Safety Recommendation A-06-014

We are aware that, in section 135.619, the February 21, 2014, final rule requires certificate holders with 10 or more helicopter air ambulances to establish operation control centers (OCC) and to document, in their operations manuals, duties and training for operations control specialists. Although the final rule does not require air ambulance operators with fewer than 10 helicopters to establish an OCC, Advisory Circular 120 96, “Integration of Operation Control Centers into Helicopter Emergency Medical Services Operations,” provides useful guidance for these operators regarding how to scale an OCC to fit even the smallest operations.

We believe that these actions constitute an acceptable alternative approach to addressing the risks. Accordingly, Safety Recommendation A-06-14 is classified CLOSED—ACCEPTABLE ALTERNATE ACTION.

From the accident report of the August 26, 2011 crash following loss of engine power due to fuel exhaustion near Mosby, Missouri of the Air Methods Corporation Eurocopter AS350 B2, N352LN. Report adopted on April 9, 2013 and published on May 6, 2013: Company communication specialists provided dispatch services to pilots but were not qualified to provide operational guidance. Company individuals qualified to provide operational guidance, such as representatives of the OCC or managers such as the chief pilot, were available but were not contacted by the communication specialist or the pilot.

If an operationally qualified individual had been involved in the decision-making process that led to the departure from Harrison County Community Hospital with insufficient fuel reserves, such an individual likely would have asked the accident pilot how much fuel was on board the helicopter, understood that there was not sufficient fuel on board to meet minimum fuel requirements, and proposed delaying or canceling the mission and having fuel brought to the helicopter. At the time of the accident, the company communication specialists had guidance to contact the OCC for certain operational issues, but these issues did not include fuel-related issues and unplanned deviations.

Following the accident, Air Methods added these items to the list of issues requiring immediate notification of the OCC. Additionally, Air Methods developed a procedure and provided training to its communication specialists on how to recognize potential elevated risk situations and when to contact the OCC. The OCC was staffed at all times with at least one specialist with HEMS operational experience who was available as a central contact point for pilots to discuss operational concerns, such as launch decisions due to developing weather.

However, the OCC did not share responsibility for “go/no go” decisions, which were solely the responsibility of the PIC,34 and the risk assessment matrixes used by pilots at the time of the accident did not include a risk threshold that triggered mandatory consultation with the OCC. Pilots interviewed after the accident stated that they rarely contacted the OCC to discuss operational issues. This practice was evident in the accident when the pilot told the communication specialist about his low fuel situation but did not contact the OCC.

Following the accident, Air Methods revised its risk assessment program by replacing its risk assessment matrix with a risk assessment tool used by the pilot to calculate a numerical risk assessment value at the beginning of each shift and then update it before beginning each flight leg. Depending on the numerical value, the risk is categorized as

The FAA’s proposed revisions to 14 CFR Part 135 to mandate the creation of an operations control center and the use of operations control specialists for helicopter air ambulance operations satisfy the intent of this recommendation. Accordingly, pending the expeditious issuance of a final rule as proposed, Safety Recommendation A-06-14 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. The FAA is proposing that commercial HEMS operators with 10 or more helicopters that are engaged in HEMS activities establish operations control centers (OCCs).

This requirement is partially responsive to Safety Recommendation A-06-14; however, numerous aspects of the proposed change do not meet the intent of Safety Recommendation A-06-14 and are delineated below.

The FAA proposes to limit the OCC requirement to HEMS operators with 10 or more helicopters that are dedicated to HEMS transport. The NTSB does not agree with this limitation and believes that the requirement for an OCC should be applied to all HEMS operators. Advisory Circular 120 96, “Integration of Operation Control Centers into Helicopter Emergency Medical Services Operations,” provides guidance on how to scale an OCC to fit the size of the organization, including Model 1, which is appropriate for the smallest HEMS operators. The NTSB interprets Model 1 to apply to HEMS operators with as few as one or two helicopters.

The FAA states that there were 74 certificate holders who were authorized to conduct HEMS operations in February 2009. Of these, 50 operators had fewer than 10 helicopters in their fleet. These certificate holders operated 264 of the 884 helicopters (30 percent) dedicated to HEMS operations at that time. Testimony provided during the 2009 NTSB hearing on HEMS safety indicated that, in 2007, each EMS helicopter, on average, flew 580 hours and transported 420 patients annually. The NTSB believes that if the current proposed rule is enacted, operators with fewer than 10 helicopters will transport approximately 100,000 patients or more per year without the added safety benefit of an OCC.

The FAA’s May 5, 2008, issuance of Advisory Circular (AC) 120-96, Integration of Operations Control Centers [OCC] into Helicopter Emergency Medical Services Operations, which provided guidance on the establishment and operation of an OCC by an EMS operator, and the FAA’s subsequent survey to determine how many helicopter EMS (HEMS) operators had adopted the guidance in the AC are responsive actions to this recommendation. However, the NTSB remains concerned about the long time required by the FAA to develop and issue new regulations.

