Objectives: To examine the causes associated with high risk helicopter operations, in particular external load and aerial application flight. and determine the role of crew management in accident mitigation strategies. Methods: Data from the US National Transportation Safety Board online database were analyzed. Flight phases and types of rotor strike were added categories extracted from the narrative statements included in the accident reports. Results and recommendations: Aerial application and external load accidents are characterized by high numbers of rollovers, rotor strikes and errors during preflight checks. Additional flight or ground crew may assist the pilot in maintaining a visual lookout. The number of accidents can be further reduced with adequate fuel management in which both pilot and ground crew can contribute. Although the ground crew can be both victim and cause of an accident, their supporting role has much to contribute to safety in high risk helicopter operations.