Abstract
The Helicopter Emergency Medical Service (HEMS) industry plays a crucial role in developing an industry approach to risk management in the area of air medical transport. The aviation sector has been known to manage risk at very high levels, but the current state of HEMS, given the many accidents, needs higher level risk assessment. An analysis of the risks involved in the HEMS industry would allow operators to maximize their opportunities and minimize probable threats. While some risks are uniform to most HEMS operators, there are some risks that are unique to an operator. For this paper, Air Methods Corporation will be the operator under investigation. The analysis provided in this paper will be rank-based, including “very high” and “high” risks because they have greater impacts on an organization. Some of the risks will also be about the entire HEMS industry.
Keywords: risk, risk analysis, Helicopter Emergency Medical Services, Emergency Medical Services, accidents
Air medical transportation is a significant element of health care in many nations, especially in countries with an excellent geographical coverage. In such countries, the traveling time to a hospital facility may be excessive by ground ambulances, and people living in remote regions may lack proper health care services (Kontogiannis and Malakis, 2012). This form of transport may also be necessary in cases of national emergency and rescue. In many instances, there may be no alternatives for air medical services or these services may be cost effective over the lifetime of the patient because they provide appropriate initial care. Therefore, effective air medical resources are necessary to the current Emergency Medical Services (EMS) systems in any country.
In the United States, Helicopter Emergency Medical Services (HEMS) and EMS are offered through several relationships encompassing Part 135 air carriers, EMS agencies, hospitals, and public entities. To demonstrate the effectiveness of HEMS, the Association of Air Medical Services reports that these helicopters transport almost half a million patients every year in the United States (Kontogiannis and Malakis, 2012). Also, since 1995, the number HEMS helicopters increase at an annual rate of about 130%. Today, there are more than forty Helicopter EMS providers in the United States, including Air Methods Corporation, which is the focus of the risk analysis in this paper.
Air Methods Company Profile
Air Methods was founded by Roy Morgan and was incorporated on 1st April 1987. The Air Medical Service (AMS) Division of the company offers air medical transport services to about forty states in the form of community-based services and hospitals and other health care institutions in the form of hospital-based services (Air Methods Corporation, n.d.). Most of the patients receiving these services are either accident victims who need intensive care or patients in general care institutions who need to be transported promptly to skilled trauma hospitals or tertiary health care facilities. The services offered by this Division include aircraft operation and maintenance, medical billing and collections, and a twenty-four-hour communication and dispatch. Currently, the company has more than three hundred helicopters operating mostly the national center in Omaha, Nebraska.
The Air Methods has not looked back since the beginning. It has always expanded its service delivery both geographically and in the number of patients transported to the healthcare facilities in the United States. For example, in 2007, it acquired CJ Systems Aviation group, which also offered Helicopter EMS (Air Methods Corporation, n.d.). Four years later, there was another acquisition, Omni-flight, which currently operates as an Air Methods subsidiary.
Current Safety Concerns
The National Transportation Safety Board indicates that there have been sixty-two HEMS-related accidents in the United States between 2008 and 2014. The report states further that these accidents could have been avoided by considering simple precautions such as flight risk assessments, oversight, integration of new technology and advanced dispatch procedures (Bledsoe and Smith, 2014; Kontogiannis and Malakis, 2012). In the year 2009, the NTBS analyzed some nine HEMS-related accidents which led to the death of thirty-five people and consequently included HEMS safety in its “Most Wanted List” of transportation safety developments (Kontogiannis and Malakis, 2012). Despite being a leader in HEMS industry, Air Methods have had its share of accidents over the past decade. The latest of these accidents occurred on 26th August 2011 when four people, including three crew members and a patient, lost their lives when one of the corporation’s helicopters crashed when it was approaching Liberty Hospital in Missouri. Initial reports stated that the helicopter had run out of fuel, and that was the primary cause of the accident. However, in 2013, it was alleged that the pilot was texting when the helicopter was mid-air (Bledsoe and Smith, 2014). He had received four texts and sent three during that flight. It was also found that the pilot had been deprived of proper sleep, as evidenced in one of those texts, which would be the reason why he forgot to check his fuel status before taking off.
