Document ID: FAA-2008-1208-0028
Agency: faa
Document Type: Rule
Title: Helicopter Emergency Medical Services Operations
Posted Date: 2009-01-23T05:00Z

[Federal Register: January 23, 2009 (Volume 74, Number 14)]
[Notices]               
[Page 4277-4279]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23ja09-117]                         

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DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

[Docket No: FAA-2008-1208]

 
Helicopter Emergency Medical Services Operations

AGENCY: Federal Aviation Administration (FAA), DOT.

ACTION: Notice of consideration of comments.

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SUMMARY: This notice discusses comments received on proposed revisions 
to Operations Specification A021, pertaining to Helicopter Emergency 
Medical Services (HEMS) operations, and Operation Specification A050, 
pertaining to Helicopter Night Vision Goggle Operations (HNVGO) and 
changes made to the proposed revisions based upon comments received.

FOR FURTHER INFORMATION CONTACT: For technical questions regarding the 
A021 and A050 Operations Specifications revisions contact: Dennis 
Pratte or Larry Buehler, FAA Flight Standards--Part 135 Air Carrier 
Operations Branch, AFS-250, Federal Aviation Administration, 800 
Independence Avenue, SW., Washington, DC 20591; telephone (202) 267-
8166; e-mail dennis.pratte@faa.gov or larry.buehler@faa.gov. For legal 
questions concerning this notice, contact: Dean Griffith, FAA Office of 
the Chief Counsel, AGC-220, 800 Independence Avenue, SW., Washington, 
DC 20591; telephone (202) 267-3073; e-mail dean.griffith@faa.gov.

SUPPLEMENTARY INFORMATION: 

Summary of Action

    On November 14, 2008, the FAA issued a notice of availability of 
proposed revisions to Operations Specifications A021 and A050 
pertaining to HEMS operations and requested comments to the proposed 
revisions. The FAA received 25 comments in response to the notice and 
has made changes to proposed Operations Specification A021 based on the 
comments. Operations Specification A050 will not be changed.

Availability of Document

    Copies of Operations Specifications A021 (HEMS) and A050 (HNVGO) 
which are to be implemented can be found and downloaded from the 
Internet at the Federal eRulemaking Portal. Go to http://
www.regulations.gov and search for the documents using the Federal 
docket number FAA-2008-1208.

Discussion of Comments Received

    The FAA received 25 comments from industry, including HEMS 
operators (Omniflight Helicopters, Inc., Intermountain Life Flight, Air 
Evac Lifeteam, EMS Executive Forum of HEMS Common Carriers), North 
Memorial Medical Center North Air Care, Reach Air Ambulance, and 
Hospital Wing), trade associations (Helicopter Association 
International, the Association of Air Medical Services, and the 
National EMS Pilots Association), an equipment manufacturer (Max-Viz 
Inc.), and a designer of helicopter GPS approaches (STI, Inc.). The FAA 
also received comments from pilots, HEMS medical personnel, and other 
individuals. A summary of the comments received and the FAA response to 
the comments follows.

A. General Support

    The FAA received numerous comments supporting proposed Operations 
Specifications A021 and A050. Commenters supporting the revisions 
included the EMS Executive Forum of HEMS Common Carriers, Helicopter 
Association International (supported by Life Flight of Maine, TriState 
Careflight, LLC, EMS Air Services of New York, Inc., Sanford USD 
Medical Center Trauma 1, Bell Helicopter, and other organizations that 
also submitted comments independently), the National EMS Pilots 
Association, the Association of Air Medical Services, Omniflight 
Helicopters, Inc., and several individual commenters.

