AirMed&Rescue December 2019 by AirMed & Rescue Magazine

P PR S C RO O G VI UD AV DE T IA R RA TI FO IN O R IN N G FO TH R E C ES U

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December 2019

ISSUE 102 DECEMBER 2019

IN THIS ISSUE: Conference reviews - ICAR, HeliResQ and ITIC 2019 Efforts made to halt helicopter shopping in the US Crew communications and headset solutions

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EDITOR’S COMMENTS Plenty of food for thought in the features this month – whether you’re considering upgrading the avionics in your helicopter and need to know about the options other operators are choosing, or are dealing with the issue of the pressure to accept a patient transfer mission when it could endanger the lives of your crewmembers. There is a suggestion that we should stop using the term ‘helicopter shopping’; perhaps this term doesn’t do justice to the importance of the issue. Lives are being put at risk, and it is imperative that the brave men and women who work onboard medical helicopters are not endangered when trying to save the lives of others. Only by working together and presenting a unified front can the industry educate the healthcare institutions and state regulators to put an end to the practice of calling multiple HEMS providers without disclosing why others may have turned down a mission. Flying into bad weather is also under consideration in our Industry Voice in this issue, where Mike Biasatti explores the impact of the Federal Aviation Administration’s rule change on IFR regulations. It’s conference season in the air rescue sector at the moment – we’ve got three conference reports in this issue, covering a range of topics from mountain rescue, to rescue swimming and around-the-world repatriation flights. Meanwhile, AMTC is happening as this issue goes to print, and the AirMed&Rescue team will be at Heli-Expo in January; I look forward to meeting our readers there!

Editor

Mandy Langfield

Safe flying!

CONTRIBUTORS

Charley Shimanski Charley Shimanski is President of the Air Rescue Commission for the International Commission for Alpine Rescue. He is a 30-year member of Colorado’s Alpine Rescue Team, the Mountain Rescue Program Co-ordinator for Flight For Life Colorado, and Past President and Education Director of the Mountain Rescue Association.

Joetey Attariwala Dr Attariwala trained as a medical doctor and has established himself as a highly regarded journalist who contributes to various aerospace, defence, training and simulation, and law enforcement publications around the world. He is a regular contributor to AirMed&Rescue.

Sami Ollila Following his conscription with the Finnish Navy as a mine clearance diver, Sami was accepted for the helicopter rescue swimmer training program at the Finnish Border Guard’s Air Patrol Squadron in 1996. Sami graduated with a Bachelor of Healthcare in 2018 and now holds a dual-role position as a Rescue Swimmer and Paramedic, in the five-man crew of H215-Super Puma helicopter. Sami currently volunteers as the Vice-President of Rescue Swimmer Association and as an instructor at Finnish Swimming Teaching and Life Saving Federation.

James Paul Wallis Previously editor of AirMed&Rescue from launch up till issue 87, James Paul Wallis continues to write on air medical matters. He also contributes to AMR sister publication the International Travel & Health Insurance Journal.

Mario Pierobon Mario Pierobon is a safety management consultant and content producer. He writes extensively about aviation safety and has in-depth knowledge of European aviation safety regulations on both fixed and rotary wing operations. His rotary wing expertise is concerned primarily with specialised operations and the operations requiring specific approval, such as HEMS, hoist operations and performance-based navigation.

Dr Kerry Hunter Dr Kerry Hunter is a senior Flight Doctor with Capital Air Ambulance and has been working with the company since September 2019 on a part-time basis. When she is not working for Capital, she works as a senior NHS Anaesthetist in Edinburgh.

Mike Biasatti A helicopter air ambulance (HAA) pilot in the US for over 15 years and a certificated helicopter pilot since 1989, Mike Biasatti continues to enjoy all things helicopter. In 2008, the deadliest year on record in the US HAA industry, he founded EMS Flight Crew, an online resource for air medical crews to share experiences and learn from one another with the goal of promoting safety in the air medical industry. He continues to write on the subject of aviation safety, particularly in the helicopter medical transport platform with emphasis on crew resource management and communication.

Front page image (c) Barry Smith

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Editor-in-Chief: Ian Cameron Editor: Mandy Langfield Sub-editors: Robyn Bainbridge, Lauren Haigh, Stefan Mohamed, Sarah Watson Advertising Sales: James Miller, Kathryn Zerboni, Marton Modis

IN THIS ISSUE...

Design: Rosi Yip, Tommy Baker, Will McClelland, Robbie Gray

FEATURES

Web: Tom Reed Marketing: Kate Knowles

Finance: Elspeth Reid, Alex Rogers, Kirstin Reid Contact Information: Editorial: tel: +44 (0)117 922 6600 (Ext. 3) email: editor@airmedandrescue.com Advertising: tel: +44 (0)117 922 6600 (Ext. 1) email: jamesm@airmedandrescue.com Online: www.airmedandrescue.com @airmedandrescue www.airmedandrescue.com/facebook www.airmedandrescue.com/linkedin www.vimeo.com/airmedandrescue Subscriptions: www.airmedandrescue.com/subscribe subscriptions@voyageur.co.uk Published on behalf of Voyageur Publishing & Events Ltd Voyageur Buildings, 19 Lower Park Row, Bristol, BS1 5BN, UK The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Publishing & Events Ltd can accept any responsibility for any error or misinterpretation. The views expressed do not necessarily reﬂect those of the publisher. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or firm mentioned, is hereby excluded.

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AIRMED & RESCUE ISSUE 102

ISSN 2059-0822 (Print) ISSN 2059-0830 (Online) Materials in this publication may not be reproduced in any form without permission.

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NEWS 6 8 10

ITIC Review Report from ITIC Global in Malta ICAR Annual Congress report HeliResQ Review Rescue swimmer training in Finland

Avionic evolution The upgrades breathing new life into older aircraft

It’s good to talk Rear crew communications in rescue helicopters

Under pressure to respond Helicopter shopping – engaging medical professionals

INDUSTRY VOICE 20

A change in the weather Latest IFR regulation changes in the US

SPECIAL REPORT 22

PROVIDER PROFILE

Silver Arrow 2019

Scotland’s Charity Air Ambulance

CASE STUDY 38

The dangers of task ﬁxation Capital Air Ambulance

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NEWS

Russian air ambulance service could be left without long-distance aircraft Russia’s Federal Biomedical Agency said that at the end of the year, it would have no choice but to write off its AN74 – the only long-distance air ambulance aircraft currently on duty in the country. The AN-74 was originally put on duty in 1992 and during its service, has saved the lives of around 500 patients, most of which would not have survived without their transfer to a higher level of care. The move to take it out of servive would undoubtedly adversely affect the safe and timely delivery of patients from remote provinces to Russia’s top-tier medical centers in Moscow and St Petersburg, according to Vladimir Uiba, Director of the Federal Biomedical Agency. The service life of the AN-74 expires at the end of 2019 and there is nothing that could be done to continue its operations,

Uiba said. Although in theory, the service life of the aircraft could be extended through repair and overhaul, it was originally manufactured in Ukraine, which is thus the only country able to provide the necessary spare parts. Given the present state of the Russia-Ukraine political relationship, ‘this is not an option’, Ulba explained. Rush for a new plane Russia’s Healthcare Minister Veronika Skvortsova has already applied to the federal government asking for an allocation of funds to purchase a Falcon 7X in order to replace AN-74. The alternative is an SSJ-100, but Sukhoi, the Russian manufacturer, said it wouldn’t be able to deliver the aircraft to the Ministry any earlier than the fourth quarter of 2020. Speaking at a government

meeting, Skvortsova emphasised that the national air ambulance services needed the new aircraft ‘right away’. Russia’s Industry and Trade Ministry, however, has said that it would rather opt for SSJ-100, especially since there is an air ambulance version of that aircraft already – the MEDIVAC option. Uiba argued that SSJ-100 was not exactly what the air ambulance service requires. The most important point, he said, is that the aircraft

must be able to make a non-stop flight from every point in Russia to Moscow. The maximum flight distance of SSJ-100 is 4,500 km, while the distance between Vladivostok and Moscow is 6,000 km. Russian press reported that as long as the final decision is yet to be taken, there will be at least a 12-month gap between the end of the service life of AN-74 and putting its replacement into operation.

outcomes for patients.” The ITIJ Awards also took place on the final night of ITIC, in a sparkling evening full of fine wine, delicious food and dazzling Halloween-themed entertainment.

The award for Air Ambulance Company of the Year was given by Dr Paul Beven of Healix International to Jet Rescue Air Ambulance, which was accepted on the evening by Shai Gold.

ITIC Global 2019 – conference review The International Travel & Health Insurance Conference (ITIC) took place in Malta on 28-31 October, during which time, the great and the good of the international fixed-wing air ambulance community gathered to exchange expert views and share industry insights. There were several sessions dedicated to the world of air ambulance missions, including a focus on air ambulance pricing, and how to improve the air ambulance commissioning process. Meanwhile, the Air Ambulance and Medical Assistance Forum proved a popular platform for afteraction reviews of missions that have taken place over the past 12 months. Ian Cameron, ITIC 6

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Chairman, commented: “It was a really great event, with hundreds of attendees from all over the world taking the opportunity to share thoughts on best practice, transparency and improving

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2018 and 2019 VFR air-to-air collision prevention/Limitations of ‘see and avoid’ • Winch operations in SAR • A 1,000-meter longline recovery in Norway • Drones as assets and hazards • Teamwork in HEMS • Critical incident support – psychological first aid • Satellite-based solutions for SAR operations Fabrice Legay, Section Manager - Medium & Light Rotorcraft for EASA (European Aviation Safety Agency), led the most significant presentations during the Air Rescue Commission sessions; his presentations on key areas of focus by EASA were well received by attendees. The collaboration between EASA and the ICAR AirCom is important, and our partnership was further strengthened by his presence. Air Rescue Commission Vice-President Renaud Guillermet, Chief Pilot at the Grenoble France Base of Sécurité Civile, leads the Air Rescue Commission work with EASA. During the field day, the host team of Tatra Volunteer Search and Rescue performed an impressive medical packaging and hoist demonstration. Rescuers from Alidaunia also performed a rescuer insertion and hoist demonstration as part of the practical exercise.

