Public Policy / Public Affairs
FAA OpSpec A021 Changes, Future
Rulemaking Initiative
NTSB’s Most
Wanted List, Upcoming Hearings
Congressional Interest, Possible
Hearings
Medicare Bill Moves
through Congress
AAMS Supports
Expansion of the Public Safety Officer Benefit Program
Senator Cantwell Introduces
New Air Medical Safety Bill
FAA
OpSpec A021 Changes, Future Rulemaking Initiative
The FAA has proposed changes to both Operations
Specifications (OpSpecs) A021, Helicopter Emergency Medical Service
Operations, and A050, Helicopter Night Vision Goggle Operations.
View the Federal Register Notice on the current proposed changes to
Operations Specification A021and A050 - click here.
Download the proposed changes to Operations Specification A021 - click here.
Download the proposed changes to Operations Specification A050 - click here.
The following is a description of these change from the Federal
Register dated Friday, November 14, 2008:
The FAA has determined that safety in air commerce and the public
interest requires additional hazard mitigation for HEMS operations, and
therefore has revised Operations Specifications A021 and A050 pursuant
to 14 CFR 119.51.
The A021 revisions specify that if a flight, or sequence of flights,
includes a part 135 segment then all visual flight rules (VFR) segments
of the flight must be conducted within the weather minimums and minimum
safe cruise altitude determined in pre-flight planning. Specifically,
A021 requires pilots to identify a minimum safe cruise altitude during
pre-flight planning by identifying and documenting obstructions and
terrain along the planned flight path. HEMS pilots must also determine
the minimum required ceiling and visibility to conduct the flight using
the revised weather minimums contained in A021.
Revised Operations Specification A021 also permits HEMS instrument
flight rules (IFR) operations at landing areas without weather reporting
if an approved weather reporting source is located within 15 nautical
miles of the landing area or if an area forecast is available.
Revised Operations Specification A050 changes weather minimums for
HNVGO conducted in Class G Airspace to be consistent with changes made
to the Class G Airspace minimums in A021.
The full text of the changes to Operations Specifications A021 and
A050 are available on the FAA Web site and on http://www.regulations.gov as
discussed above.
AAMS will submit comments to the FAA before the December 14th
deadline. AAMS members are also encouraged to submit their comments to
the FAA directly at www.regulations.com. If you
have any questions please contact Christopher Eastlee at ceastlee@aams.org.
Also available on the website are slides from a presentation made by
Dennis Pratte, Manager of the FAA’s AFS-250 office, regarding both
the OpSpec changes and long term plans to address several issues with a
formal rulemaking. Among those issues may be some requirement for
helicopter terrain alert warning systems (H-TAWS), and devices that
would perform the function of recording flight data and voice
communication. These recording devices may include video or software
based devices that are currently available but do not meet the current
“Cockpit Voice and Flight Data Recorder” definitions at the
FAA, which refer to specific devices often found in large fixed wing
aircraft. To view the presentation, click here.
NTSB’s Most Wanted List, Upcoming
Hearings
During a public meeting on Tuesday, October 28th, the
NTSB voted unanimously to add air medical safety, and their 2006 safety
recommendations, to the NTSB’s Most Wanted List of Transportation
Safety Improvements for Aviation. The NTSB also announced plans to hold
a three day hearing on air medical safety beginning on February 3rd of
2009.
Click here for a copy of
the presentation made to the Safety Board at that meeting.
The NTSB also voted to move three of the four air medical
recommendations to “open, unacceptable response”; greatly
increasing the pressure on the FAA to address the recommendations
through rulemaking. Those recommendations are as follows:
-
Conduct all flights with medical crew on board in accordance with
commuter aircraft regulations.
-
Develop and implement flight risk evaluation programs.
-
Install terrain awareness and warning systems on
aircraft.
The following recommendation was left as an “open, acceptable
response” based on the activity of the FAA to address the
issue:
The Board further announced plans for their three day hearing on air
medical service safety, and discussed some of the many topics they wish
to cover in that informational hearing. Initial plans for the
hearing call for the inclusion of witnesses and safety experts from the
air medical community, including aviation operators, medical personnel,
researchers, FAA officials, and state EMS officials. The topics range
from aviation procures to safety equipment, training practices and pilot
experience, and issues created by competition and the financial
reimbursement of air medical services. While it is possible that this
hearing could result in further safety recommendations by the Board, the
informational nature of this hearing is very different than the 2006
hearing which did not include witness testimony or the availability of
questions or comments from air medical professionals.
