A business of flight risks

PAUL SAND; The News Tribune
Published: October 25th, 2005

Air nurse Liza de Guzman knows she has a dangerous job.

It killed three of her colleagues, including one she’d known for 14 years, when their helicopter plunged into Puget Sound near Edmonds Sept. 29.

Despite the risks, de Guzman has willingly flown hundreds of flights throughout Western Washington over the past 12 years, retrieving injured or ill patients and bringing them to treatment.

“It can be dangerous, but at the same time you could go on the street and who knows what could happen there,” said de Guzman, 45, of Des Moines.

De Guzman might be at peace with her job’s dangers, but the Federal Aviation Administration is not. Earlier this year, the agency launched an inquiry into the rapidly expanding air ambulance industry, which has suffered more than 100 helicopter crashes and at least 92 fatalities since 1995, according to FAA and National Transportation Safety Board statistics.

Another 35 people, both patients and crew members, have been killed in fixed-wing air ambulance crashes during the same period.

“We were seeing quite a few accidents,” said Alison Duquette, an FAA spokeswoman. “Any time we see a rise in accidents, we’re going to take a look.”

Government and industry officials have been working together, particularly on the subject of dangerous flying conditions, Duquette said. Many recent accidents involving medevac helicopters have been blamed on pilots becoming disoriented in bad weather or darkness, she said.

Because the number of air ambulance companies has grown so dramatically in the past decade, they are prone to flying in less-than-ideal conditions to stay competitive, said Bryan Bledsoe, a professor of emergency medicine at George Washington University in Washington, D.C.

Bledsoe also co-authored research that suggests air ambulance companies are transporting people who aren’t seriously ill or injured, often at the cost of $5,000 to $10,000 a ride.

“It’s an industry that’s just totally out of control,” he said.

THE INDUSTRY IN WASHINGTON

In Washington, two nonprofit companies dominate the air ambulance business. Seattle-based Airlift Northwest transports patients primarily in Western Washington and Alaska. On the other side of the mountains, Spokane-based Northwest MedStar flies patients throughout the eastern half of the state, portions of surrounding states and southern Canada.

A third company, Hillsboro, Ore.,-based Life Flight Network, transports patients in parts of southwestern Washington, and sometimes flies as far north as Olympia, said Paula Derr, operations manager.

Airlift Northwest and Northwest MedStar officials say they have experienced a growing demand for their services. This mirrors a nationwide trend, said Tom Judge, president of the Association of Air Medical Services. The number of helicopters used for medical purposes has doubled to about 725 in the United States since 1997, he said. Air ambulance companies transport about 350,000 people each year, an association spokeswoman said.

An aging population, combined with rural hospitals closing their doors and the consolidation of trauma centers has spawned the growth, Judge said.

Airlift Northwest has bases in Puyallup, Seattle, Arlington and Bellingham, said Mardie Rhodes, a company spokeswoman. The company also flies fixed-wing aircraft from Seattle, Wenatchee and two bases in Alaska, she said.

Airlift Northwest pilots fly missions following both visual and instrument flight rules, said air nurse de Guzman. This means they can fly using only what they can see, and they can fly using only the aircraft’s instruments and gauges when visibility is poor.

Investigators from the NTSB determined darkness, fog and pilot disorientation were the probable causes for the Sept. 11, 1995, crash of one of the company’s helicopters off Bainbridge Island. Three crew members died.

Investigators have not yet issued a preliminary report on last month’s crash in Edmonds.

Still, Phillip Milnor, an air nurse who flies with the company, doesn’t feel pressured to fly. Anyone in the three-person flight crew can say they don’t want to fly if conditions are poor, he said.

“We all have the right and the privilege to say, ‘We’re done, turn around,’” said Milnor, 51.

At Northwest MedStar, pilots fly only under visual flight rules, said Michael Day, outreach educator and clinic nurse specialist.

“That gives us specific limitations,” he said. “If the ceiling is below our minimums, we won’t fly, and that’s simply based on safety issues.”