The increase in the number of helicopter EMS accidents has become a major concern not only for Air Methods but also for the entire industry. The government, for example, has committed to thoroughly investigating the root of this phenomenon (Bledsoe and Smith, 2014). Air Methods has realized that efficient risk management would allow the firm to channel resources strategically to meet governance obligations, financial goals and enhance safety levels.
Purpose
The purpose of this analysis is to determine the hidden and systemic issues affecting Air Methods that have the ability to bring about operational and safety risk with the aim of addressing the issues that, so far, have not received due emphasis.
Objectives
Determine the systemic risks in Air Method’s structure that may contribute to operational and safety risks.
Provide accurate opinions concerning the organizational risks in one paper that may be transferred to other agencies in the HEMS industry and adopted as a focal point for encouraging a sense of responsibility for change.
Risk Analysis
Most of the risks the Air Methods Corporation faces are similar to those of other companies in the industry (Kontogiannis and Malakis, 2012). For this paper, the analysis will consist of some risks which are unique to Air Methods and some which pertain to the industry as a whole. The risks to be covered in this analysis will be only the “very high” and “high” risks because they tend to be more significant to Helicopter EMS providers than the “moderate” and “small” ones.
Very High-Risk Level
Limited definition of the EMS framework
When HEMS was introduced the initial structure did not make provisions for the current situation, hence it has changed over the past twenty years into the current system without a proper framework. As a result, the state-based EMS are neither connected nor uniform. There is also a considerable nationwide divergence in standards, which may hold significant implications (Kontogiannis and Malakis, 2012). This risk is concerned with policy. Hence, any change in the organization’s public safety resources would help much. What is needed is a restructuring of the national EMS framework to take care of the national, state and local requirements of health care delivery.
Ineffective medical reimbursement model
The current medical reimbursement model of Air Methods may be considered as insufficient to offer the desired degree of financial coverage for both the operating expenses of providing Helicopter EMS and the potential enhancement of capability needed as a result of technological advancement (Kontogiannis and Malakis, 2012). The entire industry faces a similar risk and consequently, there is a retention of the irregularities in the payer model from one state to another. The corporation may not be able to afford new technology. It, therefore, needs to adopt and implement a revenue model that sufficiently caters for both the operation expenses and financing future capability upgrade initiatives.
Unclear responsibility of the parties involved
The roles of federal, state and national agencies taking part in HEMS are complex and lack clarity because there is not a particular regulatory body in charge of the oversight of the HEMS system wholly (Kontogiannis and Malakis, 2012). There are irregularities with the criteria that govern the application for HEMS public safety resources. The relevant authority should, therefore, clarify the responsibility of each stakeholder and
Inconsistent standards and license requirements
There is a cumulative risk linked with the irregularity from state to state concerning standards and licensing requirements for HEMS (Kontogiannis and Malakis, 2012). There is also a variability among states regarding the authority to determine a need for, and position of, fresh or current HEMS initiatives and bases; thereby creating widespread inconsistencies in the quality and safety of HEMS transport. Integration mapping to determine the regulatory gaps and possible overlaps would mitigate this risk.
Competing Interests among organizations in the industry
The EMS industry tends to have many organization having different models that have competing agenda and interests. Thus, there is a likelihood of inducing industry-level competition which would serve to increase the operational and safety risk exposure of the entire industry (Kontogiannis and Malakis, 2012). Air Methods has to attain a high level of self-governance and corporate oversight that would efficiently determine, evaluate and manage the risks within the organization that promote risky operational and safety practices. These resources should be integrated into its health care ethics system.
Underdeveloped safety management systems
Safety management systems are new to the EMS industry and are considered to be underdeveloped to manage the speed and degree of changes needed in the safety process and practices (Kontogiannis and Malakis, 2012). Air Methods has conceded to having little confidence towards the regulator because it does not provide guidance for implementation. Evidently, these systems have become less of a priority to the company, and the status quo has taken effect. Air Methods should consider calling the industry to action to implement Safety Management Systems before its assigned compliance-based timelines. The corporation should seek the industry’s commitment to creating an integrated safety management system that caters for the aviation, medical and communication components of the Helicopter EMS industry.
