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Brett Emison
Brett Emison
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Why Do Medical Helicopters Keep Crashing?


Another medical helicopter has crashed — this time in a small Missouri town. An Associated Press report suggests the helicopter lost an engine on take off and crashed at the landing zone in central Missouri. The AP report did not indicate the specific type of helicopter involved.

Many medical and life flight helicopters are a version of the Eurocopter, which has a history of mechanical malfunctions leading to crashes across the country and in other areas of the world.

The six-seat Eurocopter EC135 has a history of mid-air malfunctions and a lack of critical safety features. In 2007, the FAA issued an Emergency Airworthiness Directive for all Eurocopter Model EC135 helicopters. The European Safety Agency (EASA) notified the FAA that an unsafe condition may exist on Eurocopter EC135 and EC635 helicopters involving the failure of a tail rotor control rod. Failure of the rod would cause subsequent loss of control of the helicopter.

In October 2010, the National Transportation Safety Board (NTSB) issued a Safety Recommendation regarding a design defect on the Eurocopter AS350, which could cause an inadvertent loss of engine power or engine overspeed. A critical control device is located where it can be inadvertently moved by either the pilot or a passenger resulting in a crash.

Medical helicopters are critical safety devices that are the last best hope for many who are critically injured in rural or hard-to-access areas. The pilots, EMTs, paramedics, nurses and doctors who operate on these helicopters are among the bravest among us. We owe it to the flight crews and the patients to ensure these aircraft are free of defects and have critical safety devices.

Records from the National Transportation Safety Board ("NTSB") show there have been several Eurocopter AS350 crashes in recent years:

February 5, 2010: Three died when an AS350 medical helicopter crashed near El Paso, Texas.

November 14, 2009: Three people died when an AS350 medical helicopter crashed near Doyle, California. Witnesses reported seeing the helicopter flying straight and level and then suddenly descend vertically at a rapid rate. Witnesses lost sight of the aircraft and then observed a fireball.

October 29, 2009: An AS350 crash killed two and injured one when the engine lost power while descending near Loreto, Peru.

October 1, 2009: An AS350 crashed near Cusco, Peru killing all three on board.

February 5, 2009: An AS350 medical helicopter crashed near South Padre Island, Texas killing three on board.

Just last year the Wall Street Journal reported on a study found emergency medical helicopter pilots had the most dangerous job in the United States. Many hospitals use a version of the Eurocopter as an emergency medical helicopter. The FAA spokesman told the Wall Street Journal that only 40% of US helicopters had been voluntarily outfitted with collision-avoidance systems and only about 11% have data recorders.

Update [Dec. 27, 2010]

I ran across an interesting Popular Mechanics article from March of this year: Medical Helicopters Need Better Safety Standards — Now [Christopher Maag at Popular Mechanics]

According the report, medical helicopters have crashed 140 times since 1998, killing 140 people and injuring dozens more — the highest rate of fatal accidents in all of commercial aviation. Because of the high number of medical helicopter crashes, the FAA in 2009 finally announced it would issue rules for the medical helicopter industry. According to Popular Mechanics, the first rule should require all air ambulances to be equipped with night vision goggles. Popular Mechanics’ recommended rules:

  • Night vision goggles for air ambulance pilots
  • Terrain Awareness Systems (mandatory on airliners)
  • Flight data recorders
  • FAA should "get serious about the weather" by building more weather stations to track low-altitude storm systems and requiring air ambulance operators to have a flight control center where qualified dispatchers help pilots decide if it is safe to fly.

(c) Copyright 2010 Brett A. Emison


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  1. Mike Bryant says:
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    It really is odd to see the number of these collisions there have been. Gives you another reason to thank these workers when you meet one.

