After investigating an unprecedented 55 air-ambulance accidents between January 2002 and January 2005, the US National Transportation Safety Board is calling on the Federal Aviation Administration to impose stricter requirements on all emergency medical service (EMS) flights.
All EMS flights should be conducted under Part 135 regulations, the NTSB recommends, not just those with patients on board. The board says 35 of the 55 accidents occurred with just medical crewmembers on board, on positioning flights that can now be conducted under less-stringent Part 91 rules.
The Association of Air Medical Services supports a move to Part 135, but says it requires FAA-approved weather reporting at the destination, which is difficult to provide at rural pick-up points. The industry will meet with the FAA in March to discuss weather reporting needs.
The board recommends that the FAA require EMS operators to implement flight-risk evaluation programmes, to assess factors such as weather and either reject the flight or take steps to mitigate the risk. The NTSB says 13 of 55 accidents might not have occurred if risk evaluation had been in place.
Also, the board recommends that the FAA require operators to use formal dispatch and flight following procedures that include a dispatcher with aviation experience, noting that most pilots are notified by local emergency dispatchers or hospital staff who are unaware of the requirements for flight at night or in adverse conditions.
Finally, the NTSB recommends that the FAA require installation of terrain awareness warning systems on all EMS aircraft, saying it might have helped in 17 of the 55 accidents. Night vision imaging systems could also help, the board says, but it stops short of issuing a recommendation because night-vision goggles cannot be used in urban areas.
With 54 people killed and 19 injured in the 55 events, and a further nine crashes since January 2005 resulting in another 23 fatalities, the NTSB says this level of accidents has not been seen since the 1980s, when it last reviewed EMS safety. The 1988 study resulted in an FAA advisory circular, but the board says its guidance has not been adopted by all operators. “The carrot hasn’t worked. We’ve got to pick up the stick,” says board member Deborah Hersman.
GRAHAM WARWICK / WASHINGTON DC