Safety Alert Bulletin

In the 1980s, helicopter medical transport services were just beginning to develop. By 1990, the year CAMTS incorporated, there were approximately 200 services across the U.S. compared to over 1200 helicopters operating today. In those early days, groups like ASHBEAMS (now AAMS), NFNA (now ASTNA) and NFPA (now IAFCCP) were just evolving and starting to develop guidelines for patient care during transport that included operational issues not found in other areas of medical transport. As CAMTS developed, we studied the accidents and incidents to create standards that would address the practices that were common to the NTSB’s probable causes of HEMS accidents.

Today, we have a whole new generation of medical and aviation professionals who have the advantage of time-tested standards and of technology that was not found 30 plus years ago such as NVGs, satellite tracking, glass cockpits, simulators, improved weather reporting, etc.

But, with this new generation of pilots and medical crews, we are seeing some of the same unsafe practices that lead to accidents in the 1980s. This may be because they are not aware of the dangers that caused so many accidents in the past. 


HELICOPTER SHOPPING IS DANGEROUS! Helicopter shopping is still happening and even more dangerous in this highly competitive era. It is one of the reasons the FAA has operational control regulations and there are standards that address helicopter shopping. If a flight is turned down for weather or unsafe conditions, it is important to inform any other providers considering the flight. It is also important to respect the decision in the interest of SAFETY.

Train to Proficiency! 

Training is critical to safety of flight. It is important to ensure all pilots are trained to proficiency on sophisticated technology (glass cockpit), night vision goggles, instrument flight procedures in the event of inadvertent weather, mountain flying or cold weather operations. Pilots should be trained to fly the specific aircraft assigned including enhanced technology. They should also be trained to the specific mission, location (including terrain and unique weather) and the instrument procedures required to get safely return from an encounter with reduced or no visibility.

Recognize Fatigue!
We know fatigue leads to errors that humans make more often when tired.  Not only are crews and patients are at risk when the pilot is fatigued but medical errors can be life ending. Pilots have duty time regulations, but it is difficult to regulate sleep habits on off-duty time. Medical crews are more frequently scheduled 24, 36, 48-hour shifts. Unless downtime is planned, emergency services must be available 24/7 so there is no guarantee how much sleep they will get. “Reducing fatigue-related accidents” was on the NTSB’s 2019-2020 Most Wanted List (see

Another safety recommendation on that list was “Eliminate Distractions”.

Avoid Distractions!

There are more distractions today than ever imagined. Cell phones may provide temptation to send a brief text when the crew’s full attention should be on assisting the pilot in looking for obstructions. Drones, laser and bird strikes are more and more prevalent and can be deadly. 

So, let’s get back to basics!

  • Take care of yourselves and each other.
  • Proper rest, diet and exercise
  • Don’t take short cuts.
  • Do the pre-flights, do the walk-arounds, use the checklists
  • Speak up – ask questions – if you see something- say something!
  • Stay Situationally Aware
  • Be alert – Stay alive!