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DURING THE PAST TWO AND A HALF


DECADES IN THE UNITED STATES AND ELSEWHERE, THOSE ASSOCIATED WITH COMMERCIAL AVIATION OPERATIONS HAVE COME TO ACKNOWLEDGE A BROAD RANGE OF SYSTEMIC FACTORS THAT MAY AFFECT THE QUALITY OF A PILOT’S DECI- SION MAKING PROCESSES DURING FLIGHT.


transport operations, the medical crew members on board are close enough to the sharp end of the accident sequence to be considered “affil- iate” sharp-enders. During the past two and a half decades in the United States and


elsewhere, those associated with commercial aviation operations have come to acknowledge a broad range of systemic factors that may affect the quality of a pilot’s decision making processes during flight. In partic- ular, an interest in identifying the root causes of EMS helicopter accidents has prompted research to carefully review and analyze the information gathered by the NTSB in their investigations of those accidents. A careful review of the accident dockets shows that the NTSB


investigative procedures do not typically look very deep into the com- plex systems in which air medical helicopters operate. Due to the con- straints imposed by very limited resources, and faced with the difficulties of processing any evidence other than that which is the easiest to gath- er and to interpret, the investigations tend to focus on the traditional sharp-enders and upon such tangibles as the weather and the physical evidence of the aircraft wreckage. Aircraft maintenance records and pilot logs and training records are examined and information from any avail- able witnesses is carefully gathered and documented. But eyewitness accounts, even when they are accurate, can only shed more light on the terminal link in the accident chain. There remains a need to identify, clas- sify, and mitigate each of the systemic factors that may have played a sig- nificant role in the preceding causal sequence. A formal classification of these factors is helpful because a carefully structured system of classifi- cation will facilitate the effective and economical development and imple- mentation of a system of interventions to prevent future occurrences of similar accidents. Review and analysis of NTSB accident investigation dockets by the


Joint Helicopter Safety Advisory Team (JHSAT) and recommendations by the Joint Helicopter Safety Implementation Team (JHSIT) have laid an initial foundation for the identification and mitigation of the causes of helicopter accidents. In addition, the current efforts of a research effort


titled


Opportunities for Improvement in Helicopter Emergency Medical Services (OSI-HEMS) are focusing specifically on the air medical heli- copter accidents that have occurred in the United States from 1998 through 2009. This on-going project began in January 2008 under the direction of Dr, Ira Blumen of the University of Chicago Air Medical


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