Responding to a sharp increase in fatal helicopter emergency medical services (HEMS) operations in 2008, the NTSB on September 1 issued 19 safety recommendations to the FAA, two other federal agencies and 40 government-operated public HEMS operators. The Safety Board added HEMS operations to its Most Wanted List of Transportation Safety Improvements for the first time as a result of the eight accidents and 29 fatalities in 2008, the deadliest year for the sector.
The 10 recommendations aimed at the FAA address the issues of improved pilot training; collection and analysis of flight, weather and safety data; flight data monitoring; development of low-altitude airspace infrastructure; and the use of two pilots, autopilots and night vision imaging systems (NVIS).
Two of the safety recommendations were aimed at the Centers for Medicare & Medicaid Services at the Department of Health and Human Services (HHS). The Safety Board urged that department to evaluate the current HEMS reimbursement rate structure and its relationship to patient transport safety. In addition, it asked its staff to draft recommendations regarding safety audit standards for Medicare & Medicaid Services.
The Board issued two recommendations to the Federal Interagency Committee on Emergency Medical Systems to address coordination and integration of helicopter emergency medical transport into local and regional emergency medical systems and selection of the most appropriate emergency transportation mode for victims of trauma.
Finally, five recommendations were issued to public operators (trips flown by government entities) to improve pilot training; initiate flight data monitoring; and use dual pilots, autopilots and NVIS.
HEMS operations include an estimated 750 helicopters, 70 operators and 60 hospital-based programs. They transport seriously 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…environments makes these types of operation inherently more risky than other…commercial flight operations,” said NTSB chairman Deborah Hersman. “Operators need to use every available safety tool to conduct these flights and to determine when the risk of flying is just too great.”
In February, the Board held a four-day public hearing to address the issues associated with HEMS safety. The hearing called upon 41 expert witnesses, representing eight HEMS operators, 12 associations, six manufacturers and four hospitals.
In addition, several organizations had an opportunity to question the witnesses directly. These parties, who were designated for their technical expertise in their respective fields, were the FAA, the Helicopter Association International (HAI), the Association of Air Medical Services, the Professional Helicopter Pilots Association, the National EMS Pilots Association, Air Methods and CareFlite.
As a result of the hearing, the NTSB identified the following safety issues: pilot training; collection of flight operations data; use of flight recording devices and data; safety management systems; weather information; use of autopilots or dual pilots; NVIS; reimbursement rate structures; and federal policy and guidelines.
In April, the House Transportation and Infrastructure Committee held a hearing on HEMS safety and called for congressional action. Two bills have already been introduced in the House and there is companion legislation in the Senate.
At that hearing, John Allen, director of the FAA’s Flight Standards Service, said that the agency is working on notices of proposed rulemaking (NPRM) that would require helicopter terrain awareness warning systems; radar altimeters; training for recovery from inadvertent flight in IMC; and flight data recorders, cockpit voice recorders and NVIS.
But with the FAA’s cumbersome rulemaking process, a final rule probably would not be adopted until sometime in 2011, which HAI president Matthew Zuccaro called unacceptable. “Clearly, the FAA rulemaking process is not timely and needs to be revised,” he told lawmakers. “Accordingly, Congress should direct the FAA to review its current rulemaking procedures and revise same to expedite implementation of beneficial safety initiatives, when appropriate.”
At the NTSB session last month, Jeff Marcus of the Board’s office of safety recommendations and advocacy said the FAA has indicated there may be an NPRM either late this year or early next year. But Hersman said, “It looks like we are looking at years” before any of this equipment is required to be installed.
Meanwhile, NTSB member Robert Sumwalt, who chaired the Board’s February hearing, proposed that HHS develop safety audit standards for the HEMS industry. He suggested that Medicare, which is the nation’s largest insurer, pay only for flights that meet such safety standards.
Linking Medicare payments to patient safety breaks new ground, Sumwalt acknowledged. “If you always do what you’ve always done, you are going to get what you always got, and we don’t want what we always got,” he said. Board member Chris Hart added that private insurance carriers should be added to the proposal.