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ITIC GLOBAL 2016 AIRMED & RESCUE MAGAZINE

magazine ISSUE 81 | DEC 2016 / JAN 2017

ITIC Global 2016 ISSUE 81

Air ambulance sessions, award

Hurricane Matthew

DEC 2016 / JAN 2017

Winds and rain lash Haiti and the US

Through the clouds IFR to extend options in HEMS

DAA’s surveyed landing sites Community engagement aids night ops 22

AIRMED & RESCUE

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Saving Lives. Anytime, Anywhere

Contents

Editor-in-chief: Ian Cameron

HEADLINE NEWS

Editor: James Paul Wallis

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Sub-editors: Christian Northwood, Lauren Haigh, Mandy Langfield, Stefan Mohamed, Sarah Watson Advertising Sales: James Miller, Mike Forster, Paul Noble Production/Subscriptions: Richard Eatwell Design: Katie Mitchell, Tommy Baker, Eli Butler, Steve Mundey, Will McClelland and Peter Griffiths

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ITIC Global 2016 Air ambulance sessions, award

Hurricane Matthew

Winds and rain lash Haiti and the US

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Finance: Elspeth Reid, Alex Rogers, Kirstin Reid Contact Information: Editorial: +44 (0)117 922 6600 (Ext. 3) email: editorial@airmedandrescue.com Advertising: tel: +44 (0)117 922 6600 (Ext. 1) fax: +44 (0)117 929 2023 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

Through the clouds DAA’s surveyed IFR to extend options landing sites in HEMS

Voyageur Buildings, 19 Lower Park Row, Bristol, BS1 5BN, UK

Community engagement aids night ops

Main stories

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.

Printed by Pensord Press Limited © Voyageur Publishing & Events 2016

Finmeccanica is now Leonardo - inspired by the vision, curiosity and creativity of the great master inventor designing the technology of tomorrow.

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Lives depend on you. The AW169 is ideally suited to life-saving primary and secondary EMS missions anytime, anywhere. Easily adaptable, rapidly configurable and uniquely designed around patients’ needs; the AW169 ensures that air medical professionals can provide the best care at the most critical moments.

The tender trap Provider profile: magazine SAR and medevac contract design

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50 Buona notte

Wales Air Ambulance, UK NVG HEMS comes to Italy

AIRMED & RESCUE ISSUE 81 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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Validated SMS

The value of a validated safety management system for air ambulance operators

leonardocompany.com Helicopters | Aeronautics | Electronics, Defence & Security Systems | Space

Cover image: A Bell 429 flown by Air Zermatt, Switzerland (Bell Helicopter)

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HEADLINE NEWS

FAA warns on d-rings

Welcome to Issue 81 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. As AMR has been adjusting to a new bi-monthly printing schedule, it’s been some time since our last edition, but subjectively it feels even longer to me, largely due to the time-stretching effect of being involved in Voyageur Publishing & Event’s flagship conference ITIC Global, with this year’s incarnation being held in Berlin, Germany, in November. It’s an event that caters to the international travel and health insurance industry, a key component of which is formed by the fixed-wing air ambulance providers that fly sick and injured travellers around the world, helping to reunite families and get patients to facilities where they can receive the care they need. As ever, AMR reports on the relevant sessions from the week’s agenda (see p.32) – for the first time, though, you can also watch full video recordings of select sessions on our Vimeo channel, giving perhaps a more nuanced experience of what was said than can be achieved through text alone. Follow the links on the pages. We’ve also been busy with footage on the helicopter side of things, with a couple of films edited from our visit to Helitech in Amsterdam in October. There’s a report compiling the views of some of the exhibitors on where airborne SAR and medevac is heading (www.airmedandrescue.com/video/1627) and footage of Team AAR’s session discussing the Falklands Sar contract, moderated by yours truly (www.airmedandrescue.com/video/1641). Meanwhile, look out for the IIMC safety card included in the mailing wrapper with each print edition of this issue. Provided by VisionZero in association with AirMed & Rescue Magazine, the card carries a procedure for helicopter air ambulance medical crew members to read out to assist pilots flying with Garmin 430/530 stacks who inadvertently enter instrument meteorological conditions, a potentially fatal event. As the blurb on the card explains: “Studies have shown that, in the majority of instances, throughout [an IIMC] encounter, the pilot alone deals with all the necessary actions and often misses vital steps in the process that can have an adverse result, while the crew sit silent ... The aim of this checklist is to reduce the workload on the pilot by involving the crew in the process to ensure no steps are overlooked.” If you’re reading this magazine in a digital format, head over to www.airmedandrescue.com/visionzeroiimc for a link to download the card in PDF form. We hope you enjoy this issue of AirMed & Rescue Magazine. James Paul Wallis Editor editor@airmedandrescue.com

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FAA

Editor’s comment

The Federal Aviation Administration (FAA) has released a Safety Alert for Operators (SAFO) for rescue helicopter crews on the possibility of d-ring reversal or dynamic rollout during winching and longline operations. The SAFO states: “D-ring reversal has directly contributed to several fatal accidents. This phenomenon can be described as the unintended release of the primary engaging ring from the winch hook that may occur subsequent to a pause in the winching sequence.” It continues: “When the ring in the rescue strap and the hook are temporarily relieved of the load, a dynamic condition exists allowing the ring to travel up and flip over the tip of the hook and come to rest on the spring-loaded keeper. The ring is now only supported by the spring-loaded keeper. When the load is re-applied, the ring is forced open and the spring-loaded keeper allows the ring to fall free from the hook.” The FAA recommended a number of actions in order to try and stop this event from occurring, including using only rescue hooks with a mechanical locking keeper or guards, ensuring initial and recurrent winch operational training is tailored for each helicopter type and winch combination, and developing ‘procedures which list the specific d-rings or equipment which may be attached to a specific rescue hook wherein the possibility of d-ring reversal is physically impossible’.

Patient and three crew members killed in plane crash US air ambulance operator American Medflight announced on 18 November the loss of three crew members and a patient after one of the provider’s medical transport Piper PA 31 planes crashed. Local news outlet Elko Daily Free Press reported that the craft crashed into a car park in Elko Country, Nevada, on the evening of 18 November shortly after take-off. The plane was carrying a heart patient who was being flown to the University of Utah Medical Center from Elko Regional Airport. The Federal Aviation Authority (FAA) has reported that there were no known injuries on the ground. So far, the only victim named has been Captain Yuji Irie who, according to American Medflight, was ‘a skilled aviator and had saved hundreds of lives over a long career at American Medflight’. American Medflight said in a statement that it is working closely with the National Transportation Safety Board (NTSB) and the FAA in investigating the cause of the crash. American Medflight added: “As a medical family, we are mourning the loss of our crewmembers and patient … our priority at this time is to look after the well-being of the affected family members and their co-workers and to be responsive of their needs.”

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The head of Wales Air Ambulance has condemned pranksters who shone a laser into the cockpit of its helicopter as it flew on an emergency mission, temporarily blinding the onboard doctor. The aircraft was attending an emergency call on the evening of 5 November (Bonfire Night) when it was targeted several times over Swansea, UK, by what the service said appeared to have been a commercialstrength laser beam. The aircraft’s flying doctor was temporarily blinded in the incident, and required several days to recover. Video footage captured the moment the green laser beam illuminated the inside of the cockpit, which the charity said it has passed on to South Wales Police. Wales Air Ambulance chief executive Angela Hughes said: “Our aircraft was flying a rescue mission and the doctor onboard was temporarily blinded. This could have been

A new docuseries by Red Bull, which follows aerial search and rescue team Air Zermatt, launched on 17 October. In the show, entitled The Horn, Air Zermatt’s pilots, doctors, paramedics and mountain guides carry out life-saving helicopter emergency medical systems (HEMS) missions in the Swiss Matterhorn mountain with the aid of a Bell 429 helicopter. Available to stream for free online, the show is said to provide a real-life glimpse into the team and its rescues, shedding light on how the team members put their own lives at risk when saving others. “It isn’t a show just about mountain rescues, but the rescue scenes are catalysts to learn about our characters, turning a helicopter rescue show into a meditation on what it means to be human,” said Red Bull TV executive producer Josh Cole.

catastrophic. People get laser burns to their eyes and are blinded for life. It is beyond belief how anyone thinks it is clever to do this.” She added that the pilot managed to avert his eyes in time and could carry on flying the aircraft. The incident happened after dark as the air ambulance was returning to its base in Dafen, Llanelli, following a call-out in

Cardiff. Hughes said: “The aircraft was flying at 2,500 ft over Swansea Bay. The fact a laser reached it at that height shows the beam was much stronger than any produced by a standard pen laser. Someone set out deliberately to try to disable our aircraft. We have passed the video footage to South Wales Police and I appeal to anyone who knows who did this to contact the police.”

Watch the series via: www.airmedandrescue.com/story/1624.

RED BULL

SAR docuseries features Air Zermatt team

WALES AIR AMBULANCE

Air Ambulance chief exec condemns laser pranksters

AAA

The winners on stage

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The AAA reported that over 250 people were present to see the awards hosts, BBC News reporter and presenter Sophie Long and Helicopter Heroes presenter Rav Wilding, hand out 11 awards to individuals and

teams at the Millennium Gloucester Hotel in London. Hampshire and Isle of Wight Air Ambulance (HIOWAA) scooped the Air Ambulance Campaign Award for its ‘999 Be a Hero’ campaign, designed to teach young people how to respond in an emergency and to highlight the importance of the Air Ambulance and other emergency services. HIOWAA CEO Alex Lochrane commented: “We are thrilled to be recognised for the success of our ‘Be a 999 Hero’ programme and the part that it has played in spreading our life-saving message to children aged five to 11 across our region.” Elsewhere, Devon Air Ambulance picked up the Innovation of the Year Award, while Dr Mark Wilson of London Air Ambulance won Doctor of the Year, Erica Ley of Essex and Herts Air Ambulance won Paramedic of the Year and Steven Norris of East Anglian Air Ambulance won Pilot of the Year. Rounding off the awards, Alastair Wilson, medical director of East Anglian Air Ambulance received the Lifetime Achievement award for the work he has done for UK HEMS charities, including being a founder of London HEMS.

RED BULL

On 14 November, the Association of Air Ambulances (AAA) held its annual awards ceremony, honouring clinicians, aviators and fundraisers from UK air ambulance charities.

RED BULL

Association of Air Ambulances announces award winners

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CONGRATULATIONS TO AIR ZERMATT ON A SUCCESSFUL FIRST SEASON OF THE HORN Operated by Air Zermatt, the Bell 429 carries out life-saving Helicopter Emergency Medical Service missions on the Matterhorn. The Horn, a Red Bull TV original series, provides a real-life glimpse into most virtuous aspects of putting your own life at risk to save others.

BELLHELICOPTER.COM

© 2017 BELL HELICOPTER TEXTRON INC.

the incredible Air Zermatt team and their harrowing rescues with the Bell 429, shedding light on the


HEADLINE NEWS

HEADLINE NEWS

Blood delivery drone makes first flight in Rwanda

Belgium-based NGO the European Emergency Number Association (EENA) and Chinese UAV maker DJI have released a joint report, The use of remotely piloted aircraft systems (RPAS) by the emergency services. In April, EENA and DJI entered into a partnership for an in-depth analysis of how emergency services use drone technology with the aim of identifying best practices in terms of operational, technical, safety, privacy and legal issues. Four pilot sites were selected for the project, whose teams used UAVs for several months in a variety of

Rwandan officials launched the country’s first blood delivery UAV on 14 October. The programme has been in development for some months in conjunction with US

EENA/DJI

Report identifies challenges of emergency drone use the benefit of RPAS for themselves and we remain available to support them wherever possible.” Steve McLinden of the Med and West Wales Fire Rescue Service comments in the report: “It is apparent the role of drones and the requirements of emergency services in regards to future technologies will increase substantially over the next two to five years. Issues such as longer endurance, [ability] to operate in higher wind speeds, optical devices that work effectively in bad weather and deployable payloads will be a vital requirement for us. In relation to software the ability to securely and quickly stream to remote locations determined by the end user as well as online virtual repositories for the images would be considered an advantage. As a service, we have gained a considerable insight into the use of drones in other European countries and this information has enabled us to develop our operational procedures to deliver an effective and vital response capability for our communities and our staff.”

A drone ready to take off

On 9 November, the US Army’s Company C, 2nd General Support Aviation Battalion, 1st Combat Aviation Brigade (CAB), 1st Infantry Division relocated its headquarters, operations, and aircraft hangar to new facilities recently completed at Bagram Airfield, Afghanistan. It previous home, which was described as old and dilapidated, had been home for US Army air medical evacuation units since 2004.

Read the report via: www.airmedandrescue.com/story/1668.

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treatment, a lengthy delay at a time when swift medical care is critical.” The 16-hour course is designed to make agencies from the Houston area work closer together in ‘unexpected crisis situations’, says Memorial Hermann Life Flight. The programme features both classroom work and role playing scenarios. “By exposing first responders to situations they have never encountered before, they learn quickly how best to evaluate the risks in dangerous situations and make quick decisions that can mean the difference between life and death for the victims of an active shooter incident,” Tarver said. “Through this training, multiple agencies learn strategies and techniques that can help boost survivability in tragedies of gun violence.” Watch more footage here: www.airmedandrescue.com/story/1625

US FORCES AFGHANISTAN PUBLIC AFFAIRS

MEMORIAL HERMANN LIFE FLIGHT

the only air medical transport service in the southeast of the US to offer this particular training service. Over the last year and a half, Memorial Hermann Life Flight has developed its programme, named Tactical Emergency Casualty Care, with the help of the National Association of Emergency Technicians. “Few of these agencies have been trained on how to respond to active shooter events,” said clinical educator and senior flight medic for Life Flight, George Tarver III. “That lack of preparedness means that EMS and paramedics who are thrust into these situations must wait for law enforcement to clear the scene first before they move in to provide lifesaving patient care. In some situations, victims A Memorial Hermann Life Flight helicopter lands during a training exercise may wait several hours for

regular national drone delivery system. Rwandan President Paul Kagame was present at the launch, even stepping in to release one of the drones from a launch catapult. Initially, the fixed-wing drones will deliver blood to 21 clinics in rural areas. The UAVs can travel up to 93 miles (150 km) and up to a speed of 62 mph (100 kph), cutting down delivery time significantly in a country that has poor infrastructure in its rural areas. The blood can be requested via text by a health professional and will be delivered to them within half an hour. “Rwandans have learned to embrace innovation, especially when it is clear that it can help us solve the challenges we face,” said President Kagame. “I hope that this project will inspire more innovation and entrepreneurship in commercially viable technologies in Rwanda.”

New home for Bagram DUSTOFF

Crews train to respond to shooter situations Memorial Hermann Life Flight, part of the Memorial Hermann healthcare system in the US, announced that it has trained over 200 EMS providers, paramedics, firefighters, SWAT team members and corporate emergency response teams across Houston in dealing with active shooter situations. The HEMS service claims it is

drone manufacturer Zipline. The aim is to use the aircraft to deliver blood to hard-toreach rural hospitals across Rwanda. This system is thought to be the world’s first

OFFICIAL TWITTER ACCOUNT OF THE OFFICE OF THE PRESIDENT OF RWANDA

operational scenarios: Mid and West Wales Fire and Rescue Service, UK; Donegal Mountain Rescue Team, Ireland; Greater Copenhagen Fire Department, Denmark; and Reykjavik SAR Team, Iceland. EENA said five key challenges were identified at an early stage, and the participants were asked to identify best practices over the course of the project. These comprised: integration of RPAS in standard operating procedures; training of teams on the use of RPAS; hardware needs and maintenance; logistics; and the external framework for RPAS use. Among the recommendations were to have a minimum of two people to operate the aircraft – one controlling the vehicle, with the second analysing the video footage. It was also suggested that when considering hardware, operators should look at whether the platforms on offer are reliable and boast redundant systems. Tony O’Brien, EENA deputy executive director, said: “EENA would encourage all emergency services to evaluate

The new hangar

Col John M. Cyrulik, 1st CAB commander, and Col G. Shawn Wells, Jr, Area Support Group – Afghanistan commander, thanked all the teams, including the US Air Force 455th Expeditionary Mission Support Group (EMSG), 389th Engineer Company (Iowa Army National Guard), that pulled together to complete the new project. Cyrulik even presented awards to several individuals who played key roles in getting the job done. Wells and 455th EMSG leadership, US Air Force Col Bradford D. Coley and Chief Master Sergeant Eugene Elking, also congratulated each of the award recipients. Cyrulik commented: “Everything we do here, everything, it’s multicompo, it’s soldiers, airmen, sailors, reservists, National Guardsmen, from all the compo’s, from all the services … That’s the only way we get work done around here. It’s by consummate teamwork.” The new hangar is dedicated

to retired Maj. Gen. Patrick H. Brady, who earned the Medal of Honor for his gallantry as a medevac helicopter pilot in Vietnam. He also designed the unit emblem still in use by Company C. Kelly was killed in action in Vietnam. The former home, Building 960, has some history of its own. The hangar was originally built by the US in the early 1950s for the Afghan government, but was later occupied by the Russian military throughout the 1980s. The Taliban used the hangar from 1990 until they were ousted by US forces in 2002. It was named the Evan W. O’Neill Hangar as a dedication to the 10th Mountain Division private first class infantryman who was killed in action in 2003. 1st CAB has relocated the memorial stone and rose bushes to a place of honour near the new facility. Although the plaque commemorating the dedication disappeared some years ago, the soldiers here researched and found an old photograph online and a replica of the original plaque is being made. Building 960 is slated for demolition later this year, and after the ribbon cutting on the new facility, Cyrulik and Wells wielded sledge hammers to ceremoniously take the first demolition swings.

