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Occupant Injury Severity and Accident Causes in Helicopter Emergency Medical Services (1983-2014)

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BACKGROUND: Helicopter emergency medical services (HEMS) transport critically ill patients to/between emergency care facilities and operate in a hazardous environment: the destination site is often encumbered with obstacles, difficult to visualize at night, and lack instrument approaches for degraded visibility. The study objectives were to determine 1) HEMS accident rates and causes; 2) occupant injury severity profiles; and 3) whether accident aircraft were certified to the more stringent crashworthiness standards implemented two decades ago.

METHODS: The National Transportation Safety Board (NTSB) aviation accident database was used to identify HEMS mishaps for the years spanning 1983–2014. Contingency tables (Pearson Chi-square or Fisher’s exact test) were used to determine differences in proportions. A generalized linear model (Poisson distribution) was used to determine if accident rates differed over time.

RESULTS: While the HEMS accident rate decreased by 71% across the study period, the fraction of fatal accidents (36–50%) and the injury severity profiles were unchanged. None of the accident aircraft fully satisfied the current crashworthiness standards. Failure to clear obstacles and visual-to-instrument flight, the most frequent accident causes (37 and 26%, respectively), showed a downward trend, whereas accidents ascribed to aircraft malfunction showed an upward trend over time.

CONCLUSION: HEMS operators should consider updating their fleet to the current, more stringent crashworthiness standards in an attempt to reduce injury severity. Additionally, toward further mitigating accidents ascribed to inadvertent visual-to-instrument conditions, HEMS aircraft should be avionics-equipped for instrument flight rules flight.

Boyd DD, Macchiarella ND. Occupant injury severity and accident causes in helicopter emergency medical services (1983–2014). Aerosp Med Hum Perform. 2016; 87(1):26–31.
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Keywords: air medical services; crashworthiness; helicopter emergency medical services; injury severity

Document Type: Research Article

Affiliations: University of Texas, Graduate School of Biomedical Sciences, Houston, TX, USA

Publication date: 2016-01-01

More about this publication?
  • This journal (formerly Aviation, Space, and Environmental Medicine), representing the members of the Aerospace Medical Association, is published monthly for those interested in aerospace medicine and human performance. It is devoted to serving and supporting all who explore, travel, work, or live in hazardous environments ranging from beneath the sea to the outermost reaches of space. The original scientific articles in this journal provide the latest available information on investigations into such areas as changes in ambient pressure, motion sickness, increased or decreased gravitational forces, thermal stresses, vision, fatigue, circadian rhythms, psychological stress, artificial environments, predictors of success, health maintenance, human factors engineering, clinical care, and others. This journal also publishes notes on scientific news and technical items of interest to the general reader, and provides teaching material and reviews for health care professionals.

    To access volumes 74 through 85, please click here.
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