Further, a review of helicopter training resources suggested that the accident pilot may not have been aware of the specific control inputs needed to successfully enter an autorotation at cruise speed. The NTSB concluded that because of a lack of specific guidance in Federal Aviation Administration training materials, many other helicopter pilots may also be unaware of the specific actions required within seconds of losing engine power and recommended that FAA revise its training materials to convey this information. 

An examination of cell phone records showed that the pilot had made and received multiple personal calls and text messages throughout the afternoon while the helicopter was being inspected and prepared for flight, during the flight to the first hospital, while he was on the helipad at the hospital making mission-critical decisions about continuing or delaying the flight due to the fuel situation, and during the accident flight. 

While there was no evidence that the pilot was using his cell phone when the flameout occurred, the NTSB said that the texting and calls, including those that occurred before and between flights, were a source of distraction that likely contributed to errors and poor decision-making. 

"This investigation highlighted what is a growing concern across transportation distraction and the myth of multi-tasking," said Hersman. "When operating heavy machinery, whether it's a personal vehicle or an emergency medical services helicopter, the focus must be on the task at hand: safe transportation." 

The NTSB cited four factors as contributing to the accident: distracted attention due to texting, fatigue, the operator's lack of policy requiring that a flight operations specialist be notified of abnormal fuel situations, and the lack of realistic training for entering an autorotation at cruise airspeed. The NTSB made a nine safety recommendations to the FAA and Air Methods Corporation and reiterated three previously issued recommendations to the FAA.