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Hexcells Infinite 2 Pony Island 2 Half-Life 1 Muse Dash 1 Bit Blaster XL 1 Nuclear Throne 1 Refunct 1 New entries today Kind Words. Fallers today 6 A Short Hike 3 Abbreviations Toolkit. December 29, More Medical Helicopter Hazards. Four people, including a patient, a nurse, a paramedic, and the pilot died in that crash. That crash occurred during a planned mile night flight in rainy, foggy conditions. Initial reports did not provide the medical reason the patient was being transported. A quick search on Google Maps estimates ground transport time between the two sites to be 49 minutes though rainy, foggy conditions would be expected to likely increase that time as well.

Actually, another one just occurred after we began work on this column. A medical helicopter crashed in Arizona, killing the pilot and a nurse and injuring a paramedic Schwartz No patients were on board when the crash occurred. The helicopter was apparently returning to its base. Details are not known at this time. A fatal crash in Oklahoma in March occurred in the setting of lower than expected cloud ceilings during a night flight NTSB a.

A fatal crash of a twin-engined medical evacuation plane in New Mexico in August occurred after the plane was erroneously fueled with Jet A fuel instead of the required fuel NTSB a. An engine caught fire, leading to the crash, and four people including a patient, a nurse, a paramedic, and the pilot died in that crash. The patient had been staying in Las Cruces and receiving radiation therapy after having surgery for a brain tumor in a Phoenix hospital. He was being transported back to the Phoenix hospital after recent deterioration Llorca In March a helicopter attempting to land on a rooftop helipad at St.

Louis University Hospital hit the edge of a hospital building and crashed in an adjacent parking lot, killing the pilot who was the only one aboard at the time NTSB b. The pilot had dropped off his crew and a patient previously, returned to his air base to refuel, and was now returning to the hospital to again pick up his crew. This was a night flight, with winds gusting to 25 knots, and the helicopter experienced loss of directional control. The patient being transported died and 3 crew members were seriously injured.

The pilot had aborted a first attempt at landing on the helipad, then went into a violent spin during the second attempt. There are many factors that make accidents involving medical helicopters and some other medical aviation more likely to occur. Many medical flights occur at night or in inclement weather.

The landing areas are also often not nice ample open spaces like airport runways, but are often rather tight spaces with wires and other obstacles nearby. The emergent nature of the medical mission often keeps the team from canceling the flight or diverting to safer routes. Most helicopter programs say that any crew member has the ability to call off the flight at any time but we wonder how often that really happens.

The time pressures may be great. The same applies when transporting organs for transplantation. Medical helicopters also are often flying without the benefit of air traffic controllers and sometimes without flight dispatchers. The NTSB report had pointed out that most medical helicopters do not make optimal use of night vision imaging systems or night vision goggles. Many medical helicopters also still do not utilize terrain awareness and warning systems, another safety feature recommended by the NTSB.

And you can add drones to the list of hazards as a drone in Pennsylvania almost collided with a medical helicopter Choate There was no patient on board at the time. As the cost of personal drones has come down the number of drones being flown has increased significantly. A recent report counted at least reports of close encounters between drones and manned aircraft that meet the Federal Aviation Administration's definition of a near-collision, including 38 that involved helicopters. Lowy Helicopter blades are considered especially vulnerable if collisions were to occur.

In New Hampshire a program was recently introduced requiring anyone operating a drone within 5 miles of Manchester-Boston Regional Airport to contact air traffic control before flying the drone Brewer And the FAA just put forward a new rule requiring drone owners to register their drones by February 19, Morgan Surviving a medical helicopter crash may also be difficult for a number of reasons.

Helmets, shown to help save lives and prevent head injuries in military helicopter crashes, are often not worn by all medical helicopter occupants. The same applies to shoulder harnesses. And there is some evidence that serious or fatal injuries are more likely to occur to those who are not in the front seats, that is those back in the cabin may be at more risk. They also noted that helicopter EMS accidents were more likely to occur when a patient is not on board when rules and regulations are less stringent. But the NTSB and FAA have been shortsighted and operated in a silo mentality in their analyses and approaches to the problem and the state and local regulatory agencies and even the medical community have done the same.