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HEADLINE NEWS

HEADLINE NEWS

PHOENIX AIR

On 18 November, the US Department of State demonstrated the US government’s new Containerised Biocontainment System (CBCS) at Dulles International Airport, Virginia, US. The system, called ‘state-of-the-art’ by the Department of State, facilitates the aeromedical transport of critically ill patients who require biocontainment, such as those suffering from infectious diseases like Ebola virus.

The event was part of an exercise, named Tranquil Surge, which saw the CBCS return from Monrovia, Liberia in a retrofitted Boeing 747 aircraft. The CBCS unit is the first of its kind, according to the Department of State, and has become viable due to a partnership between Paul G. Allen Foundation and the Department of State. The system will use specially fitted transport containers to take four to six critically ill patients at a time. The hope is that the new system will be a ‘revolutionary step towards the future of global biosecurity’ and aims to learn from the 2014 Ebola outbreak. The Departments of State and Health and Human Services scheduled a series of four tests on the new unit to test its capabilities. The 747 was operated by Kalitta Air and Phoenix Air.

EURAMI elects new board The European Aeromedical Institute (EURAMI), an air ambulance membership organisation and accreditation body, recently held its annual general meeting at ITIC Global in Berlin, Germany. During the meeting, three members of the sixstrong board stepped down, and an election was held to select replacements. Prior to this, a motion was passed to amend the Institutes statues to allow board members to serve for four years instead of two, as was previously the case. Lisa Humphries (Capital Air Ambulance) and Dr Cai Glushak (AXA Assistance USA) replaced outgoing board members Anne Rodenburg (AirLink Ambulance) and Sean Culligan (Awesome Air Evac). Philipp Schneider of Quick Air Jet Charter took over from Mark Jones of Air Ambulance Worldwide as treasurer. The new members, who won out against fellow candidates David Fox (Fox Flight Air Ambulance), Mike Vallee (Air Ambulance Worldwide) and Brian Weisz (reva), join Dr Laurent Taymans of International 14 14

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SOS and Pascaline Wolfermann of United Healthcare Global, who under the new rules continue in the roles of president and vice-president respectively for a further two years. Franziska Hollenstein of Prime Nursing Care also continues to serve as a board member. Taymans, whose term as president now runs until 2018, told AMR that while the standard term for a board member has increased from two to four years, board elections will still take place each two years as before, with three places being up put to the vote each time. This ‘staggered’ election schedule will allow for greater continuity, he said. Schneider last served on the board as interim EURAMI president after Michael Weinlich (Med Con Team) stepped down from the role in August 2012, before Taymans was elected as president the following November. The Institute’s revised standards have been submitted to the courts in German for the required validation.

waypoints An Air Transport Europe helicopter crashed late on 7 September resulting in the deaths of the three crew members and one patient onboard. The Bell 429 came down near the village of Strelniky shortly after the crew began the flight to take a 38-yearold man with a broken leg to hospital in Banska Bystrica. Air Ambulance Northern Ireland and the Northern Ireland Ambulance Service Health and Social Care Trust (NIAS) have both joined the UK Association of Air Ambulance (AAA) as full members. Dr David McManus, NIAS medical director, said: “The Northern Ireland Ambulance Service is delighted to become a member of the Association of Air Ambulances and looks forward to working with AAA.” On 16 September, an air ambulance crashed in Fars, Iran, according to Iranian media reports. All onboard were said to have been killed. The helicopter was taking a patient from a remote area of the countryside to the city of Shiraz when it crashed, said State TV. Four medics were also onboard. CHC Helicopter has announced its inking of a deal with the Australian Army to provide aeromedical evacuation and crash response support for deployments throughout Australia. The 21-month contract commenced on 1 October and runs up to 30 June 2018. GainJet Aviation, a Greek VIP charter and management provider owned by the Gulfbased Alghanim Group, is acquiring new planes for medevac operations, specifically with the aim to expand into Africa. According to the company, Africa presently accounts for 15 per cent of its charter and management business. It is reportedly considering Rwanda as a base for its operations. Three crew members were injured in a medical helicopter crash in Alexandria, Oregon, US on 17 September. The North Memorial Health Care aircraft en route to pick up a patient from the Douglas County Hospital when it crashed near Lake Winona, north of the Alexandria Municipal Airport. All three passengers were then placed into critical care.

US Air Force working on improved stretcher Scientists from the US Air Force School of Aeromedical Medicine (USAFSAM) are assisting with the testing and evaluation of a new aeromedical stretcher design that puts an emphasis on the safe transport of traumatic brain and spinal injury patients in air and ground vehicles. Cornerstone Research Group (CRG) of Dayton, Ohio, US, first developed the stretcher, and entered into cooperative research with USAFSAM in 2013. USAFSAM supplies medevac experts and access to C-130 Hercules and C-17 Globemaster III high-bays for ongoing device compatibility and testing and evaluation. CRG began the design of the device under an agreement with the US Army, but went on to work with the Air Force so that the design could result in a common stretcher

platform between the services, thus eliminating the need to transfer a patient from an Army stretcher designed for ground transport to an Air Force stretcher designed to interface with airborne medical systems. One of the major changes is that the stretcher is rigid; the current standard stretcher can bend more than six inches (15 cm) in certain conditions. The stretcher also has a specialised mattress pad to eliminate bed sores. The new foot replacement can also absorb shock and vibration while in transit. The new design still meets the NATO design standards for loading, altitude and vibration. “Our goal is to exceed safety requirements for use and safety. Feedback from users and access to the military vehicles for testing has been hugely beneficial,” said Kristin Cable, team leader with CRG. “Having adequate spinal immobilisation

is very critical when transporting patients with these types of injuries. Our wounded warfighters experience a much rougher ride back to definitive care than we experience stateside,” said Dr David Burch, a biomedical engineer with the 711th Human Performance Wing. “Military medical transport relies on vehicles of opportunity, which were never designed to provide a smooth ride. There is a lot of vibration and perturbation from turbulence or terrain gets transmitted to the patient, making adequate fixation necessary to prevent further neurologic damage.”

US AIR FORCE

Six-patient Ebola evac system launched

New partnership set to benefit Queensland, Australia The Royal Flying Doctors Service (RFDS) and RACQ LifeFlight have announced that they will be providing a joint service for residents of Queensland, Australia. The RFDS has said that co-ordinated operations will be overseen by a new Aeromedical Joint Operations Oversight Committee, meaning that patients will benefit from the most appropriate aircraft and personnel being used for each individual mission. Chaired by Mount Isa mayor Tony McGrady, the committee held its first

meeting on 6 October. “Our approach is to work collectively and cooperatively to provide operationally efficient and cost effective lifesaving aeromedical services to the communities we serve,” said LifeFlight CEO Ashley van de Velde. The first step towards the partnership was co-locating both companies’ assets in RFDS’s hanger, said van de Velde. He added: “There will be many occasions when a rescue helicopter is the appropriate aircraft to deploy and we envisage there will also be occasions

when a combined response with an RFDS aircraft will lead to a better patient outcome.” McGrady also saw the benefit in the cooperative effort: “This is a great outcome for the region and deserves our support to ensure the long-term viability of the region’s aeromedical services. I agreed to chair the Aeromedical Joint Operations Oversight Committee because the success of the initiative will ensure the people of our region can access the very best aeromedical care when needed.”

CCAT hits training centenary CCAT Aeromedical Training has announced the completion of its 100th three-day advanced level aeromedical seminar on 9 September. The milestone was completed as the company celebrates 20 years of teaching. The course saw 93 attendees over the three days of the programme travelling to stay in the Royal Lodges in Windsor Great Park, UK, in order to learn and discuss issues relating to medical transport on commercial airliners, medical emergencies in flight, human factors in aeromedical transport,

case handling in medical assistance, and more in depth reviews of clinical and logistic case studies. CCAT Aeromedical Training said that the course saw participants having ‘frequent discussions on pertinent medicolegal and updates on lots of relevant hot topics’. A CCAT foundation level course was held earlier in July in the University of Surrey, UK with 30 ‘enthusiastic’ participants from all over the world and with differing levels of experience. The group visited London’s Air Ambulance, the new British Airways

crew training centre and Andark for sea survival training. The courses, collectively known as CCAT, have also been delivered in 11 other centres around the world. Educational director, Dr Terry Martin, started the not-for-profit organisation in 1996 and has grown the suite of courses steadily over the years to cover all aspects of aerospace medicine related to patient transfer, as well as the logistics and organisational aspects of operating both helicopter and fixed wing air medical, retrieval and transport services.

www.airmedandrescue.com

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HEADLINE NEWS

HEADLINE NEWS

UK government awards funds to HEMS charities

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A 3D plan of Wiltshire Air Ambulance’s new base

for the first time. As has been the case since the charity was established, we continue to rely on donations and grants and make no demands upon the taxpayer to fund our vital service. However, I would like to thank those local [members of Parliament] who lobbied on our behalf since without their help this funding would not have happened.” He added that the total cost of the base will be £5.1 million. Thanks to the new funds, the charity has just £1.3 million left to raise. Great North Air Ambulance Service (GNAAS) had applied for £1.9 million to build proposed new base and medical centre. Chief executive of GNAAS, Grahame Pickering, commented: “The £1 million we have been allocated is a welcome boost towards this project, though the £900,000 shortfall leaves us with some work to do to reach our target. It’s a shame that the decision leaves something of a question mark over a project which will ultimately save lives and ease suffering of patients, young and old. However, we are well accustomed to overcoming such hurdles and will be re-examining our contingency options to determine how best to make our dream become a reality.” Elsewhere, Cornwall Air Ambulance will be putting the money towards new helicopters, as will Great Western Air Ambulance, Midlands Air Ambulance, Kent Sussex and Surry Air Ambulance.

UPS

“We are now flying into the hours of darkness. We have been working hard with the community since January to build a network of community night landing sites. These sites are pre-surveyed and have state-of-the-art technology with remote switching to turn on and off the lights at scene,” Nigel Hare, operations director of Devon Air Ambulance, said. “Communities have very much taken ownership of their own landing site, not only funding them but also undertaking to ensure they are kept in good order. Even though the communities would still need to raise the funds to buy the equipment, the grant would be available to fund the cost of installing the flood lighting.” The charity says it will be able to open 300 community landing sites with the money. Wilshire Air Ambulance is proposing to its share of funding towards building a new permanent airbase. The charity said it has already been given planning permission to build on a site in Semington. David Philpott, chief executive of Wilshire Air Ambulance, said: “We are delighted to have been awarded this £1-million grant from Her Majesty’s Treasury towards our new airbase. The funding will be used to complete the building, equipping and fitting out of our purpose-built Operations Centre and will bring together the aircrew, helicopter and charity team onto one site

WILTSHIRE AIR AMBULANCE

Eleven of the UK’s air ambulance charities have announced that they will be receiving a share of £10.8 million allocated by Chancellor of the Exchequer Phillip Hammond from the LIBOR Fund, made up of banking fines, for air ambulance operations. The announcement was made on 23 November as part of the Chancellor’s autumn statement. The money will be divided equally, meaning that each charity will receive just under £1 million. The Association of Air Ambulances (AAA), which represents the majority of UK air ambulance providers, said that the allocation ‘once again shows support for those who demonstrate the best values of British society from fines of those who demonstrated the worst’. Clive Dicken, AAA national director added: “We are delighted with the Chancellor’s announcement today and thank him for giving 11 air ambulance charities significant support. These sums of money will absolutely enhance life-saving pre-hospital emergency care across the UK.” The 11 providers that are set to benefit are: Cornwall Air Ambulance Trust, Devon Air Ambulance, Great North Air Ambulance Service, Great Western Air Ambulance, Kent Surrey Sussex Air Ambulance, Lincolnshire and Nottinghamshire Air Ambulance, MAGPAS Air Ambulance, Midlands Air Ambulance, The Air Ambulance Service, Wales Air Ambulance and Wiltshire Air Ambulance. Wales Air Ambulance has been one of the services to speak about the funding, and has announced it will be using the money to increase flying hours and put into action its plans for night operations. “It’s the charity’s vision to become a 24hour operation, and this donation from the LIBOR fund takes us a step closer to reaching that goal,” Wales Air Ambulance chief executive Angela Hughes said. “Our bid set out how a donation from LIBOR would help us to set up a fully-functional night operation for the whole of Wales, enabling us to carry out paediatric, neonatal and adult missions onboard our aircraft. We’re delighted to have secured £1 million, which will cover one third of our costs for night flight planning.” Devon Air Ambulance will also be using the money to facilitate night landings.

UPS plans to deliver medical supplies via drone

UPS has announced that it will be trialling the use of drones to deliver medical supplies in time critical situations. The delivery company has teamed up with drone manufacturer CyPhy Works to test out the possibilities of making deliveries of this kind to hardto-reach locations. The companies staged a mock delivery of urgently needed medicine from Beverly, Massachusetts, US to Children’s Island on 22 September. The island lies three miles off shore in the Atlantic Ocean. The test saw a self-driving drone fly an asthma inhaler to the island, which is not reachable by automobile. UPS has said that the test was a success. “Our focus is on real-world applications that benefit our customers,” said Mark Wallace, UPS’ senior vice-president of global engineering and sustainability. “We think drones offer a great solution to deliver to hard-to-reach locations in urgent situations where other modes of transportation are not readily available.” The new research has been given the go-ahead after the expansion of drone use in the US into the commercial sector by the Federal Aviation Administration (FAA). UPS says that it intends to work closely with the FAA in its new venture, but states that the new rulings are ‘a step in the right direction’. “We’re thrilled to partner with UPS in this endeavour,” said Helen Greiner, CyPhy’s founder and chief technology officer. “Drone technology used in this way can save lives and deliver products and services to places that are difficult to reach by traditional transitinfrastructures.”

www.airmedandrescue.com

1717


FEATURE

HEADLINE NEWS

Earthquake New Zealand

DJI

Drone manufacturer DJI and Irish tech start-up DroneSAR announced a new search and rescue (SAR) app that will aid in SAR searches, feeding data from a drone into incident management software to help rescue crews to use drones to save lives. The app can stream live images and video, both from regular and thermal cameras, to an incident centre or team on the ground. The software, say DJI and DroneSAR, can also tag the GPS coordinates of a victim, transmitting back via SMS or email. Search patterns are also logged so it is easier for multiple search crews to use the software. “From understanding on how to use the technology, to communicating findings and data, to figuring out the most appropriate tactical approach, first responders can benefit greatly from this software app on our DJI hardware,” said Romeo Durscher, director of education at DJI. “Many of the tasks and strategies deployed during a search and rescue operation can get sped up with automation, helping to reduce the time it takes to find a victim and save lives.” The software has been developed in conjunction with the European Emergency Number Association and Ireland’s Donegal Mountain Search and Rescue team. DJI and

CORPORAL AMANDA MCERLICH / NZDF

New drone software will help SAR first responders

A screenshot of the app

DroneSAR claim that the software enables a drone to search an area of one square kilometre in 20 minutes. “Our aim is to save lives,” said Oisin

McGrath, co-founder and CEO of DroneSAR. “Our software will reduce risk to search teams and reduce search time. If we can save just one life, that is mission success for us at DroneSAR.”

