In the industry as a whole, "From a competition standpoint, there are pressures sometimes to fly," Air Methods' Stockhausen said.
Air Methods has a corporate philosophy to base all decisions to fly on aviation factors, he said. But others may face pressure, Stockhausen said. "I mean, let's face it - most of us are in it to make money, so if you're not getting the volume, then you're not covering your costs."
Even when financial issues are not a concern, "We have gotten caught up in the life-saving mission, and that allows us to maybe not make the best decisions," Stockhausen said. "It seems there are times when crews will 'push the weather"' - flying when perhaps they shouldn't.
It's an inherent tendency of air-ambulance pilots who have a "rescuer mentality," Slack said.
Last year, the air-ambulance industry in Colorado started a paging system to share information on why air- ambulance services decide to turn down a flight, aimed at preventing practices like helicopter shopping.
Air-medical transports are growing because of centralization of trauma centers and helicopter-fleet operations that negotiate contracts with medical insurers and payors to deliver patients to their facilities, Slack said. Many air-ambulance crashes occur when an air ambulance isn't necessary, according to Slack.
And the increased demand for pilots can lead to more pilots with less experience.
"Whenever you have a high growth rate, there's always a risk that safety awareness and management has not kept up," Todd said. "I think there was certainly some of that that may have given rise to the higher incident rate."
A recent report calls for more FAA oversight and better record keeping as accidents appear to be climbing.
Firm withheld past incidents Utah air-ambulance service whose plane crashed, killing 3, once lost accreditation
The air-ambulance flight service whose plane crashed Friday in southwestern Colorado, killing three medical workers, previously failed to report accidents and incidents involving its planes to...
The new rules would require stricter flight rules and procedures, improved communications and training, and additional on-board safety equipment.
In the last 10 years, there have been 20 helicopter sightseeing tour accidents in Hawaii, 10 in Arizona, eight in Alaska and one in New York.