MEMPHIS, Tenn. - When Hospital Wing celebrated its 20th anniversary, the air ambulance chairman said, "We've never had an accident. It makes me nervous just saying it."
Since Dr. Bruce Steinhauer made that statement to The Commercial Appeal in 2006, the Memphis-based air ambulance service has experienced two fatal accidents that killed a total of six people.
The crash Tuesday near Somerville, Tenn., that took the lives of the pilot, a nurse and a respiratory therapist pushes the U.S. toll for air-ambulance fatalities so far this year to 12. It's the first time such deaths have reached double digits since 2010 when 16 people died.
JEMS: NTSB Investigates Tennessee Medical Helicopter Crash
That was the same year when Hospital Wing's streak of 24 fatality-free years ended. A Hospital Wing pilot and two nurses died in a crash near Brownsville, Tenn. A National Transportation Safety Board (NTSB) probe concluded the pilot's "risky decision" to outrun an approaching thunderstorm probably caused the 2010 accident.
JEMS: Hospital Wing Pilot Tried to Beat Storm Prior to Crash (2010)
Hospital Wing was cited for six relatively minor safety violations between 1994 and 2009, each involving the air ambulance's employee drug-testing program, according to FAA records.
A seventh alleged violation in 2010 was investigated but resulted in no action by the FAA.
None of the violations lodged against the Memphis Medical Center Air Ambulance Services Inc., branded as Hospital Wing, resulted in anything more severe than a letter of correction or a warning letter, the records show.
Nationally, the record of helicopter ambulance crashes is "unacceptable," concluded a 2011 study by the NTSB. The agency determined that while many air ambulance services adopt best practices for pilot training, aircraft equipment and operations, "some have not."
"Not all air ambulance operators are created equally from a safety perspective, the NTSB report stated.
Over the past 16 years, annual deaths from medical helicopter flights have totaled as low as three (2012 and 2001) and as high as 18 (2004) and 28 (2008). The average has been 10.5 deaths a year.
Thirteen medical helicopters have been involved in fatal crashes since the beginning of 2010, with two of those crashes involving the Memphis air service.
Safety recommendations that emerged from NTSB public hearings on the medical helicopter crashes included a call that the FAA develop criteria for scenario-based training that includes simulators. They also called for pilot training to fly by instruments during low visibility.
The NTSB also recommended that the FAA should require systems that alert helicopters to terrain conditions, night-vision imaging systems and autopilot if a second pilot is not aboard.
The FAA addressed the NTSB recommendations which became effective in 2012.
Under the heading "Not all operations are the same ... but Medicare reimbursement is the same," the NTSB report described helicopters that cost $800,000 to $3 million that have one engine, are flown by a single pilot only, have limited weather capability and have limited weight capacity.
The report compared those to helicopters that range from $4 million to $12 million, have two engines, can have two pilots, and come with auto pilot, a longer range, and instrument weather capability.
The report posed the question: "To what level are helicopters that you utilize operating?" The level categories are world class, best practices, basic regulatory compliance or substandard performance.
Hospital Wing is part of a nonprofit consortium called Memphis Medical Center Air Ambulance Services Inc., which was formed by the city's three largest hospitals in 1986.
Hospital Wing generated $15.1 million in revenue in 2011, according to the latest report required of nonprofit organizations. Its expenses that year totaled $13.9 million.
According to its 2011 nonprofit report, Hospital Wing transported an average of 181 patients a month, with 38 percent being trauma patients. The service also flies patients from community hospitals to Memphis for specialized care.
Hospital Wing flies a 150-mile radius that encompasses parts of Tennessee, Arkansas, Mississippi, Alabama, Missouri and Kentucky.
The service provided more than $2.8 million in charitable care to patients unable to pay in 2011, according to its nonprofit report.
Efforts on Tuesday to reach Hospital Wing officials who could describe the safety measures it takes and safety investments it makes were unsuccessful.