The coroner in the inquest into the death of Harry Dunn has recommended better driver training for Americans at the RAF base near where the 19-year-old was killed.
Mr Dunn was hit by Anne Sacoolas in August 2019, after she drove her Volvo on the wrong side of the B4031 in Northamptonshire while he was riding a motorbike.
He died at hospital the same day.
The coroner concluded Mr Dunn died as a result of a road traffic collision and issued three prevention of death future notices.
Two prevention death notices were over the drugs paramedics carried and overworked ambulance services.
The third notice was issued to the Foreign Office and the MOD around driver training at RAF Croughton.
Northamptonshire coroner Anne Pember criticised the US government for a lack of training provided to employee Anne Sacoolas prior to the crash.
Evidence and two witness statements from Sacoolas were read out during the inquest after the US government employee rejected the coroner's invitation to attend in person.
In one of the statements Sacoolas apologised for the "tragic mistake" she made on the day of the crash and said it was something that would live with her "every single day for the rest of my life".
She said that when she turned out of RAF Croughton, taking a left turn, she instinctively moved to the right side of the road as she was "accustomed to driving in the US".
She also told Northamptonshire Police in a voluntary interview two months after the crash that she was a "safe driver" but "drove like an American and drove on the American side of the road".
The 45-year-old said she had not received any training on driving on UK roads after arriving in the country and after the crash "hysterically flagged down a motorist" and "begged her to get help".
"There is not a single day that goes by that Harry is not on my mind, and I am deeply sorry for the pain that I have caused," the statement said.
Reacting to the statements, Radd Seiger, a spokesman for the Dunn family, said: "We have heard most of that before.
"Why on earth is Sacoolas not in court to answer the court's and the family's questions?"
Sacoolas left Britain 19 days after the crash after the US State Department asserted diplomatic immunity on her behalf.
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Tap hereShe appeared before a High Court judge at the Old Bailey via video link in December 2022, where she pleaded guilty to causing death by careless driving.
Sacoolas was advised against attending her sentencing hearing by the State Department, which prompted the Dunn family to say they were "horrified" the American government was "actively interfering in our criminal justice system".
She was given an eight-month prison sentence, suspended for a year.
The inquest also heard from Mr Dunn's twin brother Niall who referred to him as "an amazing person" who helped him when he found life hard-going.
In a video played to the inquest, he said: "I couldn't have asked for a better brother, but beyond that, just a better person to just be forced to know".
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