Congressional Interest, Possible
Hearings
Congressional interest in air medical safety is
especially prominent, especially from members of the House
Transportation and Infrastructure Committee. While AAMS regularly keeps
Congressional members informed of activities, especially those related
to safety, key members of Congress grow more concerned on these issues
in recent weeks. As noted previously, Ranking Member John Mica of the
Transportation and Infrastructure Committee has requested that committee
hold hearings on air medical safety in the next Congress. To see the
letter from Ranking Member Mica to Chairman Jim Oberstar of the
Transportation and Infrastructure Committee, follow this link.
Air Medical Services: future development as an
integrated component of the Emergency Medical Services (EMS) System:
a guidance document by the Air Medical Task Force of the National
Association of State EMS Officials, National Association of EMS
Physicians, and Association of Air Medical Services.
Prehospital Emergency Care. 2007 Oct-Dec; 11(4):353-68.
For the portion of H.R. 6331 concerning Air Medical Services, click here.
Medicare Bill
Moves through Congress
The Congress passed the Medicare Improvement Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) on July 15th
over the President’s veto. The bill included two provisions
specific to air medical services:
-
An 18 month hold-harmless for air medical services negatively
affected by changes to the urban/rural coding of certain transports.
This is hold-harmless will begin on July 1st, 2008, and end on December
31st, 2009, and will reimburse zip codes that were previously considered
rural but now considered urban at the previous rural rate.
-
A technical change that helps to clarify previously passed
legislation outlining who may be authorized to call for air medical
transport. The intent of this change is to reduce the number of audits
to Medicare claims, especially when a physician or other medically
trained individual is willing to certify, even after the transport has
taken place, that they made the request.
AAMS has met with CMS on the implementing these changes in CMS policy
and CMS will need some time to implement the policy changes. It has
already been established that CMS will task the carriers with the
responsibility of providing payments to providers based on the zip code
hold-harmless retroactively to July 1, 2008. Both changes, although
technical, should provide some reimbursement relief, especially in those
areas negatively affected by the zip code change.
AAMS Supports
Expansion of the Public Safety Officer Benefit Program
Congressman Keith Ellison (D- MN 5th) introduced
legislation that would extend benefits offered by the Department of
Justice to public safety officers killed or injured in the line of duty
to public safety officers who may be employed by the private sector.
-
The bill, H.R. 3822, was introduced on October 12th by Congressman
Ellison after requests from the Minnesota ambulance community following
the numerous efforts undertaken by both public and private EMS services
surrounding the Minneapolis bridge collapse earlier this year.
-
AAMS, along with numerous other organizations representing various
facets of the EMS community, including the American Ambulance
Association (AAA) and the International Association of Flight Paramedics
(IAFP), supports this legislation through the Congressional Air Medical
Caucus and individual lobbying efforts.
Issue: Support the extension of public safety officer benefits
to the
employees of private services by passing the Public Safety
Officer Benefit extension bill, H.R. 3822.
Action: AAMS members are encouraged to contact their
local
congressional
representative and ask him or her to co-
sponsor
H.R. 3822, or ask that office to contact Christopher
Eastlee
directly at (703) 836-8732 for more information.
For a copy of this bill, H.R. 3822, click here.
For a copy of S. 3229, click here.
For a copy of H.R. 3939, click here.
Presentation on Safety Bills and
Status, click here.
Senator Cantwell
Introduces New Air Medical Safety Bill, S. 3229
Senator Cantwell (D-WA) introduced S. 3229, a bill to
increase the safety of the crew and passengers in air ambulances, on
July 8, 2008; the bill, freestanding legislation based on amendments to
Section 508 of S. 1300, was released the day the Senate returned to
Washington following the tragic mid-air collision of two air medical
helicopters in Flagstaff, AZ.
The following is a copy Senator Cantwell’s prepared
remarks:
“I come to the floor today to ask for my colleagues’ support
for the Air Medical Service Safety Improvement Act of 2008, a measure
that redefines our commitment to improving the safety for the flight
crews, flight nurses, and passengers aboard emergency air medical
service helicopters and fixed wing aircraft.
“These EMS aviation operations provide an important service to the
public by transporting seriously ill patients or donor organs to
emergency care facilities. Each year, on average, air medical companies
transport about 350,000 patients by helicopter and 100,000 by fixed wing
aircraft.
