Air Ambulance Regulations:

14 CFR Part 135 Subpart L – Helicopter Air Ambulance Operations

This regulation establishes the operational, safety, and certification requirements for helicopter air ambulance (HAA) services under Part 135. It outlines pilot training and qualification standards, operational control procedures, and flight risk assessment protocols to enhance the safety of emergency medical flights. The regulation also mandates the use of advanced safety technologies such as terrain awareness warning systems (TAWS) and flight data monitoring to reduce operational risks.

Advisory Circulars (ACs)

Part 135 Air Ambulance Operations

AC 135-15 – Emergency Medical Services/Air Ambulance Operations
This advisory circular (AC) provides guidance on air ambulance operations under Part 135 of the Federal Aviation Regulations (FARs). It covers operational control, pilot requirements, equipment, and procedures necessary for safe and effective emergency medical services (EMS) flights. The document emphasizes best practices for crew resource management and patient care during air transport.

AC 135-14B – Helicopter Air Ambulance Operations
AC 135-14B outlines specific guidance for helicopter air ambulance (HAA) operations, including regulatory compliance, risk management, and safety enhancements. It discusses the importance of preflight planning, adverse weather considerations, and pilot training requirements. Additionally, it highlights the FAA’s recommendations on terrain awareness, night vision goggles, and other technological improvements to enhance flight safety.

AC 00-64 – Air Ambulance Safety Recommendations
This circular provides best practices and safety recommendations for air ambulance operations. It highlights the importance of operational risk assessments, weather planning, and patient handling procedures. The document also addresses key safety enhancements such as night vision systems and improved communication protocols between medical personnel and pilots.

3900.71A – FAA Occupational Safety and Health Programs
This document outlines FAA workplace safety policies for aviation personnel, focusing on hazardous materials handling, personal protective equipment (PPE), and emergency response plans.

Airworthiness and Aircraft Safety

AC 20-164A – Airworthiness Approval of Enhanced Vision Systems (EVS)
This advisory circular explains the requirements for integrating Enhanced Vision Systems (EVS) into aircraft, including air ambulance helicopters and fixed-wing aircraft. EVS technology enhances situational awareness in low-visibility conditions, reducing the risk of controlled flight into terrain (CFIT) accidents. The document provides guidance on certification, installation, and operational use.

AC 20-140C – Guidelines for Airborne Navigation Equipment
AC 20-140C covers the approval and operational use of navigation systems such as GPS and performance-based navigation (PBN) equipment. It is crucial for air ambulance operators who rely on precise navigation in emergency response situations. The circular details compliance requirements and testing standards for onboard avionics.

AC 27-1B CHG 1-9 – Certification of Normal Category Rotorcraft
This advisory circular provides guidance for the certification of normal category rotorcraft under 14 CFR Part 27. It includes amendments and clarifications on airworthiness standards, structural integrity, and performance requirements for helicopters.

Crew Training and Safety Management

AC 120-96A – Approval of Aviation Safety Management Systems (SMS)
This AC provides an in-depth overview of Safety Management Systems (SMS) and how they should be implemented in aviation organizations, including air ambulance operators. It explains the four pillars of SMS—safety policy, risk management, assurance, and promotion. The document serves as a guide for operators seeking FAA approval of their SMS programs.

AC 121-32A – Flight Crew Fatigue Management
Fatigue management is critical in aviation, particularly for emergency services. AC 121-32A outlines the physiological effects of fatigue and provides guidance on mitigating its impact on flight crews. The document discusses strategies such as controlled rest periods, proper scheduling, and the use of fatigue risk management systems (FRMS).

AC 120-51E – Crew Resource Management (CRM) Training
CRM training is essential for effective teamwork in aviation, especially in air medical transport. This AC provides guidelines on CRM principles, including communication, situational awareness, and decision-making skills. It emphasizes the importance of interdisciplinary collaboration between pilots, medical staff, and ground control.

AC 00-59 – Meteorological Services for Pilots
This advisory circular provides information on meteorological services available to pilots, including weather briefings, aviation forecasts, and turbulence prediction models. It helps pilots make informed flight decisions based on current and forecasted atmospheric conditions.

