- Email: [email protected]
The National Transportation Safety Board's Helicopter Emergency Medical Services Public Hearings
The National Transportation Safety Board’s Helicopter Emergency Medical Services Public Hearings February 3–6, 2009 Eileen Frazer, RN, CMTE
The setting was more like a congressional hearing than a courtroom. The National Transportation Safety Board (NTSB) is not a rule-making or regulatory body, but its staff members are experts in accident investigation, analysis, and safety. The purpose of the hearings was to obtain information from experts in the air medical profession and make recommendations to mitigate risks and improve the safety record of helicopter emergency medical services. These hearings took place at the NTSB headquarters in Washington, DC, over a 4-day period, February 3–6, 2009. The hearings were organized as follows: Chairman Robert Sumwalt and the board of inquiry (NTSB board members) sat at the head table, facing the spectators. To their right was the technical panel composed of NTSB board members, analysts, researchers, and investigators. To the left of the board of inquiry was the panel of witnesses, and on the floor in front of the board of inquiry were the parties to the hearings. The parties were individuals with a singular spokesperson who represented the following groups: Helicopter Association International (HAI), Pilots’ Union, Association of Air Medical Services (AAMS), National Emergency Medical Services Pilots Association, Large (Part 135) Operator—Air Methods Corporation, Small (Part 135) Operators, and the Federal Aviation Administration (FAA). The technical panel, followed by each party, asked questions of the witnesses. The board of inquiry then asked follow-up questions of the witnesses. Sumwalt held the groups to a very tight schedule and orderly conduct, providing a brief summary at the close of questioning for each panel of witnesses. There were 12 panels of witnesses, as follows: Panel 1: Presentation of Historical Risks and Factors and Canadian Perspectives, Speakers: Ira Blumen, MD, Matthew Zuccarro (HAI), and Sylvain Sequin (Canadian Helicopters) Panel 2: Current EMS Models and Reimbursement Structures, Speakers: Christine Zalar (AAMS), Kevin Hutton, MD (AAMS), Tom Judge (Life Flight of Maine), Robert Bass, MD (MEMSS), Mark Hartstein (Medicare and Medicaid), and Suzanne Wedel, MD (Boston MedFlight) 128
Panel 3: State Oversight and Competition, Speakers: Dan Manz (National Association of State EMS Officials), Bryan Bledsoe, MD (emergency physician), and Dave Thomson, MD (AAMS) Panel 4: Patient Transport Request Processes, Speakers: Jack Davidoff (Air Medical Physician Association), Dan Hankins, MD (Mayo Medical Transport), and Chief Carlton Burkhammer (Fairfax County Fire and Rescue) Panel 5: Flight Dispatch Procedures, Speakers: Garet Hickman (National Association of Airmedical Communication Specialists), Dennis McCall (Air Methods Corporation), and Ray Dauphinais (CareFlite) Panel 6: Safety Equipment and Flight Recorders, Speakers: T. K. Kallenbach (Honeywell), Scott Baxter and Dave Downey (Bell Helicopters), Dave Batcheller (Appareo), and Tim Shaver (FAA) Panel 7: Flight Operations Procedures and Training, Speakers: Neil Wink (Mayo Medical Transport), Kevin High (Air & Surface Transport Nurses Association), Bruce Webb (Eurocopter), Terry Palmer (Flight Safety International), Tony Bonham (Air Evac EMS, Inc.), Larry Buehler (FAA), and James Riley (International Association of Flight Paramedics) Panel 8: Corporate Oversight, Speakers: Chris Bassett (Air Methods), Tom Judge (Life Flight Maine), and Eileen Frazer (Commission on Accreditation for Medical Transport Systems) Panel 9: Safety Management Systems (SMS), Speakers: Keith Johnson (Airborne Law Enforcement Association), Don Arendt (FAA), and Ed Stockhausen (Air Methods) Panel 10: FAA Principle Inspector Functions, Speakers: Jon Prater and Kent Gibbons (FAA) Panel 11: FAA Flight Standards National Policy and Regional Implementation, Speakers: Dennis Pratte and Brad Pearson (FAA) Panel 12: FAA Aviation Safety Policy, Speaker: John Allen (FAA) The NTSB announced that they are specifying EMS accidents in their database, and their definition of an EMS acciAir Medical Journal 28:3
