Frazer, RN, executive director of the organization, testified at the hearing that CAMTS added new safety guidelines Jan. 30. “The No. 1 issue we have concerns about is fatigue and sleep deprivation,” Frazer testified. She said 49% of helicopter EMS accidents happen at night, while only 34% of flights take place at night. “One of our biggest concerns is sleep inertia that period after you wake up. What is your cognitive function? What are your psychomotor skills and what activities must you do immediately after being awakened?”
CAMTS is looking to secure funding for a study on sleep deprivation and sleep inertia spefically targeting helicopter EMS crews, possibly using simulators, Frazer said. “We see more and more medical personnel working 24- and 48-hour shifts.”
Until that study can be done, educating personnel on the signs of fatigue is important, she said.
Another hot topic is safety management systems, Frazer said. “One of the issues we run into when we go out and review programs is that there may not be anyone at a hospital helipad that you can directly communicate with you are coming in,” she said. “If it’s a program that’s based at that hospital, usually there’s sophisticated procedures and there’s somebody to meet you. That may not be the case with a hospital helipad that’s not within your own system.”
Helicopter Association International president Matt Zuccaro, who is also co-chairman of the International Helicopter Safety Team, addressed recommendations including mandatory use of night vision goggles; an all IFR (instrument flight rules) operating environment; elimination of launch/response times; study of fatigue factors in helicopter EMS; education programs; non-punitive safety reporting environments; and implementation of safety management systems.
Zuccaro also asked for discussion on “the need to provide a sterile operating environment for pilots and technicians, absent of undo pressures, so that any considerations are limited to safe aeronautical decision making.”
“You need to be engaged on a national level know what’s going on, pay attention, read, and make your voice heard,” ASTNA’s High said. The NTSB invites members of the EMS community, including RNs, to make submissions related to the safety of the industry through March 9. Materials should be submitted to NTSB, Ms. Lorenda Ward, Hearing Officer, 490 L’Enfant Plaza East SW, Washington, DC 20594, or they may be submitted electronically to [email protected]