•

The International Commission for Alpine Rescue (ICAR) Annual Convention, hosted by Tatra Volunteer Search and Rescue (Tatrzańskie Ochotnicze Pogotowie Ratunkowe (TOPR)), included 440 rescue professionals from 109 rescue organisations, representing 37 countries. Commission President Charley Shimanski sent AirMed&Rescue this report after the event With a theme of ‘TEAMWORK’, the convention started with a full day of practical workshops in the field and continued with three days of seminars inside the Nosalowy Dwór Resort in Zakopane. Four rescue helicopters from four different countries participated in rescue demonstrations and test flights. Conference programme This year, the ICAR Air Rescue Commission sessions included 90 representatives from 27 countries and 67 rescue agencies. Presentations by an assortment of rescue experts worldwide included reports on: • Accidents and incidents in

Attendance by helicopter manufacturers The ICAR Congress also included special onsite presentations of helicopters and rescue programs representing Airbus Helicopters (through EliFriulia), Bell Helicopters (through ATE Poprad, Slovakia), and Leonardo Helicopters (through Alidaunia). Air Rescue Commission delegates and pilots experienced these helicopters first-hand, through

For more information about ICAR, please contact Charley Shimanski, President, ICAR Air Rescue Commission, US – charley. shimanski@gmail.com

REMEMBERING NICOLAS REVELLO During the 2019 Congress, ICAR participants learned of the tragic death of Nicolas Revello, a French police rescuer with CRS Secours en Montagne in France. ‘Nico’ died on 11 October while working to rescue two alpinists at the summit of Barre des Ecrins. His sacrifice was a sombre reminder of the dangerous work performed by helicopter rescue mountaineers. Our hearts go out to Nico’s family, and his colleagues in the rescue communities of Grenoble, France.

live test flight operations and field demonstrations. The Grand Nosalowy Dwór hotel was the perfect venue, as it included a helipad and other open spaces that were suitable to host three helicopters at the same time.

REVIEW

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HeliResQ event review Sami Ollila, Vice-President, EURORSA - Rescue Swimmers Association, reviewed the recent HeliResQ – Nordic Workshop for AirMed&Rescue

life rafts. Theoretical presentations and practical training briefs were implemented as part of practical training sessions at the Meriturva training pool and at a local swimming centre.

The Finnish Border Guard Rescue Swimmer Association, in co-operation with Lite Flite, Ursuit and EURORSA – Rescue Swimmers Association, organized an event for helicopter SAR crew members that was held at

Workshop 1 – Rescue swimmer fitness Report by Ben Darlington President, EURORSA - Rescue Swimmers Association The first workshop looked into helicopter rescue swimmers’ aquatic

HeliResQ 2019 © Aleksi Mehtonen

Meriturva – Maritime Safety Training Centre from the 27 to 28 September 2019. The HeliResQ – Nordic workshop consisted of a tribute to the rescue work conducted during the MS Estonia catastrophe, which occurred exactly 25 years ago on the day of workshops. The event covered physical tests of rescue swimmers, rescue gear, communication during a winch rescue operation, and standard operating procedures during mass casualty rescues from 10

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with the critical gear used by the majority of members.) • 100-m fin kick with a 4-kg weight, climb out. (To simulate a weighted tow, of a survivor, or of operational mission. The HeliResQ swimming on the cable or with a workshop provided another fantastic Hi/Trail line.) opportunity to gather further data • 25-m swim with fins pushing the and feedback on the test. weight along the bottom of the The test is done continuously, with pool, then a 75-m swim to the each serial simulating something finish, climb out; clock stop. (To that a rescue swimmer may face simulate apnoeic environments, on live operations. With members when due to external factors, of the Association operating in the swimmer is unable to sub-zero waters, from deep within breathe freely.) the Arctic Circle, to warm subIn between each section, the equatorial waters and everywhere swimmer climbs out of the pool to in between, the test is performed simulate the upper body strength in swimming trunks with gear required to pull oneself from the

HeliResQ 2019 © Aleksi Mehtonen

abilities and their ability to maintain a personal capability to respond to operational SAR missions. Individuals from lifesaving and other branches of aquatic rescue also took part in the trials to offer external feedback from fellow water-based professionals. Since their meeting in La Spezia, Italy in 2016, the EURORSA – Rescue Swimmers Association has been developing a fitness test, designed to best prepare their members for the stressors they may face during an

including a mask, fins and snorkel, which are relatively common to all swimmers. This enables comparisons and competition to take place regardless of the member’s operational environment. EURORSA RS PT – 600-m swim • 200-m freestyle, climb out. (Designed to test and develop general swimming ability.) • 200-m freestyle with fins, mask and snorkel, climb out. (To prepare members for swimming

water up into a raft, onto a yacht or a drifting vessel. With the data collected from this test being examined and combined with the data gathered from previous meetings in La Spezia 2016 and Reykjavik 2018, findings will be presented at the next EURORSA Rescue Swimmers Meeting, in Cascais 2020. The Association is looking forward to publishing a guideline that will best prepare their members for operational missions. The Rescue Swimmer’s Association

REVIEW

wishes to remind readers that all tests were conducted under close supervision. Due to the dangers of shallow water blackout, underwater training should never be conducted without professional supervision. Workshop 2 – Quick release Report by Kim Germishuys Secretary, EURORSA – Rescue Swimmers Association Lite Flite was invited as one of two main partners to arrange HeliResQ. Thomas Knudstrup (Lite Flite, CEO) and Darren Craig (Lite Flite, SAR Specialist) presented a workshop about rescue swimmer harnesses equipped with a quick release device.

for the person on the wire. The choice of implementing a quick release device into harnesses gives the rescue swimmer or person on the wire the ability to separate from a taught cable at a time of their choosing. Participants at HeliResQ were given the chance to test out the Lite Flite Quick Release Box (QRB) over water, and practise optimal positioning for a fall while activating the quick release device under tension. Workshop 3 – Drysuits Report by Sami Ollila Mika Aitio (Sales Manager) and Linda Granberg (Head

Risto Leino at HeliResQ 2019 © Lloyd Horgan

The presentation looked specifically at how a Rescue Swimmer can release themselves from the hook in an emergency, while the cable is under tension. In research conducted by Lite Flite, it was estimated that around 60 per cent of SAR helicopter operators around the world use a quick release device. The other 40 per cent rely on the hoist operator and pilot’s reaction time to hit the cable cut switch, hopefully within a time that will result in minimal implications

Designer) from Ursuit were the other main partners with HeliResQ, who presented a general overview about how a drysuit is manufactured, and how Ursuit responds to the needs of its customers. Ursuit’s strength in the industry is cost-effective customization. Customer specifications are not always easy to interpret, so a continuous dialogue between the manufacturer and end user is often needed to provide the

specifications. Mika presented several examples of customerbased innovations and about implementing customization requests by respecting the needs of their customers. Ursuit was one of the very first companies to partner with EURORSA - Rescue Swimmer Association. Workshop 4 – Operational communication Report by Sami Ollila Workshop 4 combined operational communication with a practical winch rescue simulation from life rafts. David Betts of All Elements Protection presented

especially for rescue swimmers, when compared to that of the traditional radio communications such as using a hand-held VHF radio. By being connected to the helicopter’s intercom system, the rescue swimmer is ‘in the loop’ throughout the operation. This generates a lot more reaction time for the rescue swimmer, in case of a critical malfunction in the helicopter or a malfunction during the winch operation. The facilities at the Meriturva Maritime Safety Training Centre enable ‘scenario builders’ to replicate conditions close to those a rescue swimmer would experience during an operational mission.

HeliResQ 2019 © Aleksi Mehtonen

the Polycon wireless intercom system from Axnes, who provided all the necessary equipment for communication during the simulation. In his presentation, David also highlighted the importance of being prepared with other means of operational communication, like hand and/or light signals and ensuring that these signals can be clearly understood during night-time operations. A wireless intercom system enhances situational awareness,

With wind and swell generators creating sea chop, black-out lighting conditions, along with speakers which can drown out normal audible conversations, adding in thunderstorms and helicopter noises into the mix, it was the ideal location for a large-scale ‘scenario exercise’ to take place. The rescue swimmers were tasked with recovering four people from a life raft. Each of the survivors had triage tags, with two being fully ambulant, while the third was

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REVIEW

HeliResQ 2019 © Aleksi Mehtonen

moderately ambulant and the fourth was completely incapacitated. The centre was initially blacked out and swimmers were able to compare different verbal and nonverbal signals and work through different recovery methods, from accompanied recoveries in the single and hypothermic strops, through to implementing the hi-line and guide-line ring set ups. With rescue swimmers from 13 different nations taking part in the exercise, including three who had been a part of the MS Estonia rescue, the practical exercise was an opportunity to compare operating procedures, share techniques and learn from past experiences. MS Estonia catastrophe – A mass casualty rescue Report by Ben Darlington Rescue swimmers Risto Leino, Patrik Nilsson and Thorbjörn Olssen gave unique and at times, 12

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emotional, presentations about the rescue efforts during MS Estonia catastrophe. The MS Estonia sunk on the 28 September 1994 after her bow door failed in rough seas whilst travelling from Tallin, Estonia to Stockholm, Sweden. The final report on the tragedy estimates that of the 989 persons on board, 310 made it to the outer decks before the vessel slipped below the water at 01h50. With the water temperature no more than 11°C and winds up to 40kts, by the time the first Finnish Rescue Helicopter arrived on scene at 03h05, it is thought that a third of survivors had already been lost to drowning or hypothermia. With no persons recovered from the water alive after 09h00, between 03h00 to 09h00, Swedish and Finnish helicopter rescue crews raced against time to rescue as many people as they could from the frigid Baltic waters. With so many survivors in

so many rafts, rescuers had to be ruthless in order to rescue as many people as possible, a fact that weighs heavily on those involved. Swedish Rescue Swimmer Patrik Nilsson recounted how on arrival at the rafts, he was confronted with multiple victims in various stages of advanced hypothermia. With the rafts being tossed about in waves up to 20ft and reduced dexterity for rescuers, being able to definitively determine who was alive and who wasn’t was extremely diﬃcult and ultimately, it came down to the intuition of an individual rescue swimmer. Nilsson lamented that helicopter crew members, and especially the rescue swimmers, have struggled with the thoughts of whether they had left someone behind that was possibly alive at that moment when the rescue was at hand. A further unique challenge was the number of life rafts in the area during the early stages of the rescue. With rescuers forced to leave the deceased in rafts and move on in order to rescue as many people as possible, there were occasions of individual rafts being checked multiple times by different crews. With the evolution of infra-red technology becoming more common in SAR aircraft over the past 25 years, this would have assisted in such situations. Whilst rafts have serial numbers and/or service cards on or in the raft, these are unreadable from an aircraft in a hover. During a discussion by attending rescue swimmers, a few ideas were exchanged on how marking a raft that had been checked could be carried out: • The last two digits of the raft’s serial number could be displayed in a large font on the canopy and underside of the raft. (On the morning of the 28 September, many of the rafts had capsized due to the rough conditions, and survivors had scrambled onto the

floors of the over-turned rafts). Sea marker dye could be smeared on the canopies of the rafts. Those with experience with sea dye can attest to the manner in which it stains material, and trials of this approach by the Estonia Police Airwing have proved positive. While the MS Estonia tragedy was an unprecedented maritime disaster in European peacetime waters, Rescue Swimmer Risto Leino did find comfort in the fact that he had the opportunity to save people from the cold Baltic Sea that night. Leino went on to acknowledge his colleagues, who subsequently worked long hours recovering bodies from life rafts and the ocean. For future reference, Leino urged every SAR crew present to go out and train when the conditions are hard. At the end of the day, it is in these conditions that you really have to be able to perform as a crew.

•

A learning experience Sami Ollila summarised the event: “The HeliResQ – Nordic Workshop enabled interaction and dialogue between helicopter SAR crews and existing partners who were able to share experiences and learn through the workshops and informal interactions. We believe it is important for meetings like HeliResQ to be arranged. Direct interactions and sharing of ideas between colleagues about rescue gear and implemented procedures may be an effective way to implement improvement processes in the operational sector of different organizations. It’s equally important to be able to meet your colleagues internationally and to have an opportunity to make lifelong friends from another corner of the world who understands the line of work you do.” Source: The Joint Accident Investigation Commission of Estonia, Finland and Sweden (1997) Final report on the MS Estonia disaster of 28 September 1994.

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Avionic evolution

Dr Joetey Attariwala finds out more about the technology that is breathing new life and capability into existing air rescue helicopter platforms

LS Zachariah Stopa, Canadian Forces Combat Camera

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upgrades essentially breathe new life into older platforms through enhanced situational awareness and increased mission capabilities. Such upgrades also tend to improve the performance of aircraft as technological advancements typically mean reduced component size and weight as older analogue systems are replaced with solid state parts. These newer components often include built-in diagnostics, which is an

avionics upgrades essentially breathe new life into older platforms through enhanced situational awareness and increased mission capabilities added benefit compared to legacy systems. The frequency of avionics upgrades is totally dependent on the operator, however,

there are times where regulations make avionics upgrades mandatory.

FEATURE

New aircraft acquisitions often take much of the limelight when it comes to news coverage, but a greater story lies in the modernisation of aircraft, particularly when considering new avionics systems. Avionics upgrades are done for three key reasons: the first is that it is cheaper to upgrade a platform than acquire a new one; secondly, to maintain compliance with regulatory changes; and thirdly, to increase operational effectiveness by increasing safety and reducing pilot workload. The latter aspect is particularly important when considering aircraft that are tasked with Search and Rescue (SAR) and aeromedical evacuation duties. Avionics include communications, navigation, the display and management of multiple systems, and the hundreds of systems that are fitted to aircraft to perform individual functions. This can be as simple as adding a new radio, or the complete modernisation of the flight deck, but no matter the extent, avionics

Provider options Countless companies around the globe offer avionics upgrades, with a growing trend towards open architecture. Companies like Honeywell have been leading providers of navigation, display systems, flight controls, and flight management systems since the early days of aviation. The company is one of a handful that have led the evolution from electromechanical instruments to cathode ray tube (CRT) displays, and from CRTs to high-performance colour liquid crystal displays. Honeywell accelerated the transition away from analogue cockpits with the introduction of the Primus 1000/2000, which presented flight data on a need-toknow basis, and an advanced three-axis autopilot. Honeywellâ&#x20AC;&#x2122;s next generation Primus integrated avionics system is at the

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core of the Primus cockpit family, which consists of the Epic / 2.0, Apex and Elite 875 / 885. Thales’ expertise in avionics has yielded their new FlytX solution, which, according to the company, is designed to reduce pilot workload and offers the highest level of efficiency in terms of human-machine interaction. This ‘flight deck of the future’ allows faster access to information, coupled with a synthetic representation

(FAA) has deemed it critical to move from ground-based surveillance and navigation to more dynamic and accurate airborne-based systems and procedures to modernise America’s air transportation system. In 2007, the FAA published a notice of proposed rulemaking to mandate ADS-B Out. ADS-B equipment is an advanced surveillance technology that combines a Mode S transponder (1090ES) ADS-B transmitter, Global Navigation Satellite System (GNSS),

The US Federal Aviation Administration (FAA) has deemed it critical to move from groundbased surveillance and navigation to more dynamic and accurate airborne-based systems

and the deployment of ground-based surveillance systems, to create an accurate surveillance interface between aircraft and air traffic control. ADS-B Out periodically broadcasts information about each aircraft, such as identification, current position, altitude, and velocity, through an onboard transmitter. A final rule in August 2010 mandated that all aircraft operating in US airspace have ADS-B Out technology operational by 1 January 2020. Aircraft operating below 18,000 feet in the US will require either a Mode S transponder, or a Universal Access Transceiver (UAT). UAT equipment provides the ability to receive traffic and weather data provided

by the FAA ADS-B network. Deployment of ADS-B is a worldwide effort, and it is not only American airspace that will be impacted. The European Union Aviation Safety Agency (EASA) laid down requirements that from 7 June 2020, all aircraft that weigh more than 5,700 kg, or have a maximum cruise speed greater than 250 knots, will need to be equipped with ADS-B capabilities. This represents a great business opportunity for numerous supplemental type certificate applicants who have experience in avionics installations. However, according to EASA, an ADS-B installation is much more than a ‘simple’

Master Corporal Johanie Maheu, 14 Wing Imaging

of the outside environment. With a large display area, it facilitates crew interaction, closely integrates with all the other aircraft systems, fuses information and enables more informed and intuitive decisions. Gil Michielin, Executive Vice-President – Avionics at Thales said: “The FlytX solution will fully meet the new standards in military aviation. This intuitive flight deck with touchscreen interaction allows pilots to familiarise themselves with the system in record time. The FlytX avionics suite is also available for civil helicopters.” Mandated avionics requirements The US Federal Aviation Administration 16

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change of transponder, and it may not be as easy to handle as it might initially appear, as applicants have to approach the certification by considering the ‘end to end’ ADS-B system (e.g. including sensors and control panels), and not solely the installation of the Mode S 1090ES transponder. RCAF invests in the future Speaking to AirMed&Rescue, LieutenantGeneral Al Meinzinger, Commander of the Royal Canadian Air Force (RCAF), shared his thoughts on avionics upgrades: “I’ve learned in my career that aircraft are incredibly flexible and avionics upgrades allow you to leverage a platform’s inherent capability to do many different things. I think back to the work we did two decades ago to configure night vision goggles into the Griffon helicopter. That allowed us to operate the aircraft more effectively, so I would suggest that avionics upgrades add overall safety and capability, and that makes aircraft more employable across a

broad range of mission areas.” A notable upgrade programme in Canada today is for the RCAF CH-149 Cormorant, a dedicated SAR derivative of the Leonardo AW101. Although not old by most standards, its systems are ageing and becoming difficult to support, so the Cormorant Mid-Life Upgrade (CMLU) programme presents a low-risk solution to ensure continuing airworthiness; provide greater operational capability; improve the reliability and availability of the helicopter through the introduction of state-of-theart technologies; and make continuous improvements to maintenance activities. Mid-life upgrades like CMLU also result in a reduced cost of ownership, the resolution of obsolescence issues and a rationalisation of the supply chain. The CMLU capability improvements are based on Norway’s AW101 SAR helicopter – itself based on the AW101612 standard – which enhances overall mission effectiveness by incorporating

the latest avionics and mission systems, with advanced radars, sensors, vision enhancement and tracking systems. The AW101-612 standard includes a modern five-screen, fully integrated Collins Aerospace cockpit, and advanced SAR mission equipment including Leonardo’s Osprey multi-mode 360-degree AESA radar system, four-axis digital Automatic Flight Control System (AFCS), onboard Obstacle Proximity LIDAR System, two rescue hoists, searchlight, a cell-phone detection system, and an electro optical/ infrared sensor. Speaking to AirMed&Rescue in September was Stefano Villanti, Senior Vice-President of International Government Sales at Leonardo Helicopters. “Canada has identified Leonardo Helicopters as the company which will conduct the CMLU programme. We are working with the Canadian MoD for the project definition phase, and that is moving quite smoothly, so we are expecting to reply to a RFP