AC 91-32B Ed Update 2 – Safety in Cold Weather Operations
This document provides operational guidance for pilots flying in cold weather conditions, including ice protection strategies, de-icing procedures, and aircraft performance considerations. It is essential for operators flying in extreme winter environments.

FAA-H-8083-21 – Helicopter Flying Handbook
This FAA handbook serves as a primary reference for helicopter pilots, covering aerodynamics, flight maneuvers, emergency procedures, and operational best practices. It is widely used for pilot training and certification under 14 CFR Part 61.

FAA FAASTeam Library – Flying in Flat Light and White Out Conditions
This FAA Safety Team (FAASTeam) publication provides critical guidance on the hazards of flying in flat light and whiteout conditions, particularly in mountainous or snow-covered environments. It includes tips for visual awareness and risk mitigation.

Medical Equipment and In-Flight Safety

AC 20-177 – Use of In-Flight Medical Equipment
This document provides guidance on the use, installation, and certification of in-flight medical equipment used in air ambulance operations. It ensures that medical devices, such as ventilators and defibrillators, meet FAA safety and airworthiness standards. The circular also discusses power supply considerations and electromagnetic interference with avionics systems.

AC 91.21-1D Ed Update – Use of Portable Electronic Devices Aboard Aircraft
This advisory circular outlines the regulations and best practices for the use of portable electronic devices (PEDs) on board aircraft. It explains how operators can determine whether PEDs might interfere with aircraft navigation and communication systems.

FAA Legal Interpretations

Kfir_2002_Legal_Interpretation – FAA Legal Interpretation on Foreign Aircraft Operations
This legal interpretation clarifies FAA regulations regarding the operation of foreign-registered aircraft within U.S. airspace, addressing operational limitations, certification requirements, and leasing agreements.

Triponey_2018_Legal_Interpretation – FAA Interpretation on Pilot-in-Command Authority
This legal interpretation clarifies pilot-in-command (PIC) authority regarding operational decisions in Part 135 operations. It discusses liability, decision-making authority, and compliance with FAA operational control standards.

Wheeler-HeliFlite_Shares_2017_Legal_Interpretation – Fractional Ownership and Operational Control
This FAA legal interpretation discusses the distinction between fractional aircraft ownership and charter operations. It provides guidance on operational control requirements for shared aircraft ownership programs.

Waldinger-Intermedix_2012_Legal_Interpretation – Air Medical Transport Compliance
This legal interpretation clarifies air medical transport operations under Part 135. It examines regulatory requirements for patient transport, medical crew training, and compliance with FAA safety policies.

Masterson_2013_Legal_Interpretation – Operational Control in Part 135 Air Ambulance Operations
This interpretation focuses on who holds operational control in air ambulance operations, specifically under Part 135. It provides clarification on operator responsibilities versus third-party medical service providers.

Kenny-STATMedEvac_2012_Legal_Interpretation – Emergency Medical Services and FAA Regulations
This legal interpretation outlines FAA regulatory compliance for air medical transport providers. It examines the distinction between medical personnel responsibilities and flight crew authority during EMS flights.

FAA Guidance and Information Notices (InFO)

InFO 16011 – Operational Considerations for Part 135 Operators
This FAA notice discusses best practices for Part 135 operators, focusing on crew resource management, fatigue mitigation, and operational decision-making. It also addresses safety management system (SMS) implementation.

InFO 16002 – Guidance on Helicopter Air Ambulance Pre-Flight Risk Assessments
This Information for Operators (InFO) notice provides updated guidance on pre-flight risk assessments for helicopter air ambulance (HAA) operations. It emphasizes the importance of evaluating weather conditions, pilot readiness, and operational risks before takeoff.

InFO 13005 – Advisory on Flight Crew Fatigue Management
This Information for Operators (InFO) notice highlights the risks associated with pilot fatigue and provides mitigation strategies for flight duty limitations and rest periods under Part 135 operations.

FAA Order 8900.1 References

8900.1, Vol.3, Ch19, Sec4 – Operational Risk Management in Emergency Medical Services (EMS)
This section covers risk management strategies for EMS flights, particularly those operating under Part 135. It highlights pilot decision-making, night operations, and hazardous weather considerations for air ambulance missions.

