The medical helicopter crashed about one nautical mile from the airport where the pilot planned to refuel. The crash killed all four people on board. (NTSB photo)

Helicopter EMS Under Scrutiny Again

NTSB has reissued a recommendation that FAA require helicopter EMS pilots to undergo periodic, FAA-approved, scenario-based simulator training.

The National Transportation Safety Board has renewed its recommendation for the Federal Aviation Administration to require the pilots of medical helicopters to be trained in simulators. The safety board acted on April 9 when it issued its report on the Aug. 26, 2011, crash of a medical helicopter in Mosby, Mo., citing the pilot's distraction, fatigue, and his lack of any simulator training.

This NTSB illustration shows the 40-degree angle at which the helicopter struck the ground.The pilot, a flight nurse, a flight paramedic, and a patient died in the crash of the Eurocopter AS350 helicopter after the aircraft ran out of fuel about one nautical mile from an airport where the pilot intended to refuel. NTSB's synopsis of the report says the helicopter's fuel system was operating properly and its low fuel state was clearly indicated, yet the pilot "missed three opportunities to detect the condition: 1) before departing on the first leg of the mission as a result of his inadequate preflight inspection, 2) before takeoff by failing to properly complete the before-takeoff confirmation checklist, and 3) after takeoff when he erroneously reported the fuel level."

The safety board's chairman, Deborah A.P. Hersman, noted the board has now reclassified as "open -- unacceptable response" a previously issued recommendation that FAA require helicopter EMS (HEMS) pilots to undergo periodic, FAA-approved, scenario-based simulator training.

"That really has to do more with training pilots for emergency situations that they might face only once in their lifetime, but they're not really going to get a sense of what that's like when they're flying in the operating environment. You want them to be able to experience the bad [situation] in a high-fidelity simulator if possible," Hersman said during an April 12 interview. "So, for example, in this case, pilots might actually get good training on autorotation, but they're doing it in a very controlled environment. They're doing it over an airport, they're doing it maybe at 80 knots at 1,000 feet. In this situation, the pilot was in cruise flight, he was flying at a much faster speed at a lower altitude. So he really needed to make some decisions very, very quickly -- he had about two seconds to make the right inputs. And if he didn't, he wasn't going to be able to recover. He didn't have enough altitude, and his air speed was pretty high."

Hersman said some large air ambulance companies have their own flight simulators, while others contract out to have their training done by other entities. "Certainly the question is, can you do it with good fidelity so that it's very representative of real-world conditions? It really is going to probably depend on what's available and how big the operation is. It's much better to experience an emergency in a simulator than in revenue flight, and certainly in a situation like this, for an EMS operator with a passenger and a medical crew on board."

The synopsis points out the pilot did not comply with several standard operating procedures of his employer, LifeNet of the Heartland, and violated its policy on cell phone use by texting while airborne. LifeNet of the Heartland is owned and operated by Air Methods Corporation. Based in Denver, it has operations in most U.S. states.

Air Methods Corporation announced March 19, 2013, that it will use FlightSafety International's Eurocopter EC135 Level D qualified full flight simulator in Dallas as part of its pilot training program. The company's press release said it employs 550 EC135 pilots "who will cycle through the simulator for their annual recurrent training" and also will send new hires for initial training and pilots transitioning from other helicopter models to the EC135. "Air Methods continues to actively pursue cost-effective technology, systems and training in excess of regulations that we know can encourage safety improvements in the air medical community," CEO Aaron Todd said in the company's news release. "We believe simulator training is another step in that endeavor and are proud to add this fifth simulator solution to our robust pilot training program."

'Self-Induced Distraction' Cited
The NTSB synopsis indicates the pilot’s cell phone records showed he sent and received multiple personal text messages on the day of the crash, including while flying, while the helicopter was on the ground and being prepared to fly to pick up the patient, and later during a telephone call with a specialist at his company's EMS communication center as the pilot was deciding to fly to the airport in Mosby for refueling. The synopsis calls this activity "a self-induced distraction that took his attention away from his primary responsibility to ensure safe flight operations. Further, although there is no evidence that the pilot was texting at the time of the engine failure, his texting while airborne violated the company's cell phone use policy."

The pilot reported his low fuel situation to the communication specialist, but he "did not request and was not referred to the company's [air methods operational control center] or to someone such as the chief pilot who would likely have asked how much fuel was on board the helicopter and proposed canceling the mission. If the communication specialist or the pilot had notified operationally qualified personnel about the low fuel situation, the accident might have been averted," it states. Self-induced pressure probably caused the pilot to fixate on his intended refueling point and continue the flight rather than land as a precaution as the fuel gauge indication approached zero, the board concluded.

NTSB has issued numerous reports about safety in the air medical industry. It issued more than 20 recommendations from a four-day forum in 2009 and produced an investigative report three years earlier on more than 50 accidents involving medical aviation, both fixed-wing and rotary wing. "The issue of HEMS was on our most wanted list for a number of years," Hersman said. "We have really focused on this issue for decades. We're still waiting. And I think in particular one of the things that we're most frustrated with is there is a proposed rulemaking from the FAA that has been delayed. It should have been finalized over a year and a half ago, and we are still waiting for that rule. If that rule were to be finalized, it would incorporate dozens of our recommendations.

"They did have a very good NPRM. It's very comprehensive, we were very pleased with it. We'd just like to see it finalized," she continued.

Asked about the rule's status, Les Dorr of FAA Public Affairs in Washington, D.C., provided a link to the agency's monthly reports on the status of significant rulemakings. This one, docket number FAA-2010-0982, remained in the final rule stage as of April 2013, with a projected OMB clearance date of June 13, 2013, and a projected Federal Register publication date of July 1, 2013, which is 14 months later than FAA's originally scheduled date.

The NTSB report contains two recommendations for Air Methods Corporation:

  • "Expand your policy on portable electronic devices to prohibit their non-operational use during safety-critical ground activities, such as flight planning and preflight inspection, as well as in flight."
  • "Revise company procedures so that pilots are no longer solely responsible for nonroutine operational decisions but are required to consult with the Air Methods Operational Control Center for approval to accept or continue a mission when confronted with elevated risk situations, such as fuel-related issues and unplanned deviations."

To read the NTSB report's synopsis, visit

This article originally appeared in the June 2013 issue of Occupational Health & Safety.

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