WASHINGTON - Stacy Friedman didn't think her sister's job was particularly risky.
As a flight nurse for Airlift Northwest, her sister, Erin Reed, tended seriously ill or injured patients being transported by helicopter.
Then on Sept. 29, 2005, the helicopter that carried Reed, 48, another nurse, Lois Suzuki, 47, and pilot Stephen Smith, 59, crashed into Puget Sound. All three were killed.
It was dark and raining at the time, but the cause of the accident was never determined.
Now, Friedman says she wants to honor her sister's memory by making the job of emergency medical workers safer.
"We didn't really understand, I think, that what Erin did for a living was all that dangerous," said Friedman, who lives in El Dorado Hills, Calif., east of Sacramento.
Friedman is advocating stricter helicopter-ambulance safety regulations that U.S. Sen. Maria Cantwell has proposed to add to a Federal Aviation Administration reauthorization bill before Congress.
The changes would set new standards for emergency medical helicopter flights, require the aircraft to install computerized warning systems that alert pilots when they're too close to dangerous terrain, and mandate voice and flight data recorders to aid accident investigations.
The emergency aviation industry opposes many of the proposed regulations, arguing they would be costly and ground some lifesaving flights but wouldn't improve safety.
Between 1998 and mid-2004, there were 83 accidents involving medical-transport helicopters, the FAA says.
A study last year by the Johns Hopkins University School of Public Health found that helicopter emergency medical crews are 16 times more likely to die from job-related injuries than the average U.S. worker.
A separate study last year by the National Transportation Safety Board (NTSB) found that most fatal accidents involving medical helicopters occur without a patient on board.
The study attributed that in part to less-stringent FAA standards when flying without a patient. For instance, under federal regulations, pilots must maintain visibility of at least two miles at low altitudes when patients are on board. But there is no minimum visibility standard when flying without a patient.
Reed's helicopter wasn't carrying a patient when it crashed. The twin-engine A109/Mark II was flying back to its base in Arlington shortly after 9 p.m., after transporting a critically ill man from Cascade Valley Hospital in Arlington to Harborview Medical Center in Seattle.
Pennsylvania-based CJ Systems Aviation Group owned the helicopter that crashed. Ed Marasco, the company's senior vice president of air medical services, said some of the requirements that Cantwell proposes particularly the terrain warning system recommended by the NTSB would be too expensive for many operators to implement quickly.
If air ambulance helicopter companies can't afford the equipment, "The reality is there are going to be sick people who are not going to get health care because they cannot be flown," Marasco said in a phone interview.
On May 11, the Association of Air Medical Services sent a letter to Senate Commerce Committee members that said the industry has worked hard to improve safety for patients and crew over the years.
But the proposed regulations, the letter said, would have a significant negative impact, "adding millions of dollars to the costs of out-of-hospital care and decreasing public access to needed emergency care without a corresponding increase in safety."
Marasco said he supports more cost-effective ways to improve safety, such as equipping helicopters with night-vision goggles.
Friedman first learned about the air ambulance safety issues at a U.S. Senate hearing in January 2006. The hearing was called to discuss the John Hopkins and NTSB studies.
She began trying to enlist the help of her congressional delegation in California as well as Washington state's lawmakers to make emergency medical system helicopters safer for pilots and nurses.
During that first trip to Capitol Hill, Friedman met with legislative staffs.
She returned three months later, a little more prepared, but found that she was giving the same information to the same people, who acted as if they'd never heard it before.
She put together a more formal presentation and in March this year began trying to get "higher up the food chain," she said.
She and her family members never landed a meeting with a representative or senator, although someone on Cantwell's staff suggested it would be easier to add more stringent safety standards to the FAA Reauthorization Act than to push for new regulations.
Friedman said she didn't expect much, but then she got a call earlier this month from a member of Cantwell's staff saying the senator would add the safety language to the FAA bill.
"He said sometimes when you ask for things, they happen," Friedman said.
The proposed safety regulations are still in the Senate Commerce Committee. "Things take a lot of time to make happen in Washington," Friedman said.