Evidence table: Summary of aeromedical incidents (2003 - 2012)

OPUS 12 Scientist 2013 Vol. 7, No. 1 S. P. A. Stawicki et al

Submitted 10/2013 – Accepted 11/2013 – Published 12/2013 – Updated 12/2014

Copyright 2007-2013 OPUS 12 Foundation, Inc. 3

Sharing Quality Science Worldwide…

Evidence table: Summary of aeromedical incidents (2003-2012)

Stanislaw P. A. Stawicki, MD 1,3

, Brian A. Hoey, MD 2,3

, Marc Portner MD 2

1 Department of Research & Innovation and

2 Regional Level I Trauma Center, St Luke's University Health Network, Bethlehem, PA, USA

3 OPUS 12 Foundation, Bethlehem, PA, USA

ABSTRACT Aeromedical transportation volumes have increased significantly over the last

two decades. Inherent to this trend is the increase in air ambulance crashes.

The purpose of this report is to provide the reader with a concise summary of

aeromedical incidents that occurred between January 1, 2003 and December

31, 2012. This evidence table, in conjunction with other sources of data

regarding aeromedical incidents, provides an excellent foundation for further

research in this important area of public health, transportation and patient

safety.

Cite as: Stawicki SPA, Hoey BA, Portner M. Evidence tables: Summary

of aeromedical incidents (2003-2012). OPUS 12 Scientist 2013;7(1):3-15.

Correspondence to: Stanislaw P. A. Stawicki, MD, Department of

Research & Innovation, St Luke’s University Health Network, Bethlehem,

Pennsylvania 18015 USA. Email: [email protected]

Keywords: Evidence table, Aeromedical incidents, Air ambulance safety;

Medical helicopter; Medical ambulance crashes.

BACKGROUND, DEFINITIONS, AND METRICS [Background] According to a variety of sources, the number of aeromedical transports has been rapidly increasing in the United States [1, 2], with an

accompanying increase in crashes and deaths [3-8]. [Purpose] To provide a comprehensive summary of all readily searchable reports of aeromedical

transportation incidents/crashes between Jan 2003 – Dec 2012. [Evaluation Methods] Various web resources were identified, reviewed and selected for

inclusion. These resources included the National Transportation Safety Board (NTSB) database and other expert web sources [9, 10]. This evidence table

represents the authors’ best effort to identify and include as many aeromedical incidents as possible; however, it is likely that some incidents may not have

been captured, either due to limited reporting (i.e., some international incidents) or incomplete supporting documentation.

Basic Information

(Location, Date)

[References]

Known Course of Events Aircraft type; Circumstances; Possible Causes Comment; Supplemental Information

Rochelle, Lee County, Illinois, USA

(2012, December)

[3, 11-13]

Helicopter registered to Rockford Memorial Hospital was flying to pick up a patient at Mendota Community Hospital. The REACT medical transport pilot

radioed that the craft encountered unfavorable weather conditions and was heading back to Rockford

Approximate distance between flight origin and crash site: 30 miles

Time of crash: Monday; Approximately 20:15 pm

Type of helicopter: American Eurocopter MBBK-117-A-3; Certified for operation in January, 1992

Location & Circumstances: The craft was heard flying low

over a field in the town of Compton, Illinois (south of Rockford) shortly after 20:00 pm; It appeared that the pilot was able to steer the helicopter away from surrounding farm buildings right before the crash

Possible cause: Unfavorable weather conditions, including possibility of icing; Around the time of crash, there was a high likelihood of low clouds with intermittent snow showers and flurries

The helicopter was heading to Rockford Memorial Hospital to pick up a patient; The patient was subsequently transported by ambulance

The pilot and two flight nurses died in the crash

Despite its age, the helicopter was well-maintained and in good working condition

Eastland, Texas, USA

(2012, September)

[14, 15]

The helicopter was flying for CareFlite medical transport service

The craft was en route to pick up a patient when the pilot tried to divert to a local airport because of limited visibility and “bad weather” [14]

Time of crash: Sunday; Approximately

09:32 am Central Daylight Time

Type of helicopter: Agusta A-109-E

Location & Circumstances: The helicopter crashed approximately 3 miles south of Eastland (4.4 miles south of Eastland Airport), or 56 miles east of Abilene [15]; The crash occurred in an open field

Probable cause: It is likely that deteriorating weather conditions may have played a role in the crash; Full NTSB

investigation report will be forthcoming

Three people were injured, including the pilot and two medics [14]

The pilot managed to avoid high-voltage power lines during the hard landing [16]

San Antonio, Texas, USA

(2012, August)

[17, 18]

The aircraft was flying for PHI Air Medical services and permanently housed at St. Joseph Regional Health Center [17]

The helicopter was transporting a patient to the San Antonio Military Medical Center

Time of crash: Sunday; Approximately 03:30 am

Type of helicopter: Bell 407

Location & Circumstances: The helicopter struck a cell tower near its intended destination, knocking off one of the aircraft’s two skids [17]; The exact location was listed as Interstate 35 and Binz-Engleman Road; The craft was forced to land at the San Antonio International Airport, using an improvised “landing cushion” made from several mattresses provided by San Antonio firefighters (to compensate for the lost skid) [17]

Probable cause: The cause is likely multi-factorial, but sources at the FAA reportedly were focusing on whether proper lighting was present on the cell tower [18]

None of the occupants (including the patient and three crew members) were injured [17]

According to accounts from the Airport crew, “…he [the pilot] suggested mattresses, and I told Engine 23 to grab three or four mattresses from the dorm. We also brought out weights from our weight room to hold the mattresses down” [17]; The mattresses were stacked and weighted down with four, 45-pound plate weights [17]

mailto:[email protected]





Basic Information

(Location, Date)

[References]


Moran Junction, Teton County, Wyoming, USA

(2012, February)

[19-22]

The helicopter was owned by Sky Aviation and flew under Teton County Search & Rescue Team

The aircraft was responding to a call for assistance to a snowmobile accident near Togwotee Mountain Lodge; The helicopter was transporting medical personnel to the scene

