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emergency care facilities, often from re- mote areas not served by adequate facili- ties. These operations comprise an estimated 750 helicopters, 70 commercial operators, 60 hospital-based programs, and 40 government-operated, or what is known as “public,” operations. These operations are unique and com- plex, mixing highly advanced medical care with the technical challenge of safely operating helicopters 24 hours a day. Each year, approximately 400,000 patients and transplant organs are safely transported by helicopter. However, the pressure to con- duct these operations safely and quickly in various environmental conditions (for example, in inclement weather, at night, or at unfamiliar landing sites for heli- copter operations) increases the risk of ac- cidents when compared to other types of commercial flight operations.

The NTSB has had a longstanding con- cern of HEMS safety. In 1988, the Board adopted a Safety Study, Commercial Emer- gency Medical Service Helicopter Opera- tions, which reviewed 59 HEMS accidents that occurred from 1978 through 1986. From that study, the Board issued 19 safety recommendations to the FAA, the National Weather Service, and two associations. These recommendations covered issues of training and guidance, operating rules, on- board equipment, industry coordination, and workload and fatigue. The majority of these recommendations have been closed acceptable action.

The late 1990s and early 2000s saw a rapid growth of HEMS operations and the number of accidents began to rise. Prompted by this rise, the NTSB com- pleted a special investigation report on Emergency Medical Services Operations in January 2006. This report analyzed 55 EMS accidents (41 of which were HEMS accidents and 14 airplane EMS accidents) that had occurred during the previous 3 years, claiming 54 lives; of these, 39 fa- talities occurred during HEMS opera- tions. Analysis of the accidents indicated that 29 of 55 accidents could have been prevented with corrective actions identi- fied in the report.

Immediately following adoption of the 2006 special investigation report, the number of HEMS accidents decreased. In calendar year 2006, 3 fatal HEMS acci- dents occurred with a total of 5 fatalities. The following year, there were 2 fatal

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HEMS accidents with a total of 7 fatali- ties, but in calendar year 2008, there were 8 fatal HEMS accidents, with a total of 29 fatalities. This was deadliest year on record for HEMS operations.

Prompted by this recent rise in the num- ber of fatal HEMS accidents, the Safety Board held a 4-day public hearing this past February to address the issues associated

with HEMS safety. The hearing called upon 41 expert witnesses, representing 8 HEMS operators, 12 associations, 6 man- ufacturers, and 4 hospitals. Additionally, several organizations had an opportunity to question the witnesses directly. These parties, who were designated for their technical expertise in their respective

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