U.S. Department of Transportation

FEDERAL AVIATION ADMINISTRATION

REGULATORY EVALUATION

Air Ambulance and Commercial Helicopter Operations, Part 

91 Helicopter Operations, and Part 135 Aircraft Operations; 

Safety Initiatives and Miscellaneous Amendments

FINAL RULE

(14 CFR PARTS 91, 120, AND 135)

Jose Castedo

Office of Aviation Policy and Plans

Operations Regulatory Analysis Branch, APO-310

January 31, 2014
TABLE OF CONTENTS

Section Page No.

Executive Summary................................................................................................. i

I. Benefits................................................................................................................... 1

A. Overview........................................................................................................... 1

 B. Accident Assessment......................................................................................... 1

 C. Benefit Model and Assumptions....................................................................... 3

D. Accident Prevention Probability ....................................................................... 5

E. FAA Effectiveness and 2006 NTSB Helicopter Study ..................................... 6

F. Aircraft Replacement Value .............................................................................. 7

G. Results............................................................................................................... 7

II. Costs...................................................................................................................... 11

A. Helicopter Air Ambulance Operations ........................................................... 14

A.1.a. Applicability and Definitions (§§ 135.1, 135.601) ............................. 14

 A.1.b. Operations Control Center (§ 135.619) .............................................. 17

 A.1.c. Operational Requirements (§§ 135.609-135.615)............................... 23

 A.1.d. Pre-flight Risk Analysis (§ 135.617) .................................................. 28

A.1.e. Safety Briefing or Medical Personnel Training (§ 135.621)............... 29

A.2.a. Helicopter Terrain Awareness and Warning Systems (§ 135.605)..... 34

 A.2.b. Flight Data Monitoring System (§ 135.607)....................................... 35

 A.3.a. Instrument Rating (§ 135.603) ............................................................ 37

 

B. Commercial Helicopter (Including Air Ambulance) Operations.................... 39

B.1.a. IFR Alternate Weather (§ 135.221)..................................................... 39

B.2.a. Radio Altimeter (§ 135.160)................................................................ 39

 B.2.b. Overwater Equipment Requirements (§§ 135.117, 135.168).............. 42

 B.3. Competency in Instrument Meteorological Conditions (§ 135.293)...... 46

 C.1. VFR Class G Airspace Helicopter Weather Minimums (§ 91.155)....... 47

C.2. Load Manifest (§ 135.63)....................................................................... 51

III. Comparison of Benefits and Costs and Sensitivity Analysis of Benefits............. 52

IV. Comments............................................................................................................. 61

V. Appendix 1 – Accident History ............................................................................ 76

VI. Appendix 2 – Fuel Prices...................................................................................... 80

VII. Appendix 3 – Costs of the NPRM and Final Rule over 10 years......................... 81

VIII. Appendix 4 – Results from two separate effectiveness measures analyses.......... 82
i

EXECUTIVE SUMMARY

To address an increase in fatal helicopter air ambulance accidents, the FAA will 

implement new operational procedures and additional equipment requirements for 

helicopter air ambulances. This final rule also revises requirements for equipment, pilot 

training, and alternate airports for commercial helicopter operations, and it increases 

weather minimums for helicopters operating under part 91.

The estimated mean benefit value for the rule will be about $821 million or $577 million,

in present value at 7%, over 10 years. The FAA estimates the cost of this rule will be 

approximately $311 million or $243 million, in present value at 7%, over 10 years.
1

I. Benefits

A. Overview

Benefits will accrue from the implementation of new operational procedures and 

additional equipment requirements for helicopter air ambulances. This final rule also 

increases safety for commercial helicopter operations by revising requirements for 

equipment, pilot training, and alternate airports and it increases weather minimums for 

helicopters operating under part 91. 

The FAA identified 131 accidents which could have been prevented by this rule. Of 

these accidents 62 were air ambulance, 20 were commercial, and 49 were basic VFR 

weather minimums accidents. These accidents resulted in nearly 227 fatalities from 1991 

to 2010. The estimated mean benefit value for preventing such future accidents will be

$821 million or $577 million present value at 7% over 10 years. 

 

B. Accident Assessment

FAA’s Flight Standards Service (AFS-250) reviewed each of the accidents and linked 

them to the provisions of the rule that were developed to address each of these accidents, 

as shown in the appendix 1. To minimize the subjectivity of the accident review, FAA’s 

Office of Accident Investigation and Prevention (AVP-210) assessed the probability that 

the rule would be effective for each of the aforementioned accidents using the applicable 

portions of the Commercial Aviation Safety Team (CAST) and Joint Implementation 

Measurement and Data Analysis Team (JIMDAT) methodology. CAST was developed 

by a U.S. government-aviation industry partnership. They developed an integrated, data-
2

driven strategy designed to reduce the commercial aviation fatality rate in the United 

States. The CAST process is straightforward: analyze causes of past accidents, identify 

areas where changes may have prevented them, implement promising safety 

enhancements, measure results, and repeat the process. 

Each safety enhancement in the rule was evaluated against each undesired condition to 

determine the probability that the enhancement would eliminate or mitigate these 

conditions if the enhancement had been in place at the time of the accident. The resulting 

score represents the fatality risk reduction of a single safety enhancement acting on its 

own.

Of the 131 accidents identified by the FAA, 89 involved one or more fatalities (about

68%) and 42 had no fatalities (about 32%). These accidents resulted in a total of 227

fatalities, 48 serious injuries, and 60 minor injuries. In addition to the injuries and 

fatalities, there was also substantial damage to the aircraft or complete hull loss as a result 

of these accidents. More specifically, 92 aircraft were destroyed, and 39 aircraft were 

substantially damaged. Table 1 provides more details.
3

Also, Appendix 1 provides the accident date, location, number of casualties, casualty

costs, the rule provisions associated with the accident, and rule effectiveness1 for each of

these accidents.

C. Benefit Model and Assumptions

We developed a model to estimate the benefits of the final rule. The relationships of the 

model may be summarized as follows: 

Benefits =[(Accidents × Aircraft) + (Accidents × Medical & Legal) + (Fatalities × 

VSLfatalities) + (Serious injuries × VSLserious injuries) + (Minor injuries × VSLminor 

injuries)] × Effectiveness

where:

Accidents = average number of accidents per year (1991-2010);

Fatalities = average number of fatalities per year;

Serious injuries = average number of serious injuries per year;

Minor injuries = average number of minor injuries per year;

Medical & Legal = average medical and legal cost per accident;

Aircraft = average aircraft damage cost per accident;

VSL = value of a statistical life;

Effectiveness = accident prevention probability.

This model was used for fatal and nonfatal accidents. In the benefit model, we assumed 

that:

• The rule would take effect in 2013. 

 1 The effectiveness measure assesses how effective the rule might have been in averting the accident at the 

time of the accident.
4

• All monetary values were expressed in constant 2013 dollars. 

• The value of a statistical life (VSL) is $9.1 million. 2

• VSL in future years were estimated to grow by 1.07 percent per year before 

discounting to present value.

• The value of medical and legal costs associated with fatal injuries was estimated 

at about $274,000. 3

 

• The value of a serious injury was $955,500. 4

• The value of medical and legal costs associated with serious injuries was 

estimated at about $96,000. 5

• The value of a minor injury was $27,300. 6

• The value of medical and legal costs associated with minor injuries was estimated 

at about $5,000.

7

• Under the rule, air ambulance and commercial operators will have either zero, 

three, four, or five years from the effective date of the final rule to comply with 

the majority of their equipment requirements. To account for the compliance 

period, we adjusted our benefit estimate accordingly. As an example, for the 

HTAWS provision (§ 135.605) which requires compliance in 3 years, we 

assumed that 1/3 of the benefits will be realized in 2013 because we estimate that 

33% of the affected entities will be in compliance during 2013. Likewise, we 

 2

Office of the Secretary of Transportation Memorandum, "Treatment of Value of a Statistical Life in 

Departmental Analysis – 2011 Interim Adjustment”, July 2011.

3

APO Bulletin APO-2-1, “Treatment of Value of Life and Injury in Economic Analyses”, February 2002, 

updated in 2010 and included in Appendix 4.

4 Ibid.

5 Ibid.

6 Ibid.

7 Ibid.
5

assumed another 1/3 of the affected entities will come into compliance in 2014,

and all entities will be in full compliance in 2015. We applied similar 

methodology for the following rule provisions which also have delayed 

compliance dates: radio altimeters (§ 135.160); emergency equipment for 

rotorcraft operations (§ 135.168); pilot-in-command instrument qualifications (§ 

135.603); flight data monitoring system (§ 135.607); and operations control 

centers (§ 135.619).

D. Accident Prevention Probability

FAA’s initial analysis of how effective each provision of the rule would be in 

preventing future accidents resulted in unusually high estimates. To address comments

that these estimates may have been too high, FAA conducted a second analysis in which 

a second group of analysts separately reviewed the National Transportation Safety Board 

(NTSB) factual and probable cause reports on air ambulance, commercial and VFR 

weather minimums accidents to determine which final rule provisions would have been 

applicable. The second analysis used more conservative criteria, which resulted in lower 

effectiveness scores for several accidents. This final rule addresses well over 100

helicopter accidents. Although these accidents have few fatalities per accident, the large 

number of preventable accidents dwarf the substantial reductions in the measures of the 

probability of effectiveness which were made for about a third of the accidents. Changes 

in the effectiveness ratings reduced the estimated benefits from $725 million to $577 

million, in present value at 7% over 10 years. Despite these changes the benefits of the 
6

rule still exceed costs and only one provision—HTAWS--had its benefits fall below its 

costs. For a full discussion of the results from the two separate analyses, see Appendix 4. 

