Flight programs are exceedingly safety conscious. While it is true that EMS helicopters have a crash rate exceeding that of non-EMS helicopters, it is probably true that, per patient-mile, EMS helicopters are safer than ground ambulances.325 Air medical programs must follow FAA rules. The industry itself has set forth additional stringent standards under the auspices of the AAMS and, more recently, the Commission on Accreditation of Air Medical Services (CAAMS). 26 On request, CAAMS performs site visits of air medical programs to certify that they comply with strict safety and operational standards.

On a mission, safety is the chief responsibility of the pilot. Because weather and collisions against ground obstacles are the leading hazards, in most programs, the pilot is not told the nature of the mission until a weather check is done and it is decided that the flight can be made safely. The pilot does not then feel pressured into flying a mission under borderline weather conditions because of the patient's condition. For helicopters, visibility, wind, and icing conditions are major limiting conditions.

The use of fire-resistant flight clothing, helmets, and emergency absorbing seats are felt to be effective in reducing preventable injuries to the medical crew in survivable crashes.27

Safety training must involve everybody in contact with the aircraft, including the communicators and dispatchers, aircraft mechanics, and especially on-scene EMS personnel. The latter must be taught to function around the helicopter at the scene.

Scene flights are inherently more dangerous than landing at a regular hospital landing zone. The unfamiliar landing area at a scene has more obstacles, such as wires and trees. More material may be scattered on the ground and blown around by the rotor wash from the helicopter. Scenes to which EMS has been called tend to be uncontrolled, with more bystanders who have the potential of walking into a tail or main rotor. A small helicopter needs a minimum of 60 ft by 60 ft for a landing zone, and a medium-sized or larger aircraft requires at least 100 ft by 100 ft. A landing zone of this size may be difficult to secure on a rural highway or at other accident scenes.

Several points are important for scene helicopter safety. First, the craft should always be approached from the front, where the pilot can see approaching personnel and can then acknowledge their presence and motion them into the helicopter. In general, a flight team member will guide ground personnel into the aircraft. Second, a rotor-wing aircraft should never be approached from the rear, since the tail rotor is going very fast and is virtually invisible. The tail rotor is the most dangerous area of a helicopter. Third, landings and takeoffs are the most likely times for adverse incidents to occur. Ground personnel need to stand well away as the helicopter lifts off.

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