8900.1, Vol.3, Ch19, Sec15 – Operational Control for Air Carrier Certificate Holders
This section provides guidance on operational control requirements for air carrier certificate holders. It details the responsibilities of certificate holders in managing flight operations, ensuring regulatory compliance, and maintaining safety oversight for commercial air transport.

8900.1, Vol.3, Ch25, Sec5 – Operational Procedures for Multi-Crew Part 135 Aircraft
This document provides guidelines for multi-crew operations under Part 135, covering standard operating procedures (SOPs), crew coordination, and communication protocols.

8900.1, Vol.3, Ch65, Sec1 – Helicopter Air Ambulance Safety Enhancements
This FAA policy details mandatory safety enhancements for helicopter EMS operations, including enhanced flight-following systems, crash-resistant fuel systems, and terrain awareness and warning systems (TAWS).

8900.1, Vol.3, Ch65, Sec2 – Air Ambulance Operational Control Requirements
This section outlines FAA oversight requirements for air ambulance operational control, including dispatcher responsibilities, pilot authority, and emergency decision-making protocols.

8900.1, Vol.3, Ch65, Sec3 – Flight Risk Evaluation for Part 135 Air Ambulance
This section explains how Part 135 air ambulance operators should assess flight risk factors, including weather conditions, pilot fatigue, and aircraft performance before conducting medical transport flights.

8900.1, Vol.3, Ch65, Sec4 – Safety Oversight for Air Ambulance Operators
This document outlines the FAA’s safety oversight procedures for air ambulance operations. It includes risk management protocols, flight operations monitoring, and compliance requirements for Part 135 operators.

8900.1, Vol.3, Ch65, Sec5 – Emergency Medical Services (EMS) Operational Requirements
This document outlines the operational standards for Emergency Medical Services (EMS) conducted under Part 135. It includes risk management strategies, flight dispatch procedures, and specific requirements for EMS aircraft and crew training.

8900.1, Vol.4, Ch5, Sec2 – Helicopter Flight Control Systems
This section of FAA Order 8900.1 provides certification and inspection criteria for helicopter flight control systems. It details the required maintenance and operational checks to ensure compliance with FAA airworthiness regulations.

8900.1, Vol.4, Ch5, Sec3 – Helicopter Air Ambulance Certification and Surveillance
This section from FAA Order 8900.1 provides inspector guidance for certifying and overseeing helicopter air ambulance operators. It details the certification process, regulatory compliance checks, and ongoing surveillance to ensure operational safety. The document also addresses risk assessment methodologies and required safety management systems (SMS) for air ambulance providers.

8900.1, Vol.4, Ch5, Sec5 – Helicopter Emergency Equipment Requirements
This section provides guidelines on the mandatory emergency equipment required for helicopter operations, including flotation devices, emergency locator transmitters (ELTs), and first aid kits. It is crucial for ensuring compliance and safety in EMS flights.

8900.1, Vol.6, Ch2, Sec4 – Training Program Requirements for Air Ambulance Pilots
This FAA regulatory document details training requirements for helicopter air ambulance pilots. It includes guidelines on simulator-based training, emergency procedures, and instrument proficiency standards.

8900.1, Vol.6, Ch2, Sec7 – Air Ambulance Pilot Requirements and Responsibilities
This document specifies the requirements and responsibilities for pilots operating air ambulance flights. It highlights the necessary qualifications, flight experience, and training standards required to operate safely in emergency medical situations. Additionally, it includes guidelines for duty time limitations and fatigue management in compliance with FAA regulations.

EP_4_2_2_135E_AW_V33 – Airworthiness Standards for Part 135 Operators
This document provides guidance on airworthiness compliance for Part 135 operators. It covers aircraft inspection protocols, maintenance schedules, and safety enhancements required for continued operational approval.

EP_2_2_1_135E_OP_V41 – Operational Procedures for Part 135 Flight Crews
This document establishes standardized operational procedures for flight crews operating under Part 135. It includes pre-flight planning requirements, in-flight operational protocols, and emergency response actions to ensure compliance and safety.

EP_2_3_1_135E_OP_V34 – Performance and Operational Standards for Part 135
This document details the performance requirements and operational best practices for Part 135 carriers. It includes minimum equipment lists (MEL), fuel management procedures, and operational checklists for different flight scenarios.

