Medical-flight safety upgrades sought

WASHINGTON — The National Transportation Safety Board (NTSB) 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. Most of Tuesday's proposals 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. But 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. There have been no fatal crashes this year.

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.

Dawn Mancuso, executive director of the Association of Air Medical Services, a trade group, said some companies have adopted some of the equipment called for and that "none of what we heard asked for here would be viewed in a wholly negative way by our members who are committed to safety." Tying Medicare payments to a safety review "was surprising to us, but it is an innovative approach" that "will keep the discussions lively."