Aviation News Item: 02549

20th Apr 2009

Source: verticalmag.com

A new study suggests that structural shortcomings within the helicopter EMS industry in the United States - including divergent operating standards and practices, inadequate reimbursement structures, and competing business models - pose a greater risk to the industry as a whole that the non-use of safety-enhancing technologies such as night vision goggles and terrain awareness warning systems.

The study, an industry risk profile (IRP) for helicopter emergency medical services in the U.S., was prepared by the Australian-based consulting group Aerosafe Risk Management. It was released by the Flight Safety Foundation on April 20, two days before a scheduled congressional oversight hearing on helicopter EMS in Washington, D.C.

A new report issued through the Flight Safety Foundation criticizes inconsistent standards and practices in the
U.S. helicopter EMS industry. Sheldon Cohen Photo

The report is the latest attempt to address problems in the United States' helicopter EMS industry, which has been under intense scrutiny in recent months. In February, prompted by a record 29 HEMS fatalities in 2008, the National Transportation Safety Board conducted a four-day hearing on HEMS; Aerosafe drew on testimony and exhibits from that hearing in preparing its IRP.

"When we started this project, we knew that industry had already been working to address the risks it faces at the operational and organizational levels," Aerosafe CEO Kimberly Turner stated in a press release. "The IRP highlights 26 key systemic risks, many of which are at the structural and oversight level of the industry. The broader context of the IRP digs deep and provides a common rallying point for all of the HEMS industry to move forward."

It remains to be seen, however, how the industry will respond to the IRP, which challenges existing regulatory and operating models. Although vague in the particulars, the report is clear in advocating far-reaching changes for the industry. For example, it notes that "no single regulatory body has responsibility for oversighting the EMS system as a whole" and that "conflicting regulatory responsibilities may place operators in a position where they make decisions that are not optimal for either the aviation or medical areas of the sector." The IRP suggests designing "national-level performance-based requirements for national use noting the need for consistent implementation at the state level."

The report also criticizes "inconsistencies in the payor model from state to state," and a Medicare reimbursement model that drives operators to minimize their overhead at the expense of simulator training and safety-enhancing technologies. It advocates the "adoption and implementation of a medical reimbursement (or revenue model) that adequately covers both the operating costs and the investment in future capability improvements."

In its sweeping recommendations, the IRP diverges considerably from HEMS safety initiatives to date, which have tended to focus more narrowly on specific regulatory or technology issues. The NTSB, for example, has concentrated its focus on four key recommendations: requiring commercial EMS operators to comply with 14 CFR Part 135 regulations during all flights with medical personnel on board; mandating formalized dispatch and flight-following procedures; implementing systematic flight risk evaluation programs; and requiring terrain awareness warning systems, or TAWS on medical helicopters. (Editor's note: the Spring issue of Vertical 911 Magazine will include an extensive article on the Federal Aviation Administration's historical resistance to mandating TAWS in helicopter EMS operations.)

Although the IRP does state that the "HEMS industry does not consistently identify, adopt, utilize and maximize aircraft technology available in the aviation industry to enhance safety parameters leading to a decrease in the risk of an accident or incident," it labels this as a "high" rather than a "very high" risk, and ranks it 22 on its list of 26 key risks.

"This is an innovative study that is calling for some of the very same safety tools that FSF (Flight Safety Foundation) has developed and used in the commercial and corporate aviation industry," William R. Voss, president and CEO of FSF, stated in the press release announcing the report.

"Acknowledging the problem and identifying risks are critical first steps toward finding solutions to accidents that have plagued helicopter emergency medical services," stated Jerod M. Loeb, executive vice president, Division of Quality Measurement and Research, The Joint Commission. "As the nation's leading health care accrediting body, The Joint Commission is committed to patient and staff safety and believes that this IRP will help target specific interventions that will ultimately save lives."

According to the IRP, the profile was "developed for use at the national level by industry leaders, standard setters, industry associations, industry bodies and groups that have the ability to develop, resource and implement voluntary industry-wide change initiatives to reduce the risk profile of the HEMS industry." A chief goal stated by the IRP is to involve industry in developing and implementing a comprehensive risk reduction plan - ideally by August 31, 2009, according to a timeline included in the IRP.

"An inclusive invitation is made for the full spectrum of industry stakeholders to work through the HEMS IRP and develop an individual submission of those industry level risk treatment strategies that are either already being undertaken or are willing to be undertaken, resourced and implemented by the submitting organization," the timeline states. A step-by-step guide to aid the preparation of submissions will be available from the Flight Safety Foundation Website. A copy of the report is available on the Flight Safety Foundation web site at www.flightsafety.org/pdf/HEMS_Industry_Risk_profile.pdf.

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