SPONSORED CONTENT Enhanced vision systems (EVS) provide an easy, cost-effective upgrade that helps pilots flying mission critical operations realize significantly increased safety. Providing situational and spatial awareness information in their cockpit, day and night, during every phase of flight, EVS serves as an additional resource when assessing airport landing areas, terrain, and impactful environmental conditions in limited or reduced visibility situations. Astronics’ Max-Viz EVS uses a proprietary image processor to control dynamic range and blending of visible and infrared images. This produces a clear, black-and-white, high-resolution real-world image of the world in real time. Pilots can see steep, rugged terrain and cloud-covered valleys and mountain ranges. EVS can even detect wildlife in a landing area and the LEDs of an airport environment on approach. Safety should never be optional, and upgrading to a Max-Viz EVS is easy. With a low-profile, 1.5-pound, lightweight externally mounted design, the system comes encased in an aluminium housing that requires no faring. This single line replaceable unit is designed as an affordable, uncomplicated, and hassle-free installation for both fixed-wing and rotor-wing aircraft. The Astronics’ Max-Viz systems use a heating element to prevent the build-up of ice. The EVS imagery requires either a multifunctional display installed in the panel or an auxiliary display that accepts a composite video signal. Safety is a team effort, and the EVS serves as an easy upgrade, providing a powerhouse tool in an aircraft’s safety toolbox.

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[Request for Proposal] in the next few months,” said Villanti. “One of the key points is to get a configuration that is as common as possible with the Norwegian configuration, which is the latest model that we are producing. That configuration has got the latest sensors, so it will be an important step up in terms of avionics and capabilities.” One of the key sensors integrated into the Norwegian AW101 is the Osprey AESA surveillance radar system, which consists of three arrays that provide 360-degree coverage. “For the Canadian CMLU, we are proposing something in that direction, but the exact configuration will be defined by the user as required,” said Villanti. “The way operations are carried out in Norway is different from how they are carried out in Canada, so there are still

operational requirements.” The avionics in the Norwegian AW101 SAR helicopter allow crews great flexibility in the use of onboard systems. For example, crews are able to overlay marine Automatic Identification System information onto moving maps, or can merge AESA radar information with GPS co-ordinates. All of this can be coupled to an advanced autopilot.

US Coast Guard modernises the MH-65 US Coast Guard MH-65 helicopters are being upgraded with a new avionics architecture from Collins Aerospace, and in common with the Coast Guard H-60 medium range recovery helicopter. The upgrade results in the new designation as MH-65E, and includes large-format all-glass digital displays that deliver a number of Pilots will have video and imaging options as multiple video increased situational sources from outside and inside the aircraft awareness and a can be displayed. Some of these include video from a hoist camera for a better view, reduced workload and a cabin camera so the pilot can observe activity in the back of the helicopter. The system allows the pilots to save images discussions to keep operations as they are, and video to a mission data recorder for or to adapt them for commonality. That immediate review or a later download off process is a core of the definition phase the aircraft. which is an optimisation of the aircraft and “Pilots will have increased situational awareness and a reduced workload, which can make a huge difference in challenging situations when every second counts,” said Heather Robertson, Senior Director of Rotary Wing Solutions for Collins Aerospace. The Collins system is designed with open architecture, which allows for the reuse of applications developed on other programs to be hosted within the avionics system. © U.S. Marine Corps photo by Lance Cpl. Dylan Walters This includes third party applications 18

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maximising pilot capability with minimal cost to upgrade the system. The upgrade includes Collins’ integrated civil and military flight management system. Search and rescue capabilities will be improved with a full integration of Collins’ DF-500 direction finder into the new flight management system and display. The DF-500 receiver continuously scans for emergency beacons over a large frequency range and pinpoints the location of any detected beacon on the digital display. The pilot can set the system to fly directly to that position, fly a search pattern if needed, and also view the point or the flight plan on a digital map, weather display or terrain map. “We worked very closely with the Coast Guard to develop these new capabilities that will improve safety and effectiveness in future missions,” said Dhiraj Raghwani, Programs Manager, Maritime and Civil Systems at Collins. Heavy helicopters On the commercial side, Coulson Unical, a joint venture (JV) with Unical Aviation of Southern California, is rapidly expanding as the premier Type 1 Helicopter Operator in the world, specialising in aerial firefighting as well as natural disaster response. The JV is delivering helicopters with a new generation of avionics based on a complete Garmin suite consisting of Dual GTN750s, TCAS with ADS-B, and G500H TXI touch screen synthetic vision displays. This equipment is paired with a Cobham Digital Audio System for clear radio communication. In addition to the Garmin package, Coulson is also working with a head-up display (HUD) provider to provide even more situational awareness to the crews, further enhancing the safety margin. “This package provides our flight crews with the latest and greatest technology to enhance the safety of the crews and aircraft,” said Mel Ceccanti, Coulson’s Rotary Wing Director of Flight Ops. “The situational awareness provided by the Garmin Synthetic Vision is second to none and there are no other utility aircraft in the industry with this type of capability.” This article is but a glimpse into the vast arena of avionics upgrades, but what it is clear is these upgrade efforts are key to breathing new life into existing platforms.

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A CHANGE IN THE WEATHER â&#x20AC;&#x201C; the latest in IFR regulations Mike Biasatti details some of the latest changes to regulations regarding helicopter IFR operations, and why they are so important. In 2009, the National Transportation Safety Board (NTSB) published a Most Wanted List issuing 19 safety recommendations for what was then referred to as Helicopter Emergency Medical Services (HEMS). This publication came after the deadliest year on record in the HEMS industry; in 2008 29 crew members perished in helicopter air ambulance crashes. In 2011, the Federal Aviation Agency (FAA) issued a Notice of Proposed Rule Making (NPRM) to address safety concerns, many of which were addressed in the NTSB Recommendations. Following industry input, many changes were made amending regulations, equipment requirements, pilot training, weather minimums and flight risk evaluation programs. HEMS operations were now going to be called HAA (Helicopter Air Ambulance). The changes that were adopted were implemented over time to allow operators the opportunity to train and configure their fleet. The importance of weather reporting One such regulation was 135.611, which allows those authorised to conduct helicopter instrument flight rules (IFR) operations to fly to an airport that does not have approved weather conditions. Now of course, to do something like this comes with additional requirements: an approved weather report within 15 nautical miles must be checked and have met filing requirements. Or, failing that, the pilot must obtain weather reports and forecasts from an approved US National 20

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Weather Service (NWS) source, or a source approved by the FAA regarding the weather in that vicinity. In the past, this would allow the pilot to use the Area Forecast (FA) to file IFR to an airport without weather reporting, but the Aviation Area Forecast has since been discontinued. In its place is the new Graphical Forecasts for Aviation (GFA) Tool, which comes with a new interface that allows the creation of a visual map of weather projected at a selected future timeframe. A solid back-up plan A second requirement of the regulation was the selection of an alternate airport, which is of course a great safety practice, but can be limiting with IFR helicopter operations due to the typically limited fuel range compared to that of their fixed-winged colleagues. In some cases, having an alternate airport might not be necessary: if the original destination

had an approved weather reporting system and the weather for an hour before to an hour after the Estimated Time of Arrival (ETA) was forecast to be at least 1,500 feet above the lowest circling Minimum Descent Altitude (MDA), or if a circling approach is not authorised, the ceiling will be at least 1,500 feet above the lowest published minimum or 2,000 feet above the airport elevation (whichever is higher); and the visibility for that airport is forecast to be at least two or three miles more than the lowest applicable visibility minimums (whichever is greater for the Instrument Approach Procedure (IAP) to be used). In such cases, the fuel requirements would have been less restrictive, but to afford this helicopter-specific allowance, one must file for an alternate airport and meet the minimum fuel requirements of Federal Aviation Regulations (FAR) Part 135.223(a)(3).

The right tools for the job Subpart (d) of regulation 135.611 stated: “Each helicopter air ambulance operated under this section must be equipped with functioning severe weather detection equipment.” Many HAA operators had, in the past (prior to the FAR 135.00 additions), been able to fly to airports without weather reporting under A021 in their respective Operations Specification, but with this change, the requirement of severe weather detection equipment had been added. The term ‘severe weather detection equipment’ was defined as ‘onboard weather radar or spherics devices such as a Stormscope’. Most visual flight rules (VFR) HAA aircraft do not have this severe weather detection equipment and many IFR aircraft also do not. The general consensus was that this requirement posed an added economic burden on IFR operators and might possibly

INDUSTRY VOICE

have the exact opposite impact on safety than was intended, i.e. pilots without this equipment would not be able to fly IFR to those airports. So, instead this might encourage them to push on in marginal VFR weather (MVFR) – a practice that has historically had deadly consequences. As such, eventually an agreement was reached whereby the operator in question was able to obtain an exemption to this rule. Those operating under the exemption would only be permitted to fly if there was no expectation for thunderstorms during all phases of the flight (Departure, Destination, Alternate, Return to Base). Additional and

thoroughly comprehensive pre-flight weather planning was also required: aircraft operating under this exemption would have to be continuously monitored by the operator’s Operations Control Centers, and additional training would be required annually for both the pilots and the flight specialists overseeing the operations conducted under this part. As of 26 August 2019, operators will no longer be required to file for or renew a request for this exemption. FAR 135.611 now reads: “(b) Each helicopter air ambulance operated under this section must be equipped with functioning severe weather detection equipment, unless the pilot in command reasonably determines severe weather will not be encountered at the destination, the alternate destination, or along the route of flight.” This is a great example of the FAA listening to HAA operators, determining that making this change will not have an adverse effect on safety and putting the updated regulation in place. This change will benefit operators who invest in operating an instrument helicopter platform and further invest in the additional training and currency required to be available to a greater extent to both trauma and medical patients without being required to invest in expensive additional equipment. It will also task the pilot with some additional planning requirements to ensure safe operations. In my opinion, this is a good move, and a sign of a greater partnership between the FAA and air medical operators in the US.

