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Aviation News Item: 02379
2nd Sep 2009
NTSB Issues Recommendations on Helicopter EMS
Source: verticalmag.com
 The NTSB has issued new safety recommendations
calling for far-reaching change in the helicopter
emergency medical services sector.
Skip Robinson Photo
Seven months after its high-profile hearing on helicopter emergency medical services, the United States National Transportation Safety Board has issued 19 recommendations related to HEMS safety.
On Sept. 1, the NTSB issued 10 specific recommendations to the Federal Aviation Administration, five recommendations to public HEMS operators, two recommendations to the Federal Interagency Committee on Emergency Medical Services, and two recommendations to the Department of Health and Human Services' Centers for Medicare and Medicaid Services.
The recommendations address familiar safety issues such as pilot training, safety management systems, and safety-enhancing technologies including night vision imaging systems and autopilots. However, they also break new ground in suggesting that HEMS reimbursement models should be restructured to promote higher levels of safety.
The NTSB recommended that the Centers for Medicare and Medicaid Services: 1) evaluate its existing HEMS reimbursement rate structure to determine if reimbursement rates should differ according to the level of HEMS transport safety provided; and 2) if that evaluation reveals 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.
Additionally, the NTSB recommended that the Federal Interagency Committee on Emergency Medical Services develop national guidelines for the use and availability of helicopter emergency medical transport, and develop national guidelines for the selection of appropriate emergency transportation modes for urgent care.
Previous NTSB recommendations on helicopter emergency medical services have focused more narrowly on operational issues. In a special investigation report issued in 2006, the NTSB made four key recommendations for improving HEMS safety, all of them related to flight operations or aircraft equipment.
However, the FAA and the industry reacted slowly to those recommendations. In early February of this year, after 29 people were killed in HEMS accidents in 2008, the NTSB convened a four-day hearing on HEMS safety (see http://www.verticalmag.com/control/news/templates/default.aspx?a=9875&z=11). Its most recent recommendations - which are drawn from the forthcoming report on that hearing - suggest that more far-reaching structural change may be required to combat the industry's competitive pressures. During the hearing, issues such as uneven reimbursement rates, helicopter "shopping," and the possible overuse of helicopter services were identified as reasons for concern.
"The pressure on HEMS operators to conduct their flights quickly in all sorts of environments makes these types of operations inherently more risky than other types of commercial flight operations," stated NTSB chairman Deborah A. P. Hersman. "Operators need every available safety tool to conduct these flights and to determine when the risk of flying is just too great."
In its new recommendations, the NTSB addresses operational issues as well. Specifically, it recommended that the FAA:
- Develop criteria for scenario-based HEMS pilot training, and require pilots to undergo scenario-based simulator training on a regular basis.
- Require HEMS operators to implement safety management systems.
- Require HEMS operators to install flight recording devices and monitor flight data to identify deviations from normal procedures.
- Expand the official weather products available to HEMS operators.
- Take steps to develop a viable low-altitude airspace infrastructure that can accommodate safe HEMS operations.
- Require HEMS operators to install night vision imaging systems and train pilots in their use during night operations.
- Require that HEMS helicopters be equipped with autopilots and that pilots be trained to use the autopilot if a second pilot is not available.
The NTSB made similar recommendations to public HEMS operators who do not operate under the FAA's Part 135 regulatory umbrella. Additionally, the NTSB recommended that the FAA require HEMS operators to report flight activity - including total hours flown and revenue miles flown - on at least an annual basis. During the February hearing, the absence of reliable data on HEMS flight activity was identified as a hurdle to drawing accurate conclusions about accident rates and trends.
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