HEMS Industry Risk Profile

Helicopter Emergency Medical Services (HEMS)
Industry Risk Profle

APRIL 2009
About the HEMS Industry Risk Prole
An industry risk profle (IRP) presents a strategic risk picture of the key risk issues that face a nomi-
nated sector within an industry at a given point in time. An IRP contains the defnition of the context
of the industry and the context of the risk profle, identifcation of risk issues, their associated impacts,
the risk rating and presents proposed high level treatment strategies the associated residual risk and the
risk ranking. An IRP provides the platform for industry to develop a detailed risk reduction plan, outlin-
ing the agreed risk reduction measures, timelines for implementation and accountabilities.
About the Flight Safety Foundation
www.fightsafety.org
Flight Safety Foundation is an independent, nonproft, international organization
engaged in research, auditing, education, advocacy and publishing to improve
aviation safety.
The Foundations mission is to pursue the continuous improvement of global aviation
safety and the prevention of accidents.
The Foundations objectives are to:
- Pursue the active involvement and participation of the
diverse elements of global professional aviation;
- Anticipate, identify and analyze global aviation safety issues and set priorities;
- Communicate effectively about aviation safety; and,
- Be a catalyst for action and the adoption of best aviation safety practices.
About Aerosafe Risk Management
www.aerosafe.com.au
The Aerosafe Group is a global aviation safety and risk management company, which
provides risk management services, support and tailored solutions to aviation compa-
nies around the world. With offces in North America, Australia, India, China and New
Zealand, Aerosafe is recognized as an international leader in this important feld. The
Aerosafe Group has been invited to set standards with aviation regulators, industry
groups and companies alike and operates at the operational, enterprise, sector and
industry levels in the application of modern risk management practices.
About the Foundation of Air Medical Research & Education
www.fareonline.org
The Foundation for Air Medical Research & Education (FARE) was established in 2001
to support charitable, scientifc and educational programs and other initiatives, includ-
ing outreach to the public, for the air medical and critical care medical transport com-
munity. Everything we do is for the patients we serve. The Foundation for Air-Medical
Research & Education (FARE) is a non proft 501 (c) (3) charity serving the international
air-medical community through:
- supporting essential air-medical and critical-care transport research and
education initiatives;
- sponsoring educational opportunities and scholarships for air medical professionals;
- advancing patient and aviation safety;
- funding grants that result in important clinical, safety and operational research;
- publishing award-winning public policy literature that helps air-medical practitioners
keep abreast of cutting-edge research and technologies;
- providing fnancial support to families in crisis after an air medical accident;
- informing the public about air medical and critical-care transport;
- convening worldwide forums for industry leaders to discuss the global initiatives,
challenges and opportunities for air-medical and critical care transport systems.
FOUNDATION FOR AIR-MEDICAL RESEARCH & EDUCATION
APRIL 2009
Published by: Flight Safety Foundation
Developed by: Aerosafe Risk Management
Developed for: HEMS Industry, United States of America
Printed & Distributed by: Foundation of Air Medical Research & Education
Helicopter Emergency Medical Services (HEMS)
Industry Risk Profle
Copyright Aerosafe Risk Management Inc, April 2009
This document has been developed by Aerosafe Risk Management Inc (Aerosafe) in response to a
specifc body of work that was commissioned and funded by industry. The background intellectual
property expressed through the methodologies, models, copyright, patent and trade secrets used to
produce the Industry Risk Profle remains the property of Aerosafe.
Aerosafe grants the Flight Safety Foundation an exclusive, world-wide, royalty-free licence to publish,
release and distribute the IRP to industry. This licence includes the ability for Flight Safety Foundation
to sub-licence printing and distribution of hard copy prints of the IRP. The intellectual property ex-
pressed in this copyright information is governed by the contract between Aerosafe and Bell Helicopter
Textron and the subsequent licensing agreement with the Flight Safety Foundation.
While the author and publisher have taken reasonable precaution and have made reasonable efforts to
ensure accuracy of material contained in this report, Aerosafe does not guarantee that this publication is
without faw of any kind. The authors and publisher makes no warranties, express or implied, with respect
to any of the material contained herein and therefore disclaims all liability and responsibility for errors, loss,
damage or other consequences which may arise from relying on information in this publication.
INTRODUCTION: Managing Risk in the HEMS Industry
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
How to use the HEMS Industry Risk Profile (IRP) . . . . . . . . . . . . . 8
Next steps: Completing the risk management process. . . . . . . . . . 9
PART 1: Context of the Industry Risk Prole . . . . . . . . . . . . . . . . 11
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Risk Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Depth of Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Methodology: Risk Management Process . . . . . . . . . . . . . . . . . . . 19
Methodology: Industry Risk Profile Model . . . . . . . . . . . . . . . . . . 20
PART 2: Summation of Results . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Summation of results risk profile . . . . . . . . . . . . . . . . . . . . . . . . . 24
Risk reduction plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
PART 3: Industry Risk Prole Tabulated Data . . . . . . . . . . . . . . . 31
PART 4: Supporting Appendices . . . . . . . . . . . . . . . . . . . . . . . . . 58
A. HEMS IRP stakeholder and distribution list . . . . . . . . . . . . . . . 59
B. Supporting documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
C. Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
D. Project contact details and project acknowledgements . . . . . . 62
Table of Contents
6
INTRODUCTION
7
The Helicopter Emergency Medical Services (HEMS) industry is to be congratulated for taking a
leadership role in developing an industry approach to the management of risk in the vital area of air
medical transportation.
Aviation has a long and proud history of addressing and managing risk, but the very nature of HEMS
calls for new and innovative ways of ensuring that risk, in all its forms, is subjected to a rigorous
process for the management of risk at all levels of the industry.
Risk is all about understanding the effect of uncertainty on organizational or in the case of the HEMS
industry, the industrys objectives. This Industry Risk Profle is the starting point on the journey of
addressing the objectives of HEMS participants, large and small, and the risks that they must manage
in order to maximize their opportunities whilst minimizing threats.
The risk management process utilized in the HEMS Industry Risk Profle has many years of practical
application throughout the world by all manner of industries including the full gamut of military
and civilian aviation organizations. The adoption of the process set out in ISO FDIS 31000, which is
derived from the long standing and well tested process of AS/NZS 4360:2004 is to be applauded.
Having received this Industry Risk Profle the challenge for the HEMS industry is to take the next step
of developing their own unique risk framework to integrate the process into the management systems
at all levels of the industry. This will allow those governing and leading the industry to fully under-
stand the risks that must be effectively and effciently managed if all the objectives of the industry are
to be achieved.
This document is an excellent starting point and I congratulate those who commissioned this inde-
pendent assessment, the authors, those who participated in its development and revision and the
Flight Safety Foundation for their unwavering commitment to safety and the willingness to take on
the role of custodian of the HEMS Industry Risk Profle.
Kevin W Knight AM
CPRM, Hon FRMIA, FIRM (UK), LMRMIA
Chairman
International Standards Organization (ISO) Working Group on Risk Management
Foreword
8
How to use the HEMS Industry Risk Prole
The HEMS IRP was developed for use at the national level by industry leaders, standard setters, industry
associations, industry bodies and groups that have the ability to develop, resource and implement
voluntary industry wide change initiatives to reduce the risk profle of the HEMS industry. The risk
information presented in the HEMS IRP presents and assesses the identifed risks and highlights
appropriate performance based risk treatments or risk reduction measures.
Many of the treatments transcend the sphere of infuence of any one individual organization such as an
individual Air Medical Program or Operator and must therefore be managed across traditional divides.
While the actions proposed are largely voluntary, it is accepted that some issues raised in the IRP may
only be resolved by regulatory or mandated action by the customers that engage or utilize HEMS.
The HEMS IRP does not identify the risks of any particular individual or group of Air Medical companies
rather it presents the systematic risks inherent in the entire industry landscape that ultimately have the
potential to induce risk at many levels of the industry.
Developing Risk Reduction Plan
This profle is based upon the assumption that there are four key ways of bringing change to the industry;
- Legislative change by Congress
- Regulatory change by the aviation, medical or state regulators
- Mandated change driven by the Customers
- Voluntary change by the industry
The HEMS IRP predominately focuses on the voluntary change that can be made by industry, yet the IRP rec-
ognizes the intersection of the other three areas and can be used as an evidence based tool to inform change
in these areas as well.
The true value of an industry level risk profle is not gained until an action plan is derived and commit-
ted. The Industry groups listed at Annex A, upon receiving the HEMS IRP, also receive an open invita-
tion to participate in an industry wide effort to develop and implement the Risk Reduction Plan.
The HEMS Industry Risk Reduction Action Plan will outline the detailed actions, tasks and activities
designed to reduce risk. Each individual strategy will vary in its effectiveness, however when combined,
the cumulative effect will be an overall reduction in the industry profle. The responsibility for the
management and implementation of each treatment is assigned to an entity, association or organization.
This accountability or responsibility for implementation is also indicated on the HEMS Industry Risk
Reduction Action Plan.
The HEMS IRP will change over time
Risk management is an iterative process. It is acknowledged that the HEMS IRP is dynamic and will
change over time to refect risk changes in the industry. This IRP provides a snapshot of the risk
profle of the HEMS industry at the time of development (January April 2009) based upon an
analysis of the information available and accessed. As further data or information becomes available
the risk profle can be updated. In addition to this, as risk reduction measures are completed the risk
profle will reduce and the residual risk rating will be realized. It is anticipated that the HEMS IRP
will be revisited every six months specifcally with the intent of monitoring progress of risk reduction
measures committed to by industry.
INTRODUCTION
9
Next Steps: Completing the risk management process
The profle of the HEMS industry is dynamic. In order to provide confdence that the risks identifed
in this IRP are being effectively addressed and managed a plan for assurance monitoring has been
outlined. The key focus is the identifcation, allocation and implementation of a detailed risk reduction
plan and the associated accountabilities to ensure action or to provide assurance that action is already in
progress. Timelines and activities are subject to industry participation.
ACTIVITY DETAILS TIMELINE
Launch of HEMS IRP to
industry