New immersive training centre opened for HIOWAA crews

HIOWAA

In the UK, Hampshire and Isle of Wight Air Ambulance (HIOWAA) has announced a new simulation training facility in Thruxton. The new facility is said to have a number of useful training functions, including

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AIRMED & RESCUE

the ability to project a series of mock incident scenes, complete with movement and sound. The crew is currently able to simulate a multitude of different training environments, from a busy nightclub to a Hampshire forest. HIOWAA hopes to add more scenes, with proposed scenarios including the New Forest, the Helipad at St Mary’s Hospital Newport and the resuscitation room in University Hospital Southampton. “This exciting piece of equipment allows us to safely practise many of the technical and non-technical skills that are required of a critical care team,” said HIOWAA consultant paramedic, Els Freshwater. “At a recent training day we were able to simulate a number of scenarios, including a

patient who had fallen in a forest, a cyclist who had been knocked off a bicycle on a busy road and a pedestrian who had been hit by a van in a residential area.” The charity has also gained a simulated patient monitor called an iSimulate. The equipment allows those training to be given life-like feedback on the condition of their patient in the situation. It aims to add another layer of realism to the experience to help crews practise important skills. HIOWAA CEO Alex Lochrane commented: “Hampshire and Isle of Wight Air Ambulance is one of the few air ambulance services in the country to benefit from this pioneering technology. The new immersive training suite is an example of our commitment to remain at the forefront of pre-hospital emergency care, continually improving the service that we are able to provide to our patients.”

A Royal Canadian Air Force CH-124 Sea King helicopter slings a load of supplies to an awaiting ship near Kaikoura, New Zealand

Lauren Haigh covers the air rescue response following November’s earthquake in New Zealand In the early hours of 14 November, a 7.8-magnitude earthquake struck New Zealand’s south island, causing up to 100,000 landslides. The earthquake triggered a tsunami warning and was followed by hundreds of aftershocks, some stronger than 6.0. Emergency crews worked as part of a relief effort to help people in the affected areas, rescuing those stranded due to blocked roads and damaged buildings. These efforts were hampered by gale-force winds and rain, but rescue personnel persevered. The Chinese Consulate in Christchurch rented two helicopters to evacuate 41 Chinese tourists from the coast town of Kaikoura to Christchurch on 14 November. The next day, three more helicopters joined in, evacuating 85 Chinese tourists. “Many people helped in the evacuation, including staff of the helicopter company, local residents, and overseas Chinese in Christchurch,” said deputy consul-general in Christchurch Li Xin. “The successful evacuation is really the result of collective effort.” Her Majesty’s Canadian Ship (HMCS) Vancouver, meanwhile, assisted the people of New Zealand affected by the quake, along with its CH-124 Sea King helicopter and air detachment. At the time of the earthquake, the Royal Canadian Navy frigate was preparing for a goodwill visit to celebrate the 75th anniversary of New Zealand’s naval forces with other allied forces. The ship helped evacuate people from the affected area and assisted in transporting emergency supplies by air as the majority of roads and rail lines were disrupted. “HMCS Vancouver’s rapid shift from training and naval operations to assisting earthquake victims in New Zealand is testament to the professionalism and capabilities of the Royal Canadian Navy,” said Canada’s Chief of the Defence

Staff General Jonathan Vance. The New Zealand Defence Force (NZDF) deployed four Air Force NH90 helicopters to help evacuate tourists and residents from Kaikoura. “We have mobilised additional assets to support the Government’s response to the earthquake, and we have been working with the Ministry of Civil Defence to ensure the lifelines and basic needs of the Kaikoura community are met,” said acting commander of Joint Forces New Zealand Darryn Webb. On 19 November, US Navy destroyer USS Sampson (DDG 102) and two embarked MH-60R helicopters from Helicopter Maritime Strike Squadron (HSM) 73 concluded relief efforts to support the residents of Kaikoura, having directly supported the Government of New Zealand onsite at Kaikoura over. Over two days, the helicopters completed 14 flights, lifting equipment and supplies from Royal New Zealand Navy multi-role vessel HMNZS Canterbury to the shore and also took the mayor of Kaikoura on a visual inspection tour of the surrounding area. “Words cannot express the enthusiasm that the crew and I have about being here helping those affected by the earthquake, while representing the US,” said Sampson’s commanding officer Commander Tim LaBenz. “Operating in close concert with our counterparts in the Royal New Zealand Navy signifies the deepening bilateral partnership we have with them and with the Government of New Zealand.” A number of regional helicopter pilots flew into the region and offered their services. Among these was Wanaka’s Pete Spencer-Bower who, over the course of a week, was part of an operation that flew up to 800 quake survivors to safety and travelled in and out of Kaikoura with food and supplies. “Every single one of these parties, and every single person involved, makes a difference and we are grateful for all the hard work being put in across the country,” said Ministry of Civil Defence and Emergency Management Director Sarah Stuart-Black.

www.airmedandrescue.com

1919


INDUSTRY VOICE

Essential reading for global travel and health insurance professionals www.itij.com

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AUTHOR DOMINIC ACEVEDO Dominic Acevedo is the director of safety for Reva Air Ambulance, US. He is an IATA-certified aviation management professional and accomplished aviation safety professional with 16 years in the aviation industry.

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The aviation industry has been changing rapidly for the last decade and, through regulation, safety management has started to envelop all commercial operators. In 2010, Bermuda Civil Aviation initiated a requirement for all operators involved in FAR Part 91 and 125 or equivalent to be compliant with ICAO Annex 6, Part 2, Section 3. One of the changes that we will be looking at is the requirement to have a safety management system (SMS) in place. An operator could quickly comply with this requirement by going through a third-party SMS provider to receive a certificate of compliance. However, a manual on a bookshelf is not an implemented programme. Some years later, the European Aviation Safety Agency (EASA) and the US Federal Aviation Administration (FAA) recognised this and began the rule-making process for commercial operators to have a validated SMS in place. In 2014, EASA published a new requirement for a single EU-wide safety authorisation that would allow commercial operators to fly to and from the EU. This authorisation is called Part TCO (third country operator) and had a mandate of 24 November 2014 to apply for the authorisation. Those operators who were fortunate enough to apply and receive their TCO number must ensure they are part of the SMS Volunteer Program under the FAA or have a fully validated programme under EASA. Failure to meet these requirements would prevent a commercial operator from flying to and from the EU after 26 November 2016. The FAA currently has a set of implementation standards under CFR Part 5 for FAR Part 135 Operators who would like to be validated. In my opinion, after having gone through half of this process [at the time of writing], it is well worth the effort. This process brings the operator and the FAA closer together as a team and enhances the working relationship between them.

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1


EQUIPMENT

EQUIPMENT Embedded WAAS/GPS

Touchscreen

Weather

Traffic

ADS-B In/Out Compliance

NOTAMs & TFRs

Helicopter unveiled for neonatal and paediatric patients On 27 October, Flight For Life Colorado (FFLC), the critical care transport service of Centura Health, and Children’s Hospital Colorado (Children’s Colorado) announced plans to expand its critical care transport services to include a new helicopter specially configured to meet the needs of neonatal and paediatric patients. The aircraft will be staffed by nurses and respiratory therapists from the flight crew based at Children’s Colorado. The service said that the interior space in the new aircraft, an Airbus H130 T2, provides a platform for an incubator and other equipment essential to newborn transport. The aircraft will be based in Denver and supplied by Air Methods, provider of FFLC’s current helicopter fleet, along with pilots, mechanics and supporting services. It will be dedicated

for the exclusive use of the FFLC team based at Children’s Colorado and provide transportation to children within its 120mile (195-km) service area. The machine is expected to take flight in early 2017. Kathleen Mayer, director of FFLC, said: “Flight For Life Colorado pioneered the hospital-based critical air transport industry at St Anthony Hospital in 1972 and we have worked closely with Children’s Colorado since 1997. To work with Children’s Colorado to expand and strengthen our partnership and commitment to the community to deliver exceptional care during transport is most gratifying to all of us at Centura Health.” Joe Darmofal, director of flight team, outreach and education at Children’s Colorado, commented: “The new helicopter, the first of its kind for

Children’s Colorado and our seven-state region, is designed to support the special care required for neonates and children. Children transported by specially trained teams, such as those at Children’s Colorado/ Flight For Life Colorado, have improved outcomes and fewer complications. Meeting the needs of our families and communities was a big part of our decision to select this larger aircraft, which can not only handle Colorado’s high altitudes and hot summers, but is also quieter and more fuel efficient.” In addition to the new helicopter, FFLC said it will provide paediatric advanced life support/basic life support ground ambulance services, and will transport an estimated 4,000 paediatric patients annually among Children’s Colorado Network of Care facilities in the Denver metro area.

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Air medical operator Air Alliance has been awarded multiple supplemental type certificates by the European Aviation Safety Agency (EASA) for its comprehensive avionics modification package for Learjet 35 aircraft. One of them is for its dual Rockwell Collins AHS-1000, which Air Alliance says is highly reliable and reduces operating costs. The Learjet 35 is the first plane to have been given EASA approval for the installation of the attitude heading reference system modification kit, and has been designed to replace previous generation analogue and iron gyro systems, says Air Alliance. The company says the kit requires no air data sensor input, eliminates costly aircraft re-wiring and ‘offers operators a costeffective upgrade solution from traditional iron gyros and AHRS technology’. The AHS-1000 is also lighter and smaller than the previous systems and uses digital quartz micro-electro-mechanical systems (MEMS) to measure the aircraft pitch, roll and heading Euler angles instead of the traditional spinning gyros. The company says the system can ‘withstand extreme environments involving high roll rates and vibration’.

The Dual Rockwell Collins AHS-1000 system

Wi-Fi Traffic & Weather to your ForeFlight App 23

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EQUIPMENT

EQUIPMENT

CONG

A Black Hawk emptying its Bambi Bucket on the fire.

UK Coastguard trials new SAR plane

24 24

AIRMED & RESCUE

successful options for permanent provision will be explored, possibly in combination

with similar requirements elsewhere in Government.

Boston MedFlight, based in the US, has taken delivery of a new King Air B200 turbine jet air ambulance, according to supplier Jet Logistics. The air ambulance has been run though Jet Logistics’ ‘Aircraft P.L.U.S’ programme, which involves the refit and sale of aircraft to air services providers. Eric Giangiordano, Jet Logistics’ director of business development, says that each

The Australian Navy has announced the testing of its new unmanned aircraft system (UAS). The ScanEagle UAS, developed by Melbourne, Australia-based company Sentient Vision Systems, uses a Visual Detection and Ranging system (ViDAR). This system is similar to RADAR, but instead uses a camera to scan and record a 180-degree view, which is then run though software to search for anomalies. Aviators Air Rescue Pvt Ltd, based in India, has leased three Airbus H130 helicopters from Lease Corporation International. The company stakes its claim as the country’s first civil helicopter emergency service with advanced life support capabilities. The aircraft will be used for emergency medical service missions. German air medical provider Quick Air Jet Charter has reported that for the past three months, it has been using pump sprays and mosquito nets to protect its patients and crew members from insect transmitted diseases. The firm says it is willing to support other air ambulance companies with the products at a cost of $1,000 per net plus bag. The Royal Flying Doctor Service (RFDS) in Australia has announced the acquisition of two neonatal transport incubators worth close to AU$180,000. The two pods were donated to the service by the Humpty Dumpty Foundation charity and will be housed at the RFDS Dubbo base.

HM COASTGUARD UK

From September 2016, HM Coastguard is trialling a Jetstream 41 turboprop aircraft as part of a development to support its search and rescue (SAR) helicopters. The new plane, which is painted in red and white HM Coastguard colours, will patrol the southern and eastern seaboard of the UK. The Coastguard said the aim of trial is to assess whether a fixed-wing aircraft will provide valuable additional support for its SAR helicopters. The new capability will help save lives at sea by identifying people, boats or ships in distress, said the organisation. The Coastguard Jetstream is provided by Eastern Airways on behalf of Bristow Helicopters and has a dedicated crew. The aircraft will be controlled through the Aeronautical Rescue Coordination Centre (ARCC), just like HM Coastguard’s SAR helicopters. It will be tasked where there is a risk to life, and in support of the helicopters. According to the Coastguard, if the trial is

The UK Children’s Air Ambulance is acquiruing two new AW169 helicopters under a £32m deal. The service said the investment will enable it to help every child who needs a life-saving flight. The new aircraft will begin flying sick children in 2017 and will provide cover seven days a week, 19 hours a day from new bases in the north and south of England.

JET LOGISTICS

The Colorado National Guard (CONG) assisted civil authorities with extinguishing the Junkins Fire after Governor John Hickenlooper gave a verbal executive order for the service to lend its support. The fire started 11 miles (18 km) east of Westcliffe in Colorado, US, on 17 October, before spreading over 16,800 acres. CONG sent two water bucketequipped UH-60 Black Hawk helicopters to fight the fire. The helicopters were able to unload their first Bambi Bucket of water onto the blaze at 15:20 hrs. “The Colorado National Guard is here to help local, state, and federal authorities contain this fire as quickly as possible. We’ll remain on scene as long as we’re needed,” said Maj. Gen. H. Michael Edwards, adjutant general of Colorado. “Our mission is to protect our communities and save lives and property.” By November, the fire was contained, but was still smouldering as late as 23 November.

Jet Logistics supplies new King Air B200

waypoints

German commercial jet fleet operator FAI rent-a-jet AG has announced a one-year public tendered contract to operate two Learjet 60s out of Algiers, Algeria for medevac and other missions. Operations for the new contract will begin before the end of 2016 with two aircraft and operating crew setting up a base in Algiers.

JET LOGISTICS

Colorado National Guard lends support to fight Junkins Fire

aircraft needs to be refitted with regard to its client’s ‘operational criteria, budgets and logistics’. He continued: “Our team has first-hand expertise with the acquisition, modification, operation and maintenance of turbine jet aircraft utilised specifically for critical care transport.” The refitted King Air B200 features a glass cockpit with ProLine 21 avionics suite, twin Pratt & Whiney PT6A-42 turbine engines, and various interior and exterior modifications. The system inside, including nonskid flooring, sanitary-friendly interior materials, satellite tracking, cabin intercom system to facilitate personnel communication and patient care in-flight, and a Spectrum 2800-series medical stretcher system, has all been CAMTS approved. Jet Logistics will also continue to manage Boston MedFlight’s fixedwing air medical transport operations. W. Ashley Smith Jr, the founder and president of Jet Logistics Group, said: “As with any partnership, the project’s success was dictated largely by the cooperative efforts of both Jet Logistics and Boston MedFlight. We look forward to the aircraft contributing to Boston MedFlight’s life-saving missions for their hospitals, patients and community.”

Medical interior installed for Ornge Moosonee base An Ornge AW139 helicopter deployed to a remote base located in Moosonee, Ontario, Canada has received a new medical interior from Spectrum Aeromed. Anthony Sharp, Ornge base manager, said: “This aircraft will serve a vital role in serving the community surrounding Moosonee. We are thrilled to have the

system from Spectrum Aeromed in our 11th AW139. This will replace another older aircraft that previously served the James Bay region. Because of the extreme conditions it is also vital to have a rugged system that can endure the harsh environment.” The interior includes an articulating stretcher and a three-drawer medical cabinet.

www.airmedandrescue.com

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MISSIONS

MISSIONS

SÉCURITÉ CIVILE

The last passengers are brought to safety

The French Interior Ministry has congratulated the teams involved in what it described as a ‘delicate operation’ to rescue 110 people stranded on the Panoramic Mont Blanc cable car at 3,800 m (12,500 ft) above sea level between Aiguille du Midi and Helbronner. A number of gondolas came to a halt in mid-air due to a ‘technical problem’. Four helicopters evacuated 65 of the tourists on 8 September before worsening conditions meant that no more hoists could be carried out. After what must have been an uncomfortable overnight stay, the remaining passengers were all taken to safety on 9 September. Interior Minister Bernard Cazeneuve paid tribute to the Sécurité Civile helicopter pilots, along with the Chamonix police and Haute-Savoie firefighters who took part in the air rescue, noting that the mission was successfully completed in difficult and dangerous conditions.

