Hersman Says They Will "Prevent Accidents And Save Lives"

In a letter to the Secretary of Health and Human Services Kathleen Selibus, NTSB Chair Debora Hersman has offered four recommendations for the providers of medical helicopter services.  The recommendations follow the investigations of recent accidents, which reached record numbers in 2008.

Hersman says in the letter that there were 12 accident involving HEMS aircraft in 2008, and that eight of those accounted for 29 fatalities. The services were the subject of an NTSB hearing in February, and the recommendations are derived in part from testimony given at those hearings. "Topics examined were flight operations procedures including flight planning, weather minimums, and preflight risk assessment, as well as safety-enhancing technology such as TAWS and NVIS. Flight recorders and associated flight operations quality assurance programs were also discussed," Hersman wrote. "Training, including use of flight simulators, was discussed at length, as well as corporate and government oversight of HEMS operations.

One of the principal issues to arise during those hearings was the matter of reimbursement. HEMS services are not covered by insurance companies unless a patient is actually transported, which Hersman says motivates the companies to transport patients to generate revenue. "the NTSB is concerned," she wrote, "that the current reimbursement strategy used by CMS (Centers for Medicare & Medicaid Services) serves as a disincentive for some HEMS operators to make capital investments or other improvements that would increase the level of transport safety provided and thereby reduce risk."

"To that end," she continued, "the NTSB believes that a CMS reimbursement structure requiring compliance with safety standards that incorporate HEMS safety recommendations issued by the NTSB since 2006 would encourage HEMS operators to increase their level of flight safety to best industry practices rather than minimum legal requirements."

Debora Hersman

Hersman made the following recommendations on behalf of the NTSB:

• Evaluate existing helicopter emergency medical services (HEMS) reimbursement rate structure to determine if reimbursement rates should differ according to the level of HEMS transport safety provided.
• If the findings from that evaluation conducted reveal that higher levels of reimbursement are required to increase the level of safety, establish a new reimbursement rate structure that considers the level of helicopter emergency medical services transport safety that is required.
• 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.
• Once the accreditation standard requested in Safety Recommendation A-09-106 is developed, establish a policy that provides Medicare reimbursement for helicopter emergency medical services (HEMS) transportation only to those HEMS operators that meet those standards.

Hersman said the NTSB has also issued recommendations to the FAA to improve the safety of HEMS operations, including installation of the safety equipment outlined in the letter. She said the NTSB expects the FAA to enact changes in the safety requirements for HEMS operators in response to these recommendations.

FMI: www.ntsb.gov