Release and distribution
of HEMS IRP by FARE
Development of industry
response including
submission of current or
proposed industry risk
reduction measures

Risk reduction
planning conference

Finalization of the HEMS
Industry Risk Reduction
Action Plan

Release of HEMS
Industry Risk
Reduction Plan
Check point
reporting
Update risk
reduction plan
Report to indus-
try on progress
Update HEMS IRP
Continuous follow up
until profle is reduced to
an acceptable level
Launch coordinated by Flight Safety Foundation as industry custo-
dian of the IRP. Technical briefng provided to the media. Registered
downloadable electronic fles available at
www.fightsafety.org

FARE has approved a grant to fund the printing and distribution of
copies of the HEMS IRP to the industry distribution list outlined in
Annex A. Additional copies available through FARE.
www.fareonline.org

An inclusive invitation is made for the full spectrum of industry
stakeholders to work through the HEMS IRP and develop an individ-
ual submission of those industry level risk treatment strategies that
are either already being undertaken or are willing to be undertaken,
resourced and implemented by the submitting organization.
A step by step guide to aide the preparation of submissions can be
downloaded from the Flight Safety Foundation website.

One authorized representative from each stakeholder group will be
invited to the inaugural risk reduction planning conference where
risk reduction strategies will be agreed to and prepared as the HEMS
Industry Risk Reduction Action Plan for presentation to industry.

A small group of representatives from the industry to review the
proposed HEMS Industry Risk Reduction Action Plan. An assurance
regime for monitoring and reporting progress will be established.

Industry Risk Reduction Plan formally released to industry.
Those industry stakeholders who have taken responsibility for an
individual risk treatment strategy will provide a status report on their
progress against the HEMS Risk Reduction Action Plan. This informa-
tion will be compiled and a report card prepared for public release.
Upon receiving the progress report from the above activity, the
HEMS Industry Risk Reduction Action Plan will be updated and pre-
pared for presentation to the risk monitoring and assurance group.
A formal progress report will be released to industry.
As the context of the industry changes, appropriate triggers for a
full update or overhaul of the HEMS IRP will be determined. These
triggers may include signifcant progress in completion of the risk
reduction measures, emergence of signifcant new risks, context of
the industry shifts signifcantly or the accident profle of the industry
is not visibility decreased.
The Industry to continue on the six monthly cycles for the formal
management of risk until an acceptable risk profle is achieved.
April 20, 2009
April 30, 2009
May 1, 2009
July 15, 2009.
August 13-14, 2009
August 25, 2009
August 31, 2009
February 10, 2010
February 15, 2009
Feb 22, 2009
As determined
Ongoing
S
I
X

M
O
N
T
H
L
Y

C
Y
C
L
E
10
11
Context of the Industry Risk Prole
PART 1
12
PART 1 Context of the Industry Risk Prole

