Medscape: US Air Ambulances: Expensive, Risky, and Regulation-Averse

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.

OneZero: Don’t Let Boeing Off the Hook for the 737 MAX Disasters

Six months and billions in losses after two of its 737 MAX airliners suffered deadly crashes, Boeing is still working on a fix for the troubled aircraft model. What’s clear by now is that the problem isn’t just, as originally suspected, a faulty sensor. Like a homeowner whose attempt to repair a soft spot in the molding reveals a rotten joist and then a whole rotten wall, the facts behind 737 MAX fiasco reveal a corporate culture that has been quietly deteriorating for decades. While the proximate cause of the accident was a piece of hardware you can fit in your hand, solving the problem might require tearing the company down to its foundation.

Thanks to reporting by many superb journalists, the genesis of the tragedy is now understood in detail. The tale begins in the 2000s, when Boeing decided against investing in a clean-sheet replacement for its hugely popular but aging 737 narrow-body jet. It continued in the 2010s, when the company decided to make massive payouts to investors through dividends and stock buybacks rather than invest in engineers or technology. And it reached its culmination with the decision to hastily update the 737 by slapping together a Frankenplane whose powerful new engines caused it to be dynamically unstable. To paper over the plane’s flaws, Boeing fitted it with an ill-conceived automated system that would spring into action at unexpected times, and farmed out the software that ran it to coders in India. Worst of all, it didn’t even tell pilots that the system existed.

To be sure, the 737 MAX that started to roll off the production line in Renton, Washington in February 2018 was mostly fine. It was sleek, efficient, and solidly constructed. And it worked as intended almost all the time. But in modern aviation, 99.99% reliable is not reliable enough. Tens of thousands of planes take off every day, and in order to preserve public confidence, all of them have to land in one piece. A plane that crashes once every hundred thousand times isn’t good enough. And there’s no reason today for anyone to build a plane that is less than perfect.

Read the rest of the story on Medium, where it originally appeared on September 23, 2019.

OneZero: The Mystery Behind the Missing Malaysia Airlines Flight Isn’t Solved Yet

William Langewiesche is a titan among aviation journalists. He has covered, in depth, some of the most important air disasters of our time for outlets such as the Atlantic and Vanity Fair. He also has extensive experience as a professional pilot. His credibility on the subject of aviation is, in a word, unmatched. So when he turned his hand to the greatest aviation mystery of our time — the disappearance of Malaysia Airlines Flight 370 — there was every reason to hope that he would bring some clarity, at last, to a story fogbound in confusion.

The 10,000 word Atlantic cover story posted on June 17, however, did not accomplish that. Langewiesche writes evocatively, and he wrangles a mountain of information, but he falls victim to a siren temptress: the yearning for a concise and reasonable solution to a deep mystery.

“The simple story is usually the right one,” Langewiesche told me, during one of the many conversations we had while he researched the project. Having immersed myself in the technical arcana of this story for more than five years — first as a CNN contributor, then as a freelancer for New York, Popular Mechanics, and other outlets — I tried to show him that no simple answer can be made to fit the thicket of contradictory evidence that has grown since MH370 vanished on March 8, 2014 while flying from Kuala Lumpur to Beijing. As the saying goes, “everything should be made as simple as possible, but not simpler.” In the case of MH370, Langewiesche arrives at a solution that requires ignoring or dismissing whole categories of evidence.

It’s not a new solution. Langewiesche hitches his wagon to what has become the default, commonsense explanation, the one which the international authorities responsible for the search have implicitly held — the captain did it. This is a reasonable first pass at a theory of MH370. Since the plane was clearly taken by someone who knew what they were doing, and the only other person locked in the cockpit was the inexperienced first officer Fariq Abdul Hamid, then it must have been Captain Zaharie Ahmad Shah who purposefully turned the plane around and flew it off into the darkness until it ran out of fuel and crashed in the remote ocean. Case closed.

Ah, but already we run into problems. Continue reading OneZero: The Mystery Behind the Missing Malaysia Airlines Flight Isn’t Solved Yet

MH17: Russia Pwned the West

In the immediate aftermath of the shootdown of Malaysian Airlines Flight 17 on July 17, 2014, Western observers quickly reached a consensus. Rogue separatists in eastern Ukraine, they concluded, had gotten their hands on a stolen Buk missile launcher and had fired at what they erroneously believed to be a Ukrainian military transport. 

