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AIRMED & RESCUE MAGAZINE

magazine ISSUE 83 | APRIL / MAY 2017

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ISSUE 83

Whether you are looking for Civil Aviation Authority (CAA) compliant and certiied basic to advanced hoist mission training, new aircraft type SAR role conversion, or complete turn-key Air Ambulance/HEMS and SAR/LIMSAR program implementation with operational Paramedic and Rescue Specialist Aircrew staffing, we deliver proven solutions. Priority 1 Air Rescue is dedicated to providing unparalleled capability, safety, and service to perform lifesaving missions.

Mission simulation for HEMS medics Bridging the gap from the classroom to real-world practice

Provider profile

Ice protection developments for light/medium helicopters

Queensland Government Air

Docs onboard

Take-off talk

Should helicopter services be paramedic or physician-led?

When the caller says ‘go’, but the crew says ‘no’


Contents

Editor-in-chief: Ian Cameron Editor: James Paul Wallis Sub-editors: Christian Northwood, Lauren Haigh, Mandy Langfield, Stefan Mohamed, Sarah Watson

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Advertising Sales: James Miller, Mike Forster Production/Subscriptions: Richard Eatwell Design: Katie Mitchell, Tommy Baker, Eli Butler, Steve Mundey, Will McClelland, Peter Griffiths

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Subscriptions: www.airmedandrescue.com/subscribe subscriptions@voyageur.co.uk Published on behalf of Voyageur Publishing & Events Ltd Voyageur Buildings, 19 Lower Park Row, Bristol, BS1 5BN, UK The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Publishing & Events Ltd can accept any responsibility for any error or misinterpretation. The views expressed do not necessarily reflect those of the publisher. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or firm mentioned, is hereby excluded.

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Mission simulation for HEMS medics Bridging the gap from classroom learning to real-world practice

ISSUE 83 ISSN 2059-0822 (Print)

Should helicopter air ambulance services be paramedic or physician-led?

Main stories 52

magazine AIRMED & RESCUE

Docs onboard

Provider profile

Take-off talk

Queensland Government When the caller says ‘go’, Air but the crew says ‘no’

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

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Unmanned aircraft – not a binary choice Ian Povey, UK Civil Air Patrol

Air Methods agrees to American Securities buy-out US-based HEMS giant to be acquired by affiliates of private equity firm

Cover image: An ambulance Tasmania Beechcraft B200C King Air, January 2017 (Michael Lueck)


NEWS

Editor’s comment Welcome to Issue 83 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. Followers of this column (anyone? hello?) may recall my recent nagging, calling for all drones to be fitted as standard with navigation lights visible under NVGs and infrared. The idea being that if UAVs are being flown at night, whether for authorised emergency response or by regulation-ignoring amateurs, such lights could improve the chances that they’ll be spotted by helicopter pilots, reducing the risk of collisions. Only a reduction in risk, perhaps, but everyone tells me the suitable LEDs are cheap enough to use on all UAVs sold, so why not? Previously I found little interest from quadcopter makers in engaging with the idea, but I had very slightly more luck when talking to drone maker DraganFly recently. What caught my eye was their announcement on integrating lighting from SureFire to provide a 2000-lumen beam to help in, for example, night search missions. A drone specifically designed for night searching? A perfect example of when NVG/IR navigation lights would seem worthwhile as a standard fitting, I thought, to help helicopter pilots at the same scene to see and avoid. DraganFly told me that adding an IR LED strobe would be a simple, low-cost swap, and would be very visible under NVGs. The next version of the search-oriented drone may have these as the firm commercialises the product, said a representative. Speaking of drones, it seems to me from monitoring the news wires that some of the novelty is wearing off. I mean that in a good way, as rather than just being in thrall to the possibilities, the discussion is moving on to a sober assessment of, yes, the capabilities, but also the limitations and how to actually integrate remotely piloted vehicles into the rescue environment. It’s a topic explored by Ian Povey, a commercial operator of small unmanned aircraft and member of the UK Civil Air Patrol’s Northern Region, on p.33. He acknowledges that UAVs are a highly effective tool, but adds that they are not a panacea. To paraphrase Povey, it’s a question of horses for courses – using the tools that are appropriate in each given circumstance. See also the video from the UK National Police Air Service that we shared on our website, airmedandrescue.com. NPAS Chief Pilot Captain Paul Watts points out the advantages of manned machines over remotely piloted aircraft, such as their greater range and endurance. However, he also predicts that as drone tech improves, the number of helicopters needed may reduce, leading to cost savings. Of course, every month, new agencies are coming at this from the other end of the budget scale – buying quadcopters as the only affordable way to take to the air for the first time. As long as it can be done safely, it’s surely a win-win for the rescuers and the rescuees.

New study finds trauma signifier

NEWS

Preflight check and lack of alert led to helicopter crash

A new study published in the Air Medical Journal has examined the levels of fibrinogen degradation product (FDP) in trauma victims transported by air ambulances. After retrospectively charting the recorded levels from 151 patients that were flown into the Numazu City Hospital, Japan, by the Doctor Helicopter service, the scientists’ investigation concluded that FDP ‘must be a useful biochemical parameter for the initial evaluation of the severity of the trauma, even in blunt trauma patients without head injury or with stable vital signs’. The study, which the researchers described as the first of its kind, theorised that as FDP levels were shown as a good signifier for the severity of a head injury, it may also prove a good signifier for other trauma injuries. The researchers, made up from the Department of Acute Critical Care Medicine, Juntendo, and the Numazu City Hospital, then analysed 151 patients who had been taken to the hospital via air ambulance with severe trauma between February 2011 and July 2016. The study aimed to help reduce the number of fatalities suffered in air ambulances by trying to prove that FDP levels could show whether a patient would need a transfusion. The patients were first spilt up into two groups; a survival group and a fatal group. The two groups were then compared over a range of data, including each patient’s sex, age, presence of head injury, mechanism of injury, Glasgow Coma Scale on arrival, systolic blood pressure, heart rate, type of injury, injury severity score (ISS), FDP level at arrival, and base excess in a univariate analysis. “There were no significant differences between the two groups with regard to age, sex and heart rate,” stated the study report. “However, the ratio of head injury, value of ISS, and the level of FDP in the fatal group were significantly greater than in the survival group. The average Glasgow Coma Scale, systolic blood pressure, and level of base excess in the fatal group were significantly smaller than in the survival group.” From this, the researchers concluded: “This is the first study to show that among trauma patients transported by Doctor Helicopter, the level of consciousness, blood pressure, ISS, FDP level, base excess, and the presence of head injury were associated with fatality. In addition, the FDP level at arrival had a positive correlation with anatomic traumatic severity.”

A preflight system check and the lack of an indication in the cockpit that could have alerted the pilot of low hydraulic pressure resulting in high pedal loads and a subsequent loss of control after takeoff, was the probable cause of a helicopter crash in Colorado, US, that killed the pilot and seriously injured two flight nurses, the National Transportation Safety Board (NTSB) said on 28 March. On 3 July 2015, the pilot, with two flight nurses onboard, took off from a hospital helipad in Frisco, Colorado on a Flight for Life mission operated by Air Methods Corporation. As it became airborne, the AS350 B3e began spinning counterclockwise, gaining about 100 ft (30 m) of altitude before plunging downward, impacting the ground at an estimated vertical speed of about 40 mph, said the Board. A statement from the NTSB explained: “The pilot was required to perform a preflight check during which the hydraulic switch was moved to its off position, which cuts off hydraulic pressure to the tail rotor flight controls. The investigation revealed that the hydraulic system was likely misconfigured. Just 10 months before the accident, the helicopter manufacturer had issued a safety notice to inform operators that attempting flight without the hydraulic switch in the correct position could render the helicopter uncontrollable because of the resulting lack of hydraulic assistance to the tail rotor system.”

James Paul Wallis Editor editor@airmedandrescue.com Numazu City Hospital (library image)

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known that people make mistakes, which is why we need to take every opportunity to enhance systems that can help mitigate human error,” said Dinh-Zarr. As a result of the investigation, the NTSB issued two recommendations to the Federal Aviation Administration, two to Airbus Helicopters, and one each to the European Aviation Safety Agency, the Association of Critical Care Transport, the Association of Air Medical Services and the Air Medical Operators Association. The NTSB also reiterated two previously issued recommendations related to flight data recorders. Dinh-Zarr added: “The pilot died of injuries that he sustained in the accident. The two flight nurses survived the accident with serious injuries. On behalf of my fellow Board Members and the entire NTSB staff, I would like to offer our sincerest condolences to the family and friends of the pilot. We hope that this investigation will help prevent a similar tragedy in the future. We also know that the flight nurses who survived the crash will suffer lifelong complications from their injuries. We hope that both are on their way to the fullest possible recovery.” The abstract, including the full text of the findings and probable cause of the crash, along with staff presentations and safety recommendations, is available at www.go.usa.gov/xXXGk. The NTSB also published two videos of the crash recorded by surveillance cameras: www.airmedandrescue.com/story/1971.

UCX MedFlight will ‘disrupt’ fixed-wing air ambulance industry US-based UCX MedFlight, which announced the launch of global air ambulance services in February, has stated that it is set to ‘disrupt’ the fixed-wing air ambulance industry. The industry as a whole is prime for a new entrant to disrupt the status quo and lead out with fresh ideas, new technology, and precision, said the organisation. UCX MedFlight believes it is ‘uniquely positioned’ to pioneer these updates in global air ambulance services.

We hope you enjoy this issue of AirMed & Rescue Magazine.

