After a Maryland State Police medevac helicopter crashed while on approach to Andrews Air Force Base in November 2008 killing four people (only the patient survived), Tom Judge, CEO of LifeFlight of Maine was asked to participate in a state panel to review and make recommendations regarding the emergency medical protocols for the use of medevac transport of trauma patients from the scene of an incident.

"That was a brave thing for Maryland to do," he says. "They took a lot of heat and this was no whitewash. They took a good hard look at the industry."

They were hardly alone in their review.

The early 2000s saw continuous rapid growth of helicopter emergency medical service (HEMS) operations - and the number of accidents began to rise. In response, the FAA in 2005 created a HEMS Task Force. The resulting FAA analysis of HEMS accidents identified three primary safety concerns: inadvertent IMC encounters, night operations and controlled flight into terrain (CFIT). As a result, the FAA heightened best practices awareness in the field, and continued to support voluntary industry safety initiatives.

Also prompted by the rising accident rate, the NTSB completed a special investigation report on aviation EMS Operations in January 2006. This report analyzed 55 accidents (41 HEMS and 14 airplane mishaps) that had occurred during the previous three years, claiming 54 lives. Of that total, 39 people were killed in HEMS operations. Analysis of the accidents indicated that 29 of 55 accidents could have been prevented with corrective actions identified in the report.

To further identify hazards and reduce the number of HEMS crashes, the NTSB conducted a public hearing in February 2009 in Washington, D.C. The event lasted four days - making it the longest Safety Board public hearing on record. The session brought together aviation experts, helicopter personnel and industry executives, and drew lots of media attention as safety advocates appeared and demanded a crackdown on the medical helicopter industry.

The NTSB focused specifically on:

HEMS operational models, reimbursement and, significantly, industry competition;

flight operations procedures including flight planning, weather minimums and preflight risk assessment;

safety enhancing technology such as TAWS and Night Vision Imaging Systems (NVIS), flight recorders and associated flight operations quality assurance programs;