Following a deadly weekend helicopter crash, the chairman of the National Transportation Safety Board said Monday that an increase in medical flight accidents is a "serious issue" that the safety agency is very concerned about.
At a Monday press conference in Arizona, NTSB chairman Mark Rosenker said those accidents have reached a "disturbing level" following a small reduction in accidents after the NTSB's 2006 report on EMS aircraft.
Two emergency medical helicopters collided Sunday afternoon in Arizona as they were each rushing a patient to a Flagstaff, Arizona hospital. The crash, which is the fourth involving one or more medical evacuation helicopters in less than two months, left six people dead. A nurse, the sole survivor, is hospitalized in critical condition.
According to the NTSB, this weekend's crash was the ninth accident involving EMS aircraft this year and the first to involve two aircraft that were both operating as air medical flights.
"It's extremely unusual," said ABC News aviation consultant John Nance. "First, because there's not that many of them and second, because they're usually very much aware of each other's operations."
Watch "World News with Charles Gibson" TONIGHT at 6:30 p.m. ET for the full report.
The falling debris from the accident missed a nearby neighborhood by a few hundred yards. Two emergency workers sustained minor burns in the aftermath of the crash when one of the aircraft exploded on the ground. The crash also ignited a 10-acre brush fire that firefighters soon contained.
The crash may be the latest warning signal to insiders in aviation safety that more measures are needed to ensure the safety of the emergency medical workers and patients onboard the life-saving aircraft. Prior to this tragedy, the June 8 crash of a medical helicopter near Huntsville, Texas, killed four — the patient, the pilot, a nurse and a paramedic.
Though several crashes in a period of a couple of months may be seen by some as just a terrible coincidence, government officials have noticed a very real upward trend in the past 15 years, prompting the U.S. National Transportation Safety Board to investigate.
Many details of Sunday's accident remain sketchy. The names of the dead, as well as the identity of the critically injured nurse, have not yet been released. And the exact cause of the accident remains a mystery for now.
"There is no one, single magic bullet cause" for a medical helicopter crash, says Jeff Guzzetti, deputy director for regional operations at the NTSB Office of Aviation Safety in Washington, D.C.
However, experts say a major contributor to the surge in helicopter accidents in general is the massive increase in the number of medical helicopter flights. A growing number of Americans over the age of 60 are in need of medical care; emergency rooms, hospitals and ambulance services around the country have closed; and changes the way health care is delivered to rural areas mean there are far more EMS helicopter flights now than just a few years ago, according to the Association of Air Medical Services.
In 2002, there were about 400 dedicated EMS helicopters, but that number rose to more than 800 in 2008, according to the association. The number of hours logged for medical helicopters more than doubled between 1991 and 2005 to 300,000 hours in-flight a year.
Most of these rescue missions aren't the ones citizens watch at an accident scene or see on a televised broadcast from a remote mountain trail. In fact, roughly 70 percent of medical emergency helicopter flights now run between hospitals, says Blair Beggan, communications and marketing manager of the Association of Air Medical Services in Alexandria, Va.
Beggan explains that hospitals are increasingly specializing in their care, such as cardiac or orthopedic treatment. Although every hospital keeps an open emergency room, it's not unusual for staff to send serious cases to the nearest specialty hospital.
"Medical helicopters are one of the most important medical service that we have in the US, especially as our roads get more and more crowded," Nance said. "They do make the difference between life and death."
A recent beneficiary of this service was Sen. Ted Kennedy, who took such a flight from the Cape Cod Hospital in Hyannis, Mass., to the Massachusetts General Hospital in Boston last month.
"The health care industry is rapidly changing," says Christopher Eastlee, government relations manager for the Association of Air Medical Services. "There's a misconception that when you get hurt, the hospital nearest you is the best equipped to take care of you.
"A lot of what we find is, you have these hospitals that are outlying the suburbs or exurbs or rural areas that are not equipped to handle some of these patients," he said.
With the two-pronged increase in flights to the scene of accidents as well as between hospitals, the NTSB might reasonably expect to see a relative increase in accidents.
But the number of crashes has outpaced the increased flight numbers. The NTSB reports that since 1991, the rate of helicopter accidents increased from 3.53 for every 100,000 flight hours to 4.56 accidents for 100,000 flight hours.
The problem of extracting what keeps going wrong in these crashes — and why — becomes compounded by the fact that no single entity governs medical flight helicopter services.
"Air medicine is a unique combination of two distinct industries — aviation and health care," Beggan says. "Each service is independent, or could be part of a group of similar programs."
However, all helicopters, medical or not, are governed by safety rules under the Federal Aviation Administration. By examining 50 example crashes, Guzzetti and his colleagues at the NTSB found five common causes in the majority of medical helicopter accidents.
Primarily, the NTSB found helicopter crews could have followed the more rigorous FAA safety standards set for flights with patients, even if only the medical staff are onboard while on the way to the accident scene.
The NTSB also found a lack of systematic weather safety checks before takeoff and a lack of consistent dispatch procedures for helicopters. New technologies to improve "terrain awareness" and night vision would also keep the medical flights safer.
Even with the medical airlift industry's shortcomings, patients with serious situations that warrant a medical flight — such as heart conditions, potential brain injuries or strokes — are better off in the air.
Emergency medical helicopter flights can transport patients quickly, while simultaneously offering crucial medical care.
"That's where the profound benefits come in," says Eastlee, who adds that the industry is happy to hear the NTSB guidelines, even if it's a long battle to update an entire fleet of helicopters.
"Regardless of the number, or the trend, any accident is one too many," Eastlee says. "Unfortunately, the technology moves faster than the red tape."
"The only thing that would prevent all accidents, 100 percent, would be if we never took off," said Dawn Mancuso, executive director and CEO of the Association of Air Medical Services. "But that would mean hundreds of thousands of patients would die because they wouldn't be getting the care they need in the time they need it."
ABC News' Lisa Stark and Matt Hosford and The Associated Press contributed to this report.