Lack of a specific regulatory agency
The HEMS industry lacks an accredited agency that would offer general definition and monitoring for aviation, emergency, and health care management functions to give the industry an outline (Kontogiannis and Malakis, 2012). The organization should try initiating an interagency task force that would take responsibility for defining and evaluating the issues concerning the common denominators of these three pillars in the HEMS industry.
High-Level Risk
Thin line between the roles of aircrew and medical personnel
Possible non-compliance because of multiple stakeholders in the industry
The compliance framework for governing the HEMS industry is somewhat complicated and confusing because multiple stakeholders oversee it. Consequently, there is a great likelihood that Air Methods and other HEMS operators are not complying with some of the regulations. Two main factors seem to be contributing to this risk (Kontogiannis and Malakis, 2012). First, the compliance framework that runs the HEMS industry is designed by three disciplines: healthcare, aviation, and emergency services. Second, it is difficult to determine the overlap between these compliance frameworks because they are not clearly mapped out. As a leader in the industry, Air Methods should push for a cross-discipline regulator to access the interceptions of the Helicopter EMS industry at the greatest level.
Lack of a data-based safety analysis
The safety assessment techniques used for the Helicopter EMS industry currently is not based on data. Consequently, it is difficult for Air Methods to gain a proper understanding of the actual safety issues affecting the corporation and the industry as a whole (Kontogiannis and Malakis, 2012). Air Methods needs to develop a data collection, assessment, and management strategy for the AMS Division to achieve a more accurate safety analysis. The company should also consider creating a vehicle for sharing statistical information with other operators in the HEMS industry for the purpose of trend analysis.
Insufficient use of simulators and advanced training techniques
Only a handful of the AMS Division personnel has undergone a thorough training in simulators and modern technology required for efficient HEMS delivery, unlike other Divisions in the company. This situation exists mainly because of the expenses that would be incurred in acquiring the equipment and other resources that are needed for advanced training methods (Kontogiannis and Malakis, 2012). The company should consider joining efforts with other operators who are keen on using simulators on new helicopters. The company should also be able to identify resource and proficiency concerning simulator working groups at and industrial level.
Varied participant profiles
The profile of patients and medical personnel in Air Methods varies considerably as compared to the other Divisions in the company. This is because the patient barely has an opinion on which operator would take care of his or her transportation (Schmidt et al., 2016). The implied duty of care for the medical staff and the patient on board the helicopter cannot be considered to be met. This risk is difficult to treat to some extent but the company to should always comply with Part 35 standards at all cost.
Ineffective operational control arrangements
The company suffers a significant level of inefficiency in operational control, which contributes to a risk of poor operational decision making. The implementation of the current control arrangements is not efficient and therefore the company has found itself, at least once over the past two years, misaligning responsibility for flight operations or having pilots make tasking decisions before they gain access to the relevant information (Bledsoe and Smith, 2014). Thus, Air Methods is encouraged to improve its operational control arrangements. The company needs to develop proper strategies aimed at enhancing communication both within the organization and with other operators in the HEMS industry.
References
Air Methods Corporation (n.d.). Air Methods - Defenders of Tomorrow - Air Medical Transport. Retrieved from AIRM website https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjCk8z4qZDNAhUBOxQKHbNNDKcQFggcMAA&url=http%3A%2F%2Fwww.airmethods.com%2F&usg=AFQjCNFJNBMbQ6l_dbU7-D8Pvcx-Zc9PBg&sig2=45k9PhKmMt43ikoPaqJNGQ&bvm=bv.123664746,d.d24
Bledsoe, B. E., & Smith, M. G. (2014). Medical helicopter accidents in the United States: a 10-year review. Journal of Trauma and Acute Care Surgery, 56(6), 1325-1329.
Kontogiannis, T., & Malakis, S. (2012). A systemic analysis of patterns of organizational breakdowns in accidents: A case from Helicopter Emergency Medical Service (HEMS) operations. Reliability Engineering & System Safety, 99, 193-208.
Schmidt, A. R., Ulrich, L., Seifert, B., Albrecht, R., Spahn, D. R., & Stein, P. (2016). Ease and difficulty of pre-hospital airway management in 425 paediatric patients treated by a helicopter emergency medical service: a retrospective analysis. Scandinavian journal of trauma, resuscitation and emergency medicine, 24(1), 1.