The NTSB’s investigation found that there was no warning in the cockpit to alert the pilot that a critical system needed for safe flight was not configured correctly. “Because the pilot had no alert indication in the cockpit that the switch was not in the correct position, he likely didn’t know why he was having difficulty controlling the helicopter,” said NTSB acting chairman Bella Dinh-Zarr. “It’s in these treacherous airborne seconds that pilots need access to the information that a warning indication can provide.” Surveillance video showed a fuel-fed fire ignited a few seconds after impact. Investigators determined that the helicopter occupants’ severe thermal injuries would have been reduced or eliminated had the helicopter been equipped with a crashresistant fuel system, said the Board. While at the time of the crash, no such system was available for existing AS350 B3e models, the NTSB noted that Airbus Helicopters has since provided a crash-resistant fuel system retrofit for that model. The Board added that although described by colleagues as safety conscious, risk adverse and one who followed procedures, the pilot did not perform a hover check, which could have alerted the pilot of an increase in pedal loads, as company procedures required. Such a check involves ‘hovering the aircraft three to five feet above the ground to determine that all systems are functioning and the helicopter is controllable’. “Although adherence to flying procedures could have prevented this crash, we have long

In a statement, the firm said: “The fixedwing air ambulance/air medical transport industry has long been entrenched in old routines of inefficiency and dated technology. The frustrations of patients, families, caregivers, hospital case managers, insurance companies, and travel assistance companies are rooted in the fixed-wing air ambulance industry’s long history of unreliability, lack of customer service, non-transparent billing

practices, and lack of consistency in training capabilities.” UCX MedFlight, which describes itself as ‘one of the most trusted names in medical air transportation’, added that it can fly faster, farther and less expensively than the historical standard set by operators in the fixed-wing air ambulance industry. The company is planning for rapid expansion, and has said it expects to gain 300 new staff members by February 2019.

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NEWS

Air Methods agrees to American Securities buy-out US-based HEMS giant Air Methods Corporation announced on 14 March that it had entered into a definitive agreement to be acquired by affiliates of private equity firm American Securities LLC. Under the terms of the agreement, affiliates of American Securities will acquire all outstanding shares of Air Methods for $43.00 per share in cash. This represents a 20.4-per-cent premium to Air Methods’ stock price of $35.70 as it stood on 31 January prior to reports published that speculated a buyer was being sought. The transaction, which Air Methods said was unanimously approved by its board of directors, has a total enterprise value of approximately $2.5 billion, including net debt. Aaron Todd, Air Methods CEO, said: “This transaction will enable us to continue to execute against our strategy and strengthen our market position as a global leader in air medical transportation and air tourism.

American Securities offers us a great opportunity to continue to invest and pursue long-term growth with greater operational flexibility, and we look forward to working with such a sophisticated private equity investor. Importantly, patients, employees, customers and partners will continue to benefit as we execute against our strategy.” Air Methods boasts over 300 bases of operations serving 48 states. The company said its strategy to drive long-term growth includes a focus on improving the utilisation of its assets, growing its air medical footprint in underserved markets and increasing the revenue and profitability of its tourism operations. “We are pleased to have reached this agreement, which will deliver certain and immediate cash value and a compelling premium to our stock price prior to press speculation for our shareholders,” said C. David Kikumoto, chairman of the

Air Methods board of directors. “We are confident that today’s announcement represents the best path forward for all of Air Methods’ stakeholders and appreciate the leadership of Morad Tahbaz, the chairman of the finance and strategic planning committee, who led the board through this process.” Marc L. Saiontz, a managing director of American Securities, commented: “We strongly believe in Air Methods’ strategic direction and the opportunities to grow the company’s leading positions in the attractive air medical and air tourism markets. We respect the company’s commitment to providing access to patients in the communities that need it the most, with a focus on quality of care and safety in aviation. We look forward to partnering with the Air Methods team to drive value.” The transaction is expected to be completed by the end of the second calendar quarter of 2017.

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Plasma trial results in ‘unexpected survivors’

GNAAS

Great North Air Ambulance Service (GNAAS), a UK HEMS charity, has announced that the early results of its trial

A GNAAS team with a plasma transfusion kit

using plasma onboard it helicopters has seen yet more ‘unexpected survivors’. The trial began in May 2016, and a review of

the first five months of data has revealed that the effects have been positive. “We’re delighted to see evidence that using fresh frozen plasma alongside red blood cell transfusions, when stabilising patients with life threatening injuries, has had such a positive impact,” said Dr Rachel Hawes, an experienced GNAAS aircrew doctor and consultant in anaesthesia and prehospital emergency medicine at Newcastle’s Royal Victoria Infirmary. “Across the first five months of the new trial, we have seen three unexpected survivors, which is fantastic news.” During the trial period, 36 patients were treated with the procedure, something that Hawes says shows ‘how much this new approach has become routine practice’. She added: “We always hoped the balanced transfusion technique would mean more patients arriving at hospital with their bleeding under control and minimal abnormal clotting. What we didn’t expect to see was that these patients then required fewer transfusions in hospital.” GNAAS said that it is planning to build a regional Centre of Medical Excellence to enable more research projects.

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NEWS

LAA responds after UK terror attack On 22 March, a London’s Air Ambulance (LAA) helicopter landed in Parliament Square, London, UK, after a fatal attack that is being treated as a terrorist incident. The HEMS charity said its advanced trauma team worked with London Ambulance personnel to treat multiple casualties. The attacker and four victims died and 40 were left injured after a man drove a car along the pavement of Westminster Bridge and then entered the Parliament complex on foot. One of those killed was Police Constable Keith Partner, who was stabbed as officers tackled the attacker. A further victim died of her injuries in hospital in April. In a statement released by LAA, Dr Gareth

Davies, the charity’s medical director and a consultant at Barts Health NHS Trust said: “Our thoughts and prayers are with the friends, families and colleagues of those who lost their lives or were injured at the tragic incident in Westminster yesterday. Our team worked alongside other emergency services, including the London Ambulance Service, the Metropolitan Police and the London Fire Brigade, to assess and treat multiple casualties. I would like to thank all of our team who were involved, whether directly or indirectly, and commend the London Ambulance Service for their management of a highly complicated scene.” Davies also expressed the service’s gratitude

to the members of the public and medical professionals who ‘showed courage and strength by rallying together to help in what must have been the most frightening ordeal’. He continued: “We have been blown away by the generosity of Londoners who have, in less than 24 hours, donated £10,000 to the London’s Air Ambulance charity. We are a service for Londoners, funded by Londoners. London is a great city and we all stand together, especially in difficult times.” Another of the LAA team, Dr Tony Joy, was interviewed by the BBC Breakfast television programme on 23 March. Go to www.airmedandrescue.com/story/1953.

NZ trials centralised air ambulance dispatch A two-year trial to centralise the coordination and dispatch of New Zealand air ambulance helicopter services began on 20 February, announced emergency responder charity St John. The charity noted that the trial has been funded by the New Zealand Ministry of Health and Accident Compensation Corporation (ACC). The NZ$591,000 project is the result of a collaboration between St John, Wellington Free Ambulance and Air Rescue Group. An ‘Air Desk’ staffed by two clinical support officers (CSO) will be on call 15 hours a day, seven

NEWS

North Carolina releases best practice for disasterresponse drone use The North Carolina Department of Transportation (NCDOT) has released a final report giving best practices and recommended policies for agencies using drones in emergency situations, such as flood response or searching for lost hikers. Advice includes a recommendation to use a visual observer to confirm visual separation of all aircraft. The report also highlights data management issues, saying that policies should be in place defining where any data captured is stored, how long it should be kept, and who should be able to access it. NCDOT’s Division of Aviation is tasked with leading state-wide drone education and training through a series of exercises and workshops, said the Department. The

report was released after the Division of Aviation held a workshop with emergency management personnel from around the state of North Carolina in January. The organisation said that agencies should educate the public about any UAS programme plans including aircraft capabilities, sensors, the types of activities the UAS will perform, expected outcomes, and the risk mitigations implemented to ensure public safety. Aviation Division director Bobby Walston commented: “The exercise produced several key findings and recommendations that support the immediate, safe integration of drones into the National Airspace System. This will make our state’s public agencies more effective as drone

operations become more routine.” Walston added that the need for this type of exercise has never been stronger: “Ensuring the use of this technology is properly co-ordinated is top priority in guaranteeing operations are conducted safely and effectively.” NCDOT noted that the advantages of using drones in disaster response include: navigating unreachable locations more closely and easily compared to larger aircraft; providing a quicker response time; taking away the human risk that can come with operating larger aircraft; and conducting search and rescue less expensively. See the full report via www.airmedandrescue.com/story/1961.

air ambulance helicopter resources in New Zealand. It will assess calls to make sure the correct type of helicopter and staff will be sent to an accident scene. Lane continued: “At times, the helicopter closest to an incident may not be the right one, so the Air Desk staff will play a key role in determining which aircraft and available staff are best for the situation at hand. They will work closely with land-based response teams and will be particularly valuable in situations where there are many medical trauma victims and where accessibility for land-based crew is difficult.”

days a week from a base in Auckland Clinical Control Centre. “The CSOs are all paramedics trained to intensive care level and the six staff appointed to the role all have air sector experience,” said St John director of clinical operations Norma Lane. “The experience is important because we want to ensure that the most appropriate air ambulance services are dispatched at the most appropriate times in order to optimise clinical outcomes for patients in urgent need.” The Air Desk will be used to centralise the dispatch and co-ordination of all emergency

The Italian fire service, the Vigili del Fuoco, has been rewarded for its use of drone technology in the rescue efforts after the earthquakes in Amatrice and Central

Italy and after the avalanche that hit Hotel Rigopiano. The Roma Drone Awards 2017 have honoured the service after a ‘difficult year’. During the earthquakes in 2016, the Vigili del Fuoco used its drones to investigate damaged towns, using the data collected to assess the extent of the damage and work on plans for recovery. This in turn helped to protect the lives of the firefighters and volunteers tasked with the recovery, allowing fragile and dangerous buildings to be cordoned off before rescuers went in. The award was presented to Giuseppe Romano, the director of the Vigili del

Fuoco, on 21 February. The service was also named as the world’s best firefighting service due to its hard work over the last year.

VIGILI DEL FUOCO

VIGILI DEL FUOCO

Italian fire service’s innovative use of drones honoured

Drone footage of Amatrice after the earthquake.