ED_2_2_1_135E_OP_V45 – Emergency Procedures for Part 135 Operators
This document provides emergency procedure guidelines for Part 135 operators. It includes protocols for dealing with in-flight emergencies, medical evacuations, aircraft system failures, and unplanned diversions to ensure passenger and crew safety.

NFPA Standards and Guides for Emergency and Fire Services

NFPA 30B – Code for the Manufacture and Storage of Aerosol Products
This code provides requirements for the safe production, storage, and handling of aerosol products. It includes fire protection measures, facility design guidelines, and hazard classification systems to mitigate risks associated with flammable aerosol products.

NFPA 55 – Compressed Gases and Cryogenic Fluids Code
NFPA 55 establishes safety standards for the storage, use, and transportation of compressed gases and cryogenic fluids. It includes guidelines on cylinder handling, ventilation requirements, and fire protection measures to prevent hazardous incidents.

NFPA 99 – Health Care Facilities Code
This code outlines fire protection and safety standards for health care facilities, including hospitals, clinics, and nursing homes. It provides requirements for medical gas systems, electrical systems, and emergency preparedness to ensure patient and staff safety.

NFPA 232 – Standard for the Protection of Records
NFPA 232 specifies fire protection measures for storing vital records and documents. It covers fire-resistant storage techniques, suppression system requirements, and recovery plans to prevent data loss due to fire incidents.

NFPA 329 – Recommended Practice for Handling Releases of Flammable and Combustible Liquids and Gases
This document provides guidelines for the safe handling, containment, and mitigation of flammable liquid and gas releases. It includes procedures for leak detection, fire prevention, and emergency response planning.

NFPA 402 – Guide for Aircraft Rescue and Fire-Fighting Operations
NFPA 402 offers guidance on fire suppression, evacuation, and rescue procedures for aircraft emergencies. It is designed to help emergency responders improve preparedness and operational effectiveness in aviation-related incidents.

NFPA 730 – Guide for Premises Security
This guide provides recommendations for securing commercial, residential, and industrial properties. It includes risk assessment strategies, security system implementation, and emergency response planning.

NFPA 1550 – Standard for Emergency Responder Health and Safety
NFPA 1550 establishes safety and health requirements for emergency responders, including physical fitness, mental health programs, and protective equipment standards. It aims to enhance the well-being of fire, EMS, and law enforcement personnel.

NFPA 1225 – Standard for Emergency Services Communications
This standard sets communication requirements for emergency services, including dispatch centers, radio systems, and data interoperability. It ensures that first responders have reliable and effective communication channels.

NFPA 1580 – Standard for Emergency Responder Occupational Health and Wellness
NFPA 1580 focuses on occupational health programs for emergency responders, including preventive medical exams, injury rehabilitation, and wellness initiatives. It aims to reduce long-term health risks associated with high-stress professions.

NFPA 1585 – Standard for Exposure and Contamination Control
This standard provides guidelines for minimizing exposure to hazardous substances, including carcinogens and biohazards. It includes decontamination procedures, PPE requirements, and best practices for reducing contamination risks.

NFPA 1900 – Standard for Aircraft Rescue and Firefighting Vehicles, Automotive Fire Apparatus, Wildland Fire Apparatus, and Automotive Ambulances
NFPA 1900 consolidates standards for emergency response vehicles, covering design specifications, performance criteria, and maintenance requirements for firefighting and EMS transport vehicles.

NFPA 1910 – Standard for the Inspection, Maintenance, Refurbishment, Testing, and Retirement of In-Service Emergency Vehicles and Marine Firefighting Vessels
This standard provides guidelines for the ongoing maintenance and operational safety of emergency vehicles, ensuring they remain functional and compliant with industry standards. It includes inspection protocols and retirement criteria for aging vehicles.

NFPA 1930 – Standard on Fire and Emergency Service Use of Thermal Imagers, Two-Way Portable RF Voice Communication Devices, Ground Ladders, Rescue Tools, Fire Hose, and Fire Hose Appliances
NFPA 1930 sets performance and safety standards for critical firefighting and rescue equipment. It ensures that thermal imagers, communication devices, and rescue tools meet operational requirements for emergency responders.