That column delved into some of the financial and other less altruistic incentives driving the industry. They have focused only on the issues related to flights that they would address in their investigations of any aircraft crash or other transportation accident. Proposed solutions to these crashes have always focused on proximate causes and recommendations have come out in favor of mandating night vision goggles, terrain warning systems, better weather information, changes in pilot training, etc.

It focuses on inspection and maintenance, crew fatigue, and the need for flight risk evaluation programs and formalized dispatch and flight-following procedures. Not a word about assessment of the medical necessity of air transport. No one is asking similar questions when reviewing medical transport crashes.

Ironically, on the very day we started preparing one of our columns, we chanced upon a medical helicopter evacuation scene. Judging by the state of the cars involved in the crash, it was pretty clear that the injuries suffered by someone were likely severe enough to merit transport to a Level I Trauma Center. By car from that spot is exactly 29 minutes in morning traffic we know because we did that exact drive daily for over 12 years, where I was the medical director of the trauma hospital.

It was a sunny day and the roads were dry, though it was a bit windy. It was not rush hour. Rather it was just shortly before 1PM. It would probably take the helicopter about 10 minutes to fly to the Trauma Center. We wondered how long it had taken the helicopter to arrive. The helicopter base site is about 30 miles from the accident site. The accident site was actually less than half a mile from another hospital so an ambulance was probably available within minutes of the accident.

Bryan Bledsoe and his colleagues that was a meta-analysis of helicopter transport of trauma patients Bledsoe Even in Maryland, where the trauma system is a model and the medical helicopter system a public one, the post-crash hearings revealed that almost half of patients transported by helicopter to trauma centers were released within 24 hours Dechter For example, if a remote hospital is transporting a patient to a tertiary center for percutaneous coronary angioplasty for an MI and the statistics suggest that such patients seldom arrive within the standard window for PTCA, the remote hospital should consider giving thrombolytic therapy before sending the patient.

Of course, it would also be nice to have a better understanding of how often crashes occur with ground ambulance transports. Such data are surprisingly hard to come by and are likely to be underreported Ballan Good luck with the former! Unless a celebrity dies in such a crash it is unlikely that state legislatures will do anything. So the task really falls to hospitals. Even if your organization does not own its own medical helicopter, there are things you can do to help ensure the safety of your staff and patients:.

Yes, compared to the total number of transports, crashes of such aircraft are relatively few. But any time we might unnecessarily put lives at risk we need to be circumspect. CBS News ; December 11, Choate K.

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Brewer R. Manchester airport introduces new drone guidelines. Address Unique Characteristics of Helicopter Operations. Bledsoe BE. Wesley AK. Eckstein M. Dunn TM. O'Keefe MF. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. Greene J. Dechter G, Jones B. The Baltimore Sun. October 1, Effective July 1, To get "Patient Safety Tip of the Week "emailed to you, click here and enter "subscribe" in the subject field.

Click on the " Contact Us " button at the left to send us your comments on our "Patient Safety Tip of the Week" cases. EHR-related Malpractice Claims. Lessons from an Inpatient Suicide. Double Check on Double Checks. Repeat Adverse Drug Events. Lessons from Hospital Suicide Attempts.

More on Promoting Sleep in Inpatients. Thought You Discontinued That Medication? Think Again. Adverse Events in Inpatient Psychiatry. Target Drugs for Deprescribing. Delayed Emergency Surgery and Mortality Risk. Dialysis and Alarm Fatigue. Yet More Jumps from Hospital Windows. Alarm Fatigue in the ED. More Issues in Pediatric Safety. Managing Distractions and Interruptions. Desmopressin Back in the Spotlight.

Falls from Hospital Windows. It was just a matter of time….