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NEWS

CAMTS to add IIMC training to standards The Commission on Accreditation of Medical Transport Systems (CAMTS) has said that the next revision to the CAMTS Standards will encourage additional helicopter instrument flight rules (IFR) training requirements for air ambulance providers. The US-based organisation said the draft of the recommendation, which is to be incorporated into the 11th Edition of the Standards, will require quarterly inadvertent instrument meteorological condition (IIMC) training, demonstration of the pilot’s ability to safely manoeuvre the helicopter into visual meteorological conditions (VMC) and completion of an IFR approach. For instrument proficiency training in nonIFR-certified rotorcraft, the pilot should perform such manoeuvres as are appropriate to the vehicle’s installed equipment, the certificate holder’s operations specifications, and the operating environment, said CAMTS. Explaining the rationale behind the move,

the organisation stated: “A recent analysis of fatal accidents over a five-year period, conducted by the US Helicopter Safety Team, revealed that the helicopter air ambulance industry had the second most fatal accidents, second only to personal/ private operations. Fifty-two per cent of these accidents involved inflight loss of control, IIMC [or] low altitude operations. Increasing IFR training requirements is an attempt to reduce the historical accident rate in our industry while focusing on data-driven causal factors and is in keeping with the CAMTS mission to continuously improve transport safety.” CAMTS said the proposed revision of the standards is being recommended by the CAMTS Aviation & Safety Advisory Committee, comprised of industry safety experts including non-CAMTS board members. The final wording will require approval from the CAMTS board of directors.

AirMed International makes Texasbased acquisition

AIRMED INTERNATIONAL

AirMed International has announced that it has acquired San Antonio, US-based fixedwing air ambulance firm Air Medical. Air Medical, which AirMed described as

AirMed International president Denise Treadwell and Air Medical chairman Joe McCart

the largest fixed-wing company in Texas, has a fleet of three jets and two King Air turboprops. It is based out of San Antonio

International Airport. AirMed said it already operates out of nearly 30 bases. “Strategically, this acquisition will allow AirMed International to serve growing requirements for critical care transport as we meet the needs of healthcare in the Texas region and enhance support for area military medical transports,” said AirMed president Denise Treadwell. “The compassionate, dedicated and experienced Air Medical team that chairman Joe McCart has built is quite compatible with our professional medical and flight teams.” McCart said that the acquisition will benefit his company due to AirMed’s ‘integrity, financial strength and commitment to patient care’. Air Medical has operated for 15 years, and is accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS).

NEWS

Rescue helicopter crashes off Irish coast

waypoints

The four-person crew of the Irish Coast Guard’s Rescue 116 S-92 helicopter was killed after the vehicle crashed off the County Mayo coast, Ireland on 15 March. The helicopter was dispatched from its Dublin base at around 22:00 hrs to respond

Thailand-based international repatriation service Asia Air Ambulance has announced a new ‘strategic alliance’ with US-based Commercial Medical Escorts. The agreement will see the two companies work together to better provide CME’s assistance clients with medical escort services on commercial flights in the Asia-Pacific region. A helicopter flying for the Trento Autonomous Province in Italy crashed near Madonna di Campiglio on 5 March. The AW139 was on a rescue mission to pick up two trapped skiers, but crashed while hovering. All of the crew survived the incident, but serious injuries have been reported. The onboard doctor, Matthew Zucco, was admitted to hospital for fractures to both arms.

to a call from a fishing vessel regarding an injured crew member. A crew from Sligo was sent to pick up the patient, whilst the

CHC Group has successfully concluded its financial restructuring and emerged from the Chapter 11 bankruptcy process as its courtconfirmed Plan of Reorganization went into effect on 24 March. The firm said: “With the support of its creditors and stakeholders, CHC completed its court-supervised financial restructuring process and emerged as a significantly stronger, better-capitalised company. CHC’s competitive financial and operating structure will allow the company to capitalise on its legacy of innovation and invest in and grow the business.”

morning of the crash. A specialist craft was brought in on 20 March to assist with the search for the wreckage of the helicopter and the bodies of the missing crew members. The majority of the wreckage was eventually located 60 m (200 ft) off Blackrock Island lying on the seabed at a depth of approximately 40 m (130 ft), said the Irish Air Accident Investigation Unit (AAIU). Naval divers were able to locate the helicopter’s black box and the body of copilot Captain Mark Duffy. At the time of writing, the two other crew member’s bodies are still yet to be found. The craft’s wreckage was excavated from the seabed on 5 April and the first official black box report is expected a mid-April. The data gathered from the device so far has ruled out mechanical fault, according to the AAIU.

Some times, using a rescue sling strop may be the only and last way to save a life. We have all learned, however, that a traditional rescue sling strop is not always the best option.

A fixed-wing Air Charter Services plane flying from Dehli, India, to Bangkok, Thailand, crashed on 5 March, killing pilot Arunaksha Nandy and injuring two onboard doctors. The plane, tail number VT-AVG, had been charged with picking up a patient from a Bangkok hospital for onward transport to Medanta Hospital in India, but caught fire and was forced to make an emergency landing at Kamphaeng Saen Airport.

In many situations, our safe and comfortable Rescue Wrap may turn out to be a better solution. You should try it.

Bristow US has announced that it has been awarded a contract with Shell Offshore Inc. to provide SAR services in the Gulf of Mexico. Part of the contract will see Shell join the new SAR consortium formed by Bristow. It aims to provide ‘unrivalled service and lifesaving capabilities to members whilst simultaneously reducing overall costs’ said the industrial helicopter services provider.

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Dublin helicopter, with four crew members onboard, was to follow as backup as a safety measure. The Irish Coast Guard said that it lost contact with the helicopter around 01:00 hrs. A search mission was then launched to find the crew. Pilot Captain Dara Fitzpatrick was spotted at first light by an S-92 helicopter based in Shannon, whilst an Achill-based RNLI lifeboat recovered her. She died later in hospital. Also taking part in the search, according to were a helicopter from Sligo, an Air Corps CASA fishery protection aircraft and the Achill and Ballyglass lifeboats. Some local fishing boats also joined the search. Dublin’s Transport Minister Shane Ross expressed his ‘sincere support and sympathies for all those involved’ on the

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NEWS

Think safe.

NEWS

Growing demand for air ambulances in medical tourism According to a new report from Orbis Research entitled Global Air Ambulance Market 2015-2019 demand for air ambulance services in the medical tourism sector is soaring. As an effective way of carrying critical patients to healthcare facilities, these services have become an essential

component of the modern healthcare system and are used in war-torn regions, during natural disasters, outburst of epidemics and road accidents, said the organisation. The report covers the current global air ambulance market, as well as its growth prospects, discussing major trends, key

drivers that influence the market’s growth, and challenges that vendors, and the market at large faces. According to the analysts, the global air ambulance market is set to grow at a compound annual growth rate of 9.57 per cent over the 2014 to 2019 period. The vendors mentioned are Lifeguard Air Ambulance and REVA Air Ambulance.

Call for guidance on winching unconscious casualties CHC Ireland, operator of the Irish Coast Guard’s rescue helicopters, has been called on to improve its guidance on winching unconscious casualties. The recommendation was made by Ireland’s Air Accident Investigation Unit (AAIU) in a report published on 8 March covering an incident where an unconscious 14-year-old girl slipped out of a rescue strop while being winched from the sea off County Wexford on 6 December 2015. She died four days later in hospital. The girl was one of two casualties located in the Hook Head vicinity by a Waterfordbased S-92A helicopter crew. The winchman

placed strops on both casualties and a simultaneous double-lift was attempted. As they reached the door of the helicopter, the girl slipped through a hypothermic rescue strop and fell around 45 ft (14 m) into open water, said the report. She was recovered ‘immediately’. Both casualties were transferred to a nearby hospital in Waterford for medical treatment. The AAIU found no evidence of wear and tear, damage or failure of either strop used during the mission. According to the report, among the operator’s SAR personnel interviewed, there was a shared view that crews used the same

winching procedures for both conscious and unconscious casualties. No specific guidance was found in the operating manuals on the medical implications for casualties when using rescue strops, or on winching unconscious casualties. The reports states: “CHC Ireland should provide documented guidance to their SAR crews that can be used to assess and address the operational and medical risks associated with winching casualties, whether conscious or unconscious, by use of a helicopter rescue strop.”

BRIGHTON AND SUSSEX UNIVERSITY HOSPITAL NHS TRUST

Sussex County Hospital, in Brighton, UK. The donation is part of a £1 million

pledge made by the charity to help fund the redevelopment. The new helipad, which will be situated on the roof of the Thomas Kemp Tower, will allow direct and time efficient access into the hospital’s emergency department, ensuring that patients receive emergency attention as quickly as possible, said the HELP Appeal. The helipad, which manufacturer Bayards said is constructed from maintenance-free

Lightest weight

Least maintenance

Lowest cost of ownership

Longest life span

Read the full report at www.aaiu.ie/node/1043.

Brighton helipad receives first instalment of £500,000 The HELP Appeal has made an initial donation of £500,000 to go towards the installation of a helipad at the Royal

Bayards helipads:

aluminium, will be served by a new lift that will give speedy access from the roof of the building to emergency, resuscitation and trauma services. The HELP Appeal provides funding for providing helicopter landing pads at major trauma centres and key accident and emergency hospitals across England and Scotland. Robert Bertram, chief executive of the HELP Appeal, said: “The new helipad at The Royal Sussex County Hospital will help to ensure that patients get the fastest access to the often life-saving treatment they require. Life-saving infrastructure such as this doesn’t just save time; the seamless transfer process into the hospital’s emergency and trauma department will help to prevent any further patient trauma or longer-term complications, [which] can often arise from secondary road transfer.” The helipad is scheduled to open in 2018.

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LIFE....

Visit us at FAMEX in Mexico City booth E-03 16

16 www.bayards.co.uk

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NEWS

NEWS

Rural areas let down by lack of HEMS access

Aeromedical transport training in Hong Kong

A report from the British Columbia (BC) Forest Safety Ombudsman, which reviews the BC Forest Safety Council in Canada, has stated that injured forestry workers in rural or remote communities must wait twice as long for access to air ambulance

DR TERRY MARTIN

Hong Kong’s Government Flying Service (GFS) provides a permanent and full-time flying service to deliver airborne emergency services to the Chinese special administrative region, including search and rescue (SAR), HEMS, police air support and firefighting, as well as load lifting, transport of VIPs and government passengers, aerial survey work and any other general government services. As such, the GFS has operated a large fleet of Eurocopter AS332 Super Puma L2 and EC155 helicopters for many years, supplemented by HP Jetstreams (now about to be retired) and Bombardier Challenger 605 fixed-wing aircraft for longer range ops. Medical personnel are voluntary and part-time, but they have considerable experience in SAR and HEMS missions. However, the vision going forward is to include a long-

BC FOREST SAFETY

Dr Terry Martin, medical director and director of education of CCAT Aeromedical Training, has announced the successful start of a new relationship with the Government Flying Service of Hong Kong.

