The National Transportation Safety Board (NTSB) recently added safety enhancements for air ambulance flights on its annual "Most Wanted" list of suggested improvements. The NTSB stated that the air ambulance industry and the FAA have moved too slowly to halt the record number of air ambulance accidents. This year has been the deadliest year in air ambulance history with the deaths of 35 people.

The NTSB has recommended the following actions to help improve the safety of air ambulance flight operations (1) implementation of a flight risk evaluation program for air ambulance operators, (2) establishment of formalized dispatch and flight-following procedures including up-to-date weather regulations, (3) installation of terrain awareness and warning systems on aircraft, and (4) conduct all flights with medical personnel on board in accordance with the stricter rules which are generally applicable to commuter aircraft.

Investigations of air ambulance flight accidents often pointed to a lack of ground support personnel and operational control procedures as contributing factors. Consequently, in May 2008, the FAA published an Advisory Circular (AC) 120-96 which provided detailed recommendations to assist helicopter air ambulance operators to develop and implement Operations Control Centers with enhanced operational control procedures designed to provide flight crews with information the FAA considers to be critical to the flight safety decision process from qualified support personnel on the ground.