NTSB Seeks Flight Data Recorders in Air Ambulances

Other key recommendations adopted Sept. 1 ask CMS to study whether reimbursement rates for transport flights should differ according to the level of safety provided and adopt a new rate structure if so.

The National Transportation Safety Board issued 19 recommendations Tuesday to increase the safety of helicopter emergency medical services (HEMS), a topic NTSB has addressed regularly for more than 20 years. The most important recommendations this time are to install flight data recorders and autopilots in air ambulances; to require helicopter EMS operators to report hours flown, revenue flight hours, revenue miles flown, patient transports completed, and number of departures at least annually; and for the U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) to study whether reimbursement rates for transport flights should differ according to the level of safety provided and then adopt a new rate structure if so.

NSTB says today's helicopter EMS network includes an estimated 750 helicopters, 20 operators, and 60 hospital-based programs transporting about 400,000 patients and transplant organs annually. The industry's deadliest year was 2008, with 12 accidents and 29 fatalities, according to NTSB, which responded by placing the issue of HEMS operations on its Most Wanted List of Transportation Safety Improvements and conducting a public hearing last February to examine HEMS safety issues.

"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," NTSB Chairman Deborah A.P. Hersman said Monday. "Operators need to [use] every available safety tool to conduct these flights and to determine when the risk of flying is just too great."

NTSB's recommendations were directed to the Federal Aviation Administration, CMS, the Federal Interagency Committee on Emergency Medical Systems, and the 40 government-operated or "public" HEMS operators. An abstract of the recommendations is available here.

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