DR TERRY MARTIN

DR TERRY MARTIN

Roger Harris

range medical transport capability to the current impressive list of services provided by GFS. Dr William Woo, GFS senior medical officer, appreciated that the new service required some training input and he undertook the CCAT Foundation Level course at the University of Surrey, UK, in August 2016 to learn more about the issues concerned with long-range and long-duration patient transports. Almost immediately after his visit to the UK, Dr Woo (the top-scoring student on his course and an absolute enthusiast for aeromedical transport) gained support from the GFS and the Chinese Government of the Hong Kong Special Administrative Region to bring similar training to Hong Kong. With only a few months to prepare, CCAT Aeromedical Training designed a bespoke training programme to include essential aspects of aerospace physiology, clinical considerations in complex patient transfers, logistic issues of long-range and long-duration fixed-wing aeromedical ops, as well as practical training sessions on patient care onboard and in flight, using aircraft from the GFS fleet. Altogether, 18 students attended, there being equal numbers of doctors, nurses and paramedic/aircrewmen in the class. To ensure everyone started the training at the same level, they were all given a pre-course learning package which required a test on day one of the classroom phase of the course. It was apparent that all participants had thoroughly prepared for the week ahead and the enthusiasm and passion for the topic was palpable in the classroom. Without any obvious language barriers, the class interactions were impressive and the students kept the faculty of instructors on their toes with excellent debates and impressive team-working in the small group sessions. Suffice to say that every participant successfully completed the end of course exam and the scores were high. CCAT Aeromedical Training is providing follow-up mentorship to those who ask for it and is in discussion with GFS to establish an educational pathway for both new recruits to GFS and as ongoing continuing education for its existing staff.

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services than patients in more urban settings. The report, titled Will It Be There

– A Report on Helicopter Emergency Medical Services in BC, states that the gap between rural and urban access to emergency medical transport threatens the lives of workers and residents. “Rural communities are impacted twice compared to urban centres – first, in reduced access to medical care and again in the reduced access to emergency medical transportation,” said BC Forest Safety Ombusman Roger Harris. “For remote communities, as the distance to the nearest medical centre increases, the access to HEMS should be enhanced, not reduced.” According to the report, the BC area system falls short when compared to similar systems in surrounding areas. It recommends that the provincial government pass legislation to guarantee all residents access to a level three trauma centre, like other, geographically similar states, have done.

“There are no technical or infrastructure barriers to the delivery of air ambulance within that critical first hour to any resident of BC, regardless of where they live. The decision by government not to provide that access is a choice,” continued Harris. Other recommendations the report makes includes reviewing the Emergency Health Services Act to allow for flexibility when it comes to expanding the scope of practice and role of First Responders in the transportation of accident victims, and expanding the use of hoist rescues to reduce extraction and transfer times. “These recommendations support faster care for workers and all residents regardless of where you live in the province. Faster care results in better medical outcomes for the patient – which in turn, results in lower cost to the healthcare system,” concluded Harris.

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FEATURE

FEATURE

FEATURE

All in the edit? Considering the go/no-go decision aspect of the conversation, the impression I took away was that the pilot said no, only to be overruled by the medic. That’s a long way from what many would consider good procedure, to say the least. But is that really what happened? First of all, let’s cover the personnel. Ram Nepal is managing director of Alpine Rescue Service Pvt Ltd (ARS) and can be seen in some of the episodes. He confirmed that Jeff Evans and Anthony Gordon have since moved on to other projects, but they were indeed working with ARS at the time of the filming. However, although Capt. Andrew Gutsell was titled in the show as ‘ARS pilot’, he in fact works for Air Dynasty Heli Services. Let’s turn to Gutsell. He told AMR: “As for the example you used from Everest Air, unfortunately it’s not a realistic example of how we run our operation. The BCIITV Travel Channel team (including Jeff) were here for around three weeks filming for their show. Jeff was never actually employed by us as a medic and had no say in decision making. I’m sure it made good television but was not as you would expect after reading it.” That sounds like the reality was less gung ho than you’d imagine from the onscreen snapshot. Gutsell continued: “We are constantly faced with people calling who are very close to death and with the weather here we have to frequently say no despite a known outcome that is not favourable. This puts a high emphasis on our decision making needing to be solid with no allowance for outside influences having a say.” Evans also told AMR that Gutsell took the decision to fly: “Capt. Andrew made the call to go in. He is the most experienced pilot in the world with regards to landing at Camp 2 on Everest.”

When the caller says ‘go’, but the crew says ‘no’

James Paul Wallis looks into an interesting example of decision making portrayed on the TV show Everest Air, and asks how crews can be helped to sound go/no go decisions One night recently I was scrolling through TV channels and came across Everest Air on the Travel Channel (I didn’t even know I could get the Travel Channel). My attention was fixed by what seemed an unusual go/no go conversation. A guy at Camp 2 on Everest was urging a helicopter medic and pilot to take off, stat. The pilot refused to move until markings in the snow had been made, but the medic seemed to accept the flight and they were next shown in the air. Reaching the landing area, a snowy bowl in flat light, they found no markings had been stamped out. Was what I saw a good example of how to balance risk to the rescuers versus potential benefits to the rescuee in need of urgent care? Was the portrayal accurate, or the result of selective editing to boost the drama? And just how do you keep the emotion out of the frame when lives are at risk? I made a note to follow it up. Dramatic onscreen edit OK, let’s kick off with detail of what was shown on screen. To be specific, this is from the episode Medicine Mountain Chaos at around 26 minutes in. Two men, named in captions as Jeff Evans (‘ARS chief medic’) and Capt Andy Gutsell (‘ARS pilot’), are alongside a helicopter (9N-ALA, an AS350 B3e) and preparing to depart from Lukla for Everest Camp 2 to pick up a Norwegian climber in critical condition who has waited overnight for an airlift. However, a second patient has presented at the camp bleeding from the nose. We then see Anthony Gordon, who is described as ‘ARS Base Camp manager’, call Evans who has the conversation on speakerphone with Gutsell standing alongside. 1919

AIRMED & RESCUE

Here’s a transcript: Gordon: We have a 19-year-old Sherpa from Seven Summits that came down from [camp] 3 to 2. Bleeding through his nose, convulsing, headache, cannot walk. Evans: OK, good copy. Here’s what I want you to do. Let’s go back to Una, the Norwegian gal. Let’s go ahead and give her another 250 of Diamox this morning and stay off the dex with her. But I want you to go ahead and give him a dex injection now. Gordon: OK just stand-by. [On a radio to Lakpa Sherpa, who is attending the patient: OK Lakpa, I have Jeff on the telephone, and he has advised that you need to give the Sherpa four milligrams of Dexamethasone, copy.] Evans: Mark the time that it was administered, keep him on oxygen. We should be there in under 45 minutes I would imagine. Gutsell: I need the snow marked though before I can come up. Evans: Did you get confirmation that they’ve gone out and done their 25 metres north and south. Gordon: I have not covered that yet. We just need to get a helicopter up here cos it’s like perfect condition now. Evans: Yeah, so before we roll we gotta know that he’s got visual reference, but we’ve got... Gordon: You’ll have that, just tell him to get in the helicopter and we’ll mark his lines on the snow, alright? Gutsell: I’m not coming until you mark the snow, because I can’t land without the snow being marked. Gordon: Look, dude, I know that. It’s the least of my problems right now. It’s very easy to put marks in the snow. We just need the helicopter up, alright? Evans: We got it, the seats are coming out right now, man. We’re getting ready to go, so take a deep breath and we’ll be up there shortly. We’ll go scoop these guys up, no worries.

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TASC PERFORMANCE

A plane takes off from Lukla Airport (library image)

All to go, one to say no A quick review of what good practice would look like. We asked Stacy Fiscus, chair of the AAMS Vision Zero safety campaign, to explain: “‘All to go, one to say no’ should be a standard of practice with all air medical crews these days … When a flight request comes out, every member of the flight crew must make their own acceptance/decline decision after taking weather and other contemporaneous conditions under consideration. While the pilot will be expected to make their decision based on available weather information ensuring that the conditions meet or exceed legal minimums for the An image of Jeff Evans from a press release on the TV show from tasc Performance clothing flight, it is often a misconception that the pilot alone makes the decision on whether or not to accept a flight. Each person must have a voice and maintain their own personal weather minimums they are willing to fly in. So, if each person on the crew says ‘go’, then have a safe flight. If any one person says no, even if everyone else is comfortable, then the team must stand down and decline the flight. This

BCII TV

Gordon: Alright, see you soon. Evans: Alright. We then see clips from the rest of the mission, with a voiceover saying that flat light and lack of references have turned the landing into a dangerous and tricky manoeuvre.