B. Instrument Flight Rules (IFR) Point in Space (PinS) Special 
Instrument Approach Procedures

    Several commenters recommended changes to proposed Operations 
Specification A021 paragraph ``h,'' regarding IFR PinS Special 
Instrument Approach Procedures, with a proceed Visual Flight Rules 
(VFR) transition to a heliport or landing area, and standard or special 
instrument approach procedures. The comments identified that the 
language proposed in the operation specification could lead to 
misunderstandings with respect to ``proceed VFR'' transitions and the 
conduct of visual operations in accordance with visual minimums as 
noted in A021 Table 1. Commenters also noted that if an approved 
``proceed visually'' segment exists as part of an approved Instrument 
Approach Procedure (IAP) or special IAP, the associated approach 
minimums would apply.
    The FAA acknowledges that proposed Operations Specification A021 
made no distinction between the weather minimums associated with an 
instrument approach which ends in a ``proceed visually'' versus a 
``proceed VFR'' instruction. The FAA agrees with the commenters that 
the language in proposed A021 could lead to confusion for operators 
making visual transitions from instrument approaches and therefore 
intends to change A021 paragraph ``h,'' to clarify the procedures to be 
followed when making VFR or visual transitions from instrument 
approaches.

C. Weather Minimums

    Three commenters recommended different weather minimums from those 
in the proposed Operations Specification A021. Two generally supported 
higher weather minimums than the ones proposed by the FAA. The third 
stated that the 5 mile visibility standard in mountainous terrain would 
be too restrictive.
    Proposed Operations Specification A021 increases the weather 
minimums for part 135 VFR flight by raising ceilings and increasing 
visibility requirements. The FAA believes that the proposed weather 
minimums will enhance safety for HEMS operations by lessening the 
probability of encountering situations that could lead to inadvertent 
operation into instrument meteorological conditions (IMC), pilot 
spatial disorientation, or lack of situational awareness, all causes of 
HEMS accidents.
    The first commenter who suggested higher weather minimums did not 
provide supporting information for why minimums higher than the ones 
proposed are warranted. The FAA agrees that as a general principle the 
likelihood of controlled flight into terrain, loss of control, and 
obstacle collisions decreases as weather minimums increase. However, 
the FAA understands that HEMS operators provide an invaluable service 
to the nation by providing crucial, safe, and efficient transportation 
of critically ill and injured patients. The FAA believes that the new 
weather minimums will help to prevent accidents by providing operators 
a greater margin of safety without unnecessarily impinging upon 
otherwise safe HEMS operations.

[[Page 4278]]

    The second commenter suggested higher weather minimums in 
conjunction with the additional suggestion that pilots should have to 
maintain a minimum of 300 feet AGL day, or 500 feet AGL night. The 
commenter believes that the VFR flight planning requirement in proposed 
A021, that requires vertical clearance of terrain and obstacles by 300 
feet during the day and 500 feet at night, would place HEMS aircraft in 
controlled airspace in high density traffic areas and in the flow of 
fixed wing and IFR traffic. The commenter further states that in 
controlled airspace the weather would have to be 500 feet above the 
aircraft's altitude prohibiting flights although conditions are well 
above VFR.
    In response to the commenter's suggested weather minimums which are 
higher than the proposed A021's minimums for all but daytime local 
flight, the FAA refers to its response to the first commenter in this 
section. With respect to the concern about the proposed preflight 
planning requirement, paragraph ``i'' of proposed A021 does not require 
pilots to maintain the highest vertical clearance for the entire 
flight. Rather, pilots may vary altitudes over portions of the flight. 
Further, operators may plan flights so that major obstacles are not 
along the planned route. Finally, paragraph ``i'' notes that pilots may 
deviate from the planned flight path as required by conditions or 
operational considerations.
    The third commenter expressed concern that the 5 mile visibility 
requirement would unnecessarily restrict safe cross-country mountainous 
terrain operations because night visibility of 3 to 5 miles under clear 
skies due to haze is common in the Southeast United States during the 
summer months. The FAA notes that operators have several options that 
would allow them to operate under different minimums. These options 
include IFR flight, adopting NVIS (Night Vision Imaging System) or 
Terrain Awareness and Warning Systems (TAWS) technology, or 
establishing local flying areas.