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SILVER ARROW 2019

In September this year, the Ohio Air National Guard’s 179th Airlift Wing participated in Silver Arrow, an exercise that took place at Ramstein Air Base in Germany. Team members were given the opportunity to complete numerous multinational missions resulting in increased capabilities, readiness, and interoperability for all involved. “Silver 22

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Arrow is designed for Guard and Reserve to participate as a force multiplier in the United States European Command (EUCOM) in regards to exercises, missions and regular training in the international community as well as building relationships with our partners,” explained Chief Master Sgt Michael McDonald, Detachment Superintendent for Silver Arrow at

Ramstein Air Base. Joint effort While participating in Silver Arrow, the 179th joined an Aeromedical Evacuation Mission with the 86th Air Medical Evacuation Squadron at Ramstein Air Base. This mission simulated patient transportation to and from the aircraft

SPECIAL REPORT © DVIDS / US Air National Guard / Airman 1st Class Alexis Wade

Â© DVIDS / US Air National Guard / Airman 1st Class Alexis Wade 24 AIRMED&RESCUE

Saber Junction 19 While at Ramstein, the 179th also had the opportunity to participate in Saber Junction 19 (SJ19), which provided vital opportunities for total forces interoperability training to take place between approximately 5,000 individuals from partner and allied nations’ militaries, US Active components, US Reserves,

and National Guard units. SJ19 is a 7th Army Training Command (7ATC) conducted, US Army Europe (USAREUR) directed exercise designed to assess the readiness of the Army 173rd Airborne Brigade to conduct unified land operations alongside NATO allies and partners. The 179th provided airlift support with personnel drops, heavy equipment drops and air attack operations. “This was a great learning exercise for our personnel, as well as a great opportunity to form international relationships and increase our interoperability with all involved through this exercise,” said Lt Col Pete Tesner, 179th Airlift Wing’s Director of Operations for Silver Arrow. Throughout the course of the two weeks, 179th AW members increased their readiness, capabilities, international relationships and interoperability through

SPECIAL REPORT

and in-flight patient care while traveling from Ramstein to Naval Station Rota, Spain. “Exercises like these are extremely beneficial for both the 164th and 86th by not only giving each other the opportunity to train on our skills, but to also increase interoperability, globally through this mission,” said Col Darren Hamilton, 164th Operations Group Commander, assigned to the 179th Airlift Wing.

the numerous missions they were involved in thanks to Silver Arrow. “The missions we’re flying here are directly tied to our Air Force readiness and posture of being able to take the mission forward, and interacting with our active duty counterparts here at Ramstein as well as our joint partners across EUCOM,” said Tesner. “We’re inter-flying with local Air Forces here, supporting missions out of Aviano, Italy. This truly is a joint endeavour which is the core of the C-130 mission, inter-theatre tactical airlift. We’re hitting all the high points, checking all the boxing, it is great training for all involved.” All images © DVIDS / US Air National Guard / Airman 1st Class Alexis Wade

It’s good to talk

Rear crew communication During helicopter rescues, communication with and among rear crew members is critical to safe and effective operations. Mario Pierobon delves into the specific requirements and distinctive features of rear crew communication, and explores how developing technology is enabling improved communication options 26

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In the last few years, the helicopter operations industry has witnessed an important step forward in terms of communication solutions that facilitate the operations of a helicopter rescuer. “Nowadays, there are many companies that offer ‘active noise reduction’ technology in their headsets or helmets; this new technology lowered unwanted noise and

increased the acoustical comfort,” said Capt. Vincenzo Pucillo, Flight Operations Manager at helicopter emergency medical services (HEMS) operator Alidaunia. “The helmets are now more ergonomic, and more attention is placed on this type of equipment. One should also not forget that many systems have become lighter compared to the past, and this is also important when using night vision imaging systems (NVIS), for example.” Communication needs of rescuers Overall, the communication needs of rescuers vary from operator to operator. According to Pucillo, however, rescuers always require clear communications with everyone involved in the specific operation;

For rescue swimmers, there is the additional compounding factor of everything having to be waterproof for Mountain Leadership in South Africa, the communication requirements of the rear crew are actually quite straightforward. “There must be a communication headset that mounts onto a rescue helmet and has an integral push-to-talk (PTT), and that plugs into the aircraft intercom system (ICS) but can rapidly disconnect and plug into a handheld aviation radio. It also needs to be easy to remove from the rescue helmet quickly and without tools, either for

ground rescues or to reconfigure it back to an Alice-band style headset,” he said. “Moreover, it should not be bulky or heavy. Previous experience has shown that a flight crew helmet is a misery to deal with when working as a technical rescuer.” Microphones and earpieces must guarantee clear communications, especially in noisy technology environments as well as under the heavy downwash of the helicopter. “Helmets must be light in order not to compromise the movements of the rescuers, but at the same they must be capable of protecting the user from danger,” highlighted Pucillo. ICS plugging and unplugging Of particular importance to helicopter rescuers is the ability to unplug from their radio and plug into the helicopter ICS, and vice versa. According to Thomas, there are currently a few standard options available to rescue crews. One option is an aviation headset with aviation plugs. “The rescuer can then unplug from the ICS and plug into

FEATURE

for example, there might be the need to talk at the same time with both the crew on board of the aircraft and the staff on the ground, causalities included. According to Rob Thomas of The School

a radio when needing to exit the aircraft. It is simple to use and probably the most cost effective,” said Thomas. Another option is to remain constantly on the radio, and communicate with the flight crew exclusively by radio, even when in the aircraft. “The downside of this is that the rescuer is excluded from all intercom chatter and may lose some of the essential intra-aircraft communications. This is often the option available to rescue swimmers,” said Thomas. “It is also possible to use a plug-in system that connects to the ICS as an interface between the rescuer and the aircraft. Some of these work on Bluetooth with all the range limitations associated with that, while others seem to work on ultrahigh frequency (UHF).” Custom solutions are also an option. There is normally a hefty price tag that goes hand in hand with these, and the after-market support may leave a lot to be desired. “For rescuers who are flight crews and who are using flight helmets, it is simply a

Corporal PJJ Létourneau, 19 Wing Imaging

bone-conduction mic and results in a highly specialised solution.”

Corporal Mathieu Gaudreault, Canadian Forces Combat Camera

matter of getting a handheld radio and an appropriate pigtail, but the issue of the PTT emerges. Finding the PTT on a handheld radio that is in a chest rig can sometimes be awkward, especially when wearing gloves,” said Thomas. For rescuers who are not flight crews but are either rescue technicians or rescue swimmers, many rescue helmets have the option of mounting ear defenders and clipon communications headsets, but there are not many aviation headsets that have an offthe-shelf option for mounting onto a helmet. “An additional requirement for technical rescuers is the ability to disconnect the headset from the helmet in the field easily if the nature of the task becomes less aviationcentric,” said Thomas. “As an example, it is possible to take an aviation headset which has a built in PTT on the ear cup and make

Experience has shown that a flight crew helmet is a misery to deal with when working as a technical rescuer 28

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a helmet mount for it, using the helmet mounts for a set of passive ear defenders. It does the trick, but it requires some tinkering. For rescue swimmers, there is the additional compounding factor of everything having to be waterproof. Sometimes this means that the solution needs either a throat-mic or

Future developments Looking to the future and in particular at the possible improvements that could be provided by the manufacturers, Pucillo says that developments are revolving around lighter helmets with a particular focus on the safety of the devices that cannot be compromised. “Some companies are developing ‘wireless’ helmets that can guarantee a great freedom both on board of the aircraft and on the ground. Moreover, in the future we will see helmets with data projected directly on the visors, this is a kind of technology that is normally used only on high-end military aircraft,” he concludes.

Babcock’s Oil and Gas search and rescue (SAR) team in the UK is boosting the service they offer men and women working offshore by replacing their traditional hard-wired helicopter intercom with a new wireless network. The new communications system can link up to eight helmets at the same time and has been formally accepted on both of our AW139 SAR helicopters based at Aberdeen. The system is also helping our rescue operations communicate more effectively as it extends to doctors and winchmen as they are lowered onto vessels or into the water to help people. SAR Operations Manager Paul Walters said: “SAR is all about teamwork, and effective communications is essential. This on-board network will help us provide a lifesaving service to men and women working in the North Sea for years to come. It’s unlike anything I’ve seen in a SAR aircraft before; it blocks out noise and feels like we are just talking normally, with no wires to get in the way, whether we are in the pilot’s seat or hanging from a winch 50 feet below the aircraft.” Dominique Retali, General Manager of Globalsys, which manufactured the wireless communications system implemented by Babcock, told AirMed&Rescue: “We design our wireless solutions with adaptability and ﬂexibility in mind. Our systems have the highest sound quality, which is of great importance for SAR operators. They can also be reconfigured for use on different aircraft and for many different mission types in no more than five minutes.