  2. Bryn Elliott says:
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    According to my brief research the helicopter used by this operation is indeed a Eurocopter provided by Air Methods.
    I am unsure what your message was supposed to indicate, but the actual helicopter type appears to be a twin-engine BK117 and not either the castigated twin-engine EC135 or the single engine AS350.
    Whilst there are instances where the airframe has been at fault in many instances it has been the operating method … a twin engine helicopter losing one engine should only rarely result in an accident if they are flying correctly.
    What percentage of Eurocopters are crashing when compared with other types?

  3. John Doe says:
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    Look at the pictures…it was an AS350.

  4. Bryn Elliott says:
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    I stand corrected…. but I have not seen any pictures……
    Fly single engine and lose an engine ….. crash.
    That is why Europe uses two engines…. less crashes, mostly.

  5. Sydney says:
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    Anyone with a bare working knowledge of rotor-wing accidents and statistics knows there is no correlation, none, zero, between single and twin engines and accident rates.

    So stand yourself corrected on every word you’ve written.

  6. It's about the money says:
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    As usual, it comes down to money.

    Helicopter EMS operations in the U.S. are done on the cheap. A marketing director at a hospital sees getting a helicopter as a means of competitive differentiation, but is ignorant of the actual costs of implementing a proper program. As an unintended consequence, many U.S. based EMS programs are flying single-pilot, single-engine, visual (as opposed to instrument) operations without night-vision equipment.

    Aviation operational decisions are made by non-aviation personnel, training and equipment decisions are made by accountants, and weather and crewing decisions are made by people with no stake in the outcome. Pilots in need of work take these jobs with little or no operational authority and the cycle continues.

    If you were to write a treatise on how to design from scratch an unsafe helicopter program, you could hardly do better than the existing single-engine EMS model in the U.S.

    Canada has far fewer machines than the U.S. (most U.S. operations are frankly unnecessary and provide no level of increased care) and all the Canadian-operated machines are twin-engine, dual pilot, instrument, with training programs to reflect that. Their safety record reflects this, as does their cost of operations.

    A “Eurocopter” can refer to any one of about a dozen different helicopter types ranging in weight from around 2,000 pounds up to the mid-20,000 pound range with dozens of potential equipment options. As a descriptor, it’s not a very useful term. It’s much like saying a “Chevy”.

    Because there is no effective regulatory model for EMS helicopter flying in the U.S., a hospital administrator and his accounting staff can dictate the specifics of a helicopter EMS program, which from a safety standpoint is what makes the programs so dangerous. Having flown helicopters professionally for 25 years, I wouldn’t get anywhere near a single-engine EMS program in the U.S. They wouldn’t hire me anyway, because I wouldn’t do it their way.

  7. Professional Pilot says:
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    The idiot that wrote this article only showed his extreme ignorance in the knowledge of this industry. Ofcourse, being a scumbag lawyer it’s only natural you would find some way to blame the party with the greatest amount of money, Eurocopter. Hell why don’t just ground all Bell and Robinson helicopters too, hey crash more often. The accidents you listed were caused by poor maintenance, local factors, or stupid pilots. Keep your mouth shut about things you know nothing about.

  8. Brett Emison says:
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    There has been a thoughtful and civil debate about this post until Pro Pilot’s comment. PP contributed no thoughtful debate, but instead resorted to baseless personal attacks. However, I have yet to censor comments and will not do so now.

    I will however state the obvious — name calling and mud slinging have no place on this forum. Such conduct betrays the true character of the commenter. Resorting to name calling and slander belittles the commenter; not me. PP’s conduct says far more about him/her than it says of me.

    Pro Pilot has accused me of ignorance, though I included a citation and reference for each statement made. PP failed to support any of his/her anonymous comments with facts or citation.

    As a professional pilot, I am surprised PP shows such little concern for the safety and welfare of fellow pilots. I know several pilots. Each one is greatly concerned with the safety of his/her aircraft, crew, and passengers. We owe it to all pilots — and particularly to those such as the air ambulance crews who risk their lives to save others — to ensure that their aircraft are safe and equipped with all necessary safety devices.

    Thanks for reading and Merry Christmas.

