Paul Cline will never forget the day he almost didn’t make it home.
It was winter, and a heavy snowstorm had wrapped itself around the mountains north of Phoenix, Arizona. Cline was working as an aviation nurse aboard an air ambulance — Helicopter Emergency Medical Service (HEMS), in the parlance —based in the town of Safford, on the eastern edge of Arizona. A boy had fallen while skiing in the mountains and had broken his femur. He needed to get to a hospital, stat.
The weather blocked all the Phoenix-based choppers, and it looked pretty iffy to the east, too, but it might be possible to get through from Safford, 165 miles away. Cline and his partner, the helicopter’s pilot, faced the kind of life-or-death-decision that HEMS crews face all the time. Do we launch and put our own lives at risk — or stay safe and leave a patient to his fate? “We were a long way away, and the storm was closing in,” Cline recalls.
They decided to give it a shot. “We said, ‘We’ll just launch and take a look when we get there.’ You can’t do that. That’s how people die.” The danger is that when a pilot who is flying by visual reference to the ground flies into a cloud or fog, it becomes incredibly difficult to tell which way is up. “You turn it upside down and you die,” Cline says.
They launched and headed northwest, up into the mountains, threading between storm clouds. When they touched down at the accident site, “there was snow and zero visibility on three sides of us. There was only one way out, over the top of a mountain. We had 20 minutes, or we were going to be grounded for 2 days. My partner reconfigured the helicopter in NASCAR-pitstop time so we could fit this kid with his splint in. We launched. The ride back was the bumpiest I’d ever taken. We were really getting our butt kicked in turbulence. We looked at other, like, ‘Why are we here? What the hell are we doing?’ This is how things go bad in a heartbeat.”
Cline was lucky that day. The way through the clouds stayed open, and they made it home safe. But not all HEMS crews have been so lucky. Between 1972 and 2018, 339 people have died in 127 fatal crashes in the United States, according to data compiled by Ira J. Blumen, MD, medical director of the University of Chicago Aeromedical Network.
Despite recent efforts by operators and regulators to stem the tide, the risk remains significantly higher than in other forms of commercial aviation. Air ambulances have a fatal accident rate 800 times greater than commercial jets in the last decade.
Some of the danger springs from the nature of the flying itself; patients may need to be picked up at remote sites that are unfamiliar to the pilot, with unknown potential hazards like power lines or steep terrain. But critics say the way the industry is set up makes HEMS even more dangerous and expensive than it needs to be. “It’s the poster child for healthcare market failure,” says Ge Bai, PhD, a professor of accounting at Johns Hopkins Carey Business School in Baltimore, Maryland, who studies health care economics. Congress is taking note.
Read the rest of the article at Medscape, where it first ran on November 20, 2019.