Time of crash: Wednesday; Between 12:24-14:30 pm

Type of helicopter: Bell 407

Location & Circumstances: The helicopter was hovering in search of a landing zone when it suddenly began to lose altitude prior to crash landing in an area with dense tree coverage [19]; The crash site was approximately 6.7 miles south of Togwotee Mountain Lodge, located in the Bridger-Teton National Forest [20]

Probable cause: According to the Teton County Sheriff, “…the tail rotor of the crashed helicopter might have failed”; The NTSB investigation was initiated [20]; [Editor Update] As of late 2014, the official cause of the crash was narrowed to

likely pilot error and loss of tail rotor effectiveness, with several other possible causes ruled out, including engine failure or damage [21, 22]

The crash killed one medical rescue team member and injured the pilot and another team member [19]

After approximately 45 minutes following the loss of radio communications, the pilot contacted the communication center and verified that the airship has indeed crash landed [19]

Green Cover Springs, Florida, USA

(2011, December)

[23, 24]

The helicopter was owned by SK Jets, and the pilot involved in the crash was the company’s president, owner, and director of operations [24]

The helicopter was flying to Gainesville hospital to pick up a heart for a transplant in Jacksonville [23]; The aircraft took off from the Mayo Clinic around 05:37 am

Time of crash: Tuesday; Approximately 05:54 am

Type of helicopter: Bell 206-B

Location & Circumstances: The crash occurred in a remote wooded area about 12 miles northeast of the Palatka Municipal Airport in overcast, somewhat misty conditions; A number of trees that were severed by breaks at descending altitudes marked the start of the debris field; The first tree strike was at an estimated height of 30 feet above the ground, and severed an approximately 50-foot tree at a ground elevation of 118 feet [23]

Probable cause: According to NTSB report, the likely reason for the crash was “…the pilot’s improper decision to continue visual flight into night instrument meteorological conditions, which resulted in controlled flight into terrain. Contributing to the pilot’s improper decision was his self-induced pressure to

complete the trip…” [24]

The crash killed the pilot, an organ procurement technician, and a heart surgeon [23]

The wreckage was spotted approximately 4 hours after the accident; The crash ignited a fire that burned approximately 10 acres of woods and, according to investigators, most of the wreckage was consumed by the fire [23]

A lawsuit was filed in 2014 by a family of one of the victims, accusing SK Jets of negligence [25]

Mosby, Clay County, Missouri, USA

(2011, August)

[26-30]

The helicopter was owned by Air Methods, Corporation of Englewood, Colorado; The craft was operated by LifeNet Air Medical Services

The helicopter originated from a hospital in St. Joseph, Missouri, flew to Bethany's Harrison County Community Hospital (near Iowa) then headed for Liberty Hospital, with a planned stop for fuel in Mosby, Missouri

Time of crash: Friday; Just before 19:00 pm

Craft: Eurocopter AS-350; Certified in 2005

Location & Circumstances: The helicopter ran out of fuel and crashed in the field northeast of Kansas City, approximately a mile away from Midwest National Airport in Mosby, Missouri, just west of Highway 69 and Cameron Road; Weather was reportedly good at the time of crash

Possible cause: According to NTSB, the pilot “…was distracted, tired, and skipped preflight safety checks…”; Reportedly, the craft was low on fuel, which could have been detected during routine preflight checks; Despite knowing that the craft is low on fuel, the pilot proceeded with the fatal last portion of the flight; Text messaging may have been among contributing factors; Finally, the pilot failed to set the helicopter up for autorotation [30]

Four people died, including the pilot, the patient being transported, a flight nurse, and a paramedic

The pilot only had 5 hours of sleep the night before, and the crash occurred at the end of the pilot’s 12-hour shift; It was noted that the “low fuel” warning light was set on “dim” and may not have been easily visible; Air Methods policies prohibit the use of electronic devices by pilots during flights

The pilot reported that there were approximately 45 minutes of fuel remaining when the craft actually had only 30 minutes of fuel left; Moreover, FAA regulations require 20 minutes of reserve fuel at all times; With no nearby place to refuel, the pilot opted to continue with a plan to stop for fuel in approximately 32 minutes; However, the helicopter stalled and crashed 30 minutes later

Walnut Grove, Van Buren County, Arkansas, USA

(2010, August)

[31-37]

The helicopter was operated by Air Evac Lifeteam

The chopper originated in Vilonia and was heading to Alread (approximately 70 miles away) to help transport a patient injured in a traffic accident

Time of crash: Tuesday; Just before 04:00 am

Craft: Bell 206-L-1, N62AE; Built in 1978

Location & Circumstances: The flight crashed minutes away from its intended destination; Debris was spread over several hundred yards, between local area homes

Possible cause: Per NTSB: “…probable cause(s) of this accident [may be] the pilot’s loss of aircraft control, due to spatial disorientation, resulting in the in-flight separation of the main rotor and tail boom” [37]

Three crew members died, including the pilot, a flight paramedic, and a flight nurse

The craft was destroyed upon impact; Review of radar data indicates the helicopter flying from the southeast to the northwest, at which time it initiated a turn to the left and then a turn to the right, followed by disappearance from radar; Witnesses reported “…sound of rotor blades slow in speed…” and “…hearing an explosion…” as well as “…increase in the engine sound before ground impact…”





Basic Information

(Location, Date)

[References]


Tucson, Arizona, USA

(2010, July)

[38]

The helicopter was operated by Air Methods as LifeNet medical transport

The aircraft was traveling from Marana to Douglas at the time of the crash, but was not transporting a patient [38]

Time of crash: Wednesday; At 13:45 pm

Aircraft type: Eurocopter AS-350-B-3

Location & Circumstances: The helicopter crashed into a fence in front of a house on North Park Avenue just south of East Glenn Street and burst into flames; According to a witness, the pilot appeared to be maneuvering the chopper away from the home [38]

Possible cause: According to one witness account, the helicopter’s rotors stopped working and it started plummeting toward the ground; Others also indicated that there was some type of mechanical malfunction right before the crash [38]

All three people on board died in the crash

Kingfisher, Oklahoma, USA

(2010, July)

[39, 40]

The helicopter operated as EagleMed [39]

The flight left Oklahoma City’s Integris Baptist Medical Center and was traveling to a hospital in Okeene when it crashed [39]

