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A life saved by quick responseA life saved by quick response

Helicopters fly in the ‘golden hour’Helicopters fly in the ‘golden hour’

It was a clear, hot day, with light northwesterly winds. Immediately after takeoff the engine on Joe Castanza’s rented Cessna 210 started spraying oil on the windscreen and lost power.

When the mission fails

The deadliest medevac helicopter crash in 40 years of service by the Maryland State Police occurred during a foggy, early morning rescue attempt September 28, 2008, when four people were killed. The crash in Prince George’s County, Maryland, was the eighth fatal medical helicopter crash in the United States in 2008.

Crashes in Texas, Wisconsin, and Arizona—where two medical helicopters collided—underscore the need for new equipment and operating procedures to improve flight safety in the medevac helicopter industry. “As the new Obama administration has recognized, it is imperative that we address our nation’s crumbling infrastructure by finding ways to quickly implement beneficial new technologies, and that philosophy should extend to the low-altitude aviation infrastructure,” said Sandy Kinkade, president of the Association of Air Medical Services (AAMS) in Alexandria, Virginia. “As this intolerable accident rate has demonstrated, immediate improvements are needed in the current medical helicopter operating environment, and air medical services are committed to the changes needed to improve safety.”

AAMS, along with the Helicopter Association International (HAI) and the Air Medical Operators Association (AMOA), presented recommendations in a joint position paper to the NTSB. The recommendations include: that all medical night-flight operations be required to either utilize night vision goggles or similar enhanced systems or be conducted strictly under instrument flight rules; that Congress expedite funding for hospital helipads, enhanced off-airport weather reporting, and GPS technologies; and that the FAA study flight crew fatigue factors, establish guidelines to discourage “helicopter shopping” among local emergency response networks, and adopt regulations and new technology standards that govern equipment, devices, and procedures.

“While the NTSB has not yet released all its findings, what we do know is that recent studies reveal that the majority of accidents occur in low light and changing weather,” said Kinkade. “A review of accidents over the last two years shows that no service model, category of operator [for-profit, not-for-profit, civilian, or government], or geographical area is immune to accidents. It is imperative that our industry continue to adopt appropriate safety measures, particularly with regard to nighttime and changing weather situations, and that more funds be dedicated to aviation infrastructure improvements for helicopters.” —JSW

It was a clear, hot day, with light northwesterly winds. Immediately after takeoff the engine on Joe Castanza’s rented Cessna 210 started spraying oil on the windscreen and lost power. His instructor Neil Tucker took over, and guided the airplane into the trees just ahead. The impact sheared off the left wing, and the 210 spiraled down, hitting the ground on the left side of the fuselage. Castanza’s face struck the instrument panel, and he suffered seven skull fractures, four broken ribs, and deep lacerations. Despite a broken shoulder, Tucker dragged Castanza from the wreckage and called 911. EMTs arrived within 15 minutes of the crash. Castanza’s brain was swelling and bleeding. His blood pressure dropped and his heart started shutting down from blood loss and internal injuries.

The 60 minutes following an accident are known as the “golden hour,” the time in which a patient can be stabilized and long-term damage lessened once lifesaving treatment has begun. Castanza needed a trauma surgeon, and the EMTs decided his best hope was the New Jersey State Police medevac helicopter, or NorthStar, which could fly him to a hospital in Morristown, New Jersey. They put the call in, and police, paramedics, and EMTs carried Castanza to a clearing about 200 yards away from the crash site. He remembers a state trooper leaning over him and asking him for contact information. Castanza muttered his parents’ phone number.

“Joe,” the trooper said, “look—I’m sorry; I realize you were just in an airplane crash, and you’d probably be happy to be done with flying for the day, but we’re going to load you into another aircraft to take you to the hospital.”

“It’s that bad, huh?” Castanza said.

“Yeah, but you’re gonna pull through just fine, buddy,” he said. “We take care of our fellow pilots.”

“Well, I wish you all luck. I’ll be right here, rooting for you,” Castanza said. “Will I be logging this flight time?” As he felt the growing whoosh-whoosh-whoosh of the Sikorsky S–76’s blades, he blacked out.

