8900.1 CHG 443



Section 3  Safety Assurance System: Air Ambulance Service Operational Procedures

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4-941    GENERAL. This section contains information and guidance to be used by inspectors when evaluating a Title 14 of the Code of Federal Regulations (14 CFR) part 135 operator’s special operational procedures for air ambulance operations (helicopter or airplane). This section covers the evaluation of an operator’s operational preflight, in-flight, and emergency procedures. To conduct an air ambulance operation, an operator must comply with all of the pertinent requirements of part 135 as well as meet additional requirements for the issuance of air ambulance operations specifications (OpSpecs). This section is related to Safety Assurance System (SAS) Element 2.2.1 (OP), Airmen Duties/Flight Deck Procedures; Element 3.3.1 (OP), Operational Control; Element 2.1.7 (OP), Flight Crewmember Flight/Duty/Rest Time; Element 2.3.1 (OP), Appropriate Operational Equipment; Element 3.2.2 (OP), Use of Approved Areas, Routes, and Airports; Element 5.2.1 (OP), Crewmember Duties/Cabin Procedures; and Element 6.2.1 (AW), Fueling.


A.    Operational Control Procedures. Inspectors must evaluate an operator’s operational control procedures to determine that a pilot may not initiate a flight when:

    Not authorized by the operator,

    Total risk exceeds the risk limitations established and documented by the operator.

B.    Final Authority to Fly. Inspectors must evaluate the operator’s policies and procedures to verify that a pilot has the final authority to refuse a flight request or terminate an assigned flight. The operator’s procedures must be in compliance with part 135, 135.77 and 135.619. The procedures must be adequate with regard to the overall size and scope of the operations and if applicable, the number of satellite locations.

NOTE:  No later than April 22, 2016, all operators authorized to conduct helicopter air ambulance (HAA) operations with 10 or more HAAs assigned to that certificate holder’s OpSpecs must have an Operations Control Center (OCC) in compliance with the specifications established within that section OpSpec.

C.    Flight-Locating. An air ambulance operator is required by regulation to use flight-locating procedures (refer to 135.79), unless a Federal Aviation Administration (FAA) flight plan is filed and activated. Flight following, conducted by the HAA operator even where it is not required by regulation, is recommended as an HAA industry best practice and is a permissible and desirable adjunct to supplement flight locating.

1)    An inspector must evaluate an operator’s flight-locating/following procedures to verify the procedures are followed, are effective in determining when an aircraft is overdue, and are helpful in providing situational awareness to the following/locating staff so that appropriate flight information updates may be shared with the flightcrew.
2)    In the event an aircraft becomes overdue, the operator’s procedures (commonly referred to as post-accident/incident procedures) must document specific actions that must be accomplished with respect to that overdue aircraft, to include immediate notification of the local (jurisdictional) FAA Flight Standards District Office (FSDO), National Transportation Safety Board (NTSB) and FAA certificate-holding district office (CHDO). The operator should periodically conduct training exercises with these procedures. These notifications are requirements shared with other part 135 operations (refer to 135.23(d)). HAA industry best practices for flight locating and flight following are described in the current edition of Advisory Circular (AC) 135-14, Helicopter Air Ambulance Operations.

D.    Flight Time and Rest Requirements. Inspectors must ensure that an operator maintains well-defined records logging individual flight time, and unassigned duty time in accordance with part 135 subpart F, Flight Crewmember Flight Time Limitations and Rest Requirements. Air ambulance operators will normally operate under either one of the following regulations:

1)    Section 135.267, Flight Time Limitations and Rest Requirements-Unscheduled One- and Two-Pilot Crews. According to this regulation, the flightcrew members are allowed to conduct any flight or other duties as assigned, such as training, testing or routine transport missions, while on duty/assignment. For an assignment conducted under 135.267, flightcrew members must receive at least 10 consecutive hours of rest during the 24-hour period that precedes the planned completion of the assignment.
2)    Section 135.271, Helicopter Hospital Emergency Medical Evacuation Service (HEMES). The rest requirements for HEMES (now HAA) differ from the requirements for flights conducted under  135.267. During operations in accordance with 135.271, provisions must be made for 8 consecutive hours of rest during any 24-hour period, and the time of that 8-hour rest period must be declared in advance. If a flightcrew member does not receive the required rest period, that person must be relieved of the assignment. The operator should establish recordkeeping to show that only emergency medical evacuation flights are conducted during these assignments. While a flightcrew member is assigned to duty under 135.271, that person may not be assigned to any other duties. Prohibited duties during an HAA assignment include, but are not limited to, maintenance, test flights, public relations flights and administrative duties. Operations under 135.271 are, in practice, considerably less widespread than operations under 135.267.