Time of crash: Thursday; Approximately 19:30 pm

Helicopter type: Eurocopter AS-350

Location & Circumstances: The crash occurred approximately 4 miles southeast of Kingfisher, Oklahoma [39]; The helicopter crashed and burned in a grass pasture [39]

Probable cause: According to a witness, “…the helicopter was swirling over the creek and out of control… I heard it hit and then saw smoke…” [39]; Following an exhaustive investigation, the NTSB concluded that a “low-flying” stunt maneuver by the pilot is the proximal cause of the crash [40]

Two people (pilot and nurse) were killed and one person was injured during the crash

Reportedly, right before the crash crew members were discussing a low-flying maneuver “used to scare and chase coyotes during hunts” [40]; The pilot then tilted the helicopter’s nose down, following which the aircraft went into a straight dive, resulting in a collision with a tree and the crash [40]

Midlothian, Ellis County, Texas, USA

(2010, June)

[41-43]

The helicopter was operated by CareFlite medical transport services

The air ambulance was on a maintenance

flight that originated at Grand Prairie Airport


Helicopter type: Bell 222

Location & Circumstances: The crash occurred at Highway 67 and Wyatt Road; The tail boom was found to be separated by

approximately 250 feet from the heavily damaged aircraft fuselage, with relatively little damage [41]; A trail of debris stretched about 1,500 feet, with the rotor system located about 100 yards from the wreckage [43]

Probable cause: According to witnesses, prior to the crash “…they heard a sound, looked up and saw parts of the aircraft coming off… [after which] …the aircraft fell to the ground and burst into flames” [43]

The pilot and the mechanic died in the crash

Following the crash, CareFlite immediately grounded all of its helicopters and resumed flights at 07:00 am the following

day [43]

Brownsville, Haywood County, Tennessee, USA

(2010, March)

[5-7, 44-48]

The craft was operated by Hospital Wing

The flight originated in Brownsville at 04:26 am to pick up a patient in Parsons, and then flew to Jackson. Apparently, the pilot wanted to fly back from Jackson to Brownsville in order to avoid an approaching storm

Time of crash: Thursday; Approximately 06:00 am

Craft: Eurocopter AS-350-B-3; The helicopter was well-maintained

Location & Circumstances: The flight crashed in a field approximately 55 miles northeast of Memphis, Tennessee; The helicopter was traveling approximately 105 miles per hour at the time; The location of the crash is just a few miles from the craft’s planned destination

Probable cause: Pilot error (e.g., trying to “outrun the storm”); Unfavorable weather conditions, including severe turbulence and a “gust front” of an approaching thunderstorm, with wind speeds of up to 40 miles per hour; There were reports of intense lightning in the area of the crash

Per NTSB report, the probable cause was “…the pilot’s decision to attempt the flight into approaching adverse weather, resulting in an encounter with a thunderstorm with localized instrument meteorological conditions, heavy rain, and severe turbulence that led to loss of control” [48]

The pilot and two flight nurses were killed; The damage to the craft was extensive, including damage from a fire that ensued after the crash

The helicopter crew was communicating with ground base when radio contact was lost; There was no indication of any problems from the pilot

Of note, another aeromedical transport company reported that weather conditions were too dangerous in the area to fly at the time of the Hospital Wing crash [46]

Pilot fatigue could also play a role in the crash, as the pilot was finishing a 12-hour night shift when he made the decision to try to “beat the storm” and fly back to his home base [7]

Local factory workers reported seeing “…a large burst of lightning, followed by an orange glow in the area of the crash” [6]





Basic Information

(Location, Date)

[References]


Georgetown, Georgetown County, South Carolina, USA

(2009, September)

[7, 49]

The aircraft was operated by OmniFlight

The flight originated in Charleston (where the crew dropped off a patient) and was returning to home base in Conway

Time of crash: Friday, Approximately 23:31 pm

Helicopter type: Eurocopter AS-350

Location & Circumstances: The crash occurred in Georgetown, South Carolina; Weather conditions at the time were challenging, and the craft was not equipped with autopilot; The helicopter was not certified to fly in instrument meteorological conditions (IMC) but was sufficiently equipped to operate in IMC if it entered such conditions [49]

Probable cause: Pilot error combined with poor weather conditions; Per NTSB “…the pilot did not have to enter the weather and could have returned to Charleston Air Force Base/International Airport or landed at an alternate location.

The pilot, however, chose to enter the area of weather, despite the availability of safer options” [7]

Further information from NTSB included “…the pilot’s decision to continue the visual flight rules (VFR) flight into an area of instrument meteorological conditions, which resulted in the pilot’s spatial disorientation and a loss of control of the helicopter. Contributing to the accident was the inadequate oversight of the flight by OmniFlight’s Operational Control Center…” [49]

Three crew members died in the crash, including the pilot, a flight nurse, and a paramedic

The culture of the company that operated the helicopter service may have contributed to the crash because “…it did not have a formalized dispatch system that required its pilots to check in with dispatchers before taking off” [7]; Moreover, the craft was not equipped with an autopilot [49]

The NTSB voiced concerns about less stringent requirements for flights without patients on board [7]

Walker Mill Regional Park, Maryland, USA

(2008, September)

[50-52]

The air ambulance was operated by the Maryland State Police and was based at Andrews Air Force Base [1]

The flight originated at Andrews, and initially flew to a landing zone at Wade Elementary School in Waldorf to pick up two slightly injured victims from a car

crash [52]; The medical mission’s destination was Prince George’s Hospital Center; The flight had to be re-directed to Andrews Air Force Base because of fog [51]

Time of crash: Saturday; Approximately 01:15 am Eastern Time

Helicopter type: Aerospatiale (Eurocopter) SA-365-N-1

Location & Circumstances: According to weather reports, thick clouds were descending to 800 feet, the minimum for night flights in state police helicopters; The area 1 mile north of Prince George’s Hospital was completely fogged in; Approximately 34 minutes into the flight, the pilot radioed air traffic control that the weather was unfavorable and the

mission will need to be diverted to Andrews [1]; Blinded by fog, the pilot sent the helicopter into a dive approximately 3.2 miles short of the runway [1]

Probable cause: The pilot’s decision to accept the flight, after an inadequate assessment of the weather, contributed to the accident [52]; Although the reason for the helicopter’s final dive is not known, it is believed that the pilot likely thought he could “duck” under the clouds and land by sight given the weather conditions and the fact that the sky immediately over Andrews was clear when the craft took off [1]; The pilot failed to adhere to instrument approach procedures when he did not arrest the helicopter’s descent at the minimum descent altitude [52]; Traveling at 106 miles per hour, the helicopter collided with trees and terrain

The crash killed the pilot, a state police paramedic, a volunteer medic, as well as one injured passenger who was being transported to the hospital; The other passenger was significantly injured following the crash, requiring prolonged hospitalization and multiple surgeries [51]

There was no formal flight risk evaluation program at Maryland State Police before the accident [52]

The FAA was subsequently sued for negligent air traffic control practices related to this incident [50]

Burney, Decatur County, Indiana, USA

(2008, August)

[32, 53-57]

The craft was operated by Air Evac EMS, Inc.

