Aviation Safety:

Improved Data Collection Needed for Effective Oversight of Air Ambulance Industry

GAO-07-353: Published: Feb 21, 2007. Publicly Released: Mar 5, 2007.

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Air ambulance transport is widely regarded as improving the chances of survival for trauma victims and other critical patients. However, in recent years, the number of air ambulance accidents has led to increased industry scrutiny by government agencies, the public, the media, and the industry itself. The Federal Aviation Administration (FAA), which provides safety oversight, has been called upon by the National Transportation Safety Board (NTSB) and others to issue more stringent safety requirements for the industry. GAO's study addressed (1) recent trends in the air ambulance industry, (2) FAA's challenges in providing safety oversight, and (3) FAA's efforts to address the challenges and what is known about the effects of these efforts. To address these issues, we analyzed FAA, NTSB, and industry data, interviewed federal and industry officials, and conducted five site visits, among other things.

From 1998 to 2005, the air ambulance industry grew, largely in stand-alone (independent) operations, and experienced an increased number of accidents, resulting in added industry efforts to improve safety. Although there are few data on the industry's basic aspects, available data show increased numbers of helicopters and base stations between 2003 and 2005. Most of the base-station growth has been at airports and stand-alone helipads rather than hospital-based locations, a strong indication of the shift to stand-alone operations. The annual number of accidents increased from 1998 to 2003 but declined in 2004 and 2005. The decline may reflect added industry safety efforts, such as the creation of a study group that recommends best practices. However, the lack of actual flight-hour data prevents calculation of the industry's accident rate, making it difficult to determine whether the industry has become more or less safe. FAA's main challenge in providing safety oversight for air ambulances is that its oversight approach is not geared toward air ambulance operations. For example, FAA uses the same set of regulations to oversee air ambulance operations as it uses to oversee other air taxi services. Air ambulance flights are subject to greater risks than other helicopter operations because they often fly at night, in a variety of weather conditions, and to remote sights to provide medical attention. These transports also can involve multiple medical and aviation officials, increasing the potential for human error. The broad nature of the applicable regulations further inhibits FAA oversight because they may not fully address the potential risks air ambulance operations face. FAA has initiated many efforts to strengthen its oversight of air ambulances but does not evaluate the effectiveness of its efforts. FAA's efforts include establishing a task force to review air ambulance accidents, plans for hiring additional staff to oversee large operators, and issuing guidance to inspectors and operators promoting various safety practices. However, FAA does not track implementation of its voluntary guidance. Also, FAA cannot measure basic industry trends, such as accident rate changes. Measuring these trends requires actual flight-hour data, which FAA does not currently collect. Without this data, FAA cannot know if its efforts are achieving their intended results.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In 2007, we reported that the number of air ambulance helicopters and the number of accidents had grown. However, a lack of data about the number of flights or flight hours precluded the calculation of the industry's accident rate, making it difficult to determine whether the industry was becoming more or less safe. Without such data, FAA could not evaluate the effectiveness of its efforts towards safety. We recommended that FAA identify the data necessary to better understand the air ambulance industry and develop a systematic approach for gathering and using this data. We said that this data should include the number of flights and flight hours and the number and locations of air ambulance helicopters. In 2011, we confirmed that FAA now annually surveys all helicopter operators and requests, among other things, the number of helicopters, the state in which they primarily operated, the number of landings, the total flying hours, and the percentage of hours that were flown in air ambulance operations. With these data FAA can gain a better understanding of the air ambulance industry and the impact that its safety efforts are having.

    Recommendation: To help FAA monitor industry growth trends, accident rates, and operator implementation of FAA guidance, the Secretary of Transportation should direct the Administrator of FAA to identify the data necessary to better understand the air ambulance industry and develop a systematic approach for gathering and using this data. At a minimum, this data should include the number of flights and flight hours, and the number and locations of air ambulance helicopters, and the number and types of FAA violations and enforcement actions related to the air ambulance fleet.

    Agency Affected: Department of Transportation

  2. Status: Closed - Implemented

    Comments: FAA published Notice 8900.63, Validation of Helicopter Emergency Medical Services (HEMS) Safety Initiatives, which required inspectors to validate implementation of the HEMS safety initiatives and to report their findings to FAA Headquarters no later than February 1, 2009. FAA reported the results of this survey in its February 2009 HEMS Fact Sheet.

    Recommendation: To help FAA monitor industry growth trends, accident rates, and operator implementation of FAA guidance, the Secretary of Transportation should direct the Administrator of FAA to collect information on the implementation of voluntary FAA guidance by air ambulance operators and evaluate the effectiveness of that guidance.

    Agency Affected: Department of Transportation

 

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