INDUSTRY CRITICISMS

Bledsoe, the professor at George Washington University and a former flight paramedic, co-authored a study that examined more than 37,500 patients who were transported by air ambulance. The researchers discovered that one-quarter of the patients weren’t injured badly enough to be admitted to the hospital after their transport, and two-thirds had only minor injuries, he said.

“You always want some rate of over-triage, but two-thirds is just ridiculous,” he said.

The industry has become more competitive as more for-profit operators jump into the game, hoping to profit from transporting patients at thousands of dollars per ride, Bledsoe said.

Washington has largely escaped that trap because Airlift Northwest and Northwest MedStar are nonprofit organizations, he said.

In other parts of the United States, particularly the South and sections of the Midwest, for-profit air ambulance services routinely buy local emergency medical workers food or give them coffee mugs with the transport company’s name emblazoned on the side, Bledsoe said. The companies hope to create a positive, lasting impression with the workers because they are the first to call for an air transport from accident sites, he said.

“It’s an industry being driven for profit,” Bledsoe said.

The boom of airborne medical transport companies has nearly drained the pool of qualified pilots and nurses, he said.

Judge, the air ambulance industry official, said he agrees with Bledsoe on the industry’s shortage of pilots and nurses. Many pilots first flew during the Vietnam War and are beginning to retire, and the shortage of nurses at hospitals and clinics nationwide also has affected the air ambulance industry, he said.

But Judge disagrees with Bledsoe’s contention that many companies are entering the market merely to cash in.

While the industry has grown significantly in the past eight years, the number of nonprofit companies and for-profits entering the market has stayed about the same as before the boom, he said. The split is about half nonprofit and half for-profit, Judge said.

“There’s a common misconception that there’s a lot of money to be made here,” he said.

The start-up costs for an air ambulance service are enormous, including buying or leasing aircraft and staffing pilots and nurses every hour of every day of the year, Judge said.

Judge also questioned the accuracy of Bledsoe’s findings on the transport of patients who weren’t seriously ill or injured.

Local emergency medical workers make the call whether or not people should be transported by air, and air ambulance companies don’t know the condition of the person until they land at the scene, he said.

“It’s very easy to say you didn’t need to be flown, but it’s not as precise out in the field,” Judge said. There’s also a “better safe than sorry” sentiment about aerial transport, he said.

Judge said the FAA’s concern about the role poor weather and night flying play in many medevac crashes is valid. But the service is needed, even if it can be dangerous, he said.

“The bottom line is, we’re flying in a very challenging environment,” Judge said. “There’s thousands and thousands of people who would lose their lives every year without us.”

Northwest Companies

Airlift Northwest

Founded: 1982

Base locations: Puyallup/South Hill, Seattle (home base), Arlington, Bellingham, Wenatchee, Juneau, and Ketchikan

Covers: Primarily Western Washington and Alaska

Aircraft: Four helicopters, four planes

Employees: About 160

Northwest MedStar

Founded: 1992, result of a merger between two air medical companies

Base locations: Spokane (home base), Moses Lake and the Tri-Cities. Moses Lake and Tri-Cities to merge next Tuesday.

Covers: Primarily Eastern Washington and parts of northeastern Oregon, northern Idaho, northwestern Montana and Canada

Aircraft: Five helicopters, two airplanes

Employees: About 100

Where are some helipads located around Tacoma?

• St. Joseph’s Medical Center, Tacoma
  
  
• Tacoma General Hospital
  
  
• Clover Park Technical College, Lakewood
  
  
• Pierce County Airport – Thun Field, South Hill
  
  
• Auburn Municipal Airport

There are dozens of other landing zones that Airlift Northwest crews use in the area, including vacated school yards and empty parking lots, said Brenda Nelson, assistant chief flight nurse. Officials from local fire departments generally select these sites, she said.

The company requires landing areas that measure 60-by-60 feet to land during the day, and 100-by-100 feet at night, Nelson said. They can also land on closed highways or deserted country roads and logging areas, she said.

Paul Sand: