Newsflash: Transportation is Dangerous

It’s been in the news (at least, in the medical worlds’ news) that there are a lot of EMS helo crashes this year: 

The Associated PressThe five-member National Transportation Safety Board in January 2006 urged the Federal Aviation Administration to take a series of steps to improve the safety of EMS helicopter flights.

At a meeting Tuesday, the safety board acknowledged that the FAA is working on the proposals, but not quickly enough. Over the past 11 months, nine emergency medical helicopters have crashed, killing 35 people.

Interestingly, the NYTimes is on point today with an article about the untimely deaths of politicians, musicians, etc, with the common denominator being that they’re ‘unscheduled’ (charter) flights. 

New York TimesThey fly to the next gig or the next game, to the next political rally or the next board meeting — another day, another town, and another ride in a corporate jet, chartered plane, helicopter or whatever other conveyance seems convenient, sometimes regardless of risk.

When their planes crash, the headlines name another musician, politician or athlete killed in an aviation accident: Will Rogers, Knute Rockne, Otis Redding, Hale Boggs, Rocky Marciano, Thurman Munson, Rick Nelson and John G. Tower, to name just a few. The song "American Pie" memorializes the crash in February 1959 that killed Buddy Holly, Ritchie Valens and J. P. (The Big Bopper) Richardson.

Because they are busy and prosperous, prominent people often fly in planes not operated by major airlines. By doing so, accident statistics show, they increase their chances of crashing.

(Wikipedia listing of deaths by aircraft of the rich and powerful here).

Airlines have their outstanding safety record because they work terrifically hard (and well) at doing the same thing the same way every time, managing risk, and by avoiding anything that’s been historically risky.  That doesn’t mean they’re perfect, or that accidents don’t happen, but when you’re looking for a safe transportation baseline the scheduled airlines are where to start.

EMS helos are, by definition unscheduled.  They are, with a few exceptions, expected to be available every minute of every day.  They also don’t have the luxury of flying into well lit, organized airports, they’re landing in areas with trees, wires, etc.  There are a lot of things the NTSB has recommended, and hopefully they’ll help.

So, you’ll avoid an accident if you take the ground ambulance, instead, right?  Umm, no.  EMS crashes happen as well.  Per the CDC:

MMWREMS personnel in the United States have an estimated fatality rate of 12.7 per 100,000 workers, more than twice the national average (1). This report documents 27 ambulance crash-related fatalities among EMS workers over a 10-year period.

(Before you point out that 27 isn’t a big number, read the limitations section of the paper).  Here’s a somewhat less scientific but much more inclusive list of EMS crashes, from the EMS Network.

The WSJ Health Blog points out a real concern: if a helicopter is always available, it’ll get used, sometimes when it shouldn’t be:

Medical helicopters have been under scrutiny for a while now. In 2005, the WSJ reported that air ambulances are often used to transport patients who are “minimally injured,” and who could make it to a hospital faster and more safely via ground transport.

Helos on the ground don’t pay for themselves, so there’s a bias to fly.  I understand it, but we all need to understand there are risks to everyone.

None of us like helos falling out of the sky, and it’s always going to be risky.  Steps should continue to be taken to mitigate risks in all transportation, but remember that all unscheduled travel is risky.


  1. Ignoring hours/sorties/souls transported for a moment: when a wheeled motor vehicle has a loss of propulsive power, the consequences typically amount to an inconvenience. When a fixed-wing aircraft of multiple engines has a single-engine failure, the consequences range from inconsequential (arrival delay) to catastrophic (especially in the case of uncontained fan failures), but, for the most part, engine-out or transmission (ie, prop shaft) failures are minor. When a single-engine fixed-wing aircraft has an engine flameout, there’s a period of time that the captain can make decisions that can protect the airframe and the occupants from a multi-G collision with terrain. Those things glide, and can do it quite successfully, whether it’s a single-engine Cessna or a 767 (see also Gimli Glider).

    Rotary-wing aircraft, by their very design, are extremely vulnerable to single points of failure – there are any number of components that cannot have redundant systems to support them, which, when they fail (and they will), result in a large mass heading towards Earth. These components, ranging from entire engine assemblies to single bearings, mean that operators have to engage in expensive maintenance operations with alarming frequency – and frequently, these maintenance operations fail to improve the safety of the aircraft. Either the aircraft was fine and the procedure was neutral, or, as studies have typically shown, 15% of the time, when technicians perform scheduled maintenance on healthy equipment, they lower the reliability of the system through incidental damage or incorrect application of service procedures.

    Perhaps more troublingly, goal conflicts are endemic among helo operators. The nature of their pay-for-performance contracts frequently creates a culture where the line between “good enough to fly” and “legally allowed to fly” is not as bright and sharp as it might be. This isn’t limited to EMS – fire, forestry and agribusiness contractors are just as guilty. When one goal is “make money for firm that is already stressed by fuel prices” and another is “operate within the law” and the third is “show I’m not a pansy, worried about a little squeak”, early signs of failure are consciously and subconsciously underreported to dispatch and maintenance. A culture of “mission failure is not an option” is frequently found in such organizations, creating an issue of brittleness at the interfaces between finance, maintenance and operations.

    NASA and FAA have both published extensively on these operational problems, and for the most part, they simply don’t effect Part 125 (>20 pax) aircraft operators. The systems and the FAA oversight inherent in 125 ops work like crazy as you pointed out.

    Part 135? Less oversight, more thinly-spread operators….maybe a bit riskier. I fly Part 135 operators a few dozen times a year, and I don’t blanch.

    But understanding the risks? I’d never voluntarily get on a rotary-winged aircraft. Period. Fullstop. The number of single-point failures that could lead to death or disability (and not just bumps and bruises) are too numerous, and that’s coming from someone with 400,000 butt-in-seat lifetime air miles before age 35.

  2. Aerospace Genius says:

    The level of risk in fixed wing general aviation is comparable to motorcycling. I can’t imagine helicopters are any safer.

    I’m an aerospace engineer and I’m scared of helicopters. Aside from the horrendous complexity of the underlying physics, the consequences of any failure are far worse than airplanes.

  3. Its past time for a Time Out or ground stop for all EMS helicoptors. When a military aircraft crashes all of the same type of aircraft or unit are grounded until a root cause analysis is performed. I say ground them all until a RCA is done and improvements in safety are implemented. The problem in my area is over saturation. Within 45 minutes of my ED are aprox 15 EMS helicoptors. Hospitals shop around for helicoptors when one service turns the flight down due to weather others will take the chance. 15 years ago there were about 5 and we didnt have much trouble getting one when we needed it. Many flight in are not necessary and save little transport time.


  1. […] GruntDoc: “Newsflash: Transportation is Dangerous” Posted on October 31, 2008 by coptermedic An insightful summary and comments on recent regulatory oversight and reportage pertaining to air medical (and ground) EMS transport from GruntDoc. […]