As the Guardian reported five days later,

A press conference was held this afternoon by the US office of the director of national intelligence (ODNI), at which select reporters were briefed on US intelligence with regard to MH17, …  The briefing underlined the theory espoused by most of a senior official at the briefing, and by most analysts since plane first crashed: rebels “most likely shot down the plane by mistake”.

But as new investigative reports make clear, that narrative was false. The Buk missile launcher that downed MH17 was not in the possession of rebel militiamen but belonged to a regular Russian Army unit. The operation was overseen by Russian military intelligence, the GRU. It was not “blind,” as many assumed from the fact that it was dispatched alone to Ukraine, but was operating within the air defense umbrella of the Russian army. It was manned with a trained Russian crew. 

The Buk is a powerful weapon that is capable of singehandedly starting a war, as we’ve seen recently in the Persian Gulf. In the course of their training it is drilled into crews’ heads that above all else they are not to fire it without an order from a superior officer. Hence, the Russian mililtary heirarchy bears chain-of-command responsibility for the shootdown, and this responsibility reaches all the way to the Kremlin. The “rogue militiaman” narrative is a fiction peddled by the Russian military, and its near-universal uptake by Western pundits is a case study of Russian skill in controlling the world media narrative.

There were two main reasons why experts believed that rogue militiamen had made a mistake. The first is that the rebel commander, Igor “Strelkov” Girkin, had made a statement on social media to the effect that “we” had shot down a military transport—and once it became widely understood that what had been shot down had in fact been a commercial airliner, the post looked hastily removed. It looked very much like Girkin had removed the post because it was embarrassed. The idea that someone would deliberately post something incriminating, for the sake of obscuring an even more incriminating reality, implied a level of cunning that few at that time were willing to credit—never mind that Strelkov was not really a rebel commander but a GRU officer.

The second reason that people were bamboozled by the “rogue militiamen” story was that truth did not match their conception of how the world was supposed to work. Surely, they imagined, a major nuclear power would not simply blow up a jet carrying hundreds of foreign civilians. What would the motive be? What benefit accrued to them? The fact is, sometimes people do things that are hard to understand. To this day, we don’t really know why Russia would deliberately destroy MH17, or what possible connection it might have to the hijacking of MH370.

But thanks to the work of the JIT and Bellingcat, we now know in great detail exactly how they pulled of the former act, and the circumstantial evidence for the former will only continue to grow.

The upshot for me isn’t that the West is facing an adversary who is willing to kill large numbers of civilians in the pursuit of unknown ends. It is that this adversary has shown itself capable of utterly baffling the Western intelligentsia who under normal circumstances would be responsible for organizing the societal response to this threat.

As the kids would say, we’ve been pwned.

Businessweek: Underwater Drones Nearly Triple Data From the Ocean Floor


Last November a small seabed-exploration company out of Houston called Ocean Infinity made the discovery of a lifetime–or so it seemed, until it made another three months later. First, Ocean Infinity successfully located the remains of the San Juan, an Argentine navy sub that had vanished while on patrol. Then it found the wreck of the Stellar Daisy, a South Korean bulk ore carrier. Both vessels had been missing for more than a year, which often means a wreck won’t ever be found. The two-year-old company’s secret was teamwork: a set of eight drone subs working in tandem to scan a much larger area in record time.

These successes could be part of a broader shift in how humanity understands the sea. We know far more about the surface of Mars than we do about the bottom of the ocean, but seabed-scanning technology is growing sophisticated enough to render the inky depths much more transparent. Seabed 2030, a joint project of two nonprofits, aims to map the entire ocean floor by its namesake year. Key to that effort is Kongsberg Maritime AS, the Norwegian company that made Ocean Infinity’s subs.

Bjorn Jalving, senior vice president of Kongsberg’s subsea division, says the Hugin, its flagship drone, is a testament to advances in robotic strength and stamina. Hugins can dive as deep as 20,000 feet and stay underwater for 72 hours at a stretch. Costing $5 million to $10 million apiece depending on the onboard instruments they have and the depths they can handle, the drones are hardy enough, Jalving says, that “you let them out in the ocean, and you know that they’ll come back.” They’re also packed with sensors, including sonar that can cover five times the area of models from a decade ago, with 10 times the detail.

