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National Transportation Safety Board

Issues Recommendations To The Helicopter Emergency Medical Services Industry


BOARD has issued 19 recommendations re- garding Helicopter Emergency Medical Services (HEMS). These recommenda- tions address various safety issues includ- ing pilot training; safety management systems to minimize risk; collection and analysis of flight, weather, and safety data; flight data monitoring; development of a low altitude airspace infrastructure; and the use of dual pilots, autopilots, and night vision imaging systems (NVIS). HEMS operations include an estimated 750 helicopters, 20 operators, and 60 hos- pital-based programs. They transport se- riously ill patients and donor organs 24 hours a day in a variety of environmental conditions.

“The pressure on HEMS operators to conduct their flights quickly in all sorts of environments makes these types of opera- tions inherently more risky than other types of commercial flight operations,” said NTSB Chairman Deborah A. P. Hersman. “Operators need to every avail- able safety tool to conduct these flights and to determine when the risk of flying is just too great.”

For the HEMS industry, 2008 was the deadliest year on record with 12 accidents and 29 fatalities. In response to this in- crease in fatal accidents, the NTSB placed the issue of HEMS operations on its Most Wanted List of Transportation Safety Im- provements.

Last February, the NTSB conducted a 4-day public hearing to critically examine the safety issues concerning this industry. The hearing, which included testimony by expert witnesses representing HEMS op- erators, associations, manufactures, and hospitals, explored the increasingly com- petitive environment of the HEMS indus- try and provided a more complete understanding of why this industry has grown rapidly in recent years. As a result of recent accident investigations and tes- timony presented at the hearing, the NTSB made recommendations to the Fed- eral Aviation Administration (FAA), the Centers for Medicare & Medicaid Ser-


copter emergency medical transport into local and regional emergency medical sys- tems and selection of the most appropriate emergency transportation mode for vic- tims of trauma.

Finally, five recommendations are to public operators to improve pilot training, flight data monitoring; and the use of dual pilots, autopilots and NVIS.

vices (CMS) at the Department of Health and Human Services, Federal Interagency Committee on Emergency medical Sys- tems (FICEMS) and 40 government-op- erated or public HEMS operators. The 19 recommendations issued in- clude 10 recommendations to the FAA to address the issues of improved pilot train- ing; collection and analysis of flight, weather, and safety data; flight data mon- itoring; development of low altitude air- space in infrastructure; and the use of dual pilots, autopilots, and NVIS.

The two safety recommendations to the

CMS are to evaluate the current HEMS reimbursement rate structure and its rela- tionship to patient transport safety. Two recommendations are to FICEMS to ad- dress coordination and integration of heli-

In addition to the recommendations is- sued, the Board also asked its staff to draft additional recommendations to CMS re- garding safety audit standards. This is a synopsis from the Safety Board’s report and does not include the Board’s rationale for the conclusions and safety recommendations. Safety Board staff is currently making final revisions to the report from which the attached con- clusions and safety recommendations have been extracted. The final report and pertinent safety recommendation letters will be distributed to recommendation re- cipients as soon as possible. The attached information is subject to further review and editing.

Summary And Conclusions

Helicopter emergency medical services (HEMS) operations provide an important service to the public by transporting seri- ously ill patients and donor organs to Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52
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