AIR AMBULANCE SAFETY
NTSB AIR AMBULANCE SAFETY RECOMMENDATIONS
For decades, the NTSB has investigated air-ambulance crashes and urged the FAA to address recurring safety risks. This page tracks those recommendations, the FAA’s responses, and what changed.
A DECADES-LONG PUSH FOR CHANGE
Following a series of fatal helicopter air-ambulance crashes, the NTSB issued a broad set of recommendations intended to address recurring risks in HEMS operations. These recommendations focused not only on pilot actions, but also on the systems operators and the FAA use to identify, monitor, and control risk.
WHAT SAFETY REQUIREMENTS DID THE NTSB RECOMMEND TO THE FAA?
Two Pilots or Autopilot
The NTSB found that several HEMS accidents might have been prevented or mitigated by a second pilot. It recommended that helicopters used for emergency medical transport be equipped with autopilots and that pilots be trained to use them when a second pilot is not available.
Night Vision Goggles
The NTSB recommended requiring night vision imaging systems in HEMS helicopters and training pilots to use them during night operations.
Scenario-Based IMC Training
The NTSB recommended recurrent scenario-based training addressing inadvertent flight into instrument meteorological conditions and hazards unique to HEMS operations.
Safety Management Systems
The NTSB recommended formal safety management systems with structured risk-management practices for HEMS operators.
Flight Data Monitoring
The NTSB recommended installation of flight-data recording devices and formal programs that routinely analyze the data for deviations and emerging safety problems.
Low-Altitude Infrastructure and Weather Information
The NTSB also recommended evaluating and improving the low-altitude infrastructure used by HEMS, including weather-data collection and dissemination, ADS-B, helipads, landing zones, and integration with the National Airspace System.
WHAT REQUIREMENTS DID THE FAA ACTUALLY ADOPT?
Two Pilots or Autopilot — Not Required as Recommended
The NTSB recommended that EMS helicopters be equipped with an autopilot when a second pilot is not available. The FAA has not imposed a general requirement that HAA helicopters operate with two pilots or be equipped with an autopilot. Part 135 IFR operations can require a second-in-command, with an autopilot permitted in some circumstances as a substitute, but that is not the same as the NTSB’s proposed HEMS-wide requirement.
Night Vision Goggles — Not Required
The NTSB recommended that HEMS operators install night vision imaging systems and require pilots to be trained in their use during night operations. The FAA studied the feasibility of such a requirement but did not adopt a general rule requiring NVGs for all nighttime helicopter air-ambulance operations.
Scenario-Based IMC Training — Not Required as Recommended
The NTSB recommended development of HEMS-specific scenario-based training for inadvertent IMC and then periodic FAA-approved simulator training. Those recommendations were ultimately classified by the NTSB as Closed—Unacceptable Action.
Safety Management Systems — Yes
The FAA issued a final rule in 2024 requiring Part 135 operators, including helicopter air-ambulance operators, to implement Safety Management Systems. Existing Part 135 operators generally have until May 28, 2027, to fully implement the required SMS.
Flight Data Monitoring — Partially Required
The FAA requires helicopter air ambulances to be equipped with and operate a flight data monitoring system under 14 CFR §135.607. However, the FAA did not require operators to establish the structured program the NTSB envisioned for routinely collecting and analyzing that data. The FAA explicitly stated that its rule requires the equipment, not data collection or analysis.
Low-Altitude Infrastructure and Weather Information — Partially Implemented
The FAA has expanded ADS-B, weather-information capabilities, instrument procedures, and other infrastructure relevant to low-altitude helicopter operations. However, it did not create a single nationwide HEMS-specific low-altitude IFR infrastructure exactly as envisioned by the NTSB recommendations.
WHAT CAN YOU DO?
Contact Your Members of Congress
Federal aviation safety requirements are shaped through FAA rulemaking, congressional legislation, oversight hearings, and appropriations. Members of Congress can ask the FAA for information, request hearings, introduce legislation, or seek changes through future FAA reauthorization legislation.
Contact Your U.S. Representative
Use the official House of Representatives website to identify your representative and access their contact information.
Contact Your U.S. Senators
Each state has two U.S. senators. The Senate maintains an official directory with links to each senator’s contact information.
Tell Them What Concerns You
Identify the specific air-medical safety issue you are concerned about, reference the relevant NTSB recommendation, and ask the office to review the FAA’s response and current regulatory requirements.
Read the recommendations above. Review the FAA’s response. Decide what you think should happen next—and tell the people who represent you.