The subs can also transfer, process, and share much larger amounts of data with distant control centers than was possible before. Five years ago, Fugro NV, the Dutch survey and geosciences company responsible for searching the Indian Ocean for the downed Malaysia Airlines Flight MH370, relied on crewed survey boats that towed sonar gear on long cables up and down the seafloor as shipboard analysts monitored incoming data. Today the company streams field data to command centers onshore and plans to do away with some crews entirely.

Since 2017, Seabed 2030 has single-handedly increased the percentage of the seabed that’s been surveyed from 6% to 15%, mostly by compiling data from the likes of Fugro and Ocean Infinity. Fugro keeps mapping even when it’s moving ships between jobs. Beyond potential benefits such as finding clearer routes for undersea internet cables or energy pipelines, the extra intel will help answer big scientific questions related to climate change, says Larry Mayer, who contributes to Seabed 2030 as director of the Center for Coastal & Ocean Mapping at the University of New Hampshire. “How heat is distributed has to do with currents, and where those currents go is determined by where there are ridges and valleys and things,” he says. “It’s the most fundamental information that we can get.”

Just as the first sequencing of the human genome led to businesses sequencing many other people’s genomes, seabed mapping could one day become routine, or even just an ongoing process, helping to track things such as pollution, ocean warming, and fish stocks. “It will enable the world’s decision-makers to sustainably manage the oceans,” Jalving says.

For now, though, the oceans are keeping a great many secrets. After Fugro failed to find MH370, Ocean Infinity gave the search a shot last year, scanning 43,000 miles in five months—about 15 times the pace in 2014. That team, like Fugro’s, found nothing.

This article originally appeared in the June 10, 2019 issue of Bloomberg Businessweek.

MH370 Passenger’s Daughter: “The Evidence is That He is Not Dead” UPDATED

After reading my book a journalist with the UK’s Daily Star newspaper, David Rivers, reached out to the daughter of passenger Sergei Deineka, Liza Deineka, whose social media postings I quoted. He published her response in a story today.

As you may recall, just 11 day after her father and all the other passengers aboard MH370 had effectively been declared dead by the Malaysian prime minister, Liza posted a photo of herself with her father on Instagram with the comment, “Happy Birthday, Daddy.” Several friends added comments with their own well-wishes. One wrote, “With the birthday boy! Let everything always be good for him,” followed by a string of emojis: a blushing, smiling face; a gift wrapped with a bow; a noisemaker; confetti; a toy balloon; a bow. “Thank you,” Liza responded, with a kissy-face emoji.

I found this exchange startling because signals transmitted from MH370 suggested that the plane was hijacked to Russia. Since Deineka and Chustrak were former Soviet Army veterans who happened to be sitting right under the SDU, they seemed top suspects as potential hijackers. Of course, if they took the plane and flew it to Kazakhstan, they would not be dead as commonly assumed, but alive. And Liza’s social media posts (both here and elsewhere) seemed to be saying just that.

I long ago reached out directly to Chustrak and Deineka’s families but had been told they didn’t wish to speak to me. Rivers, however, had better luck. After he contacted her and asked about my theory she responded with a statement. The translation reads:

Since March 8, 2014, I have not seen or heard (from) my dad. The evidence is that he is not dead, so all I can do is hope for the best.
I am very sorry people want to discuss and condemn the emotions of people who have a missing person missing. I don’t agree with many in this article.
Starting with answers, ending the reasons why my dad flew this way. They flew to Beijing to get a visa.
No plane wreckage was found, so I can’t be sure that they crashed. All I can do is hope that people could be saved.
Unfortunately, so far no one has given us reliable information about what happened to the plane and the people in it.”

A couple of things about this statement struck me as remarkable. Continue reading MH370 Passenger’s Daughter: “The Evidence is That He is Not Dead” UPDATED

New York: How Yesterday’s Aeroflot Disaster Echoes the 737 Max Crashes

An Aeroflot passenger jet burst into flames during an emergency landing at Moscow’s Sheremetyevo airport yesterday, resulting in a conflagration that left 41 of 78 people aboard the plane dead. The plane, a Sukhoi Superjet SSJ100 operating as Aeroflot Flight 1492, had taken off at 6:03 p.m. local time bound for the Arctic Ocean port of Murmansk. Approximately five minutes after takeoff, the pilot began a spiraling descent to return to the runway. Amateur video footage of the landing shows the plane bouncing several times before flames erupt in the tail of the aircraft. A video shot by a passenger from inside the plane shows flames engulfing the wings as panic set in inside the cabin.

