************************************************************ NTSB SAFETY RECOMMENDATION
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National Transportation Safety Board
Washington, DC20594
September 24, 2009
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NTSB Safety Recommendations A-09-87 through -96
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The National Transportation Safety Board therefore
recommends that the Federal Aviation Administration:
Develop criteria for scenario-based helicopter emergency
medical services (HEMS) pilot training that includes
inadvertent flight into instrument meteorological conditions
and hazards unique to HEMS operations, and determine how
frequently this training is required to ensure proficiency.
(A-09-87)
Once the actions recommended in Safety Recommendation A-09-
87 are completed, require helicopter emergency medical
services pilots to undergo periodic FAA-approved scenario-
based simulator training, including training that makes use
of simulators or flight training devices. (A-09-88)
Require helicopter emergency medical services operators to
implement a safety management system program that includes
sound risk management practices. (A-09-89)
Require helicopter emergency medical services operators to
install flight data recording devices and establish a
structured flight data monitoring program that reviews all
available data sources to identify deviations from
established norms and procedures and other potential safety
issues. (A-09-90)
Require helicopter emergency medical services operators to
report activity on at least an annual basis to include total
hours flown, revenue flight hours flown, revenue miles
flown, patient transports completed, and number of
departures. (A-09-91)
Permit the helicopter emergency medical services (HEMS)
Aviation Digital Data Service Weather Tool to be used by
HEMS operators as an official weather product. (A-09-92)
Conduct a systematic evaluation and issue a report on the
requirements necessary for a viable low-altitude airspace
infrastructure that can accommodate safe helicopter
emergency medical services (HEMS) operations. The evaluation
should consider improved collection and dissemination of
weather data, the role of automatic dependent surveillance-
broadcast, approaches to helipad and designated landing
zones, and integration into the National Airspace System.
Include in the evaluation process HEMS operators, related
industry associations, and hospitals, among others. (A-09-
93)
Once the evaluation and report as recommended in Safety
Recommendation A-09-93 are completed, initiate action to
develop this infrastructure. (A-09-94)
Require helicopter emergency medical services operators to
install night vision imaging systems and require pilots to
be trained in their use during night operations. (A-09-95)
Require helicopters that are used in emergency medical
services transportation to be equipped with autopilots and
that the pilots be trained to use the autopilot if a second
pilot is not available. (A-09-96)
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NTSB Safety Recommendations A-09-97 through -101
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The National Transportation Safety Board therefore
recommends that your organization:
Conduct scenario-based training, including the use of
simulators and flight training devices, for helicopter
emergency medical services (HEMS) pilots, to include
inadvertent flight into instrument meteorological conditions
and hazards unique to HEMS operations, and conduct this
training frequently enough to ensure proficiency. (A-09-97)
Implement a safety management system program that includes
sound risk management practices. (A-09-98)
Install flight data recording devices and establish a
structured flight data monitoring program that incorporates
routine reviews of all available sources of information to
identify deviations from established norms and procedures
and other potential safety issues. (A-09-99)
Install and require that pilots use night vision imaging
systems for visual flight rules operations at night. (A-09-
100)
Equip helicopters that are used in emergency medical
services transportation with autopilots, and train pilots to
use the autopilot if a second pilot is not available. (A-09-
101)
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NTSB Safety Recommendations A-09-102 and -103
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The National Transportation Safety Board therefore
recommends that the Federal Interagency Committee on
Emergency Medical Services:
Develop national guidelines for the use and availability of
helicopter emergency medical transport by regional, state,
and local authorities during emergency medical response
system planning. (A-09-102)
Develop national guidelines for the selection of appropriate
emergency transportation modes for urgent care. (A-09-103)
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NTSB Safety Recommendations A-09-104 through -107
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Therefore, the National Transportation Safety Board
recommends that the Centers for Medicare & Medicaid:
Evaluate your existing helicopter emergency medical services
(HEMS) reimbursement rate structure to determine if
reimbursement rates should differ according to the level of
HEMS transport safety provided. (A-09-104)
If the findings from the evaluation conducted in response to
Safety Recommendation A-09-104 reveal that higher levels of
reimbursement are required to increase the level of safety,
establish a new reimbursement rate structure that considers
the level of helicopter emergency medical services transport
safety that is required. (A-09-105)
Develop minimum safety accreditation standards for
helicopter emergency medical services (HEMS) operators that
augment the operating standards of 14 Code of Federal
Regulations Part 135 by including, for all flights with
medical personnel on board, (a) scenario-based pilot
training, (b) implementation of preflight risk evaluation
programs, (c) formalized flight and dispatch procedures, (d)
safety management systems, and (e) the installation of
Federal Aviation Administration-approved terrain awareness
warning systems, night vision imaging systems, flight data
recording systems for monitoring, and autopilots if a second
pilot is not used. (A-09-106)
Once the accreditation standard requested in Safety
Recommendation A-09-106 is developed, establish a policy
that provides Medicare reimbursement for helicopter
emergency medical services (HEMS) transportation only to
those HEMS operators that meet those standards. (A-09-107)