ROBERT SIEGEL, Host:

From NPR News, it's All Things Considered. I'm Robert Siegel.

MELISSA BLOCK, Host:

And I'm Melissa Block. This year's been the deadliest on record for EMS Helicopters. Twenty-eight people have died in seven separate accidents. There's no common thread in the crashes. They've involved bad whether, pilot disorientation and mistakes by the flight crew, but the record number of accidents has gotten the attention of the EMS Helicopter Industry, Federal aviation officials and even Congress, as NPR's Russell Lewis reports.

RUSSELL LEWIS: Imagine it's a dark, rainy night and your car skids off the highway. It's bad, really bad. Bad enough emergency responders don't think an ambulance will get you to the hospital in time. You're lying on the side of the road when a bright light appears from above.

(Soundbite of helicopter)

LEWIS: Your best chance of survival is an emergency helicopter and what you don't know - what you'd rather not know - is that this year, these aircraft have killed a record number of people. Aviation safety expert, Christine Negroni.

Ms. CHRISTINE NEGRONI (Aviation Safety Expert): I think if people knew how unsafe emergency medical helicopters are, they would not choose to get on them.

LEWIS: This year's fatal crashes have happened at night, during the day, in good weather and bad. Pilots have flown into tower guide wires, lost control in the clouds, and in the worst accident, two EMS helicopters collided in mid-air above Flagstaff, Arizona.

Ms. NEGRONI: There's an acceptance in the world of emergency medical aviation that there's going to be some death involved. That's wrong. That's wrong-headed, it's immoral, it's bad math.

LEWIS: In the last two decades, more than 200 EMS helicopters have crashed killing at least 150 people. This year's fatalities, 28, or twice as many as any past year. National Transportation Safety Board member Robert Sumwalt, says his agency is concerned.

Mr. ROBERT SUMWALT (Board Member, National Transportation Safety Board): This is a business that is supposed to be going out saving lives and when we have people that are actually losing their lives, not only is it tragic, but it is downright sad.

LEWIS: The EMS helicopter industry has seen rapid growth, and aviation experts say needed government safety oversight has been lacking. In the past eight years, the fleet has doubled to 900 aircraft. Most are operated by private companies.

Mr. ROY SUMJA (Emergency Medical Services Helicopter Pilot, Madison County, Alabama): For take-off check, (unintelligible) the in flight gate.

LEWIS: In Madison County, Alabama, pilot Roy Sumja and his paramedic and nurse prepare for a flight. Federal health privacy rules prohibit reporters from flying on a real emergency. But this training mission is like a regular call. Dispatchers tell the crew where to go, but nothing more. They don't want that to affect the pilot's decision-making.

(Soundbite of Dispatcher on Radio)

Unidentified Woman: (unintelligible) Madison County for New Market. Madison County for New Market.

LEWIS: It's not until the helicopter has lifted off before the crew gets information about the patient. In this case, a car accident about 10 miles away. A helicopter is inherently unstable. The pilot has to keep both hands and feet on the flight controls. He must navigate by peering out the window and using instruments, monitor several radio frequencies, and look out for trees and power lines. Once he gets to the accident site, Pilot Sumja circles above the scene. His nurse, Rhonda Bailey, calls out obstacles.

Ms. RHONDA BAILEY (Nurse, EMS, Madison County, Alabama): Got the lines to the east and to the west.

Mr. ROY SUMJA: Got them. Thank you.

LEWIS: The helicopter lands safely and then it takes off again for a hospital. Back at the airport, pilot Roy Sumja says safety comes first. He never feels pressure to start a mission or continue one if the weather deteriorates. But this year's deadly accidents have made him pause.

Mr. SUMJA: If we ever took any chances, we're certainly probably not taking a map. We really err on the side of safety. If there's any question, we just don't go.

LEWIS: Aviation experts say what could save lives is if the government forced helicopter operators to install cockpit equipment that would warn pilots about terrain, mandate night-vision equipment, and even require a second pilot. The NTSB has made safety recommendations to the Federal Aviation Administration for years - recommendations that could have saved lives but the agency hasn't instituted them. FAA's Peggy Gilligan says, it's a slow bureaucratic process.

Ms. PEGGY GILLIGAN (Deputy Associate Administrator, Federal Aviation Administration): Rules are like laws, they take time because we want to be certain that anyone affected by it has an opportunity to comment on it. You want to seriously consider those comments and then you want to move forward to a final action.

LEWIS: But 2009 may be the year of change. The National Transportation Safety Board will hold hearings in February to try to figure out why an industry that's designed to save people's lives is killing them at record levels. Russell Lewis, NPR News, Birmingham.

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