Air Medical Committee
Board of Emergency Medical Services
Kathy Robinson, NASEMSO Program Manager
- Standing Agenda (2017)
- Meeting Record (Mar. 6, 2017)
- Workplan - State Model Rules for the Regulation of Air Medical Services (April 2017)
NASEMSO Releases State Model Rules for Regulation of Air Medical Services
(09/21/16) Today at its Fall Meeting, NASEMSO announced the release of “State Model Rules for the Regulation of Air Medical Services” to assist states with regulatory language intended to avoid conflict with the Airlines Deregulation Act (ADA) and the possibility of Federal preemption. These model rules are intended to be applied in a manner that would confine their scope to matters solely related to medical care, and not construed in a way that could constitute regulation of aviation safety or economic matters.
NASEMSO is the lead national organization for emergency medical services (EMS) and a respected voice for national EMS policy. Air ambulances are medical resources that are used and integrated within EMS systems to provide patient care. In response to “Guidelines for the Use and Availability of Helicopter Emergency Medical Transport (HEMS)” published by the United States Department of Transportation in April 2015, NASEMSO sought to identify opportunities for state regulations that address outcomes related to:
- Quality of emergency medical care provided to patients
- Requirements related to the qualifications and training of air ambulance medical personnel
- Scope of practice and credentialing
- Maintenance of medical records, data collection, and reporting
- Medically related equipment standards
- Patient care environments
- EMS radio communications
- Medically related dispatch requirements
- Medical transport plans including transport to appropriate facilities
- Other medical licensing requirements
- DOT Guidelines Support State Authority to RegulateMedical Functions ofAir Ambulances (May 29, 2015) In response to recommendations
(issued in 2009) by the National Transportation Safety Board (NTSB)
intended to improve safety in the air medical transport industry, the
Federal Aviation Administration (FAA) issued various resource documents
regarding helicopter air ambulance safety and operations (see related
items below.)NTSB safety recommendations A-09-102 and A-09-103 specific
to the air medical transport of patients with emergency medical
conditions were addressed to the Federal Interagency Committee on EMS
(FICEMS). New guidelines recently published by the US Department of
Transportation (USDOT) Office of General Counsel are in response to
A-09-102 and refer to medical standards of care that serve primarily a
patient objective as “properly within a state’s regulatory authority.”
The guidelines outline opportunities for state regulations that address
outcomes related to:
- the quality of emergency medical care provided to patients
- requirements related to the qualifications and training of air ambulance medical personnel
- scope of practice and credentialing
- maintenance of medical records, data collection, and reporting
- medically related equipment standards
- patient care environments
- EMS radio communications
- medically related dispatch requirements
- medical transport plans including transport to appropriate facilities
- other medical licensing requirements
“Guidelines for the Use and Availability of Helicopter Emergency Medical Transport (HEMS)” describes the regulatory and oversight framework for helicopter air ambulance operations that state emergency medical services (EMS) system planners should consider in developing regulations to help ensure patients receive appropriate medical attention and care. FICEMS recently transmitted these guidelines to the NTSB as a component of its response to A-09-102. The referenced document is now available online.
- Helicopter Air Ambulance Operations (135-14B) (04/17/15)
The Federal Aviation Administration (FAA) has issued this advisory
circular (AC) to provide information and guidelines to assist existing
HAA operators, other Title 14 of the Code of Federal Regulations (14
CFR) part 135 operators considering becoming an HAA operator and those
considering new-startup HAA operations. To address an increase in fatal
HAA accidents, the FAA has implemented new operational procedures and
additional equipment requirements for HAA operations.
Audit Report: Delays in Meeting Statutory Requirements and Oversight
Challenges Reduce FAA’s Opportunities To Enhance HEMS Safety
(AV-2015-039) (04/17/15) TheFAA issued a
final HEMS rule in February 2014, and Congress passed the FAA
Modernization and Reform Act of 2012 (FMRA). In light of these efforts,
the Ranking Member of the House Aviation Subcommittee requested that we
review FAA’s progress in improving air ambulance safety.
- Public Law 112-95
(PDF), the "FAA Modernization and Reform Act of 2012." Section 311
amended Title 18 of the United States Code (U.S.C.) Chapter 2, § 39, by
adding § 39A, which makes it a federal crime to aim a laser pointer at
- Reported Laser Incidents for 2010, 2011, 2012 & 2013 (ZIP) (2/11/2014)
- Legal Interpretation of 14 CFR 91.11, Interference with a Crewmember via Laser (PDF) (6/1/2011)
- California Man Walloped With 14-Year Sentence for Shining Laser at Helicopter (US News and World Report, March 2014)
- NTSB Remands Administrator v. Pirker Case Back to ALJ for Further Review.
