Air Methods is one of the founding members of air medical operations in the U.S. Roy Morgan started the company in 1980 to fulfill his dream of operating a medevac helicopter and saving lives. Mortgaging his house, he bought a Bell Long Ranger and put it to work at St. Mary’s Hospital in Grand Junction, Colorado. He and his team of nurses flew their first patient their first night in business.
His company continued to grow, expanding into air medical interiors and completions as there were few other sources for that work. Air Methods became well known for high-quality interiors, and customer completions grew faster than new hospital programs. The company would go on to create medical interiors for the Army’s Black Hawk, an initiative that would become a significant source of revenue.
As Air Methods grew, Morgan brought in business professionals to run day-to-day operations. Determined to expand by buying market share, they embarked on a search for acquisitions. The largest was Rocky Mountain Holdings, the parent of Rocky Mountain Helicopters, one of the biggest commercial operations in the U.S. Based in Provo, Utah, Rocky Mountain operated a large fleet involved in all segments of commercial helicopter operations. Its air medical unit operated helicopters throughout the U.S. For Air Methods, the acquisition was more complex because Rocky Mountain was a much larger company. But when it was done, Air Methods emerged as the largest air medical services provider in the U.S., a position it maintains to this day.
Air Methods employs more than 1,400 pilots and operates 450 aircraft. From corporate headquarters in Denver, it manages more than 400 bases in the U.S. The company accounts for about 65 percent of all U.S. medevac operations.
High Accident Rates
The civilian medevac community saves more than 40,000 lives a year, but it comes at a cost. Almost 450 medevac crew members have been killed as they as they've flown across rough terrain at night, often in marginal weather conditions, to reach trauma victims who without the helicopter to save them would likely perish.
Accident statistics testify to the danger medevac crew members endure. In 2001 the fatal accident rate for airlines was 0.011 per 100,000 hours, and air charter operations had a rate of 0.60. For helicopter air ambulances, the rate was 1.64 fatalities per 100,000 hours, almost 150 times worse than the rate for airlines.
About 77 percent of medevac fatalities are attributed to pilot error, with the most dangerous of all causes being inadvertent entry into instrument meteorological conditions. This is when pilots fail to recognize they are entering worsening weather until they are enveloped, then lose control and crash. A near-constant stream of these accidents, dubbed IIMC, has plagued commercial helicopter aviation.
From 2005 through 2017, Air Methods experienced 56 accidents, of which about 15 percent were IIMC-related. And yet, its safety record was four times better than the average for all medevac operators.
The culture of the commercial helicopter business, which experienced a trend-breaking expansion after the Vietnam War, may have contributed to the problem. Most of the pilots were veterans whose instrument training had been minimal. According to retired CW5 Joe Walker, who attended helicopter flight school at Ft. Rucker in 1968, flew in Vietnam, and then taught new pilots how to fly, students received only basic instrument training. “We got some time in the ‘Blue Canoe’ [the original Link trainer/simulator] and that was about it,” he said.
“When we were flying in Vietnam, we did all we could to stay out of clouds,” Walker explained. “But a lot of pilots flew into them as they tried to avoid ground fire, at night when they couldn’t see where they were going, or when the weather changed rapidly as it did on any given day over there. A lot of pilots lost their way and crashed.” Pilots returning from the war who went to work for utility operators strongly preferred to rely on visual flying skills rather than their rudimentary instrument training to survive encounters with weather.
Pilot training and the limitations of training aircraft have been factors as well. While commercial airplane pilots are instrument trained and usually have experience flying in actual instrument conditions by the time they take their first flying jobs, that's not the case with helicopter pilots, even those who complete formal instrument training. They may complete instrument training while wearing a view-limiting device or hood but then they never transition to flying in actual instrument conditions. The reason: none of the helicopters available to flight schools are certified for IFR. So, unlike their peers in airplane training who likely experience actual IFR conditions as a part of their training or shortly thereafter, helicopter students, even those who go on to become helicopter instrument instructors, have rarely if ever flown in actual instrument conditions.
Commercial operators have never considered this a problem. Aerial survey, fire-fighting, logging, and other such operations all focus on the ground environment and visual contact with their objectives.
Challenging Conditions
While air medical missions are in visual conditions at their terminus—the scene where the patient is picked up—the route from the base to the scene often is over rough terrain and in unknown, often terrible weather conditions. And it is likely to be at night, when most accidents and other trauma events happen, all of this creating the right environment for IIMC encounters.
Nearly 450 medevac crew members have died, with IIMC encounters the most significant cause of accidents. And yet, in the pilot training environment, the requirements for passing an FAR Part 135 initial or recurrent checkride in a helicopter state that the pilot must “…demonstrate the ability to maneuver the rotorcraft solely by reference to instruments.” How is it then that pilots being trained under Part 135 fail to cope when encountering unforeseen instrument conditions?
One answer may be that, until recently, almost all medevac helicopter training was done in the aircraft, with minimum time allotted for instrument training. What little time was allotted was done under a hood. Medevac pilots wear helmets so the choice of view-limiting devices is minimal. Foggles, which are worn like glasses, are the accepted device.
