The Associated Press

FLAGSTAFF -
A fiery collision that killed six people aboard two medical helicopters has underscored the dangers of emergency flights and renewed questions about whether they are worth the risks.
Experts agree air ambulances can save lives when the victim is in grave condition and the hospital is a long way off or hard to reach by road. But they say there are other cases in which an ordinary ground ambulance is just as good, and perhaps safer.
The collision involved two helicopters that were arriving with patients Sunday at Flagstaff Medical Center. It was the ninth accident in the U.S. this year involving emergency medical aircraft, bringing the number of deaths to 16, National Transportation Safety Board officials said Monday.
"This has been a serious issue," NTSB chairman Mark Rosenker said. "We're going to work very, very hard to make sure we understand exactly what happened here, determine the probable cause and make recommendations to prevent it from happening again."
Crashes of medical aircraft have been on the rise since the 1990s for a number of reasons, experts said. It is a booming business, fueled by the closing of emergency rooms in rural areas and an aging population, according to the National EMS Pilots Association. The number of emergency medical helicopters has climbed from roughly 400 in 2002 to more than 800 now, according to the Association of Air Medical Services, an industry group in Washington, D.C.
From 2002 to 2005, about 1 of every 50 medical helicopters in the U.S. fleet was involved in a crash, according to a report by the Congressional Research Service. That is a far deadlier rate than that of the U.S. airline industry, which earlier this decade went nearly five years without a single commercial jetliner crash.
The report also cited NTSB figures that said the accident rate for emergency medical helicopters has risen from 3.52 accidents per 100,000 flight hours between 1992 and 2001 to 4.56 accidents per 100,000 flight hours between 1997 and 2001.
Dr. Bryan Bledsoe, an emergency medicine physician who teaches at the University of Nevada and has researched accident rates of medical helicopters, said flights benefit only a small subset of patients, such as those needing a cardiac stent or balloon within a 90-minute window.
But helicopters aren't necessary for transporting most other patients and needlessly expose them to danger, Bledsoe said.
While helicopters are faster than ground transportation, traditional ambulances can often get patients there quicker, given the difficulty of finding places to land helicopters and the decision sometimes to turn off the engines when the aircraft arrives and then power them up again when it is time to take off, Bledsoe said.
Bledsoe said 2 out of 3 patients transported by an EMS helicopter generally have minor injuries, and 1 in 4 is sent home without being admitted to the hospital. He said the standards for the severity of injuries for transporting people are too low.
"It's an amazingly liberal criteria, and because the industry is driven by profit, there is little movement to change it," Bledsoe said.