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Improve the Safety of Emergency Medical Services (EMS) Flights

 

Objective

 

Importance

EMS aviation operations (conducted with either helicopters or fixed-wing aircraft) provide an important service to the public by transporting seriously ill patients or donor organs to emergency care facilities.  The pressure to quickly conduct these operations in various environmental conditions (for example, in inclement weather, at night, and at unfamiliar landing sites for helicopter operations) continues to result in an increasing number of accidents. 

Although the Safety Board issued recommendations in 2006 to improve EMS helicopter operations safety, 9 fatal helicopter EMS (HEMS) accidents occurred between December 2007 and October 2008, killing 35 people. 
                                                            

 

The Safety Board is concerned that these types of accidents will continue to occur if a concerted effort is not made to improve the safety of emergency medical flights.  Specifically, the following actions would help to improve the safety of EMS flight operations:  (1) implementation of a flight risk evaluation program for EMS operators,    (2) establishment of formalized dispatch and flight-following procedures including up-to-date weather regulations, (3) installation of terrain awareness and warning systems on aircraft, and (4) conduct of all flights with medical personnel on board in accordance with stricter commuter aircraft regulations.

 

Summary of Action
In August 2004, the Federal Aviation Administration (FAA) convened a Helicopter Air Ambulance Accident Task Force to make recommendations to reduce HEMS accidents; however, in spite of numerous actions to address this issue through notices and guidance, little progress has been made by the FAA in improving the safety of EMS operations.  

In 2005, the FAA issued three notices addressing HEMS safety; however, all three of the following notices expired after 1 year: 

 

In January 2006, the FAA issued revised guidance to inspectors regarding HEMS Operations Specifications (OpSpecs), amending the visual flight rule (VFR) weather requirements for HEMS operations, including consideration of the adverse affects of reduced ambient lighting at night and mountainous terrain (HBAT 06-01 Helicopter Emergency Services; OpSpec A021/A002 Revisions).

 

In January 2006, the Safety Board issued four safety recommendations concerning EMS flight safety.  In June 2006, at the FAA’s request, the Radio Technical Commission for Aeronautics (RTCA) established a special committee to develop Helicopter TAWS (H-TAWS) standards.  The RTCA, in March 2008, completed the development of a set of minimum operational performance standards for H-TAWS.  The FAA anticipates publishing in early 2009 a Technical Standards Order that is based on the RTCA standards.  The FAA will still need to consider rulemaking to require H-TAWS on EMS flights.

 

In August 2006, the FAA revised the Aeronautical Information Manual to provide guidance to pilots on assessing ambient lighting for night VFR operations and for  off-airport/heliport landing zone operations.

Most recently, in May 2008, the FAA published Advisory Circular (AC) 120-96 regarding operations control centers (OCCs) for HEMS.  The AC provides a list of tasks that should be completed by OCCs.  Although the AC is responsive to Safety Recommendation A-06-14, the FAA has not yet incorporated a requirement for an OCC into HEMS regulations.
    
Despite the FAA’s efforts to improve EMS operations safety, the FAA has not imposed any requirements on aircraft EMS operators regarding flights conducted without patients on board, risk management, flight dispatch, or the use of such technology as TAWS or H-TAWS.  The FAA’s published notices simply constitute information that principle operations inspectors may provide to their operators and encourage the operators to incorporate.  The Safety Board concluded in its 2006 report (2) that the implementation of a flight risk evaluation before each mission, such as the action Notice N8000.301 proposed, would enhance the safety of EMS operations.  N8000.301 expired in 2006; however, its contents were incorporated into FAA Order 8900.1.  This inclusion was a positive step; however, the FAA still does not require EMS operators to take the actions recommended by the Board.  The guidance provided by the FAA has not been widely adopted by EMS operators; accordingly, the Board is concerned that until the FAA institutes our recommended requirements, some EMS operators will continue to operate in an unsafe manner, which could lead to further accidents.   

         

Actions Remaining
Require all EMS operators to comply with 14 Code of Federal Regulations Part 135 operations specifications during the conduct of all flights with medical personnel on board.  Require all EMS operators to develop and implement flight risk evaluation programs that include training all employees involved in the operation, procedures that support the systematic evaluation of flight risks, and consultation with others trained in EMS flight operations if the risks reach a predefined level.  Require EMS operators to use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions.  Require EMS operators to install terrain awareness and warning systems on their aircraft and to provide adequate training to ensure that flight crews are capable of using the systems to safely conduct EMS operations.


Safety Recommendations
A-06-12 (FAA)
Issued: February 7, 2006
Added to the Most Wanted List: 2008
Status: Open—Unacceptable Response
Require all EMS operators to comply with 14 Code of Federal Regulations      Part 135 operations specifications during the conduct of all flights with medical personnel on board.  (Source:  Special Investigation Report on Emergency Medical Services Operations.
[NTSB/SIR-06/01])


A-06-13 (FAA)
Issued: February 7, 2006
Added to the Most Wanted List: 2008
Status: Open—Unacceptable Response
Require all EMS operators to develop and implement flight risk evaluation programs that include training all employees involved in the operation, procedures that support the systematic evaluation of flight risks, and consultation with others trained in EMS flight operations if the risks reach a predefined level.  (Source:  Special Investigation Report on Emergency Medical Services Operations. [NTSB/SIR-06/01])

 

A-06-14 (FAA)
Issued: February 7, 2006
Added to the Most Wanted List: 2008
Status: Open—Acceptable Response
Require EMS operators to use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions.  (Source:  Special Investigation Report on Emergency Medical Services Operations. [NTSB/SIR-06/01])

 

A-06-15 (FAA)
Issued: February 7, 2006
Added to the Most Wanted List: 2008
Status: Open—Unacceptable Response
Require EMS operators to install terrain awareness and warning systems on their aircraft and to provide adequate training to ensure that flight crews are capable of using the systems to safely conduct EMS operations.  (Source:  Special Investigation Report on Emergency Medical Services Operations. [NTSB/SIR-06/01])

 

 

October 2008

 

  1. National Transportation Safety Board, Special Investigation Report on Emergency Medical Services  Operations (NTSB/SIR-06/01) (Washington, D.C.: NTSB, 2006).
  2. National Transportation Safety Board, Special Investigation Report on Emergency Medical Services Operations (NTSB/SIR-06/01) (Washington, D.C.: NTSB, 2006).

 

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