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Avoiding Distractions in the OR. Medical Staff Risk Issues. Mistaking Antiseptic Solution for Radiographic Contrast. Reminders of Dilaudid Dangers. Dueling Chlorhexidine Studies. More on Delays for In-Hospital Stroke. Errors with Oral Oncology Drugs. Slip and Capture Errors. Specimen Issues in Prostate Cancer. Factors Related to Postoperative Respiratory Depression. The Anticholinergic Burden and Dementia. More on Numeracy.

Smartwatch to the Rescue. A Gap in ePrescribing: Stopping Medications. Ophthalmology: Blue Dye Mixup. More on the Unintended Consequences of Contact Isolation. Systems Approach Improving Stroke Care. We Miss the Graphic Flowchart! Evidence-Based Prescribing and Deprescribing in the Elderly. Nudged, But Who Nudged Who?

Diagnostic Error: Salient Distracting Features. The Second Victim. Reducing Harm from Falls on Inpatient Psychiatry. Missed Care: New Opportunities? More on Inappropriate Meds in the Elderly. Missing Patients. Informed Consent and Wrong-Site Surgery. Predicting Perioperative Complications: Slow and Simple. Adverse Events in Home Care. Let Me Sleep! Amphotericin Mixups Continue.

Reducing Unnecessary CT Scans. Perioperative Distractions. Drug Errors in the Home. Photographic Identification to Prevent Errors. Distracted While Texting. Absconding from Behavioral Health Services. Dealing with the Violent Patient in the Emergency Department. More on Communicating Test Results.

Practical Postoperative Pain Management. Antidepressants and QT Interval Prolongation. A Flurry of Activity on Handoffs. Falls on Inpatient Psychiatry. Breastfeeding Mixup Again. Dealing with Distractions. Surgical Scheduling Errors. Latent Factors Lurking in the OR. What is the Evidence on Double Checks? Call for Focus on Diagnostic Errors. Preoperative Assessment for Geriatric Patients. Insulin Pump Safety. More Infant Abductions. Surgical Case Duration and Miscommunications. Recycling an Old Column: Dilaudid Dangers. More Problems with Faxed Orders.

Minor Head Trauma in the Anticoagulated Patient. Falls, Fractures, and Fatalities. Update on Preoperative Screening for Sleep Apnea. Diagnostic Error Chapter 3. Importance of Nontechnical Skills in Healthcare. Fire Hazard of Skin Preps Oxygen. Error Disclosure by Surgeons. Adverse Events Related to Psychotropic Medications.

Medical Emergency Team Calls to Radiology. Lab Error. Handoffs More Than Battle of the Mnemonics. Another Neuromuscular Blocking Agent Incident. Medication Safety in the OR. Patient Safety in Ambulatory Care. Delirium and Contact Isolation. Verbal Orders. Unintended Consequences of Restricted Housestaff Hours. Infant Abduction. Surgical Fires Again. More on Diagnostic Error. Perioperative Management of Sleep Apnea Disappointing. Rethinking Colonoscopy. High-Risk Surgical Patients.

LEAN in the Lab. Unintentional Discontinuation of Medications After Hospitalization. Catheter Misconnections Back in the News. Crisis Checklists for the OR.

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Frailty and the Surgical Patient. Hazards of e-Prescribing. Hourly Rounding. Communication Across Professions. Pass it onHow a kids game can mold good handoffs. Sidney Dekker: Patient Safety. A Human Factors Approach. Failure to Follow Up. Timeouts Outside the OR. Hand Hygiene Resources. Opioid-Induced Respiratory Depression Again!

Its All in the Timing. Medication Issues in the Ambulatory Setting. More Aviation Principles.

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Early Warnings for Sepsis. Yes, Physicians Get Interrupted Too! Tests Pending at Discharge. Rethinking Alarms. Controversies in VTE Prophylaxis. Inducing Too Early. MRI Safety Audit. Procedural Sedation in Children. Safer Use of PCA. Focus on Cumulative Radiation Exposure. Lost Lab Specimens. Insulin: Truly a High-Risk Medication.