The craft was at an fundraiser event for the local fire department and crashed as it was returning to the home base in Rushville, Indiana (Rush Memorial Hospital)

Time of crash: Sunday; Approximately 13:00 pm


Location & Circumstances: The fuselage was found approximately 1.2 miles from the point of origin at the Burney Volunteer Fire Department; According to witnesses, the helicopter’s nose tipped down before it crashed and exploded; The crash occurred in Burney, approximately 40 miles southeast of Indianapolis

Cause: Main rotor failure; According to NTSB: “…there was an in-flight separation of a main rotor blade due to a fatigue failure of the blade spar, rendering the helicopter uncontrollable, and the manufacturer's production of main rotor blades with latent manufacturing defects, which precipitated the fatigue failure of the blade spar…” [57]

Three crew members died in the crash, including the pilot, a flight nurse, and a paramedic; The flight was not carrying a

patient at the time of crash

The rotor blades were found approximately 320 yards from the rest of the wreckage; There was significant fire damage to the fuselage

It has been reported that “…main rotor flew off…” before the fatal crash [54]





Basic Information

(Location, Date)

[References]


Grand Rapids, Michigan, USA

(2008, May)

[58-60]

The helicopter operated as Aero Med medical transport [59]

The aircraft was at the Spectrum Health Butterworth hospital when it crashed and exploded on the helipad [59]

Time of crash: Thursday; At 10:58 am

Helicopter type: Sikorsky S-76

Location & Circumstances: As witnessed by many observers, the helicopter hit the radio tower, then spun around to the east, then it went “face down” and exploded in flames [59]

Probable cause: The NTSB determined that the aircraft’s tail rotor struck a radio antenna located on the roof next to the landing pad as the helicopter attempted to depart, resulting in crash and fire [58]

Both the pilot and the Federal Aviation Administration (FAA) examiner escaped the aircraft, but were unable to leave the helipad area because the burning wreck obstructed both the elevator and the stair tower [58]

The chopper landed on its side before it caught fire [60]; The crash and the ensuing fire necessitated evacuation of some of the patients receiving treatment at Spectrum Health Butterworth hospital [59, 60]; Emergency traffic was being diverted to St. Mary’s Healthcare [59, 60]

Cherokee, Colbert County, Alabama,

USA

(2007, December)

[55, 61-63]

The helicopter was operated by Air Evac Lifeteam

The crew was on a rescue mission to find a hunter who crashed in thick woods; The crash occurred shortly after the man was located

Time of crash: Sunday; At 03:06 am CST


Location & Circumstances: The crash occurred as the aircraft was hovering, according to the FAA [61]

Probable cause: According to NTSB, the probable cause of the accident was “…the pilot's failure to maintain control of the helicopter during an out-of-ground-effect hover. Contributing to the accident was a loss of tail rotor effectiveness…” [63]

Three people on board were killed, including the pilot, a nurse and a paramedic

The pilot was out of compliance with the aircraft operation manual regarding the minimum altitude (500 feet) for night searchers and was unable to be persuaded by the command center flight data analyst’s recommendations to terminate the search due to safety concerns (e.g., the helicopter was flying low and slow) [63]

Mullinville, Kansas, USA

(2007, August)

[64]

The aircraft was registered to GM Leasing Company, LLC (Louisiana), and operated by Air MD, LLC (Kansas)

The helicopter was dispatched to an automobile accident on highway 54 in Mullinville; The air ambulance was circling the landing zone at the scene of a car crash when the accident occurred; The helicopter sustained significant damage during a hard landing following an impact with power lines;

Time of incident: Wednesday; At 12:26 pm Central Daylight Time

Helicopter type: Bell 206-L-4

Location & Circumstances:; The pilot had planned a landing zone (LZ) to the west of the car accident on a section of the road that was clear of vehicles. The pilot circled the LZ to the south when, "the aircraft felt like it was being pushed to the northeast and began to shutter." An eastbound semi-truck passed underneath the helicopter's flight path. At that time the pilot stated that he had a feeling that the helicopter "went limp" and subsequently heard the low rotor rpm warning. He then “…immediately leveled the aircraft from a slight bank and lowered the collective and lost the low rotor warning, but the

aircraft still felt real sluggish." The aircraft drifted toward ground personnel and the pilot stated that he “…remembers putting in left [rudder] pedal and steering us back to the parallel road which was going to keep us away from the ground personnel, but the aircraft still seemed sluggish and lost power again and I got the low rotor a second time." The pilot said that he set up an autorotative profile and remembers flaring the helicopter prior to the initial impact [64]

Probable cause: Examination of the wreckage revealed wire damage to the main rotor and tail boom, as well as substantial damage to the fuselage. There was no evidence of any other preimpact mechanical anomaly. Weather in the area was reported by local authorities as strong gusty winds [64]

The pilot and one medical member of the crew sustained serious injuries; Another medical crewmember sustained minor injuries

Kalispell, Montana, USA

(2006, November)

[65]

The aircraft was owned and operated by Kalispell Regional Medical Center

The crash occurred after the aircraft

departed from the Kalispell Medical Center; During post-crash interview, the pilot stated that “…approximately 1 minute after takeoff (during the initial climb) from the hospital's helipad, the flight paramedic in the left front seat, informed the pilot that the "Engine CHIP" light on the caution light panel had illuminated…” After confirming the caution light, the pilot immediately flipped his night vision goggles up and turned the helicopter around and headed back to hospital (the closest available and illuminated pad) [65]