A promotional image for the TV series

very concept has without doubt given several flight crews the ability to live another day.” What about the sharing of medical information with the pilot, is that an issue? Fiscus said: “In a perfect world, no information whatsoever should be communicated to the pilot. They should be making a decision to fly based solely on the available aviation information that they can complete the flight safely. They should treat the flight as if they were transporting inanimate objects, placing no importance on the ‘cargo’. Many new EMS pilots struggle with this concept and enter into the profession believing they are there to save lives. This is another common misconception. The pilot is there to safely fly the aircraft. One of the most important decisions made by a pilot happens prior to a patient ever making it onboard the aircraft. So, it is realistic to expect that the initial decision to accept a flight will not be affected by patient condition, if the dispatch was done properly. Once the patient is onboard, the crew can be isolated by the pilot, which will cut their chatter off from he/she hearing it. This does not completely blind the pilot to what is occurring during flight, but can help.” With the initial dispatch of a flight, the only information that should really be shared is the weight of the patient so that the crew can make a decision on the aircraft’s ability to transport the patient, said Fiscus. She continued: “Occasionally, you will find that the flight will be designated as ‘medical’ or ‘trauma’, which is OK, as it does not give any pertinent medical information. The idea is that if information is shared about the patient being paediatric or some type of another sensitive nature, it could affect the crew’s decision to take a flight under risky conditions.” Nepal – outside the norms? ARS shared with us an article titled The paradox of following safety standards over saving lives. The piece notes that the reality-based documentary was intended to highlight the daily challenges faced by Alpine Rescue Service Pvt. Ltd, adding: “ARS is very much appreciative to BCII and the Travel Channel for putting on a fantastic show that illustrates the veracity of emergency rescue carried out in the most dangerous zone of the planet. The arena of emergency assistance in a third-world country like Nepal demands that if lives are to be saved, at times, a certain amount of risk is unavoidable.” Watching some of the episodes in the series, you certainly get the impression that the crews are accepting a higher level of risk than you might expect in a ‘standard’ HEMS mission conducted in a less extreme environment. That’s from the footage itself and emphasised by the added dramatic music. But does it make sense to expect normal standards in a non-standard environment? Ram Nepal told me: “In a few cases, a certain amount of risk is required depending upon the complexity/severity of the patient’s condition. Please note further that throughout the world, >>

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FEATURE

in cases of extreme rescue initiatives, rescue personnel do put their life in danger to save lives and it is no different in Nepal.” To highlight the extreme nature of the terrain, consider the fact that Everest Camp 2 is at an altitude of 21,000 ft, while the Air Dynasty website gives the maximum operating altitude of the helicopter involved in our example as 23,000 ft. Gutsell explained: “As with any helicopter rescue operation, the decision making here must be absolute, especially on operations above 20,000 ft. The consequences are very real in the Himalayas. To the point where a bad decision only has one outcome and no amount of luck will help.” For a comment on standards, we turned to Roylen ‘Griff’ Griffin, executive director of NAAMTA, the US-based National Accreditation Alliance of Medical Transport Applications. He accepted that ‘the industry of rescue and transportation via specialised aircraft of the sick and injured is a very dangerous endeavour’ and made the point that procedures and standards have their limits: “Thinking outside the box should not be discouraged, but should be closely scrutinised. Standards should not be ‘the only rule’ – they are guidelines that if followed, will reduce the risk.” Going back to Fiscus’s comments on withholding medical information from the pilot and even the crew, it’s worth noting that in the televised mission, Evans was not only working as flight medic, but was also advising the team at Camp 2 on how to treat the patients prior to the helicopter’s arrival. And this was done in the company of the pilot, who couldn’t un-hear the medical conditions of both patients. Safe outcome If you’re wondering how the flight to Camp 2 turned out, Evans and Gutsell landed without incident in the snow field, despite a lack of visual references,

and the climber was successfully taken to medical care at a lower altitude. Gutsell then returned and picked up the sherpa. One last point to explore. Does a successful outcome to a mission mean that the decision making was sound? (Noting again that no judgement should be made on the mission as shown in the TV show, as the edited clips only give a partial picture of the decision making process.) Asked to comment in general whether an outcome justifies a decision, Griff of NAAMTA suggested that what’s important is to judge the decision-making process on its own merits, adding: “When it comes to rescuing and transporting a sick or critically injured person, [human nature] may impact the decision to go or not to go. The human-nature factor that compels a person to jump to action should be tempered by an algorithm of seasoned facts, which could point to underlying dangers. Seasoned facts equate to the measurement of outcomes; identifying the processes that produce the best outcomes then evolve into industry standards … The idea of ‘let’s go and hope luck is on our side’ must change to implementing tools that calculate and foster better outcomes; realising sometimes to ‘not go’ is the best option.” I’m sure the crews in Nepal would agree with that. And of course, although you get some weather delays followed by successful pick-ups in the series, the viewer at home never gets to see all the missions that were turned down during the filming – that wouldn’t make for great TV. Let’s give the last word to Alpine Rescue Service: “ARS feels immense pride and appreciation toward the instigation and effort of Brentwood Communications International Inc. in unfolding the previously concealed dynamics of emergency rescue from the high altitude Himalayas of Nepal.”

AIRCRAFT SPOTLIGHT

Leonardo GrandNew Developed originally as the A109 by Agusta and first flown in 1976, the Leonardo GrandNew is the latest-generation of the light twin helicopter, evolved from the Grand platform and enhanced with the global navigation

For Jeff Evans’ tips on trekking to Mt Everest Base Camp, go to www.tinyurl.com/amr-evans.

satellite system for all-weather operations. The aircraft features a rapidly reconfigurable, modular cabin for multi-role versatility, cocoon-type, high strength airframe and crash-resistant systems for passenger safety. For EMS and rescue services, the GrandNew allows single and dualstretcher configurations with up to four seats for the medical crew. Pilots benefit from a full glass cockpit, which minimises crew workload, and enhances situational awareness and visibility, and as it further integrates synthetic vision system and helicopter terrain awareness and warning systems functions. Wide sliding doors provide operational flexibility for police and security use, as well as hoist operations; for the oil and gas industry, manufacturer Leonardo says that as the aircraft has been designed for low noise and low vibration in the cabin, passengers fly in more comfort, minimising fatigue. In the US, Intermountain Life Flight, an air ambulance company located in

A helicopter at Mt Everest Base Camp (library image)

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Salt Lake City, Utah, operates one AgustaWestland AW-109 K2 and five AW109SP GrandNew aircraft. Life Flight acquired the A109SPs between five and eight years ago. Jerry Bastian, Rotor Wing Chief Pilot, told AMR: “We operate the helicopters between 4,500 ft (1,370 m) mean sea level (MSL) and 13,000 ft (4,000 m) MSL and routinely land the aircraft at altitudes above 9,000 ft (2,750 m) MSL. Prior to purchasing the A109SP, Life Flight operated the Bell 407 single engine aircraft.” Bastian went on to say that years ago, the company made the decision that twin engine aircraft were better suited for the mission profile in Utah. “The A109SP is a twin engine, IFR certified aircraft,” he explained, “[and as] we routinely fly over water, [we] have used the A109SP to transform our company into an instrument flight rules (IFR) programme. The A109SP has a four-axis auto-pilot which minimises the pilot workload. During the winter months, the aircraft is very fast – we often cruise at 140 kts. During the summer months, we cruise about 120 kts. The cabin space is large enough to load a patient so the medical team can access the patient from their head to their toes. Overall, the A109SP has served this company well over the past several years.” Other users of the GrandNew include the Italian Army, Belgian Air Component, Royal New Zealand Air Force and Rega. Specifications of the Leonardo GrandNew Crew/passengers: Stretchers + Passengers: Powerplant: Max cruise speed: Max range: Length: Height: Rotorspan:

1 or 2 pilots with 6 or 7 passengers 1-2 stretchers + 3/4-2 med. attendants 2 x Pratt & Whitney Canada PW207C (Take-Off: 2 x 735 shp) 289 kph (156 kts) 859 km (464 nm) 12.96 m (42 ft 6in) 3.4 m (11 ft 2 in) 10.83 m (35 ft 6 in)

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EQUIPMENT

EQUIPMENT

Beijing Red Cross acquires new jet worldwide sales at Gulfstream, said the ‘uniquely tailored’ plane’s customisable cabin will serve as an example for future programmes. The aircraft will be fitted with ‘hospital beds with inboard tracking capabilities for better doctor-patient access’, said Gulfstream. It will also feature X-ray

viewing equipment, refrigerated medical storage cabinets, a medical bay, a powered gurney loading system and ‘crew rests with berthing’. The new G550 will join Beijing Red Cross Emergency Medical Centre’s fleet of two medical helicopters, a fixed-wing medevac aircraft and 300 ground ambulances.

In an effort to address the problems of providing power to neonatal transport equipment as it is moved between vehicles, European Air Ambulance (EAA) of Luxembourg has announced the development of an intelligent interface, BLUEBOX, to deliver power to an incubator and all connected appliances, such as a respirator and monitoring equipment, ensuring ‘continuous operation in any vehicle for any length of transport’. The device runs independently of the external current source, limits the need for extra cables and adapters, and is integrated into the stretcher next to the incubator. In the unlikely event of a problem, said EAA, it can easily be replaced by a spare BLUEBOX which is stored in the aircraft. EAA also said it has purchased a Hamilton T1 transport respirator equipped with special software for newborn babies, which allows the addition of a gas heater/humidifier that will enable the provider’s crews to adopt techniques such as continuous positive airway pressure (CPAP) and high-flow therapy delivered via a nasal cannula.

EAA

Gulfstream Aerospace Corp has announced that its Gulfstream G550 fixed-wing aircraft has been selected to launch a new medevac service in Beijing, China. The aircraft will be used in support of the Beijing Red Cross Emergency Medical Centre for disaster relief and air rescue services. Scott Neal, senior vice-president of

EAA adopts new gear for neonatal transfers

An incubator set-up with BLUEBOX (right)

GULFSTREAM

NVG mod approved for S-76D The aircraft being launched

The Chilean Navy has announced that the last two of its new fleet of seven P68 Observer 2 fixed-wing aircraft will soon begin operations for marine SAR and patrol purposes. The Italian-built aircraft have been brought in as part of the Piquero project, and have a lower fuel consumption and better technology than their Skymaster predecessors, according to the Navy.

The aircraft boast infrared cameras with a range of 25 km (16 miles). The planes have already used these capabilities during the recent wildfires in the country. Also on the equipment list are wingmounted rescue pods that can be dropped during flight. The commander of the squadron that will operate the aircraft, Captain Corvette Miguel Gallegos, stated: “The main

differences between these the former aircraft and are mainly in their equipment and their greater patrol capacity. We can now patrol the 200-mile exclusive economic area in complete safety.” Gallegos added that the new aircraft have a lot of flexibility of operation, being able to do many missions more efficiently to help Navy the fulfil its search and patrol responsibilities.

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ADI

New Chilean Navy SAR aircraft integrated

Aero Dynamix Inc. (ADI), a Texas, US-based night vision cockpit modification manufacturer has announced that its Sikorsky S-76D Night Vision Lighting Modification has received validation approval from Transport Canada Civil Aviation (TCCA). “ADI added the certification of the S-76D to our long list of existing STC’s in 2015 and now we are working to obtain further international approvals,” said Tonka Hufford, ADI’s chief operating officer. “The lighting modification is a combination of internal avionics modifications in concert with manufactured overlays and The new NGV system edge lit panels (ELPs).”

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EQUIPMENT

actual patient or incident can be seen, which improves the already high quality of care provided still further.” The live camera footage also has a number of other benefits, stressed TVAA, including: working as a training aid for doctors and paramedics joining the service; to enable staff to review cases to ensure best practice can be embedded across the air ambulance service; helping to prevent HEMS staff from being interrupted by staff from the clinical co-ordination centre as they are performing critical, clinical procedures; allowing HEMS desk staff to proactively pre-order key supplies, such as blood or plasma packs, if they can see stocks being used at an incident so the air ambulance is ready sooner for the next mission. With regard to data security, TVAA said: “The Real Time Visualisation project has been subject to rigorous testing to ensure it conforms to SCAS IT governance requirements. The camera streams information live to the HEMS Desk in the clinical coordination centre and all footage is stored on secure, encrypted SCAS servers – not on the camera itself.”

Hovercraft tailored as base for search drones

HOV POD

Hov Pod, a supplier of hovercraft, has released details of a new design concept, the HoverHome Mobile Drone Station. The company has described how the amphibious vehicle would serve as a base for drone aircraft that could be used in search and rescue or security patrol roles. Ron Harris, vice-president of marketing at Hov Pod, explained: “Drones have distance, flight time and operational limitations due to battery life, maximum remote control range and line of sight restrictions. If the drone’s

home station is static, operators must ensure that drones stay within remote control range or line of sight and that each drone has sufficient power to get home safely. This is a major problem for drone operators because, limited range reduces mission capacity.” He added that the HoverHome Mobile Drone Station extends the range associated with any UAV operation that utilises tethered or autonomous drones. The company’s president, Peter Ward, suggested that two such mobile stations and six drones carrying infrared and night vision cameras could perform a continuous, 24/7 search and rescue mission, either over a static or migrating 10-square mile area of ‘ocean, delta, river, swamp, meadow, ice, island or desert’. The HoverHome solution was introduced at Milipol Asia-Pacific International Homeland Security Conference in Singapore.

German fixed-wing air ambulance operator FAI rent-a-jet has announced that it has sold its last Learjet 35A to Mexican

Car manufacturer Land Rover has announced Project Hero, a new adapted version of its Discovery model that allows for a SAR drone to take off and land on its roof. Aimed at enhancing Red Cross and Red Crescent emergency response operations, the vehicle was designed in collaboration with the Austrian Red Cross, said Land Rover. The UK Ministry of Defence (MOD) has signed a £14-million deal with Remote Diagnostic Technologies (RDT) to supply medical monitors to the UK Armed Forces. The Tempus Pro monitor will be used by the Royal Navy, British Army, and Royal Air Force personnel for missions including aeromedical evacuation. The MOD said the portable monitor transmits data back to medical facilities and treatment teams in real time, giving them a better understanding of a patient’s condition ahead of time.

FAI

Thames Valley and Chiltern Air Ambulance (TVAA) has reported that Dr Syed Masud, clinical governance lead for the UK HEMS charity, has been working in close collaboration with its medical partner South Central Ambulance Service (SCAS) and local hospitals to introduce real-time visualisation. TVAA said its crews are now equipped with live-streaming cameras when they are sent to incidents, enabling them to share information with senior clinicians based in hospital and with the SCAS ambulance service co-ordination centre whilst at the scene. Masud, who is also a consultant in emergency medicine and pre-hospital medicine and a senior lecturer in trauma and pre-hospital emergency medicine at Oxford University, said: “When senior clinicians are being asked by staff at the scene of a medical emergency or major trauma for advice, those clinicians can now see live footage of what is happening. This not only saves valuable time – and in the life-threatening emergencies that air ambulance crews are sent to, every second counts – but also means more accurate advice can be given because the

Jet Rescue Air Ambulance buys FAI’s final Learjet 35A

waypoints

The last 35A

Australian air ambulance operator the Royal Flying Doctor Service (RFDS)

Air Zermatt, Switzerland, has announced a new partnership with apparel brand Helly Hansen to deliver ‘professional grade gear’ to the service’s teams. The new clothing will be worn by flight attendants, paramedics and doctors, and will be useful against the cold weather, strong winds, rain and snow the company said its staff are put up against. Milestone Aviation Group has announced that it has agreed a new deal to lease a Leonardo AW169 to HeliKorea. The company said this will help HeliKorea to accelerate its expansion into HEMS operations in South Korea.

The cockpit view of the B350 King simulator. Jenoptik revealed a new prototype of its SkyHoist 800 civilian rescue hoist system at HAI Heli Expo in Texas, US. The system has a hoist capacity of up to 350 kg (770 lbs), dead weight of 50 kg (110 lbs), cable length of 120 m (390 ft) and a hoist speed of two metres per second.

Axtmann on 26 February at Albrecht Duerer International Airport in Nuremberg, Germany. It was handed over to Carlo Salinas, CEO of Jet Rescue Air Ambulance. “Today is an emotional day. The Learjet type was our first Learjet aircraft and served as the engine for the company’s growth in the field of air ambulance,” said Axtmann. “I hope that it will perform many happy landings for its new owner.” FAI said that the demand for larger cabins and economic reasons in respect to different type ratings, maintenance and spare parts stocks resulted in its decision to discontinue the 35A. Axtmann also said that FAI will be replacing its two remaining Learjet 55s with Learjet 60s.

has announced the launch of a new pilot training centre on the Sunshine Coast, Queensland. The centre has been created by aviation solution provider Flight Options. RFDS said that its pilots will use the facility to undergo simulator training to get used to the newly introduced Beechcraft B350 plane. It also said there are plans to introduce the KingAir

B200 aircraft, of which the RFDS currently has 14 in its fleet. The simulator means that the charity no longer has to send their pilots to the US for training. “The safety of our crew is paramount to the standard of care we deliver at the RFDS,” said Nino Di Marco, CEO of the Queensland section of the RFDS. “Without the most skilled and highly trained pilots, doctors and nurses, we simply would not be able to carry out the work we do in delivering the finest care to the furthest corner of the state.” Di Marco added that the new centre would mean pilots’ training would be more accessible and therefore more in-depth.

DIY vomiting airway training mannequin Dr Andy Caldin from Australia’s Royal Flying Doctors Service (RFDS) South Eastern Section’s Dubbo Base, has assembled his own Suction Assisted Laryngoscopy Airway Decontamination Device (SALAD). “In short, a SALAD is an airway training mannequin that vomits,” explained Caldin. “Keeping lungs and airways clear is a critical skill when dealing with unconscious patients as any blockage could be fatal.” The training tool was invented by US

Wysong Enterprises Inc. has announced that it has delivered two Bell 407GX helicopters to US-based HEMS operator PHI Air Medical. Wysong said that these aircraft are the first two helicopters of their kind in PHI’s 260-aircraft fleet.

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provider Jet Rescue Air Ambulance. FAI said it has operated four Learjet 35A aircraft since 2001, logging around 38,000 hrs of flight time. After this sale, its fleet is now comprised of two Learjet 55s, 11 Learjet 60s, five Challenger 604s and three Global Expresses. FAI said that another Challenger 604 and a further Global Express are also expected to join the fleet soon. The plane in question, registration number D-COKE, received a sendoff from FAI’s founder and chairman Siegfried

New training centre opens on Sunshine Coast

RFDS

Live video to improve HEMS care

EQUIPMENT

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physician Dr James DuCanto, who then shared instructions online to enable other services to build their own. Caldin is a former carpenter, so built a wooden frame and fitted an old airway head with parts sourced from local hardware stores. The ‘stomach’ is a shower pump connected to a 50-litre (11-gallon) reservoir. It pumps up to four litres of ‘vomit’ per minute, which is water mixed with green food colouring. “Our medical skills have to be constantly

refreshed and updated, and we are using our DIY SALAD simulator to do this work with RFDS SE medical staff at all levels,” revealed Andy. “We have taken it to Broken Hill to do some demonstrations for the RFDS SE and local ambulance, emergency department, anaesthetic and intensive care staff.” To watch the SALAD in action visit www.airmedandrescue.com/story/1910.

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INDUSTRY VOICE

MISSIONS

THE SATELLITE SECURITY BLIND SPOT Nigel Davies

Head of secured navigation, QinetiQ By 2020, the UK’s National Police Air Service (NPAS) and a number of partner agencies, including helicopter air ambulance services, are switching over to state-of-the-art, vehicle-mounted communications devices operating on a private 4G network. Part of the Emergency Services Mobile Communications Programme (ESMCP), this new equipment can provide increased resilience and security across all communication channels and navigation devices used by emergency services air crews in the UK. In addition, new services and applications will be launched which improve the function, efficiency and safety of the emergency aircraft services. However, the nature of the security landscape for these technologies and services is evolving rapidly. Their reliance on Global Navigation Satellite Systems (GNSS) to deliver location data to users of the ESMCP leaves them open to outside disruption. Unless properly addressed and mitigated, these threats could pose a critical risk. Emergency services aircraft in the UK use satellite navigation for tactical operations; they do so primarily through the satellite receivers in their onboard vehicle communications systems. However, when such systems fail, the consequences have the potential to be severe. According to reports filed on NASA’s Aviation Safety Reporting System (ASRS), there were nearly 80 incidents of aircraft GNSS signal interference or malfunctions between 2013 and mid-2016. One particular entry from a helicopter pilot who was delayed in taking off from an urban helipad provides an unnerving example of the effects of GPS failure: “Loss of reception on both GPS units when departing the helipad. Ground units use this pad as an LZ due to very few options available in that area. Loss of reception occurred at XA:40 and GARMIN 530 unit gave me the error message and reacquired satellites in about 10 seconds and the GARMIN 430 unit took about three to four minutes to reacquire satellites. Reception was regained and no other anomalies.” Whilst the satellite signal was re-established, such time delays could prove fatal for emergency service call-outs where a matter of minutes often means life or death for patients in critical conditions. What’s more, the large majority of the incidents logged involving GNSS system failures involved either a total loss of signal or misreporting of the aircraft’s position. While GNSS has become a phenomenally successful source of navigation for a plethora of industries, it suffers from vulnerabilities that make systems reliant on GNSS inherently fallible. GNSS satellites orbit the Earth at an altitude of over 20,000 km. By the time this signal reaches the Earth’s surface it is very weak – sometimes imperceptible from the background noise of other transmissions – and so complex algorithms are needed to identify and track them. If additional ‘noise’ is transmitted over the top of a GNSS signal – called ‘jamming’ – it can stop a receiver from working. Jamming devices, designed for this specific purpose, are available for as little as £30 online and their effects can be severe. To put it in perspective, 10mW jammers for that price can be as small as cigarette packs and could knock out satellite signals across the area of a commercial airport. Results from the NSL Strike3 Project – an international investigation into GNSS threats funded by the European GNSS Agency – found in one location 400 GPS jamming interference incidents in a single week at an airport, 138 incidents on a motorway and 839 in an inner city location.

