Unnecessary flight risks?

Review of 26 fatal medevac crashes shows many didn't involve life-or-death missions

Sun Special Report

October 23, 2008|By Robert Little | Robert Little,robert.little@baltsun.com

The medical helicopter crash in Prince George's County that killed four people last month was one of more than a dozen fatal crashes nationally during the past six years that raise doubts about whether the victims ever needed to leave the ground.

A review by The Baltimore Sun of crash records and other documents on the 26 fatal medevac crashes in the United States since 2003 shows that many did not involve urgent, minutes-from-death missions. At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down.

The recent history of medevac crashes also includes heroic accounts of late-night flights to retrieve critically ill or injured people in foul weather and urgent missions such as transferring a sick woman from an underequipped hospital in rural Alaska or plucking a young hiker with heat stroke off a mountain in Utah. In the wake of last month's deaths, Maryland officials have repeatedly defended the state's 4,500 annual flights as safe and necessary for saving lives, even if some flights appear unnecessary in hindsight.

But one patient who died after an accident in Arkansas had waited in an ambulance for more than an hour for a helicopter that was to fly him 35 miles. Another victim with a broken leg waited while three helicopters tried to fly through fog, even as ambulance drivers offered to take her to a hospital.

In four cases, including the Sept. 28 incident in Forestville, patients survived not only their initial condition but a subsequent helicopter crash.

Half of the 26 fatal medevac accidents occurred during missions to transfer patients between hospitals - one for a distance of 10 miles - and many of the transferred patients waited hours from the time a helicopter was called until it arrived and was ready to take off again, records show.

Officials at the state agency that oversees emergency medical care in Maryland plan to convene a panel of national specialists to review the state's medevac system and recommend potential improvements. The National Transportation Safety Board will hold a public hearing next year to explore the potential causes of a sharp increase in fatal medevac crashes, including eight this year.

But a growing list of medical specialists are planning their own national dialogue. While regulators such as the NTSB and the Federal Aviation Administration focus on issues of maintenance and safety each time a helicopter crashes, some doctors say that a critical review of helicopter flights from the medical perspective is overdue.

"I'm all for heroes - for the firefighters who climbed up the stairs while the World Trade Center was falling down or anyone else who risks their life to help people," said Dr. Jeffrey P. Salomone, deputy chief of surgery at Grady Memorial Hospital in Atlanta, and chairman of an American College of Surgeons committee that considers guidelines for pre-hospital emergency care. "But it's a real tragedy to think someone could die trying to help a patient who didn't have a life-threatening injury to begin with."

"I remember a patient, an 11-year-old boy, who flew in from a motor vehicle accident and was just standing there, and I asked him, 'Are you hurt?' and he looked at me and said no," said Dr. Marc R. Matthews, trauma director of the Maricopa Medical Center in Phoenix.

"It's that kind of laxity that can get people killed," Matthews added. "It's unintentional, of course, but it's dangerous and it needs to stop."

The records of helicopter crashes do not always include detailed medical information, and doctors caution that the complexities of each case often are not apparent from the paperwork. Police accounts of the fatal collision of two helicopters in Flagstaff, Ariz., in June, for instance, do not reveal that one of the patients onboard, a firefighter bitten by a spider, was apparently in anaphylactic shock, a condition that can be quickly fatal without advanced care.

But the records do show that patients sometimes are not in such dire medical condition that a few minutes - or even a few hours - would make a difference.

For example, a 71-year-old man injured in a vehicle rollover in Arkansas last year waited with an ambulance crew for more than an hour before a helicopter came to fly him 35 miles. He died from injuries received when the aircraft crashed soon after takeoff.

In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight.

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