In both analyses, the FAA assessed whether the rule would have had a high, medium, or 

low likelihood that the rule would be effective in preventing the accident. We then

assigned the following effectiveness numbers:

 Low effectiveness (0-33%).

 Medium effectiveness (34-67%).

 High effectiveness (68-100%). 

Once the values were assigned, we calculated the weighted probability average for every 

provision, as well as for each accident type (fatal or nonfatal). See section G for the 

results.

E. FAA Effectiveness and 2006 NTSB Helicopter Study

In 2006 the National Transportation Safety Board (NTSB) published a study on 

emergency medical services accidents8

. The study detailed 7 accidents, 5 of which 

involved helicopter emergency medical services. These 5 accidents, along with 13 

others that had similar probable causes as those reported in the NTSB study, represent 

45% of the preventable air ambulance accidents used in the benefits analysis for this rule. 

 8 Special Investigation Report on Emergency Medical Services Operations (Jan. 25, 2006), found at 

http://www.ntsb.gov/safety/safetystudies/sir0601.html (December, 10, 2013)
7

In fact, 64% of all the fatal air ambulance accidents between 2002 and 2010 were similar 

to those cited in the study. 

F. Aircraft Replacement Value

We valued destroyed aircraft at an average replacement cost of aircraft potentially 

affected by this rule and we valued aircraft with substantial damage at an average 

restoration cost of aircraft potentially affected by this rule (which we estimated at about 

15 % of the replacement cost). 9 After that, we calculated the average aircraft damage 

cost per fatal or nonfatal accident by weighing the replacement and restoration costs by 

the number of destroyed aircraft and by the number of aircraft with substantial damage 

(See table 2). 

G. Results

The results are displayed in the next few tables, which are classified by rule provision. 

Air Ambulance Benefits

 9

Table 5.10 from the “Economic Values for FAA Investment and Regulatory Decisions, A Guide”.
8
9

Commercial Benefits
10

VFR Class G Airspace Helicopter Weather Minimums Benefits

Total Benefits
11

II. Costs

From 2012 to 2021, the cost of the final rule will be approximately $311 million ($243

million, present value) as shown in Table 7.
12
13

General Cost Assumptions

• Monetary values are expressed in 2013 dollars, unless noted otherwise.

• Discount rate applied is 7 % as directed by the Office of Management and Budget.

• Using the FAA Aerospace Forecasts, for fiscal years 2011-2031, the FAA estimated 

that the helicopter fleet would grow at 2.8 % per year.10

• We use the following costs per hour as the burdened wage rates for this evaluation.

The societal costs include the overhead costs that are allocated to labor as well as the 

direct cost. Once the wage rates are established, to assess the incremental cost to 

society, we add Bureau of Labor Statistics fringe benefits and overhead to calculate 

the actual employer costs of employee compensation.11

 10 Table 27, FAA Aerospace Forecasts Fiscal Years 2011-2031. 11 http://www.bls.gov/bls/blswage.htm.
14

A. Helicopter Air Ambulance Operations

A.1.a. Applicability and Definitions (§§ 135.1, 135.601)

The final rule will require that all helicopter air ambulance operations with medical 

personnel on board be conducted under part 135 thus eliminating the part 91 portions of 

the operation. This change will result in: (1) a medical personnel briefing in addition to 

the normal briefing for passengers; (2) flight and duty time requirements applying to 

more flight segments; and (3) the increased possibility of flight cancellations or delays 

due to weather. As discussed below, although the FAA does not have specific cost data, 

we anticipate a minimal economic impact on the regulated community.

1. The costs for briefing medical personnel are accounted for in section A.1.e. Safety 

Briefing or Medical Personnel Training.

2. Some flight time now accrued under part 91 would count toward flight and duty time 

limitations. Generally flight time spent repositioning helicopters under part 91 does not 

count against a pilot’s daily flight time limitation. Moving flight segments from part 91 

to part 135 will mean that additional flight time must be counted against the pilot’s 

maximum daily flight time. Although we do not have specific data on what this impact 

would be, we believe that the cost of this transition will be minimal for the following 

reasons.

First, under current rules some part 91 flight time counts toward the pilot’s daily flight 

time limitation. If a part 91 flight precedes a part 135 flight, the part 91 segment counts 
15

towards flight time. A part 91 flight that does not precede a part 135 flight would count 

as “other commercial flying” which does not count against daily limits, but must be 

factored into quarterly and yearly flight time limitations. Therefore, in the example of a 

three-segment operation consisting of a part 135 flight operated between two part 91 

flight segments, the first part 91 flight is already being counted towards flight time, as is 

the part 135 flight. However, the final part 91 flight does not count against the daily 

limits, but cannot take place during a pilot’s required rest period and needs to be factored 

into the pilot’s quarterly and yearly limitations.

 

We note that duty time would not be affected because all flights assigned by a certificate 

holder currently count as duty time. This would not change under the new rule.

We also do not anticipate that pilots will have difficulty with staying within flight time 

limitations because helicopter air ambulance flights are generally short, as explained 

above. The part 135 flight and duty regulations already allow for flight time to be 

exceeded when a flight is extended beyond its scheduled time due to situations beyond 

the control of the operator. 

Second, helicopter air ambulance operators currently follow flight and duty rules and 

have pilot scheduling policies and systems set up to prevent exceeding flight time and 

duty period limitations. This is an operational issue they are familiar with and they 

would not need to implement new procedures for following these rules. Although, some 

operators may need to adjust pilot schedules, we anticipate that any minor modifications 
16

to these systems and policies that are needed can be made during the 60 days allotted for 

implementation following publication of the rule. 

Although we anticipate that this rule’s impact on flight time limitations would be 

minimal, we estimated that each certificate holder employs 3.1 pilots for each helicopter 

in its air ambulance operation and that each helicopter is staffed 24/7. Therefore, because 

we anticipate that the costs associated with the change from part 91 to part 135 with 

respect to flight time limitations would be minimal this conservative staffing model 

would adequately cover any costs incurred. 

The risk to patients and medical personnel presented by a fatigued pilot justifies the 

anticipated limited circumstances that a flight would need to be delayed or cancelled. 

This rule gives protection to the medical personnel as well as to the pilots by taking care 

that the pilots are rested. 

3. This rule assigns weather minimums for helicopter air ambulance flights with medical 

personnel on board which are more stringent than what is currently required for part 91 

legs. Some flights may be cancelled or delayed. We do not have specific data on how 

many helicopter air ambulance flights will be cancelled or delayed due to the new rule’s 

increased weather minimums for Visual Flight Rules (VFR) operations, however we 

anticipate the impact will be minimal.
17

It is possible that the first segment of each operation could be delayed or cancelled, which 

could result in delay or cancellation the follow-on segments. We do not collect data on 

whether an operator cancels or delays a flight. However, because operators have tools to 

mitigate a situation where a cancellation or delay may occur, we do not believe this rule 

would lead to large amounts of delay in or cancellation of patient transport. For example, 

the operation could be conducted under Instrument Flight Rules (IFR), and then the VFR 

weather minimums would not apply. Certain transports, such as an inter-facility 

transport, may be able to be rescheduled for later in the day if weather is indicated to be 

improving.

As an alternative to helicopter air ambulances, ground ambulances are often a viable 

means of patient transport even in circumstances where a helicopter is requested. In 

circumstances where patient transport cannot be conducted via helicopter the patient may 

have other means of medical transport available. 

A.1.b. Operations Control Center (§135.619)

This rule will require companies with 10 or more helicopter air ambulances to establish 

operations control centers (OCCs) to provide pilots with weather information, monitor 

flights, and help assess preflight risks to provide additional safety for complex operations. 

Operations Control Specialists (OCSs) must be trained by the certificate holder.
18

Air ambulance operators with 10 or more helicopters that do not have an OCC12 

• Of the 15 air ambulance operators with 10 or more helicopters, 10 of them do not 

have an OCC yet. 

• Based on FAA expertise, we estimated that operators with 10 or more helicopter

would create one OCS position for every 10 helicopters. We received no comments 

on this relationship and therefore continue to use this value. 

• Currently there are 219 helicopters in use by these operators. Dividing the 219

helicopters by 10 helicopters per OCS position equals 22 OCS positions. 

• To fill the 22 OCS positions which are functioning 24 hours a day, 10 hours per shift 

and 7 days on/7 days off, a total of 119 OCSs will be needed in the first year (22 OCS 

positions x 2.4 shifts/day x 2 OCSs to provide 52 weeks coverage x 1,820 annual 

working hours/1,610 annual available working hours). 

• Based on FAA forecasts, the helicopter fleet is expected to grow at 2.8% per year.

• The 119 OCSs must have 80 hours of initial training and pass a 2 hour practical 

exam.13 A total of 12 chief pilots will administer the training and exams (119 OCSs / 

10 OCSs per chief pilot = 12 chief pilots). The 119 OCSs would also need to take 40 

hours of recurrent training and pass a 1 hour examination.

• 9.9 hours (119 OCS x 5/60 hours) per year would be needed for a clerical person to 

maintain records of the training and examinations.

