The NTSB, prompted by an alarming rise in fatal accidents involving medevac helicopters, is initiating measures to ensure the mission safety of the rescuers and the rescued.

On Oct. 28, the NTSB added "improving emergency medical services (EMS) helicopter safety" to its "Most Wanted List" of recommendations. The list, initiated in 1990 and updated yearly, targets major issues that, once resolved, will have a positive impact on safety. And last week, NTSB Chairman Mark V. Rosenker also announced the board will hold a public hearing Feb. 3-5 to gather industry input with an aim to developing safety measures.

The NTSB's January 2006 "Special Investigative Report on EMS Operations" notes that in 2002-05, 55 accidents (41 helicopters, 14 airplanes) killed 54 and injured 19 people--and emphasized that 29 of the 55 would have been prevented with corrective actions.

In 2006, two EMS accidents killed four people. In 2007, seven people died in two accidents. This year, seven accidents caused 28 fatalities; and since December 2007, nine EMS helicopter accidents killed 35 people.

The most recent occurred Sept. 28, when a Maryland State Police Aerospatiale 365 (Eurocopter Dauphin II) crashed into a heavily wooded area, killing four of five people on board, including one of two highway accident victims being rushed to a trauma center. The accident was preceded by a June 29 midair collision of two Bell 407 EMS helicopters at Flagstaff, Ariz., which killed six of seven people on board.

The rate of EMS helicopter accidents is "disproportionate" to those in other general aviation accident sectors, says Jeff Guzzetti, NTSB deputy director for regional operations. But he is careful to point out that accident metrics are difficult to pinpoint because of varying flight conditions and the different numbers and types of aircraft involved in operations.

About 750 EMS helicopters are currently in operation, most of them under Part 135 regulations, according to the FAA. Currently, operators may conduct ferry and repositioning flights without passengers/patients under Part 91.

The FAA notes that most of the 83 accidents that occurred from 1998 through mid-2004 were caused by controlled flight into terrain, inadvertent flight into instrument meteorological conditions, and pilot spatial disorientation/loss of situational awareness. The agency adds that it is important to consider that the helicopters often operate in "extremely challenging conditions"--dispatched to roadsides and rugged terrain in inclement weather and low-visibility conditions.

The reality of helicopter operations is the antithesis of the public's TV-derived image of air ambulance rescue: Choppers swirling up dust as they land near a M.A.S.H. unit (always on sunny days), while doctors rush out of operating tents to treat war-wounded. The next challenging step is accident prevention. And at last week's Most Wanted meeting, the NTSB urged the FAA to act on four EMS-related safety recommendations, the same four that initially appeared in its 2006 special investigative report.

They call for the FAA to require that all EMS helicopter operators: