In a special report adopted today, the National Transportation Safety Board called for the Federal Aviation Administration to impose stricter requirements on all emergency medical services flights. The NTSB undertook the special report after investigating fifty-five EMS accidents in the three-year span between January 2002 and January 2005. "The very essence of the EMS mission is saving lives. Operating an EMS flight in an unsafe environment just makes no sense," commented NTSB Acting Chairman Mark Rosenker.
During the study the Board found that while carrying patients or organs, EMS flights are required to operate in accordance with 14 CFR Part 135 regulations. However, when positioning flights are conducted without patients on board, they are permitted to operate under the much less stringent provisions of 14 CFR Part 91. The Board noted that thirty-five of the fifty-five accidents occurred on positioning flights with medical crewmembers, but no patients,on board.
Part 135 and Part 91 requirements differ significantly regarding weather minimums and crew rest requirements -- two key factors found in the EMS accidents investigated by the Board. The Board concluded that the safety of EMS operations would be improved if the entire EMS flight plan operated under Part 135 regulations and recommended that the FAA require all emergency medical services to comply with Part 135 regulations during the conduct of all flights with medical personnel on board.
The Board's investigation also examined the decision-making process of EMS operators when evaluating the potential risks of a flight. Weather, nighttime flight, spatial disorientation from the lack of visual clues, pilot training and experience, and pressure to take the flight are all risks associated with the EMS mission. Safely operating in this high risk environment calls for the systematic evaluation and management of the risks. However the Board found that none of the operators involved in the highlighted accidents had an established aviation risk evaluation program at the time of the accident. Therefore the Board recommended that the FAA require EMS operators to develop and implement flight risk evaluation programs.
In conjunction with the lack of risk evaluation programs, the Board's investigation revealed that many EMS operators lack a consistent, comprehensive flight dispatch procedure to assist pilots in determining the safety of a mission. Currently most EMS operators are notified of an assignment by the local 911-dispatch system or emergency hospital staff. Because most hospital staff and 911 dispatchers do not have aviation expertise, they are not aware of flight requirements, particularly requirements for nighttime flight or adverse conditions. This information is critical and can help avoid accidents. The Board asked the FAA to require EMS operators to use formalized dispatch and flight following procedures that include a dispatcher with aviation experience, up-to-date weather information, and assistance in flight risk assessment decisions.
Finally the report reviewed several technologies that can assist in flight operations - terrain awareness warning systems (TAWS) and night vision imaging systems (NVIS). Controlled flight into terrain is a common factor in helicopter EMS accidents that could be alleviated by the use of TAWS. The investigations of seventeen of the fifty five accidents determined that TAWS might have helped pilots avoid terrain. The Board recommended that the FAA require the installation of terrain warning systems on all EMS aircraft.
In addition to TAWS, the Safety Board found that some EMS operators were using NVIS to enhance a pilot's ability to avoid terrain. The Board determined that if used properly, NVIS could help EMS pilots identify and avoid hazards during nighttime operations. However, because NVIS are not feasible in some situations such as populated areas with ambient light or numerous streetlights, the Board did not make a recommendation on this subject.
In its action today, the Board also adopted final reports for seven EMS accidents highlighted in the safety study. A synopsis of the report that includes the conclusions, and recommendations can be found on the Board's website, www.ntsb.gov. Briefs of the individual accidents, including probable cause statements, will be available on the website, on Friday, January 27.