Why Helicopter Ambulances?

by Shawn Coyle on December 9, 2010

in Helicopter Safety

Responding to Christine Negroni’s December 1 Huffington Post article on helicopter medical evacuation, I submit the following:

For a short but interesting period, I was a helicopter pilot for an EMS operation in California. Much of our business was related to off-road recreational vehicle accidents, often in rugged terrain. We would be called and responded immediately for any of these accidents, as opposed to waiting for police or ground ambulance personnel to arrive and assess the case. We could be on location when normal highway vehicles were going to be hours away.  The benefits for serious injury cases were obvious – every minute saved getting someone seriously injured was vital.

One incident still sticks in my mind. We arrived on scene and our nurse and medic were preparing the teenaged patient. The patient’s mother was watching all this with great interest. Then the ground ambulance pulled up. I was still in the helicopter and noticed the mother talking to the flight medic and pointing at the ground ambulance. A short conversation took place and the mother pointed to the helicopter and nodded vigorously. We loaded the patient and had him to the regional hospital in about 20 minutes.

Later, I asked the medic about the conversation. The mother was obviously worried about the cost, the medic said. ‘I pointed out that while it would be cheaper to use the ground ambulance, it was going to take at least half an hour over very rough roads to get to the nearest highway, and then 30 minutes to the local hospital. Given the boy’s injuries, all the local hospital could do was stabilize him. The time in the hospital was going to be at least an hour if not more and then they would have to transfer him to the same regional hospital we would take him to. That ground ambulance trip would take about 2 more hours. We’d have the boy there in 20 minutes. That time saving made the difference for the mother.

Not every decision on ground vs. air is that clear cut. Many times, the personnel who make the call to send an air ambulance don’t pass on the details clearly or exactly, and the people who receive the call don’t know the questions to ask. Not all the medical information is clearly known when the decision to launch (or not launch) is made. I’ve also seen cases where it should have been obvious that a helicopter was needed, but it took over an hour to make that decision. Sometimes the helicopter was not launched when it should have been, with sad results.

So, Ms. Negroni has a point, but let’s not be reckless and throw out the good with the bad.  The fact is that the helicopter medical evacuation network is necessary and helpful.  And yes, it is expensive.  I do not doubt that sometimes it is used when it was not needed.  That needs work.  But too many regulations regarding use could cause confusion, delay, and a harmful curtailment of this service.

As for the accidents, all in the industry are aware and are working on that.  I have never met a helicopter pilot that wanted to die in a crash, let alone hurt others he or she was trying to help.

Shawn Coyle is an ex-Canadian Air Force helicopter test pilot. He’s logged more than 6,500 hours of helicopter time in over 50 different types of helicopters. He’s worked in industry, the military and government in flight testing and certifying helicopters and avioinics systems. He is the author of Cyclic and Collective, widely regarded as the best book on helicopters and helicopter flying to date. He is active as an expert in helicopter and aviation accidents and teaches courses on helicopter technical matters.

{ 1 comment… read it below or add one }

James Crouse December 9, 2010 at 6:52 pm

Shawn gives the other side to New York Times’ reporter Negroni’s comments. Both have a point: there are times where helicopter air ambulances are not necessary and goodness knows they are expensive. But there are also times that they are absolutely necessary, and the cost is irrelevant. Put the issue into your own personal experience, and it becomes clear.

No one can deny that there is a serious safety problem with aeromedical operations. The helicopter industry worldwide has addressed and is addressing the many safety issues (weather, operational environment, crew, training, maintenance, equipment, design) through various means. One of the most important has been the International Helicopter Safety Team, created in 2005 and consisting of representatives of worldwide operators, manufacturers,
NGO’s and governments with the intention of exploring the reasons for helicopter crashes and then implementing means to prevent them. I have personally witnessed their work and they have done a remarkable job. But the accidents continue. The nature of the industry requires not only maximized cultural safety but also enhanced equipment, operational oversight and training—and the means to pay for them.

Recently the FAA got into the picture with a NPRM which is intended to help. See: http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480b6cd48. This is a good initial step but we don’t believe it goes far enough. See my take at http://aviationsafetyblog.com/2010/10/20/faas-proposed-new-helicopter-safety-rules/


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