Crash of medical helicoptors in Arizona

[DebbieC]

Breaking news. 2 medevac helicoptors collided in air over Flagstaff, Arizona. 7 killed including a patient.

This is tragic. Very close to home for our Mike......

[MmacFN]

Yah the one only a few days before in AZ my buddy was in (the medic) and this one was classic lifeguard and guardian air. 7 killed (6 crew) and 1 pt as well as 3 ppl on the ground critically injured when it happened.

Its a sad day. Not sure if I know any of them yet, im waiting for friends to call me.


Breaking news. 2 medevac helicoptors collided in air over Flagstaff, Arizona. 7 killed including a patient.

This is tragic. Very close to home for our Mike......

[FlTraumaRN]

It's a terrible tragedy.

God bless them and their families!

[armygas]

7 die as medical helicopters collide over Arizona

By AMANDA LEE MYERS – 9 minutes ago
PHOENIX (AP) — Two medical helicopters collided Sunday afternoon about a half-mile from a northern Arizona hospital, killing at least seven people and critically injuring three, a federal official said.
All three people on one of the helicopters were killed in the Flagstaff collision, including a patient and the pilot, said Ian Gregor, spokesman for the Federal Aviation Administration.
Four others were killed and three critically wounded, Gregor said. He wasn't sure if they were all on the second helicopter or whether some were on the ground.
Capt. Mark Johnson, a spokesman for the Flagstaff Fire Department, said the helicopters crashed in a wooded area about a half-mile from Flagstaff Medical Center. The helicopters spread debris across the scene.
"They're not recognizable as helicopters," he said.
Johnson said two emergency workers with a ground ambulance company suffered minor burns in an explosion on one of the aircraft after the crash. The injuries were not life-threatening, he said.
Both helicopters were Bell 407 models, according to the FAA. One was operated by Air Methods of Englewood, Colo., and the other by Classic Helicopters of Woods Cross, Utah. Neither company returned calls from The Associated Press on Sunday.
The crash started a 10-acre brush fire that authorities were able to extinguish, said Coconino County sheriff's spokesman Gerry Blair.
The cause of the crash about a half-mile from Flagstaff Medical Center is being investigated. Hospital spokeswoman Starla Addair said she did not have any information to release.
National Transportation Safety Board spokesman Keith Holloway said a team will leave for Flagstaff from Washington, D.C., on Monday to take over the crash investigation from the FAA.
Two news helicopters collided while covering an auto chase last summer near Phoenix, killing all four people on board.
Flagstaff is about 130 miles north of Phoenix.
Associated Press writer Chris Kahn contributed to this report.

[tractorRN]

This hits too close to home, I pulled a flight shift sat. Way too many flight crew are dying needlessly, not that there is a good reason. My prayers are with all involved.

[berry]

I wonder how many patients have truly benefitted from medevac vs how many lives have been lost.

Dont take it the wrong way you ex FNs, but the reality is lots of pts would live even with ground transport and lots of them die even with medevac They may make it to the hosipital and out the OR only to die in the unit over the next week or month.

In my opinion lots of trauma patients are similar to Nicu babies.....we have the know-how and equipement to keep them alive but that doesnt mean we should. If i had a choice i would rather die in the field then on a vent septic/renal failure/DIC

[KermitRN]

Here is an article with the names and more information...


http://www.azcentral.com/news/articles/2008/06/30/20080630coptercrash30-on.html

[Sleptym]

Berry:

Honestly, I cannot believe you are even asking that question. The US Army Dustoff helicopters alone are responsible for a dramatic reduction in the mortality of our war wounded since Vietnam. In the US, evac. helicopters have saved countless lives. Lives lost to medical evac. crashes have been minimal (greater this calendar year). I'm befuddled to even try to understand the rationale behind your question.

[ethernaut]

Berry:

Honestly, I cannot believe you are even asking that question. The US Army Dustoff helicopters alone are responsible for a dramatic reduction in the mortality of our war wounded since Vietnam. In the US, evac. helicopters have saved countless lives. Lives lost to medical evac. crashes have been minimal (greater this calendar year). I'm befuddled to even try to understand the rationale behind your question.

i second you, george.

aside from what you have said, many would die without it.

berry,
explain to me how you'd get a rig in the middle of nowhere?
what about time is of the essence?
where would that golden hour be?

[berry]

George the military is a unique situation, I would not lump battlefield extraction into the same category as civilian world. The alternative use of ground transport in-theatre is almost unfeasible.