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AirMed&Rescue spoke to Scotland’s Charity Air Ambulance (SCAA) Senior Pilot Captain Russell Myles, who has flown with the charity since it launched in 2013. He has personally flown the charity’s original Bolkow 105 and then its replacement, the EC135 T2i, over 60,000 nautical miles

What are the main challenges that SCAA faces in terms of serving a large population spread over a wide area with many different climates and urban/wilderness environments? The weather can be significantly different at opposite sides of the country. It can be beautiful on the west coast and foggy on the east coast and vice versa. Our base is in Perth (with a second helicopter coming on line at Aberdeen

next spring), which is fortunate in that we have our own microclimate in the lee of the mountains. The Carse of Gowrie takes advantage of this and is a prolific fruit growing area. In our own local area, we can be responding to an RTC at sea level in the morning and then to the mountains for a skiing accident in the afternoon. The size of the area also dictates the way we respond – unlike some air ambulance

BONNIE SCOTLAND’S EMERGENCY ANGELS

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How do you manage your pilot’s flight hours schedule to ensure that they adhere to regulations when they are covering such large distances? We cover the whole of Scotland, but a job to the far end of the country and back is well within the 12-hr shift time. Orkney and back, for example, may involve the aircraft being away from base for up to five

hours, but that is completely manageable within our FTL scheme. In an emergency, we have the option of exercising commander’s discretion to extend a flying duty period – this is usually when a job comes in late in the shift. Extending by up to two hours gives us the flexibility to get the job done, deliver the patient to hospital and return to base. This can have a knock-on effect the next day if the same pilot is on duty, leading to a late start. It doesn’t happen often and if it does start to become a regular occurrence, then we can look at changing our operating hours. At the moment our shift on the EC135 is from 07:30 hrs to 19:30 hrs, but in the past when we did 10-hour shifts on the Bolkow 105, we varied from 08:00 hrs to 18:00 hrs to 10:00 hrs to 20:00 hrs, depending on the time of year. Do you work with volunteer mountain rescue teams (MRTs)often? What, if any, training do you do with such teams to ensure their safety and understanding regarding working with helicopters? The MRTs work closely with the Maritime and Coastguard Agency (MCGA) and are used to working with rescue helicopters. They are experienced and capable and always a pleasure to work with as they understand helicopters and know the dos and don’ts. The paramedics also host helicopter awareness training days at the base for

other services.

PROVIDER PROFILE

units in England where the pilot runs out the door to start the aircraft when the ‘Bat Phone’ rings, we take an extra 30 seconds to gather all the information about the job, especially the location. A job further away may require more fuel than our standard load, and we can quickly top up at base or get going and refuel on the way. The distance back to hospital also has a bearing on our planning; we regularly drop the paramedics on scene and then transit to the nearest refuelling location for a top up before returning. Usually by the time we get back the patient has been stabilised and packaged and is ready to load. In the old Bolkow days when we were day VFR only, I even dropped the guys on a hill and ran away for home before it got dark; they and the patient were subsequently winched off the hill by a Royal Navy Sea King.

Flying a single pilot helicopter means the crew have to perform air crew functions as well. What training do your medics undergo in terms of aviation training? Helimed 76 is a single pilot helicopter, with one pilot and two paramedics, designated as Helicopter Technical Crew Members (HTCM). All paramedics undergo the Babcock HEMS crewmembers course, which is two-to-three weeks long and covers fundamentals such as meteorology, principles of flight, helicopter technical subjects, navigation, aeromedical subjects and crew resource management. Navigation exercises are flown in the aircraft and the course culminates in a final line check. Once back at base, we teach them the specifics of our helicopter, as the aircraft used for their course usually has a different avionics fit than G-SCAA. The HEMS crewmember course is a great grounding, but the final line check is basically a licence to learn. For a new paramedic, I like to do an interim line check after about six months just to check progress. What’s been your most challenging case you’ve ever worked on, and why was it more difficult than all the others?

KEY FACTS Scotland’s Charity Air Ambulance (SCAA) was launched in May 2013. Since then, SCAA has responded to nearly 2,300 emergencies. SCAA is a unique model for effective and successful partnership working between the private, public and Third Sectors. SCAA’s operation is very different in the UK’s charity air ambulance services in that it offers a national – rather than county – service. This sees pilots fly far further than their English counterparts – often facing four seasons in one day as they tackle the challenging and ever-changing weather. SCAA’s paramedics, paid for under contract by the charity, are all highly trained and very experienced professionals from the Scottish Ambulance Service. Scotland’s Charity Air Ambulance is funded 100 per cent by the generosity and support from the people of Scotland. SCAA receives no funding from the NHS or any other government body.

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Some of the landing sites can be a bit more challenging than others. On occasions, we have to land further away and the paramedics get a lift to the scene from the police or a passing local. Sometimes the most challenging thing about the job can be the infamous Scottish biting midges, basically teeth with wings, they swarm into the attack as soon as the rotors stop. But it’s all in a day’s work. AirMed&Rescue also spoke to John Pritchard, Lead Paramedic, who helped set up the air ambulance station ready for launch in 2013 and has led the team ever since.

Key figures SCAA is funded entirely by public donations, with over £15,000,000 being raised in 5 years. SCAA employs 6 paramedics seconded from the Scottish Ambulance Service and two pilots, along with an EC135 helicopter, leased from Babcock Mission Critical Services Onshore. There are 3 main components of Scotland’s Charity Air Ambulance – Aviation, Paramedics and Charity staff. As a vital component of Scotland’s 999 emergency response network, operating 365 days of the year, SCAA needs enough front-line staff to meet its 12-hour shift requirements 7 days a week 52 weeks of the year. In total, the charity employs 19 staff and crew – comprising 6 paramedics and 2 pilots, and 11 charity staff. Scotland’s mainland and its 100 inhabited islands represent over a third of the UK land mass. SCAA’s second helicopter – planned for launch from an Aberdeen base by spring 2020 – will add resilience and capacity. While Scotland is the only country in the UK to have Government-funded air resources, SCAA provides the country’s only charity-funded air ambulance – in sharp contrast to the 39 charity helicopter air ambulances operating in England, Wales and Northern Ireland.

What first attracted you to working for SCAA? I have over 17 years’ experience of living and working in a beautiful semi-rural area in Scotland, delivering patient care as part of remote and rural healthcare teams made up of General Practioners, Nurses and Ambulance staff – often on call and responding to incidents that could be at least 50 miles away by road. On occasions, we would be met by a Scottish Air Ambulance helicopter. Working with the Helimed teams, I witnessed the fact that the speed of transferring timecritical patients to definitive care centres was often crucial to the patient’s survival. In early 2013, Scotland’s Charity Air Ambulance (SCAA) was launching its aircraft, based from its central Scottish location of Perth, which would be fully integrated into the Scottish Ambulance Service Air Ambulance Division fleet and 999 response network. Helimed 76 is the first charity air ambulance to launch in Scotland and become an important life line to the people of Scotland. For these reasons, it was an attractive role for any paramedic. 32

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(c) Captain Russell Myles (left) and Lead Paramedic John Pritchard have served with SCAA since the service launched in 2013.

You spent seven years as a medic in the Royal Air Force (RAF) before returning to civilian life – was this a challenging transition for you to make? Having developed my early medical career in the RAF, I was fortunate to work in many remote areas such as the Falkland Islands and Norway, where air transport is key in movement of both people and consumables. This gave me a greater understanding of working with multidisciplinary teams from RAF, Army, Navy and Civilian patients. The move from RAF Medic to Ambulance Service Paramedic was quite easy as both professions have the patient at their heart and a similar discipline and rank structure. Not forgetting the humour that is needed when working at the front line. Continuing professional development is a key part of keeping current for paramedics – what training do you and your team undertake to ensure your emergency medical skills are as good as they can be? Maintaining core emergency medical and trauma skills is essential in the pre-hospital

arena and we are fortunate to have a clinical skills room with a varied selection of training equipment such as airway, trauma and paediatric mannequins to refresh procedures and re-run a unique case that the team has encountered. We learn a huge amount in protected simulation and it also helps with cognitive overload, non-technical skills and working as a team to deliver the best care to the patient within our scope of practice. What’s been your most challenging case you’ve ever worked on, and why was it more difficult than all the others? Sometimes a call comes in where a patient is in a whole heap of trouble somewhere in a remote part of Scotland and you know that you are their best hope of surviving their illness or injury. And if the Scottish weather conspires against you, that hope can soon be in jeopardy. One such call saw us respond to a heart attack patient living away at the head of one of our remote glens. Helimed operations had already been

thwarted that day because of bad weather and we relied on expert flying to get us there. We worked as a team to find a route through the cloud, over the mountains, out to clear skies above the sea and then along the valleys to reach our patient. This challenging flight – for which SCAA’s pilot won a national award – saw the helicopter touch down in front of the remote house, allowing us to rush to the patient’s aid, assess the severity of the heart attack and administer treatment. We knew he was in a serious condition and we knew we had to get him to critical coronary care as quickly as possible – the helicopter was his only chance. Luckily, the weather allowed us to get through to the hospital and the day ended happily for all. Although the patient suffered heart damage in the attack, he made a steady recovery. It’s being able to reach this sort of patient and get them to definitive hospital care that makes the Helimed service so vital - and so rewarding for all of us involved. www.scaa.org.uk

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Under pressure to respond In the first of two articles, James Paul Wallis looks at the role that hospital dispatchers play in the complicated issue of helicopter air ambulance ‘shopping’ in the US healthcare system, a practice that has potentially fatal consequences Wherever a region is served by more than one helicopter air ambulance provider, there is the possibility for helicopter shopping to occur. Writing in a 2008 34

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position paper for the Indiana Association of Air Medical Services (INAAMS), the Association’s President Rex J. Alexander defined helicopter shopping as: “...the practice of calling, in sequence, various operators until an operator agrees to take a flight assignment, without sharing with subsequent operators the reasons the flight was declined by the previously called operators.” Although it’s long been discussed as a

dangerous practice that puts lives at risk, helicopter shopping continues to be a concern. For example, following the fatal crash of a medical helicopter in January 2019, many commentators were quick to point out that two other providers had turned down the flight before Survival Flight accepted the mission. In this article, we’ll look at why helicopter shopping may occur, and how helicopter air ambulance providers can work with those

