The National Transportation Safety Board adopted a broad set of safety recommendations Tuesday covering medical helicopters, expanding beyond equipment and technology matters to address the business models of the $2.5 billion industry.
The board also recommended extending federal oversight to government medical helicopter operations such as that of the Maryland State Police.
The most sweeping change was a proposal that Medicare, the nation's largest insurer, pay only for flights conducted by medical helicopter programs that abide by safety and performance standards that the Medicare program would develop.
The NTSB has no regulatory authority, but it can make safety recommendations to other agencies to remedy problems it uncovers during accident investigations. Most of the proposals adopted Tuesday were directed to the Federal Aviation Administration and the Centers for Medicare and Medicaid Services.
Private, for-profit companies dominate the medical helicopter industry, with about 830 medical helicopters vying for patients, a recent investigation by The Washington Post found. The number of aircraft has doubled every decade since 1980, leaving some firms with fleets as large as that of US Airways. Yet unlike commercial airlines, medical helicopters can fly without safety features such as terrain warning systems or flight data recorders.
The NTSB recommendations come after the industry's deadliest year, with 23 crew members and five patients killed in seven accidents in 2008. NTSB counted another accident by an Arizona state police helicopter in its count, but the police were on a search not a medical mission.
Four people died last September when a Maryland State Police medevac helicopter went down in darkness and fog in Prince George's County.
The NTSB noted that hundreds of thousands of patients have been safely transported by helicopter, and that there has not been a fatal crash this year. However, board staff also noted that there have been cyclical spikes, and that the so-far accident-free year might be due to the "significantly increased attention" focused on the industry.
The NTSB recommendations include requiring terrain warning systems, flight data recorders, night vision systems, use of autopilot to help single pilots and enhanced pilot training. It also recommended establishing national guidelines for when to transport a patient by helicopter, and annual data collection of flight hours and trips to improve analysis of safety records.
