New rules from the Federal Aviation Administration (FAA) will have a significant impact on helicopter air ambulance services.  These regulations implement new operational procedures and require additional equipment for helicopter air ambulances in response to an increase in fatal helicopter air ambulance accidents.  The new rules identify four common factors in those accidents- inadvertent flight into Instrument Meteorological Conditions, loss of control, controlled flight into terrain, and night conditions.

This rule, which becomes effective on April 22, 2015, requires all helicopter air ambulance operations with medical personnel on board to be conducted under Part 135 operating rules.  The rule also introduces new weather minimums and visibility requirements, mandates flight planning and pre-flight risk analysis, safety briefings for medical personnel and the establishment of operations control centers for certain operators.  The rule also requires helicopter air ambulances be equipped with both helicopter terrain awareness and warning systems and flight data monitoring systems and imposes additional requirements on helicopter air ambulance pilots.

The rule has been updated to include all helicopter air ambulance operations with medical personnel on board in the Part 135 rules. This provision is intended to provide additional safety protections to medical personnel through increased requirements for helicopter air ambulance operators.  Under the new rule, all flights to pick up a patient, to transport the patient, and the flight to return to base after dropping off the patient must be operated under Part 135 rules. Currently, the flight to pick up the patient and the flight returning to base after dropping off the patient may be operated under Part 91 rules.  Medical personnel is defined as “persons with medical training, including, but not limited to a flight physician, a flight nurse, or a flight paramedic, who are carried aboard a helicopter during helicopter air ambulance operations in order to provide medical care”.  The FAA intends for the definition to be applied broadly to any individual who might be carried aboard the helicopter to provide patient care and should not be given a narrow interpretation to avoid Part 135 requirements. 

As a result of operating pursuant to Part 135, all flights with medical personnel on board will now be counted towards a pilot’s flight time limitations, not just the flight with the patient on board as can be done currently.  Additional requirements are also being imposed on helicopter air ambulance pilots.  Pilots must now hold a helicopter instrument rating and be able to demonstrate the ability to recover from inadvertent flight into instrument meteorological conditions during their annual competency check.

The rule creates more stringent weather minimums, detailed in § 135.607, for helicopter air ambulance operations in uncontrolled air space.  The minimums are determined by whether the helicopter is flying in a mountainous or non-mountainous area and whether the flight is taking place in the Part 135 certificate holder’s local flying area.  The certificate holder will not be required to designate a local flying area but may do so in order to use the less stringent weather minimums allowed in a local flying area.

Current regulations only permit instrument flight into or out of airports with an on-site weather reporting source.  However, the final rule allows for instrument flight at an airport without weather reporting if the certificate holder has an area forecast for the vicinity of the destination from the National Weather Service (NWS), a source approved by the NWS, or a source approved by the FAA.  Helicopters conducting these operations must be equipped with functioning severe weather detection equipment and the weather at the departure point must be at or above the minimums for visual flight rules.

Pursuant to the new rule, any helicopter air ambulance pilot conducting Visual Flight Rule (VFR) operations must now evaluate, document, and plan to clear terrain and obstacles by no less than 300 feet for day operations, and 500 feet at night.  Once the safe cruise altitude is established, the pilot must use it to determine the minimum required ceiling and visibility for the flight.  If the weather minimum will not permit visual flight at the safe cruise altitude, the pilot must conduct the flight under Instrument Flight Rules (IFR) or not fly at all. 

The rule mandates that all helicopter air ambulance operators conduct a preflight risk analysis that includes characteristics of the planned flight path, flight crewmember availability to safely conduct the operation, weather, and if the flight has been rejected by another operator.  The FAA estimates that this risk analysis can be completed in ten minutes.  In determining whether the flight has been rejected by another operator, the FAA has said that it is acceptable for an operator that is called for a flight to ask the caller if another operator has turned it down; it is not necessary for an operator to call other operators to ask if the flight was refused.  The risk analysis requirement is based on FAA Notice 8000.301 Operational Risk Assessment Programs for Helicopter Emergency Services which may provide guidance in the development a risk analysis procedure. 

A new provision requires certificate holders with 10 or more helicopter air ambulances to establish Operations Control Centers (OCCs) staffed with operations control specialists.  The specialists must take part in the pre-flight risk analysis and sign off on the analysis worksheet, work with the pilot to mitigate any identified risk, maintain two-way communication with pilots, give pilots weather information and monitor the progress of the flight.  OCCs are to be staffed with a sufficient number of specialists at all times to ensure operational control of each flight.  Operational control specialists have a 10-hour duty time limitation pursuant to the rule.  If a company holds multiple Part 135 certificates for helicopter air ambulance operations each certificate is evaluated independently to determine if the OCC requirement applies.  

This section also requires that medical personnel on board a helicopter air ambulance flight receive a preflight safety briefing on the physiological aspects of flight, patient loading and unloading, safety in and around the helicopter, in flight emergency procedures, emergency landing procedures, emergency evacuation procedures, efficient and safe communications with the pilot, and operational differences between day and night operations.  As an alternative to the safety briefing, operators can instead provide four hours of ground training and four hours of training in and around the air ambulance every two years. 

The rule has been updated to require that all air ambulance helicopters be equipped with a Helicopter Terrain Awareness and Warning System as well as an FAA-approved radio altimeter or an FAA-approved device that incorporates a radio altimeter by April 22, 2017. 

By April 22, 2018, all helicopter air ambulances must be equipped with a flight data monitoring system that is capable of recording helicopter flight performance and operational data.  Helicopters equipped with an operational Flight Data Recorder in compliance with §135.607(a)-(b) will also be in compliance with this rule.  While the rule requires the installation and operation of a flight data monitoring system, it does not require collection of data from that equipment or development of a data collection process. 

This rule does not apply to public aircraft operations which is defined as an aircraft owned or operated by the government of a State or a political subdivision of one of these government except when the aircraft is used for commercial purposes or to carry an individual other than a crewmember or qualified non-crewmember.  Commercial purposes under the statute means the transportation of persons or property for compensation or hire.  Therefore, if any compensation is received for the flight, the aircraft is operating as a commercial vendor and bound by this final rule.