US HEMS “Delays & Oversight Challenges” – IG Report

US Helicopter Emergency Medical Service (HEMS) “Delays & Oversight Challenges” – Inspector General Report

We recently published an article on two March 2015 night-time US HEMS accidents.  This month the US Department of Transportation’s Inspector General has released a report entitled: Delays in Meeting Statutory Requirements and Oversight Challenges Reduce FAA’s Opportunities To Enhance HEMS Safety

The Office of Inspector General works within the DoT to “promote effectiveness and head off, or stop, waste, fraud and abuse in departmental programs”.

They say:

The Helicopter Emergency Medical Services (HEMS) industry safely transports over 400,000 patients in the United States each year, frequently in challenging conditions, including night flight, poor weather, low visibility, and landing at unfamiliar accident sites. The industry has grown significantly in the last few decades, with more than 1,500 specialized air medical helicopters used by 75 different companies in 2014. As the industry has grown, so has the number of accidents, and the Federal Aviation Administration (FAA) and Congress continue to seek ways to enhance safety in the HEMS industry. FAA issued a final HEMS rule in February 2014, and Congress passed the FAA Modernization and Reform Act of 2012 (FMRA). In light of these efforts, the Ranking Member of the House Aviation Subcommittee requested that we review FAA’s progress in improving air ambulance safety.

They go on:

While FAA’s recently issued HEMS rule is a good first step toward realizing FMRA goals, continued delays in finalizing the remaining congressional mandates affect FAA’s ability to focus its accident reduction efforts and limit the effectiveness of safety initiatives. Additionally, until FAA updates key oversight policies and obtains meaningful safety data to analyze for trends, it will not be well positioned to effectively oversee a rapidly expanding HEMS industry.

In particular:

FAA met or partially met three of the six major FMRA safety requirements for HEMS operators but has not completed the remaining three requirements involving safety data collection.

Specifically, FAA completed a night vision goggle study, issued a HEMS rule implementing new operational procedures and additional equipment requirements, and initiated a second HEMS rule requiring improved training standards and additional safety equipment for crews and passengers.

While FAA completed the requirements for both rules, the first rule was nearly 2 years late, and neither rule has been fully implemented. Therefore, the industry is not yet benefitting from the rules’ provisions.

Additionally, FAA did not complete the remaining three requirements for collecting, storing, and reporting HEMS-specific operations data. FAA has issued a notice to the industry that it will require operators to report operational data; however it did not meet the February 2013 congressionally mandated deadline to start this action. Therefore, FAA is currently not in the position to report its data gathering efforts to Congress, though it was required to do so starting in February 2014. Continued delays in meeting statutory deadlines will postpone enhancements needed to improve safety in the HEMS industry.

The IG has made five recommendations to the FAA:

1. Develop helicopter-specific accident reduction goals and communicate them in FAA planning documents and business plans.

2. Expand the criteria for dedicated certificate management teams and use of SEP [Surveillance and Evaluation Program] for HEMS operators with 20 to 24 aircraft [note – currently only used for operators with >25].

3. Conduct a workforce assessment that includes a determination of whether:

a. inspectors are at the right locations to provide adequate surveillance of the growing number of HEMS certificates,

b. it has the correct number of inspectors with the required specialized knowledge, and

c. district office inspector workload is adequately measured in complexity ratings and balanced between district offices.

4. Review and revise inspector hiring and training policies so that they provide sufficient flight and aircraft systems experience and training needed for inspectors to successfully accomplish their surveillance duties.

5. Develop and implement a plan to provide inspectors access to new technology training opportunities and leverage both airplane and helicopter training if needed in their surveillance requirements.

The FAA concurred with partially concurred with the first three and concurred with the last two recommendations.

In there response the FAA noted:

The FAA is transitioning to a risk-based oversight system for helicopter air ambulance operators so we can better target resources. Our Safety Assurance System (SAS) is the best way for us to allocate inspector resources and we’re evaluating those resources now. We’re also working with industry on a system for the FAA to collect and analyze operating data.

UPDATE 10 February 2016: Following US NTSB Board Member Robert Sumwalt’s recent HEMS article in Professional Pilot, we thought we’d take a look at how the US HEMS accident rates have changed over the last decade: US HEMS Accident Rates 2006-2015

UPDATE 24 December 2016: Dr Ira Blumen, program/medical director for the University of Chicago’s Aeromedical Network (UCAN) has been tracking US HEMS safety performance since 2000. A recent report based on his data noted:

In 1980, a HEMS crewmember had a 1 in 50 chance of being in a fatal accident; today that number is 1:850. 

From 1972 to 2016 there were 342 helicopter EMS accidents…123 of those 342 resulted in at least one fatality. Some 1,053 personnel were involved in those accidents; 328 died, 116 sustained serious injuries, 136 had minor injuries and 473 were uninjured… [meaning] 68.8 percent survived

Unfettered competition has allowed the nation’s HEMS fleet to mushroom from 151 aircraft in 1986 to 309 in 1996 to 648 in 2006 to 852 today. If you add in dual-purpose aircraft, the number is 979, and it could be as high as 1,048 if you count non-operational spares. [However] “This is the first year ever there has been a contraction in the number of helicopters,” Blumen said. 

…the average aircraft flew 800 hours in 1994 and 600 hours between 2003 and 2008, at which time flying dropped precipitously after the accidents of 2008 and the ensuing negative publicity.  “People said, ‘We are not sending our patients in helicopters,’” Blumen noted. Now the number of flight hours per helicopter is moving up again, averaging 490 in 2016.

UPDATE 26 May 2018: US Fatal Night HEMS Accident: Self-Induced Pressure & Inadequate Oversight Four died when Metro Aviation Airbus Helicopter AS350B2 N911GF suffered a loss of control due to spatial disorientation after taking off into night instrument meteorological conditions from a remote site.

UPDATE 29 September 2018: HEMS A109S Night Loss of Control Inflight

UPDATE 21 December 2019: BK117B2 Air Ambulance Flameout: Fuel Transfer Pumps OFF, Caution Lights Invisible in NVG Modified Cockpit

UPDATE 26 September 2020: Fatal Fatigue: US Night Air Ambulance Helicopter LOC-I Accident 

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