Original ResearchResults and recommendations from the helicopter EMS pilot safety survey 2005
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.
Section snippets
Methods
The PSS2005 had its origins in the NEMSPA Pilot Survey. The PSS2005 was reworked to include current issues regarding HEMS safety, remove questions that were not pertinent to safety, and phrase answers that would lend themselves for methodical analysis. It was also imperative that the survey could be taken within a reasonable amount of time; on average it took 15 minutes to complete. A non-randomized sample of 20 pilots were invited to a trial survey and offer criticisms; their input helped us
Results
A total of 832 completed surveys. Based on the criteria described previously for removing duplicates, 13 pairs of responses were eliminated resulting in a total sample size of 806 respondents; this is estimated to be roughly 27% of the total number of HEMS pilots. This was approximated by assuming 753 aircraft in 2005 (see Figure 2) and multiplying this by 4 pilots per aircraft. Table 1 describes basic pilot demographics. The pilots' ages ranged from 24 to 66 years (mean [±SD] age, 48.6 ± 8.1
Discussion
The pilots who responded to this survey are, taken together, an exceptionally accomplished group. The mean amount of hours spent flying exceed 6,500 hours, and the mean amount of years spent flying helicopters in the commercial setting approached 18 years; this does not include those who had a previous career as a rotor wing pilot in the military. The group further distinguishes themselves in their steadfast resolve in collectively accepting culpability for HEMS crashes. When candidly asked
Recommendations
From the initial results of the Pilot Safety Survey 2005, the Pilot Safety Study Group is prepared to make the following recommendations:
- 1.
Annual CRM training for pilots, medical crew, and communication specialist.
- 2.
Annual realistic and sophisticated motion simulator training for all pilots.
- 3.
For night flying, NVGs or night vision devices be used by the flight crew, including the medical crew. If NVGs are not feasible, then specific initial and annual mission-oriented nighttime training be
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(2006) - Blumen IJ, and the UCAN Safety Committee. A Safety Review and Risk Assessment in Air Medical Transport. Supplement to...
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