The combined search and rescue attempts of a drone, a helicopter and a ground team helped to find, and safely return, a man lost in the Carlos Avery Wildlife Management Area, Minnesota, US on 21 September. The man, a small game hunter, lost his way and found himself stuck in a swamp, waist deep in water. The rescue crew consisted of personnel from the Anoka County Sheriff ’s 26 26

AIRMED & RESCUE

MINNESOTA DEPARTMENT OF NATURAL RESOURCES

Hunter rescued by combined aerial effort Office, Minnesota State Patrol, Saint Paul Fire Department and Forest Lake Fire & Rescue. After receiving an emergency phone call from the hunter, crews were dispatched to find him, though tall cattail plants make it hard to spot him. Once found however, he was pulled out of the swamp and then winched up to an awaiting rescue helicopter, before being flown to safety.

waypoints An Australian Navy MH-60R helicopter supported a search and rescue mission in the Seychelles, marking the first time that one of the service’s MH-60Rs has been used in such a mission whilst on operational deployment. The chopper, which was attached to HMAS Perth, helped to find and spot two survivors from a shipping vessel that had capsized between the islands of Praslin and La Digue, 45 km (28 miles) from Port Victoria. The Brazilian Air Force transported 60 organs for transplant over three summer months in its military aircraft, and completed its 51st mission since June on 13 September. Major Flavio Cardoso Abadie, commander of the aircraft, expressed pride in the Air Force’s achievements. “We are very proud to be able to carry out our work and save lives.” The Spanish Air Force Sappers Parachute Squadron (EZAPAC) participated in the Air Centric Personnel Recovery Operatives Course 2016 (APROC 16) held at Lechfeld air base, Germany from the 25 September to 13 October. EZAPAC was able to participate in air support drills, with a Super Puma helicopter having been provided by the Spanish Air Force 48th Wing. A Russian military Il-76 aircraft delivered the first batch of humanitarian aid, including food products and clothes, from Armenia to the population of Syria. The plane transported 40 tons (36,000 kg) of canned products, fresh vegetables and fruits, flour and sugar from Erebuni Airfield, Armenia. A NATO helicopter assigned to its Kosovo Force (KFOR) peacekeeping operation performed an emergency medical evacuation of a new-born baby from a hospital in Pristina to a facility in Belgrade, Serbia. NATO said that the mission was made possible by the close co-operation of the Serbian authorities and KFOR. The Society for Emergency Medicine India (SEMI) has performed what it described as India’s first ever patient retrieval drill using a highly-specialised air ambulance. The drill was performed at the 18th National Conference (EMCON 2016) in Madurai City, India.

Safe landing despite ‘collective friction event’ In a report issued through the CONCERN Network at the end of October, an air ambulance service has described an incident in which a helicopter collective was affected by the co-pilot’s seat belt. The report explains that the incident occurred while taking off from a community hospital helipad in order to fly to a to a tertiary care facility with a patient onboard. The left cockpit seat was unoccupied. The pilot noticed a ‘very slight friction’ in the movement of the collective, used to control the pitch angle of the main rotor blades. The pilot opted to lower back down to the helipad and visually check the area around the pilot and copilot collective levers. As no obstructions were detected in the cockpit with the collective full down, the pilot took

off again and continued the flight. The pilot subsequently felt a ‘very slight friction’ with every power increase, but all flight characteristics and aircraft systems performed normally. Once in level flight with the autopilot engaged, the pilot reinspected the copilot’s collective using his flashlight and observed the copilot seat belt was unbuckled and lying over the collective. A crewmember reached forward from the passenger compartment to find the lap belt end was lying over the collective and was also caught in the closed door. The pilot then adjusted the collective to deliver full power and determined that there was enough slack in the belt to allow full collective travel. The pilot performed a high-power approach

and landing to the tertiary care hospital helipad without incident. The company noted that the event occurred halfway through a shift as the crew was performing its second transport flight of the night. The copilot seat had been occupied by a medical crewmember en route to the second patient pick-up; however the crew member had not buckled the seatbelt as they exited the aircraft to retrieve the time-critical patient. The pilot performed a walk-around inspection and then assisted in loading the patient. After safely landing at the receiving hospital, the pilot found the copilot lap belt jammed in the copilot door with approximately 1/16 in (1.5 mm) of buckle spade showing under the door jamb.

103 Squadron takes SAREX trophy A Royal Canadian Airforce (RCAF) search and rescue squadron has emerged as the best overall crew at a recent national SAR exercise (SAREX). The event, held in Yellowknife, Northwest Territories, Canada from 18 to 24 September, brought together over 230 participants from rescue organisations such as the Civil Air Search and Rescue Association (CASARA), the Royal Canadian Mounted Police (RCMP) and various RCAF squadrons in the weeklong exercise. Participants took part in SAR missions that tested their ability to respond to situations, with scenarios such as rescuing a canoeist in distress and rescuing four individuals from a remote area challenging the teams. A friendly competition was set up throughout the five days to see which squadron responded best to the situations, with 103 Squadron from 9 Wing Gander, Newfoundland and Labrador scooping the trophy for best overall SAR squadron. “The national SAREX is a strategic enabler, allowing for valuable interaction between the Canadian Armed Forces and other government and non-government partners, which strengthens our ability to operate efficiently for possible SAR missions,” said Major-General Christian Drouin, the commander of 1 Canadian Air Division. “I wish to thank all of those that contributed

to this successful exercise and congratulate 103 Squadron on being named this year’s best overall squadron.” The exercise also saw the department of Fisheries and Oceans, Environment and Climate Change Canada, Public Safety

Canada and Transport Canada help and observe proceedings. A variety of RCAF aircraft were used during the exercise, including CH-149 Cormorant helicopters, CH-146 Griffon helicopters, and CC-130H Hercules and CC-138 Twin Otter planes.

RCAF

IPRÉFET HAUTE-SAVOIE

Mass cable car rescue on Mont Blanc

Two SAR team members are hoisted up after searching a lake

www.airmedandrescue.com

27 27


MISSIONS

MISSIONS

Israeli wildfires spark international response able to land in Israel within 12 hours. The plane is billed as the largest firefighting aircraft in the world, capable of dumping nearly 20,000 gallons of retardant, water

IAF

IAF

EMERCOM RUSSIA

technicians and a liaison officer were also deployed. The Russian Emergency Ministry (EMERCOM) sent a task force that consisted of two Be-200ChS amphibious

An IAF Drone

A Russian firefighting jet

An Israeli Air Force firefighting plane.

assisted by the Israeli Air Force (IAF), began fighting fires in the country on 22 November, with blazes sweeping across large areas due to the hot, dry conditions within the country. On 24 November, the fire swept into Haifa, meaning 80,000 citizens had to be evacuated. Forces from Cyprus, Greece, Croatia, Italy and Russia have all arrived in the country

jets to fight the flames. Seventy firefighters from Cyprus were also flown in on a IAF Super Hercules C-130J. Israeli firefighting services have assisted in Cyprus before, and the Cypriot forces were dispatched quickly when it became clear that the wildfires were getting worse. US company Global SuperTanker dispatched its Boeing 747 firefighting plane.

or foam. As Global SuperTanker are yet to finalise a contract with the US Forest Service, the mission in Israel was the first the Boeing 747 had participated in. The IAF’s UAV division also participated in the effort to extinguish the fires. The operators used their technology to identify the main fires, search for arson suspects and communicate the information to the forces

In October, the Esquadrão Corsário (Privateer Squadron) conducted its first humanitarian aid mission using a Brazilian Air Force’s Boeing C-767 plane. The team used the aircraft to transport 120 tents to Haiti donated by the Ministry of National Integration to support those made homeless by a hurricane that struck the country earlier in the month. The tents were delivered to the authorities of the Embassy of Brazil in Haiti, so they could be distributed.

ESQUADRÃO CORSÁRIO

Efforts to contain wildfires raging in Israel saw foreign services lend aircraft and crew to help fight the flames. Israeli forces, led by the Israeli Police’s Aerial Unit and

Esquadrão Corsário conducts first humanitarian aid mission

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Watch footage at: www.airmedandrescue. com/video/1622. Boeing C-767.

Vigili del Fuoco responds to earthquake The Italian national fire service Vigili del Fuoco has used its helicopter and drone aircraft to provide an aerial view of the aftermath of the earthquake that struck central Italy on 30 October. The service

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in an attempt to try to stop the fires, which became so large they were seen from space. “The fact they are here and arrived so quickly reflects the deep and true connection between the countries,” said Gilad Erdan, minister of public security. Israeli authorities said that, due to the scale of the fires, foreign forces were operating in different areas to the Israeli efforts, though added that there was ‘a close co-operation between the sides’. The Italian national fire service, Vigili del Fuoco, sent over two Canadair CL415 planes that were deployed at the Hatzor Air Force Base. Eight pilots, four 28 28

AIRMED & RESCUE

Israeli authorities coordinate firefighting efforts

An IAF plane refuels

Upon receiving a call for aid from Israeli authorities, the specially adapted plane was

on the ground and in the air, said the IAF. The teams also mapped the fires and wind patterns to try to predict where the fires might spread. “It’s amazing to see the devotion of our reserve personnel and operators. Everybody understands that this mission means protecting our home,” said Lt Ofek, an instructor in the UAV academy and UAV operator. The fires were said to be under control by Israeli authorities on 30 November, with the residents of Haifa being allowed back to their homes. Authorities also stated that they believed the fires were started deliberately.

NASA

Cypriot firefighters on their journey to Israel to fight the fires

The fires were visible from space

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IAF

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reported that at 07:40 hours, a magnitude-6.5 quake struck Umbria, with its epicentre in Norcia, Preci, and Castel Sant’Angelo sul Nera, at a depth of 10 km (six miles). It was followed by a number of aftershocks. The earthquake was felt in much of the Italian territory. The quake caused a number of structures to collapse, including historic buildings. The US Geological Survey noted that it is reportedly the largest earthquake in Italy since the magnitude-6.9 Irpinia earthquake struck southern Italy in 1980. Watch footage at www.airmedandrescue.com/video/1646.

FLIGHT NURSE Air Methods Roswell, New Mexico, US

www.emsflightcrew.com/job/117

FLIGHT NURSE Air Methods Springerville, Arizona, US

www.emsflightcrew.com/job/116

www.airmedandrescue.com

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FEATURE

FEATURE

Hurricane Matthew

RAM

Winds and rain lash Haiti and the US

TECH. SGT RUSS SCALF / USAF

RAM makes an airdrop

US Agency for International Development in delivering and co-ordinating humanitarian relief to Haiti. An advance team, led by the US Agency for International Development’s Office for Foreign Disaster Assistance, was sent to set up operations in Port-au-Prince. It arrived aboard CH-53E Super Stallion, CH-47 Chinook and UH-60L Black Hawk helicopters before additional personnel and equipment were transported via helicopters and a C-130 Hercules cargo aircraft. US Sailors and marines assigned to Joint Task Force (JTF) Matthew delivered food to villages in Haiti using an MH-60S Sea Hawk assigned to Helicopter Sea Combat Squadron 28 (HSC-28). The Airbus’s Foundation and

US forces worked alongside Haitian citizens as part of Joint Task Force Matthew to provide relief to Jérémie

MAF

Hurricane Matthew first made landfall over Haiti on 4 October, before hitting Cuba, the Bahamas and the US. It’s estimated to have caused damages of over US$10.5 billion, making it the costliest storm since

A MAF KODIAK aircraft arrived at Port-au-Prince on 15 October

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Hurricane Sandy in 2012, and killed as many as 1,600 people, making it the deadliest since Hurricane Stan in 2005. Fatalities were reported in Columbia, the Dominican Republic, St Vincent and the Grenadines, with the US and Haiti seeing the highest death tolls. Haiti In a video (see www.airmedandrescue.com/story/1618), Mission Aviation Fellowship (MAF), which has been working in Haiti since 1986, detailed the vital role of aircraft in disaster relief. Vaugh Woodward, a member of MAF’s international disaster response team, explained that the damage caused to ground infrastructure in Haiti means that aircraft are the only way for aid to be brought in to some of the damaged areas. MAF worked with partner organisations Samaritan’s Purse, HERO, World Concern, CARE, Christian Aid Mission, Medair, Global Orphan Project, Children’s Hope, Sonlight, and Food for the Hungry. As of 11 October, it had completed 71 disaster flights, carried 233 passengers, and delivered 5,378 kg (11,856 lb) of cargo. By 18 October, MAF had deployed four planes, including a Kodiak that flew from Idaho, US, carrying a satellite communications system that was set up in Dame Marie. The Fellowship noted that 145,000 homes had been destroyed, and 750,000 people were in need of food. In response to a request from the Haitian Government, the US Southern Command (Southcom) supported the US State Department and the

LANCE CPL MELANYE E. MARTINEZ / US MARINE CORPS

James Paul Wallis reports on how teams responded to the devastation caused by Hurricane Matthew in Haiti and the US.

US Marines with the 24th Marine Expeditionary Unit load relief supplies to a CH-53E

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FEATURE

FEATURE

Forces also flew in from south of the Equator. A Brazilian Air Force Boeing 767 made flights from Brasilia on 14 and 17 October, carrying Army and Navy personnel and aid supplies to Haiti (see www.airmedandrescue.com/ video/1622). The Corsair Squadron was following up on a flight made in July to assist United Nations Stabilization Mission in Haiti (MINUSTAH).

Adra Haiti and the World Food Program, distributed aid to hard-hit and difficult to reach communities via helicopter. Shortly after the disaster hit the island, rapid-response humanitarian relief organisation Airlink reached out to its aviation partners searching for helicopters. GE Capital Aviation Services (GECAS) connected Airlink with Milestone Aviation Group, the helicopter leasing company that GECAS purchased in 2015. Bell Helicopter then stepped up to provide a Bell 412EP and a Bell 429 with crew. Airlink scheduled a second charter flight to Haiti with 175,000 pounds of supplies for Bell’s team to distribute to remote areas of the island. Remote Area Medical (RAM) volunteer pilot Joe Blasenstein, RAM airborne director Dick Stoops and RAM medical director Dr Chris Sawyer touched down in Port-au-Prince 72 hours after the storm struck Haiti. They joined forces with Air Mobile Ministries to begin dropping food in devastated areas. Stan Brock and a second RAM team joined on 16 October. The two teams later reported having used a C206 and a Caravan plane to successfully airdrop 24,804 and delivered 30,310 highnutrition meals made by Feeding Children Everywhere, Deliver the Difference, and RAM volunteer Ben gives tennis balls supplied by Air Mobile Minitries to children at Jérémie airfield Feed My Starving Children.

RAM

France-based Action Against Hunger lent the services of an Airbus A330 test aircraft to assist with the transportation of 20 tonnes of humanitarian aid to Haiti. The supplies were flown to Port-Au-Prince to be distributed by various NGOs. Another organisation involved was Global Medic which, in partnership with

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STAFF SGT ROBERTO DI GIOVINE / US ARMY NATIONAL GUARD

US Coast Guard Rear Adm. Meredith Austin, Commander, 5th Coast Guard District, surveys flooded areas in Greenville, North Carolina on 12 October

Flying into Port-Au-Prince on the first plane allowed to land in Haiti post Hurricane Matthew was a surreal experience. Though I live in Haiti, I was on vacation in the US when I heard of the incoming hurricane. The second we had boots on the ground, we went straight to work. Haiti Air Ambulance staff and our four visiting volunteers spent the next several hours briefing a plan for the following day. The next day, both of our Bell 407s were skids-up at sunrise and flying west to Les Cayes, Port Salut and Jeremie, the main cities on the devastated southwestern peninsula. We assessed the hospitals, evaluated needs and interviewed citizens about the number of dead, wounded and missing. We off-loaded the medical supplies we had and transported patients back to Port-Au-Prince with each trip we made. The following days continued to be a mixture of transporting patients, delivering food and medical supplies and assisting in patient treatment in the field. We were able to support other NGOs in triage of patients, give tetanus vaccines and treat hundreds of infected wounds. Cholera was starting to become present, necessitating the transport of infected patients (if we could find hospitals to receive them). In the following days, we would ferry rehydration salts and aqua tablets out to the communities lacking clean water and food, as well as provide training on use and prevention. For two weeks straight, Haiti Air Ambulance, the country’s only permanent HEMS organisation, was engaged in various facets of medical care, inter-agency logistical support, training and education. Stacy Fiscus is interviewed in AMR TV New Update 8 December, www.airmedandrescue.com/tv.

A South Carolina National Guard’s CH-47F delivers water and food supplies to the community of Seabrook

rescued from their rooftops by helicopter. In one Coast Guard mission, personnel from Air Station Elizabeth City and partner agencies used a helicopter to medevac a woman from Kinston, where flooding had caused a power outage, to Vidant Medical Center in Greenville. Also in North Carolina, local news channels reported an unusual rescue. According to reports, Navy veteran Chris Williams was unable to call for help by phone and so sent a message to his brother via Facebook saying he and his dog, Lana, were trapped by flooding. Quavas Hart, who was flying a camera-equipped drone nearby, somehow saw the message and responded on Twitter. He managed to alert a passing Federal Emergency Management Agency boat rescue crew who picked up the man and his dog while he filmed the rescue (look for the video at @ImSoFIRST on Twitter).

