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Investigative Reporter Delivers DiagnosisThe following speech was delivered

byAndrew Schneider, medical editor forthe Pittsburgh Press, at the annualAwards Luncheon at the ASHBEAMSConference held Dciober 14, 1987.

I usually avoid speaking about aproject until it is over, until everythinghas been published. But in return forASHBEAMS' agreement to help usgather the research and data that weneeded, I had to agree to come andspeak here. When 1 made thatagreement, we assumed we werelooking at three or four months oflearning what we needed to know andwriting the story.

We are now eleven months into it,and we still don't know everything weneed to know. We're still working on it.We did get a lot of cooperation and weappreciate it, and we need more. All butone of the 231 programs we surveyedresponded with the information. Ail butone of the vendors agreed to beinterviewed at length and discuss theirperspective of the industry _. how itworks and the problems. All but one ofthe manufacturers were willing todiscuss at great depth their perceptionof the safety problems, the equipmentissues, the things that they deal with.

Many ofyou in this room spenthundreds of hours with me and mycolleagues, teaching USwhat we neededto know, helping us understand whatyour problems truly are.

After surveying the 230 programs,visiting about 60 of them, and flyingmore than 250 missions, we came upwith one overwhelming conclusion thatprobably the vendors and the hospitaladministrators are not going to like toheal'. And that conclusion is that justabout everyone in this room is horriblyunderpaid! And we think somethingshould be done about it.

But all joking aside, we did find someshortcomings out there. We went tohospitals and programs and foundbeautifully worded weather minimumpolicies, strongly endorsed by theadministrator, the program director,the lead pilot. But sometimes later thatvery day, we saw aircraft from thosevery same programs, launching in thefog or snow so heavy that you couldn'tsee the skids 30 feet above the pad.

We were lectured on how closelyprograms work with their competingprograms to ensure safety. But later the

same day, we'd see that same programaccept three flights when a programonly 4 miles away with identicalequipment declined it because theythought the weather was unsafe.

Administrators insisted they neverpressured pilots to take mission, thatthe final decision was always withthem. But we were on a flight 15 milesaway from the base when the pilot raninto sloppy weather and wanted toabort, and reported back to medicalcommand and a shrill voice came overthe earphones saying, "How can you dothis? Ifyou don't go, the baby will die."

We met mechanics who treated theiraircraft with more care and love thanthey probably show their wives or girl­friends· who work for long hours tryingto track down that one weird noise oran unexpected vibration. But we alsofound cases where records were falsifiedand daily inspections required byairworthines:l directives weren't done.

We found lots of tired pilots, hut wefound lots of other people tired at threeo'clock in the morning. We sawprograms with four pilots working 12hour shifts where the RNs and theparamedics were working 24 hourshifts. Much has been said about whatfatigue does to pilots. 1 think someoneshould look at the quality of medicalcare being given on the floor of thathelicopter by flight crews at the end ofthose 24 hour periods.

We were Iectured by medicaldirectors that their aircraft w~s.a~integral part of their CQmmunltlesemergency medical care system and

Andrew Schneider

they worked hand in glove. But laterthat same afternoon, we bypassed threehospitals that could offer moreappropriate treatment and had ~eopleavailable, so we could fly the patientback to the sponsoring hospital.

We found lots of problems. I don'tthink I have to belabor them becauseyou deal with them everyday. You knowwhat they are. You're professionals inyour field. We tell you that we do P,ut itinto perspective. In one of our stonesearlier this month, we wrote: "With allthe shortcomings, the pittsburgh Pressfound that a vast majority of theprograms operate safely, and are staffedby dedicated and highly trained Crewsthat save thousands oflives a year." Webelieve it; we say it in many of ourstories.

Let me give you an opinion. Thebiggest enemy of ~erom.edical " ..evacuation is not 60 Mmutes, It s not"20/20," it's not me and my.work forthe Pittsburgh Press or Scnp~s/Howard, it's not even a certam U.S.senator who, when the TV cam~ras arcrolling, likes to compare the accidentrate of med-evac helicoptc~s to that ofcommercial jets. I truly believe yourbiggest enemy is yourself1 .

Four years ago I was teUmg myfriends in your profession t~at they hadbetter start letting the public knowexactly what it is that yOU do, how youdo it and why you do it. You have a ,great story to tell.and yOU truly haven tbeen telling it. It IS somethmg yo~should have been talking about sincethe time you turned your first rotor.

You are very lucky. You've gotHoward Collett and Jim p~ge putting(Jut great magazines that diSCUSS atgreat length what you do. You've gotyour own outstanding journal whichaddresses important issues. But theseare trade publications. These arcprofessional journals wri:ten byprofessionals for professionals. But thepublic doesn't get to see the issues ; theyaren't exposed to them. They should he.

