Safety Recommendation A-06-012

We are aware that, in section 135.1, the February 21, 2014, final rule requires that helicopter air ambulance flights with medical personnel on board be conducted under Part 135 rules. Accordingly, Safety Recommendation A-06-12 is classified CLOSED—ACCEPTABLE ACTION.

The FAA’s proposed revision to 14 CFR Part 135 defining helicopter air ambulance operations as those conducted by a Part 135 certificate holder, if adopted, would satisfy this recommendation. Accordingly, pending the expeditious issuance of a final rule as proposed, Safety Recommendation A-06-12 is classified OPEN—ACCEPTABLE RESPONSE.

-From Michael P. Huerta, Acting Administrator: On October 12, 2010, the FAA issued Notice of Proposed Rulemaking (NPRM), Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135 Aircraft Operations; Safety Initiatives and Miscellaneous Amendments. The comment period closed on January 10, 2011. The FAA received the comments submitted by the Board and is reviewing those comments as part of the rulemaking process. The NPRM proposes to add requirements for: • A load manifest for all aircraft operated under part 135 (§ 135.63(c)); • Radio altimeters for all helicopters operated under part 135 (§ 135.160);

• Initial and recurrent pilot testing to include procedures for aircraft handling in flat-light, whiteout, and brownout conditions (§ 135.293(a)(9)); • Competency checks that include a demonstration of the pilot's ability to maneuver solely by reference to instruments (§ 135.293(c)

Notation 8272: The National Transportation Safety Board (NTSB) has reviewed the Federal Aviation Administration's (FAA) Notice of Proposed Rulemaking (NPRM) titled "14 CFR [Code of Federal Regulations] Parts 1, 91, 120, and 135 Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135 Aircraft Operations; Safety Initiatives and Miscellaneous Amendments; Proposed Rule," which was published at 75 Federal Register 62640 on October 12, 2010. Operational Procedures

Part 135 Applicability

The FAA is proposing that all HEMS operations with medical personnel on board be conducted under the operating rules of Part 135. Currently, flights with medical crewmembers on board who are the aircraft operator’s employees can be conducted under Part 91 on those trip legs where there is no patient or transplant organ on board the aircraft. The ability to fly under Part 91 potentially provides the operator with additional operational flexibilities due to decreased visual flight rules (VFR) weather minimums and no flight crew rest requirements.

The FAA revised Operations Specification (OpSpec) A021 to require HEMS operators to comply with Part 135 weather minima on all flights with medical personnel onboard the aircraft, unless otherwise operating on a Part 91 instrument flight rules (IFR) flight plan. The FAA stated that, because an IFR flight provides guaranteed obstacle clearance, continuous radio communication with air traffic control, and radar contact, this option provides a HEMS operator with an equivalent level of safety to that of a Part 135 visual flight rules flight. The FAA further stated that, as of February 2, 2009, all HEMS operators have complied with this OpSpec.

Finally, the FAA stated that the NPRM discussed in response to Safety Recommendations A-02-35, A-07-111, and -112 will also include language addressing Part 135 weather minima and Part 135 flight and duty time.

The revision to the OpSpec is a commendable revision that quickly addresses one of the aspects of this recommendation. Timely issuance of the NPRM with the provisions described, and their enactment in the resulting final rule, will complete the recommended action. In recognition of this process, at the February 18, 2010 Board meeting Safety Recommendation A-06-12 was reclassified OPEN -- ACCEPTABLE RESPONSE, pending the FAA's issuing a final rule that requires Part 135

Letter Mail Controlled 8/31/2009 10:34:54 AM MC# 2090543 - From J. Randolph Babbitt, Administrator: On October 29, 2008, the FAA met with HEMS operators and trade associations to discuss the adoption of the language contained in this recommendation. The FAA proposed adopting the recommended language through an amendment to HEMS Operations Specification (OpSpec) A021 by February 1, 2009. Because OpSpecs are regulatory in nature, an amendment to an operator's OpSpecs can provide an immediate safety enhancement to HEMS operations.

At the conclusion of the October 2008 meeting, and after considering the comments of all stakeholders, the FAA revised OpSpec A02 1 to require HEMS operators to comply with part 135 weather minima on all flights with medical personnel onboard the aircraft, unless otherwise operating on a part 91 instrument flight rules (IFR) flight plan. Because an IFR flight provides guaranteed obstacle clearance, continuous radio communication with air traffic control, and radar contact, this option provides a HEMS operator with an equivalent level of safety when compared to part 135 visual flight rules flight. As of February 2, 2009, all HEMS operators have complied with this OpSpec.

The NPRM for air ambulance and commercial helicopter operations will have language addressing part 13 5 weather minima and part 13 5 flight and duty time. We plan to complete our internal work on the NPRM in January 2010 with publication following clearance from the DOT and the OMB.

The National Transportation Safety Board met on October 28, 2008, to consider our list of Most Wanted Safety Improvements issued to Federal agencies. At this meeting, the issue Improve the Safety of Emergency Medical Services (EMS) Flights was added to the list, as were Safety Recommendations A-06-12 through -15, stated below. The Safety Board also reclassified three (A-06-12, -13, and -15) of the four recommendations.