 12 Air ambulance operators with 10 or more helicopters that do not have an OCC = 10 operators; 219

helicopters (20%). Air ambulance operators with 10 or more helicopters that already have an OCC = 5 

operators; 677 helicopters (63%). Air ambulance operators with fewer than 10 helicopters = 58 operators; 

179 helicopters (17%). Helicopter data from FAA, Vital Information Subsystem (VIS) database. 13 Source: FAA (unless otherwise noted, the FAA is the source for all estimates of hours of training, testing, 

and record maintenance).
19

• In the first year, 60 new permanent OCSs will be hired (119 OCSs x 50% will be 

new). We estimate that 50% of employees who are already performing duties similar 

to an OCS will be assigned to the OCC.14 This estimate was based on FAA expertise 

and we received no comments on it. Therefore, we have not changed the NPRM 

estimate. 

• 22 new computers and televisions will be needed per OCS position (21 is the same as 

the number of OCS positions). 

• We assume all OCSs already have workstations. This is based on the assumptions that 

OCCs will be housed in existing space and the certificate holder will not need to buy 

new furnishings other than what we stated here.

• The FAA determined 60 hours for a chief pilot and 30 hours for a clerk would be 

required to develop the OCS training (10 operators).15

• We determined on a yearly basis 5% of the OCSs would be tested at random for drug 

and alcohol for 30 minutes at a cost of $65 per test.16 Calculation in the first year = 

(119 OCSs x 5% x 0.5 hours x $41.55) + (119 OCSs x 5% x $65 per test) = $512.

Using the preceding information, the FAA estimates the cost of this provision to air 

ambulance operators that do not have an OCC at about $68 million or $51 million present

value at 7%, as shown in Tables 9-11. 

 14 Source: FAA (unless otherwise noted, the FAA is the source for all percent estimates related to affected 

populations).

15 Source: FAA. 16 Source: FAA.
20
21
22

Operators with 10 or more helicopters that already have an OCC

• Of the 15 air ambulance operators with 10 or more helicopters, 5 of them already have an 

OCC. FAA data shows that that these 5 operators have a total of 677 helicopters. 

• We calculated that 68 OCS positions will be needed in the first year (677 helicopters / 10 

helicopters per OCS position = 68 OCS positions). We assume certificate holders will 

create one position for every 10 helicopters operated.

• Using the same procedures as above 369 OCSs are required based on 68 OCS positions. 

• The 369 OCSs must have 40 hours of initial training and pass a 2 hour practical exam. A 

total of 37 chief pilots will administer the training and exams (369 OCSs / 10 OCSs per 

chief pilot = 37 chief pilots). There is no change in the number of required chief pilots as 

a function of the reduced training requirement because chief pilots are required for other 

purposes. The 369 OCSs would also need to take 40 hours of recurrent training and pass 

a 1 hour examination.

• 31 hours (369 OCS x 5/60 hours) per year would be needed for a clerical person to 

maintain records of the training and examinations.

• The FAA determined 60 hours for a chief pilot and 30 hours for a clerk would be 

required to develop the OCS training (3 operators).

• We determined 1 hour for a chief pilot and 30 minutes for a clerk to make small 

amendments to their existing manuals (2 operators).

• The FAA estimates on a yearly basis 5% of the OCSs would be tested at random for drug 

and alcohol for 30 minutes at a cost of $65 per test. Calculation in the first year = (369

OCSs x 5% x 0.5 hours x $41.55) + (369 OCSs x 5% x $65 per test) = $1,587.
23

The FAA estimates the cost of this provision to air ambulance operators that already have 

an OCC at about $9 million or $7 million present value, as shown in Table 12.

Although we received very few economic comments on this provision, we adjusted our 

NPRM results in the following three ways: 

1. Because a few commenters pointed out that a 10-hour work day for an OCS will 

add an additional full time employee to the OCC, we reassessed at our adjustment

factor. We decided to increase the adjustment factor from 3.2 (in the NPRM) to 

5.4. 

2. We understood from the comments that this provision will affect fewer air 

ambulance operators than we had estimated in the NPRM because there are 

operators that already have an OCC at this time. 

3. We failed to capture a growth rate for the helicopter fleet in the NPRM, but we 

are estimating a 2.8% growth in this final rule.

A.1.c. Operational Requirements 
24

VFR Weather (§135.609)

This provision will require helicopter air ambulance operations to comply with more 

stringent VFR weather minimums in uncontrolled airspace than those currently 

established in part 135. This requirement increases the safety margin and has a minimal 

cost impact because it utilizes existing infrastructure and implements requirements of 

Operations Specification A021 that are currently being used. We received no comments 

regarding this cost estimate. Therefore, we have not changed the NPRM cost estimate.

Local Flying Area

Additionally, we estimate that 50% of the air ambulance operators will designate local 

flying areas. A chief pilot would spend 2 hours mapping and describing it for the local 

FAA office. The FAA estimates the cost to designate local flying areas at about $7.5

thousand or $7.5 thousand present value, as shown in Table 13.
25

IFR Operations without Weather Reporting (§135.611)

The FAA will allow helicopter air ambulance operators to conduct IFR operations in 

certain circumstances at airports or heliports without a weather reporting facility. 

Currently, the regulations permit only IFR operations into and out of airports with an onsite weather reporting source. This requirement will increase the use of IFR flight by 

helicopter air ambulance operators which will result in more aircraft operating in a 

positively controlled environment and within the existing infrastructure resulting in 

unquantified net benefit gains. Commenters noted that the rule as proposed, which did 

not allow for use of area forecasts, could have the effect of requiring operators to add 

approved automated weather stations near to locations from which they operate or 

operate VFR. The FAA notes that the final rule was amended to permit use of area 
26

forecasts for IFR operations at airports and heliports without weather reporting. 

Therefore, these final results are unchanged from the NPRM results.

IFR/VFR Transitions (§135.613)

The FAA will allow a helicopter air ambulance pilot to fly IFR to a point in space (PinS) 

within 3 nautical miles of the flight’s destination, at which the pilot will be able to 

continue an approach to a heliport or landing area under VFR conditions, weather 

permitting. 

The requirement will benefit pilots by enabling them to access more destinations by 

flying within the IFR structure, and then continuing VFR along approaches that have 

been flight checked for obstacles by the FAA. In the initial regulatory evaluation the 

FAA estimated that this provision would generate minimal additional costs. We received 

no comments regarding these results. Therefore, these final results are unchanged from 

the NPRM results. 

VFR Flight Planning (§135.615)

This provision is intended to prevent obstacle collisions by requiring pilots to be aware of 

the terrain and highest obstacles along a planned route. The FAA will require helicopter 

air ambulance pilots to perform preflight planning to determine the minimum safe 

altitude along the planned en route phase of flight when conducting VFR operations. 

Pilots will be required to evaluate, document, and plan to clear terrain and obstacles along 
27

the planned route of flight by no less than 300 feet for day operations, or 500 feet for 

night operations. 

Although we received no comments regarding this cost estimate, we increased the 

helicopter pilot wage from $48 to $75 because the previous estimate was based on a 

typical 40-hour week as opposed to the actual working hours of a helicopter pilot (1,800 

annual working hours). Also, because we failed to capture a growth rate for the 

helicopter fleet in the NPRM, we are estimating a 2.8 % growth in this final rule.

Pilots will have to look at a sectional chart, plan their course, and determine specific 

altitudes which could be completed in conjunction with the risk assessment. The flight 

planning will be required prior to take-off for all helicopter air ambulance operators and 

is estimated to take an additional 5 minutes. With an hourly pilot cost of $75, the cost for 

5 minutes of planning would be an additional $6.25 per operation. To calculate the 2013

cost of $2.5 million, we multiply the estimated additional cost ($6.25) by the number of 

affected air ambulance helicopters (1,073) and then by the estimated operations per year 

per aircraft (367). Additionally, we estimate operators will need change flight plans on 

5% of flights, which will take an additional 5 minutes per flight. As summarized in Table 

14, when summed over the period of analysis, the total cost of the flight planning 
28

requirement is $29 million or $22 million present value.

A.1.d. Pre-flight Risk Analysis (§135.617)

This final rule will require operators to implement an FAA-approved pre-flight risk

analysis program resulting in two cost categories. First, the operator will develop a riskanalysis program, and then the operator will implement and perform a risk analysis 

before each flight in order to mitigate the risks.

We estimate that it will take a chief pilot and a clerk 30 hours each to design and 

implement an approved pre-flight risk analysis program.17 With a burdened hourly labor 

rate of $79 for the chief pilot and $25 for the clerk, the estimated cost per operator is 

$3,120. When we multiply this cost per operator by the number of operators (73), the 

total industry cost is about $228,000 ($228,000 present value). An FAA inspector from 

the FAA district office will review the pre-flight risk analysis program.

 17 Source: FAA.
29

In evaluating the minimum proposed requirements for a pre-flight risk analysis program, 

we estimate there will be roughly 393,791 affected flights18 in the first year and that the 

accompanying risk analysis would take an additional 10 minutes per flight.19 This 

equates to 65,632 hours in the first year. When multiplied by the hourly cost of a pilot 

($75), the first year cost is $4.9 million and the 10-year cost is $55.8 million.

For the period of analysis, the total cost of this provision is about $56 million ($42

million present value).

