The Honorable NAME United States House of Representatives/Senate Washington, DC 20515 (H)/20510(S)

Re: FAA Reauthorization/Extension – need for legislative language to protect state authority to oversee air ambulance service patient quality, access and availability.

Dear Congressman/Senator NAME:

I am writing to ask you to support legislative language to make clear the authority of states to regulate within their boundaries the coordination and quality of medical care provided by air ambulances services. This language has been proposed by Senator Dole as an amendment to legislation that would reauthorize the Federal Aviation Administration. It is important that this language be included in this reauthorization bill or in any short-term FAA extension bill that Congress may consider this fall.

This amendment is urgently needed to enable states to fulfill their public health function in ensuring the safe and coordinated transport of critically ill or injured patients whether by ground or air.

The States and territories have crafted emergency medical services systems that are designed to meet the specific needs of their residents, including facilitating the safe and immediate transport of critically ill or injured patients to trauma centers. Some states regulate certain aspects of air medical transport in addition to ground medical transport of patients. The variety of approaches employed by states reflect the unique geography and availability of trauma care within each state.

Unfortunately, the ability of states to oversee air ambulance services has come under attack by both the Department of Transportation and by private entities. The challenges are based on air safety preemption language contained in the 1978 Airline Deregulation Act (ADA) which was intended to enhance competition in the commercial aviation realm. The ADA was enacted while air medical transport was in its infancy and mature state EMS systems didn't exist. The authors of ADA envisioned that the federal preemption language would be used to thirty years later to thwart state regulations ensuring the coordination and quality of care for critically ill or injured patients needing air medical transport for whom minutes may mean the difference between life and death. Without this amendment, the FAA’s overly broad interpretation of the preemption language will invalidate states' approaches to ensuring coordinated and safe air medical services and put even more people's lives at risk.

As States’ legal authority to oversee air ambulance services has been called into question and the FAA has limited its own involvement, over the past decade there has been a proliferation of air ambulance services with negative consequences. There has been an increase in deadly air ambulance accidents, inconsistent access to timely and quality air ambulance services, excessive use of air ambulance services in non-life threatening situations, and price increases. Industry experts consulted by the GAO have identified a number of dangerous practices related to increased numbers of air ambulance operations, including helicopter shopping and call jumping. The IOM has recommended that States assume regulatory oversight of the medical aspects of air medical services, including communications, dispatch and transportation protocols.

Under the Dole amendment, states would not be prohibited from regulating access to or availability of air ambulance services or the standards of quality of patient care. The language is clear that such limited state regulation would be permissible only within the borders of that State and that the FAA retains exclusive jurisdiction over matters of aviation safety (such as aircraft equipment, operation and pilot qualification). The amendment is consistent with the states' historic role in regulating the provision health care practices within its borders including the licensure of health care practitioners, hospitals, and ground ambulances. Air ambulance services are different from ground ambulance services only in that patients are transported by air. While FAA should regulate aviation safety, the coordination of and quality of care during transportation of critically ill or injured patients whether by ground or air has and should remain the purview of states or their political subdivision designees.

Without the language that Senator Dole is proposing to clarify that states may take reasonable measures to guarantee seamless delivery of air medical services, we may see the collapse of a number of carefully constructed EMS systems that could endanger the lives of patients who are most in need of urgent care and protection and the continued proliferation of unneeded air ambulance services that increase health care costs and the possibility of crashes.

I urge you to support inclusion of this amendment in any legislation advanced this fall to either comprehensively reauthorize the FAA or to provide a shorter term extension of FAA authority.

Sincerely, # 5570677_v2