Hello,
This morning’s NPR story on the recent NTSB hearings regarding the upward trend in medical helicopter crashes and the resultant fatalities got me thinking. You see, I’ve logged over four years as a pilot of those same emergency medical helicopters. So while I do not run the industry, I have had a good look at how it works from the inside. Friends, it’s got troubles.
http://www.google.com/search?hl=en&q=medical+helicopter+fatalities+npr
Follow me through the following scenario: I have experienced variations on it, many, many times. No shit, there I was (I have to use the regulation beginning so you’ll know it’s a pilot talking). Three-thirty in the morning. I’m about half asleep, which is as close to sleeping as I get while in my tiny room at the hospital. My radio, the one I’ve left hanging on the doorknob so I can’t leave the room without it, lets go with this god-awful screaming that tells me someone wants me to fly.
I’m on my feet, trip over the boots that I’ve left in front of the door and somewhere in there I wake up. I pick up the radio and try to sound awake while I let them know I’m kindof listening. Dispatch responds, “Rocket Med Pilot, Podunk County requesting a flight - Zamboni Memorial to Bananaberg Trauma Center.”
Oo-kay: Pull up the weather computer. Hmm. Can I even take off? Ceilings are twelve hundred feet, visibility three miles. Not great, but above company minimums. Can’t say no yet. Zamboni is over on the other side of the ridge, and…where’s the wind? Hmm. Wind from behind me. Tailwind. Weather will tend to pile up on my side of the ridge, but should be better on the other side of it.
I’m not happy yet, but there’s more to check. What are the predictions from the airports nearest to where I’d be going? Zamboni is predicting three miles and an overcast of fourteen hundred feet. Not great.
Bananaberg is predicting four miles and fifteen hundred feet. Close, but doable. Hold on. It’s 45 minutes to Zamboni and the medical types will need half an hour on the ground, minimum. Another 30 minutes to Bananaberg. That’s getting close to two hours from now to when I’ll be looking to land. What’s the dewpoint spread?
Shit. Bananaberg’s reporting a dewpoint spread of 10/08. That means that right now the temperature is 10 degrees Celcius and there’s enough water in the air that it will turn into fog if the temperature drops to 08 degrees - which I know it will, because it’s already three-thirty in the morning now and it will certainly be colder by the time we get there.
So. I can accept this flight, and we can take off, zoom to Zamboni Memorial, scoop up the patient and wing it off to Bananaberg - where I will fly into a wall of fog with two medical types, a patient and an aircraft that doesn’t really like to be right-side-up. With the fog I won’t be able to see which way is up, although it’s pretty easy to find down. Trust me, it is no fun to look out the windows of a helicopter and see absolutely nothing but the inside of a ping-pong ball.
Ah, but I have instruments for that. Yes! - theoretically I will be able to use them to turn around and fly back to someplace where we can see, while whichever of the medical crew is not yacking up their dinner will get on their radio and arrange for an ambulance to meet us somewhere. The medical crew, which will have quit vomiting by that time, will depart in the ambulance with the patient because once they touch the patient, they can’t hand him or her off to anyone except a doctor.
I will then wait on the ground for the weather to clear. When it does, I will go get my crew at Bananaberg and go home. In the meantime our region will have been without the services of a medical helicopter for…I-don’t-know-how-many hours.
Or, I can do this: I key the mike and say, “Rocket Med Dispatch, Rocket Med Pilot declining for weather.” The medical crew go back to whatever they’re doing, I get on the company website and explain why I just said no to ten thousand dollars of revenue for them, and go back to sleep.
But that’s not the end of the story. Because as soon as my dispatcher tells Zamboni Memorial that I decided not to kill my crew and the patient, the folks at Zamboni are on the phone again. This time they call Speedy-Air. The Speedy-Air pilot looks at the map and instantly knows that Zamboni is in my territory – so why is he getting the call? Ah, it must be the weather. He checks and sure enough, it’s not great and he’d like to turn it down - but Speedy-Air has a smaller market share than Rocket Med, and now he has a chance to snake ten thousand dollars of revenue away from my company and toward his.
He takes the flight, they get to the hospital, get the patient and off to Bananaberg. The lights on the ground disappear into the fog from time to time, but they helicopter doesn’t fly into the ground. They fly lower to give them a chance of seeing the radio towers and stuff, and while they get scared a few times, they make it! and deliver the patient.
And because they missed flying into the towers, and the buildings, and the ground…nothing got reported to anybody, there are no statistics that night and we’re all back to work the next day.
This happens a lot. The ones you hear about, like NPR was talking about this morning, and the ones where the helicopter doesn’t quite make it. The above is to give you a little look into some of the reasons why this is happening.
The first: Operational Control. The FAA makes us really, really aware that the Pilot-in-Command is the last authority over the flight. He or she decides if it’s safe to fly and is required to make a change if not to make a change would be unsafe. Sounds good, but the helicopter is parked at the hospital, on hospital property, with hospital medical people in flight suits, and a pilot watching TV in hospital quarters somewhere. It’s very, very easy for the hospital to think of that helicopter as being their helicopter. Which it isn’t – it belongs to the helicopter company. Also, everyone concerned spends a lot more time with the hospital people than they do with the helicopter company people. So when the hospital says, “go,” it’s easy for everyone to think that they have that authority. They don’t. Legally, they can only ask.
The second: Competition. Not just competition among medical helicopter providers, but among the hospitals themselves. When our hospital got a really cool twin-engine helicopter (no helicopter should work in EMS unless it’s got two engines), the hospital across the street had to have one too – or everyone would think we were the better hospital. And of course these helicopters have to be parked out in front where everyone can see them.
So we have two twin-engine helicopters serving an area that could be served by one. This means we have patients being flown that don’t need to be flown, in order to: make more money for the hospital, get CTD (circling-the-drain) patients into somebody else’s hospital so they don’t die within our walls and mess up our statistics, and not take an ambulance out of the town for half a day.
Of course there is the aforementioned competition between helicopter companies. I personally know two good pilots who were fired by their company for turning down flights because the weather was unsafe to fly in. We were glad to get them.
There’s a look at the problem. So what do we do about it?
It’s instructive to look for relevant analogies from history. Once upon a time, fire departments were independent, revenue-producing companies – just like medical helicopter companies are today. They worked for the insurance company. You bought fire insurance and you got a nice brass plaque to put on your house. If it caught fire (the house, not the plaque) the fire department showed up. If they saw their name on the plaque, they put out your fire. If they saw someone else’s name on the plaque, they might watch it, or get in the way of the next fire company to arrive – but they would ***not ***put the fire out.
But something changed. In time people saw that it would be better for the community for fire departments to be…nationalized? Paid for by and working for the benefit of the entire community. Couldn’t we do that with the medical helicopter industry?
Ah, but that’s creeping Socialism. And we need the competition among the free market to encourage quality and keep prices down.
Really? I haven’t noticed any decline in the quality of firefighters recently. Have you? I also think we’ve got better policing since police left off being the personal thugs of the rich and became funded by and working for the benefit of the community.
Ah, I see your game, you lefty. How do we pay for it? Well, Europe pays for their emergency medical services with a portion of the highway taxes. Could we not do the same? This would eliminate the pressure for one helicopter vendor to fly closer to the edge of death than the vendor across the street. As an extra benefit it would reduce the number of families who are bankrupted by the flight that it took to save a family member. Nobody but the state gets a bill.
But what do we do about those entrepreneurial heroes who invested their blood and treasure in the helicopter companies that they now own?
I don’t know. But we solved this problem once before: how did we compensate the people who once owned the firefighting companies?