While the plane was not a Boeing and did not involve a control system like the one implicated in the recent crashes of Lionair Flight 610 and Ethiopian Airlines Flight 302, the overall circumstances eerily echo the conditions that led to the loss of the two 737 Max jets. In all three cases, pilots suffered a dangerous and unexpected emergency during takeoff, lost the automation that they were used to relying on, and lacked the necessary skills to adequately handle the ensuing crisis. As such, these crashes illustrate the dangers of poorly integrating human and automatic control, a problem that will only worsen as automation becomes more ubiquitous. Continue reading New York: How Yesterday’s Aeroflot Disaster Echoes the 737 Max Crashes

New York:Is the Boeing 737 Max Worth Saving?

As the costs of grounding the fleet of Boeing 737 Max jets mount — earlier this week, Southwest Airlines said the grounding was partially to blame for $150 million in lost revenue in the first quarter — so, too, do doubts about when the plane will manage to get back into the air. After Boeing announced a slate of fixes it intended to make to the 737 Max, CNBC reported that aviation analysts predict it “will take a minimum of six weeks and up to 12 weeks before the grounded jets are airborne again.”

And even when the Max does get FAA approval to fly again, its troubles won’t be over. Bloomberg reported that China had suspended the plane’s airworthiness certificate, meaning the plane would face additional hurdles before it was able to return to that huge and fastest-growing aircraft market.

Perhaps the question should not be when the 737 Max will return to the sky but whether it should. Continue reading New York:Is the Boeing 737 Max Worth Saving?

MH370 As Stage Magic

Ed Dentzel is the host of the missing persons program, Unfound. He’s covered over 120 disappearances including Flight 370. However, before devoting his life to helping missing persons families, he was the Stage Manager for “The World’s Greatest Magic Show” at the Greek Isles in Las Vegas from 2005 to 2008. While there he worked with more than 50 magicians, helping them create and hone new tricks.

“Magicians don’t go on stage with a new trick until it’s flawless,” he told me. “Sometimes it means months and months of choreography, lighting changes, equipment changes, costume changes, all in an effort to make sure the audience can’t figure out how the trick works. I got paid lots of overtime while helping them find perfection.”

I asked him: given his experience in devising magic tricks, what does he think of the idea I laid out in The Taking of MH370 that the disappearance could best be thought of a stage magic–does the disappearance match with the way a magic trick would be crafted? This is an edited version of the reply he sent me.

I do see a lot of similarities. And I think you’ve touched upon a few of those qualities without possibly knowing it.

First, every magic trick is tailored to the environment in which it will take place. In other words, there’s a reason at a child’s birthday party you don’t see a magician cutting a woman in half. Why? Because to do that trick, the audience can’t be “on top of” the magician. If the audience is too close, then the trick is exposed. Also in other words, the simpler the trick, the more it can travel from a stage, to a convention room, to a home. Card tricks are probably the best known of this kind.

How does that relate to Flight 370? Well, if things happened the way you’ve written, the “trick” couldn’t have been performed over the USA at noon on a Wednesday. Why? Other jets would see Flight 370 leaving its path. People on the ground would see it. Military and civilian radar would see it.  Instead, these hijackers picked the correct venue for their trick: Southeast Asia, where things are a little lax, especially at night.

Second, every trick has a tell. Not because the magician wants it that way. But because there is no easy way to make things seem possible that are truly physically impossible. What do I mean? Well, a magician can’t make birds appear out of nowhere if he is naked on stage. So, her costume/his suit/those pants are not something you’d pick up at the Men’s Warehouse. Those are specially designed clothes for that bird trick. Likewise, in almost every levitation trick out there, there’s a reason the magician drapes a piece of cloth over the entire assistant before she is suspended in the air. Why? Because that’s to cover the woman sliding into the table she is lying on, and what the cloth is really covering as it goes into the air is a wire frame suspended by wires. But, to the audience–the magician’s clothes, the draping of the assistant, etc. appears to be very natural and unassociated with the trick itself, even though it is.  Maybe the best example is when David Copperfield walked through the Great Wall of China. Great trick. Yet, the tell was right in front of everyone the whole time . . . why exactly did he use the same platform and shrouding on one side of the Wall, then the other? You mean a rich guy like that couldn’t afford platforms for both sides. Well . . . it was because he was hiding in the platform and thus got carried by his assistants from one side of the Wall to the other.

