There's little question that EMS helicopters are the most dangerous aircraft in the sky. EMS Helicopters In The NewsEMS helicopters have a fatal accident rate 6000 times that of commercial airliners. Flying EMS helicopters is one of the most dangerous jobs in America. In fact, according to the Washington Post, only working on a fishing boat is riskier. And the EMS helicopter safety record is getting worse, not better.

Why, exactly, is the EMS helicopter accident record so bad? As discussed here, one problem is that it's not clear who is ultimately responsible for overseeing the industry. State agencies, county agencies and the federal government all have a hand in oversight but no one appears to be in charge. That means that definitive industry standards cannot be established and hazards cannot be effectively managed.

This week, the NTSB recommended that the FAA take steps to address the most serious of the industry's problems. Some of the those recommendations are not particularly surprising. For example, the NTSB suggests that pilots be better trained in bad weather flying, and that helicopters be equipped with night vision equipment and autopilots.

One of the NTSB's recommendations, however, no one saw coming. The NTSB suggests that Medicare -- which funds most of the EMS helicopter industry by paying up to $20,000 for each patient transport -- adjust its rate reimbursement structure according to the level of safety the helicopter company provides. In plain english, the NTSB suggests that Medicare not pay air ambulance companies unless they meet certain safety standards. NTSB board member Robert Zumwalt concedes this recommendation "pushes the envelope". But the air ambulance record is so bad, extreme steps are necessary.

By targeting the air ambulance industry's source of funding, the NTSB is looking beyond the FAA for help in making the air ambulance industry safer. Why not just leave it to the FAA? For one thing, the FAA has yet to act on the EMS helicopter recommendations the NTSB made 3 years ago. The NTSB is hoping the Department of Health and Human Services (Medicare) will be more responsive to its safety concerns than the FAA has been.

Views expressed in this post as well as any other do not necessarily represent those of emsflightcrew.

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