The problem with these is they are made for cabin environments in which the windshield glass does not extend below the airplane cabin’s lateral centerline, so the pilot’s view is generally limited to the instrument panel, with the rest obscured by the hood or Foggles. But a helicopter has windows clear down to those between the pilot’s feet, the so-called chin windows. With Foggles or a hood on, a pilot still can see out the bottom half of the helicopter, negating the purpose of the training, which is to fly by reference to instruments alone and not outside visual cues.
Having taken numerous 135 checkrides in these circumstances, I can attest that I had plenty of visual attitude cues while flying with Foggles on. So the training and checking process for IIMC survival does not subject the pilot being trained to actual instrument conditions.
Improved Training
Given that pilot error was the root cause of most of Air Methods’ accidents, the management team identified improved pilot training as a key remedial factor in reducing accidents. To that end, it was decided to transition the training programs from the in-aircraft environment to simulators. The FlightSafety facility in Denver was commissioned for that very purpose. The Air Methods training team had identified the economic benefits of simulator training, but it was equally important to refine and improve the curriculum and the course structure using simulators. The ultimate result: creating more-focused, better-defined scenarios and measurably improving pilots’ skill levels.
Early in the process, several pilots were having trouble with the IIMC scenarios. Air Methods training managers identified the problem as a lack of basic instrument flying skills. They had to create a short course to review and teach pilots instrument flying basics sufficient to manage an IIMC encounter. Pulling together the fundamentals from instrument training resources, they designed a course that could be taught in a single simulator session. Within the scope of remedial training as prescribed in FAA Part 135, instructors could administer the course when needed, equipping the pilot with the skills required to successfully complete the IIMC training.
For pilots attending recurrent training, Air Methods developed IIMC scenarios that would take them into slowly decreasing visibility during the assigned mission in one of the simulator sessions. The preflight briefing would include advising pilots that they might encounter worsening weather and a review of IIMC protocols. It might also include a question on whether the pilot had ever had an IIMC encounter and, if so, how he or she handled it. The objective of the discussion would be to ensure pilots had a clear picture of how to avoid deteriorating weather and the steps they should take should they inadvertently enter IMC.
The instructor might set the weather to 1,000 feet overcast with five miles visibility. As the flight climbs to a cruising altitude of 800 feet, the instructor, over two or three minutes, slides the visibility down to a mile while keeping up a chat about other details of the flight.
Pilots should, at that point, call out the decreased visibility and initiate a 180-degree turn. If they do, then they are commended for their decision-making. If they don’t, the visibility drops rapidly to zero. The pilot is allowed to respond without further input from the instructor. If the pilot does manage to maintain control and asks for a vector to visual conditions, the instructor might suggest that no safe VFR weather is close by, including the fact that it has closed in behind them. The pilot should ask for vectors to an airport and an instrument approach. Then the instructor works with the pilot to fly to an airport and execute the approach.
If the pilot instead loses control and crashes, then the instructor would review how the pilot allowed himself to fly into IFR conditions and what he might have done to maintain control. The instructor would then start the short IIMC course, planning to take the pilot through it in an hour or so of simulator time. The events planned for that hour would be pushed back into the following simulator session.
By the end of the course, the pilot should be comfortably flying instruments such that he or she can maintain control and execute a plan to fly to an airport and complete an approach.
Those who did recognize the deteriorating conditions could expect another scenario in which the weather closed in on them faster than they could react to it, giving them the chance to fly in the cloud environment the simulator provides and manage the problem.
Success
The program worked. Within a few months, pilots who had experienced problems were successfully flying out of the weather and completing their recurrent training, all while demonstrating their ability to manage an IIMC encounter.
The results have been profound. Since the simulator training program was launched in early 2017, Air Methods has not experienced any IIMC-related accidents. The training team had effectively identified the problem and solved it. Air Methods chief pilot Raj Helweg agreed this was an accomplishment to be credited to his dedicated team but he is also philosophical about it. “We launch dozens of flights every day all over the U.S. under all kinds of weather and terrain conditions,” he said. “We seem to have gotten the IIMC problem under control, but we always have more work to do. We can never stand on our laurels.”
What does the future hold to build upon that success? IFR certification is finally moving into smaller helicopters, thanks to lower-cost autopilots with sophisticated stability augmentation and envelope-protection features. Recent examples include the Bell 407GXi and Leonardo’s A119, which are now certified for IFR. According to a senior training pilot at Air Methods, the company anticipates a transition to IFR operations in these helicopters and other types in the fleet as they become IFR certified. This will inform a more comprehensive instrument pilot training program and the potential for at least limited IFR operations, if for no other reason than to give pilots the option to enter the IFR system should they encounter unforeseen weather. Just the ability to climb or descend through a marine layer in coastal cities or fly through ground fog that otherwise is mission-stopping would be significant operational breakthroughs.
Industry leaders like Air Methods recognize the benefits of this new technology and are hard at work implementing it, within the limits of cost and logistics challenges that come with such dramatic changes. Tragic accident causes like IIMC will be minimized and medevac flight operations could, in the not-too-distant future, be conducted with the same high levels of safety as those in other segments of aviation.