Time of crash: Thursday; At 20:55 pm MT

Helicopter type: Bell 407; Most recent aircraft inspection was on September 1, 2006

Location & Circumstances: Loss of engine power shortly after

departure led to a forced landing and significant damage to the aircraft [65]; The helicopter touched down at the perimeter of the intended helipad and collided with a chain link fence. The helicopter slid about 25 feet before coming to rest. The pilot completed an emergency "shutdown," and he and the two crewmembers exited the helicopter without injuries [65]

Probable cause: Extensive tearing type damage was noted to the upper engine cowling, mostly at the 9-11'oclock and 1-3'oclock (viewed from the aft of the engine looking forward), and in the same plane of rotation as the 2nd stage turbine wheel; The fuselage was intact and minimal damage was noted to the cabin. Damage was noted to the tail rotor driveshaft, driveshaft housing and horizontal stabilizer. A section of the tail rotor drive shaft has separated from the aircraft and was found >200 feet away from the fuselage. [65]

Three people on board sustained no injuries

After exiting the helicopter, the pilot and staff from the hospital's emergency department extinguished a small fire in

the helicopters engine bay [65]

The pilot stated that, right before the crash, the engine started making "weird growling noises" and began to "surge" as he approached the helipad. The growling noise and surging was followed by a loud "bang" from the rear of the helicopter; The pilot then lowered the collective and entered an autorotation [65]

Of note, a section of the tail rotor drive shaft was located on the roof of the hospital approximately 225 feet from the point of touchdown. All four main rotor blades were intact, but impact related damage (near the blade tips) was observed to the leading edges of the main rotor blades. The tail rotor gearbox and associated tail rotor blades were intact [65]





Basic Information

(Location, Date)

[References]


Gentry, Arkansas, USA

(2006, February)

[53, 66]

The aircraft was operated by Air Evac Lifeteam

The helicopter was transporting a patient injured in a motor vehicle crash; The aircraft crashed during attempted departure from the scene

Time of crash: Monday; At 13:39 pm

Helicopter type: Bell 206-L-1; The aircraft was completely refurbished and underwent annual inspection in January, 2005

Location & Circumstances: After landing on a front lawn of a private residence, the patient was placed on the helicopter; There was concern about nearby power lines; As the craft reached “…an altitude abeam of the power lines, it began an uninitiated spin to the right…” [66]; The pilot was unable to gain airspeed and initiated autorotation; There was insufficient main rotor rotation to stop the high rate of descent, resulting in hard landing

Probable cause: Per NTSB report, this accident is probably due to “…the pilot’s improper decision to maneuver in an environment conductive to loss of tail rotor effectiveness” [66]

One fatality; Three serious injuries

The patient being transported died subsequent to the crash, with the primary cause of death listed as “skull fracture” and the secondary cause being “fractured trachea” [66]

When witnesses first arrived at the scene, the pilot was still strapped into his seat, and both the flight nurse and the paramedic were found outside of the craft; It was noted that large amount of fuel was leaking from the helicopter following the impact; Crash survivors were taken to area hospitals [66]

Ponce, Puerto Rico

(2006, January)

[67]

The helicopter was registered to and operated by MSE Air Group, Inc. and flew as Aviane Air Ambulance

After picking up a patient, the helicopter began taking off from San Cristobal Hospital in Ponce, Puerto Rico; At that time, the aircraft experienced unexpected loss of power to one of its engines, forcing the pilot to attempt an emergency landing [67]

Time of crash: Thursday; At 03:43 am Atlantic Standard Time

Helicopter type: Eurocopter Messerschmitt-Boelkow-Blohm BO-105-S

Location & Circumstances: After the patient was placed aboard the helicopter, the pilot started the engines and performed a hover check. He then moved the helicopter forward to gain airspeed and initiated a climb to cruise altitude. After reaching an altitude of 100 feet, the main rotor rpm light and warning system activated, and the #2 engine N1 rpm and torque began to decay. The pilot attempted to regain normal engine parameters, but was unsuccessful. The pilot maneuvered to avoid several light poles as he attempted to land in a parking lot. By now, the main rotor rpm had bled off sufficiently to prevent the hydraulic pumps from pressurizing the hydraulic system, and all flight controls locked in a slight right banked attitude. Unable to reach the parking lot, the helicopter impacted a construction area in a right bank, nose

down attitude [67]

Probable cause: A detailed investigation by FAA and Rolls-Royce experts revealed a B-nut on the Pc line connecting the power turbine governor (PTGOV) to the fuel control unit (FCU) had become loose at the T-fitting end. It was partially torqued and could be moved with the fingers. The female end was threaded onto the male end three-quarters of a turn. There was no cross-threading. The torque stripe was broken. According to Rolls-Royce, "This line serves a critical function to the engine control system and … leakage may cause the engine to roll back to an idle or near idle condition" [67]

One minor injury reported; Three occupants of the craft were uninjured

Olympia, Washington, USA

(2005, October)

[68, 69]

The aircraft was operated by Airlift Northwest

The helicopter was taking off the hospital roof on the way to Seattle’s Harborview Medical Center

Time of crash: Friday; At 23:24 pm PDT

Helicopter type: Agusta A-109-E

Location & Circumstances: On takeoff from St. Peter Hospital in Olympia, “…the helicopter lost power and more or less fell off the building, landing between the hospital and an outbuilding” [68]; The pilot then promptly shut down the engines and assisted with the evacuation of the aircraft [69]

Probable cause: FAA examination revealed that “…both engine control switches were in the “off” position. Testing of various components and both engines showed no anomalies which would have precluded normal operation of the helicopter. Data from the Enhanced Ground Proximity Warning System (EGPWS) revealed that the #1 engine was producing normal and abnormally high torque values during the takeoff sequence, while a zero torque value but proper Ng values were observed from data on the #2 engine during takeoff, consistent with the #2 engine control switch remaining in the “idle” position. The pilot revealed that the operation of the limit override switch was never demonstrated during his training and remembered that it was in an “awkward” position. The limit override switch was not activated during the takeoff sequence, as the pilot was unsuccessful in locating it” [69]

