Baker SP, Grabowski JG, Dodd RS, Shanahan DF, Lamb MW, Li GH. EMS helicopter crashes: what influences fatal outcome? Annals of Emergency Medicine. 2006;47(4):351-356.

INTRODUCTION

Emergency Medical Service (EMS) helicopter crashes have more than doubled in the last few years. As Emergency and Trauma personnel, we desire to see patients arrive at our facilities safely. We also share similar concern for our colleagues who are responsible for air transport of patients.

ABSTRACT

Baker et al have performed a retrospective study examining the number and causes of EMS helicopter crashes and associated fatalities. They have also made suggestions for changing clinical practice to improve outcomes.

The authors used National Transportation Safety Board records to review helicopter EMS crashes during a 22-year period from January 1983 to April 2005. Specifically, they reviewed crashes that resulted in 1 or more deaths.

Of the 182 crashes during this time period, 71 or 39% resulted in a fatality. Further analysis revealed that 56% of crashes that occurred in the dark resulted in a fatality, while only 24% of daylight crashes caused death. Seventy-seven percent of fatal crashes occurred while pilots were using instruments to fly because of inclement weather and resultant poor visibility, compared with 31% during good weather conditions. Thirty-nine percent of all deaths were associated with postcrash fires. In summary, fatal outcomes have been associated with darkness, inclement weather, and postcrash fire.

The authors have concluded that fatalities can be reduced by improving crashworthiness of helicopters by updating safety features to include better restraints at nonpilot positions, energy-absorbent seats and landing gear, crash-resistant fuel systems, and safer interiors. Review of air medical transport records deemed that many EMS transports were unnecessary. On the basis of these findings, the authors suggest the United States revise policies related to patient transfer at night to include only critical cases. Further suggestions include training first responders to recognize which patient conditions truly warrant air transport (24 references).

COMMENTARY

The transportation of patients via helicopter has increased dramatically in recent years. This increase in use has also resulted in an increase in crashes and deaths of patients and medical personnel. The rate of EMS helicopter crashes resulting in fatality from 1997 to 2001 was higher than rates for all other aviation categories. This was further highlighted by the fact that EMS flight crews had a death rate 16 times higher than the occupational death rate for all US workers from 1995 to 2001. Given current figures for fatal crashes, an EMS pilot or flight member flying 20 hours per week for 20 years has a 37% chance of dying in a crash. In conclusion, we feel the recommendations suggested by the authors should be seriously considered by the National Transportation Safety Board, EMS helicopter companies, and first responders to ensure the safety and safe arrival of patients and their flight crews.