NOTE:  Inspectors must ensure that operators scheduling pilot duty and flight assignments under  135.271 have identified those procedures and policies in their operations manual.

NOTE:  Both 135.267 and 135.271 require a comprehensive recordkeeping process.

NOTE:  An inspector should ensure that company training manuals and OpSpecs should specify with which of these sections the HAA operator will comply.

E.    Flight Data Monitoring. After April 23, 2018, in accordance with 135.605, all HAAs must be equipped with an FAA-approved Flight Data Monitoring System (FDMS) capable of recording flight performance data. The regulation intentionally does not prescribe retention or use of the FDMS recordings. These decisions are at the discretion of the air ambulance operator. Beyond the minimum flight performance data stated below, the type and frequency of data recorded is at the discretion of the operator. The current edition of AC 27-1 MG 6, Miscellaneous Guidance (MG) for Emergency Medical Service (EMS) Systems Installations, suggests flight data that should be considered for recording; however, this is a recommendation, not a requirement. The minimum requirements are:

    The FDMS must receive electrical power from the bus that provides the maximum reliability for operation without jeopardizing service to essential or emergency loads.

    The FDMS must be operated from the application of electrical power before takeoff until the removal of electrical power after termination of flight.

    FAA approval will be granted to an FDMS which has the capability of recording flight performance data including, at a minimum, altitude (mean sea level (MSL)), time/date of sampling with a minimum sampling rate of one record per second, and sufficient memory to record an entire flight. The FDMS must also be installed securely and must be powered as stated above in the regulation. The installation must be approved under the authority of a Supplemental Type Certificate (STC), an engineering review conducted by the Aircraft Evaluation Group (AEG), or a field approval.

F.    Helicopter Terrain Awareness and Warning System (HTAWS). After April 24, 2017, in accordance with 135.605, any helicopter approved for air ambulance operations must be equipped with an HTAWS that meets the requirements in Technical Standard Order (TSO)-C194, Helicopter Terrain Awareness and Warning System (HTAWS). Upon implementation, inspectors must evaluate an operator’s equipment installation and the pilot training curriculum to determine whether the requirements of 135.605 are met. The operator’s Rotorcraft Flight Manual Supplement (RFMS) and training curriculum must contain appropriate procedures for:

    The use of the HTAWS; and

    Proper flightcrew response to HTAWS audio and visual warnings.

NOTE:  Providing HTAWS is operational and the pilot is trained and qualified, the operator may use HTAWS to qualify for relief against Local Flying Area (LFA) Class G visual flight rules (VFR) night minimum ceiling and visibility restrictions, in accordance with 135.609.

NOTE:  Operators with HTAWS required by 135.609 with an approved deviation under 14 CFR part 21, 21.618 are in compliance with this regulatory mandate. A minimum equipment list (MEL) deferral procedure may be requested but is subject to Flight Operations Evaluation Board (FOEB) approval.

G.    Situational Awareness. Inspectors should evaluate the operator’s actions aimed at ensuring the situational awareness of HAA personnel. This includes their procedures for receiving and filtering information and providing inputs for or conducting regulatory-required risk assessments, VFR flight planning, shift-change briefings, and preflight briefings. Procedures must address ensuring situational awareness of pilots, Operations Control Specialists (OCS) and other operations support personnel coming on duty, and maintaining of situational awareness throughout their duty period. Procedures should include methods for providing information on current operational and flight conditions, with emphasis placed on hazard updates. Conference calls, shift change briefing documents, or other technologies to link personnel at remote sites may be applied.

H.    Potential Hazard Information. Inspectors should evaluate the operator’s means at each base and satellite location for depicting hazards to flight operations. All potential hazards should be annotated. Power lines, towers, and tall structures in the vicinity of designated Landing Zones (LZ) and newly erected towers, including temporary construction cranes, are particularly important.