dent must meet three criteria: dedicated to air medical transport, configured for such operations, and piloted by a dedicated EMS flight crew. In 2006, the NTSB made the following recommendations after conducting an EMS accident study: • EMS should fly under Part 135 regulations for all legs of the transport. • Operational risk analysis tools should be mandated. • Flight locating should be conducted by certified flight coordinators. • Terrain awareness and avoidance systems should be required. It was obvious that the NTSB still supports these recommendations. In addition, there was concern and discussion about public versus private services; human factors such as fatigue, competition, and pressures on pilots; training; SMS and risk analysis; dispatch procedures; states and federal preemption; and technologies. The FAA explained the actions they have taken since the 2006 NTSB recommendations that include requiring risk mitigation and SMS programs, Advisory Circular A021, which outlines weather and flight planning, and A008, which further defines operational control. The subject of public versus private services was discussed several times, and the FAA made it clear that public services are outside the purview of the FAA. Public aircraft must operate under Part 91 when operating in
May-June 2009
public airspace, but statute law must be changed to make the FAA responsible for public service aircraft and operations overall. The FAA believed that they had the infrastructure to address EMS services under Part 135 regulations but did not rule out the possibility of a separate Part for EMS operations in the future. General Allen, who testified last for the FAA, stressed that the agency believes in voluntary standards. Rulemaking takes approximately 2 years, so they rely on voluntary measures as issued in FAA Advisory Circulars, for example. This was a great learning experience and an opportunity to meet new people and reacquaint with peers from the past. Family members of the victims of fatal accidents were a presence during the hearings as well. Pulling together to address and resolve the issues that face the air medical community must involve all of the stakeholders, who were well represented at this meeting. The entire proceeding was webcast in real-time on the NTSB web site. If you missed all or part of the hearings, go to www.ntsb.gov for the archived recordings. The NTSB will announce and publish their recommendations after reviewing all the testimony. Eileen Frazer, RN, CMTE, is the executive director of the Commission on Accreditation for Medical Transport Systems. She can be reached at [email protected].
129
The setting was more like a congressional hearing than a courtroom. The National Transportation Safety Board (NTSB) is not a rule-making or regulatory body, but its staff members are experts in accident investigation, analysis, and safety. The purpose of the hearings was to obtain information from experts in the air medical profession and make recommendations to mitigate risks and improve the safety record of helicopter emergency medical services. These hearings took place at the NTSB headquarters in Washington, DC, over a 4-day period, February 3–6, 2009. The hearings were organized as follows: Chairman Robert Sumwalt and the board of inquiry (NTSB board members) sat at the head table, facing the spectators. To their right was the technical panel composed of NTSB board members, analysts, researchers, and investigators. To the left of the board of inquiry was the panel of witnesses, and on the floor in front of the board of inquiry were the parties to the hearings. The parties were individuals with a singular spokesperson who represented the following groups: Helicopter Association International (HAI), Pilots’ Union, Association of Air Medical Services (AAMS), National Emergency Medical Services Pilots Association, Large (Part 135) Operator—Air Methods Corporation, Small (Part 135) Operators, and the Federal Aviation Administration (FAA). The technical panel, followed by each party, asked questions of the witnesses. The board of inquiry then asked follow-up questions of the witnesses. Sumwalt held the groups to a very tight schedule and orderly conduct, providing a brief summary at the close of questioning for each panel of witnesses. There were 12 panels of witnesses, as follows: Panel 1: Presentation of Historical Risks and Factors and Canadian Perspectives, Speakers: Ira Blumen, MD, Matthew Zuccarro (HAI), and Sylvain Sequin (Canadian Helicopters) Panel 2: Current EMS Models and Reimbursement Structures, Speakers: Christine Zalar (AAMS), Kevin Hutton, MD (AAMS), Tom Judge (Life Flight of Maine), Robert Bass, MD (MEMSS), Mark Hartstein (Medicare and Medicaid), and Suzanne Wedel, MD (Boston MedFlight) 128