Four people were injured, none of them seriously; One member of the hospital security staff sustained minor injuries during the subsequent rescue

The pilot's total time in all helicopters was 7,923 hours, with 15 hours in make and model. The pilot reported that during his training courses on the Agusta helicopter, he had

questioned the instructors about previous accidents involving the position of the engine control switches during the start sequence. A comparison of the Agusta Rotorcraft Flight Manual and the General Familiarization Training Manual revealed they provided inconsistent instructions about when to move the engine control switches from “idle” to “flight” position [69]

Of note, the helicopter featured an upgraded night-vision system [68]





Basic Information

(Location, Date)

[References]

Known Course of Events Craft type; Circumstances; Possible Causes Comment; Supplemental Information

Edmonds, Washington, USA

(2005, September)

[70]

The helicopter was operated by Airlift Northwest

The air ambulance just dropped off a patient at Harborview Medical center and was heading back to its home base at Arlington Airport [70]

Time of crash: Thursday; Approximately 21:13 pm PDT

Helicopter type: Agusta A-109 Mark II twin-engine

Location & Circumstances: Although no witnesses actually saw the craft go down, according to one “911 caller”, there may have been “…engine trouble…” and “…an explosion on the water…” at the time of crash [70]; A half mile field of floating debris from the helicopter was subsequently found in the waters of Puget Sound off the shores of Edmonds [71]

Probable cause: According to NTSB: “Examination of the helicopter's maintenance records revealed no evidence of any uncorrected maintenance discrepancies. Damage observed on the recovered wreckage was consistent with the helicopter

impacting the water in an uncontrolled descent. Examination of the … wreckage revealed no evidence suggesting mechanical malfunction or failure. However, the majority of the helicopter, including most of the flight control system and all flight instruments and avionics, was not recovered, precluding determination of the reasons for the crash” [71]

Three crew members died, including the pilot and two flight nurses

Falkner, Mississippi, USA

(2005, January)

[72]

The helicopter was registered to Rocky Mountain Holdings LLC, operating as Air Methods Corporation

The air ambulance was dispatched from North Mississippi Medical Center in Tupelo to an automobile accident in the vicinity of Country Road 564; The pilot called the communications center by cell phone at 21:00 pm stating that he had a problem with a damaged chin bubble; During attempted repair, when faced with

possible delays and the need to leave the craft in the field, the pilot informed the mechanic that the field was prone to flooding and then decided to move the aircraft to a safer location at a nearby helipad; The crash occurred after the helicopter departed for the alternate location [72]

Time of crash: Wednesday; At 23:03 pm CST

Helicopter type: Aerospatiale AS-350-D

Location & Circumstances: The aircraft collided with trees and the ground; A cold front had just passed through the area and winds were strong and gusty with frequent downpours; According to the local Sheriff, “…the helicopter cleared the treetops and flew on a westerly heading towards Highway 15. The helicopter did not appear to gain much altitude as it was flying away. The helicopter lights disappeared from view about 1 mile after it departed”, which was initially attributed to low cloud ceiling [72]

Probable cause: According to the NTSB, “…There is no record that the pilot obtained a weather briefing by radio or by cell phone before departing the accident site. The wreckage was located the following morning. Doxylamine, a sedating over-the-counter antihistamine used in sleep aids and cold relievers, was found in the pilot's blood on toxicological examination. Pseudoephedrine, a decongestant available in many “cold symptom” relievers, was also found in the pilot's blood” [72]

The pilot died in the crash

Battle Mountain, Nevada, USA

(2004, August)

[73, 74]

The aircraft was operated by Jeflyn Aviation, Inc., of Boise, Idaho

The flight involved a transfer of an 11-day-old infant between a hospital in Battle

Mountain, Nevada and another facility in Reno, Nevada [74]; The pilot selected a direct route that crossed rugged mountainous terrain with maximum elevations of approximately 9,000 feet versus a slightly longer route that followed an interstate highway, with maximum elevations of about 6,000 feet [74]

Time of crash: Saturday; Approximately 23:58 pm PDT


Location & Circumstances: The accident occurred at an elevation of approximately 8,600 feet; Information gathered suggests that the helicopter was in level flight at impact,

consistent with controlled flight into terrain; According to satellite data, there may have been cloud cover at the accident site, but the two closest aviation weather stations reported good visibility, clear skies below 12,000 feet, and no precipitation at the time of crash [74]

Probable cause: According to NTSB investigators, the crash was due to “…the pilot’s failure to maintain clearance from mountainous terrain. Contributing factors were the pilot’s improper decision to take the direct route over mountainous terrain, the dark night conditions, and the pressure to complete the mission induced by the pilot as a result of the nature of the emergency medical transport” [73]

Five fatalities reported, including the pilot, flight nurse, flight paramedic, the 11-day-old infant patient, and the patient’s mother

The helicopter was not equipped with an enhanced ground

proximity warning system (EGPWS), which may have alerted the pilot of high terrain ahead at least 35 seconds prior to impact





Basic Information

(Location, Date)

[References]


Louie Lake, Idaho, USA

(2004, July)

[75]

The helicopter was registered to PNC Leasing LLS of Pittsburgh, Pennsylvania and operated by CJ Systems Aviation Group of West Mifflin, Pennsylvania

The flight was dispatched to Louie Lake to pick up a patient; The pilot then dropped off the crew and due to the landing zone’s elevation of 6,500 feet above mean sea level, performed a successful “out of ground effect” maneuver; After locating and reaching a landing zone that was closer to the pickup point, the pilot made preparations for takeoff with all the

personnel and the patient on board [75]


Helicopter type: Bell 222-U

Location & Circumstances: The helicopter was damaged while maneuvering during departure from Louie Lake, Idaho; The pilot noted that the vertical climbout was uneventful and that he expected the aircraft to easily clear the 100 foot tree line as the helicopter transitioned to forward flight; As the rotor cleared the tree line and forward progress was started, the aircraft lost all lift and began to settle toward the approaching trees; Despite pilot’s efforts, the aircraft touched down and the left skid impacted a boulder; Following that, the helicopter “bounced” back into the air, experienced further damage, after which the pilot performed a hover autorotation; After that, emergency aircraft shutdown and evacuation were

implemented [75]

