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STAR  Flight  is committed to offering the residents and citizens of Travis County an effective, efficient and, most importantly, safe air-ambulance transport and rescue operation. In an effort to stem the tragic loss of lives in Helicopter Air Ambulance accidents, HAA Operations are now governed by Federal Aviation Regulation 135.601.

The FAA published this regulation, effective April 22, 2015, to address operational procedures and equipment requirements for helicopter air ambulance (HAA) operators. This regulation governs existing and prospective Part 135 certificate holders planning to conduct HAA operations, their employees, employees of associated medical services, public service and governmental operators conducting air medical transport, and FAA Principal Inspectors with oversight responsibility for HAA certificate holders.

Part 135 Subpart L addresses safety improvements for commercial helicopter operations through equipment requirements, pilot testing, alternate airports and increased weather minimums for all general aviation helicopter operations.

STAR Flight will seek Airborne Law Enforcement Association (ALEA) accreditation for when it becomes available.

The intent of the Accreditation Program is to encourage safe, efficient and accident free aviation operations in support of law enforcement missions. The Accreditation Program is designed to objectively evaluate and certify a unit’s overall compliance with the standards as developed and adopted by the Public Safety Aviation Accreditation Commission (PSAAC), which is an affiliate of the ALEA. The Commission recognizes and accepts its responsibility to fairly review and evaluate the relevancy and applicability of the standards as they apply to each unit evaluated.

The entire voluntary process of becoming accredited can generally be divided into two parts: adoption of the standards and the unit application and assessment process. The standards, as outlined in the adopted Standards Manual (Standards for Law Enforcement Aviation Units) are the building blocks from which everything else evolves. The unit assessment process of accreditation provides a blueprint by which a unit can build the standards into a solid base of operation that provides a vital safety structure and becomes a measuring device of excellence, quality, safety and effective service.

National Transportation Safety Board

Public Meeting of September 1, 2009
(Information subject to editing)
Four Safety Recommendation Letters Concerning
Helicopter Emergency Medical Services


In 2009, the NTSB again made recommendations to the FAA in an attempt to curb the unacceptable accident and fatality rates in HAA operations. Staying pro-active, STAR  Flight  did not wait for the FAA to mandate these recommendations and implemented procedures to meet the intent of the NTSB recommendations for the greater concern of safety.

The NTSB is issuing the following safety recommendations:

To the Federal Aviation Administration

  1. Develop criteria for scenario-based helicopter emergency medical services (HEMS) pilot training that includes inadvertent flight into instrument meteorological conditions and hazards unique to HEMS operations, and determine how frequently this training is required to ensure proficiency.

    STAR  Flight  developed and implemented a mandatory internal Inadvertent Instrument Meteorological Conditions (IIMC) training program to enhance the safety margin. STAR  Flight  now conducts quarterly IIMC recovery procedures training, which includes a full instrument approach to termination. This training is conducted on a “crew” basis and involves the participation of the entire crew in the training. Always open to better ways to train, our current program can be easily modified, should the FAA mandate more stringent requirements.

  2. Once the actions recommended in Safety Recommendation (1) are completed, require helicopter emergency medical services pilots to undergo periodic FAA-approved scenario-based simulator training, including training that makes use of simulators or flight training devices.

    STAR  Flight  developed and implemented a mandatory scenario-based simulator training at Airbus Helicopters, Inc., the U.S. manufacturer of the EC145. Located in Grand Prairie, Texas, this training facility is equipped with an EC145 simulator. Annually, STAR  Flight  pilots are required to complete the training.

  3. Require helicopter emergency medical services operators to implement a safety management system program that includes sound risk management practices.

    The current industry standard Safety Management System (SMS) was implemented at STAR  Flight  in 2008. STAR  Flight  continues to update and improve the SMS. We have added a formalized GAP analysis program, a web-based hazard and occurrence reporting system (PRISM) to supplement our current electronic tracking logs, and added the Safety Officer as a full-time position. We continue to review, critique and refine our safety program.

  4. Conduct a systematic evaluation and issue a report on the requirements necessary for a viable low-altitude airspace infrastructure that can accommodate safe helicopter emergency medical services (HEMS) operations. The evaluation should consider improved collection and dissemination of weather data, the role of automatic dependent surveillance-broadcast, approaches to helipad and designated landing zones, and integration into the National Airspace System. Include in the evaluation process HEMS operators, related industry associations, and hospitals, among others.

    STAR  Flight  continuously monitors our local area airspace and our integration into the National Airspace (NAS). We annually conduct weather evaluation and classes on trends in our area. We conduct annual hospital helipad inspections for safety issues and provide recommendations to the hospital executives, as well as producing a pad safety presentation, which is sent out to all HAA operators in the Central Texas Area.

  5. Require helicopter emergency medical services operators to install night vision imaging systems and require pilots to be trained in their use during night operations.

    Though it is not yet mandated by the FAA, in the summer of 2006, STAR  Flight  began conducting all night operations with the use of NVGs. Our aircraft were purchased with all modifications for compatible NVG operations installed. We continue to monitor improvements and availability of new night vision system products and will consider them for enhancements for our program.

  6. Require helicopters that are used in emergency medical services transportation to be equipped with autopilots, and that the pilots be trained to use the autopilot if a second pilot is not available.

    The EC145 was purchased as a Single Pilot Instrument Flight Rule (SPIFR) aircraft. To meet that requirement, the aircraft must have an autopilot. Our aircraft are equipped with two identical and redundant autopilot systems capable of providing true hands-off flight capability. In addition, we have equipped our aircraft with a radar altimeter, color weather-radar, storm scope, twin Garmin GPS navigation systems (which include a Traffic Information Service - an aid for collision avoidance), as well as the latest Enhanced Ground Proximity Warning System (EGPWS) for terrain and obstacle avoidance.

To the Federal Interagency Committee on Emergency Medical Services

  1. Develop national guidelines for the use and availability of helicopter emergency medical transport by regional, state, and local authorities during emergency medical response system planning.
  2. Develop national guidelines for the selection of appropriate emergency transportation modes for urgent care.

To the Department of Health and Human Services’ Centers for Medicare & Medicaid Services

  1. Evaluate your existing helicopter emergency medical services (HEMS) reimbursement rate structure to determine if reimbursement rates should differ according to the level of HEMS transport safety provided.
  2. If the findings from the evaluation conducted in response to Safety Recommendation 1 reveal that higher levels of reimbursement are required to increase the level of safety, establish a new reimbursement rate structure that considers the level of helicopter emergency medical services transport safety that is required.

NOTE: The Board approved additional recommendations regarding safety audit standards to CMS that are being drafted.

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Charles Brotherton
County Executive

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