Jim Mobley, RN, CEN, CFRN, EMT-P

1
We Have an Aircraft Down! Lessons Learned From
an Air Medical Crash

• Jim Mobley, RN, CEN, CFRN, EMT-P
• Chief Flight Nurse
• Mike Clumpner, MBA, NREMT-P, CCEMT-P, FP-C
• Flight Paramedic
• Regional One
• Spartanburg, South Carolina

2
There is an Aircraft Down!

• 911 Dispatcher Newberry County 911, where is
  your emergency?
• Caller Uh, yes were out here on the
  interstate, and there is a crash out here
• 911 Dispatcher Do what now?
• Caller Im on the interstate
• 911 Dispatcher Uh-huh
• Caller Im on the interstate and there was a
  crash out here. LifeStar came and picked somebody
  up and we think the helicopter just crashed out
  here.
• 911 Dispatcher You think the helicopter
  crashed?
• Caller There is a helicopter that picked
  somebody up
• 911 Dispatcher Right
• Caller And the helicopterit just like fell
  out of the sky

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4
Accident/Incident Reporting

• United States Department of Transportation lists
  in FAR Part 830 the definition of an accident
• An occurrence associated with the operation
  of an aircraft which takes place between the time
  any person boards the aircraft with the intention
  of flight and all such persons have disembarked,
  and in which any person suffers death or serious
  injury, or in which the aircraft receives
  substantial damage.

5
Accident/Incident Reporting

• Serious injury is defined as
• Requiring hospitalization greater than
  twenty-four hours within seven days of the
  accident
• Results in fractures of any major bone(s)
• Causes severe hemorrhages, nerve, muscle or
  tendon damage
• Involves any internal organ
• Involves second or third degree burns to more
  than five percent of the body

6
Accident/Incident Reporting

• Substantial damage is defined as
• Damage or failure which will adversely affect the
  structural strength, performance, or flight
  characteristics of the aircraft, and which would
  normally require major repair or replacement of
  the affected component.

7
Accident/Incident Reporting

• Occupational Safety and Health Administration
  (OSHA) reporting
• 1904.7(a) Basic requirement. You must consider
  an injury or illness to meet the general
  recording criteria, and therefore to be
  recordable, if it results in any of the
  following death, days away from work, restricted
  work or transfer to another job, medical
  treatment beyond first aid, or loss of
  consciousness. You must also consider a case to
  meet the general recording criteria if it
  involves a significant injury or illness
  diagnosed by a physician or other licensed health
  care professional, even if it does not result in
  death, days away from work, restricted work or
  job transfer, medical treatment beyond first aid,
  or loss of consciousness.

www.osha.gov
8
Air Ambulance Accidents

• Since 1997 the air medical industry fleet has
  doubled to over 700 aircraft
• Patient transports by air ambulance are
  increasing five percent a year
• Although there is a rising trend in the number of
  accidents there is also a tremendous increase of
  aircraft in the fleet and population served by
  air ambulances

9
Air Ambulance Accidents

• In the United States there was a twelve percent
  increase in flight hours between 1998 and 1999
• Utilizing the exposure rate and normalizing it
  over time, medical helicopter accident rates per
  100,000 flight hours are lower than those of all
  helicopter operations, general aviation and
  scheduled Part 135 operations.

University of Chicago Safety Committee, A Safety
Review and Risk Assessment in Air Medical
Transport 2002
10
Air Ambulance Accidents

• In the mid-1980s the rate of medical helicopter
  accidents was 13.42/100,000 flight hours
• Averaged over the past five years 1999-2004, the
  medical helicopter accident rate has fallen to
  3.45/100,000 flight hours

Association of Air Medical Services (AAMS)
11
Air Ambulance Accidents

• 300,000 medical flights are conducted annually in
  the United States
• A study published in American Emergency Medicine
  found that between years 1998 and 2000, anywhere
  from 11,000 to 65,000 people would have died if
  they would not have been transported by air
  medical
• A study published in the Journal of Trauma in
  2002 shows that air medical transport reduces
  mortality by twenty-four percent

12
Air Ambulance Accidents

• The following agencies are actively working to
  lower the air medical accident rate
• Federal Aviation Administration (FAA)
• National Aeronautical and Space Administration
  (NASA)
• Association of Air Medical Services (AAMS)
• Helicopter Association International (HAI)
• National Association of EMS Pilots (NEMPSA)
• International Association of Flight Paramedics
  (IAFP)
• Air and Surface Transport Nurses Association
  (ASTNA)
• Air Medical Physicians Associations (AMPA)
• National Association of Air Communication
  Specialists (NAACS)

