Jim Mobley, RN, CEN, CFRN, EMT-PChief Flight Nurse

Mike Clumpner, MBA, NREMT-P, CCEMT-P, FP-CFlight Paramedic

Regional One Spartanburg, South Carolina

We Have an Aircraft Down!

Lessons Learned From an Air Medical Crash

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“There is an Aircraft Down!”•911 Dispatcher: “Newberry County 911, where is your emergency?”•Caller: “Uh, yes we’re out here on the interstate, and there is a crash out here…”•911 Dispatcher: “Do what now?”•Caller: “I’m on the interstate…”•911 Dispatcher: “Uh-huh”•Caller: “I’m on the interstate and there was a crash out here. LifeStar came and picked somebody up and we think the helicopter just crashed out here.”•911 Dispatcher: “You think the helicopter crashed?”•Caller: “There is a helicopter that picked somebody up…”•911 Dispatcher: “Right”•Caller: “And the helicopter…it just like fell out of the sky”

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Accident/Incident Reporting United States Department of Transportation lists

in FAR Part 830 the definition of an accident:

“An occurrence associated with the operation of an aircraft which takes place between the time any person boards the aircraft with the intention of flight and all such persons have disembarked, and in which any person suffers death or serious injury, or in which the aircraft receives substantial damage.”

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Accident/Incident Reporting Serious injury is defined as:

Requiring hospitalization greater than twenty-four hours within seven days of the accident

Results in fractures of any major bone(s) Causes severe hemorrhages, nerve, muscle or

tendon damage Involves any internal organ Involves second or third degree burns to more

than five percent of the body

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Substantial damage is defined as: Damage or failure which will adversely affect the

structural strength, performance, or flight characteristics of the aircraft, and which would normally require major repair or replacement of the affected component.

Accident/Incident Reporting

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Occupational Safety and Health Administration (OSHA) reporting:

1904.7(a) Basic requirement. You must consider an injury or illness to meet the general recording criteria, and therefore to be recordable, if it results in any of the following: death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, or loss of consciousness. You must also consider a case to meet the general recording criteria if it involves a significant injury or illness diagnosed by a physician or other licensed health care professional, even if it does not result in death, days away from work, restricted work or job transfer, medical treatment beyond first aid, or loss of consciousness.

Accident/Incident Reporting

www.osha.gov

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Air Ambulance Accidents Since 1997 the air medical industry fleet

has doubled to over 700 aircraft Patient transports by air ambulance are

increasing five percent a year Although there is a rising trend in the

number of accidents there is also a tremendous increase of aircraft in the fleet and population served by air ambulances

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In the United States there was a twelve percent increase in flight hours between 1998 and 1999

Utilizing the exposure rate and normalizing it over time, medical helicopter accident rates per 100,000 flight hours are lower than those of all helicopter operations, general aviation and scheduled Part 135 operations.

Air Ambulance Accidents

University of Chicago Safety Committee, “A Safety Review and Risk Assessment in Air Medical Transport [2002]

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In the mid-1980’s the rate of medical helicopter accidents was 13.42/100,000 flight hours

Averaged over the past five years 1999-2004, the medical helicopter accident rate has fallen to 3.45/100,000 flight hours

Air Ambulance Accidents

Association of Air Medical Services (AAMS)

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300,000 medical flights are conducted annually in the United States

A study published in American Emergency Medicine found that between years 1998 and 2000, anywhere from 11,000 to 65,000 people would have died if they would not have been transported by air medical

A study published in the Journal of Trauma in 2002 shows that air medical transport reduces mortality by twenty-four percent

Air Ambulance Accidents

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Air Ambulance Accidents The following agencies are actively working to

lower the air medical accident rate Federal Aviation Administration (FAA) National Aeronautical and Space Administration (NASA) Association of Air Medical Services (AAMS) Helicopter Association International (HAI) National Association of EMS Pilots (NEMPSA) International Association of Flight Paramedics (IAFP) Air and Surface Transport Nurses Association (ASTNA) Air Medical Physicians Associations (AMPA) National Association of Air Communication Specialists