  9. Brett Emison says:
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    There is a good (and spirited) discussion about this post by and among pilots at originalforum.justhelicopters.com. You can view and participate in the discussion at http://bit.ly/justhelicopters.

    To the folks at justhelicopters: thanks for reading, but let me clear up a few misconceptions I noticed in your discussion.

    First, I’m not a “scumbag lawyer” as our anonymous friend “Professional Pilot” suggests. I understand there is a negative perception of my profession by some and too often readers think the worst of me without considering they might not know or understand what I do or what motivates my writing.

    Second, I appreciate your suggestion to leave “a polite comment or two”. I encourage such comments.

    Third, I am not involved in a lawsuit against EC, nor am I “laying some ground work”.

    Fourth, I am not a professional pilot, but I know many (both professional and recreational) and am closely related to some. I like pilots (particularly those flying me) well trained, well rested, well paid, and flying safe equipment.

    Fifth, because of my interest in aircraft and the nature of this safety blog I have followed several of these crashes rather closely. Also, being a trial attorney, I have been involved in cases against aircraft manufacturers and have seen several instances where faulty design and cutting corners directly resulted in crashes. Too many times manufacturers cut corners to save either time or money.

    So, justhelicopters and your readers, I would like to hear from you. Why do these medical helicopters keep crashing?

    Is it design problems with the aircraft?
    Is it maintenance?
    Is it lack of training?
    Is it lack of safety devices like terrain avoidance, radar and night vision?
    Is it something else entirely?

    Thanks for reading and Merry Christmas.

  10. xb105drvr says:
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    I agree with you in reference to having a civil conversation. In regards to the AS350 crash, it will be some time before the “official” cause of the crash is released. The FAA/NTSB will do a thorough investigation and the results will be published in do course.

    You asked why aircraft continue to crash in EMS. To answer that, a case study of all accidents would have to be done. In the last 8+ years I have been flying EMS (27+ years flying experience), there have been numerous accidents. Most have been attributed to pilot error. There is the occasional mechanical incident, but ultimately, the burden of a crash falls on the pilot. The pilot is responsible for the safe operation of an aircraft, thus often receiving the blame, despite other issues, of which human factors places a huge role.

    I will attempt to address your individual questions.

    Is it design problems with the aircraft? If you consider single engine performance vs. twin performance and relate it to safety – yes. Engine failures in singles, while not common place, are a real safety issue when faced with unfriendly terrain and forced landing areas. Statistics will reveal that twins in our industry have also crashed and can be compared to the singles. If you separate out the crashes due to engine failures, then there is a definite disadvantage of a single vs. twin engine aircraft. The problem appears in our industry that most of the accidents are “continued flight into terrain” (CFIT). Neither aircraft is immune to this issue.

    Is it maintenance? I am inclined to say no. Few accidents are related to maintenance. Poor maintenance can cause an accident. The manufacturers are keenly aware of liability and are very proactive in working with the operators to address shortcomings.

    Is it lack of training? I would say 70%. Most operators require an instrument rating to apply for positions we fill, but very few devote any additional time or training to promote competency. They expect you to be competent, despite earning the rating many years earlier. Emergency procedure and basic procedural training could be greatly enhanced with desktop simulators and full motion simulation. Semi-annual training versus annual training would also be a major step in monitoring and promoting competency.

    Is it lack of safety devices like terrain avoidance (forth coming), radar (nice, but for VFR flying – not required) and night vision (most larger operators use them now)?

    Is it something else entirely? I would say there are other influencing factors in this proliferation of accidents. Desire to remain a profitable operation can affect the safety of a a program. That is a whole subject in itself. Another factor I would include is placed upon ourselves. We have to be professionals 100% of the time. To deviate from known standards and take unacceptable risks is not tolerable. Human factors also play a significant role in accident prevention and causation.

    Great strides have been made in reducing accidents. NVG’s have finally become integrated in most programs. Radar altimeters are the norm. Terrain avoidance is on its way. A simple autopilot along with some sort of weather viewing ability would be of benefit. I believe a recording device (cockpit/systems recorder) would be beneficial to identifying out of tolerance maneuvers and help provide data to address those issues for training.

