Although they have saved thousands of lives, the medical choppers that rescue and transport patients have also claimed the lives of hundreds of crew members in the past 29 years. The $2.5-billion-dollar private industry often pressures inadequately supplied pilots to fly under dangerous conditions, according to a Washington Post investigation published online today.

A ride in a medical helicopter can cost as much as $20,000, much of which goes to the copter company, so pilots are pressured to give lifts to as many patients as possible. And the industry is growing rapidly. In 1980, the Post reports, the U.S. had about 40 medical helicopters. That number has grown to more than 800 today, with many states having more than 40.

But unlike commercial airplane flights, these helicopters are not required to have some of the basics, such as collision-avoidance systems, radar altimeters or black boxes, the Post reports. And even though a majority of deadly accidents happen at night, fewer than half of helicopters have night-vision goggles for pilots. One Florida-based pilot told the Post: "I'm hoping we will get them before long. Because a lot of the areas we fly are dark, it would be a great help."

As underscored by the fatal tourist helicopter crash earlier this month over the Hudson River in airspace between Manhattan and New Jersey, helicopters of all sorts frequently take low-altitude and hazardous routes that can be congested with other aircraft.

The Federal Aviation Administration (FAA) doles out relatively low fines to the industry when accidents do occur. "I'd rather use a carrot than a hammer," John Allen, the FAA director for flight safety standards, told the paper. The agency has refrained from creating sweeping regulatory changes for these companies. As Allen told the Post, when the FAA "starts asking for data from the industry, they get very nervous."

Basics, such as flying hours and pilot fatigue, have proved difficult for the FAA to investigate. "You don't have to be a math wizard to understand that missions equal revenue, and revenue equals survivability in the air business," Randy Layman, a ground coordinator for a fatal 2004 chopper flight, told the paper.

And income isn't confined to the helicopter companies. "A patient flown in by helicopter can mean thousands of dollars in downstream revenue" for the hospital where the person is admitted, Paul Taheri, of the University of Vermont, who wrote a paper on the subject, told the Post. "That fact is not lost on hospital administrators." Neither does it appear to be lost on the emergency dispatchers who often select which helicopter company is called to the scene.

Despite the occasional rap for being hovering hazards, medical helicopters are frequently symbols of rescue and heroics, which improves the images—if not the bottom lines—of all involved, notes the Post. "It's the equivalent of a medical centerfold," Thomas Judge, executive director of a Maine helicopter company, told the paper. "It's sexy advertising." 

Image courtesy of audreyjm529 via Flickr