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Chapter 36 - Aviation Management and Safety

Part 5 - Management Services

Title Section
Introduction 5-36.1
    Purpose 5-36.1A
    Background 5-36.1B
    Policy 5-36.1C
    Authority 5-36.1D
Operational Requirements 5-36.2
    Contracting Aviation Requirements 5-36.2A
    Attending Physician 5-36.2B
    Contracting Officer 5-36.2C
    Vendor 5-36.2D
    Aeromedical Transport Service Companies 5-36.2E
    Safety 5-36.2F
    Refusal to Fly 5-36.2F


  1. Purpose.  This chapter updates and revises the Indian Health Service (IHS) policy for acquiring contract aeromedical aviation services.
  2. Background.  The IHS periodically contracts for aeromedical and other special mission aviation services in support of Area Office and Service Unit operations.  Contracted services may include both fixed wing and rotary wing aircraft.  The contracted services are typically used for the purposes of emergency medical services, patient transport, site surveys, and inspections, or other logistical and operational support services.  Passenger transport and allied services provided by other Federal, state, tribal, or local government agencies, or, commercial airlines and carriers providing routine employee or passenger transport, are not within the scope and intent of this chapter.
  3. Policy.  It is IHS policy that all:
    1. Contract aircraft, pilots, flight or ground crews, and allied services shall meet all applicable regulations of and be certificated by the Federal Aviation Administration (FAA) for the anticipated mission-sets, aircraft types, operating conditions, and geographic locations of intended employment.
    2. Aeromedical transport and emergency medical services personnel shall hold current accreditation from a nationally recognized and independent accrediting body.
    3. Related operations and services, shall be fully staffed commensurate with operational needs, and operating under the direction of a licensed medical physician immediately available by telecommunications.  The physician ensures that flights are staffed in accordance with Federal, state, and local standards for aeromedical personnel.
    4. Aeromedical transport service companies' medical personnel must be appropriately licensed and/or certified.
    5. Aeromedical transport service companies that provide emergency medical air transportation services must:
      1. Provide the appropriate number of medical personnel;
      2. Provide the level of care as ordered by the IHS;
      3. Provide the level of care that is medically necessary should it exceed that level ordered by the IHS and needed based on patient changing condition; and
      4. Provide the level of care that is consistent with State- and accreditation-required and defined levels of care.
    6. Aeromedical transport service companies must be licensed by the appropriate State medical and business authorities to conduct business, practice, and provide services in the anticipated area of operations.
  4. Authorities.  Aviation management and safety policies and procedures, and contracts for aeromedical and special mission aviation services, shall be implemented and administered in accordance with, but not limited to, the following laws:
    1. Federal Acquisition Regulation (FAR)
    2. Applicable FAA regulations, including but not limited to 14 Code of Federal Regulations Parts 61, 91,119, 125, and135.
  5. Other.  The appropriate ordering official shall ensure that air carriers maintain commercially-acquired insurance coverage no less than the minimum required by the state(s) where the air carrier is conducting business and operations while supporting the IHS.


  1. Contracting Aviation Services.  Area Directors may contract for aviation services when:
    1. Commercial airline or aircraft services are not reasonably available or suitable.
    2. Emergency or contingency situations exist and present imminent danger to patients, personnel, or public health.
    3. Aviation services can be contracted for only when these situations cannot be dealt with locally.
    4. Other operational considerations make the use of government or standard commercial transportation impractical.
  2. Attending Physician.  The IHS attending physician will specify the medical needs and requirements for all patient care during aeromedical transport.
  3. Contracting Officer.  The IHS Contracting Officer (CO) should consult with the attending physician regarding operational needs and requirements as the medical condition may impact operational parameters (i.e., altitude, cabin pressurization, time, speed).
  4. Vendor.  In accordance with applicable FAA regulations, medical standards of care, and industry best practices, the appropriate IHS ordering official may permit the vendor providing the aviation services to select the most appropriate and capable aircraft, pilots, crews, technicians, and other support services personnel and equipment appropriate to safely satisfy IHS requirements.
  5. Aeromedical Transport Service Companies.  Aeromedical transport service companies must provide the appropriate level of medical personnel to meet the care needs of patients transported.
  6. Safety.  The IHS procurement documents for aviation services shall include the following safety provisions:
    1. All occupants of aircraft shall follow applicable FAA and vendor safety guidelines.
    2. Only non-essential IHS personnel, other family members, or other community members, visitors, guests, or passengers may be permitted to fly via aviation transport services procured by the IHS for aeromedical or special mission flights (as can be accommodated by the airframe type).
    3. with prioritizing of translation services.  Interpreters may be exempted from this provision when deemed medically necessary by the IHS.
    4. A parent, legal guardian, or medical proxy for a patient who is not able to make medical decisions may accompany the patient on air medical transports if approved by the IHS attending physician and mission pilot responsible for the aircraft.
    5. Items prohibited from air transport by FAA regulations shall not be carried on IHS contracted aircraft.
    6. Hazardous materials and cargo, to include biomedical samples, tissue, or waste, shall be fully manifested, and disclosed to/by the IHS personnel, aviation services vendor, and/or mission pilot in charge responsible for the material or cargo.
    7. All aircraft occupants shall be fully documented on flight manifests.
  7. Refusal to Fly.  All IHS personnel or patients concerned about their personal safety, air crew or medical personnel qualifications, environmental conditions, condition or safety of the vendor provided aircraft may refuse aeromedical transport following the informed consent process or may refuse to fly on vendor provided aircraft.
    1. Patients should refer their concerns to the IHS attending physician overseeing their care.  The attending physician will forward concerns to the IHS CO and advise the patient of the availability of alternatives, which may or may not be readily available.
    2. The IHS personnel should document and report their concerns to their immediate supervisor and the IHS Project Officer in charge of the special mission or medical transport.
    3. The Supervisor or Project Officer will forward concerns to the IHS CO and advise the concerned IHS personnel on the availability of replacement air services, which may or may not be readily available.
    4. Refusal to fly on a given aircraft does not obviate the need for medical transport of the patient.  All reasonable efforts will be made to obtain appropriate alternative transportation commensurate with the patient's needs and consent.