An

An Analysis
Analysis of
of
HEMS
HEMS Accidents
Accidents
and
and Accident
Accident Rates
Rates

Ira Blumen, MD
UCAN
University of Chicago Medical Center
NTSB Public Hearing February, 2009
Ira Blumen, 2009. Used with permission
NTSB
NTSB Report,
Report, 1988*
1988*
X 59 HEMS accidents
O 47 patient missions
O 12 other
X Accident rates
O 12.34/100,000 flight hours
O Nearly double other Part 135
X Fatal Accident rates
O 5.4/100,000 flight hours
O Nearly 3.5 times other Part 135
* Safety Study -- Commercial Emergency
Medical Service Helicopter Operations
 HEMS Accidents Rates
/ 100,000 Flight Hours
30

25

20

15

10

5 ?
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07
 You cant manage
what you cant measure
Our
Our Study:
Study: 2002
2002,
2002, 2005-2008
2002 2005-2008
X Determine the magnitude of the HEMS risk
O Accident rates
O Fatal accident rates
O Death rates
X Compare the risk to
O Other occupations
O High risk activities
 U.S. HEMS Accidents
and Fatal Accidents
20
18
16
NTSB 13 Acc
report 14 RW
14
12
10
8
6
4
2
0
72- 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08*
79
Total Accidents Fatal Accidents

*Dedicated and dual-purpose

through December 31, 2008
Accidents and Injuries: 1972-2008
X 264 accidents
O 256 dedicated HEMS
O 8 dual-purpose aircraft
O 98 (of 264) with fatalities
X 797 individuals
O 264 fatalities
O 89 serious
O 104 minor
O 340 uninjuried
through December 31, 2008
Focus: 1998-2008
X 146 HEMS accidents
O 55% off all HEMS accidents since 1972
O 141 dedicated HEMS
O 5 dual purpose
O 50 (of 146) fatal
Q 47 HEMS
Q 3 dual purpose

through December 31, 2008

Focus: 1998-2008
X 430 individuals
O 131 fatalities
Q 105 HEMS crewmembers
Q 6 dual purpose crewmembers
Q 16 patients
Q 4 others
O 49 serious
O 42 minor
O 208 uninjured
 HEMS: 1998-2008 (146 accidents)
98-08: 12.4
Avg. accidents/yr 1988-1997: 5.0 Fatal98-08: 12.4 4.5
Accidents:
20
18 Flying more. . . . .?
16 . . . .or flying less safe?
14
12
10
8
6
4
2
0
72- 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08*
79
Total Accidents Fatal Accidents
Dedicated and Dual-purpose
through December 31, 2008
 Percentage of Fatal Accidents
Dedicated and Dual-Purpose aircraft
100% 100%
100%
90%
80%
67% 67%67%
70% 63% 64%
60% 56%
50% 50%
50% 44% 43%
40% 36% 35%
33% 31% 29% 30% 31%31%
30% 25% 25% 25% 25%
20% 21%
17% 18%
20% 14%
10%
0%
0%
72- 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
79
Fatal Accidents: 39% 46% 34%
 HEMS Fatalities and Injuries
55
50
45
40
35
30
29
25
20
15
10
5
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08

Fatal Serious Minor None

Dedicated and dual-purpose

through December 31, 2008
When and Why? 1998-2008

X Night:49% of the accidents

X Scenes: 49% of the accidents
during patient-related
missions
When and Why? 1998-2008

X Probable cause. . . .
O Human error 77%
Q Weather-related
Q Collision with objects
O Mechanical 17%
O Other 3%
O Undetermined 2%
When and Why? 1998-2008

X In flight collision with objects

O 33 accidents*(3.3/yr)
O 3 fatal
X CFIT
O 21 accidents*(2.1/yr)
O 19 fatal
X 54 of 128 = 42% of all accidents* (*with final reports)
X 1990-1998 8 (Frazer)
O < 1/yr
O 8 of 45 = 18% of all accidents
When and Why? 1998-2008

