title: Should Charity Air Medical Organizations Require Commercial Certification of Their Pilots?
abstract: OBJECTIVE
  Fixed wing medical transportation crashes operating under 14 CFR Part 91 show higher fatal outcomes than nonmedical Part 91 flights. Advanced certification may translate into increased safety, yet we know of no charity air medical transportation requiring such certification. Herein, in a retrospective study, we determined whether commercial certification is associated with a reduced fatality rate compared with the less stringent private pilot certificate and accident causes.
  
  
  METHODS
  The National Transportation Safety Board accident database was queried for fatal accidents in single-engine aircraft occurring between 2002 and 2012. Poisson and proportion tests were used in statistical analyses.
  
  
  RESULTS
  For the period spanning 2002-2012, commercial pilots showed a lower fatality rate. Under visual meteorologic conditions, aerodynamic stall was a frequent cause for fatal accidents affecting both airman cohorts equally. For operations in instrument meteorologic conditions, fatal accidents were most commonly attributed to instrument approach deficiency and spatial disorientation. At night, failure to maintain obstacle/terrain clearance was the most prevalent cause of fatal crashes.
  
  
  CONCLUSIONS
  Our data suggest that charity air medical transportation organizations should encourage their pilots to acquire commercial certification. Furthermore, our study indicates areas in which general aviation training/currency should be directed to reduce fatal accidents.
authors.affiliation: University of Texas, Houston, TX, USA. Electronic address: douglas.boyd@uth.tmc.edu.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Boyd
authors.affiliation: University of Houston, Houston, TX USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Peters
mesh_terms: D000060:Accidents, Aviation / Q000706:statistics & numerical data*; D017732:Air Ambulances; D002568:Certification; D002608:Charities; D006801:Humans; D000070356:Pilots / Q000193:education / Q000592:standards*; D012189:Retrospective Studies; D014481:United States