All four recommendations were issued to the Federal Aviation Administration (FAA) as a result of the Safety Board’s special investigation of a number of aviation accidents between January 2002 and January 2005 involving aircraft performing EMS operations. The intent of this recommendation is to ensure that weather minimums and pilot flight and duty time limitations in Part 135 be applied to all EMS flights, including those that include medical personnel on board, but no patients.

On November 14, 2008, the FAA published revised Operations Specification (OpSpec) A021, which requires that all EMS flights with medical personnel on board, regardless of the presence of patients, be subject to the weather minimums limitation stated in Part 135. Although the revised OpSpec is responsive to the recommendation, the FAA must still require the Part 135 flight and duty time limitations for EMS flights in order to fully satisfy this recommendation.

Accordingly, pending the issuance of a requirement that all EMS flights with medical personnel on board, regardless of the presence of patients, be subject to the flight and duty time limitations stated in Part 135

Letter Mail Controlled 10/7/2008 1:08:49 PM MC# 2080609: - From Steven B. Wallace, FAA: At the October 12, 2006, meeting the FAA discussed a potential problem with requiring that all EMS flights be conducted under Part 135 when medical personnel but no patients are aboard. The FAA indicated that a number of helipads located at hospitals have installed equipment and developed procedures that enable EMS flights to use instrument approach procedures when arriving at these helipads.

However, the helipads do not have the weather-reporting equipment or personnel required for a Part 135 flight’s approach, and it would impose a significant burden on the owners/operators of these helipads to acquire this capability. As a result, many of these helipads cannot be used in instrument conditions for Part 135 flights. The FAA believes this result would not be in the interest of overall flight safety for EMS flights.

Therefore, the FAA plans to require that most of the Part 135 flight rules, including weather minimums and pilot flight and duty time limitations, be applicable to all EMS flights when only medical crew are on board, but plans to exempt the EMS flights from the requirements for weather reporting at their destination.

The intent of this recommendation is to ensure that weather minimums and pilot flight and duty time limitations in Part 135 be applied to all EMS flights, including those where there are medical personnel, but no patients, on board. The Safety Board agrees with the FAA that exempting EMS flights from destination weather reporting requirements, but mandating other

At the October 12, 2006, meeting the FAA discussed a potential problem with requiring that all EMS flights be conducted under Part 135 when medical personnel but no patients are aboard. The FAA indicated that a number of helipads located at hospitals have installed equipment and developed procedures that enable EMS flights to use instrument approach procedures when arriving at these helipads. However, the helipads do not have the weather-reporting equipment or personnel required for a Part 135 flight’s approach, and it would impose a significant burden on the owners/operators of these helipads to acquire this capability.

As a result, many of these helipads cannot be used in instrument conditions for Part 135 flights. The FAA believes this result would not be in the interest of overall flight safety for EMS flights. Therefore, the FAA plans to require that most of the Part 135 flight rules, including weather minimums and pilot flight and duty time limitations, be applicable to all EMS flights when only medical crew are on board, but plans to exempt the EMS flights from the requirements for weather reporting at their destination.

The intent of this recommendation is to ensure that weather minimums and pilot flight and duty time limitations in Part 135 be applied to all EMS flights, including those where there are medical personnel, but no patients, on board. The Safety Board agrees with the FAA that exempting EMS flights from destination weather reporting requirements, but mandating other

Letter Mail Controlled 6/6/2006 1:29:53 PM MC# 2060276: - From Marion C. Blakey, Administrator: Medical personnel on board an EMS flight are considered part of the aircraft crew and thus operations can be conducted under 14 CFR Part 91. This definition is consistent with a 1992 memorandum of understanding (MOU) between the FAA and the Safety Board designed to establish guidance in the reconciliation process of the legal basis for the aviation operation. The MOU states that EMS positioning flights are 14 CFR Part 91 operations until a passenger is picked up. A doctor, nurse, or medical technician is considered part of the crew.

Implementation of this recommendation may require revision of that MOU. We will contact your staff to schedule a meeting to discuss several issues raised by this safety recommendation. These issues include: This recommendation raises critical issues related to the weather requirements associated with operations under 14 CFR Part 91 versus 14 CFR Part 1.35. The general consensus from the industry is that if the FAA could establish policy that would allow 14 CFR Part 135 instrument flight rules (IFR) operations at locations without weather reporting (with certain limitations), the industry would readily accept the proposal.

At the current time, adopting this recommendation would result in disqualifying IFR operations at the majority of hospital heliports served by instrument procedures, forcing those operations to conduct flights under visual flight rules (VFR), which may reduce safety. To develop a viable approach to this weather issue, the FAA hosted a weather summit meeting on March 21-23, 2006, that addressed weather requirements for

At the October 25, 2008 Board meeting addressing the NTSB’s Federal Most Wanted List of Transportation Safety Improvements (MWL), the Board voted to place Safety Recommendations A-06-12 through A-06-015 on the Federal MWL under the issue category “Improve the Safety of Emergency Medical Services (EMS) Flights.”