    I do not believe there is a magic answer to the problem we have. I encourage all of my fellow pilots to be knowledgeable of their aircraft, systems, emergency procedures, limitations and fly as if you were going to court. One day, we will all be judged. May it not be in court!



  11. EMS pilot says:
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    Everyone in the Helicopter EMS industry knows you can look back over the last 10 years and see a plethora of different EMS helicopters that have crashed. Bell, Sikorsky, Agusta, and yes, Eurocopter. All this suggests is that crashes still happen its just that the AS350 is a cost effective aircraft and a large section of the industry is using them.

    The Airworthiness Directives are not uncommon in helicopters. Just look at all the above mentioned manufacturers and you will find them in their aircraft.

    The biggest problem with the article, even though meant to generate discussion, is the way it was written. Using terms like “the Eurocopter” instigates people like Professional Pilot to
    to make unprofessional comments. It just makes it seem like somebody skimmed the surface of facts to throw something together to stir the pot and does not truly understand the issues or industry.

    Frankly, Sydneys observation that twin engine are no more safe than single engine helicopters is starting to make me ill. The crash in Missouri sounds like an engine failure at high enough hover that the pilot had little choice but to land straight back to the Pad and he wasn’t able to maintain any rotor RPM and it resulted in a hard landing. Had that been a twin engine helicopter they would have not suffered a hard landing or at worst minor damage. I can personally attest to several instances where having a twin engine aircraft allowed people to go home to their families that night because the pilot was left with some time to think and had options on where to land. Those statistics don’t seem to be counted in when doing their “single vs twin” homework. Sydney’s comments come from either an accountant watching the pocket book or people that have no real experience in what goes on in the EMS helicopter world.

  12. Mike says:
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    The aircraft you describe is not an EC135 its an AS350 here’s the video for the accident. The EC135 is a twin engine helicopter and the AS350 or Astar in this video is a single engine.

    Just thought I’d clarify. EC135’s Accident rate is far less than the AStar due to it having two engines.

    I’m a EC135 Mechanic.

  13. up arrow

    Any discussion of helicopter safety and accident prevention must begin with the International Helicopter Safety Team and its web site, http://www.ihst.org/. The IHST was created in 2004 at a meeting at the American Helicopter Society International headquarters when a core group of participants from the Helicopter Association International, the FAA, helicopter manufacturers and others interested in reducing helicopter accidents decided something had to be done.

    Out of this meeting was set the first International Helicopter Safety Symposium held in Montreal, Canada in September 2005. Industry interest and attendance was
    remarkable. The IHST began its study and analysis of helicopter accidents, produced its findings, and subsequently has issued recommendations for reducing the helicopter accident rate, which was rising while all other aviation accident rates were flat, or descending.

    A synopsis of this effort and results to date can be found in the words of Dave Downey, at http://www.ihst.org/portals/54/heliprops.pdf. Dave is now VP of Safety at Bell Helicopters, but at the time was the manager of the FAA’s Rotorcraft Directorate.

    The full story of what the IHST has done so far can be found at its web site on the right had side under the heading “IHST JSAT Reports,” which is the analytical work done by the Joint Safety Analysis Team. It is thorough, well-written, and is the most complete analysis of helicopter accidents done in the United States to date. It does not have all the answers, but it is a tremendous start. The flying public owes a great deal to these tireless safety advocates.

    At Aviation Safety Bloghttp://aviationsafetyblog.com/, we are beginning an ongoing discussion of the causes of helicopter crashes and ways to prevent them. We will use the work of the IHST, the HEMS community, HAI, AHS and other organizations, in addition to our 30 years of investigating aircraft accidents, to try to develop a comprehensive list of causes, as well as some suggestions for prevention.

    We welcome your input–in fact, we need it to make sure everyone is heard.

    James T. Crouse