1)    The operator should develop hazard maps for each service area regardless of whether or not an LFA exists. The operator should involve flightcrew members from each service area when frequently and regularly reviewing and updating the hazard maps and as new hazard information becomes available. A system to identify and depict newly-added hazards and to ensure pilots are immediately aware of them should be developed. VFR/IFR transition corridors and preferred routes should appear on hazard maps.
2)    The operator should display the hazard map in a conspicuous location at each base for pilots to review. In evaluating the provision of this information, consider that recommended practices include treating the hazard map as a living document, updated by the use of grease pencils or map pins with appropriate notes or captions or other rapid and temporary updating methods. Transient hazards (including construction cranes or other temporary obstructions, private heliport equipment outages, repairs, or maintenance operations, as well as hazards created by seasonal sun angles, and localized high winds or reduced visibilities due to seasonal meteorological effects, or as recorded in Notices to Airmen (NOTAM)) should appear on the map with their applicable times.

I.    Landing Site Depiction. Inspectors should evaluate the operator’s means for providing LZ information. Criteria should be established, documented, and included in training programs to periodically assess each heliport/LZ on a continuing basis. The operator should document criteria for LZ selection. These criteria should include size, obstructions, wires, lighting, surfaces, and methods to determine wind direction, etc. A reporting system for unsatisfactory or dangerous locations, approach and departure paths, and a continuing LZ evaluation program should be part of HAA operations. Operators should distill findings into a simple record of recommendations and precautions regarding each landing facility regularly used and make this available to flightcrew members.

J.    Protection and Control of Infectious Conditions. Inspectors should evaluate the operator’s procedures for protection against blood-borne pathogens, biohazard and infection control, and propagation prevention and control of infectious diseases. Operators should have documented procedures and training, including disposal and decontamination of equipment and aircraft cleaning (which could be provided by an associated medical service or hospital or by contract to a service company). Inspectors should ensure that training in precautions for the operator’s flight operations and maintenance employees is emphasized in documentation and in training programs.

4-943    PREFLIGHT PLANNING AND ACTIVITIES. When evaluating an operator’s preflight planning procedures and activities for an air ambulance service, inspectors should consider:

A.    General Operations Manual (GOM). In accordance with 135.615 and 135.617, all HAA operators must document procedures for VFR Flight Planning and Risk Analysis. If the operator maintains a GOM, these mandatory procedures should be included and distributed in their GOM system. Regardless, the mandatory procedure documents and forms must be available at each location where aircraft are based and flights are initiated, and appropriate sections should be available in each aircraft. It is recommended but not required that smaller certificate holders conducting air ambulance operations (including single-pilot and basic operators) develop a GOM that covers the subject matter contained in 135.23. Voluntarily developed GOMs should be available at each location where aircraft are based and flights are initiated, and appropriate sections should be available in each aircraft.

B.    Accident Incident Plan/Post-Accident Incident Plan (AIP/PAIP). Per 135.23(d), air ambulance operators must establish accident and incident notification procedures. This is a requirement shared with other part 135 operations.

C.    Refueling and Servicing Procedures. Refueling with the engine(s) running, rotors turning, and/or passengers on board can be hazardous and must be accomplished in accordance with appropriate documented procedures and by trained personnel. (Refer to AC 135-14 and the current edition of AC 91-32, Safety In and Around Helicopters, for suggested methods and precautions.)

D.    Fuel Quality. The inspector must evaluate the operator’s fuel quality verification procedures. The operator may choose to procure fuel from commercial fixed base operator sources and/or maintain their own private fuel storage and delivery system. Due to the nature of HAA operations, many bases are at locations other than airports. Where these bases have a private fuel source maintained by the operator, it is recommended that the operator develop a documentation system for determining and maintaining fuel quality within their own system throughout the chain of custody from receipt (from the distributor) to delivery (into the helicopter). If the operator chooses to procure fuel from commercial fixed base operator sources, they should have a formal audit program to verify the fixed base operator maintains fuel quality throughout the chain of custody from receipt (from the distributor) to delivery (into the helicopter). The inspector should evaluate the operator’s compliance with standards reflected in International Civil Aviation Organization (ICAO) Doc 9977 AN/489, Manual on Civil Aviation Jet Fuel Supply, and the current edition of AC 150/5230-4, Aircraft Fuel Storage, Handling, Training, and Dispensing on Airports.

