Lax safety led to fatal medical air crash, investigators say

Federal investigators say a lax safety culture led to the crash of a medical helicopter last year in snowy weather in Ohio that killed three people

WASHINGTON — A lax safety culture at an air ambulance company led to the crash of a medical helicopter last year in snowy weather in Ohio that killed three people, federal investigators said Tuesday.

Survival Flight’s “inadequate management of safety” led the pilot to depart in deteriorating conditions. The helicopter was heading from one hospital to another to pick up a patient in January 2019 without a thorough pre-flight weather evaluation, the National Transportation Safety Board said Tuesday.

All three occupants – pilot, flight nurse and flight paramedic – were killed in the crash in rugged terrain about 75 miles (120 kilometers) southeast of Columbus.

“This accident was all but invited by the actions and culture of Survival Flight,” NTSB Chairman Robert L. Sumwalt said in a statement.
“Unfortunately, we have seen yet another case of how a poor safety culture can lead to tragedy.”

The safety board made six recommendations for changes at the company including revising flight risk assessment procedures “including procedures for determining prior flight refusals by another helicopter air ambulance operator and forecast en route weather.”

Ryan Stubenrauch, a spokesperson for Survival Flight of Batesville, Arkansas, called the accident “a tragedy that took the lives of three brave people who’d dedicated themselves to saving others.”

“We’re learning from this tragedy and have already completed five of the NTSB’s six recommendations with ongoing work on the final recommendation,” Stubenrauch said in a written statement. “Survival Flight will continue to learn, improve and adapt as a company in order to better serve our communities and save lives.”

The Bell 407 helicopter, which wasn’t supposed to operate in low-visibility conditions, made a sharp turn after encountering the second of two bands of snow showers – probably as the pilot tried to gain visibility, investigators said — but failed to maintain altitude and hit trees before going down near the tiny community of Zaleski.

Killed were pilot Jennifer Topper, 34, of Sunbury, Ohio; and flight nurses Bradley Haynes, 48, of London, Ohio, and Rachel Cunningham, 33, of Galloway, Ohio.

Two other companies had opted not to accept the assignment over concerns about the weather that day, authorities said, but the pilot didn’t know that and didn’t know about potential bad weather along the planned route.

Current and former Survival Flight employees told investigators there was pressure from managers to operate flights in challenging conditions and to take flights other operators declined because of poor weather, the safety board said.

Survival Flight pilots and operations staff routinely failed to comply with pre-flight risk assessment procedures because such noncompliance had become “‘normalized’ by Survival Flight’s deficient safety culture,” the board said.

Stubenrauch declined to comment on those assertions.

The board also faulted the Federal Aviation Administration’s oversight of the company’s risk management program and said it had repeatedly urged that all on-demand aircraft operators, including helicopter air ambulances, be required to have formal programs and procedures to manage safety risks. An email seeking comment was sent to an FAA representative.

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