1
Ira Blumen, An Analysis of HEMS Accidents and Accident Rates, 2009 NTSB Hearings into the EMS Industry, 2009
Background
Air medical transportation has become a key component of healthcare in many countries throughout
the world. Air medical transport services are particularly important in large countries where traveling
times to hospital care may be excessive by surface vehicles or where remote communities might other-
wise be deprived of the required level of healthcare service. In addition to acting as an air ambulance
service, aircraft are particularly important in times of national emergency or to provide support to
rescue and other emergency services.
While air medical services may at frst glance appear expensive compared to traditional ground ambu-
lances, an examination of the cost structures and benefts on an annual system wide basis demonstrates
its cost effectiveness. In many cases, air medical services may be the only option and the difference be-
tween life and death for the patient. In other circumstances timely, appropriate initial care may provide
ongoing reduced cost over the lifetime of the patient. Integrated air medical resources are therefore an
essential component of contemporary Emergency Medical Services (EMS) systems.
Helicopter Emergency Medical Services (HEMS) and EMS services are provided in the United States
through a multitude of relationships involving Part 135 air carriers, public entities, hospitals and EMS
providers, by both proft and not-for-proft organizations. It is estimated by the Association of Air Medi-
cal Services (AAMS) that helicopters transport 400,000 patients annually in the United States.
As the medical benefts of rapid transport by air medical providers have become more recognized, there
has been ongoing growth and expansion since the 1970s with HEMS operations beginning in 1972.
Recent data shows that since 1995 the number of helicopters used in the EMS industry increased by
approximately 130% to 2008. Prior to 1995, there was a similar doubling of the number of helicopters
being utilized within the HEMS Industry over a ten year period.
Current Safety Concerns
The National Transportation Safety Board (NTSB) notes that there were 55 EMS related accidents (fatal
and non-fatal) that occurred between January 2002 and January 2005 and that many of them could have
been prevented with simple corrective actions including: oversight, fight risk evaluations, improved
dispatch procedures and the incorporation of available technologies. In the last twelve months the
NTSB investigated an additional nine fatal EMS accidents which killed 35 people. The Board has also
added helicopter EMS safety to its Most Wanted List of transport safety improvements.
The recent increase in the fatal accidents has created general concern by the Air Operators, the Air
Medical Programs and the broader public community. The HEMS industry is actively working on many
fronts in an attempt to identify those issues that have led to these avoidable and, hence, unacceptable
accidents. Parallel to these industry driven initiatives, the government also committed to proactively
examining the causes of the high accident profle. This culminated in the February 2009 NTSB Public
Forum regarding Operational Safety in the Helicopter EMS Industry and an agreement by the industry
that a call to action is required.
Over recent years, many industries have recognized that effective management of risk allows regulators,
organizations and operators to target resources strategically to meet both governance obligations, com-
mercial objectives and improve levels of safety.
Risk management takes place at multiple levels. This Industry Risk Profle (IRP) provides at a strategic
level, a description of risk for the HEMS industry as a whole. The risk management process allows
13
operators within the industry to develop individual risk frameworks and risk management plans. It can
also assist Regulators to develop regulatory solutions which achieve the statutory safety outcomes while
allowing individual operators the fexibility to effectively meet their corporate goals.
An Industry Risk Profle can also be a call to action for all parties involved in the industry. It sets
out in a clear and concise document both the problems and, more importantly, the solutions that are
available to reduce the inherent risk profle.
Commission to Develop the HEMS Industry Risk Profle
As part of the industrys commitment to the efforts of the International Helicopter Safety Team (IHST)
and the achievement of the published goal of an 80% reduction in global helicopter accidents in the
next 10 years, the industry commissioned and funded the development of the HEMS IRP.
The IRP methodology utilized is usually applied by industry regulators or those industry sectors that
have been delegated self administration by the regulator. This innovative step for the HEMS industry to
adopt and utilize this methodology demonstrated a level of maturity that is not common in industries
under the public and regulatory spotlight.
The industry recognized the need for a holistic and broader view of the systemic strategic risks that are
inherent in the current national HEMS model. It was realized that a different approach was needed and
there was great value in an industry wide risk assessment that would provide a platform for the coordi-
nation of nation wide initiatives to aggressively reduce the risk profle and the associated negative trend
in safety.
Purpose
The purpose of the HEMS IRP is to identify the latent and systemic issues inherent in the current
national HEMS structure and model that have the potential to induce operational or safety risk in order
to proactively address issues that have not yet been subject to attention.
Based on the use of the Reason accident causation model, and the accepted hierarchy of layers, barriers
and defenses that exist in any organizational or industry level system, the HEMS IRP focuses on the
systemic issues that exist at the strategic level of the HEMS Industry.
14
Objectives
1. Identify the systemic risks inherent in the current HEMS structure that may induce operational, safety
or organizational risks taking the industry wide assessment beyond traditional analysis of historical
data into a proactive, risk based approach.
2. Utilize a data driven, evidence based approach that leverages off the array of current and past
investigations, reviews, studies, papers, analysis and knowledge publicly available on the topic of
HEMS safety. These efforts have been harnessed and utilized as risk identifcation inputs into the
HEMS IRP.
3. Provide the strategic view of industry risks in one document that can be commonly understood by
all stakeholders (aviation, medical, EMS, industry, regulatory, customer and government) and used
as a focal point for defning the accountability for change.
4. Utilize an accepted methodology (risk management) that is used broadly in both corporate America
and the international aviation community allowing a common language to be adopted that is famil-
iar to the industry and regulator alike.
5. Allow industry a tool to effectively rank and prioritize efforts for risk reduction, and where the risks
are unable to be controlled by the industry itself, the IRP provides a platform for the transfer or
referral of risk to the appropriate accountable body
6. Allow the alignment of accountability, responsibility and resourcing for the management and
reduction of risk at multiple levels of the industry.
7. Provide industry with opportunity to develop alternate solutions that will achieve the reduction in
risk that is expected or even demanded by the government and the community
8. To propose risk treatment strategies that are performance or outcome based solutions
rather than the traditional prescriptive recommendations that often come out of studies, reviews
or investigations
9. A platform for the coordinated management of risks across the Industry - Prioritize the identifed
risks in order of seriousness and to provide a general sense of urgency for the treatment of risks to
meet the industrys duty of care obligations
10. Assist the HEMS Industry in meeting recommendations from the National Transportation Safety
Board (NTSB)
11. Provide an up-to-date formal document that can be used by the HEMS industry to track and
monitor implementation of risk treatment and ultimately provide effective oversight and
governance of the Industry
12. Provide Industry Associations with a vehicle to manage governance, compliance and liability issues
by demonstrating a proactive and risk based approach to change
13. Provide a framework within which individual operators can develop their own organizational risk
profles and risk management plans to effectively position or respond to industry level risks
15
Assumptions
This Industry Risk Profle was developed within the context of the following assumptions:
1. Citizens of the United States of America have the right to expect a reasonable standard of
emergency medical transportation regardless of their location within the country.
2. The current accident and fatality rate in HEMS transport is unacceptable to Industry as a whole,
individual operators, regulators and the public.