Although we received no comments regarding this cost estimate, in this final rule, we 

increased the helicopter pilot wage and included a growth rate for the helicopter fleet.

A.1.e. Safety Briefing or Medical Personnel Training (§135.621)

This final rule will require that prior to each helicopter air ambulance operation, each 

pilot in command, or other flight crewmember designated by the certificate holder, must 

 18 1,073 helicopters x 367 operations per year per helicopter = 393,791 flights. Source for operations per 

year per helicopter: FAA Flight Standards.

19 Depending upon the level or risk, the 10 minutes might be divided between pilot, director of operations 

or the OCS. We received no comment on this 10-minute estimate, so we did not change it. 
30

ensure that all medical personnel receive a safety briefing.20 As an alternative to the 

safety briefing, certificate holders will be permitted to provide training every 2 years to 

medical personnel through an FAA-approved training program. 

The safety briefing, which would affect 50% of the operations, is estimated to take an 

additional 3 minutes. With an hourly pilot cost of $75, the cost for 3 minutes to brief 

medical personnel will be an additional $3.75 per operation. To calculate the 2013 cost 

of $738 thousand, we multiply the estimated additional cost ($3.75) by the number of 

affected air ambulance helicopters (1,073), by the estimated operations per year per 

aircraft (367), and then by 50%. As summarized in Table 16, when summed over the 

period of analysis, the total cost of the flight planning requirement is $8 million or $6

 20 the maximum total pre-flight time added by this rule is 18 minutes—5 minutes for VFR flight planning,+ 

10 minutes for pre-flight risk analysis + 3 minutes for safety briefing + some carriers will take another 5 

minutes to change their flight plan.
31

million present value. 

As an alternative to the safety briefing, we estimate that it will take a chief pilot and a 

clerk 10 hours each to design and implement an approved medical personnel training.21 

The burdened hourly labor rate for the chief pilot is $79 and for the clerk is $25. An 

FAA inspector from the FAA district office will review the medical personnel training. 

The total industry cost is estimated to be $41,464 ($41,464 present value).

 21 Source: FAA.
32

To estimate the cost of the training, we multiplied the hourly cost of medical personnel 

by the number of affected employees. We estimate 50% of medical personnel would need 

additional training. That product is then multiplied by the hourly estimate (8 hours) that 

will occur every other year. We assume one instructor will be assigned per group of 20 

students. As shown in table 18, when summed over the period of analysis, the medical 

personnel training cost is $13 million or $10 million present value.
33

Once the training has been performed, the operator will document the training provided 

to medical personnel employed by the certificate holder. We estimate a clerk will spend 

5 minutes per training record to document the training.22 The total recordkeeping costs 

are estimated to be $61,020 or $47,408 present value.

For the period of analysis, the total cost of this provision is about $22 million ($16

million present value).

 22 Source: FAA.
34

A.2.a. Helicopter Terrain Awareness and Warning Systems (HTAWS) (§135.605)

The FAA will require that all helicopters used in air ambulance operations be equipped 

with HTAWS. The costs of this provision consist of the cost of the device and 

installation, equipment downtime, and incremental fuel burn.

The FAA projected the total number of helicopter air ambulances will rise from 1,133 in 

2015 to 1,378 in 2022. Of the 1,133 helicopter air ambulances in 2015 (at that time, all 

helicopter air ambulances will have to come into compliance), we believe that 

approximately 20% will be already equipped with HTAWS. The remaining 80% will

incur the cost of this provision. Because certificate holders will have 3 years from the 

effective date of the final rule to comply with this requirement, we assume that from 2013

through 2015 approximately 1/3 of the helicopters will come into compliance with this 

requirement on an annual basis. We estimate the unit cost to be equipped with HTAWS 

at $35,000.23 Additionally, we estimate 2 days of equipment downtime24 and a revenue 

loss of about $7,000 per helicopter per day.

The additional fuel consumption per year was estimated by multiplying the amount of 

weight added (3.9 pounds for HTAWS25) by the incremental fuel burn (0.005 gallons per

 23 This cost includes installation. Source: NPRM. 24 About 40 hours are needed to install HTAWS. Of those hours only 16 hours represent equipment 

downtime because the rest of the installation would be done during an interval maintenance inspection. 25 Source: FAA (unless otherwise noted, the FAA is the source for all equipment weights).
35

pound26) times the annual utilization in flight hours (550 flight hours per year27) times the 

FAA forecasted Jet A Kerosene price per gallon.

28

Using the preceding information, the FAA estimates that the total cost of this provision 

would be about $54 million ($48 million present value at 7%) as calculated in Table 20.

Although we received no comments regarding this cost estimate, in this final rule, we 

provided a growth rate for the helicopter fleet.

A.2.b. Flight Data Monitoring (FDM) System (§135.607)

The FAA will require certificate holders conducting helicopter air ambulance operations

to install a FDM system, which comprises a system or combination of systems that record 

a helicopter’s flight performance data. The costs of this provision consist of the cost of 

the device and installation, hardware, software license fee, equipment downtime, and 

incremental fuel burn. 

 26 “Economic Values for FAA Investment and Regulatory decisions, A Guide,” Oct.3, 2007 by GRA for the 

FAA, table 6-3. 27 Source: FAA. 28 GA Jet A Kero Price - Monthly Fuel Price Survey of U.S. fuel suppliers (FBOs nationwide) conducted 

by Aviation Research Group/US (ARGUS). See Appendix 2 for the forecast of Jet A Kero prices.
36

We projected the total number of helicopters will rise from 1,164 in 2016 to 1,377 in 

2022. Of the 1,164 helicopters that will be operating in 2016, approximately 15% will be

already equipped with FDM systems. The remaining 85% will incur the cost of this 

provision prior to the 2017 effective date. Because certificate holders will have 4 years 

from the effective date of the final rule to comply with this requirement, we assume that 

from 2013 through 2016 approximately 1/4 of the helicopters will come into compliance 

with this requirement on an annual basis. We estimate the cost of the device and its 

installation at $7,000 and $8,000, respectively.

29 We estimate two one-time hardware 

and software license fee costs, respectively $2,500 and $750, per operator.

30 

Additionally, we estimate 2 hours of equipment downtime31 and a revenue loss of about 

$7,000 per helicopter per day. 

The additional fuel consumption per year was estimated by multiplying the amount of 

weight added (1 pound for FDM) by the incremental fuel burn (0.005 gallons per pound) 

times the annual utilization in flight hours (550 flight hours per year) times the FAA 

forecasted Jet A Kerosene price per gallon.

32

The FAA estimates that the total cost of this provision will be about $20 million or $18

million present value, as shown in Table 21. 

 29 Source: comments. 30 Ibid. 31 About 8 hours are needed to install an FDM system. Of those hours only 2 hours represent equipment 

downtime because the rest of the installation would be done during an interval maintenance inspection. 

Source: FAA.

32 GA Jet A Kero Price - Monthly Fuel Price Survey of U.S. fuel suppliers (FBOs nationwide) conducted 

by Aviation Research Group/US (ARGUS). See Appendix 2 for the forecast of Jet A Kero prices.
37

Although the NPRM did not contain proposed rule text, the FAA provided a detailed 

discussion of the proposals under consideration and asked for comments in anticipation 

of including an FDM system requirement in the final rule. The FAA received a number 

of comments on the cost of the FDM system. This cost estimate takes into account all the 

comments received (for details on the comments and our responses to those comments 

see the comment section and the preamble to the final rule).

A.3.a. Instrument Rating (§135.603)

The FAA will require helicopter air ambulance pilots to hold a helicopter instrument 

rating. Although pilots will have to complete some cross-country flight time as well as

actual or simulated instrument time to obtain the instrument rating, the FAA believes that 

this provision will impact a relatively small number of pilots. While the FAA believes 

very few pilots will need to be instrument trained, we provide a very high estimate as the 

base case by estimating 5 percent of the pilots will need such training. We received only 

one comment from a pilot stating that he would need to obtain an instrument rating. 

After receiving that comment we contacted three of the largest trade associations 

representing the helicopter air ambulance industry which reported that industry practice 
38

has been to hire only instrument rated pilots since at least 2006. Based on that 

information we believe that the actual number of pilots affected would be closer to the 

2% low-end estimate in our sensitivity analysis. Even at the 5 percent level of pilots 

needing training, the societal cost is very low at approximately $4 million (See table 22).

 

We estimate a one-time cost of $13,000 per pilot for the instrument rating.33 We also 

estimate time costs of $8,625 (115 hours of classroom, flying, studying and testing time34

at a wage of $75 per helicopter pilot) and the cost of lodging and meals at $129.35 We 

assume that 80 percent of the affected pilot population would fly to their training 

locations, while the remaining 20 percent of the affected population travel by car. We 

estimate an air travel cost by taking the product of two times the domestic OriginDestination Revenue per Passenger.

36 Therefore, we estimate that the cost for pilots who 

travel by air is $356. Pilots who travel by car would travel approximately 40 miles at a 

cost of $0.56 per mile.37

Using the preceding information, the FAA estimates that the total cost of this provision 

will be between $1 million to $4 million present value, as shown in Table 22.