(NAACS)

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National Transportation Safety Board Investigation Independent agency created in 1967 Ten field offices nationwide Federal “Go Team” Regional “Go Team” Go Teams arrive at the accident scene as soon

as possible Team personnel depend on accident size Average “on scene” investigation time of four to

ten days

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National Transportation Safety Board Investigation Press briefings conducted regularly

"The Safety Board will disseminate to the public all information regarding the accident [investigation], either through our Board Member, Public Affairs Officer or Investigator-in-Charge. We will hold regular briefings to the press. Please refrain from discussing the accident [investigation] in public, or giving information about it to the press. Any violation of this request will be considered a serious infraction of Board rules."

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National Transportation Safety Board Regions

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Continuing Mission/Re-training Have all personnel conduct training as a

team If pilot error is found, then conduct specific

training to address the problem(s) All flight team personnel must attend the

following: Team debriefing/critical incident stress debriefing Crew resource management

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Stan Coss, Vice-President, Med-Trans Corporation Critical to have a Post Accident Incident Plan in place prior to an

accident and everyone must be familiar with the plan Post Accident Incident Plan must be approved by the FAA prior

to implementation Scrutinize all statements made to the media for accuracy Litigation may be influenced by employee satisfaction Establish on-call administrators who can handle an accident

anytime of day Flight services must return to operations as soon as possible so

that you don’t lose established presence After accident review/critical incident stress debriefing for all

members of the flight team

Post-Crash Reflections

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Post-Crash Reflections Renee Romberger, Vice President of Professional

Services, Spartanburg Regional Healthcare System Have the leadership team visible Support families Involve the community with the memorial Critical Incident Stress Debriefing (CISD) important Re-start program when everyone is ready Keep remaining crew members well informed

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Jimmy Greene, Director of Transportation, Spartanburg Regional Healthcare System Be able to confirm the missing aircraft

Utilize flight tracking software Be willing to justify the need for air medical transport and

justify the pilot’s decision to fly Have one public relations representative for the media Immediately transport personnel data to crash site for law

enforcement and coroner Offer a public relations liaison to each family Involve all members of the flight team in post-accident

actions

Post-Crash Reflections

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Post-Crash Reflections Doug Silk, REMT-P, Program Coordinator,

Regional One Air Medical Service Make every effort to notify families as soon as possible Secure base to ensure no unauthorized personnel Liaison with agency that requested mission Start back operations when crew is ready Use hospital/vendor legal team for advice Ask questions of NTSB team, cooperate with them Monitor crews for problems, afford opportunity for discussion

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Heidi Jameson, Marketing Manager, Spartanburg Regional Healthcare System

Establish Emergency Operations Center as soon as possible

Establish Public Information Officer Press releases as soon as practical. Keep employees

informed Arrange media interviews, keep media informed Cooperate with media Give honest answers Drill for similar occurrences

Post-Crash Reflections

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Contact Information

Jim MobleyFlightNurseJim@aol.com

Mike Clumpnermclumpner@regional-one.com

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References• Bledsoe, E. Medical Helicopter Accidents in the United States: A 10-Year

Review. Journal of Trauma-Injury Infection and Critical Care. 56(6):1325-1329, June 2004

• University of Chicago Safety Committee. A Safety Review and Risk Assessment in Air Medical Transport. 2002

• American Emergency Medicine. Cost Effectiveness Analysis of Helicopter EMS for Trauma Patients. 2002

• Journal of Trauma. Helicopter Transport and Blunt Trauma Mortality. 2002• Occupational Safety and Health Association. Available online at

www.osha.gov • Coss, S. Personal interview. Conducted June 2005• Greene, J. Personal interview. Conducted June 2005• Jameson, H. Personal interview. Conducted 27 June 2005• Romberger, R. Personal interview. Conducted 28 June 2005• Silk, C. Personal interview. Conducted 27 June 2005