FEATURE

joint position paper issued in March 2019. Krista Haugen, Co-Founder of the Survivors Network for the Air Medical Community and Director of Patient Safety and Medical Risk Management at Med-Trans Corp, explained why weather information in particular is important: “Weather turn-down is a critical piece of information that must be relayed during any subsequent [helicopter air ambulance] requests so the decisionmakers can be fully informed. Even with

following the fatal crash of a medical helicopter in January 2019, many commentators were quick to point out that two other providers had turned down the flight before Survival Flight accepted the mission

requesting flights to try to prevent it. Good practice It’s not difficult to imagine why a first responder or healthcare facility might make multiple calls, trying to find a provider that will take a flight. As an example, the INAAMS paper describes a nurse with a deteriorating patient in ER that needs to be transferred to a higher level of care. The nurse has the numbers for a few providers and tries each in turn until someone takes the flight. There’s no ill intention here, just a desire to help the patient. As is stated in the INAAMS position paper, the calling of subsequent helicopters is not

necessarily a problem. It all comes down to whether or not information is passed on about who has previously turned down the flight and why. “When a sending facility is transparent, informing helicopter air ambulance providers that a request for transport has already been turned down due to weather, this valuable, time-critical information generally prompts pilots to look closer at weather conditions; this scrutiny, in many instances, has proved to be lifesaving,” stated the Air & Surface Transport Nurses Association (ASTNA), the Emergency Nurses Association (ENA), and the International Association of Flight and Critical Care Paramedics (IAFCCP) in a

current weather tools and operational control centres, there are still significant gaps in weather reporting. Reports of previous weather turn-downs add valuable information and greatly enhance the decision-making process.” Referring to the statement in the INAAMS paper that ‘most hospitals and first responders do not realise the criticality of sharing information regarding flight request turn-downs with subsequently called air medical providers’, Susan Rivers, Programme Director of Carilion Clinic LifeGuard, agreed, saying: “No hospital or first responder agency sets out intentionally to put their patient or medevac providers

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in harm’s way. I believe they simply lack awareness on the history of the problem of self-induced/competitive pressures to fly.” In their joint position paper, ASTNA et al made a nuanced argument that callers may fail to pass on information due to trust in the providers in making an informed decision: “Given how charged this topic can become, hospital staff who call more than one [helicopter air ambulance] provider are not wilfully or ignorantly gambling with the lives of flight team members, as has often been the characterisation. Rather, they make requests in the interest of the patient, with the assumption that pilots and flight teams are the experts on transportation safety and will render an expert’s decision about the safety of the flight.” Education One course of action, then, would be for air ambulance providers to work with first responders and healthcare facilities to improve education and influence protocols for making medical flight requests. The stated goal of the ASTNA/ENA/ IAFCCP collaboration was to educate individuals involved in requesting helicopter ambulance flights, said Sharon Purdom, 36

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ASTNA President. In the paper issued by INAAMS, Alexander voiced a similar aim: “It is the goal of [INAAMS] to solicit the co-operation of all hospitals and first

most hospitals and first responders do not realise the criticality of sharing information regarding flight request turn-downs with subsequently called air medical providers responders, to create and adopt weather sharing policies and protocols. By designing and implementing rules and protocols that cover all aspects of air medical transport for your organisation and staff, you can make a significant impact on the ultimate outcome of your patients. Protocols that include the passing of information in regards to flights previously turned down due to weather are paramount in creating a safer environment for everyone. Written protocols and policies that identify who can call for a

helicopter, when to call and information required to initiate an air medical transport, have been proven again and again to save time and lives during stressful situations.” Reflecting on the project today, Rex Alexander told AirMed&Rescue: “On the whole, our experience was very good. It

was not a matter of individuals not wanting to help stop this practice as much as it was a need to educate them on what it was, why it was dangerous and what they needed to do to help us curtail it.” This was in part thanks to the fact that INAAMS represented every critical care air and ground medical provider in the State at the time. He added: “It was the fact that we had a unified front and voice that we were so successful. If we had tried this as separate entities, we would

not have had the same amount of success. Having the unified front allowed us to have the one voice needed when talking with officials, the State EMS commission, EMS agencies and hospitals in asking for their help to address this problem.” In it together However, there is recognition that it’s wrong to solely place responsibility for promulgating good practice on the requesters. Discussing the joint position paper, ASTNA/ENA/IAFCCP said: “... the phrase ‘helicopter shopping’ does an injustice to not only the problem, but also to the hospital and EMS-based staff who request air medical services.” Patricia Corbett of ASTNA explained that a better term would be ‘selective resource management’, which reflects ‘the shared accountability to communicate vital information to mitigate risk’ and ‘emphasises that patient transport is a shared responsibility’. CAMTS calls for its accredited members to have a written policy to discourage shopping by first responders and other requesting agents. The policy should address ‘how the programme interfaces

with other air medical services in the same coverage area to alert them of a weather turn-down’. CAMTS prescribes a number of steps that providers should take that proactively mitigate against the risk of shopping, including specifically asking the requester whether another flight programme has turned down the request.

By designing and implementing rules and protocols that cover all aspects of air medical transport for your organisation and staff, you can make a significant impact on the ultimate outcome of your patients Casey Ping, who recently retired as Programme Director at Travis County STAR Flight, commented: “I think we as an industry send mixed messages to the requesters. We routinely tell the requester to just call and we will make a decision

about the weather. Call when other programmes have cancelled because we might be able to complete the flight.” He added that the caller’s point of view has to be considered: “We also need to look at this from the requesters perspective. As complex as these decisions are, do we really think we can educate every hospital and EMS requester on when or when not to request a second or third programme? Especially when you consider the frequency of these situations for an individual.” One answer, mentioned Ping, is to have a centralised dispatch centre that first responders and medical facilities contact: “It’s one phone call and they contact the programmes that offer the best solution to the problem. This also helps with specialised needs (weight, equipment, SAR etc.).” Perhaps what matters is to think of this education as a continual process. Susan Rivers said: “I believe the burden remains with the medevac providers to ensure that we press on to continue our education efforts for our requesters and our own peer-to-peer notification systems as a safety net in the meantime.”

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trying his best to keep control of his patients and had clearly been up all night. He had minimal nursing support and resources were scarce. He informed us that the patient had deteriorated overnight. He had become septic, spiking temperatures of 38.5oC and a lumbar puncture had returned positive for bacteria, indicating meningitis â&#x20AC;&#x201C; an infection inside the brain cavity as a result of either the previous brain surgery or frontal skull fractures allowing the entry of bacteria. He was already on appropriate broad spectrum antibiotics to cover the meningitis. His routine bloods from that morning had also returned and had showed a massive acute drop in his haemoglobin level from 12 to 6.1g/dL â&#x20AC;&#x201C; he was bleeding from

THE DANGERS OF

TASK FIXATION

A trauma case in Morocco demonstrates how working for an air ambulance company dealing with foreign repatriations requires the ability to navigate a wide range of unexpected circumstances on arrival to the patient. The medical information received prior to arrival can be incorrect, incomplete or, as in the case described below, the situation of the patient can deteriorate. Dr Kerry Hunter, Senior Flight Doctor of Capital Air Ambulance in the UK, reports As our Learjet 45 touched down on a sunny and calm landing strip in Morocco, we transferred ourselves and our intensive care kit into an ambulance and drove to a small district general governmental hospital. The information that we had received described a young man who had fallen from a three-storey building four days earlier and sustained a large extradural bleed. This had been drained in theatre and the CT report at that time stated that there were 38

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no further spinal injuries and a fracture of the ischium. Deteriorating conditions Waiting outside the intensive care department we were met by some concerned family members and the grave face of the resident ICU doctor. Apparently run ragged as the sole doctor covering a busy 10-bed ICU department, he was

somewhere internally and he was critically unwell and unstable. Before doing anything else, we arranged for an urgent blood transfusion. Blood in many countries globally is a scarce resource, but with the support of the hospital manager, authorisation was given to allow for blood to be retrieved from the blood bank. The only intravenous access in-situ was a very thin bore femoral line, which allowed for

CASE STUDY

only the very slow administration of fluids, so we placed two wide bore peripheral cannulae to allow for the rapid transfusion of four units of blood and tranexamic acid. We also placed an arterial line for closer monitoring of his cardiovascular parameters and to take off blood samples. He very quickly pinked up following the transfusion and his cardiovascular parameters stabilised, albeit perhaps temporarily. His ventilation was also problematic â&#x20AC;&#x201C; he had severe bilateral atelectasis â&#x20AC;&#x201C; probably from a lack of repositioning and suctioning. Despite efforts to re-recruit, he had poor lung function and was requiring 70-per-cent oxygen. The next problem was to work out where the bleeding was coming from. To have dropped his haemoglobin level so acutely he must have lost several litres of blood. There was no bleeding visible. The cranial cavity would not be able to conceal such

presented many logistical hurdles which we had to overcome, as the hospital did not have any portable ventilators or oxygen cylinders, so we transferred the patient over onto our portable equipment. This also required a lot of co-ordination with the local staff in order to make this happen. The CT was not up to the level of a usual trauma scan, but we were able to ascertain that the bleeding was coming from the pelvis due to fractures of both the ischium and trochanter and that an unstable pelvic fracture had been missed on his initial assessment. A pelvic binder, which provides pressure to squeeze the pelvis inwards in order to prevent further blood loss, was not available, so prior to transfer to CT we folded a bed sheet and wrapped this around the hips, maintaining tension with an arterial clamp, an act which has much the same effect. We transferred him onto our vacuum mattress with the intention that this

normovolaemic would in fact be lower than this. At this point we had replaced the critical blood loss, ascertained the source of bleeding and hopefully temporarily controlled the bleeding. This was, however, only a stop gap prior to definitive treatment, which would require an operation to fixate his pelvis and thus prevent further catastrophic blood loss.