X Weather-related
accidents
O 19% of all accidents
O Fatal Accidents
Q 56% of weather-
related accidents
were fatal (compared
to 34% of all accidents
having a fatality)
Accident
Accident Data
Data vs.
vs. Rates
Rates
X Raw numbers
X Meaningful comparison
O Compare like groups
O Normalized data
O Accident or incident rate
Q Per 100,000 flight hours

Q Per 100,000 departures

Q Per 100,000 patients transported

Q Etc.
HEMS Accident and
Fatal Accidents Rates
Number of
accidents and
fatal accidents

Normalized
Data

Exposure
Exposure
data*
data*for
for
each
each year
year
*Number of hours flown
Methodology
X 2000-2002
O Determine exposure data for 16 of 22 years
(1980-2001)
O Published data, surveys, etc.
O Web survey
O Operator survey (5)
O Manufacturer survey
X Updates: 2005, 2006, 2007, 2008
O Database analysis (ADAMS, AMT-R)
O Operator survey (9, 15, 20)
 Dedicated
HEMS Programs and Helicopters
700 668
650 Programs Helicopters
585
600
550
500
450
400
350
293
300
250
219
200 151
150
100
50
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
 836
HEMS Programs and Helicopters 820

700
650 Programs Helicopters 66
585
600
550
500
450
400
350
300 293
268
250
219
200
151
150
100
50
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
Exposure Data Collection:
Operator Survey
X 2002: 5 largest operators
X 2005, 2006: 9 operators with > 10 helicopters
X 2007: 15 operators with > 5 helicopters
X 2008: 20 operators
X Limitations
O Lack of available data for earlier years
O Paper trail vs. computer
O End of fiscal year data
Data Sampling

X Programs
O ~80% of all programs
X Helicopters
O ~90% of all helicopters
 Average Flight Hours
per Helicopter
900

800
700

600

500
400

300

200
100

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07

Published Data 02 Calculations/AMJ Surveys 08 Operator Survey

(response rate 33-96%) (sampling ~90%)
 HEMS Total Flight Hours
400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07

Estimated Total Flight Hours, 1972-2007: 4,700,000

GAO

FAA estimated that air ambulances amassed

about 900,000 flight hours annually from 1999
to 2003 and that the number of flight hours
increased to 1.6 million in 2004. However, as
noted, the reliability of these estimates is
questionable, given various shortcomings . . .
1999-2003
X 900,000 flight hours (FAA/GAO)
O 443 helicopters (OSI-HEMS)
O = 2,031 hrs per helicopter
X Operator survey (OSI-HEMS)
O Capturing >90% of the helicopters
O 587 hrs per helicopter
O Estimate 260,000 total flight hours
2004
X 1,600,000 flight hours (FAA/GAO)
O 513 helicopters (OSI-HEMS)
O = 3,119 hrs per helicopter
X Operator survey
O Capturing >90% of the helicopters
O 571 hrs per helicopter
O Estimate 293,000 total flight hours
 Average Patients Flown
per Helicopter
700

600

500

400

300

200

100

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07

Calculations/AMJ Surveys Operator

Published Data
(response rate 33-96%) Survey
 HEMS Patients Flown
300,000

250,000

200,000

150,000

100,000

50,000

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07

Estimated Total Patients Flown, 1972-2007: 4,300,000

Accident Rates

Flight
Accidents
Hours
per Year
per Year

Patients Fatal
Flown per Accidents
Year per Year
 HEMS Accidents Rates
/ 100,000 Flight Hours
30

25

20

15

10

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08

Dedicated HEMS
through December 31, 2008
 HEMS Fatal Accident Rates
/ 100,000 Flight Hours
12

10

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08

Dedicated HEMS
through December 31, 2008
AA Comparison
Comparison ofof
HEMS
HEMS to Other
Other
Types
Types of
of Aviation
Aviation
in
in the
the U.S.
U.S.
 Accidents Rates
/ 100,000 Flight Hours
25

HEMS Helicopter
General Aviation 135 Nonscheduled
20
135 Scheduled 121 Nonscheduled
HEMS
121 Scheduled
15