 33 “The instrument rating,” Advanced Helicopter Concepts. Accessed on July 12, 2012 at 

http://www.advancedhelicopter.com/site/coursepricing.php. 34 Source: http://www.usaviationacademy.com 35 2014 per diem standard rate. Source: http://www.gsa.gov. 36 Source: Airline Origin and Destination Survey, Bureau of Transportation Statistics, U.S. DOT. 37 2014 Standard Mileage Rates. Source: http://www.irs.gov.
39

B. Commercial Helicopter (Including Air Ambulance) Operations

B.1.a. IFR Alternate Weather (§135.221)

This provision will increase the alternate airport weather minimums for IFR operations. 

This additional margin for weather at the alternate airport will increase the likelihood that 

a pilot will be able land under IFR at the alternate airport if weather conditions at the 

destination airport deteriorate below the IFR weather minimums while the aircraft is 

enroute. 

The FAA estimates that the overall cost of this requirement will be minimal, as it will not 

prohibit flights from occurring and partial flights will still be able to occur. There is a 

possibility that some flights may be affected (potentially requiring more time) as a result 

of this requirement. However, we believe when operators are faced with inadequate and 

unsafe weather minimums, they will explore alternatives and plan appropriately. As we 

received no comments regarding this estimate for the NPRM, we continue to believe this 

requirement will generate only minimal additional cost.

B.2.a. Radio Altimeter (§135.160)
40

The FAA will require radio altimeters for all rotorcraft operated by part 135 certificate 

holders. The costs of this provision consist of the cost of the device and installation, 

maintenance, equipment downtime, incremental fuel burn, and deviations. 

We estimate that there will be 1,133 air ambulance helicopters, 231 air tour helicopters,

and 1,710 on demand helicopters that will need to be equipped with radio altimeters 

before the 2016 effective date. We assume an annual growth rate of 2.8% for the

helicopters. We estimate that approximately 30% of air ambulance helicopters and 25%

of commercial helicopters (air tour and on demand) will be already equipped with radio 

altimeters. Because certificate holders will have 3 years from the effective date of the 

final rule to comply with this requirement, we assume that from 2013 through 2015

approximately 1/3 of the helicopters will come into compliance with this requirement on 

an annual basis. We estimate the cost of the device and its installation at $9,000 and 

$1,000, respectively.38 We estimate an annual cost of $500 to maintain the radio 

altimeter.39 Additionally, we estimate 2 hours of equipment downtime40 and revenue 

losses of about $7,000 and $1,700 per helicopter per day for air ambulance operators and 

air tour operators, respectively.41

The additional fuel consumption per year was estimated by multiplying the amount of 

weight added (1.5 pound for radio altimeter) by the incremental fuel burn (0.005 gallons 

 38 Source: comments.

39 Ibid. 40 About 8 hours are needed to install radio altimeters. Of those hours only 2 hours represent equipment 

downtime because the rest of the installation would be done during an interval maintenance inspection.

41 Source: NPRM.
41

per pound) times the annual utilization in flight hours (550 flight hours per year) times 

the FAA forecasted Jet A Kerosene price per gallon.

42 

Using the preceding information, the FAA estimates that cost of the device and 

installation, maintenance, equipment downtime and incremental fuel burn will be about 

$21 million or $16 million present value, as shown in Table 23. 

Although on-demand operators may also incur the cost of equipment downtime, we

received no comments and did not change the low to minimal cost estimate.

 42 GA Jet A Kero Price - Monthly Fuel Price Survey of U.S. fuel suppliers (FBOs nationwide) conducted 

by Aviation Research Group/US (ARGUS). See Appendix 2 for the forecast of Jet A Kero prices.
42

Because not all rotorcraft have the room to incorporate a radio altimeter, some operators 

may ask the FAA for a deviation. We estimate a total of 107 deviations in 2015 and that 

it will take chief pilots about 1 hour to write the deviation requests. An FAA inspector at 

Headquarters will review the request for the deviation. The FAA estimates the cost of the 

deviations at $20,651 or $18,037 present value, as shown in Table 24.

Overall, we estimate the total cost of this provision at about $21 million or $16 million 

present value.

We received comments on this provision; based on those comments, we increased our 

cost estimate for the device from $3,750 to $9,000. Also, we now include a 2.8% annual 

growth for this final rule. 

B.2.b. Overwater Equipment Requirements (§§ 135.117, 135.168)
43

The FAA will require safety equipment for overwater operations. The costs of this 

provision consist of the cost of the emergency locator transmitter, life preserver, and 

incremental fuel burn.

In 2015, all helicopters will have to come into compliance. At that time there will be an 

estimated 1,133 air ambulance helicopters, and 1,710 on-demand helicopters. We 

assume an annual growth rate of 2.8% for the helicopters. Of these helicopters, we 

believe that this provision will impact approximately 5% of air ambulance helicopters 

and 15% of on-demand helicopters. Because certificate holders will have 3 years from 

the effective date of the final rule to comply with this requirement, we assume that from 

2013 through 2015, approximately 1/3 of the helicopters will come into compliance with 

this requirement on an annual basis. We assume on average 4 occupants per air 

ambulance helicopter and 6 occupants per on-demand helicopter. We estimate a cost of 

$2,850 per emergency locator transmitter and $269 per life preserver.

43 

The additional fuel consumption per year was estimated by multiplying the amount of 

weight added (0.5 pounds for the emergency locator transmitter and 4 pounds for the life 

preserver) by the incremental fuel burn (0.005 gallons per pound) times the annual

utilization in flight hours (550 flight hours per year) times the FAA forecasted Jet A 

Kerosene price per gallon.

44

 43 Source: NPRM. 44 GA Jet A Kero Price - Monthly Fuel Price Survey of U.S. fuel suppliers (FBOs nationwide) conducted 

by Aviation Research Group/US (ARGUS). See Appendix 2 for the forecast of Jet A Kero prices.
44

Using the preceding information, the FAA estimates that the total cost of this provision

will be about $2.7 million or $2.2 million present value, as shown in Tables 25 and 26.
45
46

We received several comments to extend the compliance deadline of this provision;

however, we did not extend the compliance deadline because we removed the life raft 

requirement from the provision.

 

B.3. Competency in Instrument Meteorological Conditions ( IMC) (§135.293)

Current rules do not require a pilot to demonstrate safely maneuvering an aircraft back 

into visual meteorological conditions (VMC) following an inadvertent flight into

instrument meteorological conditions (IMC) during a §135.293 competency check. The 

FAA will require pilot testing on recovery from inadvertent flight into IMC to include 

flat-light, whiteout, and brownout conditions. This testing will occur every year and will

include a demonstration of the pilot's ability to maneuver the rotorcraft solely by 

reference to instruments. 

In order to demonstrate compliance with this requirement, we estimate that each 

additional IMC recovery on an approach will take an additional 20 minutes. 

To be in compliance with this requirement, all pilots for air ambulance operators will

need to perform an additional IMC recovery every year. We conservatively estimate that 

all the other part 135 pilots (on demand, and air tours) will require an additional 20 

minutes to demonstrate compliance with the additional IMC recovery on an approach 

each year.45 

 45 Source: FAA.
47

We estimate the total weighted average “blended” total hourly cost to operate an affected 

aircraft at $1,413. With an additional 20 minutes required to perform an IMC recovery, 

additional costs per pilot will be $471 annually. 

We multiply the estimated affected number of pilots in the appropriate categories by the 

estimated annual cost per pilot of $471. When summed over the period of analysis, the

total costs are $26 million or $19 million present value. 

As we received no comments regarding this estimate for the NPRM, we only updated our 

estimates to reflect values in constant 2013 dollars.

C.1. VFR Class G Airspace Helicopter Weather Minimums (§91.155)

This requirement implements more stringent weather minimums for flights in 

uncontrolled (Class G) airspace. Pilots will need to maintain a designated amount of 

visibility, rather than staying “clear of clouds” which encourages pilots to take 

unnecessary risks. 

We anticipate that this rule could affect the following operations:

1. Helicopter Air Ambulance operators would encounter minimal additional cost because 

they would conduct a relatively small number of part 91 flights under the new rule. With 
48

the movement of helicopter air ambulance flight legs to part 135 as proposed, the only 

remaining types of flights that will be conducted under part 91 will be training flights, 

maintenance flights, and refueling flights which are all conducted in visual flight rules 

(VFR). The FAA believes that these non-revenue flights could be postponed for better 

weather at minimal cost to the operator. 

This requirement will not impact helicopter air ambulance operations with medical 

personnel or patients on board because proposed § 135.609 establishes weather 

requirements for helicopter air ambulance operators in uncontrolled airspace. Those 

weather requirements are more restrictive than those proposed under new § 91.155. 

2. On-Demand operators, other than those operating helicopter air ambulances, also 

operate under part 135 rules. The weather requirements proposed in § 91.155 are already 

contained in § 135.205(b), i.e. 1⁄2 mile visibility during the day and 1 mile at night. Ondemand operators use part 91 to reposition aircraft and for refueling, maintenance and 

training flights. These on-demand operators will use part 91 to reposition helicopters 

more than helicopter air ambulance operators because as a result of this rulemaking 

helicopter air ambulances will be conducting most repositioning flights under part 135. 

However, we do not have the data that shows how often this occurs. Nevertheless, we 

anticipate a minimal impact due to delayed or cancelled flights because some operations 

may be able to be rescheduled and training, maintenance, and refueling flights generally 

would not be conducted under marginal weather conditions. Therefore there should not 

be a large impact on these operators as a result of the new rule. 
49

3. Air Tour operators should not be impacted because their revenue comes from 

passengers who want to sightsee. The changes introduced by this rule affect operations 

conducted in marginal weather conditions. As discussed above, the rule requires a 

minimum of 1⁄2 mile visibility to conduct a VFR operation during the day. We therefore 

assumed that a passenger would not pay for a sightseeing flight when he or she cannot 

see more than 1⁄2 mile from the aircraft. As such, under existing regulations, the operators

would likely have cancelled or delayed the flights because of the weather conditions. 

