EMS helicopter crashes: what influences fatal outcome?

STUDY OBJECTIVE: In recent years, air transport of patients has been associated with disproportionate increases in crashes and deaths. We identify factors related to fatal outcome in air medical helicopter crashes and suggest preventive measures. METHODS: This was a retrospective study using National Transportation Safety Board records for helicopter emergency medical services (EMS) crashes between January 1, 1983, and April 30, 2005. The main outcome measure was the percentage of air medical crashes resulting in 1 or more deaths. RESULTS: There were 182 helicopter EMS crashes during the 22.3-year study period; 39% were fatal. One hundred eighty-four occupants died: 45% of the 44 patients and 32% of the 513 crewmembers. Fifty-six percent of crashes in darkness were fatal compared with 24% of crashes not in darkness. Seventy-seven percent of crashes in instrument meteorological conditions were fatal compared with 31% in visual conditions. Thirty-nine percent of all deaths occurred in crashes with postcrash fires; 76% of crashes with postcrash fire were fatal compared with 29% of other crashes. Multivariate logistic regression revealed that controlling for other factors, the odds of fatal outcome was increased by postcrash fire (odds ratio [OR] 16.1; 95% confidence interval [CI] 5.0 to 51.5], bad weather (OR 8.0; 95% CI 2.4 to 26.0), and darkness (OR 3.2; 95% CI 1.3 to 7.9). CONCLUSION: Fatalities after helicopter EMS crashes are associated especially with postcrash fire and with crashes that occur in darkness or bad weather and can be addressed with improved crashworthiness and measures to reduce flights in hazardous conditions. Further studies will be necessary to determine which changes will decrease the fatal crash rate and which are cost effective.

Safety challenges and oversight in the motorcoach industry: attitudes and perceptions of drivers, roadside inspectors, and federal investigators.

Interstate motorcoach travel has been the fastest-growing transportation mode in recent years. To identify challenges to monitoring compliance with motorcoach safety regulations and to examine factors affecting safety, four focus groups with a total of 32 participants were conducted during 2011, one with federal safety investigators, one with state motor carrier inspectors, and two with motorcoach drivers. Investigators and inspectors expressed concern about falsified logbooks, inadequate sleep among motorcoach drivers, hazards from speeding motorcoaches, practices by motorcoach carriers to mask ownership and avoid oversight, and difficulties keeping up with rapid motorcoach industry growth. Drivers described problems with getting sufficient sleep, pressure to drive longer than permitted, and fears of motor carriers giving them less work if they turned down driving jobs. Drivers said that driving 72-74 mph was acceptable in light traffic. To help assess workload among personnel performing safety oversight, data on numbers of motor carriers, commercial motor vehicles, federal investigators, and state inspectors were obtained from the Federal Motor Carrier Safety Administration (FMCSA). The data suggested a heavy workload (2.13 inspectors per 1,000 commercial motor vehicles). The focus groups of inspectors, investigators, and drivers indicated the existence of serious motorcoach safety problems, provided insight about the multiple factors contributing to them, and described major obstacles to effective safety oversight. The qualitative nature of focus group research means that these notable findings will need to be measured using other methods such as surveys and observational studies.