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Emergency Medical Services (EMS) Aviation Operations. Jeff Guzzetti Deputy Director for Regional Operations . Introduction: EMS Operations. Provide important service to public Inherently dangerous due to pressures and environment Increasing number of accidents

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Emergency medical services ems aviation operations l.jpg

Emergency Medical Services (EMS) Aviation Operations

Jeff Guzzetti

Deputy Director for Regional Operations


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Introduction: EMS Operations

  • Provide important service to public

  • Inherently dangerous due to pressures and environment

  • Increasing number of accidents

  • Strategies and technologies to ensure flight safety


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Introduction: EMS Accidents

  • January 2002 – January 2005

  • 55 EMS Accidents

    • 41 Helicopter

    • 14 Airplane

  • 54 fatalities, 19 serious injuries

  • Additional 9 EMS accidents since January 2005


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Introduction: 1988 Safety Study

  • 59 EMS accidents

  • Weather, training, design, crashworthiness, management

  • 19 recommendations to FAA

  • FAA Advisory Circular 135-14A

  • Advisory v. regulatory



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Introduction: Safety Issues

  • Less stringent requirements when patients not on board

  • Lack of aviation flight risk evaluation programs

  • Lack of flight dispatch procedures

  • No requirements to use TAWS or NVIS technologies


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Introduction: Recent FAA Activity

  • FAA Task Force on Helicopter Air Ambulance Accidents

  • FAA guidance issued in 2005

    • Notice N8000.293: ops guidance

    • Notice N8000.301: risk assessment

    • Notice N8000.307: ops inspections

    • HBAT 06-01: stricter VFR minimums

    • HBAT 06-02: CFIT programs

  • No requirements or rule changes


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Introduction: Regional Investigations

  • 7 regional aviation investigations presented as examples

  • 3,500 man hours

  • Probable causes submitted for Board’s consideration


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Introduction: Part 91 v. Part 135

  • Part 91 prescribes rules for all aircraft

  • Part 135 prescribes rules for commuter or on-demand operations


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Safety Issue: EMS Operations Without Patients On Board


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Safety Issue: Operations Without Patients Onboard

  • While carrying patients or organs, Part 135

  • Less stringent requirements without patients on board (Part 91)

  • Medical crewmembers primarily responsible for patient care

  • 35 of 55 accidents Part 91


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Safety Issue: Operations Without Patients Onboard

  • Weather minimum requirements:

    • Part 91: “Remain clear of clouds”

    • Part 135: 1,000-foot cloud ceiling

      3 miles of visibility

  • Positioning flights operate under Part 91


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Safety Issue: Operations Without Patients Onboard

  • Crew Rest Requirements:

    • Part 135: 14-hour duty time

    • Part 91: No duty time restrictions

  • Pilot fatigue affects safety


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Safety Issue: Operations Without Patients Onboard

  • All EMS legs critical

  • Part 135 imposes additional safety controls

  • EMS Operators must already comply with Part 135 for patients on board


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Safety Issue: Flight Risk Evaluation Programs


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Safety Issue: Risk Evaluation

  • Risks include pressure, weather, environment, spatial disorientation, and human factors

  • Risk evaluation requires pilot to assess situation without influence of urgency

  • Most operators had no formal risk evaluation process


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Safety Issue: Risk Evaluation

  • Salt Lake City: weather, route, night would have raised flight risk rating

  • Risk evaluation may have prevented 13 of 55 accidents


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Safety Issue: Risk Evaluation

  • FAA Notice N8000.301: Operational Risk Assessment Programs for Helicopter EMS

  • Not required

  • Flight risk evaluation programs would enhance safety


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Safety Issue: Flight Dispatch Procedures for EMS


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Safety Issue: Flight Dispatch

  • Many EMS operators lack flight dispatch procedures

  • 911 and hospital dispatchers

    • Not required to have aviation-specific knowledge

    • Provide minimal information regarding route, landing, or weather

  • Participate in risk assessment


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Safety Issue: Flight Dispatch

  • Airline flight dispatch

    • Airworthiness

    • Weather conditions

    • Communication and navigation in route

  • Flight dispatch may have prevented 11 of 55 accidents


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Safety Issue: Use of Technology in EMS Flight Operations


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Safety Issue: Night Vision Imaging Systems

  • Night accidents over represented

  • Benefits

    • Enhance ability to see and avoid obstacles

    • Reduce stress and spatial disorientation

    • Increase safety

  • Not widely used by EMS

    • Recent introduction

    • Cost

    • Cannot be used in ambient light


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Safety Issue: Night Vision Imaging Systems

  • 13 of 55 accidents may have benefited from use of NVIS

  • FAA encourages use of NVIS

  • Feasibility of NVIS

  • Staff to monitor effectiveness


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Safety Issue: Terrain Awareness and Warning System

  • CFIT common in EMS operations

  • Increases safety margin in poor visibility

  • Battle Mountain, Nevada


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Safety Issue: Terrain Awareness and Warning System

  • 17 of 55 accidents may have been prevented with TAWS

  • FAA requires TAWS on turbine-powered airplanes with 6 passengers

  • FAA Notice 8000.293 only “encourages” operators to use TAWS


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