Emergency Medical Services helicopters don’t get paid for being on call. They earn money only when transporting patients. But, when they do transport a patient, they are paid well — up to $20,000 per trip.

The business model has worked out well for the industry. In fact, the number of EMS helicopters in service has quadrupled since 2002. But since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions. And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.

Not surprisingly, the EMS helicopter fatal accident rate is, when compared to other forms of commercial N502MT - EMS Helicopter Crashaviation, off the charts.  In fact, with a crash rate that is 6000 times that of commercial airliners, flying an EMS helicopter is the second most dangerous job in America. Only working on a fishing boat is riskier.

Some of the reasons why EMS helicopters crash: 

  • Weather.  Inadvertent flight into clouds or fog can cause the pilot to become disoriented and lose control of the aircraft. Thunderstorms can bring a helicopter down in seconds. While accurate weather information is available for airport destinations, it is a rare commodity for the off-airport locations that EMS helicopters typically service. The lack of accurate weather information, coupled with economic pressure to complete the mission, takes a toll.
  • Unprepared Landing Sites. Helipads are designed so that there are no wires, trees or other obstacles for the helicopter to hit during landing or takeoff. The ground is firm and level so that the helicopter won’t roll over when it touches down.  But when responding to a call, EMS helicopters accept landing sites that have been neither surveyed for hazards nor otherwise prepared for helicopter traffic.
  • Terrain.  EMS helicopters crash into mountains, ridges, and hillsides with some regularity. Most of those accidents happen when it’s dark, foggy, or cloudy. “Controlled flight into terrain” is a leading cause of EMS helicopter crashes.
  • Mechanical Failure.  Rotor blades come off, engines fail, and pilots lose control of EMS helicopters due to defective parts or maintenance.

In Part II ("Golden Hour and Other EMS Myths"): With names like “Angel Flight,” “Mercy Flight,” and “Life Flight,” the EMS helicopter companies market themselves as indispensable life-savers. Is this just marketing hype, or are the benefits of helicopter transport really worth the risks?