Moreover, the rule’s impact is mitigated by the fact that not all air tours are conducted 

under part 91. Many are conducted under part 135 which has its own weather 

requirements.

 

4. Part 133 Rotorcraft External Load operators and part 137 Agricultural Aircraft 

operators conduct their revenue flights under the part 91 weather requirements. 

Therefore, changing § 91.155 would have an impact that is larger than for the part 135 

helicopter air ambulance operators and on-demand operators based on the volume of 

operations. 

In the absence of this rule change, we projected that from 2013 to 2022, part 137 

helicopter operations will rise from about 59,000 to 76,000, whereas part 133 helicopter 

operations will rise from 1.2 million to 1.5 million. We believe that this rule change will 

result in cancellation of approximately 1% of these operations.

46 We estimated the 

potential loss using the opportunity cost of capital using a 7 percent discount rate. We

 46 Source: FAA.
50

estimate a capital cost of $2.70 per operation for part 137 operations and $0.14 per 

operation for part 133 operations.

47

Using the preceding information, the FAA estimates that the total cost of this provision 

will be $36,826 ($27,259 present value at 7%) as calculated in Table 28. 

In the NPRM, our assessment was that this provision was going to generate only minimal 

additional cost. However, commenters said that this provision will negatively impact 

their ability to do business in support of power line maintenance and construction 

operations (part 133 operations). So we recalculated the cost of this provision and we 

quantified not only the impact to part 133 operators but also to part 137 operators.

 47 The capital cost is based on the number of helicopter operations and an estimated market value for the 

helicopter. The market value for the helicopter is from “Economic Values for FAA Investment and 

Regulatory decisions, A Guide,” Oct.3, 2007 by GRA for the FAA, table 5-5.
51

C.2. Load Manifest (§ 135.63)

Currently, § 135.63 requires operators of multi-engine aircraft to complete a load 

manifest in duplicate and carry one copy aboard the aircraft. No specific action is 

required for the second copy but certificate holders must retain a copy of the completed 

load manifest for at least 30 days. Single engine aircraft currently have no requirement to 

prepare a load manifest. Based upon the re-evaluation of the comments for this 

provision, the FAA has withdrawn the requirement from the final rule.

In the NPRM, the FAA proposed to apply the rule to all airplanes and helicopters, single 

and multiengine, operating under part 135, and to clarify the requirements for preparation 

and transmission of the load manifest. The FAA estimated this provision would impose 

costs of $82 million (present value) over 10 years while the benefits were estimated at 

$20 million (present value) over 10 years. 

The FAA requested comments on the cost of the load manifest provision. The NTSB 

supported this revision and commented that it responds to NTSB Safety 

Recommendation A-99-61. Association of Air Medical Services (AAMS), National 

EMS Pilot Association (NEMSPA), HAI (Helicopter Association International) and 

Angel One supported the intent to maintain accurate load manifest records, but they, and 

many commenters, expressed concerns about the cost, justification, and operational 

impact of this requirement. Commenters noted the high cost of this requirement and 

questioned how this provision would prevent accidents. 
52

Based on the comments received and additional review of the NPRM, the FAA has

withdrawn the load manifest requirement proposed in the NRPM due to the excessive 

cost of this provision. Therefore, the costs and benefits associated with this provision as 

discussed in the NPRM are not included in this final regulatory evaluation. 

III. Comparison of Benefits and Costs and Sensitivity Analysis of Benefits

Tables 29 and 30 show a comparison of benefits and quantified costs by rule provision 

for each kind of operation affected by the rule.
53
54
55

In comparison with the NPRM the benefits are higher because the value of a statistical 

life increased from $6.2 million to $9.1 million and we added medical and legal costs

associated with fatal, serious, and minor injuries. Although we eliminated several 

accidents from the air ambulance and commercial categories we also added new 

accidents to the VFR class G airspace helicopter weather minimums category.

As shown in Table 30, benefits are less than costs for seven provisions: § 135.615 VFR

flight planning, § 135.621 Safety briefing or medical personnel training, § 135.605 

Helicopter Terrain Awareness and Warning Systems (HTAWS), § 135.607 Flight Data 

Monitoring (FDM) System, § 135.603 instrument rating, § 135.168 life preserver, and 

§ 135.168 Emergency Locator Transmitter (ELT). Although quantified benefits do not 

exceed the estimated costs for these provisions, the FAA is retaining them in the rule for 

the following reasons.

VFR flight planning: The requirement to determine the highest obstacle along the 

planned route of flight increases a pilot’s awareness of the obstacles and terrain the pilot 

will encounter during a flight. 

Safety briefing or medical personnel training: Medical personnel on helicopter air 

ambulance flights will benefit from an increased familiarity with the helicopter and 

emergency procedures due to their unique role of providing patient care while 

simultaneously working around an operating helicopter. The preflight briefing and 
56

training is intended to prevent medical personnel from inadvertently introducing risk to 

the operation when outfitting the passenger compartment for the purpose of providing 

medical treatment and when providing medical care to a patient.

HTAWS: The FAA is requiring HTAWS not only because it is Congressionally 

mandated but also because of the demonstrated effectiveness that TAWS has had in 

reducing fatal accidents in fixed-wing airplanes. For details on how we came to this 

determination, see Appendix 4, section V, subsection A2 .

FDM: These systems can provide critical information to investigators in the event of an 

accident. In addition, the data can be used proactively by an operator to modify 

operational and maintenance procedures for increased efficiency and lower costs, to 

provide immediate feedback to pilots in training, and to highlight areas where additional 

training may be needed.

Instrument Rating: This regulation provides valuable instrument flight skills to pilots. It 

also more closely aligns helicopter air ambulance pilots with a commercial pilot 

certificate to airplane pilots with a commercial pilot certificate who are required to hold 

an instrument rating to carry passengers without distance or time-of-day limitations. See 

14 CFR § 61.133(b).
57

Life preserver: the FAA is retaining the requirement that a life preserver be worn when a 

helicopter is over water beyond power-off glide distance of shore because the accident 

analysis shows that the life preserver provision would generate the most benefits of the 

proposed equipment requirements in § 135.168 and provide passengers the necessary 

personal survival equipment in the event of an accident over water. 

Emegency Locator Transmitter: Equipping helicopters with a 406MHz emergency 

locator transmitter will allow search and rescue responders to locate an accident site more 

precisely allowing them to reach the site as quickly as possible.

The FAA conducted a sensitivity analysis of the effects on the benefits of the rule using 

alternative VSL values as shown in the following table.

More specifically Tables 32a and 32b shows a comparison of present value benefits and

costs by rule provision using the low alternative value of $5.2 million and the high 

alternative value of $12.9 million. We also considered these alternative VSL values

when calculating the costs of injuries. To estimate the costs of serious injuries we 
58

multiplied the fraction of VSL for a serious injury (0.105) by the VSL and to estimate the 

costs of minor injuries we multiplied the fraction of VSL for a minor injury (0.003) by 

the VSL.
59
60
61

For the base case (a VSL of $9.1 million) total benefits of the rule will be about $821

million or $577 million, present value, over 10 years. Total costs of the rule will be about

$309 million or $242 million, present value, over 10 years. Overall, final rule benefits 

exceed costs by $336 million present value over 10 years.

IV. Comments

B.2.b. Overwater Equipment Requirements (§ 135.168)

 The FAA received several comments that, because of the lack of available rafts and

concerns with obtaining approval for external mounting, a 3-year compliance period for 

externally mounted life rafts does not provide enough time.

FAA Response: The FAA has withdrawn the life raft requirement proposed in the 

NPRM.

C.1. VFR Class G Airspace Helicopter Weather Minimums (§ 91.155)

 Commenters said that the proposed change would negatively impact their ability to 

support ground crews in marginal weather and would not offer the flexibility needed to 

do business in support of powerline maintenance and construction operations.

FAA Response: The FAA recognizes that this provision will affect not only part 133 

operators (which includes powerline and construction) but also part 137 operators. In the 

NPRM, we did not quantify the impact of this provision on these operators because we
62

believed that it would generate only minimal additional cost. In the final rule, we 

quantified the impact of this provision to part 133 and part 137 operators.

A.1.b. Operations Control Center (OCC) (§ 135.619)

Some commenters opposed the proposed OCC requirement being dependent on fleet size 

(the rule only applies to operators with 10 or more helicopters), asserting the safety 

benefit of an OCC is necessary for all air ambulance operators. A few commenters 

noted that AC120-96, Integration of Operations Control Centers into Helicopter 

Emergency Medical Services Operations (May 5, 2008), provides guidance on how to 

scale an OCC to fit the size of the organization.

FAA Response: The FAA agrees that an operations control center could benefit all 

certificate holders. Nevertheless, the FAA is requiring an operations control center only 

for certificate holders with 10 or more helicopter air ambulances, as proposed. The FAA 

believes that these larger certificate holders will gain the most benefit from an operations 

control center because their operations are more complex. 

