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Before each AirCare medevac flight takes off from Shannon Airport, pilots have to make 32 checks. Are the rotors untied? Flight controls OK? Caution lights working?
Friday morning, at the start of a 12-hour shift, pilot Kurt Baden had to review the weather, inspect the helicopter and debrief the nighttime pilot.
Sitting around the kitchen table in the double-wide trailer where AirCare's Spotsylvania County operations are based, Baden led the safety briefing that marks each shift change.
In his calm pilot's voice, he reminded the crew of the routine: Always check blind spots, don't chat during takeoff or landing. He even--per FAA regulations--instructed the flight nurse and paramedic to have their tray tables stowed on takeoff.
"They talk about pilots living and dying by the checklist," Baden said. "If you miss one, you're setting yourself up for something."
Baden, a former Marine Corps helicopter pilot with sandy brown hair and cool blue eyes, said he doesn't worry about the risks of his job, because of precautions such as the routine briefing.
It gets everyone focused on safety from the start of their shifts, he said. And it's just one way crew members of the medevac flight reduce the risks of what can be dangerous work.
But a recent spate of medevac crashes have some officials looking at ways to put even more emphasis on safety. Since 2002, more people have been killed in air ambulance crashes than aboard U.S. commercial airlines, though the helicopters travel just a fraction of the distance.
At least 11 helicopters were involved in accidents last year. Eighteen people died.
In August, a mother, her sick infant and three crew members were killed when a nighttime medevac flight crashed in the Nevada mountains. In July, four died aboard a South Carolina flight that had just left an accident on the interstate.
It was the deadliest year in the history of the air ambulance business.
"This accident rate, everybody has started to question it," said Dr. Bryan Bledsoe, an adjunct associate professor of emergency medicine at George Washington University. "It's just alarming."
The trend has continued this year. One person was injured in a Jan. 3 crash in Arizona. Three days later, a pilot was killed in Mississippi.
Four days later, two crew members were killed and one injured when a LifeEvac II helicopter crashed into the Potomac River as it returned in clear weather to its Stafford County base.
Little is known about exactly how bad the problem is or what is causing it. Though the Federal Aviation Administration and National Transportation Safety Board say accidents are increasing, they don't have any supporting data.
No federal government agency keeps statistics on medevac crash rates, although a national database is expected to be available sometime this year.
Until then, neither the FAA, which regulates the industry, nor the NTSB, which investigates crashes, can say whether more accidents are happening because more helicopters are flying--or whether a systemic, industry-wide problem exists.
Though the evidence is anecdotal, NTSB spokeswoman Lauren Peduzzi said crash investigators are seeing "too many accidents."
The wrecks have drawn attention from the government, the industry and the media. An FAA task force began examining medevac safety last August, and is now considering possible regulatory changes and additional oversight.
Industry officials say it's hard to predict what the FAA will do, because no easy solutions exist.
"A lot of accidents have multiple causes," said Howard Ragsdale, director of PHI Air Medical Group, which runs the Spotsylvania-based air ambulance service. "You can't just focus on one aspect of aviation and think you've solved it."
An industry takes offSix years ago, air ambulance services in Virginia faced a bleak future. They posted chronic financial losses. State government called for contingency plans in case a service closed.
Since then, the number of air ambulance providers in Virginia has doubled. The Fredericksburg area added two helicopters last year.
This area isn't unique. Nationwide, more hospitals are outsourcing the service to private companies and more companies are competing for business.
Air Methods Inc., the parent company of the LifeEvac II operation in Stafford, has tripled its national fleet since 1999. PHI Air Medical Group increased the number of helicopters in its fleet by 50 percent.
Demand is up for transport, said Thomas Judge, president of the Association of Air Medical Services. Patients must travel farther for treatment, he said, for several reasons:
Fewer specialist doctors work in smaller hospitals.
Fewer full-service hospitals are operating in rural areas.
Fewer trauma centers exist.
Economics factor in, too. A severe burn victim who first goes to Mary Washington Hospital and then gets transported to a burn center gets two bills. Though a helicopter flight can cost $10,000, it can save money by getting the patient to the right hospital the first time, Judge said.
"[It] makes good economic sense," he said. "It's the least-cost alternative with the best outcome."
But some criticize the rapid growth as unnecessary and driven by financial motives.
"Surely, we haven't had a 500 percent increase in sick people," said Bledsoe, the GWU professor, a former flight paramedic.
Bledsoe argues that medevac services have grown unchecked. He estimated that a quarter of patients transported by helicopters aren't injured seriously enough to be admitted to a hospital. But helicopter companies want the business, he said.
"The industry is not policing itself," Bledsoe said. "It's a for-profit thing. They're a valuable tool, but we don't need 1,500 of them."
Reducing the riskAir ambulances, which trace their origins to the Korean War, first began spreading across the United States in the 1980s.
When weather-related crashes began to climb in the late 1980s, the NTSB intervened and tightened standards for acceptable flight conditions.
Now, weather-related crashes represent the smallest portion of accidents, according to a Free Lance-Star review of NTSB investigations from 2000 to 2004. The crash data showed that about 75 percent of crashes involve some pilot error.
No other common threads were apparent. For example:
The pilot is just as likely to die as the crew.
The odds are better for patients, who have rarely been on board when an aircraft went down. Six patients have been killed in crashes since 2000.
Accidents are equally likely to occur during takeoff or landing as during flight.
Crashes are equally likely to happen day or night.
In the recent Potomac River crash, a preliminary finding released Friday cited turbulence from another aircraft as a possible cause.
The FAA has taken notice of the latest increase in crashes and has begun discussing possible reforms.
The agency is considering changes in pilot and crew training and in oversight, and possible technological improvements. Specific proposals have not yet been made public.
"These people are first responders," FAA spokesman Les Dorr said. "We want to make sure they have the right information to make sound decisions about whether or not they should launch."
Doctors and emergency dispatchers can request a helicopter, but pilots decide whether it's safe to fly.
The NTSB has suggested requiring the use of night-vision goggles. Though it's expensive--equipping one helicopter can cost between $90,000 and $110,000--some companies have already begun using the technology, which allow pilots to see in dark, rural areas.
PHI Air Medical is equipping one Virginia-based helicopter in Harrisonburg with the equipment later this year. Most of its night-vision equipment is being introduced in the West, where pilots must navigate expansive swaths of rural, mountainous terrain.
"Night vision in itself is not a cure-all," said Howard Ragsdale, PHI Air Medical's director. "But it does give the crew access to a tool that gives them an ability to see things they couldn't see without it."
Local officials are monitoring medevac services to ensure they're called only when patients absolutely need to be treated at a trauma center.
"Why take that risk," said Tina Skinner, director of the Rappahannock EMS Council, "if it's not appropriate?"
To reach ROB DAVIS: 540/374-5418 rdavis@freelancestar.com