For you guys to think I have some crazy stance out of left field the research on using of helicopters to improve patient outcome shows it is inconsistent at best. That doesn’t even take into account the increased risk the crews face.

The collision involved two helicopters that were arriving with patients Sunday at Flagstaff Medical Center. It was the ninth accident this year involving emergency medical aircraft, bringing the number of deaths to 16, National Transportation Safety Board officials said Monday.

"This has been a serious issue," NTSB chairman Mark Rosenker said. "We're going to work very, very hard to make sure we understand exactly what happened here, determine the probable cause and make recommendations to prevent it from happening again."

Crashes of medical aircraft have been on the rise since the 1990s for a number of reasons, experts said. It is a booming business, fueled by the closing of emergency rooms in rural areas and an aging population, according to the National EMS Pilots Association. The number of emergency medical helicopters has climbed from roughly 400 in 2002 to more than 800 now, according to the Association of Air Medical Services, an industry group in Washington.

From 2002 to 2005, one of about every 50 medical helicopters in the U.S. fleet was involved in a crash, according to a report by the Congressional Research Service. That is far deadlier rate than that of the U.S. airline industry, which earlier this decade went nearly five years without a single commercial jetliner crash.
The report also cited NTSB figures that said the accident rate for emergency medical helicopters has risen from 3.52 accidents per 100,000 flight hours between 1992 and 2001 to 4.56 accidents per 100,000 flight hours between 1997 and 2001


A Critical Analysis of On-Scene Helicopter Transport on Survival in a Statewide Trauma System.
Articles
Journal of Trauma-Injury Infection & Critical Care. 45(1):140-146, July 1998.
Brathwaite, Collin E. M. MD; Rosko, Michael PhD; McDowell, Richard MD; Gallagher, John RN; Proenca, Jose PhD; Spott, Mary Ann MPA
Abstract:
Background: Recently, questions have been raised regarding the effectiveness of helicopters in trauma care. We conducted a retrospective study to evaluate the effect of on-scene helicopter transport on survival after trauma in a statewide trauma system.
Methods: Data were obtained from a statewide trauma registry of 162,730 patients treated at 28 accredited trauma centers. Patients transported from the scene by helicopter (15,938) were compared with those transported by ground with advanced life support (ALS) (6,473). Interhospital transfers and transports without ALS were excluded. Statistical analysis was performed using one-way analysis of variance and logistic regression.
Results: Patients transported by helicopter were significantly (p < 0.01) younger, were more seriously injured, and had lower blood pressure. They were also more likely to be male and to have systolic blood pressure < 90 mm Hg. Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival.
Conclusion: A reappraisal of the cost-effectiveness of helicopter triage and transport criteria, when access to ground ALS squads is available, may be warranted.

The Utility of Helicopter Transport of Trauma Patients from the Injury Scene in an Urban Trauma System.
Original Articles
Journal of Trauma-Injury Infection & Critical Care. 53(5):817-822, November 2002.
Shatney, Clayton H. MD; Homan, S. Jean RN, MBA; Sherck, John P. MD; Ho, Che-Chuen MICP
Abstract:
Background : Continuing controversy surrounding the value of scene helicopter evacuation of urban trauma victims led to the present study.
Methods : A retrospective review was performed of all patients brought to our trauma center from the injury scene by helicopter from 1990 to 2001.
Results : The study included 947 consecutive patients, 911 with blunt trauma and 36 with penetrating injuries. The mean Injury Severity Score (ISS) was 8.9. Fifteen patients died in the emergency department, 312 patients (33.5%) were discharged home from the emergency department (mean ISS, 2.7), and 620 patients were hospitalized (mean ISS, 11.4). Three hundred thirty-nine of the hospitalized patients (54.7%) had an ISS <= 9; 148 patients had an ISS >= 16. Eighty-four patients (8.9%) required early operation, mostly for open extremity fractures; only 17 patients (1.8%) underwent surgery for immediately life-threatening injuries. For 54.7% of the patients, the helicopter was judged to be clearly faster than would have been possible by ground transport. In 140 additional patients (14.8%) with prolonged scene time, the helicopter was probably faster than ground ambulance. Considering faster transport time and either the need for early operation or hospitalization with an ISS >= 9 as advantageous, a maximum of 22.8% of the study population possibly benefited from helicopter transport. Conclusion : The helicopter is used excessively for scene transport of trauma victims in our metropolitan trauma system. New criteria should be developed for helicopter deployment in the urban trauma environment

Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis.Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O'Keefe MF.
The George Washington University Medical Center, Washington, DC, and Saint Johns Hospital, Minneapolis, MN, USA. bbledsoe@earthlink.net
BACKGROUND: Helicopters have become a major part of the modern trauma care system and are frequently used to transport patients from the scene of their injury to a trauma center. While early studies reported decreased mortality for trauma patients transported by helicopters when compared with those transported by ground ambulances, more recent research has questioned the benefit of helicopter transport of trauma patients. The purpose of this study was to determine the percentage of patients transported by helicopter who have nonlife-threatening injuries. METHODS: A meta-analysis was performed on peer-review research on helicopter utilization. The inclusion criteria were all studies that evaluated trauma patients transported by helicopter from the scene of their injury to a trauma center with baseline parameters defined by Injury Severity Score (ISS), Trauma Score (TS), Revised Trauma Score (RTS), and the likelihood of survival as determined via Trauma Score-Injury Severity Score (TRISS) methodology. RESULTS: There were 22 studies comprising 37,350 patients that met the inclusion criteria. According to the ISS, 60.0% [99% confidence interval (CI): 54.5-64.8] of patients had minor injuries, According to the TS, 61.4% (99% CI: 60.8-62.0) of patients had minor injuries. According to TRISS methodology, 69.3% (99% CI: 58.5-80.2) of patients had a greater than 90% chance of survival and thus nonlife-threatening injuries. There were 25.8% (99% CI: -1.0-52.6) of patients discharged within 24 hours after arrival at the trauma center. CONCLUSIONS: The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries. Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization.

A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene.
Cunningham P, Rutledge R, Baker CC, Clancy TV.
Trauma Service, University Medical Center of Eastern Carolina, Greenville, NC, USA.
INTRODUCTION: Comprehensive emergency medical services and helicopter aeromedical transport systems have been developed based on the principle that early definitive care improves outcome. The purpose of this study was to compare outcomes between patients transported by helicopter and those transported by ground. METHODS: Data were obtained from the North Carolina Trauma Registry for the period between 1987 and 1993 on all patients transported by helicopter and ground admitted to one of the eight state designated trauma centers. Study patients included only those who were transported directly from the scene of injury to the trauma center (interhospital transfers were excluded). Mortality (outcome) was compared after patient stratification by injury severity and transport time, using Cochran-Mantel-Haenszel statistics and logistic regression-derived probabilities of survival. RESULTS: One thousand three hundred forty-six patients (7.3% of the total) were transported from scene to trauma center by helicopter and 17,144 were transported by ground. In patients transported by helicopter, the mean Trauma Score was lower (12 +/- 3.6) versus 14.3 +/- 3.6 (p < 0.001) and the mean Injury Severity Score was higher (17 +/- 11.1) versus 10.8 +/- 8.4 (p < 0.001). A trend toward increased survival was observed among patients transported by helicopter with a higher Injury Severity Score. Statistical significance was achieved only for patients with a Trauma Score between 5 and 12 and Injury Severity Score between 21 and 30. CONCLUSION: The large majority of trauma patients transported by both helicopter and ground ambulance have low injury severity measures. Outcomes were not uniformly better among patients transported by helicopter. Only a very small subset of patients transported by helicopter appear to have any chance of improved survival based on their helicopter transport. This study suggests that further effort should be expended to try to better identify patients who may benefit from this expensive and risky mode of transport.

Effectiveness of Helicopter versus Ground Ambulance Services for Interfacility Transport.
Article
Journal of Trauma-Injury Infection & Critical Care. 45(4):785-790, October 1998.
Arfken, Cynthia L. PhD; Shapiro, Marc J. MD; Bessey, Palmer Q. MD; Littenberg, Benjamin MD
Abstract:
Background: Helicopters provide rapid interfacility transport, but the effect on patients is largely unknown.
Methods: Patients requested to be transported between facilities by helicopter were followed prospectively to determine survival, disability, health status, and health care utilization. A total of 1,234 patients were transported by the primary aeromedical company; 153 patients were transported by ground and 25 patients were transported by other aeromedical services because of weather or unavailability of aircraft.
Results: There were no differences at 30 days for survivors in disability, health status, or health care utilization. Nineteen percent of helicopter-transported patients died compared with 15% of those transported by ground (p = 0.21).
Conclusion: The patients transported by helicopter did not have improved outcomes compared with patients transported by ground. These data argue against a large advantage of helicopters for interfacility transport. A randomized trial is needed to address these issues conclusively