AC120-96 describes four basic models of integration of an OCC and enhanced 

operational control procedures into air ambulance operations. Model 2 represents the 

minimum baseline that most air ambulance operators should strive to achieve. The OCC 

costs estimated for the final rule are based on this model’s configuration, which states 

that the operator should maintain an OCC staffed by air ambulance OCSs rather than 

allowing the fractional use of OCSs.
63

 A few commenters asserted the proposed requirement of a 10-hour workday effectively 

adds an additional full-time employee to the OCC and significant associated costs to the 

operator without a demonstrated benefit.

FAA Response: We agree with these commenters that the end result of an extended 

workday is that operators need to hire additional OCSs to provide coverage. In the final 

rule, we apply an adjustment factor based on a 10-hour workday to determine the 

additional staffing that will be needed as a result of an extended workday (see OCC costs 

for details).

As for the benefits, we disagree with these commenters. Appendix 1 lists several 

accidents to support this provision. 

Accidents

The following Table 33 summarizes the accident comments:
64
65

Responses to Accident Comments (comment numbers correspond to Table 31)

1 Commenters claim that they have identified several accidents that were listed as 

occurring under part 91 operations when they were conducted under part 135 rules, 

part 135 weather minimums, or higher. They claim the reason these accidents are 

categorized as part 91 operations is due to a “flawed accident investigation process 

and an agreement between the FAA and the NTSB, signed in a Memorandum of 

Understanding (MOU) in 1992, that accidents involving an air medical flight without 

a patient on board would be categorized as part 91.”

The FAA acknowledges that the commenters correctly characterize how accidents are 

categorized pursuant to the MOU. Accordingly, FAA’s Flight Standards Service

conducted a subsequent review of the accidents cited in the NPRM as supporting this 

proposal. In the NPRM, the FAA determined that 33 accidents (see Table 34 below) 

occurred during part 91 operations and would therefore support including those 

operations in part 135. Upon subsequent review, the FAA has now determined that 

17 of those accidents occurred while flying in weather minimums below the 

minimums that would be required under §135.609 of the rule and, therefore, still 

support the part 135 all applicability and definitions provision discussed in A1a. The 

Office of Accident Investigation and Prevention reevaluated, in terms of the 

applicability to this rule, the 16 accidents that occurred in weather minimums at or 

above the minimums that would be required under § 135.609 and decided to eliminate 

6 of them (those scored with zero). The Office of Accident Investigation and 

Prevention scored the rest of the accidents using the applicable portions of the CAST 
66

methodology except for accident ATL90FA073, which was not considered because it 

falls outside the period of analysis of this final rule. These accidents are listed in 

Table 32.

2 We agree with this commenter. For the final rule, we reviewed the accident data once 

again and were able to identify 51 accidents to support this provision (see Appendix

1, Table A.3).

3 Pre-flight risk analysis may have helped properly identify all risks associated with the 

flight and helped avoid this accident either by canceling the flight or requiring the 

helicopter to carry extra fuel in case diverting was needed. We also considered that 

HTAWS would have been a possible accident preventer or risk mitigator if it would 

have been in effect at the time of the accident.

4 An operational radio altimeter would have helped the pilot avoid the river and 

therefore avoid the accident. We also considered that HTAWS, an OCC, preflight 

risk analysis, flight and duty time, and competency in IMC would have been possible 

risk mitigations if these items would have been in effect at the time of the accident.

5 We concede that this accident is not the best example to support the radio altimeter. 

However, although a radio altimeter alone may not have prevented this accident,

when you incorporate IMC training with HTAWS and a radio altimeter, this accident 

could have been avoided, even with non-certified instruments. We have removed this 

accident from the accident analysis in this final regulatory evaluation. 

6 The FAA withdrew the load manifest requirement proposed in the NPRM.

7 The FAA disagrees that the change would be a profound shift in the regulatory 

structure as the changes to §§ 135.267 and 135.271 proposed in the NPRM only 
67

served to clarify the effect of applying part 135 rules to helicopter air ambulance 

flights previously flown under part 91. Nevertheless, the FAA removed the flight and 

duty time references proposed in the rule because they were redundant.

8 This accident is used to support HTAWS, the operations control centers, pre-flight 

risk analysis, the radio altimeter, and VFR Class G airspace helicopter weather 

minimums, not flight and duty time.

9 Although HTAWS alone would not have prevented this accident, when you 

incorporate the operations control centers, pre-flight risk analysis, the radio altimeter,

and HTAWS, this accident could have been avoided. 

10 Yes, this accident was used to justify the radio altimeter and also support competency 

in IMC. 
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FDM System Cost Comments (§135.607)

There were several comments on the device. Some commenters said that we 

underestimated costs; others that we overestimated them. Commenters also provided

estimates on the cost of the device. See Table 33 for details.

Additionally, there were comments on the FDM equipment standard that will be used,

whether the device needed to be crashworthy, and on the implementation time for the 

system. Many commenters were critical of the cost estimates in the NPRM, stating that

we did not include costs such as the hardware, the data analysis, or the FOQA program. 

Table 35 summarizes the FDM cost comments.
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Responses to FDM System Cost Comments (comment numbers correspond to Table 33)

Equipment

1. In the NPRM, we asked for comment on whether a flight data monitoring (FDM) 

system should be required. We provided cost information and a list of representative 

functions that an FDM system is capable of. Our objective was to get feedback from 

commenters and see if the industry supported a mandate to require an FDM system in 

the final rule. 

However, commenters misinterpreted the NPRM and assumed that the FAA was 

proposing that helicopter air ambulances be equipped with an FDM capable of 

recording the functions we described, rather than a piece of equipment that is capable 

of recording flight performance or operational data. The FDM capability described in 

the NPRM was meant to illustrate the type of data that could be collected by this 

equipment. We did not seek to mandate an FDM system that must record all 

information pertaining to the aircraft’s state (such as heading, altitude, and attitude), 

condition (such as rotors, transmission, engine parameters, and flight controls), and 

system performance (such as full authority digital engine control, and electronic flight 

instrumentation system). Under this rule, the operator would be able to determine the 

parameters that the FDM would record. Therefore, we believe that this

misunderstanding of the NPRM is the underlying factor in the discrepancy in our 

equipment cost estimates of $6,450 ($5,950 plus $500 for installation) and one of the 

commenter’s cost estimates of $40,000 (see Table 33). 
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In the final rule, the FAA specifically identifies a set of performance standards that 

must be met. While these performance standards are based on certain requirements in 

TSO-C197 and ED-155, the final rule does not require equipment that is compliant 

with TSO-C197 or ED-155. The FAA is aware of equipment that meets TSO-C197 

requirements that is currently available for $7,000. We used this cost as the basis for 

our estimate in this final rule. 

2. For the purposes of the regulatory evaluation we estimated the cost of a TSOapproved article. This rule does not require a TSO-compliant device but a TSOapproved device would meet the rule’s requirements. Therefore, our cost model is 

based on the TSO-C197. The TSO-C197 prescribes the Minimum Operational 

Performance Specification (MOPS) under standard and environmental conditions. 

The TSO references EUROCAE ED-155 and RTCA/DO-160 to standardize the 

design and production approval of these information collection and monitoring 

systems.

3. Our estimated cost of $7,000 per unit includes the crash survivability of the memory 

module as specified by the ED-155 standard.

4. We agree with this commenter. The FAA has determined that 4 years would provide 

additional time for equipment certification, development, production, and installation. 

The FAA has extended the proposed compliance time from 3 to 4 years after the 

effective date of the rule.

5. In the NPRM we estimated installation at $500 per helicopter (this cost was added to 

$5,950 for the device for a total cost of $6,450). We agree with commenters who said 
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that we underestimated the installation costs. For the final rule, we estimate 80 hours 

will be required to install the device at a per-hour rate of $100. The 80 hours of 

installation cost includes the cost estimate to run operational performance tests (run 

the aircraft, complete installed equipment aircraft testing, and retrieve the data). 

6. Although the $750 per year for a software license fee is correct, we did not capture a 

one-time cost of $2,500 for the hardware. We will include this one-time cost in the 

final rule. As for the $50,000 to $120,000, we disagree with this commenter. We 

believe that this operator/commenter included this large cost to include the total cost 

of implementing a flight data monitoring program corporation-wide. This commenter 

has multiple lines of business within its corporation and each line of business is set up 

with this device installed. 

 

Downtime 

Commenters said that the FAA’s estimates had not included the cost of downtime. This 

is not correct. In the NPRM, we estimated 2 hours of equipment downtime and a revenue 

loss of about $7,000 per helicopter per day.

Data Analysis

Commenters said that the FAA’s estimates had not included the costs for the data 

analysis. In the final rule, we have not included costs for development, training, 

processing, and analyzing the data because this will not be required in the final rule.

Flight Operational Quality Assurance (FOQA) Program
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Commenters said that the FAA’s estimates had not included the costs for a FOQA 

program. FOQA is a currently existing, voluntary program. We are not mandating 

participation in the FOQA program; therefore, these costs are not included in the final 

rule. 

Combined Costs

The combined cost estimate provided by the commenters includes data analysis, which is 

not part of the final rule. We did not use it in this final evaluation. 

