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By any measure, 2008 was a tragic year for the U.S. helicopter emergency medical services (HEMS) industry. From December 2007 through October 2008, 35 people lost their lives in 13 helicopter air ambulance accidents — the most ever in an 11-month period. According to calculations by Dr. Ira Blumen of the University of Chicago, the fatality rate for HEMS crewmembers in 2008 was 164 per 100,000 employees, ranking it as the most dangerous job in America that year.
Since then, a concerted industry-wide effort has attempted to improve safety in the sector, with Congress, the Government Accountability Office (GAO), Federal Aviation Administration (FAA), National Transportation Safety Board (NTSB), industry experts, and the media all playing a role in addressing HEMS safety issues. The NTSB held a public hearing on the subject in 2009, which led to them issuing recommendations.
Among other things, the NTSB wanted to see HEMS operators adopt safety management systems, night vision imaging systems, autopilots, scenario-based training, and flight data recording devices. Some of the NTSB’s recommendations were incorporated into a final rule issued by the FAA in 2014, while operators have voluntarily adopted others.
Around this time, one company, the offshore and air medical operator PHI, Inc., decided that simply reducing the accident rate wasn’t enough; that its goal should be no accidents at all. So, in late 2010, PHI launched a safety initiative called “Destination Zero” that extended to its HEMS operations under PHI Air Medical, LLC.
“Destination Zero was born of a desire to change and strengthen our culture, to have a sense of direction and a platform to direct our energy and aspirations for a more focused, more deliberate approach to safe operations,” explained PHI president and chief operating officer Lance Bospflug. “When we launched Destination Zero, our goal was to create a work environment that is accident- and incident-free — a work environment with zero personal injuries, zero flight accidents, and zero preventable occurrences.”
Beyond a commitment to continued investment in technology, systems, and processes, the organization set out to make Destination Zero a belief system that changed the culture of the company by fundamentally empowering individual employees.
“With education, ongoing engagement, and unwavering commitment by leadership at every level of PHI, Destination Zero became a movement across the company — with people embracing their responsibility to ‘Stand Up, Speak Out and Take Action’ as important as any function for which they were responsible,” Bospflug said. “Because our workforce and stakeholders are constantly changing, it is a message which needs to be told and retold so that new employees, new partners, and customers understand the passion, the history, the fears, and the expectations that were behind its original intent.”
Understanding that a culture of safety needs to be supported by a solid and proven framework, PHI set out to develop a robust safety management system (SMS). Guided by International Civil Aviation Organization (ICAO) and FAA standards, PHI initially developed its SMS using the four standard pillars of safety policy, safety risk management, safety assurance, and safety promotion.
However, as the company evolved its approach to the human element of safety, it came to believe that the traditional SMS required new and additional connection points to ensure the safety and well-being of employees and customers.
“[We] recognized that it is the human factors that most determine the ability to achieve and sustain Zero,” Bospflug said. “The more we introduced new initiatives around the human element, the more we recognized that they were obscured in a traditional SMS. We believed to ensure their full effectiveness and longevity, we needed to officially place them where they belong — at the heart of our SMS — in a codified manner.”
Consequently, PHI added a fifth pillar to its SMS, the human dimension of safety, which addresses the mental, social, and psychological well-being of individuals as it relates to one’s performance. This pillar now sits at the center of PHI’s SMS and influences and connects each of the other four pillars, reflecting how human beings influence each component of a safety management system.
“Within the fifth pillar, we will expand our work on, and support of, Destination Zero, life-saving thinking, life-saving behaviors, and brain-centric hazards and individual and team reliability. Within this new pillar, we will work on important initiatives such as unhealthy fear mitigation, fatigue risk management, the role of positivity on performance and more,” Bospflug said.
“And, the more we explore human boundaries, the more we recognize the need to better understand, manage, and support the mental, social, and physiological aspects of the human dimension,” he continued. “That is at the core of this pillar, one that is not only in compliance with the FAA and other global regulatory bodies, but demonstrates an unwavering commitment by PHI to do what is right and best for each employee.”
PHI announced the addition of this fifth pillar to its SMS in December last year. Bospflug said that initial feedback to the concept has been positive, “yet we are clear that we must continue to demonstrate a program’s merit before our informed, intelligent workforce will truly buy in and own it.” He said the company intends to take a sustained, methodical approach to introducing, educating, and reinforcing the elements of the human dimension of safety.
However, Bospflug is optimistic about its long-term potential. “We believe the human element, and the science around it, will be transformational in how we empower our employees to be and work safe,” he said. “We have only begun to scratch the surface of the human element, and as we continue to invest in the understandings and drivers of the human psyche, we will uncover new and more profound ways to educate, inform, and engage our employees to embrace the safest behaviors and practices.”
What PHI is doing isn’t just noteworthy for the aviation and air medical transport communities; it could potentially benefit all companies that rely on humans to perform tasks.
“Regardless of the industry, we all share one thing — people,” Bospflug said. “People are at the heart of our success and our ability to be and work safe. This is true for healthcare, petrochemical, energy, aviation, and many other industries. When it comes to human factors, it doesn’t matter what industry it is; people are what define success.”
Despite its current financial difficulties (PHI, Inc. filed for Chapter 11 bankruptcy protection in March 2019 in order to address the upcoming maturity of its unsecured senior notes and strengthen its balance sheet), PHI’s commitment to safety and more specifically human factors science will serve them well as they enter the second decade of their journey to Destination Zero.
“Through the human dimension of safety, we are making a bold statement that even in a changing and even challenging economic environment, we will continue to build upon what we have invested the most in over the past decades — the most important element of safety — each of our people,” said Bospflug.
As an industry, we should appreciate PHI for its transparent commitment to zero being not only obtainable, but also the only acceptable number of accidents.