E.    Procedures for Medical Equipment Installation and Removal. Removal and replacement of medical equipment items may have to be performed on a frequent basis. If the operation is simple, does not require tools, and can be done in accordance with approved data and procedures contained in the operator’s manual, any person trained by the certificate holder may be authorized to remove or replace such equipment. If the operator chooses this option, an inspector must check that they include this training in their FAA-approved training and checking program. The inspector must ensure that the operator documents who is authorized to remove and replace equipment on its aircraft. If personnel other than certified mechanics will be removing or replacing equipment, they must do so in accordance with documented instructions and training provided by the operator and evaluated by an inspector.

F.    Flight Authorization, Flight Locating Procedures, and Operations Control Personnel Duties and Responsibilities. An inspector must check that these are well considered and are documented in the operations manual. Per 135.619(c), for those operators with an OCC, a description of the duties and responsibilities of OCSs should appear in documentation. Inspectors should check that operators that are not establishing an OCC are documenting procedures for comparable functions.

G.    LFA Documentation. Inspectors must evaluate an operator’s procedures for developing LFAs (where applicable) and ensure these are documented in accordance with 135.609(b). If any LFAs are proposed and accepted, a list of LFAs and a description of the examination that is given to pilots by the certificate holder enabling the use of alternative minima in these LFAs must be provided to the principal operations inspector (POI) for acceptance. (Refer to 135.609 and OpSpec A021, Air Ambulance Operations—Helicopter.)

H.    Instrument Flight Rules (IFR) Operations Procedure. An inspector should evaluate whether the operator has effectively documented and trained pilots in procedures for IFR operations at locations without weather reporting. An inspector should verify that an operator documents approved procedures for IFR operations using special instrument procedures, point in space (PinS) approach procedures and departure procedures (DP) (Standard Instrument Departure (SID) and Obstacle Departure Procedures (ODP)). An inspector should verify that an operator has documented procedures for transitioning from IFR to VFR on approach or from VFR to IFR on departure.

I.    HAA VFR Flight Planning Procedures. An inspector must evaluate an operator’s flight planning procedures that must, by regulation, be documented in the operator’s operations manual system in accordance with 135.615(d). Inspectors must ensure that HAA operators document their procedures to:

    Determine the minimum safe cruise altitude by evaluating the terrain and obstacles along the planned route of flight per 135.615(a)(1);

    Identify and document the highest obstacle along the planned route of flight per 135.615(a)(2);

    Determine the minimum required ceiling and visibility to conduct the planned flight using the weather minimums appropriate to the class of airspace for the planned flight per 14 CFR part 91,  91.155 or  135.609(a); and

    Identify the minimum safe en route cruise altitudes per 135.615(b) or as listed in their OpSpecs.

NOTE:  When a new request is received when airborne, if this possibility was considered and documented in the original VFR flight planning as an operational consideration, the flight may proceed without conducting a full VFR preflight plan. When the aircraft completes the HAA flight operation, in accordance with 135.615(c), the PIC must perform a new preflight planning process for the next flight or series of flights.

NOTE:  VFR Flight Planning procedures must be accepted by the POI.

J.    FAA-Approved Preflight Risk Analysis Procedures. An inspector must verify that an HAA operator’s risk analysis procedures comply with 135.617. An inspector must evaluate and approve the certificate holder’s risk analysis procedures, which must be documented in their operations manual. The preflight risk analysis procedure must include both the elements identified in subparagraph 4-943I above as required by  135.615(d) and the following additional elements:

    LZ conditions;

    Fuel requirements;

    Human factors, such as crew fatigue, life events, and other stressors;

    Departure, en route, destination, and forecast weather, including establishing primary and redundant resources and methods for obtaining current and forecast weather information for the area of operation at the time of the planned flight; and

    A procedure for determining whether another HAA operator has refused or rejected a flight request.

