Category Archives: Safety

The Latest on Air Ambulance Transport Rules by FAA

The Federal Aviation Administration had laid down its groundbreaking safety rules for choppers in February of 2014, popularly known as the HAA (helicopter air ambulance) rule. It mandated that the choppers involved in emergency transport of the patient would have to meet requirements like:

  • Inclusion of certain specific safety instruments
  • Improved training and testing
  • Establishment of control systems for air ambulance transport vehicles

These were only a few requirements that were laid down. Although the initial deadline to meet these requirements was April 22 of last year, it was then extended by a year owing to the difficulties of the air ambulance transport companies to comply with them at such short notice. Most air ambulance transport companies have already complied with the first set of rules, although there is some anxiety in the air ambulance transport industry as the deadline nears.

The Air Ambulance Transport Sector will have to Meet More Deadlines

Although the air ambulance transport companies will have to comply with several of the rules laid down this year, there are some for which the sector still has time. Here’s a breakdown.

Compliance by April 2016: Setting up of operations control center.

Compliance by April 2017:

  • Installation of radio altimeters
  • Incorporation of warning systems and terrain indicators for choppers
  • Meeting qualification criteria for PIC instruments

Compliance by April 2018: Complying with mandated systems to monitor flight data.

Guidance is awaited by the Air Ambulance Transport Industry

The sources in the air ambulance transport industry revealed that it is not possible to comply with certain mandates unless there are clear guidelines by the FAA. Compliance with most of the rules will cost the air ambulance transport operators huge dollars, so obviously, they want to get it right and keep the expenses to a minimum.

For the pilots, crew and the people travelling in air ambulance transport vehicles, the rules will bring in more safety and efficiency. In general, the rules have been well accepted by the air ambulance transport industry so far.

Air Ambulance Transport – A Dangerous Profession

Wanting to help the needy by being part of air ambulance transport is no doubt a noble intent. However, the profession is fraught with several dangers and is counted among the most dangerous professions in the world. People who aspire to join air ambulance transport sector must give due consideration to certain aspects of the sector. Apart from the fact that air ambulance transport services cater to people in war torn areas, natural disasters and global epidemics such as the recent Ebola threat, there are other factors too that must be considered. Here, we highlight a few of those.

Air Ambulance Transport Crews are More at Risk than Patients

One simple reason is the fact that more than one crew member accompanies a patient usually. The second reason could be that the crew usually has to make more flights, one to pick the patient, one to drop and another trip to return to the air base. All this while the crew, with the inadequate safety standards, is exposed to more danger.

There is also a sense of urgency that surrounds most air ambulance transport trips. For instance, if a patient has had a heart attack, the first priority is always to transport the patient to the nearest medical facility within the first hour.

Some air ambulance transport industry experts have also raised concerns about the competition that exists between air ambulance transport companies to make the maximum number of flights. Such a “race” naturally puts the air ambulance transport safety in the backseat.

Stricter Rules for Air Ambulance Transport in the US are on the Way

The need of the hour, therefore, is stricter regulations. American air ambulance transport sector can take a leaf out of the Canada which has stricter regulations. For instance, it is mandated that at least two pilots must be present in every air ambulance trip. That said, the FAA has now proposed new safety rules, which will be implemented by 2015. The regulations have come into place after many postponements and delays. On the positive side, however, we hope that the new rules make air ambulance transport safer for the crews.

What is the accreditation process for medical transport services?

Accreditation begins with an application form. The form indicates the service’s intentions to complete the process. The service then receives a Program Information Form (PIF). The PIF consists of a demographic section, a list of bases and a self-evaluation of the service, based on the CAMTS Standards. Response to the PIF self-study also requires attachments that include policies, education materials, quality management and safety processes. The PIF and attachments are submitted electronically within a year of applying for accreditation.

Once the PIF is complete and returned to the CAMTS office, it is reviewed by the CAMTS staff for completeness and sent to two Board members who will review contents for completeness and for additional questions that they document for the site surveyors. Site surveyors are then appointed, based on their experience and background related to the type of service (air/ground; fixed/rotor; critical care, ALS/BLS ground, etc.) they will visit.

The site visit is then scheduled at a time agreeable to both the service and site surveyors and at least 1 month prior to a Board of Directors meeting in order to be placed on the agenda for an accreditation decision. Once onsite the surveyors will conduct a series of interviews of personnel, look at training records, quality improvement programs, safety policies, etc. Their comments and observations are documented for the two Board members who present the program anonymously to the full Board. The programs are always presented by a six digit number – proper names and specific locations are not known by the full Board. If a Board member has a conflict of interest – he or she is excused while the program is presented and the Board deliberates.

