EMS Helicopter Safety: NTSB Pushes the Envelope

There's little question that EMS helicopters are the most dangerous aircraft in the sky. EMS helicopters have a fatal accident rate 6000 times that of commercial airliners. Flying EMS helicopters is one of the most dangerous jobs in America.  In fact, according to the Washington Post, only working on a fishing boat is riskier.  And the EMS helicopter safety record is getting worse, not better.

EMS helicopterWhy, exactly, is the EMS helicopter accident record so bad?  As discussed here, one problem is that it's not clear who is ultimately responsible for overseeing the industry. State agencies, county agencies and the federal government all have a hand in oversight but no one appears to be in charge. That means that definitive industry standards cannot be established and hazards cannot be effectively managed.

This week, the NTSB recommended that the FAA take steps to address the most serious of the industry's problems. Some of the those recommendations are not particularly surprising. For example, the NTSB suggests that pilots be better trained in bad weather flying, and that helicopters be equipped with night vision equipment and autopilots.

One of the NTSB's recommendations, however, no one saw coming.  The NTSB suggests that Medicare -- which funds most of the EMS helicopter industry by paying up to $20,000 for each patient transport -- adjust its rate reimbursement structure according to the level of safety the helicopter company provides.  In plain english, the NTSB suggests that Medicare not pay air ambulance companies unless they meet certain safety standards.  NTSB board member Robert Zumwalt concedes this recommendation "pushes the envelope".  But the air ambulance record is so bad, extreme steps are necessary.

By targeting the air ambulance industry's source of funding, the NTSB is looking beyond the FAA for help in making the air ambulance industry safer.  Why not just leave it to the FAA?  For one thing, the FAA has yet to act on the EMS helicopter recommendations the NTSB made 3 years ago.  The NTSB is hoping the Department of Health and Human Services (Medicare) will be more responsive to its safety concerns than the FAA has been. 

NTSB to FAA: Ground the Zodiac Fleet

Zodiac CH-601XL

Today the NTSB issued an "urgent" safety recommendation, asking the FAA to immediately ground all Zodiac CH-601XL aircraft.  The reason:  their wings tend to fall off.  So far, six have broken up in flight, causing 10 fatalities.  The NTSB suspects that the design of the aircraft induces "flutter"-- an aerodynamic phenomenon that can destroy an aircraft in seconds.  This short NASA video depicts flutter nearly destroying the tail on a Piper Twin Comanche.

Will the FAA act on this recommendation or, like it has with regard to so many other NTSB recommendations, simply ignore it?  I'm betting that this is one the FAA will act on.  As I've noted before, the FAA has been under increasing fire for sitting on NTSB recommendations while lives are lost. The FAA will see Zodiac's manufacturer as an easy target and move against it -- if for no other reason than to quiet its critics.

More on the NTSB and Air Ambulance Accidents

A reader of this post concerning air ambulance accidents asked, “Can the FAA really get away with ignoring the NTSB?"  The answer, to date, is "yes."  And there's nothing the NTSB can do about it.

The whole reason the NTSB exists is to learn from accidents and make safety recommendations so that similar accidents won’t happen again. But the NTSB has no power to make anyone, including the FAA, follow its recommendations.  And so, frequently, the FAA just ignores them.

Of course, ignoring NTSB recommendations can lead to loss of life. Some feel that the crash of Continental Flight 3407 in Buffalo might have been avoided, and 50 lives saved, had the FAA acted on the NTSB’s safety recommendations concerning turboprop planes and airframe ice. But the FAA never did, despite that some of those recommendations are now more than 10 years old. Even by goverment standards, ten years is a long time to sit on something. 

But back to air ambulances: The NTSB studied 55 air ambulance crashes occurring between 2002 and 2004 in which 54 people were killed.  As a result of what it learned, the NTSB recommended (pdf) that air ambulance companies be required to, among other things: 

  • equip their helicopters with terrain warning systems;
  • ensure that their pilots have good weather information before taking off; and
  • ensure that their pilots get adequate rest. 

All straightforward stuff that is hard to argue with. 

That was back in 2006.  Since then, another 9 air ambulances have crashed, killing 35.  Still, the FAA hasn't acted on the recommendations. Though there has been some response from the FAA, the NTSB calls the response "unacceptable." 

One might wonder: if the FAA is free to ignore the NTSB, and has a record of doing just that, then what’s the point of even having an NTSB?

Good question.
 

NTSB: Air Ambulances Drag Down 2008 Accident Statistics

Well, that seems to be what the National Transportation Safety Board said today when it commented on the preliminary accident statistics for 2008.

The NTSB's comment:

The 2008 accident statistics reveal a mixed picture. . . We are particularly concerned with the spike in fatalities in on-demand air charter operations. There's a lot of room for improvement in this area, and as evidenced by our recent forum on emergency medical service helicopter accidents, we continue to do everything we can to identify the safety issues involved, and to advocate for the adoption of our recommendations that will make the skies safer.

Our Translation"The 2008 accident statistics wouldn't look bad except for all the air ambulance helicopter crashes.  We've got some ideas on how to make air ambulance operations safer, but the FAA keeps ignoring us.  As usual." 

The NTSB's Limited Role After an Aircraft Accident

Some people think that the National Transportation Safety Board is the final authority over an aviation accident -- that the NTSB acts as the accident "police."  They think that, in the end, the NTSB will catch the one responsible for the accident and make that person answer for what happened.  But that's just not the case.

It's true that, like a cop, the NTSB can secure an accident scene and keep others away.    It can examine the aircraft wreckage. It can have aircraft parts tested to help determine why the accident happened. It can even subpoena evidence. But the NTSB investigates a crash for one reason only: to gather and then publish information so that similar accidents may be avoided in the future.

Although it is an agency of the federal government, the NTSB has no enforcement powers. That means that the NTSB can't bring criminal charges. It can't fine anyone. The NTSB can't suspend anyone's license as a result of what it learns, and it can't put anyone out of business. If the NTSB concludes that someone, such as a maintenance facility, was responsible for the crash, that facility is free to ignore the findings and carry on business as usual. 

When the NTSB is done with its investigation, it prepares a report. The report usually includes the NTSB's opinion as to the accident's "probable cause."  The hope is that the aviation community will read the report and learn something from it.  Because that is the report's only permissible purpose, by federal law, the opinions in the report are inadmissible in any lawsuit arising from the crash. 

Sometimes the NTSB, as a result of what it learns, will publish a safety recommendation.  Often the recommendation is that the FAA pass tougher regulations.  But the FAA need not follow the NTSB's recommendations, and frequently chooses not to.   

If there is a lawsuit concerning the crash, the NTSB will not get involved.  Not only is the NTSB's report of the accident's probable cause inadmissible, but the NTSB investigators are prohibited by law from testifying in court, even if they are served with a subpoena.