3. The information provided to Aerosafe Risk Management by the HEMS Industry for the purposes of
developing this industry risk profle is complete, true and correct
4. Matters of concern raised in the consultation process, which could not be substantiated or
verifed by other risk identifcation sources, were considered as perceived risk for the purposes
of the profle.
5. The Industry Risk Profle will be provided to stakeholders and interested parties for use in
strategic planning, business planning, reporting and other processes to ensure appropriate
monitoring and oversight.
6. Statements made during the NTSB hearing (February 2009) were regarded as stakeholder
interviews and those interviewed included in the stakeholder list.
7. Formal position papers, documents and resources lodged on the public docket for the NTSB
hearing were used in the HEMS IRP literature review and included in the documentation list.
8. Formal position papers by AMOA, AAMS and HAI were taken as a representative view of the
members it represents and this data input source was used in the HEMS IRP development process
follow on discussions and surveys with individuals from these organizations augmented this initial
data input source.
9. The defnition of the HEMS Industry is taken to mean the full spectrum of stakeholders involved in
HEMS activities at all levels and is not simply the part 135 operators.
10. That all invited industry stakeholders will actively participate in the development of the HEMS Risk
Reduction Work Plan and that this plan will acknowledge the many current initiatives already
underway and in progress.
11. The Aerosafe Risk Management risk profling model and methodologies revealed to the HEMS
Industry will not be used, modifed or reproduced without formal consent.
12. Addresses HEMS operations in the United States of America.
16
Limitations
This Industry Risk Profle is subject to the following limitations:
1. The Industry Risk Profle is confned to rotary wing operations. However, many of the risks
identifed will be common to, and useful in, the development of a broader risk profle for EMS
operations. This profle excludes fxed wing air medial operations.
2. The IRP specifcally addresses both commercial for-proft and not-for-proft operations which
operate under Part 135 of the Federal Aviation Regulations.
3. This IRP does not cover the full spectrum of risk and other issues associated with public use HEMS
operators (County and Police) which conduct business as private category operations under Part 91
of the Federal Aviation Regulations.
4. Not every stakeholder in the industry was subject to an individual interview in preparing the
HEMS IRP.
5. During the consultation phase (review and interaction with the industry on the draft risk profle
made available from February 12, 2009 to April 10, 2009) a large degree of fragmentation and differ-
ing understanding of the risk management process was noted.
6. The current environment and the sensitive debate around proposed legislative change affected the
ability of some stakeholder groups to effectively participate in this process.
7. The risk treatment strategies listed in the HEMS IRP have not been agreed or allocated to the
industry at the time of release.
8. The HEMS Risk Reduction work plan is under development and was not suffciently developed by
industry to release concurrently with the release of the HEMS IRP.
9. The current context and structure of the HEMS industry does not lend itself to a collaboration,
ready agreement or a collective responses to risk.
10. The existing regulatory regimes across aviation, healthcare and EMS are not visibly integrated.
11. The HEMS IRP does not claim to have utilized every data source available to the industry. However a
rigorous and comprehensive process has been used and as a result, an 85% confdence rating in the
integrity of the data and associated profle is acknowledged.
12. The industry have actively and visibly communicated the desire for voluntary change, yet the
ability for the industry to implement such change has not been evaluated or assessed.
Risk Criteria
The following criteria were developed to allow the evaluation and quantifcation of risks. Since risk has two
components, likelihood and consequence, consideration was given to issues including:
- The positions of Association of Air Medical Services, Helicopter Association International and the
Air Medical Operators Association, as stated in their paper to the NTSB Hearing, February 2009,
that they maintain a position of zero tolerance for accidents in the air medical industry. It is
implied by this criteria that all reasonable measures will be taken to ensure that accidents do not
happen and that risks are appropriately managed.
- A positive perception of the Industry by the public, families of the deceased, the media, politicians,
legislatures, the Regulators and investigators is vital to the continued viability of the industry.
- A person/patient transported by a HEMS operator has the right to the same protections as any
other member of the public traveling by air transport.
- Where the person/patient transported by a HEMS operator does not have a choice of carrier, a
17
higher protection or duty of care than that of the travelling public exists.
- While the safety of the patient is the most important factor to be considered, the safety of the
medical personnel and other crew on board is also critically important.
- Where emerging technologies will mitigate risk at reasonable costs, they should be considered as
optional adjuncts for operational safety.
Depth of Analysis
The following is a synopsis of the depth of analysis used to develop the HEMS Industry Risk Profle:
- Context of the profle: This Industry Risk Profle has been developed in the context of providing a
detailed, data-driven analysis of the issues that affect the key objectives of the HEMS Industry. By
defning and focusing on the HEMS Industry as a single entity, this profle can provide insight into
the various elements of the Industry and how the elements interact to achieve Industry objectives.
The risk profle will be developed to cover the next ten year period commencing in January 2009.
- Literature review of publicly available documentation: A comprehensive review of a large and varied
range of publicly available documents published over the past two decades was conducted.
This review contributed to the development of an understanding of the HEMS Industry from a
historical perspective. The documentation review also provided the basis on which key industry
risk issues were identifed. A total of 267 Documents were reviewed during the document
review process.
- Stakeholder Analysis: A comprehensive stakeholder analysis was conducted in order to identify
the stakeholders within the Industry that could provide the insight into the operations, status and
issues impacting the HEMS Industry. The analysis identifed stakeholders from public, private and
government organizations, enabling the project team to conduct interviews with key industry
decision makers. A total of 161 stakeholders were identifed during the initial stakeholder analysis
process and an additional 21 stakeholders were identifed in the review of the draft HEMS IRP.
- Stakeholder Interviews: Once the industry stakeholders had been identifed, several decision
makers and opinion leaders within the industry were personally interviewed in order to collect a
wide variety of information, both from the medical arena and the aviation industry. During these
interviews a signifcant number of industry risk issues were identifed.
- Note: In line with the risk management process, the identifed stakeholders were examined and
it was determined whether formal communication, consultation or interaction was needed at the
identifcation, review or solution development phase of work. As a matter of clarifcation, the
stakeholder analysis determined the best match of risk identifcation method to each stakeholder
group. As a result, formal interviews or surveys were not conducted on every stakeholder.
Alternate risk identifcation methods were exercised on those remaining stakeholders.
- Collection of Risk Issues: A total of 1280 risk issues were identifed from the initial risk identifcation
sources. During the review of the draft HEMS IRP, and additional 200+ issues were identifed and
cross mapped to the risks listed in the HEMS IRP. The tabulated data was updated with these
additional inputs. The main additions or amendments were in the risk impacts, a minor
adjustment in the risk calculation and some additional proposed risk treatment strategies.
Culminating in the presentation of 26 industry level risks worthy of attention, the HEMS IRP
was fnalized within the specifc context outlined above.
- Risk Identifcation: This risk profling methodology allows for a greater level of depth in the
identifcation, selection and analysis of the risk information used in the risk identifcation step. In
general available risk data consists primarily of qualitative information. As an attempt to minimize
subjectivity, fourteen separate risk identifcation methods were used and the data collected from
these sources layered and cross mapped for themes and grouping against the IRP model.
18
