Air medical resource management: our last line of defense.

Air Medical Journal 34:2 Since helicopter emergency medical services (HEMS) took to the skies of America in the early 1970s, the accident rate has remained disproportionately high when compared with other segments of helicopter aviation. According to the Air Medical Memorial website, to date 374 people have lost their lives in air medical accidents, leaving more than 600 crash survivors who must daily deal with their physical and emotional pain. In February 2013, the electronic news media branded our industry “the most dangerous job in America.” A more shocking reality in our HEMS accident statistics was uncovered in an extensive study of HEMS crashes led by noted HEMS safety expert Dr. Ira Blumen, medical director and program director at the University of Chicago Aeromedical Network. Dr. Blumen and his team of researchers discovered that 94% of all HEMS accidents have an element of human error. Take time to think about that statistic for one moment. When you hear of another HEMS accident, you can be fairly certain that there will be a 94% chance an element of human error contributed to its cause. There is a proven cure used by the airlines that can reduce our HEMS accident rate. We know the cure exists because the airlines used it when it was administered 35 years ago to reduce their unacceptably high accident rate. The name for that cure is crew resource management (CRM). In HEMS, we call it air medical resource management, which is derived from the principles of CRM that are used religiously worldwide by every airline today. There have been safety improvements in aircraft and equipment design over the years, yet the HEMS accident rate still remains high. Recently, operators are addressing the issue of pilots inadvertently flying into instrument meteorological conditions, a common cause of HEMS accidents over the years. They are committing to equip their aircraft with an autopilot and helicopter synthetic vision technology to help pilots maintain spatial orientation in the event they inadvertently fly into instrument conditions. In my view, installing an autopilot and helicopter synthetic vision technology will certainly help to lower the accident rate, but as the airlines quickly discovered, technology is not the silver bullet that prevents accidents. Airliners with sophisticated computers and modern navigational aids still manage to crash because the technology has been mismanaged by the human element. The airlines know that CRM is a more powerful tool to prevent an accident than any item of technological wizardry that can be added to the cockpit. I was extremely fortunate to be exposed to CRM nearly 30 years ago. In January 1985, I was headhunted to set up a country-wide HEMS program in the Sultanate of Oman. It was in Oman that I was introduced to the whole new aviation paradigm of CRM, a much safer way to fly. As a uniformed major flying for the Royal Oman Police Air Wing, I teamed up with 12 highly experienced former British military pilots, everyone of them trained to practice effective CRM. When they left the service, they flew commercially on the North Sea in a 2-crew environment where they encountered some of the most challenging instrument meteorological conditions on earth. They performed safely and effectively by using good CRM.