However, the switch-over to the ESMCP’s private network provides an opportunity to tackle this issue. According to a Prior Information Notice issued last September, as part of the Air to Ground (A2G) Devices Project, new vehicle-mounted devices will replace those with existing GNSS security vulnerabilities: “The Home Office is intending to procure a combined Long Term Evolution (LTE) and TETRA airborne device as part of an A2G service for ESN.” Anti-jamming technology now exists which can be introduced to these devices to ensure emergency services do not fall victim to GNSS interference. A new generation of multi-constellation, multi-frequency (MCMF) receivers, has been developed by QinetiQ through its own research as well as through other projects with the likes of ESA and the UK Government. These receivers can simultaneously use signals from different frequencies and different GNSS constellations, such as GPS, Galileo, GLONASS and BeiDou. In the event of jamming, the receiver can adjust to a different frequency or signals, foiling the jamming interference. This provides enhanced resilience and robustness by using all the different satellite-based navigation systems available, ensuring continuity of service. For a sector that relies on GNSS for life and death situations, these technologies could be a turning point against the increasing threat of signal jamming. If the ESMCP is to ensure complete security and redundancy against all kinds of threats to the emergency services communications technology, then defending navigational capabilities will be paramount. The government will need to work with industry players and the emergency services to achieve this, ensuring that as the ESMCP is developed and brought online, the capability to overcome jamming incidents is a core part of its design.

AUTHOR NIGEL DAVIES Nigel Davies established and now leads QinetiQ’s Secured Navigation group. His principal focus is on the development of next-generation technologies capable of providing robust positioning, navigation and timing for users for whom it is mission critical. Previously, he led QinetiQ’s support to the European Commission and European GNSS Agency, providing specialist security advice and supporting work to transition Galileo from a technical capability to a service.

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Medicalfly transports patient with MCS Italy-based fixed-wing air ambulance service Medicalfly has reported on its transfer of a patient with multiple chemical sensitivity (MCS) to Madrid, Spain. MCS is a sensitivity or allergy to a number

of different pollutants, such as solvents, perfumes, petrol, smoke and pollen. The complexity of this illness, and the lack of understanding of the condition, meant that the service had to adopt special methods of

shielding in order to minimise the presence of potential irritants. The service said that with these extra measures the patient was ‘comfortable and safe’ during the flight.

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Flooding after Cyclone Debbie prompts multi-service response

Tropical Cyclone Debbie swept through Queensland, Australia on 28 March, causing wind speeds of 160 mph (260 kph) to lash the Queensland coast. However, it was the torrential rains that followed the cyclone that have caused the most damage, with severe flooding being reported in both Queensland and New South Wales. Several flood-affected northern New South Wales towns have been declared natural disaster zones, causing thousands to be evacuated

from their homes and prompting response from several emergency services and the Australian military. The Australian Defence Force (ADF) said it committed 1,600 personnel to its Queensland Assist 17 operation. On 31 March, it said it had completed a number of operations, including using Army Chinook helicopters to fly medical personnel and supplies to Proserpine Hospital and supplies to Daydream Island. Affected areas were surveyed by two Royal Australian Air Force (RAAF) King Air aircraft. Before the storm hit, RAAF personnel and aircraft were positioned in Townsville, Amberley and Darwin, and two Navy MRH90 helicopters were positioned in Oakey. Acting Chief of Joint Operations Major General Stuart Smith said on 31 March: “Our role now is to bring to bear the ADF’s specialist capabilities in order to provide the best possible support to the Queensland Government and those affected in their time of need.” RACQ CQ Rescue reported that its two Mackay-based helicopters took part in evacuation and rescue attempts. On 30 March, both of the choppers assisted with patient transfers around 13:00 hrs, one transferring a patient from Hamilton Island to Mackay Base Hospital and the other taking two critically injured patients from Proserpine Hospital to Townsville General Hospital. RACQ CQ Rescue was also tasked with the rescue of seven people who were stranded on the roof of their property. The party included five children, one of whom was a 10-month-old baby. The crew was able to evacuate the family, transporting them to nearby Sarina High School, where local police then took care of them. One of RACQ CQ Rescue’s crew members

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Arno Schoonwinkel described the large areas of flooding: “There’s a huge amount of water lying about and cane paddocks are all completely washed out. There’s debris everywhere like chairs and tables from inside people’s houses just floating in the middle of paddocks.” Elsewhere, RACQ LifeFlight was also called into action. Covering the south Queensland area, the Sunshine Coastbased service completed several missions, including winching an elderly couple off the roof of their flooded house. “The water had snuck up on them a little quicker than expected,” said air crewman Dan King. “They seemed to be in good spirits, they were just sitting up on the roof, not freaking out from what we could tell, but they were aware the situation they were in wasn’t the best situation to be in.” Another one of the service’s helicopters based in Toowoomba was called upon to assist Queensland Police Service (QPS) in a SAR mission for three vehicles washed off the road in floodwaters. All three vehicles were located and were unoccupied.

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MISSIONS

MISSIONS

Mass casualties following bus accident near Verona

Aid flown into flood-hit Peru

together would be better, so the first round was a double stretcher mission. Right after the plane’s departure from Verona, we got the call that a serious craniocerebral patient was also ready for repatriation. After landing, we completed the patients’ hand-over at Budapest International Airport, Hungary, to a HEMS provider who flew them to the Central Military Hospital, the designated facility for further treatment. We then partly changed our crew and departed back to Verona. The next morning, before picking up the third patient, TrustAir Aviation’s medical team made an on-site assessment at the ICU where another two patients were being treated. We had first-hand direct information on their condition. They were not fit-to-fly yet, so instead we flew home our third patient, a young man with severe head trauma and additional fractures. Over the following weeks, the remaining two patients’ conditions gradually improved. One of them, who had suffered 60-per-cent second to thirddegree burns, made a miraculous improvement, so we scheduled him as the next patient to repatriate. His flight was carried out three weeks after the accident. Our last patient, who was ventilated with a tracheotomy, and had undergone a craniotomy due to severe brain injury, was the last to leave Verona, almost exactly four weeks after the incident. Overall, TrustAir Aviation flew four rounds and five patients back to Hungary. In the meantime, we had dozens of calls, phone assessments and discussions, not just with the involved Italian and Hungarian medical facilities and colleagues, but also with the insurance companies, consuls and family members, as well as media representatives. We already had a significant background in responding to mass casualties, but this chain of missions and the complete process gave further experience that could be beneficial in the future.

AUTHOR PETER TURI Dr Peter Turi is general manager of TrustAir Aviation, a fixed-wing air ambulance provider based in Hungary. The service’s fleet comprises two Piper Cheyenne IIIAs with cargo doors and pressurised cabins.

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An Ecuadorian Air Force plane carrying humanitarian aid

COLOMBIAN AIR FORCE

A horrific bus accident occured at around midnight on the night of 20–21 January 2017 on the A4 motorway at San Martino Buon Albergo, near Verona, Italy. At around 00:00 hrs, a Hungarian coach was transporting Hungarian high school students and their teachers back from a skiing trip in France. At San Martino Buon Albergo, near Verona, the bus collided with a highway traffic barrier, crashed into a bridge pylon and then immediately caught fire. Sixteen people onboard the bus were instantly killed and another 30 sustained injuries. Of the wounded, 10 were seriously injured and two suffered life-threatening injuries. Some of the deceased were burned beyond recognition, and the investigation team had to take DNA samples from the parents to identify the bodies. The next morning, the whole country was shocked when the news broke. The injured were taken to several Verona hospitals, family members and survivors to a hotel. The Italian authorities did everything they could, providing continuous support from the first days until the very last moment when the last patient left Italy. In order to get the most precise information and to provide immediate local assistance, the Hungarian authorities sent a medical assessment team to Verona. Furthermore, the Ministry of Foreign Affairs co-ordinated all the evacuations, as many IDs and passports had been lost in the fire. It was known from the very first moment that TrustAir Aviation, the only Hungarian fixed-wing air ambulance provider, would play a significant role during the repatriation. The company’s management was involved from the next day. Both the governmental bodies (the Ministry of Health, the consulate services, and the National Ambulance Service) and the travel insurance and assistance company (Europ Assistance Hungary) kept in close contact with us. The repatriation strategy was clear: as the medical facilities in Verona were able to provide the highest level of care, all the parties agreed that a step-by-step scheduled transport home should follow. Following primary care and stabilisation on the first day, we were dispatched on Sunday for the initial two patients: a couple who had suffered extensive, but not life-threatening, burns and lost both of their children in the accident. Careful pre-assessment was performed, this time not just due to their physical status, but their mental and emotional condition as well. Questions addressed included whether they were agitated and whether it would be better to fly them together or separately. We considered whether we would be able to handle any unexpected emotional reaction that might happen en route or whether it would be preferable for them to travel together and have each other’s emotional support. Finally, we agreed that flying them

