Human external loads (HEL) refer to operations where humans are transported while suspended below a helicopter. HEL operations are often required to access remote work sites, to access power lines in need of maintenance and repair, for transport of offshore ship captains, and for rescue operations. This paper reports a human factors investigation of HEL operations and the devices used to secure HELs involved in work (non-rescue) activities. The goal of this investigation was to determine if HEL operations pose a significant safety hazard. Specifically, the paper describes the various devices used to secure HELs, the accident history associated with HELs, and human factors recommendations for the regulation of HEL devices and operations. Review of 616 helicopter accident reports revealed that only 1.5% of the accidents occurred during HEL operations and only 0.5% were directly attributable to the presence of an HEL.