Rationale for Analysis Methodology
The HEMS Industry is committed to providing timely, quality patient transportation throughout the
United States. This objective carries signifcant challenges considering the large landmass involved,
the diverse terrain, weather conditions encountered and the complexity of the business and regulatory
models. Solutions which are appropriate and effective in highly urbanized areas may not work in rural
and isolated environments. Given such variability in mission profles, options which ensure overall
system safety, while allowing local fexibility, require evaluation.
In recent years, developments such as the Reason Model have been used in the analysis of accidents
and incidents in the aviation industry. Reason identifed that accidents occur when there are multiple
failures in the various levels of defenses - when the holes line up. This model can also be used to
design safety systems by identifying defenses in depth. Analysis of defenses in depth allows safety
experts to identify potential points of failure and minimize the possibility of total system failure. Risk
analysis (identifcation and assessment) is the tool that identifes potential points of failure in the
Reason Model.
Defenses in Depth and the Relationship with Risk Reduction
A systems approach also allows a structured consideration of possible defenses which can be layered to
provide safe outcomes. A systems approach also has the further advantage of identifying the defenses
which are necessary for overall system integrity. In locations where specifc tools for risk mitigation
prove ineffective or inappropriate, alternatives can be derived to manage the risk. A hierarchy of
defenses (legislative, regulatory, mandated customer driven change and voluntary change by industry),
which link directly to the risk treatment or risk reduction strategies, will be developed and presented in
order of outcome effectiveness.
Methodology: Risk Management Process
Risk Management Process
The International Standards Organization (ISO) draft standard on risk management (FDIS ISO31000)
outlines the methodology and risk management process used to develop the Industry Risk Profle.
The following pictorial model is consistent with FDIS ISO31000 and provides the structure to classify,
present and prioritize risk information. The risk profle was developed using the following process:
INDUSTRY
STRUCTURE
& OVERSIGHT
ORGANIZATIONAL
OPERATIONAL
ADAPTED FROM REASON ACCIDENT CAUSATIONAL MODEL
19
Throughout every step of the risk management process a decision is made as to what
level of communication or consultation is required. Over 161 stakeholders were identifed
in the initial and review stages of the HEMS IRP development each possessing a different
perspective on the industry and the issues requiring attention. The opportunity for review
and comment on the draft HEMS IRP was provided to 33 different stakeholder groups.
Additional resource, dedicated briefngs or a workshop was held with AAMS, AHS, AMOA,
AMPA, CAMTS, FAA, FARE, Flight Safety Foundation, GAO, HAI, House Aviation Sub
Committee, International Helicopter Safety Team, NEMSPA, NTSB, The Joint Commission.
At this industry level, the scope, defnition and context of the industry itself was required
in order to place some boundaries around the assessment. For the purposes of the IRP,
the HEMS industry includes the aviation, medical and EMS disciplines. The FAA confrmed
there were 74 Part 135 Operators approved to operate HEMS activities. The IRP excluded
fxed wing air medical operations and any air medical operations conducted by public
use operators.
For Industry level risk profling 10-14 risk identifcation methods are normally used to
extract risk issues that are then run through the risk management process. In the case
of the HEMS IRP, 14 different risk identifcation methods were used which included a
comprehensive literature review, stakeholder analysis, interviews, environmental scan,
risk dimension analysis, data analysis, causal factor analysis, cultural assessment and task
analysis. This process produced over 1400 data input sources to the IRP process.
Using the principles of the Reason accident causation model, a layering and classifcation
process was then used to analyze the risk data. From this process, 26 industry level risks
were identifed. The consequence and likelihood of each of these 26 risk issues were
assessed. A semi-quantative risk analysis tool was then used to calculate the level of risk
associated with each of the 26 risks.
Building upon the risk analysis step above, the risks were then ordered and ranked from
highest to lowest. Where more than one risk attracted the same risk rating, sub criteria was
then applied to determine the ranking.
Multiple treatments were identifed to address each risk. They vary in their scope but are
designed to complement each other and provide a comprehensive risk response. It is recog-
nized that some treatments can be undertaken by regulators while others can be addressed by
various industry bodies, the customer that requests the HEMS service or individual operators
themselves. A residual risk calculation was then made in light of the effectiveness of the risk
treatment strategy listed. The risk treatment strategies listed in the HEMS IRP are performance
or outcome based. These solutions require actual tasks to be derived, allocated and resourced
in order to produce the HEMS Industry Risk Reduction Work Plan. It is recognized that many
activities are already underway, this fnal step of the risk process calls for these and future
initiatives to be captured and presented in this joint industry assurance and accountability tool.
It is to be noted that the context, the risks and their signifcance will change over time. The
HEMS IRP is a dynamic document and refects the assessment of the risk profle at a point
in time. The most critical aspect of the monitor and review stage of the risk process is the
follow through and implementation of the risk treatment strategies. Ultimately it is these
actions that will reduce the risk.
Analyse
the Risks
Evaluate
the Risks
Treat
the Risks
Monitor
and Review
Communication
& Consultation
Establish
the Context
Identify
the Risks
International Risk Management Standard (ISO31000)*
20
Methodology: Industry Risk Prole Model
The industry risk profle model is used to classify and catalogue the risks identifed in the HEMS IRP.
This structure is used across the aviation industry and groups the issues into categories that generally
guide the level of action required. The frst three elements of the IRP model (oversight, compliance and
assurance) combine to form the governance of the industry.
From here, other important elements are then depicted. It is to be noted, that each of these areas can be
further examined and assessed to a greater level of depth. For example the efforts of the International
Helicopter Safety Teams JSAT, JSIT and subsequent HEMS Safety Committee or the efforts of the NTSB
individual accident investigation process would be the next layer of depth provided in the safety profle
element of the HEMS IRP model.
HEMS
INDUSTRY
RISK PROFILE
OVERSIGHT
MODEL
COMPLIANCE
REGIME
ASSURANCE
MODEL
OPERATOR
PROFILE
ACTIVITY
PROFILE
AIRCRAFT
CAPABILITY
PROFILE
INDUSTRY
OPERATING
ENVIRONMENT
PASSENGER
& PARTICIPANT
PROFILE
SYSTEMS
PROFILE
SAFETY
PROFILE
Aerosafe 2008
21
OVERSIGHT MODEL:
The governance regime that exists within the
industry in all facets at the highest level. In the
case of the HEMS industry this includes gover-
nance for the aviation, medical and emergency
management services aspects. This element of
the IRP model is closely aligned with the compli-
ance and assurance elements.
COMPLIANCE REGIME:
Considers the statutory and regulatory and
framework in which the industry operates. The
compliance element, along with the assurance
element is a sub component of the overall over-
sight model. At the industry risk profling level,
these two pieces are addressed individually.
ASSURANCE MODEL:
What level of assurance is provided and to
what level of depth? These aspects are explored
in the assurance element of the Industry Risk
Profle. The objective of assurance is to
provide confdence.
OPERATOR PROFILE:
The operator profle looks at the composition,
structure and models of the operator group
within the industry. A greater level of depth
can be provided to this element if required by
conducting an individual risk profle of each
operator within the industry sector. Individual
operator risk profles are normally undertaken
by the regulator as part of the regulators routine
surveillance and intervention regime.
ACTIVITY PROFILE:
This element of the Industry Risk Profle
examines the range of operational activities un-
dertaken by the industry. In relation to the HEMS
industry risk profle the activity profle includes
inter facility transfers, scene fights, speciality
team transports, training, maintenance, commu-
nication functions to name a few.
AIRCRAFT CAPABILITY PROFILE:
This element looks at the aircraft capability,
technology and equipment.
INDUSTRY OPERATING
ENVIRONMENT:
The industry operating environment includes the
overall setting and landscape of the environment
in which the industry operates in its entirety.