For the critically injured, a medevac flight is a potentially lifesaving gift. But providing such flights can be a dangerous business for pilots and crews. There have been 105 medevac helicopter accidents in the United States during the last 10 years, according to the AOPA Air Safety Foundation. Forty of those accidents were fatal, resulting in 112 deaths and 82 injuries (see “When the Mission Fails,” below).

Gary Sizemore, president of the National Emergency Medical Service (EMS) Pilots Association, or NEMSPA, said medevac accidents first spiked in the 1970s, when civilian medevac helicopters were in their infancy. But in the last decade the number of medevac helicopters in service reached about 650. “The industry itself close to tripled during those years,” said Sizemore, a 6,000-hour medevac pilot who flies from Doctors Memorial Hospital in Perry, Florida. “It went from a few helicopters to a whole lot of helicopters. More aircraft meant more risk and more chances that this type of thing was going to happen.”

It comes down to this: Medevac pilots are people too. The idea that someone like a Joe Castanza is bleeding to death and they’re the last hope can pressure medevac pilots to take risks that would be unacceptable in any other situation. (A study by the National Transportation Safety Board revealed that most crashes occurred with no patient on board.) So the industry put in some safeguards. Now when a call comes in, the EMS crew is not told of the patient’s identity or condition. Each EMS operator has weather minimums they comply with, depending on the region they operate in. The minimums may be 500 and one, or 800 and two. “There isn’t really a standard,” Sizemore says.

But changing the rules doesn’t mean medevac is safe. And sometimes it has little to do with the weather. Victoria Spediacci, a pilot for REACH/Air Ambulance in Santa Rosa, California, and her crew picked up a patient for a 20-minute flight. It was in IMC, but they were flying an Agusta A109 packed with instruments. Once they were in the air and flying, the patient suffered a severe panic attack. He tore at his restraints and tried to abandon ship. Spediacci, a 6,600-hour pilot, couldn’t exactly land—they were 5,000 feet above the ground. While she maintained control of the helicopter, one of the crew tried to calm the patient while the other drew a dose of sedative. “I could do nothing but continue to fly the aircraft,” she says. “And it was pretty close quarters.” But the shot calmed the patient down, and Spediacci made a perfectly suitable landing at the hospital.

Another time, she and her crew received a call to pick up a patient 70 miles north of the hospital. This flight was also under instrument conditions, but there was no convective activity. On the way up, parallel to the coast, she saw what looked like flashing lights over the ocean. They landed and picked up the patient, and while the crew quickly strapped him in she worked with ATC to figure out the safest route back to the hospital. Once they took off, however, the storm surrounded them. About 10 miles away from the hospital, lightning lit up the cockpit. “It looked like someone had an intense light and shone it right on us,” she said. Spediacci checked the Stormscope, which showed a cell immediately behind the helicopter. “We got jostled around and were in a lot of turbulence,” she said. A torrential downpour began moments after they landed with lightning strikes close by. Not good flying weather.

Despite her apparent heroics, Spediacci, who’s also a check pilot and principal trainer for REACH, is against taking risks. “There are other options,” she said. “If you take more risks you really need to check yourself.”

Not all of medevac’s challenges are derived from weather or pilots overreaching to save a life. In April 2005 a medevac unit based out of central New Jersey’s Somerset Airport responded to a call from Polycel Structural Foam in Branchburg, about four miles away. There, a Polycel employee, Thomas Mulrooney, had suffered severe burns after being doused in molten plastic.

Just two months earlier the medevac unit had moved there from Newark’s University Hospital to reduce response times to the more rural areas of the state, and it worked: They reached Mulrooney in one minute instead of 20. Here’s the ironic twist: For those two months Polycel chief executive officer and local township committeeman Kurt Joerger, who owns a 175-acre horse farm near the airport, had railed against the medevac’s move, labeling it an “unlawful, unwarranted, and unnecessary intrusion into the rural region that surrounds the airport.”

Three months after Castanza’s accident, with his mouth still wired shut, he was back in the pilot’s seat, and working on his CFI. While he was home recovering, he wrote a letter to each of the medical organizations that helped him that day. From the Northstar crew he received a small piece of paper: a logbook entry for a medevac flight in an S–76 to Morristown Hospital. The patrolman made sure Castanza could record the time.

Phil Scott is a freelance writer living in New York City.

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