Radio Altimeter Cost Comments (§ 135.160)

Commenters provided estimates on the cost of the device, the implementation time, 

maintenance and downtime. Table 36 summarizes the radio altimeter cost comments:
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Response to Radio Altimeter Cost Comments (from Table 34): According to the 

commenters, the FAA underestimated the cost of this device. For this analysis, the FAA 

used the $9,000 from the commenters for the cost of the device, although we did not 

include the optional indicator or the optional night vision goggles indicator because these 

two options will not be required by this rule. We failed to capture $500 per year for 

maintenance, so we added it in this analysis. We kept our two estimates for equipment 

downtime because we received no new estimates.
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APPENDIX 1
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APPENDIX 2
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APPENDIX 3
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APPENDIX 4

I. Summary of Accident Effectiveness Evaluations

FAA’s initial analysis of how effective each provision of the rule would be in preventing future 

accidents resulted in unusually high estimates. To address concerns that these estimates may 

have been too high, a second group of analysts separately reviewed the National Transportation 

Safety Board (NTSB) factual and probable cause reports on air ambulance, commercial and VFR 

weather minimums accidents to determine which final rule provisions would have been 

applicable. The second analysis used more conservative criteria, which resulted in lower 

effectiveness scores

 This final rule addresses well over 100 helicopter accidents. Although these accidents have few 

fatalities per accident, the large number of preventable accidents dwarf the substantial reductions 

in the measures of the probability of effectiveness which were made for about a third of the 

accidents. The purpose of the second review was to—

• Determine the validity of the effectiveness scores and identify where adjustments could 

be made.

• Explain why the scores may be higher if compared to other rules.

After the second analyst team reviewed the 154 accidents, they removed 1 accident and lowered 

the effectiveness scores for 48 accidents. In the cases where the second analyst team scored a 

higher effectiveness for an accident, the lower score estimated by the first team was still used in 

order to be more conservative. These results are shown in the following table.
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Note: There are 3 categories: low (0-33%), medium (34-67%), and high (68-100%).

The second analyst team also removed the MIA08MA203 accident because the helicopter was 

conducting a public aircraft operation under part 91. Thus, part 135 regulations did not apply to 

that operation and would not have prevented this particular accident. However, prior to 

removing the accident, there was a thorough discussion acknowledging that there are aircraft 

being operated by part 135 certificate holders that may conduct both public aircraft operations

and at other times part 135 operations. As discussed in the preamble (Section E. General 

Comments, Public Aircraft Operations), it is the nature of the operation, not the ownership of the 

aircraft exclusively, that determines status as a public aircraft operation. In the end, since the 

helicopter was conducting a public aircraft operation, the accident was removed from the 

analysis. The team also reduced 22 accidents to zero (15 accident scores went from a score of 16 

to 0; 5 from a score of 50 to 0; and 2 from a score of 84 to 0). For the accidents that were 

lowered between categories and within categories—the decreases range from 5 to 88 percent. 
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These changes reduced the estimated benefits from $725 million to $577 million, in present 

value at 7% over 10 years. Despite all of these changes the benefits of the rule still exceed costs 

and only one provision—HTAWS--had its benefits fall below its costs. 

II. Why this Final Rule has higher Effectiveness Scores than Some Other Rules

This appendix addresses the reasons for why the effectiveness scores are high and related issues 

which arise from the 2006 NTSB effectiveness study. There are multiple reasons why this rule 

has higher accident effectiveness probabilities than some other part 121 rules. The operational 

improvements from the proposed new helicopter provisions are known to be highly effective and 

the resulting incremental improvement will benefit helicopter operations, which have a lower 

operational standard than part 121 operations. Recent rules affecting training and experience for 

part 121 pilots occur in a safer environment, than that experienced in helicopter operations. Part 

121 flights have air traffic controllers directing take-offs and landings. Most helicopter flights 

are under visual flight conditions without air traffic guidance. Airplanes flown under part 121 

are certificated to a higher standard with redundancy required for critical systems, and also are 

already required to have the equipment improvements proposed and adopted in this rulemaking. 

The recent part 121 rules improving training (RIN 2120-AJ00, Qualification, Service, and Use of 

Crewmembers and Aircraft Dispatchers) and requiring additional experience (RIN 2120-AJ67, 

Pilot Certification and Qualification Requirements), reinforce existing requirements, rather than 

initiate new requirements as in this final rule. For example, the proposed operations control 

center requirements in this final rule will be new for the affected helicopter operators, whereas

dispatch centers have been a standard operating requirement for part 121 operators.
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In addition, a single accident may have a high probability of effectiveness rate simply due to

multiple provisions. Each provision may have a low effectiveness, but as they are mutually 

exclusive, these low effectiveness rates, when summed, add to a high accident prevention rate. 

III. Effectiveness Measures by Provision

In conducting this analysis, we have estimated the cost-effectiveness for each regulatory 

provision, if possible. The FAA notes that we are more confident on the estimated effectiveness

values for the overall rule than for each provision. Nonetheless, the provision-by-provision costbenefit analysis resulted in the recognition that two proposed requirements (life raft and load 

manifest) did not have sufficient benefits and the FAA did not adopt those requirements in the 

final rule. 

For the provisions required specifically of helicopter air ambulance operators, we have 

calculated an effectiveness score for each provision and then summed those scores for an overall 

effectiveness score. 

To calculate this overall score, we had to make a simplifying assumption that the provisions are 

mutually exclusive (i.e., multiple provisions cannot occur simultaneously). This assumption 
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allows us to add up the probabilities of each of the provisions for each accident, but in doing so, 

we are also not able to fully account for any overlap in effectiveness amongst the provisions.48 

This simplifying assumption was necessary because in its absence, the complexity of the benefit 

model would have increased so much so as to make it unusable. For instance, when dealing with 

three provisions that are not mutually exclusive, we will have to consider the probability of either 

A, B or C occurring one at a time, the probability of both A and B, A and C, and B and C 

occurring, and the probability of A, B, and C occurring simultaneously.49 

Thus, in assessing the benefits and costs of each provision in this manner, we estimate that the 

result is a slightly higher effectiveness measure.

IV. Impact on Benefits and Costs

The impact on benefits and costs of removing 1 accident and lowering the effectiveness scores 

for 48 accidents is represented in the following table:.

 

48 Example, for two provisions: P(A ∪ B) = P(A) + P(B) – P(A ∩ B). However, with mutually exclusive events the 

last term in the formula, – P(A ∩ B), is zero, so the formula simplifies to P(A ∪ B) = P(A) + P(B).

49 P(A ∪ B ∪ C) = P(A) + P(B) + P (C) – [P(A ∩ B) + P(A ∩ C) + P(B ∩ C)] - P(A ∩ B∩ C ).
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The following key provisions explain most of the changes in the benefits

We also analyzed whether the relationship between benefits and costs has changed for any of the 

provisions. As shown in the following table, it changes for only one provision: 135.605(A2a) 

HTAWS.
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V. Helicopter Terrain Awareness Warning Systems

The second team reviewed the 28 helicopter terrain awareness system (HTAWS) accidents. 

Their review results in the removal of one accident and a lower effectiveness rate for three other 

accidents. The net effect of these changes resulted in the benefit-cost result for the HTAWS 

requirement changing from benefits exceeding costs to costs now exceeding benefits. The four 

effectiveness changes reduced the present value benefit from $59 million to $44 million with the 

cost of compliance remaining constant at $48 million. While the FAA Modernization and 

Reform Act of 2012 directed the FAA to include HTAWS,, there are a host of other reasons to 

keep the HTAWS requirement in this rule. The prevention of one more such accident and 

averting one fatality more than offsets the difference in $4 million in costs over benefits. We 

now present the reasons for including HTWAS in the rule beyond the fact that Congress has 

directed the FAA to include HTAWS in a rulemaking.

A. Why Should HTAWS be Retained in the Rule

A.1. Congressional Action

On February 14, 2012, President Obama signed into law the FAA Modernization and Reform 

Act of 2012 (P.L. 112-95). Section 306 of the Act directs the FAA to conduct rulemaking on 

helicopter air ambulance operations which will address safety-enhancing technology and 

equipment including HTAWS. 

A.2. Terrain Awareness and Warning System have been very effective in practice

The only provision whose benefit and cost outcome changed as a result of the second analysis 

was the requirement to add Helicopter Terrain Awareness and Warning System (HTAWS). To 
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determine how effective HTAWS would be in practice we examined how effective TAWS has 

actually been in practice. We have determined that TAWS has been extremely effective on fixed 

wing aircraft.

In the fixed wing TAWS final rule, the FAA identified 8 Controlled Flights into Terrain (CFIT)

accidents in part 121 operations, 5 accidents in part 135 operations and 42 accidents in part 91 

operations over the 10 years prior to the rule implementation. The FAA conducted a post review 

of this TAWS rule to determine if the requirements should continue. The study found there were 

5 CFIT accidents eight years after the publication of the final rule. We calculated the average 

annual accidents before and after the TAWS final rule (See the following table)

Most importantly each of these 5 accidents that occurred after the implementation of the final 

rule might have been prevented with TAWS. The airplanes were not yet outfitted with TAWS. 

These airplanes were not required to have TAWS installed, as the installation process required 

time to engineer, schedule, order, and install TAWS. 

Honeywell has informed the FAA that although there have been CFIT accidents where the 

aircraft was fitted with TAWS, a closer look shows the system was not maintained, did not have 
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the latest database or software, there was a loss of control, or the system was turned off with no 

terrain display. The data shows TAWS is both reliable and useful in preventing the accidents 

that were quantified in the final rule.