PASSENGER & PARTICIPANT PROFILE:
Considers the demographics of the passengers or
participants who are involved in the activity. This
element excludes aircrew or employees of the
aviation operator which is covered in the
operator profle.
SYSTEMS PROFILE:
The defnition and maturity of the various man-
agement systems available and utilized within the
industry are covered in the scope of this element
of the Industry Risk Profle. This includes but
is not limited to management systems, business
systems, information systems and safety
management systems.

SAFETY PROFILE:
This element of the Industry Risk Profle takes
into account the incident and accident statistics
and the overall safety profle of the industry sec-
tor. Much of the information and data covered in
this element is historical in nature.
22
23
Summation of Results
PART 2
24
PART 2 Summation of Results
VERY
HIGH
(1)
VERY
HIGH
(1)
VERY
HIGH
(1)
The results of the HEMS IRP can be examined in
the following ways:
Risks presented by Risk Ranking (Pages 24-28)
The tabulated data indicated below in table 1 presents the risks from highest to lowest. For those risks
that have the same number (see numbering system in the far right hand column) this indicates the risk
has been quantifed at the same level. Where this is the case, sub criteria have been used to rank the
risks within this classifcation. The summation of results in this presentation format only depicts the risk
assessment, being the identifcation and quantifcation of risk and does not list any solutions to reduce
the risk. This information is provided as a snapshot of the issues from highest to lowest and is to be
read in association with Part 3.
Risks presented against risk matrix (Page 29)
Risk is a measure of consequence and likelihood, the presentation of results against the risk matrix
provide a visual representation of the risks scatter plot. The two matrix provide a visual representation
of the before and after risk treatment. The second being referred to as residual risk, or the risk that is
remaining after full implementation of risk reduction measures are achieved.
Risks presented against the IRP Model Categories (Pages 32-58)
Part 3 of the HEMS IRP provides the risk information catalogued against the elements of the Industry
Risk Profling model. This functional grouping allows the reader to examine risks in the related cat-
egory. The information is presented in this fashion, as it is often the case that high level stakeholders
are looking for information against these classifcation elements (such as governance, aircraft capability,
safety etc).
TABLE 1 Risks Presented by Risk Ranking
NUMBER RISKS RISK LEVEL
1 Risks associated with the lack of or limited defnition of the national EMS
structure or governance framework for HEMS. The current regime was
not purposefully designed and has evolved over the past twenty years
to the current regime in the absence of a framework.
(Risk Reference 1 HEMS IRP)
2 The risk that the current medical reimbursement model (primary payer
model) is no longer adequate to provide the appropriate level of
fnancial coverage for either the current operating costs of the service
or the impending upgrade of capability required through the addition
of technology.
3 The risks associated with the complexity, non alignment and lack
of clarity around the roles and scope of federal, state and county
agencies involved in oversight of the HEMS industry.
25
VERY
HIGH
(2)
VERY
HIGH
(2)
VERY
HIGH
(2)
VERY
HIGH
(2)
VERY
HIGH
(3)
HIGH
(4)
4 Cumulative risk associated with the variability among States over licensing
requirements and standards for HEMS programs, as well as inconsis-
tent interpretation of the States authority to determine a need for, and
location of, new or existing HEMS programs and bases, has produced
widespread variability in quality and safety in HEMS transport.
5 There are signifcant risk entrenched within the current tasking continuum
used for allocating HEMS air medical assets. This inconsistency and
lack of standardization in the tasking continuum spans the following
process fow that includes:
- The evaluation of the patient need for care
- The necessity of utilization of an aircraft for the passenger transport
- The requesting agency
- The tasking process including the
allocation of the task to a specifc resource
- The acceptance of a task by a HEMS operator
- Through to operational control once the task has been
accepted and undertaken
6 The industry has many different business models that often have
competing objectives and interests. The diversity in this industry
structure has the potential to induce industry and organizational level
competition and growth in turn increasing the operational and safety
risk exposure of the industry.
7 Safety management systems are only starting to be introduced in the
HEMS industry are not yet suffciently mature to manage the level and
depth of change required in the safety philosophies, processes and
practices required.
8 The industry does not have one accredited agency that provides collective
defnition, oversight or monitoring for the combined aviation, health-
care and emergency management functions that shape the HEMS (or
broader air medical) industry.
9 The broad spectrum of stakeholders to the HEMS industry are not
aware of the entire industry risk profle leading to an inability for
the industry to effectively identify, analyze and reduce the risks in a
orchestrated and cohesive way.
26
HIGH
(4)
HIGH
(4)
HIGH
(4)
HIGH
(5)
HIGH
(6)
10 The lack of National Airspace System and other infrastructure constraints in the
airspace where HEMS operate dictate the conditions for the operational
profle for fight removing the option to HEMS Operators to fy IFR.
11 The complexity of the oversight, compliance and regulatory regimes
does not provide the structure required for the industry to have an
inclusive assurance regime or program of audits, accreditation and
checking leading to an inability to provide confdence that the
industry is being appropriately managed.
12 Owing to the nature of the task profles conducted in HEMS and the
close working relationship the aircrew have with medical personnel
involved in the tasks, there is increased blurring of lines of role and
responsibility in respect to the medical personnel contribution to safe
operation of the aircraft. This risk of ambiguity is increased with medi-
cal personnel involvement in NVG operations, passenger briefng, task
briefng, loading and unloading of aircraft, operational risk manage-
ment assessments and crew briefng and debriefng processes.
13 The risks associated with the lack of development of a tangible safety
culture that truly understands risk and the management of risk.
14 There is inherent complexity in the compliance regime used to govern the
HEMS industry which is confusing and dictated by a myriad of non-
related stakeholders leading to an increased chance that HEMS opera-
tors are non-compliant. This risk is induced by a number of
factors that includes:
- There are three distinct disciplines that all set the compliance
regime that affects the HEMS industry (aviation, healthcare and
emergency services)
- The overlap or interface between these compliance regimes has not
been clearly mapped out or is not easily accessible
- There is no agreed inter-discipline hierarchy for regulation, policy
or standards of either the national ascending hierarchy
27
HIGH
(6)
HIGH
(6)
HIGH
(7)
HIGH
(7)
HIGH
(7)
HIGH
(8)
15 Risk that the current defnition and scope of the industry is not well defned
leading to limitations in the ability or appropriate agencies and stake-
holders to effectively govern their aspect of the industry. The key risk
induced by this issue is the limitations on the ability for a complete and
industry wide data driven national solution to manage the landscape to
be identifed, coordinated and effectively implemented.
16 The current safety analysis and monitoring of the HEMS industry is
not data driven leading to an inability for the Regulator or the Industry
