Accidents like a fatal collision Sunday involving two air ambulances in Flagstaff, Ariz., invoke safety conversations among local medical and rescue flight crews.

Santa Barbara County and California Shock Trauma Air Rescue (CalSTAR) representatives said they abide by strict rules governing flights and have high standards for crews.

Still, “any accident is at least an informal training situation,” said Santa Barbara County Fire Department Capt. Curt Warner, helicopter crew chief.

“I don't care if it's an accident in New York, we'll talk about it.”

A federal safety official at the scene of the Flagstaff crash that killed six people said Monday that accidents of medical aircraft are at a disturbing level.

“We're very concerned about that,” said National Transportation Safety Board (NTSB) chairman Mark Rosenker.

There have been nine serious accidents with emergency medical aircraft this year, six of them involving helicopters, NTSB spokesman Ted Lopatkiewicz said.

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Warner said that the county's aviation unit has three helicopters and an airplane that primarily handles administrative functions.

The county doesn't routinely perform medical transports, he said, but conducts rescue operations.

“All of our pilots are very experienced,” Warner said. The pilots are used to working in adverse situations, and flying in the mountains, he added.

Night vision goggles are used, Warner said, enabling good vision at night.

The Central Coast has another safety asset.

“Everywhere doesn't have the nice, fair weather that Central California does,” Warner said.

Anytime an accident occurs within your field, you look at how the accident happened and question whether it could happen to you, said Suz Roehl, a flight nurse with CalSTAR helicopter ambulance, which serves areas including Santa Barbara and San Luis Obispo counties.

“We have conditions that we won't fly in,” she said. Other bases will take flights that CalSTAR flight crews choose not to, Roehl said.

“I think our company really, really puts so much energy into safety,” she said later.

Suzanne Bradford, director of base operations for CalSTAR, said she wouldn't say that medical aircraft flights are more dangerous than other flights.

Helicopters fly lower, she said, and there's always the risk of traffic.

The Federation Aviation Administration (FAA) stresses putting the safety of the flight first on medical aircraft, where crews can be tempted to fly to help a patient despite adverse conditions, said FAA spokesman Ian Gregor.

“Safety of flight has to be plugged into the equation,” he said.

Gregor said he didn't know why fatal crashes of medical aircraft had increased recently.

“I think that's what we're looking at,” he said.

CalSTAR has visual terrain equipment that shows on a screen inside the helicopter what the surrounding terrain looks like and gauges that can find air traffic, Bradford said.

“The avionics is just excellent for that,” she said, referring to aviation electronics.

The company also has a night vision goggle program, Bradford said.

Crews practice good communication, she said.

“If we're not taking care of a patient ... all eyes are looking out,” Bradford said.

Anyone on a crew can choose to ground an aircraft for whatever reason, she said.

Usually if flights are grounded it's because of weather, and sometimes it's too dark, Bradford said.

“But we don't question that at all,” she added.

Samantha Yale can be reached at 739-2159 or syale@santamariatimes.com. The Associated Press contributed to this report.