The National Transportation Safety Board (NTSB) has issued 19 recommendations regarding Helicopter Emergency Medical Services (HEMS), according to an NTSB press release. These recommendations address various safety issues including pilot training; safety management systems to minimize risk; collection and analysis of flight, weather, and safety data; flight data monitoring; development of a low altitude airspace infrastructure; and the use of dual pilots, autopilots, and night vision imaging systems (NVIS).

HEMS operations include an estimated 750 helicopters, 20 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 sorts of environments makes these types of operations inherently more risky than other types of commercial flight operations," said 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."For the HEMS industry, 2008 was the deadliest year on record with 12 accidents and 29 fatalities. In response to this increase in fatal accidents, the NTSB placed the issue of HEMS operations on its Most Wanted List of Transportation Safety Improvements.

Last February, the NTSB conducted a 4-day public hearing to critically examine the safety issues concerning this industry. The hearing, which included testimony by expert witnesses representing HEMS operators, associations, manufactures, and hospitals, explored the increasingly competitive environment of the HEMS industry and provided a more complete understanding of why this industry has grown rapidly in recent years. As a result of recent accident investigations and testimony presented at the hearing, the NTSB made recommendations to the Federal Aviation Administration (FAA), the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services, Federal Interagency Committee on Emergency medical Systems (FICEMS) and 40 government-operated or public HEMS operators.

The 19 recommendations include 10 recommendations to the FAA to address the issues of improved pilot training; collection and analysis of flight, weather, and safety data; flight data monitoring; development of low altitude airspace in infrastructure; and the use of dual pilots, autopilots, and NVIS.

The two safety recommendations to the CMS are to evaluate the current HEMS reimbursement rate structure and its relationship to patient transport safety. Two recommendations are to FICEMS 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 are to public operators to improve pilot training, flight data monitoring; and the use of dual pilots, autopilots and NVIS.

In addition, the Board asked its staff to draft additional recommendations to CMS regarding safety audit standards.

An abstract of today's Board actions can be found at