13
National Transportation Safety Board Investigation

• Independent agency created in 1967
• Ten field offices nationwide
• Federal Go Team
• Regional Go Team
• Go Teams arrive at the accident scene as soon as
  possible
• Team personnel depend on accident size
• Average on scene investigation time of four to
  ten days

14
National Transportation Safety Board Investigation

• Press briefings conducted regularly
• "The Safety Board will disseminate to the public
  all information regarding the accident
  investigation, either through our Board Member,
  Public Affairs Officer or Investigator-in-Charge.
  We will hold regular briefings to the press.
  Please refrain from discussing the accident
  investigation in public, or giving information
  about it to the press. Any violation of this
  request will be considered a serious infraction
  of Board rules."

15
National Transportation Safety Board Regions
16
Continuing Mission/Re-training

• Have all personnel conduct training as a team
• If pilot error is found, then conduct specific
  training to address the problem(s)
• All flight team personnel must attend the
  following
• Team debriefing/critical incident stress
  debriefing
• Crew resource management

17
Post-Crash Reflections

• Stan Coss, Vice-President, Med-Trans Corporation
• Critical to have a Post Accident Incident Plan in
  place prior to an accident and everyone must be
  familiar with the plan
• Post Accident Incident Plan must be approved by
  the FAA prior to implementation
• Scrutinize all statements made to the media for
  accuracy
• Litigation may be influenced by employee
  satisfaction
• Establish on-call administrators who can handle
  an accident anytime of day
• Flight services must return to operations as soon
  as possible so that you dont lose established
  presence
• After accident review/critical incident stress
  debriefing for all members of the flight team

18
Post-Crash Reflections

• Renee Romberger, Vice President of Professional
  Services, Spartanburg Regional Healthcare System
• Have the leadership team visible
• Support families
• Involve the community with the memorial
• Critical Incident Stress Debriefing (CISD)
  important
• Re-start program when everyone is ready
• Keep remaining crew members well informed

19
Post-Crash Reflections

• Jimmy Greene, Director of Transportation,
  Spartanburg Regional Healthcare System
• Be able to confirm the missing aircraft
• Utilize flight tracking software
• Be willing to justify the need for air medical
  transport and justify the pilots decision to fly
• Have one public relations representative for the
  media
• Immediately transport personnel data to crash
  site for law enforcement and coroner
• Offer a public relations liaison to each family
• Involve all members of the flight team in
  post-accident actions

20
Post-Crash Reflections

• Doug Silk, REMT-P, Program Coordinator, Regional
  One Air Medical Service
• Make every effort to notify families as soon as
  possible
• Secure base to ensure no unauthorized personnel
• Liaison with agency that requested mission
• Start back operations when crew is ready
• Use hospital/vendor legal team for advice
• Ask questions of NTSB team, cooperate with them
• Monitor crews for problems, afford opportunity
  for discussion

21
Post-Crash Reflections

• Heidi Jameson, Marketing Manager, Spartanburg
  Regional Healthcare System
• Establish Emergency Operations Center as soon as
  possible
• Establish Public Information Officer
• Press releases as soon as practical. Keep
  employees informed
• Arrange media interviews, keep media informed
• Cooperate with media
• Give honest answers
• Drill for similar occurrences

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Contact Information

• Jim Mobley
• FlightNurseJim_at_aol.com
• Mike Clumpner
• mclumpner_at_regional-one.com

24
References

• Bledsoe, E. Medical Helicopter Accidents in the
  United States A 10-Year Review. Journal of
  Trauma-Injury Infection and Critical Care.
  56(6)1325-1329, June 2004
• University of Chicago Safety Committee. A Safety
  Review and Risk Assessment in Air Medical
  Transport. 2002
• American Emergency Medicine. Cost Effectiveness
  Analysis of Helicopter EMS for Trauma Patients.
  2002
• Journal of Trauma. Helicopter Transport and Blunt
  Trauma Mortality. 2002
• Occupational Safety and Health Association.
  Available online at www.osha.gov
• Coss, S. Personal interview. Conducted June 2005
• Greene, J. Personal interview. Conducted June
  2005
• Jameson, H. Personal interview. Conducted 27
  June 2005
• Romberger, R. Personal interview. Conducted 28
  June 2005
• Silk, C. Personal interview. Conducted 27 June
  2005