D. Technology on Board HEMS Aircraft

    One comment stated that the FAA has treated NVGs as a safety 
appliance not for use ``to extend the `mission capabilities' of HEMS 
aircraft'' nor to ``justify the reduction of Night VFR weather 
minimums.'' The commenter asked for an explanation for why, in light of 
the previous statement, the proposed A021 operations specification 
allows decreased visibility and ceiling minimums when using NVIS.
    The FAA acknowledges the discrepancy with FAA Order 8900.1 which 
states FAA policy that NVGs are to be approved only for the purpose of 
enhancing operational safety. However, providing separate weather 
minimums for night operations with NVIS is justified by several 
factors. The Operations Specification A021 currently in effect, and 
which has been in effect since January 2006, provides that HEMS 
operators approved for NVG use may use high-lighting weather minimums 
in low-lighting conditions if using NVG. The current operations 
specification therefore permits NVG users to operate in weather 
conditions not available to non-NVG users. The proposed operation 
specification is essentially a continuation of current FAA practice as 
it relates to HEMS operators. Further, NVIS technology has become more 
sophisticated since the initial approval for operational use. 
Additionally, the FAA is pursuing changes to Order 8900.1, which 
provides instructions to FAA field inspectors, that would approve 
agency grants of operational credit for NVG operations on a case-by-
case basis.
    Another commenter supported adopting Helicopter Terrain Awareness 
and Warning Systems (HTAWS) rather than TAWS units which are not 
helicopter specific because TAWS may add additional risk factors such 
as distractions associated with nuisance warnings.
    The FAA disagrees that use of TAWS in helicopters creates 
additional risk greater than the benefit provided and intends to permit 
use of TAWS as initially proposed for Operations Specification A021. 
The commenter is correct that use of certain TAWS units in helicopters 
could potentially generate false alerts and ``nuisance warnings.'' 
However, the FAA supports voluntary implementation of TAWS in 
helicopters. Although not helicopter specific, TAWS does provide 
helicopter pilots with useful information pertaining to ground 
proximity, helping to avoid controlled-flight into terrain, and improve 
obstacle avoidance. In addition, the FAA has moved forward on 
establishing production standards for helicopter-specific TAWS systems. 
For example, the FAA published Technical Standards Order C194 to inform 
manufacturers of the minimum performance standards required for HTAWS 
for approval. HTAWS units developed to this standard will correct the 
unique issues created by use of TAWS in rotorcraft. Additionally, HEMS 
operators that wish to install HTAWS systems may do so; the terms of 
the proposed Operations Specification A021 are not limited to TAWS 
systems.
    One commenter objected to the use of the term ``NVIS'' in A021 
Table 1, and stated that NVIS technology should be considered an 
advisory technology no different than TAWS rather than included as an 
associated technology with Night Vision Goggles (NVG). This commenter 
further stated that the only technology associated with the proposed 
operations specification that should require supplemental training or 
currency is NVG technology.
    The use of the term ``NVIS'' to include NVG is consistent with FAA 
usage. For example FAA Order 8900.1, Section 4.1126, states ``NVG is 
the common term used for [NVIS] operations.'' Additionally, Radio 
Technical Commission for Aeronautics, Inc. (RTCA), an FAA Advisory 
Committee, states in Document 275, Minimal Operational Performance 
Standards for Integrated Night Vision Imaging System Equipment, that 
the term NVIS relates to the broader imaging system that includes the 
NVG goggles as well as the cockpit windows, internal and external 
lighting, and crew station design. Accordingly, the FAA intends to keep 
the term NVIS in A021, Table 1. Note that the FAA does not intend to 
extend NVIS to include systems other than NVG through this document.
    Another commenter suggested that aircraft equipped with Global 
Positioning System (GPS) moving map displays should be excluded from 
the requirement to document the highest obstacles along the flight 
path.
    A key component of the revisions to A021 is to ensure that pilots 
determine the minimum safe cruising altitude and required weather for 
the flight before takeoff rather than making such assessments during 
the flight. The FAA acknowledges that technologies, like GPS moving map 
systems, may assist operators with managing risks associated with HEMS 
operations. However, providing exceptions for technology to the 
preflight requirement would defeat the purpose of making pilots aware 
of the terrain and obstacles along the planned route of flight prior to 
departing.
    Additional commenters suggested other technological enhancements 
including requiring NVGs for all crew, and mandating satellite 
tracking, autopilot, and weather radar for all operators.
    The FAA encourages HEMS operators to adopt technologies that would 
provide additional safety measures; however, the revisions to A021 and 
A050 focus on safety enhancements to the operational aspects of HEMS

[[Page 4279]]

operations rather than the equipment requirements for HEMS aircraft.