Panel 3: State Oversight and Competition, Speakers: Dan Manz (National Association of State EMS Officials), Bryan Bledsoe, MD (emergency physician), and Dave Thomson, MD (AAMS) Panel 4: Patient Transport Request Processes, Speakers: Jack Davidoff (Air Medical Physician Association), Dan Hankins, MD (Mayo Medical Transport), and Chief Carlton Burkhammer (Fairfax County Fire and Rescue) Panel 5: Flight Dispatch Procedures, Speakers: Garet Hickman (National Association of Airmedical Communication Specialists), Dennis McCall (Air Methods Corporation), and Ray Dauphinais (CareFlite) Panel 6: Safety Equipment and Flight Recorders, Speakers: T. K. Kallenbach (Honeywell), Scott Baxter and Dave Downey (Bell Helicopters), Dave Batcheller (Appareo), and Tim Shaver (FAA) Panel 7: Flight Operations Procedures and Training, Speakers: Neil Wink (Mayo Medical Transport), Kevin High (Air & Surface Transport Nurses Association), Bruce Webb (Eurocopter), Terry Palmer (Flight Safety International), Tony Bonham (Air Evac EMS, Inc.), Larry Buehler (FAA), and James Riley (International Association of Flight Paramedics) Panel 8: Corporate Oversight, Speakers: Chris Bassett (Air Methods), Tom Judge (Life Flight Maine), and Eileen Frazer (Commission on Accreditation for Medical Transport Systems) Panel 9: Safety Management Systems (SMS), Speakers: Keith Johnson (Airborne Law Enforcement Association), Don Arendt (FAA), and Ed Stockhausen (Air Methods) Panel 10: FAA Principle Inspector Functions, Speakers: Jon Prater and Kent Gibbons (FAA) Panel 11: FAA Flight Standards National Policy and Regional Implementation, Speakers: Dennis Pratte and Brad Pearson (FAA) Panel 12: FAA Aviation Safety Policy, Speaker: John Allen (FAA) The NTSB announced that they are specifying EMS accidents in their database, and their definition of an EMS acciAir Medical Journal 28:3
dent must meet three criteria: dedicated to air medical transport, configured for such operations, and piloted by a dedicated EMS flight crew. In 2006, the NTSB made the following recommendations after conducting an EMS accident study: • EMS should fly under Part 135 regulations for all legs of the transport. • Operational risk analysis tools should be mandated. • Flight locating should be conducted by certified flight coordinators. • Terrain awareness and avoidance systems should be required. It was obvious that the NTSB still supports these recommendations. In addition, there was concern and discussion about public versus private services; human factors such as fatigue, competition, and pressures on pilots; training; SMS and risk analysis; dispatch procedures; states and federal preemption; and technologies. The FAA explained the actions they have taken since the 2006 NTSB recommendations that include requiring risk mitigation and SMS programs, Advisory Circular A021, which outlines weather and flight planning, and A008, which further defines operational control. The subject of public versus private services was discussed several times, and the FAA made it clear that public services are outside the purview of the FAA. Public aircraft must operate under Part 91 when operating in
May-June 2009
public airspace, but statute law must be changed to make the FAA responsible for public service aircraft and operations overall. The FAA believed that they had the infrastructure to address EMS services under Part 135 regulations but did not rule out the possibility of a separate Part for EMS operations in the future. General Allen, who testified last for the FAA, stressed that the agency believes in voluntary standards. Rulemaking takes approximately 2 years, so they rely on voluntary measures as issued in FAA Advisory Circulars, for example. This was a great learning experience and an opportunity to meet new people and reacquaint with peers from the past. Family members of the victims of fatal accidents were a presence during the hearings as well. Pulling together to address and resolve the issues that face the air medical community must involve all of the stakeholders, who were well represented at this meeting. The entire proceeding was webcast in real-time on the NTSB web site. If you missed all or part of the hearings, go to www.ntsb.gov for the archived recordings. The NTSB will announce and publish their recommendations after reviewing all the testimony. Eileen Frazer, RN, CMTE, is the executive director of the Commission on Accreditation for Medical Transport Systems. She can be reached at [email protected].
129