Almost every hospital out there isvery good at publishing slick, multi­color quarterly newsletters but as a rulethe public doesn't see these either. Andit is the public that must clearlyunderstand what you're to do ifyou areto have its support.

To those hospital public relationspeople that might be in the room, I gi\'l'you my apologies. YOU 'Tl' probably not

:::

HOSPITAL AVIATION. NOVEMBER 1987 1 1

Viewpoint

right through them."In Virginia, I was given this critical

information by a hospital spokesperson,"He was probably dead when theyloaded him on the helicopter, but one ofthe nurses electrocuted him while theother one poured gas or somethingdown his throat."

But by far the most disturbingcomment that I've heard from hospitalP.R. types from allover the country is,"Our helicopter saves hundreds oflives."My apologies to Agusta, Bell, MBB,Aerospatiale, Sikorsky, and the rest ofthe manufacturers, but my partner andI have flown on more than 250 missionsthis year. Yes, we were sped to the scene

risks involved. There will be crashes.You could put ten pilots on eachaircraft. You can install full IFR oneverything with a rotor. You can flyonly when the sun is shining verybrightly. You can paint the helicopterspink. You can do anything you want tomake it safe, but with 231 programsflying more than 442 helicopterseveryday of the year, you're going tolose some, no matter how cautious youare, or what you do and I think that is afact of aviation.

For days after those crashes, it willbe allover the front pages of your localnewspapers and lead every newscast onradio and television stations. Nothingyou can do will prevent the coverage ofthe crash or diminish the pain and lossthat will be felt by many. But what youdo before the crash will help keep it inperspective. The public has got tounderstand the benefits in perspectiveto the risks. It is not only the publicthat needs to understand your missionand your problems. The governmentneeds help also.

There is an amazing lack ofknowledge specific to your industry inthe Federal government, in the peoplethat are developing recommendations

"iii and regulations. In the last year, I've~ ?nly been able to find a handful peopleCD In the FAA and the NTSB who really~ understand the Med-Evac mission. Max~ Haliburton, who is in this room does.Q important rotorcraft things for the~ FAA. Bob Dodd from the NTSB who isit doing this one person investigation and

Andrew Schneider fliesaboard a BK-l17 withflightnurses from Ufe Flight busting his fanny on it, spends the time.. p'ttsburgh PA. The flight was one of morethan 250 made nationwide. Dr. John Lauber, a b~ard l?ember ofIn I , NTSB, has been fightmg air ambulancegiven the time and unfortunately some quickly in a helicopter, but if that issues for years. These three peopledon't have the interest to learn what machine saved a single life, we missed understand. They've taken the time toyou do. If you can somehow get people it. talk to you, they've visited yourfrom your program to be the We saw lots of people saving lives. We programs, they've spent hours with you.spokespersons to the media and to the saw mechanics who cared enough to They've partied with you. But there arepublic, I have a feeling that life would make it work. We saw dispatchers who very few of them.be a hell of a lot easier for you. Let me got involved in the right direction and There are other issues beinggive you a couple of the examples of sorted out the emotional gobbledy-gook considered that go beyond thesome of the statements made to me in coming from the field. We saw pilots upcoming words of David Kress in thethe last ten months by P.R. people we who got us there and back quickly and Advisory Circular that we are allencountered around the country. safely, often landing in LZs that were waiti~g for. There arc other factors now

In Michigan, a press spokesman told just criss-crossed with wires that a bird entering the picture, and a lot of thoseme, "Our helicopter can fly in the couldn't fly through. We saw medical factors don't deal solely with aviationheaviest ice storm because the blades on teams who knew what they were doing, issues. There are strong rumors thattop spin so fast that they knock all the did it when they got there, and gave suggest that HHS [Health and Humanice ofT." that patient every chance to survive. Services] is going to recommend or

In Northern California I heard, "We Helicopters did not save the lives -- demand some type of system wherehave no problem flying in fog because people did. Too many hospital public Med-Evac programs are eitherwe have this big sunlight on the bottom relations people and administrators accredited or certified by a jointand it can cut through anything." rush to give the credit to the shiny commission type body. Rumors from

In Ohio, a public relations person two-million dollar aircraft sitting on the people within the agency indicate thattold me, "We don't have to worry about pad and not the people it carries. the leverage on this may in fact be somehitting wires. We have the biggest The public has got to understand type of spinofT from Medicarehelicopter made and it can just crash what you do and why you do it and the reimbursements, not from

going to like what I say. There are somesignificant exceptions, but as a rule,hospital public relations people shouldnot be handling the routine dailyrelationships between the media andthe flight programs themselves. And I'lltake that a step further, public serviceprograms should have people on theirflight staff dealing with the press, themilitary M.A.S.T. units should havepeople on their flight staff dealing withthe press.

