A series of fatal medevac helicopter crashes last year prompted fresh calls for increased industry regulation, and by November the FAA had announced changes to the operations specifications governing helicopter emergency medical services (HEMS) flights under Part 135. Those covered flight planning, weather minimums and the use of night-vision goggles (NVGs). But it became apparent at public National Transportation Safety Board (NTSB) hearings held February 3 to 6 on HEMS accidents and operations that these measures did not completely satisfy industry critics both inside and outside government.

The FAA has been working with the HEMS community voluntarily on select flight safety issues, including the recent revision in the ops specs, since 2004 with partial success. However, the NTSB and industry critics clearly would prefer a more aggressive regulatory approach and the three days of high-visibility public hearings were clearly directed at kick-starting the process.

“The Board wants [the FAA] to know that we are very displeased and we want them to move forward,” NTSB vice chairman Robert Sumwalt said late last year. He said that HEMS operations have been a major concern at the NTSB for the last two decades and that recent crashes have intensified the Board’s focus on the industry.
“We do have a microscope on HEMS operations right now,” said Sumwalt, “due to the sheer number of fatalities that have occurred” in 2008. He hastened to add that “our public hearing will not be tied to the NPRM [notice of proposed rulemaking] process” that is the purview of the FAA. But there can be little doubt that an NPRM is on the way.

As the number of U.S.-based EMS helicopters has grown to nearly 800 and the number of HEMS flights has quadrupled in many regions of the country over the last eight years, the number of fatal HEMS accidents has increased. In 2006, the NTSB issued a report that analyzed 55 medevac accidents and made a variety of recommendations to the FAA including mandating the installation of terrain awareness and warning systems (TAWS) in HEMS aircraft.

According to Sumwalt, the FAA’s response to most of those recommendations is “open, unacceptable.” Besides advocating TAWS, that report recommended that all HEMS operations–rather than only those where patients are aboard–be conducted under some form of Part 135. It also urged operators to implement formal flight-risk evaluation procedures and use consistent flight dispatch procedures.

An FAA spokeswoman said that the agency could issue more sweeping changes in the form of an NPRM governing helicopter EMS operations later this year and that it likely would include radar altimeters and H-TAWS.

Beginning in 2004, the FAA embarked on a variety of voluntary HEMS-related initiatives. These included published guidance on helicopter EMS maintenance, operational risk assessment, air medical resource management training and VFR weather minimums; and RTCA-developed standards to develop FAA requirements for H-TAWS. The agency is also reviewing and revising Part 135 standards as they apply to HEMS. Those within the HEMS industry defend the recent collaborative rule changes negotiated with the FAA, but acknowledge that they may not be enough to assuage critics.

Just days after a fatal helicopter EMS crash–a Bell 222 accident in Aurora, Ill., on October 15 that killed all four aboard–the Air Medical Transport Conference (AMTC) convened in Minneapolis, and the helicopter EMS pilots there were clearly cognizant that exigent change is in the wind. “We are going to be looked at more closely and more carefully by legislative and regulatory branches of government because of our accident rate,” acknowledged Scott Tish, now a certificate compliance evaluator for Air Methods and formerly a helicopter EMS pilot with the University of Wisconsin hospitals.

“We feel we are making good progress with the FAA,” said Air Methods CEO Aaron Todd. “We are working closely with the agency and the other members of the HEMS community to find appropriate changes to enhance safety without compromising access to these important services.”

Two years ago, Air Methods, the nation’s largest helicopter EMS company, voluntarily agreed to equip all of its EMS helicopters with tracking systems, NVGs and TAWS “as quickly as resources and access to equipment will allow,” said Todd. Air Methods also is following Part 135 weather minimums for Part 91 repositioning flights as well as for Part 135 flights with patients aboard. Todd said Air Methods is also embracing other tools such as FOQA (flight operational quality assurance) and is “making good progress” installing new technology.

Seventeen of the 55 EMS accidents the NTSB cited in its 2006 report could have been prevented with TAWS, said Sumwalt.

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