NTSB Wants Safer Medevac Flights

WASHINGTON, D.C. -- On Tuesday, the NTSB announced a number of recommendations they hope will make the operations of medical helicopters safer.

The suggestions included the use of night vision goggles, dual pilots, autopilots, flight data recorders and low altitude monitoring infrastructure as well as weather monitoring improvements.

The recommendations to the FAA, Public Operators of HEMS and Health and Human Services' Centers for Medicare and Medicaid were established following a four-day hearing in February.

Panels of experts from various aspects of helicopter operations testified. They included trauma surgeons, state medical directors, helicopter industry engineers and others.

The hearings were held following the deadliest year on record for HEMS -- 12 crashes with 29 fatalities.

NTSB Chairman Deborah A. P. Hersman said Tuesday the sessions were "long, but very important."

She also offered her sympathy to those who lost loved ones in the crashes. "It was a difficult time for you. I know you continue to grieve. I offer you condolences on behalf of the safety board."

The board spent the first part of the meeting reviewing the numbers -- 750 helicopters, 70 commercial operators; 60 hospital-based, and 40 public services. They transport about 400,000 patients annually.

There are increased risks involved with operations of medical helicopters compared to other aircraft because crews are pressured to fly, they are of flying in inclement weather, at night and the unfamiliarity of landing zone issues.

NTSB recommendations to the FAA include:

• Develop criteria for scenario-based helicopter emergency medical services (HEMS) pilot training that includes inadvertent flight into instrument meteorological conditions and hazards unique to HEMS operations, and determine how frequently this training is required to ensure proficiency.

• Once the actions recommended in Safety Recommendation (1) are completed, require helicopter emergency medical services pilots to undergo periodic FAA-approved scenario-based simulator training; including training that makes use of simulators or flight training devices.

• Require helicopter emergency medical services operators to implement a safety management system program that includes sound risk management practices.

• Require helicopter emergency medical services operators to install flight data recording devices and establish a structured flight data monitoring program that reviews all available data sources to identify deviations from established norms and procedures and other potential safety issues.

• Require helicopter emergency medical services operators to report activity on at least an annual basis to include total hours flown, revenue flight hours flown, revenue miles flown, patient transports completed, and number of departures.

• Permit the helicopter emergency medical services Aviation Digital Data Service Weather Tool to be used by helicopter emergency medical services operators as an official weather product.

• Conduct a systematic evaluation and issue a report on the requirements necessary for a viable low-altitude airspace infrastructure that can accommodate safe helicopter emergency medical services (HEMS) operations. The evaluation should consider improved collection and dissemination of weather data, the role of automatic dependent surveillance-broadcast, approaches to helipad and designated landing zones, and integration into the National Airspace System. Include in the evaluation process HEMS operators, related industry associations, and hospitals, among others.

• Once the evaluation and report as recommended in Safety Recommendation (7) are completed, initiate action to develop this infrastructure.

• Require helicopter emergency medical services operators to install night vision imaging systems and require pilots to be trained in their use during night operations.

• Require helicopters that are used in emergency medical services transportation to be equipped with autopilots, and that the pilots be trained to use the autopilot if a second pilot is not available.

To Public HEMS Operators:

• Conduct scenario-based training, including the use of simulators and flight training devices, for helicopter emergency medical services (HEMS) pilots, to include inadvertent flight into instrument meteorological conditions and hazards unique to HEMS operations, and conduct this training frequently enough to ensure proficiency.

• Implement a safety management system program that includes sound risk management practices.

• Install flight data recording devices and establish a structured flight data monitoring program that incorporates routine reviews of all available sources of information to identify deviations from established norms and procedures.

• Install and require that pilots use night vision imaging systems for visual flight rules operations at night.

• Equip helicopters that are used in emergency medical services transportation with autopilots, and train pilots to use the autopilot if a second pilot is not available.

To the Federal Interagency Committee on Emergency Medical Services:

• Develop national guidelines for the use and availability of helicopter emergency medical transport by regional, state, and local authorities during emergency medical response system planning.

• Develop national guidelines for the selection of appropriate emergency transportation modes for urgent care.

To the Department of Health and Human Services -- Centers for Medicare & Medicaid Services:

• Evaluate your existing helicopter emergency medical services (HEMS) reimbursement rate structure to determine if reimbursement rates should differ according to the level of HEMS transport safety provided.

• If the findings from the evaluation conducted in response to Safety Recommendation 1 reveal that higher levels of reimbursement are required to increase the level of safety, establish a new reimbursement rate structure that considers the level of helicopter emergency medical services transport safety that is required.

Related News:

• NTSB Hearing Examines Increase in Fatal Chopper Crashes
• NTSB Hearing: Responder Recounts Daughter's Crash Death
• Summary of NTSB Hearings Released

Related Links:

• NTSB: Hearing Information
• NTSB: Quick links to information on Helicopter Emergency Medical Services
• Association of Air Medical Services
• Helicopter Association International