E. Maintaining Part 91 IFR Flight

    One commenter requested the ability to continue to fly IFR under 
Part 91 using Part 135 weather minimums.
    Proposed Operations Specification A021 does not prohibit part 91 
IFR operations. As noted in A021 paragraph ``d,'' operators equipped 
and approved to so may elect to fly IFR following the part 91 IFR, or 
more stringent, weather minimums. The weather minimums found in Table 1 
apply to VFR flight segments in Class G airspace.

F. Part 135 Compliance for All HEMS Flights

    One commenter suggested requiring all segments of HEMS flights to 
be flown under Part 135 operating requirements.
    This operations specification revision will increase safety for 
HEMS operators by requiring all VFR segments of flights that include a 
part 135 segment to adhere to increased weather minimums. This is an 
important factor in preventing controlled flight into terrain, obstacle 
collisions, inadvertent IMC, and spatial disorientation, or loss of 
situational awareness. The FAA believes that the increased weather 
minimums combined with the preflight planning requirements will provide 
an increased margin of safety for HEMS operations. Operators equipped 
and approved to do so may also elect to fly IFR which provides an 
additional measure of safety to VFR flight due to factors such as 
increased interaction with controllers, increased flight planning, and 
guaranteed obstacle clearance while in controlled airspace. IFR flight 
also provides the benefit of easier access to updated real-time en-
route and destination weather as well as Notice to Airmen (NOTAMS).
    The FAA has chosen to focus on the enhanced weather minimums and 
preflight planning at this time because of the enhancements to safety 
created by the proposed operations specifications, and the breadth of 
the regulatory revisions required if the FAA were to require compliance 
with part 135 for all HEMS operations.

G. Application to Public Aircraft

    Two commenters raised the issue of application of the proposed 
operations specifications to public aircraft: One asked whether the 
proposed operations specifications would apply to public aircraft, 
another recommended applying A021 to all HEMS transports, whether 
public or civil.
    The FAA intends to apply these operations specifications to part 
135 HEMS operators currently required by their part 135 certificate to 
obtain operations specifications, or to future HEMS operations that 
obtain a part 135 certificate. The FAA will consider the public 
aircraft issue separately.

H. Medical Personnel

    The FAA received several comments related to medical personnel that 
serve on board HEMS aircraft. These comments included limiting the non-
patient transport related duties assigned to air-medical crew, flight 
time and duty period limitations, incorporation of medical personnel 
into safety aspects of HEMS operations, training requirements, and 
recordkeeping requirements.
    The FAA recognizes that the air medical personnel are an important 
part of a HEMS operation. However, these operations specifications 
revisions focus on the flight operations and planning aspects of HEMS 
operations; therefore requirements pertaining to medical personnel are 
outside the scope of the revisions.

I. Other Comments

    The FAA received numerous comments on a number of other topics. 
Topics included: Requiring HEMS operators to be based at full-service 
airports; establishing regional dispatch centers for HEMS operations; 
Requiring Commission on Accreditation of Medical Transport Systems 
(CAMTS) certification for all operators; focusing on increased training 
rather than more stringent operations specifications; permitting 
landings only at preapproved landing sites; requiring two pilot crews; 
requiring two engine aircraft; pilot testing on local area hazards and 
procedures; operational credit for autopilot operations; use of common 
radio frequencies; prohibiting HEMS operators from selling memberships; 
establishment of obstacle free corridors; concern over pressure exerted 
on flight crew to engage in operations by for-profit operators; the 
FAA's role in making medical determinations; and continuing current 
exemptions for operators.
    These comments are outside the scope of the operations 
specifications revisions, relate to business decisions by HEMS 
operators, or are already addressed by the operations specification.

    Issued in Washington, DC, on January 13, 2009.
John Duncan,
Manager, Air Transportation Division, AFS-200.
 [FR Doc. E9-1448 Filed 1-22-09; 8:45 am]

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