Air Ambulance Safety by AMS

From 1972 through September, 2002, when HEMS safety research by Dr. Ira Blumen of the University of Chicago Aeromedical Network (UCAN) was completed, HEMS had flown approximately three million hours, transporting some two and three-quarter million patients.  In that time, there were 166 crashes involving HEMS, with 183 fatalities.  The UCAN study found that while the number of crashes each year has fluctuated, the number per 100,000 patients flown had dropped from 17.36 in 1980 to 5.5 in 2001.

The risk to patients, estimated over the years of the study, is reported as a fatality rate of 0.76/100,000 patients. Subsequent admission to a hospital carries with it a greater risk of death from complications or errors: various recent estimates range from 1.2/100,000 patents to 292/100,000 patients.

Nonetheless, any form of medical transport incurs inherent risk and in the past few years there have been increased numbers of accidents associated with the increased number of helicopters and transports. In an editorial comment in the UCAN study, a past president of the National EMS Pilot Association emphasizes that the causes of crashes haven’t changed over the years. The top three causes are “risk taking, pre-flight planning, and in-flight decisionmaking,” reflecting the unique pressure placed on crews by the condition of the patient and by the feelings of obligation to fly.

The air ambulance service community has taken significant steps, particularly in the area of aircrew resource management (a proven airline industry safety tool) to improve its safety for patients.  Some HEMS prograir ambulance service are replacing aircraft, hiring pilots to fly under Instrument Flight Rules (IFR), and employing new technologies such as night vision goggles (NVG’s) and terrain avoidance warning systems (TAWS), especially important when weather conditions abruptly change mid-mission.80 Transport medicine is among the most complex arenas of medicine, and is characterized by the need to provide immediate access to time-sensitive care for critically ill and injured patients at the same time that operations are conducted in hostile environmental conditions with limited planning time. As Justice Oliver Wendell Holmes once noted: “to be safe does not mean to be risk free.” Recognizing that risk cannot be completely eliminated, it is essential both for the public served, and the pilots, nurses, paramedics, physicians, and other health care providers who deliver care, that the practice environment be as safe as possible.

To that end, the Association of Air Medical Services has already initiated Vision Zero (http://aamsvisionzero.org/) and has joined the International Helicopter Safety Team (IHST, www.ihst.org), led by the American Helicopter Society (AHS), the Helicopter Association International (HAI), the Federal Aviation Administration (FAA), and Transport Canada to reduce helicopter accidents by 80% in the next ten years.

These initiatives seek more effective methods and approaches to avoiding errors in complex systems premised on the model that providers must work collaboratively, on a voluntary basis, with regulators to identify and accelerate the implementation of best practice standards. These efforts focus on developing and implementing strategies using cost benefit analysis and evidence based best practices related to safety in order to prioritize investment and financial plans to result in a goal of zero serious injuries or fatalities.

FAA Publishes New Air Ambulance Regulation

The agency said it reviewed about 4,000 accidents involving helicopters in the United States, of which 75 commercial helicopter accidents (88 deaths, 29 serious injuries, 42 minor injuries) and 127 helicopter air ambulance accidents (126 deaths, 50 serious injuries, 42 minor injuries) between 1994 and 2008 involved causal factors that are addressed in the proposal.

The Federal Aviation Administration published its 36-page proposed rule this past Tuesday intended to make helicopter air ambulance flights safer nationwide. The proposal will revise Part 91 visual flight rules weather minimums, require all commercial helicopters to be equipped with radio altimeters, require air ambulance flights with medical personnel aboard to be conducted under part 135 (including flight crew time limits and rest requirements), require Helicopter Terrain Awareness and Warning Systems (HTAWS), and require certificate holders with 10 or more helicopter air ambulances to establish operations control centers. Most of these changes fulfill NTSB recommendations made in recent years.

It says they would require training and testing on weather, navigation, flight-monitoring procedures, air traffic control procedures, aircraft systems, aircraft limitations and performance; and, more frequently, on topics specific to each certificate holder, such as aviation regulations and operations specifications, crew resource management, and the local flying area.

Along with requiring a load manifest for all part 135 operations, the proposal defines the role and training of operations control specialists for helicopter air ambulance operations. They will perform safety-sensitive functions “such as providing pre-flight weather assessment, assisting with fuel planning, alternate airport weather minima, and communicating with pilots regarding operational concerns during flight. These duties are similar to those of an aircraft dispatcher, and therefore,” the rule states, “operations control specialists would be subject to the restrictions on drug and alcohol use, and to a certificate holder’s drug and alcohol testing program as described in 14 CFR part 120.”

FAA estimated the proposal will cost the industry $225 million and yield benefits ranging from $83 million to $1.98 billion during a 10-year period.