After the FAA completes drafting of the notice of proposed rulemaking (NPRM), the document will need to be reviewed and approved by the Office of the Secretary of Transportation, followed by review and approval by the Office of Management and Budget.

Despite the delays in completing action to address Safety Recommendation A-06-14, because of the FAA’s recent actions, on February 18, 2010, the Board voted to retain the classification of this recommendation as OPEN -- ACCEPTABLE RESPONSE pending timely issuance of a final rule mandating formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions.

Letter Mail Controlled 11/23/2009 2:32:06 PM MC# 2090695: - From J. Randolph Babbitt, Administrator: The Federal Aviation Administration has taken a number of steps in support of this recommendation. On September 22, 2005, the FAA issued Advisory Circular (AC) 00-64, Air Medical Resource Management (enclosed), to EMS operators establishing minimum guidelines for Air Medical Resource Management training. The training is for all medical service operations team members, which includes pilots and dispatchers. As part of the decision making training, the AC recommends EMS operators develop a risk assessment program. It also provides guidelines for weather training.

In March 2006, the FAA and the University Corporation for Atmospheric Research hosted a weather summit in Boulder, Colorado, to identify the EMS-specific issues related to weather products and services. Attendees explored possible regulatory improvements, weather product enhancements, and operational fixes specific to EMS operations. As a result of this meeting, the FAA funded the development and implementation of a graphical flight planning tool for ceiling and visibility assessment along direct flights in areas with limited surface observation capability available. This tool improves the quality of go/no-go decisions for helicopter EMS (HEMS) operators.

The Aviation Digital Data Service Experimental HEMS Tool became available in November 2006. The response from the users continues to be very favorable. On May 5, 2008, the FAA issued AC 120-96, Integration of Operations Control Centers into Helicopter Emergency Medical Services Operations. This AC, which the Board has found responsive to this recommendation, provides detailed guidance to HEMS operators for the creation and operation of operations control centers as well as guidance for establishing the formalized dispatch and flight-following procedures recommended.

On January 12, 2009, the FAA had inspectors with oversight responsibility of HEMS operators find out how many operators have adopted specific FAA-recommended best practices. All 74 operators were surveyed and validated by FAA inspectors. The percentages of operators that have adopted the following programs are: • Decision making skills and risk assessment programs -94 percent; and • Integration of an operations control center -89 percent While voluntary compliance is the most expeditious manner in implementing new programs, the FAA also understands that under certain circumstances, follow-up rulemaking is also required.

Therefore, in April 2009, the FAA began drafting a notice of proposed rulemaking (NPRM) for air ambulance and commercial helicopter operations. There will be language in the NPRM addressing risk assessment programs and operations control centers. We plan to complete internal work on the NPRM in January 2010. Publication of the NPRM will occur after clearance from the Department of Transportation (DOT) and the Office of Management and Budget (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. In May 2008, the FAA published Advisory Circular (AC) 120-96, which provides detailed guidance about the creation and operations of Operations Control Centers for helicopter EMS operations.

Among the activities described in the AC are the formalized dispatch and flight-following procedures recommended; however, an AC is only a guidance/advisory document and does not represent a requirement. Although the AC is responsive to the recommendation, the FAA now should require that all EMS operators incorporate the guidance contained in the AC into their operations. Pending the FAA’s implementing such a requirement, Safety Recommendation A-06-14 remains classified OPEN -- ACCEPTABLE RESPONSE.

Letter Mail Controlled 10/7/2008 1:08:49 PM MC# 2080609: - From Steven B. Wallace, FAA: On May 5, 2008, the FAA issued Advisory Circular (AC) 120-96, Integration of Operations Control Centers into Helicopter Emergency Medical Services Operations.

Letter Mail Controlled 7/2/2008 11:28:41 AM MC# 2080390: - From Steven B. Wallace, FAA: On May 5, 2008, the FAA issued Advisory Circular (AC) 120-96, Integration of Operations Control Centers into Helicopter Emergency Medical Services Operations.

During the October 12, 2006, meeting, the FAA described its activities in response to this recommendation. The FAA is examining the role that a communications specialist could play in performing dispatch and flight following activities for an EMS operator. Currently, the FAA is developing a set of best practices related to standardization of communications specialists’ position descriptions and training requirements. The FAA is also examining the role of the communications specialist in operational control and flight following activities.

Pending adoption of a requirement for formalized dispatch and flight following procedures for EMS operators, Safety Recommendation A-06-14 is classified OPEN -- ACCEPTABLE RESPONSE.

Letter Mail Controlled 6/14/2006 10:24:44 AM MC# 2060276: - From Marion C. Blakey, Administrator: The FAA has identified the area of dispatch and operational control as its next area of emphasis. In the documents produced during last year, the FAA has emphasized the role of the communications specialist in assisting the pilot with the information regarding the "Go/No GO" decision. A study is being initiated to identify best industry practices in ground communications and dispatch to support effective FAA requirements and policy. The study will last approximately 1 year. The results of the study will be provided to the Board.

I will keep the Board informed of the FAA's progress on this safety recommendation.

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.”