Confirming Medications During Anesthesia. Optimizing Medications in the Elderly. Slowing Down in the OR. More Iatrogenic Burns. Diagnostic Error. Dilaudid Dangers. Wrong-Site Craniotomy: Lessons Learned. Postoperative Delirium. Preoperative Consultation Time to Change. Tip of the Week on Vacation. Postoperative Opioid-Induced Respiratory Depression. Book Reviews: Pronovost and Gawande. Disclosure and Apology: How to Do It. Dysphagia in the Stroke Patient: the Scottish Guideline. Surgical Safety Checklist for Cataract Surgery. Iatrogenic Burns. Propofol Issues. Real-Time Random Safety Audits.

Delayed Diagnosis of Cancer. More on the Impact of Interruptions. Infusion Pump Safety. Update on Handoffs. Cancer Chemotherapy Accidents. A Patient Safety Scavenger Hunt. Communication of Urgent or Unexpected Radiology Findings. Alarm Sensitivity: Early Detection vs.

Alarm Fatigue. Alarm Issues in the News Again. More on Preventing Inpatient Suicides. The Hazards of Radiation. Preventing Postoperative Delirium. Timeouts and Safe Surgery. Patient Photos in Patient Safety. Hows Your Hand Hygiene? Recognizing Deteriorating Patients. Falls on Toileting Activities. The Weekend Effect. Prescribing Errors. Patient Safety Doesnt End at Discharge. Switched Babies. Medication Safety: Frontline to the Rescue Again! Slipping Through the Cracks. Perioperative Peripheral Nerve Injuries. Barriers to Medication Reconciliation. Interruptions, Distractions, InattentionOops!

Obstructive Sleep Apnea in the Perioperative Period. The Radiology SuiteAgain! Faulty Fall Risk Assessments? Wandering, Elopements, and Missing Patients. Medication Errors in Long Term-Care. Nudge: Small Changes, Big Impacts. More on Delirium in the ICU. Learning from Tragedies.

Part II. Still Futzing with Foleys? More on Rehospitalization After Discharge. Project RED. Screening Patients for Risk of Delirium. Medication Errors in the OR. More on MRI Safety. Prolonged Surgical Duration and Time Awareness. Overriding AlertsLike Surfin the Web. Reducing Risk of Overdose with Midazolam Injection. Lab Errors in the News. Preventing Inpatient Suicides.

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Why Safety Alerts Often Fail. Huddles in Healthcare. Playing without the ballthe art of communication in healthcare. Wrong-Site Neurosurgery. Probiotics and VAP Prevention. Beta Blockers Take More Hits. More on Computerized Trigger Tools. Preventing Delirium. Managing Delirium. Lessons from Falls Hot Topic: Handoffs. Checklists and Wrong Site Surgery. More on Radiology as a High Risk Area. Less is More. Updates on VAP Prevention. Arterial Line Issues. Jerome Groopmans How Doctors Think. Heparin-Induced Thrombocytopenia.

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    Technology Workarounds Defeat Safety Intent. Medication Reconciliation: Topical and Compounded Medications. Preoperative Screening for Obstructive Sleep Apnea. Computerizing Trigger Tools. Oxygen as a Medication. More on MRSA. Lessons from Ophthalmology. Housestaff Awareness of Risks for Hazards of Hospitalization. The Hospital at Night.

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    MRI Safety. More on Tracking Test Results. Reducing Errors in Obstetrical Care. Thoughts on the Recent Neonatal Nursery Fire. More on the Cost of Complications. Managing Dangerous Medications in the Elderly. Urinary Catheter-Associated Infections. Fall Prevention. Happy Holidays. Bed Rails. Surgical Fires. More on Rapid Response Teams. Don Norman Does It Again! Medication Reconciliation Tools. Errors in the Laboratory. Taking Off From the Wrong Runway. Lessons from the National Football League. Wristbands: The Color-Coded Conundrum. Root Cause Analysis of Chemotherapy Overdose.

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