1)    Strategies and procedures for mitigating identified risks, including procedures for obtaining and documenting approval of the certificate holder’s management personnel to authorize a flight when a risk exceeds a level predetermined by the certificate holder.
2)    Prior to the first leg of each HAA flight operation, the pilot in command (PIC) must conduct a preflight risk analysis and complete a preflight risk analysis worksheet in accordance with 135.615 and 135.617 and the certificate holder’s FAA-approved operations manual.
a)    The PIC must sign (manually, digitally, or via any equivalent FAA-approved technique) the preflight risk analysis worksheet and specify the date and time it was completed. The pilot may sign this form manually, digitally, or may authenticate the form via an FAA-approved technique tying the PIC to this completed risk analysis.
b)    In the event a new request is received when airborne, and if this reassignment possibility was considered and documented in the original preflight risk analysis, a new preflight risk analysis is not required. In accordance with 135.617(c), when the aircraft completes this HAA flight operation, the PIC must perform a new preflight planning process and risk analysis for the next HAA flight operation.
3)    When a new request is received when airborne (e.g., a new diversion to a nearby hospital for a patient transport while on repositioning flight), if this possibility was considered and documented in the original risk analysis as an operational consideration, and weather, fuel requirements, crewmember stress, etc., is not adversely affected or has not materially changed, the flight may proceed on the diversion without conducting a full risk analysis. The inspector should evaluate the operator’s procedures regarding how the pilot would confer with the OCS or with the individual who maintains operational control over the current flight to address any risks which may have changed, and proceed with or refuse the diversion flight accordingly. When the aircraft completes the amended HAA flight operation, the PIC must perform a risk analysis for the next flight or series of flights.
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4)    If the operator has an OCC, the inspector must evaluate the procedures defining how the OCS will acknowledge the risk analysis in accordance with 135.619(a)(iv). This acknowledgement, in its simplest form, may be a separate record, must be directly linked to the risk analysis worksheet, and it may be digitally or manually generated.
5)    The air ambulance operator must retain the original or a copy of each completed preflight risk analysis worksheet at the location specified in the operations manual for at least 90 days from the date of the operation. An inspector must evaluate the retention method to determine whether this regulatory requirement has been met.

4-944    FLIGHT PROCEDURES. When evaluating an operator’s in-flight procedures for an air ambulance service, inspectors must consider the following.

A.    Passenger Briefing Procedures. A person designated and trained by the operator and approved by the FAA Administrator may conduct the passenger briefing required by 135.117(a) and (b). If passenger safety briefing duties are delegated to medical personnel, the procedure must be covered in the operator’s operations and training manuals. As in all part 135 passenger-carrying operations, passenger-briefing cards are required for air ambulance operations.

B.    Medical Personnel Serving As Crewmembers. Medical personnel are considered passengers. However, in some cases, particularly in the case of an emergency, the medical personnel may be requested to perform some duty in an aircraft that relates to the operation of that aircraft, such as assisting the flightcrew in seeing and avoiding other aircraft, evaluating an LZ, coordinating with ground personnel at an LZ, and emergency shutdown of aircraft systems in an accident. For safe performance of such tasks, the operator must provide medical personnel with appropriate and documented training and checking including Crew Resource Management (CRM) as applicable, which the POI should evaluate. All legs of a HAA flight operation, including the “tail-end ferry” flight for return to base, must be conducted under part 135.

C.    Medical Personnel Safety Briefing Procedures. Prior to each HAA operation, each PIC, or other flightcrew member designated by the certificate holder, must ensure that all flight medical personnel have been briefed on the following:

    Passenger briefing requirements;

    Physiological aspects of flight;

    Patient loading and unloading;

    Safety in and around the helicopter;

    In-flight emergency procedures;

    Emergency landing procedures;

    Emergency evacuation procedures;

    Efficient and safe communications with the pilot; and

    Operational differences between day and night operations, if appropriate.

NOTE:  With the exception of the briefing required by 135.117(a) and (b), this preflight medical personnel briefing may be omitted if all medical personnel on board have satisfactorily completed the certificate holder’s FAA-approved medical personnel safety training program within the preceding 24 calendar-months in accordance with 135.621.

D.    Passenger Restraint Procedures. Inspectors should evaluate the operator’s method for normal and specialized passenger restraint before takeoff. Passengers and patients who may pose a hazard to the aircraft or to its occupants (such as hysterical or combative patients) may require special restraint methods. Operators should be encouraged to establish adequate written procedures for the proper restraint of all flight personnel and the proper use of seat belts and should harnesses during air ambulance operations. In addition, it is the responsibility of the PIC to ensure that passengers who may pose a hazard to the aircraft or to its occupants are properly restrained before takeoff.