On Nov. 18, 2014, the National Transportation Safety Board announced
that it has served the FAA and respondent Raphael Pirker with its
opinion and order regarding Mr.Pirker's appeal in case CP-217,
regarding the regulation of unmanned aircraft. In the opinion, the
Board remanded the case to the administrative law judge to collect
evidence and issue a finding concerning whether Pirker's operation of
his unmanned aircraft over the campus of the University of Virginia in
2011 was careless or reckless. In reaching its decision, the
Board determined the FAA may apply the regulation that prohibits
operation of an aircraft in a careless or reckless manner to unmanned aircraft.The opinion and order is available on the NTSB website at http://www.ntsb.gov/legal/pirker/5730.pdf.
- In June 2014, the FAA published a Federal Register notice
(PDF)on its interpretation of the statutory special rules for model
aircraft in the FAA Modernization and Reform Act of 2012. The
law is clear that the FAA may take enforcement action against model
aircraft operators who operate their aircraft in a manner that
endangers the safety of the national airspace system. In the
notice, the FAA explains that this enforcement authority is designed to
protect users of the airspace as well as people and property on the
ground. Read the full press release. Read more about Model Aircraft Operations.
- Helicopter Air Ambulance, Commercial Helicopter, and Part 91 Helicopter Operations (Final enacted February 2014.) FAA final rule addresses helicopter air ambulance, commercial helicopter, and general aviation helicopter operations by revising requirements directed primarily toward helicopter air ambulance operations and all commercial helicopter operations conducted under part 135. This rule also establishes new weather minimums for helicopters operating under part 91 in Class G airspace. For helicopter air ambulances, this rule requires operations with medical personnel on board to be conducted under part 135 operating rules and introduces new weather minimums and visibility requirements for part 135 operations. It mandates flight planning, preflight risk analyses, safety briefings for medical personnel, and the establishment of operations control centers (OCC) for certain operators to help with risk management and flight monitoring. The rule also includes provisions to encourage instrument flight rules (IFR) operations. It requires helicopter air ambulances to be equipped with both helicopter terrain awareness and warning systems (HTAWS), and flight data monitoring systems. Under the rule, helicopter air ambulance pilots will be required to hold instrument ratings.
- Air Ambulance and Commercial Helicopter Operations; Safety Initiatives and Miscellaneous Amendments (Final enacted July 2013.) Federal rulemaking changes equipment and operating requirements for commercial helicopter operations, including many specifically for helicopter air ambulance operations.
- The Airline Deregulation Act (PL 95-504) The Airline Deregulation Act (ADA) is a United States federal law signed into law on October 24, 1978. The main purpose of the act was to remove government control over fares, routes and market entry (of new airlines) from commercial aviation. As states have attempted to regulate HEMS programs and ensure their integration with state and local EMS systems, operators have responded with lawsuits asserting the exclusive authority of the Federal Aviation Administration under the Airline Deregulation Act.
- Airline Deregulation Act (ADA) Clarification Legislation
- Federal Pre-emption Issues in Regulating Air Medical Services
- FAA Opinion Allowing State EMS Office Regulation of Certain Air Medical Environmental Control
- 2010 GAO Air Medical Report
- State Regulation of Coordination and Quality of Air Ambulance Service
- Air Ambulances: Taking Patients for a Ride (Consumer Reports, May 2017). This article provides background on the concerns of out-of-network billing expenses from the perspective of consumers.
- AAMS Air Medical Cost Study (Apr. 10, 2017). The Association of Air Medical Services (AAMS) announces the publication of the Air Medical Services Cost Study Report, conducted by the independent research firm Xcenda LLC. AAMS commissioned the study in response to an evident need for reputable, independent research, specific to air medical transport, to quantify the costs associated with providing emergent air medical transports. Further, the study examines the appropriateness of the 2002 Medicare rate-setting methodology for air medical services and current payment adequacy. The resulting report provides independent substantiation of actual costs to the Centers for Medicare and Medicaid Services (CMS) and Members of Congress.
