When an accredited service has an accident☆

Air medical accidents in 2002 exceeded 2001 figures, both in the total number of accidents (10) and the number of fatal accidents (6). In fact, the 6 fatal accidents were more than we experienced in any year in the past decade. Four of those 6 fatal accidents involved services accredited by the Commission on Accreditation for Medical Transport Systems (CAMTS).

Obviously, we are concerned. It may be coincidence that 4 accredited services experienced an accident in the same year, but this has not been our experience in previous years. However, the CAMTS office tracks accidents closely and looks for trends that may affect changes in accreditation standards or policies that address compliance with those standards.

We have only preliminary reports from the National Transportation Safety Board (NTSB) for the 2002 accidents at this point, but we do know a few factors for tracking purposes. Five of the 6 accidents involved helicopters. Three occurred in dark night conditions, and 3 happened in the daytime. Weather did not appear to be a factor, at least according to the preliminary reports—all the helicopters were operating under visual meteorologic conditions. One crash occurred during takeoff, and 2 others occurred while landing or attempting to land. The other 3 accidents happened en route: 1 to pick up a patient, 1 with a patient on board, and 1 returning from a patient transport.

A common thread does not arise in analyzing these factors. We rely on the NTSB final reports for cause of the accident and causative factors, but sometimes it takes up to 2 years for the final reports to be published.

When an accredited service experiences an accident, CAMTS does not immediately suspend or withdraw accreditation unless there are blatant and obvious issues that are not in compliance with the accreditation standards. However, follow-up is required. A questionnaire is sent to the service asking for conditions at the time of the accident, a detailed account of the accident, details in the NTSB preliminary report that may differ from the information CAMTS has on file, and changes made to the service as a result of the accident. The reply to this questionnaire is given to the CAMTS executive board and may prompt further progress reports or a supplemental visit (planned visit) or a monitoring visit (surprise visit) to the service.

The executive board may refer the report to the full board for an accreditation action, which may result in continuation of the current accreditation, suspension of accreditation until a site visit is completed, or withdrawal of accreditation, depending on the nature of the accident and the service's response. The spirit in which queries and site visits are handled is to help the service prevent a similar issue in the future if factors are identified that could be corrected or changed and to identify compliance with the accreditation standards—not to affix blame.

Unfortunately, in today's environment, cost-cutting and competition drive many air medical services to stay viable. This pressure only adds to the many stressors that are intrinsic to the air medical profession and further increases the risks. Each and every medical transport service is susceptible to both the intrinsic and external pressures that can lead to an accident. Pointing fingers and blaming others will not lower the number of air medical accidents. An established safety culture must begin with each and every service looking at its own practices and keeping a focus on safety—safety first!