Date: 201709
Local time of day: 1201-1800
Location: ZZZ.Airport, US
Flight conditions: VMC
Weather elements / visibility: 10
Light: Daylight
Aircraft: EC135
Operator: Air Taxi
Operating under: Part 135
Flight plan: VFR
Mission: Ambulance
Flight phase: Final Approach
Airspace: Class E ZZZ
ATC / advisory: CTAF ZZZ
Second aircraft: Robinson R44
Reporter organization: Air Taxi
Reporter function: Pilot Flying; Single Pilot
Reporter qualification: Flight Crew Commercial; Flight Crew Instrument
Anomaly: Conflict NMAC
Detector: Person Flight Crew
When detected: In-flight
Result: Flight Crew Took Evasive Action
Contributing factors: Procedure
Primary problem: Procedure

Narrative: Near Mid-Air between Helicopter Air Ambulance EC135 with patient aboard and a General Aviation R44. South bound EC135 at 80 knots descending through 700 feet AGL was setting up for landing at a hospital when it encountered an opposite direction Robinson R44 in a head on closing situation. The Pilot in Command (PIC) had just announced 'one minute out; secure the cabin for arrival;' when he saw a R44 roughly 100 feet below and just to the left at the near 12 o'clock position. Lateral separation was estimated at 100 to 200 yards. The PIC announced helicopter traffic at 12 o'clock and verbalized turning right and climbing. Both aircraft banked right. The EC135 climbed as it turned right in what both medical crew described as a 'firm maneuver.' Medical Crew Member seated in the left aft facing seat stated: 'That was close!' He then proceeded to provide advisories on the R44's position; altitude and direction of travel. The R44 cleared low to the left and was seen departing the area to the east. PIC had made up to three advisory calls arriving into the area on CTAF as the EC135 flew from the north to the south descending. No other aircraft announced they were in the area. EC135 had pulse light; strobe light; anti-collision light and position lights illuminated. The EC135's ADS-B and TCAS were fully operational and showed no traffic nor gave any traffic alerts. As a matter of practice the PIC sets up the GARMIN 650/750 with the 650 on the traffic screen and the 750 on the map screen. Both of these screens would have shown a contact had the R44 been using a transponder. Following the course deviation and climb to avoid the R44; the EC135 PIC made up to two additional advisory calls on the CTAF. No radio traffic was heard from the R44. The EC135's radios were tuned to the company VHF frequency and [local airport] CTAF. The aircraft made an uneventful landing at the hospital. ATCC was contacted as well as required company report filed. PIC had the aircraft was illuminated with every available light; ADS-B and TCAS were operational and traffic calls on the local airport frequency were being made. All the technology available was being used yet it came down to an active scan. Keeping your head on a swivel; ultimately allows for a successful 'see and avoid'. Unfortunately; not all General Aviation monitor the local CTAF nor use a transponder as they are not required to in Class G. Hazardous Attitude: 'If it's not required. I'm not doing it.' Glad this attitude is the exception in the aviation community with the majority talking; squawking and illuminating.




Synopsis: Air Ambulance pilot reported experiencing a near mid-air collision with an opposite direction aircraft while setting up for landing at a hospital. Both aircraft took evasive action by banking right.