1999 Brooke Army Medical Center study of 792 trauma patients in San Antonio. The study looked at the benefits of air versus ground transportation. It said, in part, "No statistically significant variation was seen in mortality for either the ground ambulance or the air ambulance group compared with national trauma outcome standards based on MTOS (Major Trauma Outcome Study) data

I fully recognize the need for air ems services, BUT the risk/benefits need to reviewed when the choice is made for 3-4 people to launch. The benefits to the patient need to be real. Helicopter transport for a patient, which is going to be discharged to home or one, that has gray matter leaking out is just not worth the risk.

[ethernaut]

geez berry,
that's all the references you could come up with??? :cool2:

[MmacFN]

Well here we go.

I could post literally, 20 articles (many of which in the last 5 years) that prove HEMS saves lives when used APPROPRIATELY.

The problem is that in the last 7 years orso many private operators have tried to "cash in" on HEMS. To do this they have cut corners and rush programs into operation that are simply not up to par with standards.

This increased competition and added aircraft availability has significantly increased the amount the ground crews call HEMS. Since noone turns down a call (and billing for it) even the BS calls get flown since it makes no sense to leave without a pt once your there. Even the great companies/hospital programs are being forced to fly these BS pts for fear of NOT getting called if they didnt respond. Its pathetic.

So with increased call volumes for BS and increased number of aircraft as well as operators cutting corners we are seeing more accidents.

Its wrong and for money but it happens. Kinda like when you see ppl in the OR cut corners to "move" patients. Its everywhere.

So, HEMS is valid, needed and literally the best trained RNs and Medics in existance but its being abused for the almighty dollar.

[berry]

I am sure we each could post half-a-hundred studies on this topic, but in the end that is why I say the research is inconsistant at best on it benefits for most of the paitents they transport. I in no way think we should ground all the crews but we need use them better to increase patient and crew safety.

[tractorRN]

Berry,
As a flight nurse for 10+ years perhaps I should be pi**** that you dare question HEMS and its value. I am not. I think it should be evaluated from time to time just as med errors and wrong site surgeries are looked at. This is a complicated topic with no easy answer. The large increase in helicopter #'s naturally leads to more questionable flights. When I began EMS as an EMT there were 3 helicopters within30-40 min. Today there are at least 10-12. Then we critically triaged our patients because of limited resources, today ?. That being said I have been personally involved in many cases that the patient would have died if not for HEMS (and decent weather).
As far as NICU goes, yes there is question at times to what kind of quality many of the children have. My son was a 26 weeker and caused many nights we were not sure we would see him in the am, today he is 6 and in martial arts, normal to above normal intellectially and a MIRACLE. Another child we were involved with was 23.5-24 weeks and now is an active/joyful 2.5 year old with legitimate hopes of a normal life and a blessing to her family.
This is a very long winded way of saying lets evaluate HEMS but not overreact and disregard its usefulness/dare I say necessity. However too many people are dying and we must do better.
Now back to studying!
Todd

[deepz]

Face it: out here in AZ and in the rest of the spread-out American West, where people think nothing of driving 100+ miles to go grocery shopping, air evac is indispensable.

[Sleptym]

Deep:

Where are you in Arizona?

[nojrevorg]

I can see Deepz Point. In Maine where i am from, there are really only 3 medical centers equipped to deal with any trauma. The amount of land with people in it and no trauma hospitals really puts patients at risk.
The flight service in maine is valuable. If you are stuck in acadia national park or T3 R4 (no one live ther Township 3 region 4), and you need help, hope your cell phone has service. Moose prefer the front seat of your car if you hit them going fast enough, and It would suck if you could not get your airway secure because you are in a 4 ned hospital that doesnt have a ventilator let alone a surgeon. They will actually activate life flight to go to hospitals in maine to intubate people and get them transported.
I do think you need to constantly critically evaluate the need for any service that is risky in that way though. I think it serves for good discussion and may prompt research ideas and process improvement. But Think about it, Without a HEMS service You would not have Steven King to keep you entertained anymore.

[944S]

NYT (http://www.nytimes.com/2008/07/01/us/01copter.html?partner=rssuserland&emc=rss&pagewanted=all) on the subject