How does that relate to Flight 370? Well, it may be that the SDU cutting out and coming back on is that “tell.” And you’ve kind of explained it as such. To seemingly everyone else in aviation, this is just some natural thing that occurred. To you, it’s the “tell” that a “trick” was taking place. And like the magic tricks which need the special costume or the draping of the assistant, the taking of Flight 370 couldn’t have happened without the SDU going off then on again. Continue reading MH370 As Stage Magic

New York: The Recent Deadly Boeing Crash No One Is Talking About

A few weeks ago a Boeing jet was maneuvering near an airport when it abruptly nosedived and plowed into the ground at tremendous speed, killing everyone aboard. This was not the Ethiopian Airlines crash on March 10 that has transfixed the world, however. It was an American plane, a 767, and its destruction in a muddy bay near Houston remains even more mysterious and, consequently, potentially more disturbing in its long-term implications.

At 12:30 p.m. on February 3, Atlas Air Flight 3591 was near the end of a flight from Miami to Houston’s George Bush Intercontinental Airport, carrying cargo for Amazon and the U.S. Postal Service. Two pilots were at the controls and another was riding as a passenger. A band of stormy weather lay across the route, and as the plane was descending from 8,500 feet, air traffic control advised the pilots to turn left from a northerly heading, in order to get around a band of precipitation. A different controller then said that they’d be given vectors to clear skies. One of the pilots replied, “Okay.”

A few seconds later, the plane hit a patch of rough air. For reasons that are unknown, the flight crew throttled the engines up to full thrust, and then after the plane pitched slightly up, pushed the controls sharply forward until the plane was descending at a 49-degree angle — about what you’d encounter on the steepest of ski runs. The plane kept diving, even as cockpit warning systems called for the pilots to pull up. Security-cam footage shows the plane plummeting from 6,000 feet.

Eighteen seconds after the trouble started, the plane smashed into the muddy waters of Trinity Bay, killing everyone aboard.

A preliminary report by the National Transportation Safety Board on the incident caused a stir when it cited “control input” as the cause for the steep dive. Was this a case of pilot suicide, like the Germanwings pilot who programmed his Airbus A320 to fly into the side of a mountain in 2015? But it’s hard to imagine that, in the midst of trying to maneuver through and around bad weather, a pilot suddenly decided to commit suicide.

A revised version of the NTSB report changed the language to “a nose-down elevator deflection,” which seemed to move responsibility away from the human pilots and raised the possibility that a malfunction, perhaps of the autopilot, could have been responsible. But there are no known autopilot modes that would behave like this.

In online pilot discussion forums, a third idea has been gaining adherents: that the pilots succumbed to a phenomenon called somatogravic illusion, in which lateral acceleration due to engine thrust creates the sensation that one is tipping backward in one’s seat. The effect is particularly strong when a plane is lightly loaded, as it would be at the end of a long flight when the fuel tanks are mostly empty, and in conditions of poor visibility, as Atlas Air 3591 was as it worked its way through bands of bad weather.

The idea is that perhaps one of the pilots accidentally or in response to wind shear set the engines to full power, and then believed that the plane had become dangerously nose-high and so pushed forward on the controls. This would cause a low-g sensation that might have been so disorienting that by the time the plane came barreling out of the bottom of the clouds there wasn’t enough time to pull out of the dive.

It has been speculated that this might have been the cause of another bizarre and officially unsolved accident from three years ago: Flydubai Flight 981, which crashed 2016 in Rostov-on-Don, Russia. That plane had been returning Russian vacationers from Dubai when it encountered bad weather and was unable to land. After circling for an hour and a half, the pilots attempted to land, then aborted the attempt, came around again for another attempt, and then aborted again. After climbing sharply, the plane pitched forward into a steep dive and smashed into the edge of the runway, killing all 62 people aboard.

The crash of two 737 Max airplanes — Ethiopian Airlines Flight 302 and Lion Air Flight 610 — in quick succession is horrific, but in a way, this kind of disaster shows how the system is supposed to work: a mishap occurs, officials determine what happened, and then the problem is fixed so that future air travel will be safer. While it’s still too early to draw any kind of conclusions about Atlas Air 3591, the possibility exists that a firm conclusion will never be drawn — and if it is, the cause could turn out not to be a design flaw or software malfunction that can be rectified, but a basic shortcoming in human perception and psychology that cannot be fixed as long as humans are entrusted with the control of airplanes.

Note: This article originally appeared in New York magazine.