Late last year, the FAA notified helicopter emergency medical services (HEMS) operators that it was making changes to OpSpecs A021, which regulates the industry. And also to OpSpecs A050 covering the use of night vision goggles. Further guidance from the FAA ramping up safety measures emerged recently in advance of last week's four-day hearings by the National Transportation Safety Board meant to stem what it considers an alarming tide of HEMS accidents. In the past six years, there have been 85 accidents involving HEMS operators resulting in 77 fatalities. While a recent FAA survey revealed that 94 percent of HEMS operators had adopted training programs to enhance decision-making skills and risk assessment, only 41 percent had installed terrain warning systems. The NTSB believes the FAA's encouragement of HEMS operators to use night vision goggles and terrain warning equipment does not go far enough.