E.    Air-to-Ground Communications. Inspectors should evaluate the operator’s method of air‑to‑ground communication systems that ensure the flightcrew can coordinate with emergency personnel, first responders and communication specialists or OCSs/operations control personnel.

F.    Scene Response Operations. Inspectors and operators normally associate the term “scene response” with helicopter operations; however, scene response operations are not limited to helicopters. Scene response flights may be served by airplanes as well as helicopters; these may be conducted during airplane operations in remote locations. Inspectors should consider the following operational procedures regarding scene response operations:

1)    Inspectors should evaluate the operator’s procedures for determining the suitability of the landing area. Suitability considerations should include the following:


    Surface condition (e.g., loose snow, soil and dust, spongy, muddy, or soft soil);

    Crowd control;


    Wind direction and velocity;

    Restrictions to visibility; and

    Illumination of obstacles by ground personnel at night.

2)    Final responsibility for the determination of the suitability of the LZ remains with the PIC.
3)    The operations manual should contain specific policy guidance for coordination procedures between flightcrew and medical personnel.

4-945    EMERGENCY PROCEDURES. When evaluating an operator’s emergency procedures for an air ambulance service, inspectors must consider the following:

A.    Inadvertent Instrument Meteorological Conditions (IIMC). Inspectors will evaluate emergency operations procedures for recovery from IIMC. These procedures must be presented in the operator’s GOM and initial and recurrent training manual(s). The GOM must also include procedures for aircraft handling in flat-light, whiteout, and brownout conditions, including methods for recognizing and avoiding those conditions. All pilots must be checked in compliance with 135.293(a)(9).

B.    In-Flight Medical Emergencies. Inspectors should evaluate procedures for flightcrew coordination with medical personnel resulting from in-flight medical emergencies. Such procedures must exclude the PIC from the nature of the medical emergency yet ensure the pilot is aware of and can act upon any desired diversion to a different hospital other than the original intended destination, providing risks associated with diverting from the original planned flight are not worse than the planned flight. The PIC should use the Medevac prefix or discrete company call sign when communicating with air traffic control (ATC).

C.    Emergency Evacuation Procedures. Inspectors should evaluate emergency evacuation procedures for each make and model of aircraft and aircraft configuration. This should include any additional duties assigned to the medical personnel.

4-946    IFR OPERATIONS. Inspectors should verify that all pilots meet the requirements of 135.603 by April 24, 2017. After that date, no certificate holder may use—nor may any person serve as PIC of—an HAA operation, unless that person meets the requirements of 135.243 and holds a helicopter instrument rating or an Airline Transport Pilot Certificate (ATPC) with a category and class rating for the aircraft that is not limited to VFR.

A.    Transitions Between a PinS Instrument Approach Procedure (IAP) Missed Approach Point (MAP) and the Landing Area. Such transitions may be depicted as “proceed visually” or “proceed VFR,” depending upon the results of obstruction analysis and approach design criteria. The inspector should evaluate the operator’s understanding of the terms used and the manner in which flightcrews are trained to execute the transitions accordingly.

B.    Transitions from other Published Approaches from an Airport Runway Environment to a Discrete Landing Area not on the Airport. Inspectors should ensure that operators’ manuals either prohibit or properly address executing an instrument approach to an airport and thence proceeding VFR to an LZ someplace other than on the airport to which the approach was conducted. Procedures should incorporate determining the weather at the location to which the approach is executed and along the entire route to the LZ. Weather must meet or exceed VFR weather minimums for the class of airspace to which the VFR transition will be conducted, as expressed in 135.613, at the intended landing area and along the intended route of flight.

C.    Transitions Between a Landing Site and Controlled Airspace. When a DP containing obstacle avoidance procedures (ODP or SID) is published for a site and takeoff minimums are depicted on the DP, the pilot may depart in accordance with the published minimum visibility. This is not considered a VFR departure. If takeoff minimums are not published, the departure is considered VFR and must conform to 135.613(b).

4-947    LFA FOR HAA OPERATIONS. The LFA is considered that area within which the pilot has detailed local knowledge.