I say this because most publicrelations people, while very skillful atkeeping embarrassing statements fromappearing, truly don't understand whatyou do, because they are usually not

. ,

12 HOSPITAL AVIATION, NOVEMBER 1987

What Pat Walker doesn'tknow just saved her life.

This reconditioned Sikorsk yS-76 EMS is roughly the sameprice as a much smaller, lesscapable helicopter.

But you'd never know it.Sikorsky's S-7() is the bestEMS helicopter in the world,a flying emergency roomwith space for a medicalteam of four and a patient.

Modular design permitsany EMS configuration to beset up quickly, from Traumato Neonatal to organ trans­plant missions. Built orig­inally for rugged offshore oilduty, the S-76 has a 400-milerange. And when it reallymatters, it can really move,Ask Pat Walker.

A number of previouslyowned S-7()s arc availablenow, each completely recon­ditioned tor EMS lise, atabout half the original cost.For information, please tclc­phone Mackie n Mott at(203) 3HI-(115o.

~UNITEDTECHNOLOGIES

KORSKYA RCRAFT

reimbursement on the Medicarepatients you fly but some kind of tieinto the hospitals. Whether it eversucceeds or not remains to be seen, butI assure you that there at least twogroups who are spending a lot timelooking at it. If you choose not to setyourself up as the accreditation groupfor your Industry, please don't complainwhen someone else less qualified getsthe responsibility.

The medical area is going to getmuch more attention in the comingyear, and not just from the government.The seven million dollar lawsuit inKnoxville that alleges that a seventeenyear old boy died because he was takenby an aircraft to an inappropriatesponsoring hospital is just thebeginning. I know personally of fourother similar cases around the countrythat lawyers are getting ready to me. Iknow of six other cases where lawyershave investigators gathering otherinformation. I am worried that you ofthe medical area have got to startprotecting yourself. Ifyour area or yourcommunity doesn't have a strong triageguideline, you may find yourself listedon that lawsuit. You may find yourself

Viewpoint

caught in the middle. I think you've gotto pay some attention to what yourliability is in your community.

You've come of age. In the beginningof this year, we couldn't get through aweek without a newscast discussingyour industry and usually veJY criticallyand sometimes with a negative slant.Now you can't get through a nightwithout having your real estatecompany telling us how dedicated flightnurses are and why they make goodcustomers for their houses.

You've got "Dallas" showing theworld how you saved a bum victim andyou've got Buck Jones, trauma surgeon,climbing out on the skids of hishelicopter 300 feet above the ground toassess a couple of patients clinging to asteel beam. You've become part of themainstream now. You've made it toprime time entertainment. I wouldwOfJY about what is going to happen ifyour clients start demanding you dowhat Dr. Jones does because I thinkwe're really going to have someproblems then.

I am going to share with you someviews that you have shared with me.And at this point, I would like to

remind that I was asked to come hereand share with you some things that wedidn't publish.

Three o'clock in the morning is agreat time to do interviews. Theadministrators aren't there. The chiefflight nurses and the lead pilots arerarely there. Everyone is so wired oncoffee and 50 tired that they will justtalk. I had lots of late night discussionsin some of these ready rooms. And oneof the things that quickly becomeapparent is that there is a lot of discordin this industry of yours. Some civiliangroups bad-mouth the public servicesector. Some pilots strongly denouncethe nurses. Some nurses stronglydenounce the pilots. The only thingeverybody denounces equally is thehospital food.

There a lot of people out there whohave strong opinions and concerns.ASHBEAMS is criticized by some of itsown members as being ungodly slow ontaking a stand on anything, andthought by some to be obsessedprimarily with the interests of hospitaladministrators and vendors. NEMSPAis perceived by many to be overzealousin its approach and concerned only with

11.I certify that the statements made by me abovearecorrectandcomplete. Signature and title of publisher.HowardM. Collett

STATEMENT OFOWNERSHIP, MANAGEMENT AND CIRCULATION(Required by 39 U.S.C.3685) 1A. Title of Publication: HOSPITALAVIATION; 18. Publication Number:0740-8315; 2. Dateof Filing:December 1, 1987; 3. Frequency of Issue: Monthly;4. Completemailing address of knownoffice of publication: 90 EastFirstSouth,Suite103, St.George, UT84nO; 5. Completemailing address of theheadquarters of generalbusinessoffices of the publisher: Sameas#4; 6. Full namesand complete mailing addressof publisher,editorand managingeditor: Aviation Press, Inc.90 East FirstSouthSuite103, St. George, UT84nO; HowardM. Collett, Editor,90 EastFirstSouthSuite103,St.George, UT84770; 7: Owner: Aviation Press, Inc.,90 EastFirstSouth Suite103,S1. George, UT84nO; Stockholdersowningor holding 1 percentor more of total amount of stockofAviation Press, Inc. are: HowardM. Collett,90 EastFirstSouthSuite103, St. George, UT84no; 8. Known bondholders, mortgageesandothersecurityholdersowning or holding 1 percentor more of totalamountof bonds, mortgagesor other securities: None.

