NATIONAL TRANSPORTATION SAFETY BOARD
Public Meeting of September 1, 2009
(Information subject to editing)
Four Safety Recommendation Letters Concerning
Helicopter Emergency Medical Services
This is a synopsis from the Safety Board’s report and does not include the Board’s rationale for the conclusions and safety recommendations. Safety Board staff is currently making final revisions to the report from which the attached conclusions and safety recommendations have been extracted. The final report and pertinent safety recommendation letters will be distributed to recommendation recipients as soon as possible. The attached information is subject to further review and editing.
SUMMARY AND CONCLUSIONS
Helicopter emergency medical services (HEMS) operations provide an important service to the public by transporting seriously ill patients and donor organs to emergency care facilities, often from remote areas not served by adequate facilities. 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 complex, 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 conduct these operations safely and quickly in various environmental conditions (for example, in inclement weather, at night, or at unfamiliar landing sites for helicopter operations) increases the risk of accidents when compared to other types of commercial flight operations.
The NTSB has had a longstanding concern of HEMS safety. In 1988, the Board adopted a Safety Study, Commercial Emergency Medical Service Helicopter Operations, 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, onboard 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 completed 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 fatalities occurred during HEMS operations. Analysis of the accidents indicated that 29 of 55 accidents could have been prevented with corrective actions identified 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 accidents occurred with a total of 5 fatalities. The following year, there were 2 fatal HEMS accidents with a total of 7 fatalities, 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 number 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 manufacturers, 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 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. A complete summary of the public hearing testimony, all of the exhibits, and the entire written transcript can be found on the NTSB’s web site.
As a result of the hearing, the NTSB identified the following safety issues:
The NTSB is issuing the following safety recommendations:
To the Federal Aviation Administration
To Public HEMS Operators
To the Federal Interagency Committee on Emergency Medical Services
To the Department of Health and Human Services’ Centers for Medicare & Medicaid Services
NOTE: The Board approved additional recommendations regarding safety audit standards to CMS that are being drafted.
NTSB Board Meetings | Publications