HAITI AIR AMBULANCE

COAST GUARD PETTY OFFICER 3RD CLASS CORINNE ZILNICKI / US COAST GUARD

US Hurricane Matthew left widespread flooding across parts of the US, with trees being downed by the strong winds. The Air Reserve’s 920th Rescue Wing entered Hurricane Condition III on 4 October and prepared to relocate its aircraft from Patrick Air Force Base, Florida, to Keesler Air Base, Mississippi to keep them out of harm’s way. Among the assets that were dispatched to assist was a South Carolina National Guard CH-47F Chinook assigned to Detachment 1, Company B, 2-238th General Support Aviation Battalion, 59th Aviation Troop Command, which delivered water and food supplies to the community of Seabrook, Beaufort County, South Carolina. Over 2,000 South Carolina National Guard Soldiers and Airmen were activated in the week after Governor Nikki Haley declared a State of Emergency. They supported state and county emergency management agencies and local first responders with coastal evacuations and services and resources needed to assist local citizens. In parts of North Carolina, Hurricane Matthew dropped up to 18 inches (46 cm) of rain on 8 October. In Robeson County, a levy was breached, causing flooding that left 1,500 residents stranded in Lumberton. Many were

Stacy Fiscus, chief flight paramedic, Haiti Air Ambulance

A mission to Beaumont on 12 Oct

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Berlin

Hosted by Voyageur Publishing & Events, ITIC Global brings together key industry figures from across the broad spectrum of sectors that make up the international travel and health insurance industry to inspire, educate and promote debate. This year, in Berlin, the topics on the agenda were as wide-ranging as ever, and provided a unique insight into the opportunities and challenges facing the global marketplace. A key component in the industry is the worldwide network of fixed-wing air ambulance providers who fly sick and injured travellers home or to centres providing advanced medical treatment. The AirMed and Rescue team was on hand to report on a selection of the conference sessions relating to care in the air.

EAA wins ITIJ Air Ambulance Company of the Year

ITIC GLOBAL 2016

Repatriation of women at risk for preterm birth Dr Marcus Tursch and Dr Alex Valdman – Med Call Air Ambulance Kicking off the session, Tursch said that the challenge is always in the planning. For example, deciding how to staff and equip the air ambulance. He said that providers are often asked for multiple things, suich as: doctor, nurse, neonatal equipment, incubator, obstetrician, neonatologist and midwife. However, he reiterated that there is only one plane and therefore a limit to the people and equipment that can be taken onboard the flight. He briefly introduced Med Call Air Ambulance, explaining that they have two LearJet 45s and a LearJet 31, that they have been in the market since 1997 and were issued an AOC in June of this year. Tursch then handed over to Valdman, who expressed his wish for this discussion to develop into a guidance paper of what is believed to be the state of the art, and then to get endorsement from the European AeroMedical Institute (EURAMI). He provided a case report from November 2013 of a 36-year-old German patient in her 27th week of pregnancy with no relevant past medical history, whose pregnancy had gone without complications so far, but was experiencing loss of amniotic fluid and mild contractions. Before the flight, the team completed lung maturity tests and started prophylactic antibiotics (a precaution against infection). The doctors on scene also began oral tocolytics (anti-contraction medications used to suppress premature labour) the day before. These measures were performed in an effort to ensure the woman and the team were in the best position possible before flying.

Dr Alex Veldman

(l-r) Patrick Schomaker, European Air Ambulance; Larry Baker, UC San Diego Health; Hans-Jörg Strauss, European Air Ambulance

Luxembourg-based fixed-wing aeromedical provider European Air Ambulance (EAA) has taken home the 2016 ITIJ Air Ambulance Company of the Year Award. EAA was named as the winner during the ITIJ Industry Awards ceremony in Berlin, Germany, on 3 November. Reading the judges’ comments, Larry Baker of award sponsor UC San Diego Health System told attendees that EAA was the first air ambulance company to have an infectious disease module and it has the only certified weight transportation stretchers on the market, putting the company at the forefront of the air ambulance industry. In his acceptance speech, Patrick Schomaker, EAA director of sales and marketing, thanked the firm’s clients and partners for helping the company to become what it is today. The runners-up were AMREF Flying Doctors of Kenya, US-based REVA Air Ambulance and Skyservice Air Ambulance of Canada. ITIJ – the International Travel & Health Insurance Journal – is the leading publication for the global travel insurance and assistance industry. Watch the ceremony at www.itij.com/awards/ (Air Ambulance Award at 20:12).

Dr Marcus Tursch

As Valdman relayed it, the patient’s condition the day before transport was good, the patient was in a good mood with stable circulation, no contractions, noticeable foetal movements and a small amount of amniotic fluid loss. On the day of transport, there was still loss of amniotic fluid, slight tachycardia (heart rate exceeding the normal resting rate), no contractions, no shortness of breath and, again, noticeable foetal movements. Transportation went smoothly, Valdman reported, and was, on the whole, uneventful. He highlighted that the challenge in this case, and in many others, was the planning, and said that a growing number of women are travelling during pregnancy and that more than one-third of these are embarking on long distance, intercontinental journeys. Valdman explained that although air travel is generally safe in pregnancy, the risk of preterm delivery is estimated at approximately eight per cent in a first observed pregnancy, with an increased risk of up to three per cent in women with a history of preterm delivery. He said that they cannot plan to deliver a baby in flight as there are very limited options available in the plane to handle complications of birth. Valdman added that although there is no way to prevent preterm births, delivery can be delayed, and added that the risk for delivery can be predicted relatively accurately. To round off the session, Valdman said that admission abroad for threatening birth is common. He reiterated that planned delivery in flight is not an option, but added that the risk for delivery en-route is low and, again, can be predicted. He said that the decision to transport the pregnant mother or the infant post-delivery must be driven by balancing the progress of labour versus local capacities in relation to gestational age.

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ITIC GLOBAL 2016

ITIC GLOBAL 2016

Medical transports: global case studies

Watch a full video recording of this session at www.vimeo.com/airmedandrescue/ITICcases

Peru – Best-laid plans diverted during transport of four-storey balcony fall survivor Denise Waye

President – AirCARE1 International This medically challenging and logistically difficult case saw a 23-year-

Denise Waye

old woman transported from Peru to California when she sustained life-threatening injuries after falling 43 m (141 ft) through a skylight in the roof of a hostel. She was taken to a local hospital in Trujillo on the back of a pick-up truck and given initial surgery on her back. When AirCARE1 received the call to ask it to transport the patient, there was still little medical information about her, except that she was badly hurt and was going to need further extensive surgery. The air ambulance company had an aircraft in Mexico at that time, so the plan was to fly it down to Peru, via Costa Rica for a fuel stop, and collect the patient after an overnight crew rest at the destination. The aircraft set off as planned, but after leaving Costa Rica, it got turned around; no one knew why and the company had to wait for an hour and a half for more information. It turned out that the aircraft was diverted as it did not have the correct overflight permissions for Columbia. The pilot was told to head west, but would have run out of fuel before reaching Peru, so turned back to Costa Rica. Crew duty times were now also an issue, meaning they could not now go on to Peru. Various options for how to complete the transport were considered, some of which would mean a significant delay in collecting the patient, which AirCARE1 felt was not an option. So, the pilots were dutied off in Costa Rica and subsequently flew to Peru. There were various issues at the patient pick-up – mainly that the hospital had taken the patient to the airport, in the heat, with no pain medication. Once the patient was made comfortable, she was transported to Houston, Texas, US, via Costa Rica for a fuel stop. In Houston, a second set of pilots met the aircraft to complete the onward journey to San Diego, California, where the patient was admitted to Sharp HealthCare. She remained there for several weeks before her final repatriation via commercial stretcher home to Australia. The lessons learnt from this mission, said Waye, were to make sure you have a check list, and to check it. The company responsible for obtaining overflight permits had failed to get the correct permissions for Columbia, so AirCARE1 had to pay for over two hours’ worth of extra fuel and work on pilot and crew repositioning. Waye said her company also has satellite communications on order for their aircraft.

China – Logistical issues using commercial and private business jets Steven Holt

Chief medical officer – Deer Jet Medical

Holt began by citing a case in which a wealthy family had used their G550 business jet and a hired medical crew to transport a family member from China to the Mayo Clinic in Minnesota, US for cancer treatment, to highlight some of the issues that can be faced in China when it comes to the use of oxygen onboard aircraft. The family and local medical team in China had not consulted with the Civil Aviation Administration of China (CAAC) or a local aeromedical provider about what type of oxygen tanks and concentrators were allowed onboard, and this equipment was not allowed on the flight. The flight proceeded 36 36

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with a different type of supplemental oxygen (pillows), but unfortunately, the patient decompensated in flight above Japan, leading to a diversion to Tokyo for medical treatment. The aeromedical team was unable to procure oxygen bottles or concentrators while in Japan for the rest of the journey, so at this point Deer Jet was called in to assist. The company flew the patient on a Falcon 7X with an expanded medical team, oxygen tanks, an oxygen concentrator and Intensive Care Unit (ICU) equipment in an uneventful onward journey. The emergency diversion, however, cost the family ¥1 million. Holt went on to highlight issues that foreigners to China often experience when dealing with the local healthcare system, the CAAC, and extracting patients from the country. The CAAC, he said, is an overarching

regulatory body for non-military aviation in the country, but its rules vary regionally on issues such as permission for low-altitude HEMS flights. Regarding healthcare, communication is a key issue, so Deer Jet often assists with getting comprehensive second medical opinion reports for clients. Corruption is now pretty much under control in the healthcare system, but in some areas physicians are allowed to be given direct payments for medical treatment by patients who seek out their services. Also, pain management drugs are not as widely used in China, so Deer Jet often brings its own when picking up patients. If you need to carry oxygen on a flight, continued Holt, it’s best to use a private chartered jet, as commercial carriers often decline requests to carry it, and there are issues around the CAAC and TSA rules governing oxygen onboard aircraft. Lithium batteries also, understandably, are a problem area, and CAAC rules don’t allow for the carriage of high powered lithium batteries on aircraft, plus commercial carriers are unable to charge batteries due to power supply differences. Again, private jet use is often the way around these issues. Lastly, Holt touched on the problem of extracting patients from high-altitude locations, as Deer Jet is the only operator in the country with such capabilities. Dr Steven Holt

Libya – Medevac operations from a designated ‘war zone’ Dr Gregory Kyriacou

Managing director – Gamma Air Medical Despite the challenges of trying to communicate effectively with the treating hospital in Libya, the risks associated with flying into a ‘war zone’, and the poor medical condition of the patient in this case, an impressive team effort led to a successful repatriation. The patient, a 63-yearold male from Greece, was a sailor who became ill whilst onboard a commercial ship in February this year. He was transferred to the Libyan Red Crescent Hospital in Misrata in a serious condition, with generalised oedema, and taken to the high dependency unit. Despite making initial progress in his recovery, after a few days, his condition showed sudden deterioration – hypotension, tachypnoea, decrement of oxygen blood saturation and swift representation of the generalised oedema. He also had a medical history of insulin-dependent diabetes mellitus, pulmonary oedema, obesity and anaemia. He was transferred to the Intensive Care Unit, where he was intubated under sedation with morphine. At this point, the patient’s family asked for him to be repatriated to Athens to be transferred to a more advanced ICU. Gamma Air Medical prepared to move this critically ill, intubated patient in an ICU configured air ambulance. There were a number of medical and logistical challenges in this case. These included very little direct communication with the treating doctor in Libya, and different names had been put on some of the medical forms, so Gamma didn’t even know if it had information about the correct patient. There were also: overflight permission issues as at the time of the mission, Italy wasn’t accepting overflights from Libya; the challenges of obtaining landing permission for Libya; a delay in receiving information from the insurance company; and issues regarding immigration procedures. Nevertheless, the LearJet 35 landed safely in Libya and received the patient

at the airport. His condition was not good, however – he was intubated but not sedated, and was restless. The receiving medical team sedated the patient and hooked him up to the ventilator. He was also a very large patient, so a larger aircraft would have been suggested if this information about the patient had been conveyed, said Kyriakou. The transfer flight took place without incident and an ICU road ambulance was waiting for the patient at the airport in Athens. The patient was hospitalised for 40 days before making a recovery and being discharged.

Dr Gregory Kyriakou

www.airmedandrescue.com

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ITIC GLOBAL 2016

ITIC GLOBAL 2016

Insurer due diligence: air ambulance provider selection Dr Michael Weinlich

President, founder and chief medical officer – Med Con Team Weinlich opened the session by highlighting the need to make the air ambulance provider market more transparent. He stated the importance of looking at accreditation and ‘choosing the right ambulance provider in a different way’. According to Weinlich, there are different measures of quality, including structural, process, and output and performance quality, and these competences must be demonstrated to insurance companies. He reiterated the fact that the most important thing for a patient is the outcome, but stated that with official accreditation systems, which tend to look at equipment, aircraft, and processes, the output for the patient cannot be easily found out. He said that questions arising include: ‘How do I choose the preferred air ambulance provider?’, ‘Have they done it according to international standards?’ and ‘Have they treated the patient well?’. Weinlich moved on to discuss how customers can be attracted and retained, and covered the elements that ‘count’ in a preferred provider. Another important question raised was ‘What exactly are international standards?’. As he explained it, standards are being made up by the community. He said that people came together as a group and tried to define ‘international standards’, but he questioned the basis behind these standards and whether there is any proof behind certain elements within the standards. “What would be the minimum standards you would expect?” he asked. “The right equipment, basic standards such as the service. But there is nothing that is fixed.” Accreditation should not be overestimated, he went on to say, and it is important to look at the outcome of air ambulance cases from a medical perspective and to have direct contact with the air ambulance provider rather than using brokers.

When opened up to the floor, there were a number of questions and points of discussion. Input from NAAMTA executive director Roylen Griffin (or ‘Griff’) was that municipalities have all kinds of standards, and best practice procedures should be established as standard and also be based on outcomes, i.e. ‘this is the bar that we will accredit or audit you to’. “All of the companies they audit are within an acceptable, agreeable portion,” Griff added. “If you’re not using something that has acceptable processes you will not have the outcome you need.” Griff also questioned whether it is a problem for companies if their accreditation is pulled. Europ Assistance Group’s medical director Dr Matt Kalina’s response was a resounding ‘yes’: “We do care because it’s an important part of our business.”

Watch a full video recording of this session at www.vimeo.com/airmedandrescue/ITICselection

cardiac life support), which he said became an international standard by a consensus mechanism. He said that standards are obligatory and that this is their weapon, adding that ‘we do not give missions to someone that is not accredited’. A question from the floor was ‘How honest are ambulance providers when they supply information?’ given that, naturally, they want to be more competitive than their competitors and so they may not necessarily tell the truth. Another comment from the floor was that the industry would benefit from clearer segmentation and to work things out statistically, with standards created in consultation with the users, as regulation should be inclusive – ‘Is it time to consider an industry registry?’ it was asked, although another audience member said that one potential difficulty with this is getting commercial companies to release their data as many don’t want it to be in the public domain. Kalina concluded by saying he sees an evolution towards a greater wish for a consensus bringing all of the relevant stakeholders together. “The question is identifying the organisation that can take leadership,” he said, “someone that is at arm’s length.”

Roylen ‘Griff’ Griffin

Executive director – NAAMTA

Dr Michael Weinlich

Griffin began his presentation by stating that a minimum standard needs to exist. “There is a human being involved in every flight that we do,” he said. “Standards are there for the protection and safety of the patient and the crew.” He explained that rules, regulations and standards increase outcome performances, and that this is the reason for standardisation and why there is a need for those involved to meet to talk about these things. “We seem disjointed,” he added. Griffin said that the problem with some standardisation is communication,

Dr Matt Kalina

Group medical director – Europ Assistance Global (EA) Kalina began his talk on air ambulance certification by highlighting the fact that due diligence is an important topic for major insurers, and said he believes the importance of the overall market is being underestimated. “The importance of standards is obvious,” he said. “We need optimal quality for our clients. Are all stakeholders involved as much as they should be?” Speaking from an assistance provider’s perspective, he said that providing international rules allow one to fly into an area, there should be a way for an air ambulance to access that area. He used Ebola as an example and stated that only those who agree to expose themselves to the risk should access a particular area. “We hope that no mission we deem necessary be refused,” he added. He then highlighted the reasons why an assistance provider such as EA cares about due diligence, explaining that they fly a lot (1,027 air ambulance flights in 2015) and spend a lot (over €21 million in 2015). Kalina stated that there are areas where international criteria have not been established, and said there is a need to create a mechanism whereby there is a consensus, citing the example of ACLS (advanced 38 38

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Roylen ‘Griff’ Griffin

Dr Matt Kalina

and explained that he devised tools to assist air ambulance providers with demonstrating their compliance. He listed the considerations for partnerships between patient and medical control, air ambulance and insurer as being: ethical, qualified medical team; appropriate medical supplies and equipment; appropriate aircraft and pilot; logistical operations and case management. Next, Griffin explained that there are important things to be taken into consideration when an assistance company vets an air ambulance provider, such as whether they are ethical, profit driven, honest and so on. He said that it’s important to make sure the team is qualified based on standards and rules and has appropriate medical supplies, that a minimum equipment list must be specified and that the team must have training in administering that particular treatment and be able to demonstrate this – an audit must be done where these performance standards are demonstrated. Furthermore, medical supplies should be documented and the aircraft and pilot must be appropriate: the pilot must be certified for that particular aircraft and the aircraft must be big enough to perform the mission, for example. Griffin highlighted that you can’t control anything you do not measure, and reiterated that this is a high-risk business. He said that although cost is a consideration, it is not the priority: “Remember, there’s a human being in there and cost does need to be evaluated, but not above other criteria,” he stated, also revealing that he thinks accreditation should be more thorough: “In my opinion, accreditation doesn’t go far enough. I read every incident and every complaint, which has established good rapport with my clients.” To conclude, Griffin said that the bottom line is that it’s important to standardise and follow the rules, and that there is liability, so insurance of accreditation companies needs to happen. The session came to a close with the agreement that there needs to be uniform performance and uniform standards across the globe. However, the big question was: ‘How are we going to agree a uniform protocol between the air ambulance, insurance and assistance companies?’

