On Tuesday, the NTSB issued 19 recommendations for helicopter emergency medical services (HEMS), addressing pilot training; safety management systems; collection and analysis of flight, weather and safety data; flight data monitoring; development of a low-altitude airspace infrastructure; and the use of dual pilots, autopilots and night vision goggles. HEMS operations, which transport critically ill patients, include an estimated 750 helicopters, 70 operators and 60 hospital-based programs, the NTSB said. The agency’s recommendations follow a four-day NTSB public hearing held in early February to examine safety issues after a spate of fatal HEMS accidents over the past two years. In fact, 2008 was the deadliest year on record for HEMS operations, with 12 accidents and 29 fatalities. “The pressure on HEMS operators to conduct their flights quickly in all sorts of environments makes these types of operations inherently more risky than other types of commercial flight operations,” said NTSB chairman Deborah Hersman. “Operators need to have every available safety tool to conduct these flights and to determine when the risk of flying is just too great.” Ten of the 19 recommendations are directed toward the FAA; two each for the Centers for Medicare & Medicaid Services (CMS) at the U.S. Department of Health and Human Services and the federal interagency committee on emergency medical systems; and five directly to HEMS operators.