would also provide a degree of pressure on his pelvis to prevent further blood loss. The hospital did not have the facility to run blood gases, so we used our bedside iStat machine to test his haemoglobin level, which had now increased to 9.9g/dL following transfusion. His sodium was increased at 159mmol/L, suggesting that he was still very dehydrated and that his true haemoglobin if he was

the decision to transfer a patient to the most appropriate place of safety. It was clear that despite the best intentions of the team in Morocco, they did not have the ability in their resource-poor environment to provide the best level of care to the patient. There was a general surgeon on call, but he did not have the capabilities to perform complex pelvic surgery. They had limited blood products available in their

Careful co-ordination A conference call was rapidly arranged between our team on the ground, our senior medical team back at base and senior medical representatives from the insurance company organising the repatriation. Amidst the din of the hectic ICU unit, we managed to relay the necessary information as to the current situation and a concerted decision was agreed upon. Much of medical repatriation is based upon

a large quantity of blood. His respiration on the ventilator and oxygen requirements had not worsened and examination did not show any signs of a haemothorax. There were no signs of obvious lower limb injury, which could be concealing blood loss, and so this left the abdominal and pelvic regions as the potential sources of bleeding. In order to differentiate between these sites, we organised an urgent CT scan. This

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SAVE THE DATE hospital that could provide an optimal level of care. We received military permission to fly to Gibraltar and from there a Spanish ambulance met us on the tarmac and we made the short drive to a Spanish hospital, where around 10 experienced trauma team members were waiting gloved and gowned up with open arms ready to accept our patient. Within minutes they had whisked him off for a full body trauma CT scan, from where he was directly admitted to ICU and that night was operated on to stabilise his pelvis as well as providing optimal neurological treatment for the meningitis. Two weeks later, he was stable enough to allow for his safe transfer back to the UK.

blood bank if he were to continue bleeding. Despite his instability, it was not an option to leave him where he was. On the other hand, if we were to fly him in our air ambulance, we would also have no access to blood products during the transfer, which would take several hours. The flight would also involve flying over multiple safe places of care â&#x20AC;&#x201C; trauma referral centres which did have the ability to stabilise his pelvis and provide a high level of intensive care management. We decided, therefore, to fly to the closest 40

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Closest appropriate care This case demonstrates the utmost importance within the field of aeromedicine to make appropriate decisions as to the safest place of care for patients, a decision which must take into account many variables and is relative to the current situation of the patient. As is so often the case, this decision comes down in a large part to the ability to communicate effectively within a supportive team environment. This makes the difference between a potentially stressful situation running out of control, to an immense amount of job satisfaction and allowing for a management plan which is the best available option for the patient.

DECEMBER

International Conference on Medical & Health Science Heathrow UK

21-22

IAHCP Joint London Medical Conference London UK

JANUARY 2020

21-23

27-30

Transformative Vertical Flight San Jose US HAI HELI-EXPO Anaheim US

FEBRUARY 2020

International Military Helicopter London UK

MARCH 2020

5-7

16-17

5th Annual Singapore Aviation Safety Seminar Singapore 51st World Congress on Advanced Nursing and Nursing Practice Sydney Australia

APRIL 2020

1-2

51st International Conference on Advanced Nursing Research Paris France

Search and Rescue Conference Georgia US

27-28

6th Annual Congress on Emergency Nursing and Critical Care Rome Italy

A listing in the Marketplace offers service providers and industry associations an opportunity to demonstrate their contribution to the ongoing improvement of safety and security of operators in the airborne special missions sector. To place an advertisement in the marketplace please contact: sales@airmedandrescue.com

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International Commission for Alpine Rescue (ICAR)

Association of Air Ambulances

ICAR provides a platform for mountain rescue and related organisations to disseminate knowledge with the prime goal of improving mountain rescue services and their safety.

The Association provides a platform of representation as a unified national voice for the UK air ambulance community to governments, legislators and the general public.

Contact: ICAR Office c/o Swiss Alpine Rescue SAR, Rega-Center, BimenzĂ¤ltenstrasse 87, 8302 Kloten, Switzerland

Contact: 50 High Street, Henley in Arden Warwickshire, B95 5AN

Phone: +41 44 6543554 E-mail: office@alpine-rescue.org www.alpine-rescue.org

Airborne Public Safety Association (APSA)

Phone: 01564 339959 E-mail: : info@aoaa.org.uk https://associationofairambulances.co.uk/

Royal College of Emergency Medicine

APSA is a non-profit educational, individual membership organisation, founded in 1968 to support and encourage the use of aircraft in public safety.

The College was established to advance education and research in Emergency Medicine.

Contact: 50 Carroll Creek Way, Suite 260 Frederick, MD 21701

Contact: 7-9 Breamâ&#x20AC;&#x2122;s Buildings, Chancery Lane, London, EC4A 1DT

Phone: (301) 631-2406 Fax: (301) 631-2466 E-mail: office@alpine-rescue.org https://publicsafetyaviation.org/

Aerospace Medical Association The Aerospace Medical Association (AsMA) is organised exclusively for charitable, educational, and scientific purposes. Phone: (703) 739-2240 Fax: (703) 739-9652 www.asma.org/home

Contact: 320 South Henry Street Alexandria, VA 22314-3579

Air Medical Physician Association

Phone: +44 (0) 20 7404 1999 www.rcem.ac.uk/

Mountain HEMS Association The Association aims to organise and promote all the activities that contribute to the training and scientific updating of helicopter rescue operators. Contact: S.UEM 118, Via Boehler 5 I-39100 Bolzano

Phone: hemsassociation@gmail.com www.hems-association.com

EU Society for Emergency Medicine

The Air Medical Physician Association is an international organisation committed to patient-focused, quality critical care transport medicine by promoting excellence in medical direction, research, education, safety, leadership and collaboration.

The European Society for Emergency Medicine (EUSEM INPO) is a nonprofit making scientific organisation whose aim is to promote and foster the concept, philosophy and the art of emergency medicine throughout Europe.

Contact: 951 E. Montana Vista Lane Salt Lake City, Utah 84124

Contact: EUSEM, Antwerpsesteenweg 124 B27 B-2630 Aartselaar

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Phone: 801-263-2672 Fax: 801-534-0434 E-mail: Ppeter1111@aol.com www.ampa.org

Phone: +32 3870 4616 https://eusem.org

MARKET PLACE

Australasian Society of Emergency Medicine

Latitude Air Ambulance Latitude takes pride in offering best in class service in Medical Evacuations, Critical and Noncritical Repatriations, Neonatal and Pediatric Transfers, Commercial Escort Logistics and Solution Services, Case Management and Bed Finding Services, and Organ Transfers.

The Australasian Society for Emergency Medicine (ASEM) starts, helps, supports, defends, unites, publishes, advises emergency medicine professionals.

Contact: John C. Munro/Hamilton International Airport, 9300 Airport Rd. Mount Hope. Ontario, L0R IW0, Canada

Contact: ASEM, PO Box 5315 Alexandra Hills QLD 4161

Phone: +1 289 426 1133 Fax: +1 289 426 1132 E-mail: 24.7@latitude2009.com www.latitude2009.com

Phone: (07) 3134 2272 www.emergencymedicine.org.au

African Federation for Emergency Medicine

AAMS AAMS is a non-profit trade association that represents and advocates on behalf of its membership to enhance their ability to deliver quality, safe and effective medical care and medical transportation for every patient in need.

The African Federation for Emergency Medicine is an international coordinating consortium of African national emergency medicine organisations.

Contact: 909 N. Washington Street, Suite 410, Alexandria, VA 22314, USA

Contact: Mike Pienaar Boulevard, Bellville Cape Town, 7535 South Africa

Phone: +(703) 836-8732 Fax: +(703) 836-8920 www.aams.org

Phone: 27219489908 www.afem.info

British Helicopter Association

IAFCCP The IAFCCP is the largest independent paramedic association in the world. Its focus is the professional paramedic, and its purpose is to serve as advocates to the profession on an international basis.

The BHA is the non-profit trade organisation that represents the UKâ&#x20AC;&#x2122;s civil helicopter industry to government departments and international bodies.

Contact: 4835 Riveredge Cove, Snellville, GA 30039, USA

Contact: Unit C2, West Entrance, Fairoaks Airport Chobham, Woking, Surrey, GU24 8HU

Phone: +770-979-6372 Fax: +770-979-6500 www.iafccp.org

European Air Ambulance

Phone: +44 (0) 1276 856100 Fax: +44 (0) 1276 856126 info@britishhelicopterassociation.org www.britishhelicopterassociation.org

Brazilian Association of Helicopter Pilots

European Air Ambulance (EAA) is one of the largest specialised air ambulance service providers in Europe, offering worldwide air ambulance repatriation with outstanding end-to-end patient care.

Associacao Brasiliera de Pilotos de Helicoptero (ABRAPHE) is a non-profit entity with the sole purpose of promoting flight safety.

Contact: Luxembourg Airport, B.P.24, L-5201, Sandweiler, Luxembourg

Contact: Av. Olavo Fontoura, 1078 - Sector C - Lot 7 GoAir Hangar - Field of Mars

Phone: +352 26 26 00 Fax: +352 26 26 01 E-mail: alert@air-ambulance.com www.air-ambulance.com

Cep: 02012-021-Sao Paulo / SP Phone: +55 11 2816-0966 / 11 99969-6761 comunicacao@abraphe.org.br www.abraphe.org.br

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