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ITIC GLOBAL 2016

ITIC GLOBAL 2016

Security of medical transport crews Watch a full video recording of this session at www.vimeo.com/airmedandrescue/ITICsecurity John Rose

COO – iJET International Opening the session, Rose posed the question: ‘How do we keep our flight crews safe?’. He said that he has seen medical crews refuse to go into certain areas because the safety is inadequate, and that there are many things to consider when evaluating scenarios. For example, he said, bringing in security raises the cost of the evacuation, adding that once the threat has been identified, the risk can be assessed and mitigated, and this should be a process that is laid out simply. Important questions to be asked, said Rose, are where are they flying and what conflict zones are they going through? He said that the crew may be going through an area where there are ‘bad actors’ or people on the opposition that may not want them there. He added that when it comes to such areas, the news is ‘100-per-cent useless’ as it states ‘false, crazy things’. Another important question, according to Rose, is what is the protective zone around the landing area? “You have to understand the threat in the area and assess the risk,” he said. “Is it worth attempting to land?” He then highlighted the fact that time is critical in picking up injured patients, and added that the best intelligence is required. He said that risk can be reduced by hiring security professionals, and reiterated the importance of assessing the situation, as ‘just because they are wearing a medical

Martin Bauer

Regional security manager – MedAire Bauer began his presentation by asking whether the situation changes if we know we are going into a high-risk environment. “No,” he answered. “The assessment of all of those various risks should be consistent across the board. The risk assessment should not change.” He then went on to highlight some of the threats and hazards encountered in travel security and their risk rating. At the top of the list was crime, followed by social unrest and terrorism. The hazards with the lowest risk rating were cultural issues, internal travel and natural hazards. He said it is important to ascertain whether certain weapons are easily available on the ground and decipher how lethality will affect an aircraft. Bauer then showed the audience a list of the countries with the most over-

Martin Bauer

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uniform, it doesn’t mean they are necessarily safe’. Rose went on to underline the essential pieces of knowledge, which he stated as being: the intelligence of the area, on the ground, i.e. tactical information coming in from people manning the routes; and who is being transported. “These people are hurt for a reason,” he said. “Perhaps they have been attacked and there are bad actors who still want to eliminate this individual.” Rose said that there is a need to get the individual to a safe location where the medical crew can work, and that real-time intelligence is required by the minute. Finally, Rose highlighted that real-time intelligence and alerts does not mean news. “It has been analysed and is meaningful and actionable to you,” he said.

Dr Bettina Vadera

CEO – AMREF Flying Doctors Bringing an air ambulance provider’s perspective, Vadera began by listing some of the conflict areas AMREF has been asked to visit, citing Somalia, a country in which AMREF performs hundreds of patient Dr Bettina Vadera evacuations every year, South Sudan and the DRC, followed by Burundi, the Central African Republic and Mali. Vadera explained that AMREF’s crew doesn’t leave the airport and added that there is a clear agreement that there is security all around them. Next, Vadera moved on to talk about the steps AMREF goes through from a practical perspective. These are: pre-departure briefing and clearance; pre-landing preparation; specific approach procedures; on-ground security protocols; emergency shelter for patient and crew; and finally, a debrief after landing back at their base in Nairobi. She described this example as AMREF’s ‘daily/weekly bread’. Going into detail about each of the six steps, Dr Vadera explained that the pre-departure briefing involves an active security report from UNSOS Air Ops offices in Nairobi and Somalia, insurance briefing and clearances, and flight clearances from the Government of Kenya and the Swedish Committee for Afghanistan, and encompasses security information and a security brief from AMREF Health Africa’s corporate security manager. She

highlighted the importance of flight planning, security updates between crews and a quick departure. Referring to air ambulance evacuations from Mogadishu, Vadera then revealed that pre-landing preparations involve scouting by boots and/or boats on the ground, which must happen before landing, and that a prelanding security clearance must be issued by UNSOS Air ops. She added that the ETD and ETA are classified information. She explained that the specific approach procedures involve a steep descent and a high-speed approach just above the water, with a sharp turn towards the airport before landing. When it comes to on-ground security protocols, an allocated secure parking bay for the aircraft, security on standby for both the crew and the aircraft, and an armoured vehicle for patient transport are required. Regarding emergency shelter, standard operating procedures (SOPs) and a pre-flight briefing on locations and use are crucial, Vadera said. Finally, the debrief back at AMREF’s base comprises: a hazard or incident report, a review of the voyage report, a review of protocols and SOPs with the relevant stakeholders, formalisation of the recommended changes and confirmation that these changes have been implemented. She added that all of the changes must be implemented before another mission to that area is launched, and that this is always the guideline that AMREF works through. Vadera also pointed out that some missions AMREF just cannot do, and this is because there are human lives at stake: not just the lives of the patients, but the lives of the crews.

John Rose

flight concerns. Afghanistan was top of the list, followed by Algeria, Armenia and Azerbaijan, Colombia and the DRC. He also spoke of the incident in 2014 when Malaysia Airlines Flight MH17 was shot down over Ukraine. Next, Bauer highlighted the fact that threats to aviation vary by location and altitude, and that the MedAire team provides airspace assessments to help security departments to make informed decisions about their flight plans. He explained that an airspace assessment involves the analysis of the airspace of a country or region to identify overall kinetic risk and individual threats to aviation assets throughout each phase of flight. According to Bauer, these assessments include analysis of airspace restrictions and warnings issued by governing aviation organisations, including the US Federal Aviation Administration, International Civil Aviation Organization and European Aviation Safety Agency. Bauer then went onto say that, at a minimum, each airspace assessment looks at specific weapon availability, portability, lethality, ease of use, documented use and intent (for example, government or military groups). He said that kinetic risks and non-kinetic risks must be assessed at altitude. Following the presentation, an audience member asked: “What about the ‘normal’ places and how do we deal with the aircrews; particularly the ones who stay overnight?” Bauer responded by highlighting the need for consistency in assessing each different site in the same way. “The assessment shouldn’t change just because we don’t think it’s a high-end conflict zone.” However, he added that the risk assessment may change according to how basic the resources are on the ground. For example, he said that some areas may be missing simple things such as radar and aerial communication.

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DAA’s surveyed landing sites Community engagement – the key to air ambulance night operations and villages across the county. Landing sites, which are funded and managed by the local community, can be located on a village green, field, sports pitch or playing field. The area needs to be a flat, open and at least 50 m by 50 m (164 ft by 164 ft). They can be grass, tarmac or concrete, need pedestrian access onto the site and vehicle access close by, and must have a nearby power source for lighting. Toby said: “When considering all the practicalities, it became clear that many of the communities we are working with are anticipating growth in new housing, so we need to factor in how a landing site gives the best possible access both now and in the future.” During the development stage, experienced DAA staff carry out a site survey. This involves measuring and recording the size and shape of the landing area, as well as the height and proximity of potential hazards such as buildings, trees and overhead cables. This data is used to create a unique landing site form which is added to a directory of landing sites county-wide. “This is a really important part of our night-time flying,” said Toby. “It essentially means that the pilots and crew know what a site looks like prior to their arrival. This will reduce the inherent risks involved and speed up the landing procedure. Each community landing site will be re-surveyed annually to ensure the information held remains accurate.” Site surveys also include collecting other useful information on the location of nearby roads, car parks, gateways and paths that lead to a landing site. This helps build a picture for the crew indicating where and how a land

Operating night HEMS safely is as much about the landing as it is about the flight. Charity Devon Air Ambulance explains how it is working to establish a network of lit, surveyed landing areas across the UK county it serves The case for Devon Air Ambulance (DAA) commencing night flying has been on the agenda for some time. As we all know, people don’t simply stop being unwell when it is dark, and reviews of summertime extended operational hours (until 21:00 hrs) consistently show that the service goes to over 50 patients who, if their accident or illness had happened during the

winter, would have had to rely on land ambulances. DAA’s move to extend its hours of operation until midnight every day commencing in Autumn 2016 will therefore make a considerable difference to communities across Devon, and it has been a long, but well planned, process. Although DAA’s Exeter-based helicopter was already night-flightready, it needed a few additions, including spotlights, in order to start flying into the night. The aircrew trained together after dark to get used to the adjustments that night flying brings and to use the new equipment required, including night-vision devices. So, that left one essential ingredient – where to land. An early decision was made to engage with local communities across Devon and help them establish local, surveyed and floodlit sites that enable the helicopters to land at night. Community engagement has been at the heart of DAA’s strategic plan since 2012, and the strong relationships built, particularly over that time, have proved invaluable. A community helipads liaison officer, Toby Russell, was appointed and he is currently working with over 70 communities in towns 4242

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“each community landing site will be re-surveyed annually to ensure the information held remains accurate”

ambulance can attend and how paramedics can access patients. Floodlighting is an essential component of a community night landing site for both safety and practical reasons – it will help illuminate the site during landing and take-off and will help paramedics when loading a patient into the aircraft and during transfer between a land and air ambulance. Each lighting system will incorporate an integral mobile phone SMS control box, which will enable the lights to be turned on/off remotely by the helicopter emergency medical service (HEMS) dispatch team, meaning no one needs to be on-hand when we fly into a community. DAA’s marketing and PR team supported Toby’s interaction with local communities with an imaginative and vigorous profile-raising campaign. The ‘Help us make night time flight time’ campaign had a considerable impact, but fortunately, Toby was pushing at an open door with a fantastically positive response from everyone he met. He said: “We thought there may be some issues surrounding the financing of each project locally, but our communities have embraced the idea of local night landing sites with huge enthusiasm. Funding has come from parish councils, local fund-raising events, grants and business sponsorship. Devon is a largely rural area and the air ambulance is a cherished service here. We are consistent in our message to the community that our two emergency helicopters belong to them and the recognition of this has made my job a lot easier.” An interactive location map to check progress at a community landing site is available by visiting www.daat.org/landing-sites.

DEVON AIR AMBULANCE

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HEMS­Star® Tried & Trusted H Rechargeable portable battery powered LED helipad lighting system globally deployed: The United Nations Mali Mission Scottish, Midland, Welsh, North West Air Ambulances National Police Air Service Bangladeshi Army Philippines & Mexican Navies

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Italy recently gained its first HEMS base to operate missions unders NVGs, as Dino Marcellino reports In Italy, the task of organising and managing the health service is delegated to the authorities in individual regions. The region of Lombardia, northern Italy, was one of the first to gain a helicopter rescue service, which began in 1986 with bases established in Como, Milan and a third Desenzano. August 2016 was therefore a historic date, not only because Como HEMS celebrated 30 years of service, but also because it marked another milestone in the history of the Italy HEMS, with Como becoming the first helicopter air ambulance service in the country to adopt night vision goggles. The current helicopter base of Villa Guardia, near Como, is owned by the Azienda Socio Sanitaria Territoriale Lariana, the local social health service, and offers a complex and highly specialised HEMS service. The base also houses the regional emergency operations room (Sale Operative Regionali dell’Emergenza Urgenza). Let us now examine in particular the reasons, criteria and training that led to the introduction of NVG technology, both from the aspect of aviation as well as for the health component. The aeronautics component INAER Aviation Italia is a HEMS provider that manages 31 bases throughout the country, including the Como base. AMR asked INAER pilot Alessandro Perona how the company is introducing NVGs into its service. Perona, a former military pilot with experienced in flying with NVGs, explains that in Italy, the technology has for many years been used exclusively by the military. By adopting the new European regulation 965/2012 EASA, it has been possible to introduce NVG use into the civil sector. INAER, in this first experimental phase, is using crews made up of former military pilots with NVG experience, alongside civilian-trained pilots qualified for night flight with NVGs thanks to a specific training syllabus. The target is to give adequate theoretical and practical training to the pilots, for a safe and gradual operative employment; the medical staff (doctors and nurses) and mountain rescuers are involved in this training. It should be noted that Como HEMS has been flying night missions since 2008, when it created 10 night helipads, mainly in mountainous areas, lit

DINO MARCELLINO

by adopting the new European regulation 965/2012 EASA, it has been possible to introduce NVG use into the civil sector

Images taken through NVGs of a live night mission with the new AW139

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and certified for night activities, at a substantial cost. Thanks to the new legislation, since 2014, it has been possible to use lit sports fields (mainly soccer grounds), reducing costs and greatly expanding the number of lit landing zones available. ENAC (the Italian Civil Aviation Authority) reports that INAER has installed a remote lighting switching system allowing lights to be turned on by phone, so the lights can be activated by the opertaions room staff or from the helicopter. By the end of 2016, 100 sports grounds are scheduled to be upgraded in this way. INAER and ENAC have mapped the fields, established approach routes, identified obstacles and certificated the fields for night >>

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DINO MARCELLINO

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The ops room in Como (Villa Guardia) HEMS base Images taken through NVGs of a live night mission with the new AW139

The health component In 30 years of operation, responders from the Como base have completed over 21,000 missions. They serve a densely populated area comprising the 4646

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provinces of Varese-Como-Lecco and the Legnano area, which includes over 2,250,000 inhabitants. Why activate the night service with NVG? Dr Mario Landriscina, director of the 118-Helicopter Emergency Medical Service, replies to the question: “A significant portion of our territory is in the alpine and pre-alpine zones, characterised by a complex terrain, long valleys and high altitudes. Bringing rescue by land with a traditional ambulance, and transporting the patient to hospital often takes a very long time, over an hour. That time can be fatal for serious diseases, or may cause serious consequences for in the progression of an illness, preventing the patient from recovering and returning to a ‘normal’ life.” With the helicopter, he says, the service can bring a specialised team to the patient by day or night: “We can bring in a specialised team that performs the operation on site, stabilises the patient and allows the most suitable transportation in flight to the hospital to cure his disease, which is

because ‘we can not take-off as in half an hour it gets dark’ are gone. In terms of intervention times, related to the seriousness of the pathology, the quality of care is greatly improved. By safeguarding the health of the patients, the air ambulance is also cost-effective: the service pays for itself through the benefits brought to the next stage of treatment, in addition to the lives saved.” Landriscina acknowledges that the service is in the testing phase, and there will be further refinements in the system, but adds: “I can say that it is a step from which there is no return.”

the aircraft offers the possibility to isolate the cockpit from the passenger cabin, thanks to a protective screen

not determined as the nearest hospital, but the best specialised hospital depending on the patient’s pathology, which could be in other provinces of our region or even outside of it.” A statistical analysis of the types of interventions (considering both pathologies and territorial distribution) suitable for helicopter activation confirmed a situation of hardship for citizens living in rural and mountainous

DINO MARCELLINO

HEMS activities. Perona explains: “It is thanks to [this] background that we started working step by step with the NVGs. First step: the pilots use night vision goggles to fly to lit helicpads. For these flights, we use a pilot well experienced in NVGs as commander, accompanied by a pilot who has no experience. We have seen how the pilots prefer to maintain the use of NVGs even when they are in view of the illuminated field, because this gives them the chance to see the dark areas around the field, giving them a good feeling and safety of flight.” The second step, Perona adds, involved landing on unlit sports grounds and other recognised landing sites using NVGs: “These areas are defined HEMS operating sites; they are well known sites, checked, inserted in the INAER database. They are sites accessible exclusively by NVG use, with prior aerial reconnaissance by pilots before landing to ensure that there is no material deposited on the sites.” In the third step, says Perona, pilots will fly into mountain mountain resorts, including high altitude mountain refuges, which do not have established landing places. He continues: “We will then identify an area where we will perform the winching with NVGs.” In order to use the NVGs, INAER requires compatible machines. The first AW139 helicopter is already in service and two more are on order. The aircraft offers the possibility to isolate the cockpit from the passenger cabin, thanks to a protective screen, which allows pilots to fly under NVGs while the doctor and paramedic can continue to work on the patient with standard cabin lighting. The new machine has a 7,000-kg maximum take-off weight (600 kg more than the previous models), and the landing gear and tail boom have been reinforced. In Como, a standard mission take-off weight is 6,100 kg.

areas, where suitable landing areas such as football grounds are often not available or are not illuminated. Now, says Landriscina, with NVGs, they service can also reach the small villages and isolated houses, and do it safely: “Moreover, in known places, we can perform the mission even in adverse weather conditions, something unthinkable without the NVGs. In the past, I’ve had to abort the mission due to the misfire of the landing pad lights – now, with NVGs, we land there in any case.” He continues: “The times when we were forced to decline the mission

The new NVG-compatible, AW139, the first of three ordered

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Whether a HEMS pilot will fly under IFR or VFR is also down to prevailing weather conditions. Biasatti flies for a programme in the US whose IFR capability means that the crew often accept flights that have been turned down by VFR bases/operators. “Forecasted weather might give them concerns about being able to complete their flight,” he says, “while we have

“converting a ship from VFR to IFR … is economically feasible given the potential revenue gained”

the ability to transition into the IFR system should the weather deteriorate. Depending on the time of year, seasonal weather variations and when flight requests happen to come in, we might complete 10 per cent of our flights using IFR.”