A.Totalnumbarolcopl.. (nelpr_ run) 1409B. Paldand!Ofrequestedclrculatlon:

1. Sal.. lhtough daale.. lInd carrie.., 0IIr... vendors and counter aaJat .2. Mail lubscrtpllonl 727

C.Tclal paid and!Ofreqlletted Circulation 7ZTO. F_ dlltrtMon by mall. carrieror other meanseamplet, compllmentaty lind other frae COP/Oil ~E. Totaldlltribullon 1326F.Copies not dlalribuled:

1.0111<:41 u",lall owr, u~nted,lpolled 83alIerprinling2. Retum from news agents 0

G.Total (Sum of E, Fl lind 2l 1409

10. Elden\ lind natura01clrculallon

Awraga NumberCoplet Each lnuaDurtngPreceding

12 month,

Aclual NumberCopl.. Single ISluePubUlhed Nearest

10FlIIngCata

2000

o

802802

9481750

250

o2000

EXECUTIVE DIRECTOR

A neWly formed consortium of threemajormedical centers in St. Louis, Missouri haspurchased the M.A.R.C. program of 81. LouisUniversity Medical Center.

The newprogram, ARCH, will operate threehelicopters as a region-wide resource ineastern Missouri andwestern Illinois servingmorethan 225 hospitals and EMS agencies.

ARCH is currently seeking an executivedirector. Candidates should have solidadministrative experience in operations andfinancial management of a helicopter program.Medical training a plus, but not necessary.

Send resume with clear salary history to:

BOARD OF DIRECTORSARCH

8401 Hanley Industrial Court51. LOUis, MO 63144

14 HOSPITAL AVIATION. NOVEMBER 1987

the issue of fatigue and not necessarilyspeaking for all the pilots. There is afeeling out there that it can no longerbe a question of ASHBEAMS talking tothe pilots. There is a feeling out therethat pilots and their concerns andinputs must be a full and equal part ofthis group just as flight nurses, theparamedics, and the physicians must be.

There is also concern that doctorsmust take a more active role not only inwhat they do in their own backyard butin perhaps developing guidelines thatcould be instituted throughout theirstate and perhaps even nationally.

There is an amazing amount ofdedicated talent in your ranks. Thereare brilliant ideas being instituted andimplemented by some programs andjust across town where they coulddesperately use the same thing, theydon't know about it.

I don't think you people are talkingto each other enough. If you are talking,I don't think you are listening. Youhave got lots of the answers out there.You have got to develop a forum wherethis information is going to get towhere it is needed. I believe thatpolitical bickering and back-stabbing

Viewpoint

has got to end.ASHBEAMS has served a vital

function during the formative years ofthis profession. Great work was doneand is still being done. But it is 1987and things are changing. You are in thespotlight and you're going to be for awhile. You are considering changing thename ofASHBEAMS to the Society ofAir Medical Services or whatever youhopefully decide. I think that's greatbecause half of the people in this roomcan't tell you what ASHBEAMS means,let alone the public.

But that change is just not enough. Ithink now is the time for you to domore. You've got to begin workingtogether to really communicate witheach other, to share your problems, toshare your solutions, to speak with aloud, clear, single voice because that isthe only way you can control whathappens to your profession. If you donot control your profession, yourindustry, there are outside factions thatwill eagerly jump in to do it. You havegot to take a more active role indeciding your fate. Decisions are beingmade that will affect your professionand your future. You've got to get

involved in guiding these decisions.I want to close with a quote that we

ended one of our stories with on Sundayand it is from Dr. John Lauber from theSafety Board. And John says, "We'llnever be able to stop all accidents.Aviation doesn't work that way. Butthese Med-Evac helicopters and thepeople who staff them know what it isthat is causing their accidents andproblems. We have got to listen to themand give them the laws, regulations,and the support they must have so theycan solve those problems that aresolvable and save their own lives 50they can get on with the business ofsaving the lives of others.•

Andrew Schneider is the medicaleditor ofthe Pittsburgh Press, nationalcorrespondent with the Scripts-Howardnews service serving 250 newspapers inthis country. He is a two-time PulitzerAward winner for his investigativereporting. He has worked very closelywith the aeromedical industry,completing 2,000 interviews.in a ten-.month period. He has been inuolued znEMS for 20 years beginning in Vietnamwith medevac coverage.

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Position available for full-time EMShelicopter pilot in northwestern

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HOSPITAL AVIATION. NOVEMBER 1987 15