A.    LFA. The LFA may be a symmetrical area, such as an area encompassed by a designated size radius, or an irregular area defined by landmarks and geographical features; however, visually distinct geographical features defining the irregular area must be individually identified.

1)    An acceptable LFA is an area that the pilot can identify the borders of in flight, and for which the pilot’s operational knowledge can be evaluated through an oral or written test.
2)    If an identified LFA is outside of the geographical boundaries of the CHDO, the CHDO may coordinate review of the proposed LFA with the FSDO having jurisdiction over the area.
3)    An LFA may overlap more than one FSDO’s area, in which case, coordination may be desired with all affected FSDOs.
4)    Exceptions can be approved when the LFA has limited complexity, however, in no case should an LFA exceed 50 nautical miles (NM) in any direction from the operator-designated center location.

B.    Any Number of References May Define the LFA:

    A specified radius from a point (if easily identified using installed, operational avionics);

    Bounding natural and cultural references (rivers, shorelines, roads, highways);

    Governmental boundaries, if easily identified in flight;

    By describing a polygon between natural, cultural, or aeronautical reference points (shoreline points, islands, valleys, buildings, airports, VHF omnidirectional range stations (VOR), global positioning system (GPS) waypoints);

    Any other reasonable description of an area that may be easily applied by a flightcrew, such as a predetermined route or system of routes; and

    Limitations to any of the above (e.g., 25-NM radius of the John Doe Hospital, except that portion west of Muddy River).

C.    Contiguous. A base of operations may have more than one LFA, and multiple LFAs are not required to be contiguous, that is, there is no requirement that the LFA for a particular base of operations be only one defined area. For example, if the operator conducts HAA operations in a particular metropolitan area, but often transports patients to a regional trauma center outside that area, the operator may choose to develop an additional LFA for the assigned pilots to use when operating near the trauma center. While operating in between the LFAs, the cross-country minimums would apply. (See Figure 4-56, Local and Cross-Country Flying Minimums.)

Figure 4-56.  Local and Cross-Country Flying Minimums

Figure 4-56. Local and Cross-Country Flying Minimums

D.    Flying Area Minimums. In order to use the LFA minimums provided in OpSpec A021, an HAA pilot must have completed an examination on the features of the LFA within the previous 12 calendar-months. This examination should include, but is not limited to the following:

    Terrain features;

    Prominent obstructions, including areas of obstructions;

    Minimum safe altitudes in the area;

    Weather producers (such as industrial areas, fog prone areas, etc.);

    Areas of poor surface lighting, and the effects of seasonal and other changes on surface lighting, as applicable to the LFA in question;

    Airspace/air traffic facilities;

    Radar and communications coverage, including minimum altitudes for radar service and communications with air traffic facilities and company dispatch/communications facilities;

    Airports/heliports/fuel sources, including night availability;

    Available instrument approaches;

    Predominant air traffic flows;

    Landmarks and cultural features;

    Noise sensitive areas;

    Facility-specific information, such as flight locating, dispatch, and communications; and

    Any emergency considerations appropriate to the area.

1)    This examination may be an oral or written examination, or combination, and may be conducted as a part of the line check conducted under 135.299. The manner in which the examination is conducted must be described in the operator’s approved training program.
2)    If a pilot has not satisfactorily passed an examination on the applicable LFA, he/she must use the cross-country area weather minimums.
3)    Additionally, OpSpec A021 provides different minimums for mountainous and non-mountainous areas. To ensure commonality with IFR requirements, mountainous areas are identified as those designated as mountainous areas in 14 CFR part 95.

4-948    SERVICING OF AIRCRAFT WITH PATIENTS ON BOARD. Before conducting rapid refueling with the engine(s) running or replenishment of oxygen with passengers on board, the certificate holder must develop procedures acceptable to the POI. These procedures must be published in the certificate holder’s GOM (see Volume 3, Chapter 32, Section 4). These policies and procedures should include any special considerations for the evacuation of patients in case of emergencies. The certificate holder must train and qualify all applicable personnel in these procedures before conducting such operations. (Refer to AC 135-14 and AC 91-32 for suggested methods and precautions.)

RESERVED. Paragraphs 4-949 through 4-960.