Probable cause: “The failure of the pilot to maintain rotor rpm and his inadequate recovery from a bounced landing. Factors contributing to the accident included the tailwind condition and the tree” [75]

Four involved individuals were uninjured

The helicopter sustained significant damage, including an approximately 8 inch chordwise gash to one of the tail rotor blades due to tree branch impact [75]

Newberry, South Carolina, USA

(2004, July)

[76, 77]

The helicopter was operated by Med-Trans Corporation, under Regional One Medical Air Service designation

The flight took off from interstate highway I-26 near Newberry, South Carolina and was en route to Spartanburg Regional Medical Center

Time of crash: Tuesday; At 05:32 am ET

Helicopter type: Bell 407; Manufactured in 2001, the aircraft was last inspected in July, 2005

Location & Circumstances: The helicopter collided with threes shortly after takeoff from interstate I-26; The aircraft was destroyed by the impact and the ensuing fire

Probable cause: According to NTSB, the crash may have been due to “…the pilot’s failure to maintain terrain clearance as a result of fog conditions. A contributing factor was inadequate weather and dispatch information relayed to the

pilot” [76]

There were four fatalities, including the pilot, the patient, flight nurse, and paramedic [76]

The accident occurred on U.S. Forest Service land; Recovery crews made a path with assistance of bulldozers in order to gain access to the crash site [77]

The helicopter was well maintained, with no discrepancies found upon FAA inspection[76]

Cibecue, Arizona, USA

(2004, June)

[78]

The helicopter was operated by Native American Air Ambulance service

The helicopter landed hard and damaged the tail boom when landing at an improvised landing zone (baseball field) to pick up a medical patient

Time of crash: Saturday; At 04:30 am MT

Helicopter type: Eurocopter AS-350-B-3

Location & Circumstances: The crew was dispatched from Slow Low to pick up a trauma victim at Cibecue, for transport to Scottsdale, Arizona; On approach to the baseball field, the pilot spotted a patch of grassy terrain and opted to touch down there; Approximately 3 feet above ground level, as the craft decelerated to approximately 10 knots, a dust cloud began to form, contributing to the hard landing event [78]

Probable cause: According to NTSB, “…pilot’s failure to maintain a proper descent rate during the landing approach and misjudging landing flare, which resulted in a hard landing”; Another factor in the accident was “…the brownout conditions created by the dust cloud that interfered with the pilot’s perception of ground proximity” [78]

Three people were injured in the crash

In a written statement, a medical crewmember reported that “…the helicopter was descending faster than normal…” [78]

There was no evidence of mechanical malfunction

Alice Springs, Australia

(2004, June)

[79, 80]

The helicopter was conducting a medical evacuation from Deep Well, NT to Alice Springs

Time of crash: Monday; Approximately 07:30 am local time

Helicopter type: Bell 206-B

Location & Circumstances: The helicopter was cruising at 80 knots and 500 feet above ground level, when the pilot felt a vibration develop, followed by a loud “bang” and a drop in main rotor torque [79]; The location of the event was approximately 5 nautical miles south-west of Alice Springs Airport [80]

Probable cause: According to the Australian Government, the accident was caused by failure of the driveshaft between the engine free-wheeling unit and the main transmission [79]

None of the occupants (pilot, flight medic, and three patients) were injured





Basic Information

(Location, Date)

[References]


Boonville, Indiana, USA

(2004, April)

[8, 81]

The aircraft was owned and operated by Air Evac Lifeteam

The crash occurred during an inter-hospital transport of a patient from Washington, Indiana to Deaconess Hospital in Evansville, Indiana [8]

Time of crash: Tuesday; Approximately 23:39 pm


Location & Circumstances: The craft collided with up sloping terrain during a night medical flight; The helicopter impacted the terrain in a level flight attitude; The accident site was at an abandoned strip mine in a rural area [81]

Probable cause: According to NTSB, the accident’s probable cause was “…the pilot’s inadequate planning/decision which resulted in his failure to maintain terrain clearance. Contributing factors were the pilot’s inadequate preflight planning, his diverted attention, and the dark night conditions” [81]

There was one fatality (the patient) and three serious injuries (the pilot, the paramedic, and the nurse) [81]

Pyote, Ward County, West Texas, USA

(2004, March)

[82, 83]

The helicopter was owned by Med-Trans Corp. of Bismarck, North Dakota and providing services as CareStar of Odessa, Texas

The aircraft was flying from Big Bend Regional Hospital in Alpine to the University Medical Center in Lubbock, transporting a 3-month-old infant

Time of crash: Sunday; Approximately 02:19 am


Location & Circumstances: Contact with the aircraft was lost around 02:19 am, near Pecos, Texas, when the pilot was giving an update on the helicopter’s position; The pilot’s last words were, “Hold on a minute” [82]; At that time, there was rain, thundering, and lightning activity in the area

Probable cause: Per NTSB, “…the aircraft's inadvertent encounter with adverse weather, which resulted in the pilot failing to maintain terrain clearance. Contributing factors were the dark night conditions, the pilot's inadequate preflight preparation and planning, and the pressure to complete the mission induced by the pilot as a result of the nature of the EMS mission” [83]

There were four fatalities, including the pilot, flight paramedic, the infant patient, as well as the infant’s mother [82]; In addition, one person (flight nurse) was seriously injured [83]

The wreck was found shortly after 06:00 am

Laupahoehoe, Hawaii, USA

(2004, January)

[84]

The aircraft operated as Hawaii Air Ambulance

The plane departed Honolulu to pick up a patient in Hilo, Hawaii; Approximately 1 hour later, the plane collided with trees and mountainous terrain during an en route cruise descent near Laupahoehoe, Hawaii [84]

Time of crash: Saturday; At 01:40 am Hawaiian Standard Time

Aircraft type: Cessna 414-A

Location & Circumstances: NTSB investigators estimated that

at the time of crash, the plane was 21 miles away from Hilo, Hawaii; The airplane collided with trees and mountainous terrain at the 3,600-foot-level of Mauna Kea Volcano during an en route cruise descent toward the destination airport; The debris path extended about 500 feet along a magnetic bearing of 100 degrees with debris scattered both on the ground and in tree branches [84]