“Providing emergency air medical service is dangerous work. And,
unfortunately, we have been reminded of this fact all too many times
this year, most recently by the tragic crash in Arizona.
“I first became involved in the issue of emergency air medical
service safety when an EMS helicopter crashed near my hometown in
Washington state. On September 29, 2005, an Airlift Northwest EMS
transport helicopter crashed into the waters of Puget Sound at Browns
Bay, just north of Edmonds, Washington. On board were pilot Steve Smith,
and nurses Erin Reed and Lois Suzuki. There were no survivors. Over
time, I have communicated with both Erin’s mother and sister about
their loss.
“The cause of the crash remains unknown.
“All we do know is that three people dedicated to saving lives
were lost in the Sound that night. And sadly, their story is not
uncommon.
“According to a study by Johns Hopkins University, one in four
medical helicopters will crash during its 15 years of service. In
just the last six months, there have been nine medical helicopter
crashes and 16 deaths.
“This alarming epidemic of accidents has opened the eyes of the
Federal Aviation Administration (FAA), National Transportation Safety
Board,(NTSB) and policymakers in recent days. But the recent
spike in accidents is not a new trend. In fact, between January 2002 and
January 2005, there were 55 crashes of medical helicopters. On January
25, 2006, the NTSB released a report identifying recurring gaps in
safety that must be addressed, including:
-
Less stringent requirements for emergency medical operations
conducted without patients on board;
-
A lack of aviation flight risk-evaluation programs;
-
A lack of consistent, comprehensive flight dispatch procedures;
and
-
No requirements to use technologies such as terrain awareness and
warning systems that have the power to enhance flight safety.
“At my request, Section 508 of S.1300, a bill to reauthorize
the FAA incorporated the NTSB recommendations for addressing these gaps.
Subsequent to that bill’s introduction in the spring of 2007, I
had the opportunity to discuss with stakeholders how to improve upon the
language. The bill I am introducing today is essentially the amendment I
filed this May when the FAA reauthorization bill was on the floor. Given
the uncertain status of that legislation, and in light of the recent
events, I felt the urgency to transform the amendment into standalone
legislation.
“This bill will implement new procedures and improve standards
already in place through strengthened safety requirements, comprehensive
flight dispatch and flight following procedures, improved situation
awareness of helicopter air crews, and better data available to NTSB
investigators at crash sites.
“It is time to put black boxes in these helicopters.
“It is time to require the same safety standards regardless of
whether or not a patient is on board.
“It is time to evaluate potential risks before take-off.
“It is time to improve the situational awareness of air medical
flight crews.
“If not, we are bound to witness more tragedies.
“I am committed to these changes and I ask my colleagues to lend
their support in making the skies safer for the men and women who
dedicate their lives to getting critically injured patients the medical
attention they need.
“Thank you, and I yield the floor.”
This bill now joins a slightly different House bill, H.R. 3939. AAMS
supports the passage of H.R. 3939 as an alternative to previously harsh
requirements in S. 1300. AAMS members are still considering the
provisions in the new Senate bill.
Those provisions are:
-
All air medical services (fixed wing and rotor, public and private)
must observe Part 135 Rules regarding weather and pilot duty times
whenever medical crew is aboard; making appropriate exemptions to Part
135 weather requirements in order to continue IFR operations.
-
Requires the use of pre-flight risk assessments.
-
Requires a training standard for air medical communications
specialists.
-
Requires the equipage of devices that perform the function of
terrain warning on all new helicopters ordered after the enactment of
the act before the enter air medical service. Devices must meet a
minimum standard for helicopters as directed by the Administrator.
-
Requires a study of devices that perform the function of recording
voice communications and flight data information; requires that the FAA
make a rule requiring such devices (based on a timeline developed by the
study.
While the legislation makes positive strides towards requiring safety
improvements for all air medical services, there are several technical
changes that AAMS would like Congress to consider. Among these changes
is the possibility of increasing Medicare reimbursement rates to help
offset the costs of new equipage requirements, or changing the current
fee schedule to provide for higher reimbursement rates for those
aircraft that opt for equipment advances, like H-TAWS or NVG’s.
AAMS remains engaged with Senator Cantwell, and other lawmakers, on
these changes.
With both chambers in recess for the month of August, and a short
September session planned due to the upcoming elections, it is unlikely
that this legislation will move this year; however, it is very likely
that this legislation will reappear in the next Congress. This give AAMS
and its partner organizations time to refine it position on the
legislation, and suggest additions to increase safety and support the
air medical mission.
|
