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

“There is an Aircraft Down!” 911 Dispatcher: “Newberry County 911, where is your emergency?” Caller: “Uh, yes we’re out here on the interstate, and there is a crash out here…” 911 Dispatcher: “Do what now?” Caller: “I’m on the interstate…” 911 Dispatcher: “Uh-huh” Caller: “I’m 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 helicopter…it just like fell out of the sky”

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.”

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

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.

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

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

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]

Air Ambulance Accidents In the mid-1980’s 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)

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

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)

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

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."

National Transportation Safety Board Regions

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

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 don’t lose established presence After accident review/critical incident stress debriefing for all members of the flight team

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 According to Mrs. Romberger, it is imperative that the leadership team be visible immediately following an accident, and show that someone is in charge during the crisis. Families should be supported, and involved in as many aspects of the process as possible. The community should be involved as much as possible in order to promote healing in the community.

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 pilot’s 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

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

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

Contact Information Jim Mobley FlightNurseJim@aol.com Mike Clumpner mclumpner@regional-one.com

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