Probable cause: Investigators found no anomalies with the airplane or engines that would have precluded normal operation. Pilots for the operator typically departed under visual flight rules, even in night conditions or with expectations of encountering adverse weather, to preclude ground holding delays. The pilots would then pickup their instrument flight rules clearance en route. The forecast and actual weather conditions at Hilo were below the minimums specified in the company Operations Manual for VFR operations [84]

The pilot and two occupants (emergency medical technicians) sustained fatal injuries

Paris, Arkansas, USA

(2003, November)

[85]

The helicopter was operated by Air Evac

Leasing Corporation

The air ambulance was responding to a request for medical transfer

Time of crash: At 22:08 pm Central Standard Time

Type of craft: Bell 206-L-1

Location & Circumstances: The accident occurred at the Paris Municipal Airport near Paris, Arkansas; The aircraft was substantially damaged as a result [85]

Probable cause: The helicopter experienced a blade separation from the aircraft during startup; Upon investigation, it was discovered that the pilot started the aircraft with the main rotor still tied down, and that recognition of this error came too late in the start sequence, resulting in one of the main rotor blades breaking and separating from the craft [85]

The pilot and the flight paramedic sustained minor injuries





Basic Information

(Location, Date)

[References]


Kingsland, Texas, USA

(2003, March)

[86]

Helicopter was operated by Critical Air Medicine, Inc., of San Diego, California.

The aircraft was dispatched from Marble Falls, Texas to a hospital in Llano, Texas to pick up a patient; Prior to boarding the helicopter, one medical crewmember opened the aft cargo door, removed medical equipment, and then closed the door; The same medical worker then checked the auxiliary power unit door and boarded the craft, along with the second medical crewmember

Time of crash: Thursday; Approximately 16:15 pm CST


Location & Circumstances: The pilot noted vertical vibration in cruise flight; Ten minutes after an otherwise normal takeoff, the crew heard a loud “bang”; The helicopter yawed right and the nose dipped; The aircraft subsequently landed hard on soft terrain among pecan trees and came to rest upright [86]

Established cause: According to NTSB investigators, the accident was due to “…loss of tail rotor drive as a result of a blanket coming in contract with the tail rotor blades, after the aft cargo door was left unsecured. Contributing factors were the lack of suitable terrain for the forced landing, and the

failure of the medical crewmember to properly secure the aft cargo door” [86]

Three people on board at the time of crash were uninjured

According to the FAA inspector, a medical blanket which was in the aft cargo compartment, was found in a tree upstream along the aircraft’s flight path; In addition, a section of the tail rotor drive shaft, along with other items from the aft cargo compartment, were found between the resting site of the above-mentioned medical blanket and the crash site [86]

Aegean Sea, Greece, European Union

(2003, February)

[87-89]

Craft operated by Helitalia and owned by the Hellenic Emergency Medical Service

Traveling from Mytilene Island to Ikaria Island, Greece, the helicopter crashed into the Aegean Sea

Time of crash: Tuesday; At 01:00 am local time

Helicopter type: Agusta A-109-E

Location & Circumstances: The helicopter crashed into the Aegean Sea; The craft was on visual approach to Ikaria at the time of the crash, approximately 2 kilometers south of Ikaria Airport [89]

Probable cause: Limited information regarding the cause of the crash was available at the time of this report; Mechanical malfunction has not been ruled out

The captain, the first officer, paramedic, and the flight physician were all fatally injured

Reportedly, this was the third crash during night-time flight involving the same type of Agusta helicopter used by the Hellenic Emergency Medical Service within a 5-year time frame [88, 89]

The helicopter wreckage was found in the sea 15 days after the crash, and recovered 28 days after the accident [87-89]

West Chicago, Illinois, USA

(2003, January)

[90, 91]

Helicopter operated by Air Angels Incorporated, an on-demand air ambulance service affiliated with Good Samaritan Hospital in Downers Grove

The Air Angels Medevac aircraft took off from DuPage Airport traveling to the south/south-west on a routine flight

Time of crash: Tuesday; 20:52 pm CST

Helicopter type: Agusta A-109-C

Location & Circumstances: The helicopter crashed into a field

in West Chicago; The wreckage showed significant post-impact fragmentation and fire/explosion damage

Probable cause: NTSB determination attributes the accident to “…the pilot’s failure to maintain control of the helicopter while maneuvering, resulting in the excessive descent rate and impact with terrain. Factors contributory to the accident included the dark night, low ceiling and reduced visibility at the time” [90]

One fatality (the pilot)

A crew consisting of a pilot, a paramedic, and a nurse exited

the craft before the accident pilot took over the control of the air ambulance that was being refueled; Shortly after taking off, the helicopter was noted to be “bouncing” before it went down [91]

Salt Lake City, Tooele County, Utah, USA

(2003, January)

[92, 93]

Helicopter operated by Intermountain Health Care as “Life Flight 6”

The aircraft was en route from LDS Hospital to the scene of a motor vehicle crash

Time of crash: Friday; Approximately 20:50 pm MT

Helicopter type: Agusta A-109-K-2

Location & Circumstances: The craft encountered fog and poor weather conditions shortly after departing from its hospital base; After crossing a major airport’s airspace, the helicopter pilot elected to abort and return to base; However, air traffic control instructed the pilot to hold and wait for clearance to cross back across the airspace; After approximately 10 minutes of holding, the pilot declared an

emergency; This was followed by terrain impact

Probable cause: According to NTSB report, the accident was associated with “…the pilot's delayed remedial action and continued flight into known adverse weather conditions which resulted in his failure to maintain clearance with the ground. Contributing factors were the prevailing fog, and the pressure to complete the mission induced by the pilot in command as a result of the air ambulance operation” [92]

Two fatalities; One serious injury; Flight nurse was the only survivor of the crash [93]

Prior to the Life Flight helicopter’s departure from the hospital, another air ambulance aborted the same mission, citing fog and deteriorating weather conditions [92]

Table legend: CST = Central Standard Time; ET = Eastern Time; FAA = Federal Aviation Administration; MT = Mountain Time; NTSB = National

Transportation Safety Board; PDT = Pacific Daylight Time; VFR = Visual Flight Rules.





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Evidence table: Summary of aeromedical incidents (2003 - 2012)

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