More needs to be done to improve Helicopter EMS safety

By Robert L. Sumwalt

In mid-December I visited someone in the hospital. I paused as I gazed out the hospital window and saw the hospital’s helipad. I reflected on how using helicopters to transport critically injured patients is such a vital part of our nation’s healthcare system. The Association of Air Medical Services estimates that each year approximately 400,000 patients and transplant organs are safely transported via helicopters emergency medical services (HEMS). But, being in the business that I’m in also made me reflect on the safety record of this industry. In the past ten years, the HEMS industry has averaged one crash every 40 days. In the eight-day period prior to my hospital visit, there were two fatal helicopter HEMS crashes.

The NTSB has a long-standing interest in HEMS. In 1988, the NTSB conducted a safety study of commercial EMS helicopter operations. That study evaluated 59 EMS helicopter accidents and resulted in the NTSB issuing 19 safety recommendations. After a decrease in accidents, crashes began to rise in the late 1990s and early 2000s. That uptick prompted the Board to conduct a Special Investigation Report in 2006, which resulted in the issuance of four safety recommendations to the FAA. As accidents increased, the NTSB held a comprehensive four-day public hearing, in February 2009, which resulted in the Board adopting 21 safety recommendations. Later that year, in wrapping up a HEMS crash investigation, NTSB issued nine recommendations.

In response to these and other NTSB recommendations, in February 2014, the FAA published a broad-reaching set of regulations to strengthen helicopter safety – much of it aimed at the HEMS industry. Once the rule is fully implemented, all HEMS operators will be required to be equipped with Helicopter Terrain Awareness and Warning Systems (HTAWS), establish pre-flight risk-analysis programs, establish operations control centers if they operate with 10 or more helicopters, ensure their pilots hold an instrument rating, conduct the flight using more stringent charter flight regulations (known as “Part 135” regulations) pertaining to weather requirements and flight crew duty time limitations. They will also be required to equip their helicopters with flight data monitoring systems. There are additional flight planning and weather minimums requirements, as well.

Despite the FAA’s positive actions, several NTSB recommendations were not implemented. For example, one NTSB recommendation issued in 2009 called for the FAA to require HEMS pilots to conduct scenario-based training in simulators or flight training devices (FTD). As a former airline pilot, I realize the value of simulator training. In addition to enabling pilots to train in skills that are too risky to perform in a real helicopter, simulators and FTDs can, unlike real helicopters, be used anytime, day or night, and in any kind of weather. Simulators and FTDs can also allow training for a complete flight, including an emergency. Furthermore, training in simulators or FTDs is less expensive than using the actual helicopter.

Another requirement not included in the FAA’s final rule was one for night vision imaging systems (NVIS), such as night vision goggles (NVG). When issuing a recommendation for NVIS in 2009, the NTSB noted that several accidents we investigated likely could have been prevented by use of NVIS. Of all the initiatives discussed at the NTSB’s 2009 HEMS hearing, requiring the use of NVIS received the strongest support. For example, in their joint written submission to the NTSB HEMS hearing, three industry groups noted that “all air medical operations at night [should] be conducted using either NVGs or enhanced vision system.”

As a long-time pilot myself, I realize the importance of having a qualified pilot next to me to provide an extra set of eyes, and to back up my decisions and actions. However, due to space and weight considerations, configuring an air ambulance helicopter with two pilots may not be practical. In absence of having an extra pilot, an autopilot can relieve the pilot of workload. Not only does this physically free up the pilot, it also allows more cognitive resources to be devoted to monitoring and assessing the situation. In 2009, the NTSB issued a recommendation calling for EMS helicopters have two qualified pilots; if that is not possible, the helicopter should be equipped with autopilots. FAA’s final rule was absent of such a requirement.

The FAA is to be applauded for implementing a broad-reaching set of regulations to improve HEMS. However, as evidenced by continued crashes, more needs to be done. NTSB crash investigations have demonstrated the safety benefits of scenario-based simulator or FTD training, use of NVIS, and a second pilot or an autopilot. Despite the FAA’s rule not including such requirements, the industry can voluntarily incorporate these life-saving measures. After all, an industry that is designed to save lives should not be claiming lives.

Robert Sumwalt is a Member of the NTSB Board.

4 thoughts on “More needs to be done to improve Helicopter EMS safety”

  1. Sigh…….Thank you, Member Sumwalt, for weighing in once again on this tragically unacceptable state of affairs. But we’ve all been here before, year after year, crash after crash, one NTSB Final after another. These accidents do not need to happen. It exemplifies yet another pervasive and continuing failure of a government regulator to perform the highest duty to which they are accountable; ensuring the safety of the public, in this case the “involuntary passengers” who have little if any say in how they are transported to a hospital. As well as the crews who fly them. It’s time for Congress to intervene and either convey regulatory authority on the NTSB, or separate the FAA from it’s conflicting mandate to promote air commerce. I would ask that you lead the charge. Thank you for your service.

  2. I agree more needs to be done but why wait for the FAA to mandate something when operators have already known about these issues for a long time? Why would the NTSB expect anything to change until it’s mandated by the FAA? It’s all an accident risk vs cost scenario and since the companies don’t have top management or their family members flying in the back of the helicopter, what’s their incentive to change anything? When a helicopter crashes, insurance pays and they go buy another one and hire another crew. Oh but before hiring the new crew the usual statements have to go out “our condolences to the families who lost their loved ones” and my favorite “they died doing what they loved”. Really?

  3. Despite the exponential growth in the last 15 years, there is an ever shrinking subsection of the industry who still fly medium sized twins with autopilot ( like HEMS in the rest of the developed world). There are programs that use custom GPS approaches, routine IFR flight and low level IFR routing .But until such safety measures are mandated by the FAA, or payment for HEMS services is tied to aviation/medical quality metrics- we will continue to see the death toll rise. Single engine helicopters now make up approx 52% of the US HEMS fleet – yet have been involved in 19 of 22 (86%) of the fatal crashes since 2009

  4. One crash every 40 days??? Highly dubious statistic that I’m sure can’t be sourced. That amounts to over 90 HEMS crashes in the last ten years which, unless your definition of “crash” is different than the rest of us, is patently untrue.

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