IFR to extend options in HEMS Flying an aircraft under instrument flight rules can offer further options for HEMS operations, as Lucie Wood finds out Instrument flight rules (IFR) and visual flight rules (VFR) are the two sets of regulations governing civil aviation aircraft operations. In general terms, pilots decide to fly a VFR flight or an IFR flight (if they are suitably qualified) depending on a range of factors, including cloud ceiling, visibility, the kind of airspace, time of day and which country they are operating in. Looking at VFR Under VFR, an aircraft is flown ‘by eye’ with visual reference to the horizon, buildings or terrain to maintain ‘separation’, i.e. a safe distance from obstacles. This separation is often set to a specific figure dependant on altitude for IFR aircraft, whereas VFR craft maintain a ‘see and avoid’ principal outside controlled airspace. When the visual meteorological conditions (VMC) are favourable, VFR is the usual way to fly a small craft. Under VRF, however, a pilot cannot fly through clouds, which means they must go under, around or divert if the clouds form a vertical column and block the route. In some countries, such as Germany for example, under VFR you can have visibility of just 1.5 km, but you must also be able to see the ground. Night flying rules vary according to country – Germany allows VFR by night but Spain does not.1 Alex Stobo, director of operations at Bond Air Services, Babcock Mission Critical Services Onshore in the UK, explains: “Under VFR you can see where you are going – you can see the horizon across a broad and expansive area. You can judge the flight of the aircraft from 4848

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visual references.” Under VFR, a pilot will usually take advantage of flight instruments too, as Mike Biasatti, a single pilot IFR HEMS flyer and founder of EMS Flight Crew who is based in San Antonio, Texas, explains: “Flights undertaken with VFR conditions prevailing use GPS navigation for a straight-line point-to-point trip. Part of any flight is a good cross-check of your instruments, altimeter, airspeed etc., as well as monitoring gauges for each engine, transmission and hydraulics. So, while under VFR your primary focus is outside, you need to stay on top of anything happening outside the expected.” Flying under IFR On the other hand, flying under IFR means relying on aircraft instruments. According to the US Federal Aviation Administration (FAA) Instrument Flying Handbook, an IFR flight ‘depends upon flying by reference to instruments in the flight deck’, and ‘navigation is accomplished by reference to electronic signals’. IFR is generally used when visual references outside the aircraft are obscured by clouds, rain, fog, darkness or dust and flying via VFR is deemed unsafe. IFR allows an aircraft to fly in instrument meteorological conditions (IMC) and must always be used when flying in Class A airspace – commercial aircraft worldwide must always operate under IFR. Stobo explains that UK HEMS missions are preferentially flown under VFR if possible, but must be IFR in controlled airspace. “There’s the possibility that a pilot would lift from his base, fly an approach to an airport on the runway, break off the approach and then fly visually to the HEMS site. That is one example when they might launch IFR, but ultimately the landing has to be done under VFR.”

of conditions.” The real strength of IFR, continues Stobo, is where the pilot goes when recovering from the HEMS mission: “Once they have lifted up with the patient, they are generally going back to major urban conurbations where there’ll be an airport and a runway. So, if the weather’s poor or if it’s night he or she can lift. Whereas if they weren’t instrument rated, they wouldn’t be able to do it. The real boon of the IFR flight is that they can then recover to hospitals and that’s when you’ll find HEMS and air ambulance transfers using IFR.” Flying under IFR requires a meticulous evaluation of the weather and a detailed flight plan based on route, time, distance, speed, and altitude. There is reliance on air traffic control that separates the IRF aircraft from objects using flight clearance. However, the ultimate responsibility of the safety of the flight remains with the pilot who can refuse clearances. Also, while a pilot may be able to fly through the clouds in IFR legally and safely, there are still minimum weather conditions that must be met before an IFR flight can go ahead. Stobo explains that in UK HEMS, not many aircraft have clearance to fly in icy conditions – generally smaller craft ice up very quickly and that icing is a ‘considerable issue when flying IFR in a helicopter’ and so >>

Weighing up VFR and IFR The main advantage of flying under VFR is that the pilot can go where they want, when they want and determine for themselves how they get there, with no contact with air traffic control unless operating in busy airpsace, so allowing greater freedom. To this end, it is often the first choice for HEMS missions. “VFR allows you to visually identify obstacles, calculate where the most suitable landing site is, appropriate landing direction and identify particular obstacles that are of particular concern to a HEMS pilot such as power lines and masts,” says Stobo. “The pilot will make a dynamic risk assessment to see if the landing is appropriate, taking into consideration local built-up areas.” He adds: “The decision really is a crude decision because from a medical perspective: the pilot wants to land close to the scene. From a flight safety perspective, the pilot will want to land in a big, clear area as far away from houses and built-up areas as possible. All HEMS launches and certainly HEMS arrivals will be VFR.” Biasatti says: “Operating under VFR allows for less planning time, lower fuel requirements and a greater certainty of mission completion.” However, he also adds: “In controlled airspace, other than uncontrolled Class E Airspace, communication [with air traffic control] is required whether VFR or IFR when inside Class D, C, and B. Class A begins at FL180 (18,000 ft) [in the US] and no HEMS operations are conducted that high.” Meanwhile, the main advantage of IFR is that aircraft can fly in deteriorating weather, meaning that more emergency medical missions can be completed than by using VFR alone. Determining which flight plan to choose is a calculated decision. “Any questions as to my ability to safely complete the flight – taking into account flight time to the patient, ground time, any necessary refuelling stops, return flight time, plus any possible delays – I would always file and fly any one or all legs using the IFR system,” says Biasatti. “Often, we can begin a flight in clear conditions, but upon the return leg the weather has deteriorated or is forecast to deteriorate upon or around our return time, so we may complete part of the flight VFR and another part IFR.” IFR is ‘very procedural’, says Stobo: “It allows you to fly when the weather’s bad in a wider range of conditions. It extends your operational capabilities. IFR extends the capability of the aircraft so you can operate in multiple types

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weather conditions’.2 Certainly, there has been much discussion around the 1999 FAA change to its certification guidance for single-engine helicopters in the US with stricter reliability requirements, making it virtually impossible for singleengine helicopters to be FAA-certified for IFR. The International Helicopter Safety Team estimates that from 2001 to 2013, there were 194 accidents

Stobo wholeheartedly agrees that having IFR saves lives

FAA

worldwide involving single-engine helicopters, IMC or controlled flight into terrain (CFIT) and low-level flight to avoid weather. Of this total, 326 lives were lost in 133 accidents that could have been avoided if the pilot and helicopter were not restricted to VFR.3 Reversing the 1999 change, argue industry experts, would increase helicopter safety and discourage pilots risking flying in bad weather and colliding with terrain or getting disorientated. Biasatti feels safer with IFR capability: “There are countless reports on the National Transportation Safety Board website related to HEMS crashes. Often cited as the probable cause are weather conditions and VFR aircraft continuing into IFR conditions. There’s no way to know [the cause], nor would it be appropriate for me to comment, but I find great comfort when

approaching reduced ceilings and lowered visibility knowing that I have the option to get into the IFR system and continue or abort the flight and return safely to an appropriate airport or base.” Meanwhile, in the UK, Stobo wholeheartedly agrees that having IFR saves lives. “IFR allows you to go everywhere in almost all conditions, so it increases the capability of operations. If you’re flying and the weather suddenly deteriorates, rather than having to stop the operation or land, it allows the pilot to fly up into the cloud and continue the mission.” Most HEMS helicopters in the UK have the ability to offer IFR, said Stobo: “At Babcock we operate about 50 per cent of air ambulances in the UK and all of our pilots are IFR rated. One of our competitors operates another 30 per cent of UK air ambulances and all of their pilots are IFR rated. At Babcock International, we have the advantage of a simulator in which we can train, practise and really test our pilots. I can’t underestimate the importance of training for IFR flight because it’s a perishable skill – if you don’t practise it, you lose that sharp fine motor skill that is required to do it.” In conclusion, having IFR capability flight in HEMS missions is highly advantageous – not only in increasing pilot safety by allowing flight under deteriorating conditions and in busy airspace, but in making more rescue missions possible under conditions, sometimes that arise mid-flight, where VFR would make it unsafe to continue. References 1. www.stephan-schwab.com/airtravel/vfr-ifr.html 2. Air Med J. 2000 Jul-Sep;19(3):98-101, Why IFR (instrument flight rules)?, Shuford C1, Anderson RN. www.ncbi.nlm.nih.gov/pubmed/11184484 3. www.verticalmag.com/digital_issue/2015/v14i2/files/12.html

www.hutc.fr Low altitude section chart, Washington, D.C.

one of its limitations. Radio calls, pegging altitude, making complex calculations – flying under IFR is extra workload for the pilot. “It is a much more demanding skillset – especially single pilot IFR,” explains Stobo. “It’s complex, it takes a lot of thought from the pilot, a lot of thinking and risk assessment. Under singlepilot IFR there is a lot of responsibility that remains with the pilot. The challenges are extensive.” IFR standards There’s also the expense. As flying under IFR is more demanding, it requires a pilot with more training than with VFR. In the UK, the 50 hours of simulator and aircraft training needed for a basic pilot to obtain an IFR instrument rating costs upwards of £40,000. “That IFR rating is arguably one of the most demanding courses in aviation,” says Stobo. In the US, a pilot must have an instrument rating added to their licence and have flown six instrument approaches (predetermined manoeuvres under instrument flight conditions) in the previous six months, plus holding procedures, course interception, and tracking with naviad. In addition, a helicopter will need certification that it carries the appropriate 5050

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equipment to fly IFR. Stobo says: “The majority of our crews in the UK fly single pilot, and for a pilot to fly on his own in cloud under IFR means that he or she requires a technical autopilot, a higher degree of instrumentation and he must be qualified to fly on his own under IFR.” The safety factor The key question is, of course, does flying under IFR increase safety? A study by Shuford and Anderson published in the Air Medical Journal in 2000 looked at the advantages and disadvantages of IFR and VFR helicopter flight in air medical services and the financial feasibility of using IFR in an air medical programme. Analysis of data collected on missed flights due to bad weather for Vanderbilt Lifeflight over a six-year period found that an average of 24 per cent of flights were missed because of poor visibility and low clouds (conditions in which IFR-capable craft would have been able to fly). They concluded that flying IFR increased the overall safety mission of HEMS missions, allowing a better service to be provided to the community, and that ‘converting a ship from VFR to IFR, which involves both equipment purchases and pilot training, is economically feasible given the potential revenue gained by the number of flights completed during marginal

Helicopters 3 Cabri G2 1 Hughes 300 1 Ecureuil AS350 1 Dauphin AS365N GNSS

Simulators 1 FNPTII MCC/IR GNSS 1 FFS AS365N3

Training IR(H) GNSS CPL(H) FI(H) Type ratings (SEP-SET-MET) ATPL(H)

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WALES AIR AMBULANCE

from emergency medicine, anaesthetics and intensive care medicine working alongside critical care practitioners. The consultants are all job planned through their health boards and NHS trusts, a unique feature which creates long-term sustainability rather than consultants engaging in this activity only in their own time. The service currently operates from WAA’s Llanelli and Welshpool airbases, with potential to expand to the charity’s third base in Caernarfon.” The partnership between WAA and EMRTS Cymru’s advanced medical team allows the crew to bring the A&E department to the roadside through a wealth of prehospital care treatments. The emergency procedures that can be delivered include: emergency anaesthesia; blood and blood product transfusions advanced diagnostics (blood tests, ultrasound); advanced treatments (procedural sedation, chest procedures, fracture manipulation); and neonatal resuscitation and transfer. As Gill points out: “There are a number of innovations that this service brings. In terms of blood and blood products, the service carries packed red blood cells, lyophilised plasma, fibrinogen concentrate and prothrombin complex concentrate. This allows the service to manage bleeding patients to an advanced level to support clot stabilisation. The service also carries advanced ventilator, monitor and point-of-care testing systems improving the governance around clinical management and data collection. Furthermore, we provide an enhancement of neonatal care both for home deliveries and freestanding midwife-led units, supported by the existing neonatal transfer services. Finally ,the service covers all tiers of the medical support to major incidents and mass casualty events including the strategic medical advisor role.” EMRTS is part of NHS Wales and is funded by the Welsh Government. All the consultants (Flying Medics) who work with EMRTS have permanent contracts within Wales and England and their appointment to EMRTS allows them to split their time between their main hospital role and their secondment to this new service. The critical care practitioners form other members of the critical care teams onboard the helicopter and are recruited as full-time employees after a vigorous selection process. Dr Ami Jones, a consultant in anaesthetics, intensive care medicine and prehospital emergency medicine at Aneurin Bevan University >>

Wales Air Ambulance Cardiff Castle

WALES AIR AMBULANCE

Wales Air Ambulance (WAA), a HEMS charity, was set up on St David’s Day 2001. Its mission is to aid the relief of sickness and injury, and protect human life, by the provision of an air ambulance service across Wales, one of the four countries that makes up the United Kingdom. WAA chief executive Angela Hughes says: “Our operation has grown substantially from our humble beginnings with one aircraft and one employee. As we approach the charity’s 16th anniversary, we have carried

Senior pilot James Grenfell

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out more than 25,000 missions, introduced four advanced helicopters across Wales, employed 90 full or part-time staff and have raised over £55 million in charitable donations.” Wales comprises a diverse and challenging landscape with 8,000 square miles of remote countryside, bustling towns, vast mountain ranges, and 800 miles of coastline. The charity remains entirely non-profit-making and does not receive funding any regular direct funding from the government to fly its aircraft. WAA funds helicopters, pilots and engineers and flights through the organisation’s lease with Babcock and needs to raise £6.5 million pounds each year. The charity works in partnership with NHS Wales, the state-funded national health service, which supplies the secondment of consultants, critical care practitioners and paramedics. NHS Wales pays their salaries and provides some of the life-saving kit the teams use. However, WAA remains the driving force behind the whole operation in this partnership with the NHS and Babcock. Hughes heads up a small team of dedicated permanent managers and co-ordinators that make this happen. Not only do they ‘provide the impetus that holds all these essential services together’, but they also play a significant role in raising awareness and generating funds throughout the country. Aircraft In its early inception, the charity began with only one Bolkow 105 helicopter operating from Swansea, but

thanks to ongoing fundraising WAA currently has four EC135s with airbases at Caernavon, Welshpool Llanelli and Cardiff. In 2016, it staked its claim as ‘the biggest air ambulance operation in the UK’, with the unveiling of its fourth helicopter at the Wales National Air Show in July 2016. The EC135 T2e operates from a new base in Cardiff, and became operational within the WAA fleet in August. Missions increase The number of missions flown has grown significantly over the years. In 2015, WAA attended 1,650 missions, of which approximately 30 per cent were road traffic collisions, 14 per cent falls, 16 per cent due to other trauma, and 20 per cent were cardiac missions, most of which involved cardiac arrest. A further 20 per cent of cases involved medical conditions and 14 per cent of all missions involved paediatric patients. Assisting paediatric patients under the moniker The National Children’s Air Ambulance (NCAA) is also an integral part of the charity, with WAA responding to both emergency incidents and urgent inter-hospital transfers for the children of Wales. On average, WAA airlifts 300 children per year. Many are treated at the Children’s Hospital for Wales in the nation’s capital Cardiff, but patients are also conveyed to hospitals across the UK such as Alder Hey in Liverpool, Birmingham Children’s Hospital and Great Ormond Street in London, all of which lie across the English border. WAA also works closely with road crews and other emergency and rescue agencies. If poor weather conditions restrict flying, the medical crew has access to a fleet of Rapid Response Vehicles (RRVs). Five Audi Q7s SUVs have been converted for this purpose; medical equipment is transferable between the aircraft and RRVs. EMRTS Frontline lessons learnt in Afghanistan have been brought to bear on the operations of the WAA medical programme. The Emergency Medical Retrieval Transfer Service (EMRTS Cymru), also known as the Welsh Flying Medics, is a pioneering programme established by Dr Dindi Gill and Dr Rhys Thomas in April 2015. As interim director, Gill oversees the strategic direction and clinical work of the service. Each air base has a base lead. Gill describes the service in this way: “The workforce consists of consultants

WALES AIR AMBULANCE

WALES AIR AMBULANCE

Angela Hughes

Dr Ami Jones Copyright Wales Air Ambulance Charity

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PROVIDER PROFILE

EMRTS team with charity helicopter

The Future From spring 2017, the charity 54 54

AIRMED & RESCUE

Coast heli action

Meanwhile, there is potential for EMRTS to expand its programme into the third WAA base at Caernarfon and, if the demand is evident, to move from being a 12-hour service to a 24-hour service. Things seem very positive, as Angela Hughes highlights: “In the past 18 months, we have secured consultants onboard with advanced kit and a range of blood products. Along with our move to a purpose-built airbase in Llanelli, it is truly exciting to be in Wales right now. We’re talking with HEMS operations around the world to share these pioneering developments, which has put Wales on the map.” She is quick to add “None of this would have been possible without the support of the people of Wales. It is through their passion and charitable donations we are able to fly at all.”

