Results and recommendations from the helicopter EMS pilot safety survey 2005

Abstract

Introduction

In 2005, the Pilot Safety Study Group (PSSG), consisting of members of the Association of Air Medical Services Research Committee, wrote, distributed, and analyzed a survey of helicopter pilots regarding their knowledge, attitude, and perspectives on safety in the field of air medical transport.

Methods

The Pilot Safety Survey 2005 (PSS2005) was based on another survey—one that was sponsored by Helicopter Association International (HAI) and National EMS Pilots Association (NEMSPA) and administered to pilots in 2001. The PSS2005 pared questions down so that the survey could be completed in 15 minutes on the internet, and the answers were organized in a manner to simplify analysis. An electronic link to the survey was distributed in a non-randomized fashion to HEMS pilots using the mailing lists of various operators and HEMS programs. Questions were clustered into eight groupings of safety, with a majority of responses being categorical, lending themselves to cross-tabulations.

Results

The information gathered indicated that Helicopter EMS (HEMS) pilots are very experienced, with the average pilot logging 6,625 flight hours. Collectively, they took responsibility for HEMS accidents; with 92% of total respondents citing “pushing weather minimums” and 82% citing “pilot decision making” as the main reasons for crashes. Crew resource management (CRM) was well appreciated by the pilots; there appeared to be a positive correlation with programs that offer their employees CRM and the pilots' general perspective on safety. The survey was also clear that amongst 40% of the respondents, mission-oriented training needs improvement, and 74% responded that more realistic training in flight simulators would improve safety overall. Finally, 57% of the pilots both desired night vision goggles or devices (NVG/NVD) and believed that their usage would improve safety in the field of air medical transport (55% vs 45%, P = .0025).

Conclusions

Although the recommendations from the PSS2005 are lacking in definite evidence for a decrease in HEMS crashes, we consider the direct input from pilots as critical in the absolute elimination of crashes in Helicopter EMS (Vision Zero). Pilots are, after all, the very ones held responsible for HEMS crashes. Based on these findings, the PSSG hopes that the HEMS community will incorporate the following recommendations into their standard practices. We recommend that all HEMS operators have annual and regular CRM training. We recommend that all HEMS pilots have annual and regular training in realistic flight simulators. Finally, we recommend that all HEMS aircraft be in possession of NVGs, and if this is not possible (eg, light pollution from a highly urbanized region or cost–benefit issues), then to have annual and regular mission-oriented nighttime training.

Introduction

A dilemma facing the helicopter emergency medical services (HEMS) community in analyzing accidents is the lack of awareness concerning the number of missions flown and hours flown; as well as information necessary for epidemiological evaluation of risk for morbidity and mortality. In 2002, Blumen¹ endeavored to establish a model from industry surveys to estimate exposure data for HEMS pilots and medical crews, so that an attempt could be made to calculate HEMS accident rates or morbidity and mortality rates.¹

Over the past 25 years, unprecedented growth has occurred in the air medical transport community (Figure 1). Despite the absolute increase in the number of aircraft, there does not appear to be relative increases in HEMS crashes (Figure 2). In 1985, there were 119 EMS Helicopters flying a total of 71,831 hours. According to National Traffic Safety Board (NTSB) statistics, 12 HEMS accidents occurred that year, which estimates 16.71 accidents per 100,000 hours. In 1995, there were 293 EMS helicopters flying a total of 158,221 hours; the NTSB report seven accidents, which equals 4.43 accidents per hundred 100,000 hours. In 2000, there were 377 helicopters flying 187,854 hours with 13 accidents, this estimates 6.91 accidents per 100,000. Blumen's statistics culminated with the publication of his study in 2002; however, a continuation of his methodology can be used to estimate the accident rate in 2005 of 3.4 per 100,000 hours. In other words, the HEMS community has grown enormously in the past 20 years with respect to the number of programs, aircraft, and hours flown. The number of accidents, however, has remained relatively constant, and the actual accident rate per 100,000 hours of flight can be construed as decreasing (Figure 3).

Contrarily, the literature has several studies suggesting that HEMS crashes have been steadily increasing.2, 3, 4 Several studies by Bledsoe have attempted to elucidate whether there has been an increase in HEMS accident rates² and whether the growth of the air and ground medical transport community (AGMTC) is the reason for the increase in accidents.³ Criticisms of these studies unanimously assert that the lack of a denominator of accident rates makes meaningful interpretation of the data difficult.6, 7 In fact, Bledsoe candidly acquiesces that the increase in HEMS crashes are likely due to the increase of HEMS operations and aircraft. Without a revealing comparison, the increase in HEMS crashes should be attributed to the absolute increase of the AGMTC. If there were a sudden increase in the absolute number of vehicles on the road, one would expect an increase in the absolute number of motor vehicle crashes. Consideration might be given to a national registry for the AGMTC so that denominators can be generated and meaningful comparisons made; without them the AGMTC is vulnerable to criticism based on insufficient information.

Although the scope of this paper is not to dispute the actual incidence of HEMS crashes, the truth is that they do occur, and one crash, even with a lack of morbidity or mortality, is still one crash too many. More importantly, identifying the multi-factorial causes of HEMS crashes is imperative, and including pilots in the process is essential.

In 2001 the National EMS Pilots Association (NEMSPA) and Helicopter Association International (HAI) decided to survey those who are making the final “go–no go” decisions, helicopter line pilots. The survey objective was to determine what HEMS pilots think about the problems and safety issues they face on a daily basis and their potential solutions. Approximately 250 pilots responded to their postal-mail survey, and the results were published in various trade journals at the time. The results for the NEMSPA/HAI Survey were largely disregarded because it was thought to be underrepresentative of HEMS pilots, which was roughly estimated to be 17% of the total. This figure was estimated by identifying the number of helicopters in 2000, 377 ships, and multiplying this by 4 pilots/helicopter. At the time, the respondents were too easily dismissed as being a small group of malcontents. The premise of asking the actors was sound; however, a more objective and exact approach was necessary to accurately characterize HEMS pilots' knowledge, attitudes, and perspectives on safety. Thus, the main objective of the PSS2005 was to explore the determinants of safety from a HEMS pilot frame of reference, utilizing the most precise and discriminative principles available.