NTSB · Safety Recommendation
Safety Recommendation A-09-106
Recommendation
TO THE CENTERS FOR MEDICARE AND MEDICAID (UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES): 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.
Safety Issue and Context
This recommendation letter addresses the helicopter emergency medical services (HEMS) industry and is derived from testimony provided at the NTSB’s public hearing concerning this industry, as well as investigations of recent HEMS accidents. As a result, the NTSB is issuing four safety recommendations to the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS). Information supporting these recommendations is discussed below. The NTSB would appreciate a response from you within 90 days addressing the actions you have taken or intend to take to implement our recommendations.
Additional recommendations have been addressed to the Federal Aviation Administration (FAA), the Department of Homeland Security’s Federal Interagency Committee on Emergency Medical Services (FICEMS),1 and 40 public HEMS operators. Calendar year 2008 was the deadliest year on record for the HEMS industry with 12 accidents (8 fatal accidents) and 29 fatalities. As a result of this increase in fatal accidents involving HEMS operations, the NTSB placed the issue of HEMS safety on its Most Wanted List of Transportation Safety Improvements on October 28, 2008, and also conducted a 4-day public hearing to critically examine safety issues concerning this industry.
Based on testimony given at this public hearing, in addition to findings from recent HEMS accidents, the NTSB believes that CMS needs to take action to evaluate the reimbursement policies for helicopter emergency medical transport and its relationship to the level of service provided by the HEMS operator.
Response History
April 23, 2014 · NTSB Correspondence · United States Department of Health and Human Services
We were pleased to see that, on February 21, 2014, the Federal Aviation Administration (FAA) published its long-awaited final rule, “Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations.” This rule addressed, in full or in part, a number of important safety recommendations that we had made to the FAA regarding HEMS safety. We agree with you that CMS does not have the expertise or authority to regulate aircraft safety, and that the FAA is the more appropriate organization to take the actions specified in Safety Recommendations A 09 106 and 107. Accordingly, these recommendations are classified CLOSED—RECONSIDERED.
March 11, 2014 · Recipient Response · United States Department of Health and Human Services
-From Marc Hartstein, Director, Hospital and Ambulatory Policy Group, Center for Medicare: Thank you for your letter to Secretary Sebelius requesting additional information regarding the Department of Health and Human Services' progress on addressing the National Transportation Safety Board's (NTSB) recommendation for helicopter emergency medical services (HEMS) safety. I am responding on behalf of the Centers for Medicare and Medicaid Services (CMS) to your letter.
Your letter makes reference to CMS' original response to the NTSB's recommendations on April 16, 2010. Our response suggested that while HEMS safety is an important public policy priority, we do not believe that CMS has either the expertise or the authority to regulate aircraft safety.
We believe the Federal Aviation Administration (FAA) is far better qualified to evaluate your HEMS safety recommendations and noted that your recommendations to the FAA were similar to the ones for CMS. We understand that the FAA published final regulations to address the NTSB's concerns on February 21, 2014 proposed rule (79 FR 9932) entitled "Air Ambulance and Commercial Helicopter Operations,