WALES AIR AMBULANCE

Health Board, summed up her experience: “It’s a very demanding job, more so than my job in the hospital as I am delivering the kind of lifesaving interventions that would normally only be performed in a hospital at the road side or in someone’s house, so the environment is much less controlled than a hospital bed.” Chris Shaw (former critical care nurse and EMRTS Cymru critical care practitioner), another essential crew member, adds: “Seeing a larger portion of the patient journey is a real reward of the job and has influenced my practice. We deliver care from the point of incident through to the handover to definite care.” What happens onboard the helicopter becomes a collaborative effort in these life and death situations, as senior WAA pilot James Grenfell states: “As a member of the HEMS team, we all develop new skills which crossover from our role to help others. HEMS crew members train in navigation and operations of the aircraft, and most pilots become familiar with medical terms and equipment and assist during pre-hospital emergencies. Being able to understand each other’s roles also gives an appreciation of what is going on, how you can assist and plays a huge part of crew resource management.”

will begin flying EC145s. The first of the new, larger machines, arrived at Gloucestershire airport in late November, where Babcock will adapt it for the air ambulance role. Hughes comments: “The new models represent a significant upgrade on our current fleet. They will be equipped for night flights and help take us a step closer to our goal of providing a 24hour air ambulance service. In addition, the new aircraft will have a larger cabin allowing for more room for treatments in-flight, as well as more powerful engines, which means they can fly for longer without refuelling.” WAA is also looking into increasing its flying hours and beginning night operations. It recently made a successful bid to the UK government and was one of the air ambulance charities that benefited from the latest wave of handouts related to LIBOR banking fines. The £1-million boost will go towards increasing flying hours and the charity’s plans for night operations. Hughes explains: “Our bid set out how a donation from LIBOR will help us to set up a fully-functional night operation for the whole of Wales, enabling us to carry out paediatric, neonatal and adult missions onboard our aircraft. We’re delighted to have secured £1 million, which will cover one third of our costs for night flight planning.”

WALES AIR AMBULANCE

WALES AIR AMBULANCE

PROVIDER PROFILE

EMRTS team inside charity helicopter

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FEATURE

FEATURE

helicopter ditching 180 miles offshore. That’s a start, but what is the likely survival time for survivors in the water? Once you know that, you need to consider the reaction time, the time to get on station, the search time (which will increase if survivors are drifting) and then the time to winch all onboard and return them to where they can be cared for. You also need to specify if this is to be a 24-hour, all-weather service or daylight only. It is important to consider the end-to-end process. This starts with the call-out processes and who will do what. It ends with handing a casualty to

focus on specifying the actual capability and performance you want delivered

Contracting for SAR and medevac services When it comes to contracting aerial search and rescue and air ambulance services, the devil can be in the detail. Andy Evans, director of Aerossurance looks at good practice in designing tenders from the buyer’s perspective Some organisations conduct search and rescue (SAR) or air ambulance/ medevac services as an integral part of their mission. Others contract specialist providers to operate aircraft for them. These customers may be government agencies, local hospitals or companies that need to supplement the emergency support that is otherwise available. Oil and gas, mining and offshore wind energy companies are examples of companies that contract such services. In this article, we look at a few of the criteria that need to be considered when preparing to tender for such a service. Operational needs Before you even start a tender process you need to work out your requirements. These need to be specific, verifiable objectives linked to your operational needs. SAR and medevac services are not simple commodities. Just saying you want ‘a SAR helicopter’, for example, is rather vague! Having a little aviation knowledge can, however, produce an even worse situation when a customer attempts to specify what they think a SAR helicopter looks like (e.g. ‘a helicopter with a winch and a trained winch operator and winchman’). In practice, specifying only ‘components’ is dangerous unless you are sure that every component necessary to deliver a successful service is included. Even the definition of what ‘trained’ is, for example, is a challenge. However, customers need to be careful they don’t write overly prescriptive 5656

AIRMED & RESCUE

specifications that constrain innovation and limit a bidder’s proposed solutions unnecessarily. We know one case where a customer specified the helicopter type (the one they already used for passenger transport) and specified the equipment, but neglected to consider aircraft performance in the tropical location it was to be used. The result: the aircraft did not have the one-engine-inoperative performance to conduct safe winch training and so the SAR service was never introduced, the expensive equipment sat gathering dust and the aircraft was put to use ferrying passengers. Another disadvantage of being over-prescriptive is that you may

having a little aviation knowledge can, however, produce an even worse situation inadvertently eliminate potential bidders who could legally challenge the validity of an unnecessarily specific and thus anti-competitive requirement. These reasons are why competent independent professional aviation advice is invaluable. The best option is to focus on specifying the actual capability and performance you want delivered and leave bidders the freedom to work out how best to do that. In practice, an oil company, for example, might want a SAR service capable of rescuing 14 people from a passenger

a medical service provider in a place of safety. Consider all the permutations and what your organisation will do and what you expect your aviation service provider to do. Where you are contracting a service to support your company employees at your own work sites, you also have to decide how you will respond to government requests for ad hoc support. In the investigations that followed a SAR mission off the Netherlands in 2015, investigators from the Dutch Safety Board described ‘confusion’ at the customer’s control centre that resulted in a collapsed sports diver being collected by a SAR helicopter that had no medical personnel onboard. The control centre was then unable to give direction on which hospital to fly to, so leaving the helicopter captain to decide where to take the casualty. The diver died later that day having been subsequently moved to a second hospital. Beyond regulations It’s a cliché to say that aviation is a heavily regulated industry. However, some customers of aviation services, especially those with little aviation experience, assume that this means they don’t need to consider specific safety requirements in their tender. Regulations are simply a minimum standard and mere compliance does

not guarantee a safe operation. Approved air operators, regularly audited by their regulators, still have accidents. Furthermore, in some countries the standards applied to the operators of smaller aircraft are fairly minimal compared to that expected for the operators of larger aircraft. The regulatory attention on the necessary role-specific modifications or training requirements may be less than desirable. Though the flying may be especially challenging, an air operator’s personnel may be relatively inexperienced and ‘building hours’. There may therefore still be some aspects to be explicit on. If you will be operating in an area with high levels of air traffic with an aircraft that isn’t legally required to have an airborne collision avoidance system, you may decide that is an appropriate contractual requirement. Don’t specify specific brands of equipment. Either call up an industry standard spec or set out the objective the system is required to do. For emergency service contracts, especially those where call-outs are rare, ensuring the contract funds adequate on-going training to maintain currency in all the nuances of the role is critical. This needs in-depth, expert consideration before issuing an invitation to tender. Contractual response time targets are another possible pitfall. Some less scrupulous air operators may be tempted to play a sleight of hand to avoid regulatory flight and duty time limits by not treating crew as on duty when they are actually on stand-by and unable to rest. In fact, in some countries, no flight and duty time limits may be applicable outside of airline operations, and consequently crew may be on stand-by in unsuitable accommodation to the point of fatigue – a ticking time bomb awaiting a call-out. If no regulatory flight and duty time limits exist, rather than invent your own, call up an existing regulatory or industry standard. Where the specific type of operation is exempt from particular regulations, but you wish the air operator to apply them as if they were applicable, be careful how you reference the requirements in the contract. It’s too easy to fall into a trap of inadvertently referring to the regulation in a way that the exemption is referenced too, making the requirement non-binding contractually. No organisation would commit to a multi-million dollar contract without a legal review, but Aerossurance has seen cases where expensive legal reviews have failed to spot such errors; again, a reason for competent professional aviation advice. This is not to say that air operators automatically try to pull the wool over customers’ eyes! The vast majority are competent and conscientious organisations. While they want to make a profit, they do want to deliver a good service and win further business from you and others. However, the less sophisticated operators may not take full advantage of some additional requirements. One example was a fixed-wing air ambulance accident in Canada in 2014. The Transport Safety Board’s report details how the contract required two flight crew and crew resource management training. However, the CRM training was ‘informal’, co-pilots were low-time ‘hours builders’, the captain was used to flying single pilot, and on the day the co-pilot did not have a headset, minimising the co-pilot’s ability to contribute. Investigators also found that there were unrestrained items of equipment in the cabin and role changes were being done by unqualified personnel. No approach charts were found onboard while the GPS database was found to be outdated and passenger briefings were inadequate. The benefit of certain aerodynamic enhancing modifications was being assumed in flight planning, but these >>

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diary dates

modifications were not fitted. Role equipment was not subject to formalised maintenance. In the country in question, air operators of this size were not required by regulation to have a safety management system. Investigators found no flight safety procedures. In a further, fatal accident in 2014, a German air operator was contracted to provide HEMS support to an offshore wind energy project. They had extensive HEMS experience but no offshore background. During night winch training early in the contract, the helicopter flew into the sea. Investigators

ensure the contract funds adequate on-going training to maintain currency

highlighted inadequate training, procedures and equipment. When you go out to tender, you may use a public announcement (e.g. a contracts bulletin or procurement website announcement) or by specific invitation. In the former case, be sure that the description and coding used will attract the attention of potential aviation bidders. In the latter case, professional aviation advice can usually help identify a wider range of credible bidders, locally and further afield. Do allow sufficient time for bidders to develop solutions. It’s amazing how many organisations give bidders less time to prepare than they expect to take to assess the response! Equally important is allowing time to mobilise for a contract. Expecting equipped aircraft and trained crews just weeks after contract award may not only result in disappointment, but may lead to ongoing weaknesses for months or more. Assessment and audits Aerossurance would always advise that bids are assessed transparently on their technical aspects as well as cost, using a scoring scheme that is explained in the tender documents. You may choose to conduct a specific aviation audit or on-site review of all bidders as a pre-qualification requirement. This can be a costly exercise, and it is normally better to use existing regulatory approvals or industry accreditations as a pre-qualification filter. If you do an aviation audit or review after bids are received but before contract award, you need to decide if this 5858

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is to verify specific claims in the bid, assess against pre-defined evaluation criteria that will contribute to the final selection, or simply to provide a sanity check for added confidence. Again, you have a choice of auditing all bidders, a shortlist or the preferred bidder. Aerossurance would normally recommend auditing the short-list candidates rather than all the bidders. That should give extra confidence when you select the preferred bidder, but avoids wasteful audits of organisations that will be eliminated anyway. Aerossurance would normally recommend that this is done by an aviation professional accompanied by a customer representative who will be closely liaising with the eventual service provider. Once you have selected a preferred bidder, you need to finalise the contract for signature. A contract is an agreement between two or more parties, so if you want the service provider to do things, it must be in the contract. Trying to extract extra services ‘for free’ after contract signature is just the behaviour that sours a commercial relationship. Once you sign the contract, then the hard work really starts! Implementation, possibly interlinked with the phase-out of an existing provider’s contract, and possibly with an interim operating capability stage prior to full operating capability, needs careful planning. You need to rehearse and exercise, including the interfaces between your organisation and your service provider. You also need to consider what level of independent assurance activity is likely to be appropriate through the length of the contract. Simply scheduling an annual audit to parachute in an independent aviation adviser is a simplistic approach. It’s better to consider any audits or reviews as complementary to the regulatory approvals and any industry accreditations, programmed status meetings, routine reporting and exercises. Taking a more holistic oversight approach is both more efficient and more effective. Final words If your organisation has limited aviation experience, it’s vital to contract in some aviation expertise to make sure the contract is right, the bidders’ capabilities are properly assessed and the winner is subject to periodic oversight. Just contracting for an audit after contract award may be too late and ineffective. Look for support from an aviation consultancy that has practical experience with safety, flight operations, airworthiness and contracting. Avoid consultancies that are actually just audit or training companies. Also avoid consultants who lack operational management experience or are not current with the latest developments in the industry. However, above all, make sure you only contract competent air operators who know their business and can be trusted to deliver safely and reliably. You can’t audit in competence after a contract award!

AUTHOR ANDY EVANS Andy Evans is director of aviation consultancy Aerossurance, which provides a range of specialist services to customers globally. His career has developed from design into safety regulation, all aspects of airworthiness, the management of safety and human factors within air operators, contracting for air services and safety leadership/culture development. He is a member of the Flight Safety Foundation’s European Advisory Committee and a fellow of the Royal Aeronautical Society.

BIGGLES GIGGLES

Fool me once, snakes on you…

Send your diary dates to: info@airmedandrescue.com 25-28 February

ITIC Americas

A helicopter crew in Mackay, Australia, has been twice visited by an unusual guest. A police Radio Electronics Service (RES) crew flew in on a helicopter to a remote tower to repair a computer terminal. When a technician opened it up to check what the problem was, he realised that the issue was in fact a live snake that had slithered into the terminal. The crew humanely removed the snake.

Voyageur Publishing & Events Austin, Texas, US www.itic.co

March

Age of Drones Expo

Events Interntional Dortmund, Germany www.ageofdrones-expo.com/

Freewheelers shows off new calendar

2-3 March

Unmanned Technologies & Security Expo & Conference Nürnberg Messe Nuremberg Exhibition Centre www.utsec.de

29 March

UAV & SAR workshop

Italian National Fire Service Istituto Superiore Antincendi, Rome, Italy www.vigilfuoco.it

23-28 April

Medical Transport Leadership Institute

Cut to a month later – RES staff again flew into the remote tower to perform more maintenance on the computer terminal. This time, the crew packed it into

AAMS Oglebay National Training Center, Wheeling, West Virginia, US www.aams.org

10-12 May

EAAA takes the mannequin challenge

International Biomedical Sheraton Hotel at the Capitol, Austin,Texas, US www.int-bio.com/conference.php

1-3 June

Heli UK Expo

World Aviation Events Wycombe Air Park, UK www.heliukexpo.com

5-7 June

PavCon

Police Aviation Research/NPAS Doncaster Sheffield Airport, UK www.pavcon.org

23-28 July

ALEA EXPO 2017

Airborne Law Enforcement Association Reno, Nevada, US www.alea.org/events

Freewheelers EVS, a UK charity that provides motorcycle couriers to deliver blood products to helicopter air ambulance services, has teased its new 2017 calendar in association with Sainsbury’s. The video, set to a funky soundtrack, shows snaps from the new calendar set in the supermarket in Bristol, UK. It includes a courier trying to reason with the self-checkout machine, a petrol station full of EMS motorbikes and two blood couriers seemingly finding love at first sight in the aisles. To watch full video head to: www.airmedandrescue.com/story/1645.

15th Airborne Neonatal & Pediatric Transport Conference

MACKAY POLICE

FEATURE

the helicopter and took it back to their Mackay base. When they got back to base, they again prised the terminal open and again found a snake inside. Senior constable Steve Smith was called to have a look at the snake, and upon inspecting the unit realised that there was yet another snake in the computer terminal. The crew had unwittingly carried both serpents in their helicopter all the way back. Samuel L Jackson was not available for comment.

East Anglian Air Ambulance (EAAA) has got onboard with the Internet’s latest viral trend, seemingly stopping time in their base to perform the mannequin challenge. For those unaware, the idea of the challenge is for the participants to stand as still as they can whilst acting out a scenario. By the looks of the video, the EAAA crew are getting ready to take part in the charity’s latest fundraising effort called Only The Brave. The event is an obstacle course challenge that combines a five-kilometre run with over 40 obstacles. Last year’s event raised over £110,000 for the charity. Watch the (in)action at www.airmedandrescue.com/ story/1706

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AirMed & Rescue Dec 16 / Jan 2017  
AirMed & Rescue Dec 16 / Jan 2017