itself to have an accurate picture of real safety picture.
17 The operating environment and the associated infrastructure and standard
industry practices for the two routine task profles (inter-facility & scene
fights) is not suffciently designed at the HEMS System level, leading to the
increased variance and application of fight profles, safety standards and
safety risk exposure to patient, aircraft, aircraft and the public.
18 Lack of integration and alignment of accountability, responsibility and
resourcing for the standardization of helipad operations in the inter facil-
ity environment by hospitals, impacting upon operation, maintenance
and continuous hazard management of helipads in the inter-facility envi-
ronment by hospitals, primary HEMS operator and other helipad users.
19 The current training regime for a high percentage of the HEMS industry does
not employ the use of simulators and advanced training methods broadly
used in other parts of the aviation industry predominately due to cost.
20 The current regulatory philosophy combined with the fnancial risks
induced by the funding model of the industry engender a mind set
or culture in the HEMS industry to only meet minimum prescribed
standards rather than managing risks in the operation through the
implementation of better practices.
28
HIGH
(8)
HIGH
(8)
HIGH
(8)
HIGH
(8)
HIGH
(8)
HIGH
(9)
21 There is no activity or task profle defnition set for the HEMS industry
sector making it diffcult to oversee the risks associated with the vari-
ous task profles at an industry, national or State level. In addition to
this, changes to the trends in industry activities are not easily identifed
or monitored and the platform for data driven monitoring does not
exist to the level of maturity required to capitalize.
22 The risk that the HEMS industry does not consistently identify, adopt,
utilize and maximize aircraft technology available in the aviation
industry to enhance safety parameters leading to a decrease in the risk
of an accident or incident.
23 The risk associated with the inability to effectively resource and
manage the operational, technical and cultural change related to the
introduction of new technology into service.
24 The profle of the passenger or participant (patient and medical crew)
profle in the HEMS industry differs signifcantly from that of other
sectors of the aviation community by virtue of the fact that the patient
does not have a choice in the operator allocated to undertake
their transport.
25 Aviation and medical safety management systems are not integrated at
a compliance or policy level leading to incoherent, conficting or com-
peting priorities or practices which may stife the effective introduction
of the SMS within the HEMS Industry.
26 Lack of effective and sound implementation of operational control
arrangements within the HEMS industry leading to the increased
increases the risk of poor operational decisions and misalignment of
accountability and responsibility for fight operations.
29
LIKELIHOOD
LIKELIHOOD
CERTAIN LIKELY POSSIBLE UNLIKELY
CERTAIN LIKELY POSSIBLE UNLIKELY
TABLE 2 Risks Presented against Risk Matrix
TABLE 2.A: BEFORE RISK TREATMENT
TABLE 2.B: AFTER RISK TREATMENT. RESIDUAL RISK
EXTREME
CRITICAL
MAJOR
MINOR
EXTREME
CRITICAL
MAJOR
MINOR
C
O
N
S
E
Q
U
E
N
C
E
C
O
N
S
E
Q
U
E
N
C
E
VERY
HIGH
(1)
VERY
HIGH
(1)
VERY
HIGH
(3)
VERY
HIGH
(3)
VERY
HIGH
(2)
VERY
HIGH
(2)
HIGH
(6)
HIGH
(6)
MEDIUM
(11)
MEDIUM
(11)
LOW
(15)
LOW
(15)
HIGH
(5)
HIGH
(5)
HIGH
(10)
HIGH
(10)
HIGH
(8)
HIGH
(8)
HIGH
(4)
HIGH
(4)
HIGH
(7)
HIGH
(7)
MEDIUM
(13)
MEDIUM
(13)
MEDIUM
(14)
MEDIUM
(14)
LOW
(16)
LOW
(16)
HIGH
(9)
HIGH
(9)
MEDIUM
(12)
MEDIUM
(12)
30
31
Industry Risk Prole Tabulated Data
PART 3
How to Read Tabulated Data
Part 3 of the HEMS IRP is a technical document which has been written to provide the in-depth iden-
tifcation, analysis and proposed management strategies to treat the risk. When reading the tabulated
data, the contents are to be read from left to right. These risks are not ordered in priority from highest
to lowest, but rather are grouped and classifed against the IRP Model elements outlined on page 20.
The table sub heading at the top of each page in the blue bar refects the relevant IRP model element
for each risk.
Each page of the tabulated data contains explicit, in depth information. The far left column labelled
Description of the Risk provides an overview of the risk statement. It is to be noted that these risks
statements are worded as risks (the chance something could happen - not the certainty that it is hap-
pening) to this end the risk statement is to be read in concert with the likelihood column for that item
for a complete picture of the risk.
The column to the right of the Risk Description is the impact that that risk may have on the HEMS
Industry. These dot points are potential consequences written long hand and are to be read in concert
with the Consequence column in the risk assessment component of the table. This consequence rating
is the semi-quantative assessment of the word picture outlined in the Impact column. In essence these
two columns indicate one and the same thing using different language and methods.
Risk level is calculated by multiplying consequence and the likelihood on a two dimensional matrix.
The risk level is indicated by both a word e.g. High and a number e.g.(5). This number correlates to
the placement on the matrix as indicated on page 29 given each risk level spans a number of boxes.
The most critical aspect to the whole tabulated data and the IRP itself is the identifcation, resourcing
and implementation of risk reduction measures known as Risk Treatment Strategies. For the purposes
of this IRP, the risk treatment strategies listed in this tabulated data are Performance or Outcome
based and are not specifc tasks allocated to any one group in industry. These reduction measures
need to be further developed into actual tasks that can be implemented, tracked and measured. This
information will be held in the HEMS Industry Risk Reduction Action Plan.
The residual risk rating uses this same process as the risk assessment step while taking into account
the forecast of the risk level calculation (of both consequence and likelihood) once the proposed set of
treatments has been implemented. The residual risk can only be claimed by the industry once the treat-
ments have been allocated, resourced and completed. A progress report against the implementation
should be undertaken regularly to track a downward motion of the risk profle.
The far right hand column labelled Priority provided an indication of where that itemized risk falls in
the risk ranking from 1-26.
32
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PRIORITY: 1
RESIDUAL RISK: MEDIUM (12)
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LIKELIHOOD: CERTAIN
CONSEQUENCE: CRITICAL
PRIORITY: 4
RESIDUAL RISK: LOW (15)
34
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RISK LEVEL HIGH (6)
LIKELIHOOD: CERTAIN
CONSEQUENCE: MAJOR
PRIORITY: 14
RESIDUAL RISK: HIGH (7)
38
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PRIORITY: 25
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LIKELIHOOD: UNLIKELY
PRIORITY: 26
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RISK LEVEL HIGH (5)
PRIORITY: 13
58
Supporting Appendices
PART 4
59
Appendix A
HEMS IRP STAKEHOLDER AND DISTRIBUTION LIST
Aerospace Medical Association (AsMA)
Aerosafe Risk Management
Air Medical Operators Association: United in Safety (AMOA)
Air Medical Operators holding a Part 135 Certifcate (copy per organization)
Air Medical Programs (copy per organization)
Air Medical Physicians Association (AMPA)
Air and Surface Transport Nurses Association (ASTNA)
American Academy of Pediatrics (AAP)
American Ambulance Association (AAA)
American Association of Critical Care Nurses (AACN)
American Association for Respiratory Care (AARC)
American College of Emergency Physicians (ACEP)
American College of Surgeons (ACS)
American Hospital Association (AHA)
American Helicopter Society (AHS)
American Society for Healthcare Engineers (ASHE)
