BACKGROUND: During the 1990s, Alaskan pilots had one of the most hazardous occupations in the US. In 2000, a multifaceted public health initiative was launched, focusing on Alaskan air taxi/commuter (AT) operations, including risk factor identification, improved weather information, and the formation of an industry-led safety organization. METHODS: Effectiveness was assessed by comparing rates of crashes using Poisson regression, comparing trends in annual numbers of crashes, and assessing changes in the number and type of controlled flight into terrain (CFIT) events. RESULTS: The greatest improvements were seen in Alaska fatal AT crashes with a 57% decrease in rates between time periods. While the number of AT crashes in the rest of the US steadily declined during 1990-2009, Alaska only showed significant declines after 2000. CFIT crashes declined but remained more deadly than other crashes. CONCLUSIONS: This coordinated effort was successful in reducing crashes in the Alaskan AT industry.