10
Helicopter

GA
5

135 N
0
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
 Fatal Accidents Rates
/ 100,000 Flight Hours
9

7
HEMS HEMS Helicopter
General Aviation 135 Nonscheduled
6 135 Scheduled 121 Nonscheduled
121 Scheduled
5

3
Helicopter
2
GA
1

0
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
AA Comparison
Comparison
Of
Of Individual
Individual Risk
Determining Risk
Number of
crew injuries or
fatalities per
year
Normalized
Data

Population at
Population
risk* forfor
at risk
each
eachyear
year
*Number of crew members engaged in HEMS transport
 High-Risk Occupations, 2007
Fishers and related fishing workers 111.8

Logging workers 86.4

Aircraft pilots and flight engineers 66.7

Structural iron and steel workers 45.5

Occupation

Farmers and ranchers 38.4

Roofers 29.4

Electrical power-line installers/repairers 29.1

Coal mining 28.4

Driver/sales workers and truck drivers 26.2

Refuse and recyclable material collectors 22.8

Police and sheriff's patrol officers 21.4

0 25 50 75 100 125 150 175 200

Source: Bureau of Labor Statistics Fatality Rate (per 100,000 employees)
Census of Fatal Occupational Injuries, 2007
Population at Risk

X Average number of crew members / RW (18)

X For 2008: ~12,000
X Average crew members
O Full-time vs. Part-time
O Assumes equal exposure for all
X Average flight program
 HEMS Crew* Fatalities
26
24
22 3
20
18
16
14
12 2 2
10 3 20
8
6 13
11 12 11 11 11 12
4 9 9 9 10 10 10
7 6
2 5 5 4 4 4 4 4
3 3 3 2
0 1 0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08

*With no information on population at risk, dual Thru December 31, 2008

purpose fatalities are not included in calculations
Results, 1980-2008
X 264 total fatalities
- 34 patients
- 10 dual-purpose crew members
- 7 others
213 dedicated HEMS crewmember deaths
X Population at risk over 29 years
O Range: estimated 700 12,000
O A very small sampling
 HEMS Crew Fatalities /
100,000 Personnel
900

800
Range: 0-806/100,000
700
29-yr average: 212/100,000
600
10-yr average: 113/100,000
500

400

300
164
200

100

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08
 High-Risk Occupations, 2007
HEMS Crew (Dedicated) 2008 164
Fishers and related fishing workers 111.8
Logging workers 86.4
Aircraft pilots and flight engineers 66.7
HEMS Crew (Dedicated) 2007 50
Occupation

Structural iron and steel workers 45.5

Farmers and ranchers 38.4
Roofers 29.4
Electrical power-line installers/repairers 29.1
Coal mining 28.4
Driver/sales workers and truck drivers 26.2
Refuse and recyclable material collectors 22.8
Police and sheriff's patrol officers 21.4

0 25 50 75 100 125 150 175 200

Fatality Rate (per 100,000 employees)
 High-Risk Occupations, 2007
HEMS Crew (Dedicated) (10-yr average) 113
Fishers and related fishing workers 111.8
Logging workers 86.4
Aircraft pilots and flight engineers 66.7
Structural iron and steel workers 45.5
Occupation

Farmers and ranchers 38.4

Roofers 29.4
Electrical power-line installers/repairers 29.1
Coal mining 28.4
Driver/sales workers and truck drivers 26.2
Refuse and recyclable material collectors 22.8
Police and sheriff's patrol officers 21.4

0 25 50 75 100 125 150 175 200

Fatality Rate (per 100,000 employees)
HEMS: The Risk to the Patient
X 29-year study
X ~ 4,500,000 patients flown by HEMS
X 34 patients have died in HEMS accidents
X Death rate: 0.76/100,000 patients flown
HEMS: The Risk to the Patient
X Institute
of Medicine, 1999
O Estimates of two major studies
O 44,000-98,000 deaths each year due to
adverse events
O Death rate: 131-292/100,000 pts per year
In conclusion. . . . .
X Crunched the numbers
X Validated the magnitude of the risk
O Aircraft
O Personnel
O Patient
O Community
X We have the ability to save livesand take
them
X We have the ability to make a difference
each and everyone of us
Thank you