- Up in the Air: Inadequate Regulation for Emergency Air Ambulance Transportation (March 2017). Consumers Union has released this health policy paper, which provides background on the market shifts in the provision of air ambulance services in the United States, consumers concerns, regulatory gaps, and recommendations for Congress and the states to take action.
- S. 471 – Isla Rose Life Flight Act. This bill, Introduced by Sen Jon Tester (MT) in the 115th Session of Congress on Feb. 28, 2017, seeks to preserve state authority "relating to network participation, reimbursement and balance billing, or transparency for an air carrier that provides air ambulance service."
- H.R. 817: End Surprise Billing Act of 2017. A bill introduced in the 115th Congress by Rep Lloyd Doggett (TX) with 34 Democratic co-sponsors on Feb. 2, 2017, seeks to end practices of balanced billing of health benefits for patients from out-of-network providers. While the bill does not specifically mention EMS as a source of concern, advocates for the bill are hoping for a successful “first step” to support state insurance laws that are currently preempted by the Airline Deregulation Act (ADA.)
- Cause No. D-1-GN-15-004940; Texas Mutual Insurance Company et al vs PHI Air Medical, LLC in the 53rd Judicial District Court, Travis County, Texas.
- Greene MJ. 2013 Aircrew, avionics, and operations survey, part 1. Air Med J. 2013 Nov-Dec;32(6):316-23.
- Greene MJ. 2013 Aircrew, avionics, and operations survey, part 2. Air Med J. 2013 Nov-Dec;32(6):324-8.
- Thomas SH, Brown KM, Oliver ZJ, Spaite DW, Lawner BJ, Sahni R, Weik TS, Falck-Ytter Y, Wright JL, Lang ES. An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients. Prehosp Emerg Care. 2013 Nov 26.
- Floccare DJ, Stuhlmiller DF, Braithwaite SA, Thomas SH, Madden JF, Hankins DG, Dhindsa H, Millin MG. Appropriate and safe utilization of helicopter emergency medical services: a joint position statement with resource document. Prehosp Emerg Care. 2013 Oct-Dec;17(4):521-5.
- Delgado MK, Staudenmayer KL, Wang NE, Spain DA, Weir S, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States. Ann Emerg Med. 2013 Oct;62(4):351-364.
- Andruszkow H, Lefering R, Frink M, Mommsen P, Zeckey C, Rahe K, Krettek C, Hildebrand F. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Crit Care. 2013 Jun 21;17(3):R124.
- Galvagno SM Jr, Thomas S, Stephens C, Haut ER, Hirshon JM, Floccare D, Pronovost P. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2013 Mar 28;3.
- NTSB Safety Alerts on Improving Helicopter Safety
(2014) The National Transportation Safety Board recently issued two
Safety Alerts highlighting the importance of proper maintenance and
simulator training as critical ways to improve helicopter safety. This
year, helicopter safety was added to the NTSB's Most Wanted List of Safety Improvements.
In the past decade, over 1,500 accidents have occurred involving
helicopters used as air ambulances, for search and rescue missions,
commercial helicopter operations such as tour flights, and
instructional operations. During that same time, the NTSB issued over
200 safety recommendations on issues related to helicopter
investigations. The two Safety Alerts are:
- Safety Through Helicopter Simulators
- Helicopter Safety Starts in the Hangar
Accompanying the safety alerts are two videos, produced in conjunction with Helicopter Association International. Featured in the videos are NTSB investigators sharing their perspectives about the lessons learned from helicopter accident investigations.
Emergency Care 2014, Vol. 18, No. Supplement 1, Pages 35-44: An
Evidence Based Guideline for the Air Medical Transportation of
Prehospital Trauma Patients
Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost. Included are:
- Appendix A Literature Search Strategies
- Appendix B- Evidence Tables
- Appendix C- Recommendations and Grade Tables
- National Transportation Safety Board (NTSB):
- McGinnis KK, Judge T, Nemitz B, O'Connor R, Bass R, Bishop B, Kim D, Kupas D, Rupert E, Eroe ER, Racht E, Brown G, Wikle G, Murray J, Delgado J, Hutton K, Sahni R, Rogers S, Pickering T, Cone D. MPS, EMT-P. Air Medical Services: future development as an integrated component of the Emergency Medical Services (EMS) System: a guidance document by the Air Medical Task Force of the National Association of State EMS Officials, National Association of EMS Physicians, Association of Air Medical Services. Prehosp Emerg Care. 2007 Oct-Dec;11(4):353-68.