American Society for Healthcare Risk Management (ASHRM)
Association of Air Medical Services (AAMS)
Aviation Safety Network Executive Group (ASN)
Aviation Safety Network Alumni (ASN Alumni)
Bell Helicopters Textron
Commission Accreditation of Medical Transport Systems (CAMTS)
Department of Health and Human Services
Emergency Nurses Association (ENA)
Federal Aviation Administration (FAA)
Flight Safety Foundation
Foundation for Air-Medical Research and Education (FARE)
Government Accountability Offce (GAO)
Helicopter Association International (HAI)
Helicopter Emergency Medical Services Committee
House Aviation Sub Committee
International Association of Flight Paramedics (IAFP)
International Helicopter Safety Team (IHST)
International Standards Organization Committee for Risk Management
National Association of Air Medical Communications Specialists (NAACS)
National Air Transport Association (NATA)
National Association of EMS Physicians (NEMSP)
National Association of Emergency Medical Technicians (NAEMT)
National Association of Neonatal Nurses (NANN)
National Association of State EMS Offcials (NEMSO)
National EMS Pilots Association (NEMSPA)
National Transportation Safety Board (NTSB)
Patients First Air Ambulance Alliance (PFAA)
Risk & Insurance Management Society Inc (RIMS)
The Joint Commission
60
PART 4 Supporting Appendices
Appendix B
SUPPORTING DOCUMENTATION
Accompanying Documentation:
- Executive Summary: An executive summary is provided to assist the industry in understanding the
background, scope and contents of the HEMS IRP. The next steps for risk reduction are also outlined.
- HEMS Industry Risk Reduction Plan: the main driver of assessing risk is to proactively reduce risk
through the implementation of risk treatment strategies of solutions to the risk issues. Following the
release of the HEMS IRP a facilitated process will take place calling for submission by stakeholders
who wish to take carriage of industry wide risk reduction measures. This work will be compiled into
the HEMS Industry Risk Reduction Plan.
Information Packages
- Technical Media Briefng Package: Given the comprehensive nature of the information presented
in the HEMS IRP, a technical briefng was delivered to the media on Monday April 20, 2009 at the
National Press Club in Washington DC.
- FAQs: Frequently asked questions are provided as a supporting resource.
Guide & Template
- Industry Submission Risk Treatment Strategies: Guidance material has been made available to indus-
try to assist in the preparation of their
submission of risk treatment strategies that
will be compiled in the HEMS Industry Risk Reduction Plan.
- Guide for Associations How to use the HEMS IRP: Provided for use by industry associations and
groups to inform their members and boards.
- Guide for Air Medical Operators How to use the HEMS IRP: Provided for use by Part 135 Operators to
assist in understanding how the HEMS IRP can be utilized at an organizational level by Board Members,
CEOs and Company Executives.
- Guide for Air Medical Programs How to use the HEMS IRP: Provided for use by Air Medical Pro-
grams to assist in understanding how the HEMS IRP can be utilized at an organizational level by Board
Members, Hospital Executives CEOs, Program Directors, Program Executives.
- Guide for State EMS Agencies How to use the HEMS IRP: Provided to State EMS Agencies in order to
provide information on how the HEMS IRP could be utilized at the State level.
61
Appendix C
ABBREVIATIONS
AAMS Association of Air Medical Services
ADS(B) Automatic Dependent
Surveillance - Broadcast
AHS American Helicopter Society
AMOA Air Medical Operators Association: United in Safety
AMRM Air Medical Resource Management
ATC Air Traffc Control
CRM Crew Resource Management
EMS Emergency Medical Services
FAA Federal Aviation Administration
FARE Foundation for Air-Medical
Research and Education
FOQA Flight Operation Quality Assurance
FSF Flight Safety Foundation
GAO Government Accountability Offce
HAI Helicopter Association International
HEMS Helicopter Emergency Medical Services
HTWAS Helicopter Terrain Warning
Avoidance System
IFR Instrument Flight Rules
IHST International Helicopter Safety Team
IMC Instrument Meteorological Conditions
IRP Industry Risk Profle
IRSMS Integrated Risk & Safety Management Systems
ISO International Standards Organization
JSAT Joint Safety Analysis Team (part of IHST)
JSIT Joint Safety Implementation Team
(part of IHST)
NTSB National Transportation Safety Board
NVG Night Vision Goggles
SMS Safety Management Systems
VFR Visual Flight Rules
62
PART 4 Supporting Appendices
Appendix D
PROJECT CONTACT DETAILS AND PROJECT ACKNOWLEDGEMENTS
Project Contact Kimberley Turner
Chief Executive Offcer
Aerosafe Risk Management
1325 G Street NW
Washington DC
Ph: 202 449 7693
Fax: 202 449 7701
kturner@aerosafe.com.au
Staff Acknowledgments In addition to the contact named above, Bradley Glassington, HEMS IRP
Project Manager; Robin Graham, Senior Risk Advisor (Aviation); John
W.Overton, Jr., M.D., Senior Risk Advisor (Medical) and Katherine Robinson,
Senior Planner & Communications Manager have all made key contributions
to this report. Graphic Design provided by GraphikExposure.
Technical Review Special thanks to Kevin W Knight, Chairman ISO Standards Committee Risk
Management for undertaking a technical review of the HEMS IRP.
Custodian of the Flight Safety Foundation is to be commended for their enthusiasm in taking
HEMS IRP on the role as custodian of this body of work. It is with great appreciation
and deepest thanks to Joan Sullivan Garrett, Vice Chairman Flight Safety
Foundation; William R. Voss President and CEO Flight Safety Foundation;
Emily McGee, Director of Communications for the support and interest in
this initiative.
Review & comment The opportunity for review and comment on the draft HEMS IRP was provided
on the Draft HEMS IRP to 33 different stakeholder groups. Additional resource, dedicated briefngs
or a workshop was held with AAMS, AHS, AMOA, AMPA, CAMTS, FAA,
FARE, Flight Safety Foundation, GAO, HAI, House Aviation Sub Committee,
International Helicopter Safety Team, NEMSPA, NTSB and The Joint Com-
mission. The project team would like to thank these organizations for the
time taken to review, discuss and provide feedback on either the concept of
utilizing risk management at the industry level or the provision of comment
on the draft HEMS IRP over the period February 12, 2009 April 15, 2009.
Obtaining Copies Flight Safety Foundations web site www.fightsafety.org Copies are available
of the HEMS IRP at no cost.
Order by mail The Foundation of Air Medical Research and Education has taken on respon-
or phone sibility for printing and distribution of the HEMS IRP to industry. Contact
details for ordering copies are on the back cover of this document. Special
acknowledgment and thanks to FARE Board, their Chair Dr Kevin Hutton
and staff for their ongoing commitment to safety research & education.
63
FOR MEDIA INQUIRIES, CONTACT:
EMILY MCGEE, Director, Communications
Flight Safety Foundation, 601 Madison Ave, Alexandria VA 22314
Phone: 703 739 6700 Email: mcgee@ightsafety.org
FOR INQUIRIES ON THE HEMS IRP, CONTACT:
BRADLEY GLASSINGTON, HEMS IRP Project Manager
Aerosafe Risk Management, 1325 G Street NW, Washington DC
Phone: 202 449 7693 Email: bglassington@aerosafe.com.au
TO REQUEST YOUR COPY OF THE HEMS IRP CONTACT:
AMBER BULLINGTON, Program Manager
Foundation Air Medical Research and Education
526 King Street, Suite 415, Alexandria, VA 22314
Phone: 703 836-8732 Email: abullington@aams.org
FOUNDATION FOR AIR-MEDICAL RESEARCH & EDUCATION
The HEMS Industry Risk Profle helps fulfll FAREs mission of raising awareness, and advancing
research in the emergency-medical-transport feld. FARE is distributing this document, in its hardcopy
form, to air-medical service professionals and others interested in the feld to be used as a tool in
advancing safety for the entire HEMS community.
To order your copy of the HEMS IRP go to
www.fareonline.org

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