A fiery collision that killed six people aboard two medical helicopters in Flagstaff has underscored the dangers of emergency flights and renewed questions about whether they are worth the risks.
Experts agree air ambulances can save lives when the victim is in grave condition and the hospital is a long way off or hard to reach by road. But they say there are other cases in which an ordinary ground ambulance is just as good, and perhaps safer.
The collision involved two helicopters that were arriving with patients Sunday at Flagstaff Medical Center. It was the ninth accident this year involving emergency medical aircraft, bringing the number of deaths to 16, National Transportation Safety Board officials said Monday.
“This has been a serious issue,” NTSB chairman Mark Rosenker said. “We’re going to work very, very hard to make sure we understand exactly what happened here, determine the probable cause and make recommendations to prevent it from happening again.”
Crashes of medical aircraft have been on the rise since the 1990s for a number of reasons, experts said. It is a booming business, fueled by the closing of emergency rooms in rural areas and an aging population, according to the National EMS Pilots Association. The number of emergency medical helicopters has climbed from roughly 400 in 2002 to more than 800 now, according to the Association of Air Medical Services, an industry group in Washington.
From 2002 to 2005, one of about every 50 medical helicopters in the U.S. fleet was involved in a crash, according to a report by the Congressional Research Service. That is far deadlier rate than that of the U.S. airline industry, which earlier this decade went nearly five years without a single commercial jetliner crash.
The report also cited NTSB figures that said the accident rate for emergency medical helicopters has risen from 3.52 accidents per 100,000 flight hours between 1992 and 2001 to 4.56 accidents per 100,000 flight hours between 1997 and 2001.
Dr. Bryan Bledsoe, an emergency medicine physician who teaches at the University of Nevada and has researched accident rates of medical helicopters, said the flights benefit only a small subset of patients, such as those needing a cardiac stent or balloon within a 90-minute window.
But helicopters aren’t necessary for transporting most other patients and needlessly expose them to danger, Bledsoe said.
While helicopters are faster than ground transportation, traditional ambulances can often get patients there quicker, given the difficulty of finding places to land helicopters and the decision sometimes to turn off the engines when the aircraft arrives and then power them up again when it is time to take off, Bledsoe said.
Bledsoe said two out of three patients transported by an EMS helicopter generally have minor injuries, and one in four is sent home without being admitted to the hospital. The standards for the severity of injuries for transporting people are too low, he said.
“It’s an amazingly liberal criteria, and because the industry is driven by profit, there is little movement to change it,” Bledsoe said.
Greg Williams, an analyst who monitors the air ambulance industry, said emergency transport companies can charge insurance companies almost whatever they want because they are often dealing with severe injuries.
“You’re picking up a car accident victim, a heart attack victim, a burn victim – that sort of thing,” Williams said. “Hospitals understand this.”
But Gary Sizemore, president of the National EMS Pilots Association in Alexandria, Va., and a pilot for Air Methods of Englewood, Colo., operator of one of the choppers that went down in Flagstaff, said that air ambulances are especially useful in rural areas, where narrow roads and rugged terrain can make ground rescues difficult.
“It may take them an hour, an hour and a half to get definitive care by ground, and we may be able to make that transport in 20 minutes,” Sizemore said. “So then that 40 minutes we shave off of that timeframe usually means a better outcome for the patient.”
Medical helicopters are sometimes forced to land in rough terrain and navigate through bad weather. The difficulties include extreme winds, poor visibility from darkness or fog, and tight spots in which to land, such as accident scenes with power lines nearby, said Bill Waldock, a safety science professor at Embry-Riddle Aeronautical University in Prescott, Ariz.
“It’s the rigorous environment that’s causing these accidents,” Waldock said. safety. “You are putting yourself and your aircraft into a situation that’s already not good, and you get in trouble.”
Also, many emergency medical helicopters in the U.S. lack night vision goggles, in part because of a shortage caused by the war in Iraq.
According to the NTSB, there were 13 accidents and 10 deaths involving air ambulances in 2006. There were 14 accidents last year resulting in 24 deaths.
One of the helicopters in the Flagstaff collision was coming from the South Rim of the Grand Canyon, about 70 air miles from Flagstaff, farther by ground. The drive on well-paved roads takes about 90 minutes. The other chopper was coming from Winslow, about 50 miles away on Interstate 40.
Rosenker said the two medical helicopters were on approach to Flagstaff Medical Center when they collided.
“The Classic aircraft was heading south and the Guardian aircraft was heading north. In its based final maneuver, we believe that’s where the collision occurred,” he said.
Rosenker said – for now – they don’t know why the collision occurred.
“They were both, if you will, in a place they should have been in a normal operation. The question is ‘why didn’t they see each other?’ and we’re going to hopefully learn that and be able to prevent that type of thing from happening again,” he said.
The patient on the helicopter from the Grand Canyon was a firefighter who had suffered anaphylactic shock – a life-threatening allergic reaction – from a treatment he received for a bug bite, authorities said. No information was released on the other patient’s injuries.
Three people died on each of the two Bell 407 helicopters: the pilot, the patient and a flight nurse on one chopper, the pilot, the patient and a paramedic on the other. A flight nurse on one of the helicopters was hospitalized in critical condition.
Investigators plan to begin examining the remains of the helicopters on Tuesday.
Wreckage from one helicopter sits as a pile of twisted metal among bent pine trees. One long rotor blade sticks up in the air, while another is bent up at a 90-degree angle. Green wire hangs out of the wreckage, and medical bags are strewn about. The smell of fuel lingered Monday.
More than 300 feet away, what was a helicopter is now a pile of burned metal in a clearing atop a mesa.
A surveillance camera from one of the hospital’s parking lots captured the crash, but it will require technical work to remove the time stamp that blocks footage of the collision.
“The only thing we can then see are two of the helicopters falling,” Rosenker said.
Will Summers, 74, said he was working in his yard nearby when the helicopters smashed into each other. He said one helicopter’s tail appeared to clip the other aircraft. One helicopter exploded.
“There were rotor blades everywhere,” Summers said.
Anyone who witnessed the collision is urged to call Flagstaff police at (928) 774-1414.