One person was killed when a medical helicopter crashed Jan. 6 in Tupelo, Miss. Four days later, two people died and one person was seriously injured when a medical helicopter crashed into the Potomac River in Washington, D.C.

Officials with the Federal Aviation Administration (FAA) were so concerned with the number of fatal crashes involving emergency medical helicopters — which caused 18 deaths in 2004 — that they met in late January with people who provide air ambulance services to re-emphasize safety measures and pilot decision-making.

Since then, seven people have been killed in similar crashes, including a pilot and two nurses who died when an Airlift Northwest helicopter plunged into Puget Sound on Thursday night.

"What they do is dangerous, let's face it," said Allen Kenitzer, an FAA spokesman based in Renton.

Between 1998 and mid-2004, there were 83 accidents involving medical-transport helicopters, but Kenitzer couldn't say how many of them proved fatal.

He said the main cause of all helicopter crashes is "controlled flight into terrain" — which means a helicopter is "flying along straight and level and then boom," it crashes into a mountain, the ground or a body of water.

Flying in bad weather, especially at night, is also a leading cause of crashes since pilots can experience "spatial disorientation" when they can't see outside the aircraft and have to rely on instruments to navigate, Kenitzer said.

The purpose of the January meeting was to provide guidance for safety inspections and to help operators review decision-making by pilots and mechanics, Kenitzer said.

"We are concerned, very concerned, in light of what's happened," said Kenitzer's FAA colleague, Mike Fergus, referring to the number of fatal crashes in recent years.

The group that met in January was focused not on coming up with new regulations but in "re-emphasizing and going over everything we can possibly think of to do with helicopter flight safety," he said.

Though flight safety has been the focus of recent discussions between the FAA and people who operate air ambulance services, the number of fatal crashes seems to reflect an increase in the use of such aircraft, said Blair Beggan, a spokeswoman for the Virginia-based Association of Air Medical Services, a national organization representing medical-transport services and businesses.

Growing usage

In 1980, 30 medical helicopters were in service nationwide; 10 years later, there were 230, Beggan said. By 2000, 375 medical helicopters were in service, a number that has since jumped to more than 650, she said.

The "two big reasons" for the increase are the aging population and changes to the rural health-care system, Beggan said. The country's rapidly growing population of people over 60 means more people have more complex medical needs, she said. As the population has aged, more people have suffered heart attacks, strokes and other "time-critical diseases" that require quick transport to hospitals with specialized services.

At the same time, many of the country's rural hospitals have been closing their emergency rooms and reducing hospital stays, which means patients with complex medical problems can't be adequately cared for in their home communities and need to be transferred to trauma centers or urban hospitals with more services, Beggan said.

350,000 patients a year

Helicopters shuttle about 350,000 patients to hospitals every year in the U.S., said Beggan, whose association represents 280 members. Those members include Airlift Northwest, which serves Western Washington and Alaska, and the Spokane-based Northwest MedStar, which operates in Eastern Washington.

According to data compiled by the association, 10 people died in medical helicopter crashes in 2003; 13 in 2002; five in 2001; and 11 in 2000.

"Yes, we've seen an increase [in fatal crashes], but it could be an exponential increase with the number of helicopters now flying," Beggan said.

But her association wants to examine the trend more closely and is preparing to launch a database to better track medical-flight operations over the past five years, she said.

At the association's annual conference in Austin, Texas, later this month, three days will be dedicated to educational sessions, many focusing on safety, Beggan said.

Sara Jean Green: 206-515-5654 or sgreen@seattletimes.com