Published in the Jefferson County Medical Society's "Louisville Medicine" magazine, January 2000 edition (Vol. 47, No. 8)

January 25, 2000

Saving patients is not without risk to staff

By JODIE HIGNITE
Chief Flight Nurse, Louisville Medical Center STATCARE

While writing this article we relived the tragedy of losing our comrades from the University of Kentucky Aeromedical service in an accident last summer. We think of them each time STATCARE lifts off to go on a mission.

The first air medical helicopter lifted from the roof of St. Anthony Hospital [Denver, Colorado] on Oct. 12, 1972, enroute to the scene of an automobile accident. In the following years the air medical industry underwent tremendous growth. Our crews have flown millions of miles to save countless patients. Since the first historic flight, safety of the flight crews and those working around the aircraft have remained a major concern.

With this growth came the realization that air medical transport was a much-needed service. However, it was not without risk. Statistics were staggering over the next few years. From 1980 through 1985 the accident rate for EMS air medical helicopters was almost double of that for non-emergency air taxi operators. In 1982, which was the worst year for air ambulance fatalities, the accident rate climbed to nearly 16 accidents per 100,000 patient transports.

In 1988, the National Transportation Safety Board (NTSB) released data from 1978 through 1986. There were 59 accidents (19 of those produced fatalities with a total of 53 deaths). This study concluded that most accidents were easily preventable accidents. It is estimated that 50 percent of the programs have experienced an accident or incident and 25 percent of programs experienced an accident or incident that resulted in an injury or fatality. Although 1982 has been documented as the worst year in the air-medical industry for accidents (with 16 resulting in nine crew member deaths), 1999 has surpassed the worst year with 11 crew members fatalities; four of which were from our home state.

The aviation safety institute published statistics in 1986 stating that aeromedical helicopters have a fatal accident rate three times higher than commercial operators. Risk can not be totally eliminated but must be minimized. These alarming statistics prompted widespread media coverage and caused the air medical industry to evaluate and identify causes for the high accident rate. Statewide and regional safety councils were formed with representation from pilots, mechanics, communication specialist, medical personnel and administration. This forum allowed safety problems to be identified, discussed and resolved. All information was then easily dispersed to all programs.

As discussed, helicopter transports bear great risk. Anyone who has witnessed an aircraft lifting off or landing has noticed the wind and noise it generates.

The average decibel level generated by the aircraft is 90-100 decibels. Normal conversation is about 60 decibels. Occasional exposure is not harmful. Consistent exposure, however, causes high frequency hearing loss. The use of hearing protection is necessary and provided to crew and to patients transported.

The wind or "rotor wash," produced by the rotor blades, generates winds of 50-60 miles per hour at a hover. This rotor wash produces hazards from debris. Gravel, clothing, medical equipment and fire fighter turn-out gear all becomes flying missiles. Ground personnel must recognize this and protect themselves and the patient entrusted to their care.

A second hazard is to the aircraft itself. All the loose debris can be pulled into the air intake of the helicopter. This can damage the engines, producing engine failure and creating a devastating situation.

The most obvious hazard of helicopters comes from the main rotor and tail rotors on the aircraft. These blades turn at approximately 400-500 revolutions per minute, with the rotor tips spinning at approximately 500 miles per hour. The tail rotor is 6 feet off the ground, and the main rotor is 8-9 feet from the ground. During the start-up and shut-down of the aircraft, the pilot has little control of the aircraft blades. These blades are revolving at a lower rotor velocity and can dip during wind gust as low as shoulder level. Needless to say, a serious injury or death would occur with contact. This is the reason for approaching the aircraft from the front in a "crouched" position with crew or pilot assistance. The rule to "keep low" is a strict safety rule that must be enforced at all times.

Extremes in temperature also pose a hazard for air medical crew members. Rotor wash of 50 mph can take an ambient air temperature of 10 degrees Fahrenheit to a wind chill of 40 degrees below zero. Exposed skin can suffer damage within minutes. High humidity and engine exhaust can cause dehydration and heat exhaustion. The exhaust temperature can reach as high as 400 degrees Celsius.

STATCARE air medical service transports about 40 percent of their patients directly from a scene. This knowledge of setting up a safe landing zone is not generally part of the curriculum taught to pre-hospital personnel. The information needed to provide a safe landing zone is the responsibility of the flight service. The landing zone must be a minimum of 60 x 60 feet of solid level ground during daylight hours and 100 x 100 at night. The LZ should be free of debris, stumps, and loose materials such as gravel. It should be free of overhead wires, trees and high tension lines. Although the scene is always chaotic, taking the time to survey the area is essential. The entire crew must be cognizant of their surroundings at take off and landing. The better trained the agency personnel, the safer the scene will be.

In closing, all air-medical services share the same risk. We all share the same goals. We are worth our weight in gold to the patients who truly need our services. The benefit of the transport, however, must outweigh the risk to our crews. We work with true heroes. We deal with extreme temperatures, weather, altitude, mental, physical and emotional stress. We bring order to chaos and go where others dare not to save and render aid to patients. We do it day in and day out. We know how close the other side really is -- we see it daily. This was stated at a recent conference. Geographical boundaries, competitive marketplaces and political barriers must never be allowed to encroach on our caring for each other and our patients. We all want to go home at the end of shift. It must always be SAFETY FIRST -- Fly safe.