ECUADORIAN AIR FORCE

Dr Peter Turi of TrustAir reports on a recent mission to fly victims of a bus crash from Italy to Hungary

A Colombian Air Force plane delivers 30 tons of aid

Heavy rains in mid-March led to the worst flooding and landslides to hit Peru in decades, resulting in dozens of deaths as rivers burst their banks. Peruvian Air Force helicopters and plane crews responded to assist the thousands of citizens affected by the extensive damage caused to buildings and infrastructure in the north of the country. Pedro Pablo Kuczynski, president of Peru, took to a Peruvian Air Force helicopter on 18 March to survey the region around the Peruvian capital, Lima, from the air. He said: “Our country is strong and will come out of this adversity.” Also onboard the flight were Minister of Transport Martín Vizcarra and Finance Minister Alfredo Thorne. Among the services that responded from outside the country was the Ecuadorian Air Force, which sent a plane from Simón Bolívar Air Base in Guayaquil to Lima in conjunction with Ecuador’s Ministry of Risk Management (MRM). MRM’s Vice-Minister Ricardo Peñaherrera accompanied a cargo of humanitarian aid, including 3,000 food rations. The aircraft was also used to evacuate 71 Ecuadorian and 12 Colombian citizens. Other agencies involved included the Colombian Air Force, which dispatched four helicopters and a plane carrying 30 tons of humanitarian aid, while a Chilean Air Force plane flew in a further 18 tons of supplies.

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MISSIONS

MISSIONS

SAR tech recounts rescue of man missing in Nunavut

Florida, US-based fixed-wing air ambulance provider Global Jetcare recently undertook an inspiring repatriation of a 19-year-old who was attacked by an alligator in Bolivia. Chief flight nurse Marcy Phipps explains how the mission was completed

The Royal Canadian Air Force (RCAF) has shared SAR Tech Sgt Dennis Van Sickle’s account of a tasking to locate a man who had been missing for four days in rural Nunavut in wintry conditions last November. Van Sickle flies onboard CC-130 H Hercules planes and CH-146 Griffon helicopters based at 424 Transport and Rescue Squadron from 8 Wing Trenton, Ontario. When conducting missions, he is the team leader of the SAR techs who are responsible for the primary care of the missing person. The call came in at around 02:00 hrs on Monday 21 November. The Royal Canadian Mounted Police (RCMP), Canadian Rangers and local citizens had been conducting a ground search for the man near Baker Lake, Nunavut all weekend with no sighting, and needed additional help from the Canadian Armed Forces. For the next 17 hours, Van Sickle and the team onboard a Hercules searched likely areas and followed search patterns directed by the regional control centre. The RCMP and Canadian Rangers continued to search on the ground in a forested area. The search lasted all day due to the fact that from the sky, it was difficult to definitively identify objects on the ground. “Above the tree line, we saw a ton of snow and some rocks and chunks of ice that kind of pop up. From the search altitude, they kind of looked like black spots,” explained Van Sickle. “There was a high level of similarity between the search object and what the ground conditions looked like, and there was snow blowing everywhere due to some high winds during the search. So it was difficult to pick out what was what.” By evening, there was still no sign of the man. The team onboard the plane had approximately five minutes left in their final search pattern before they’d be required to land and take mandatory crew rest. Then, the ground team made contact, saying they had found footprints and wanted the airborne team to investigate. The Hercules finished the last five minutes of its search pattern and then headed towards the area where the RCMP had found footprints. By that time, the ground team had found the missing man. The Hercules followed as the ground team headed towards a medical cabin nearby.

The patient before her repatriation

were reduced and she was treated with multiple intravenous antibiotics and a cervical collar as a precautionary measure. When our crew arrived at the hospital for pre-flight evaluation, we found our patient to be in surprisingly good spirits. “I wanted to stay here in Bolivia,” she said. “I love it here so much and my wounds have been repaired.” But after a long conversation with a German doctor with experience in crocodile accidents, Patricia decided to return to Germany to be with her family and for additional evaluation and rehabilitation for her wounds and unilateral facial paralysis. The medevac flight went very well. She received aggressive pain management and remained stable and comfortable throughout. CT scans in Dresden, however, revealed additional undisclosed facial fractures and a cervical fracture. The right shoulder wound became inflamed and infected, requiring a new course of antibiotics, and rehabilitation exercises for the facial paralysis have commenced. The emotional scars are healing as well. She had nightmares after the attack in which she relived the experience, seeing images of the crocodile’s head and hearing again the muffled sounds she heard when she was pulled under the water. She’s also had to recount the exact details of the attack many times, to many different people, something that has forced her to relive the experience, to a degree, but that she says may ultimately be helping her deal with the trauma. She remains in excellent spirits. In love with the Bolivian culture, she plans to return to South America to finish her volunteer commitment as soon as possible. In the meantime, she will shore herself up at home while she heals. And forever more, she will remain the best example I’ve seen of courage under attack, fortitude and inner beauty, all qualities too strong to be thwarted by an alligator attack.

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Once they arrived, the Hercules dropped a radio down to the ground team so they could ask if medical help was needed from the SAR techs. “They called back to us on the radio that he was indeed alive and they found him walking,” said Van Sickle. The ground team requested medical attention for the patient so the Hercules circled around the cabin while Van Sickle and fellow SAR tech Master Cpl Matthew Zukowski parachuted down. Van Sickle focused on creating an evacuation plan while Zukowski assessed the patient. The man was then moved to a nearby medical station, where a crowd of concerned citizens greeted the patient and the SAR team. Although Van Sickle had done handoffs before, this was the first time he witnessed a whole community line up to welcome the patient home. “That was

pretty incredible,” he remarked. As for the overall success of the mission, Van Sickle credits the ground team for their hard work and for finding the missing man’s footprints. “The kudos on this one I think goes to the local ground SAR team. They were pounding the ground for four days looking for this man. In reality, they are the ones that spotted the footprints and then tracked him down from there. Good on them,” he said. Van Sickle said he has a simple reason for why he and other SAR techs are so dedicated to their jobs – they have the unique experience of directly impacting the lives of Canadians. “We’re the ones jumping in to help somebody when they’re having the worst day of their life,” he said. “I think that’s likely why SAR technicians so proudly embody the trade motto: that others may live.”

RCAF

In February 2017, Global Jetcare repatriated a 19-year-old German citizen who suffered an alligator attack in the vicinity of Trinidad, Bolivia. The mission was completed in a Learjet 36XR and included stops in Santa Cruz, Bolivia, Antigua and Ponta Delgada, Azores before reaching the final destination of Dresden, Germany. The trip required two sets of pilots and the medical crew included a physician, nurse and paramedic. Our patient, Patricia, had spent many months in Sucre, Boliva as part of a gap-year opportunity with the International Youth Cultural Exchange (IYCE). She was working with the foundation Sayari Warmi – Levantate Mujer, helping indigenous families by providing educational workshops and materials on topics related to health. She’d been staying with a host family and volunteering while immersing herself in Bolivian culture, becoming fluent in the language and proficient in cooking native foods while developing bonds with the community. On a weekend excursion with friends, Patricia took a night bus to the Chuchini Ecological Reserve, a jungle lodge approximately 15 km (nine miles) north of Trinidad. The lodge, which appears to be an idyllic haven near the Ibare River, serves piranha for breakfast and promotes interaction with native wildlife. Orchids and tropical birds abound, and river tours are conducted at night by the lodge owner, an experienced veterinarian with expert knowledge of the animals of the rainforest and a lifetime of experience in the Amazon jungle. The lodge’s website describes how the intrepid owner makes night-time expeditions, silently paddling a shallow canoe and using a flashlight to point out the hundreds of alligators on the riverbanks: “Like a flash of lighting, he’s dropped his oar and picked up an alligator out of the water. Don’t be frightened. He’s done it so often since his childhood that it’s become as easy as picking flowers to him (then he lets them go).” Water sports are encouraged in the nearby lagoons. There are opportunities to water ski and swim with pink Amazon river dolphins. There is no denial of the presence of alligators, but they are not typically a threat to people visiting the reserve. In fact, our patient had been told there hadn’t been an alligator attack in the area for over 40 years – an assertion that our Trinidad hotelier begged to dispute. According to him, people are eaten by alligators ‘all of the time’. Our young patient remembers everything about the alligator attack: “I was floating in the lagoon in the morning when I looked and saw the head of a giant alligator maybe 20 cm from me. It didn’t seem to be swimming straight towards me, and I was about to try to swim away from it. In less than a second, and without a sound, it opened its jaws and grabbed me. I remember putting my arms over my head; I must have thought I could pry its mouth open. It took my head and shoulders and shook me under the water for a couple of seconds, then suddenly disappeared. I didn’t feel any pain, I just screamed and screamed and swam to shore.” Patricia suffered a laceration of significant depth to the left side of her face with nerve damage, bilateral auricle injuries, a right temporal-parietal laceration, a comminuted superior maxillary sinus fracture, orbital fracture, a large laceration at the right deltoid, and puncture wounds over her neck and thorax. She was taken to a Trinidad hospital where all wounds were irrigated, debrided and sutured by a plastic surgeon. The facial fractures

GLOBAL JET CARE

Alligator attack patient lauded for courage

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MISSIONS

Unmanned aircraft – not a binary choice

REGA

Crews assist after mid-mission crashes

still in busy rush-hour traffic on the M1 motorway, the ambulance received a case call: a road traffic accident had occurred on the opposite carriageway some two to three miles ahead of their location. The driver quickly diverted. Five minutes later, the crew arrived at the scene of a multi-vehicle collision involving four cars. Police and traffic officers had already blocked the flow of traffic in all lanes. All of the cars’ passengers were on their feet and apparently unharmed, with the exception of the driver and sole passenger of car number three, who was still in the seat of his vehicle and was visibly shaken. Redstar’s doctor and nurse and the ambulance’s paramedic performed a quick assessment of the patient, a male in his 50s.

There was no visible trauma, his vital signs were consistent with having experienced an adrenaline-inducing event and his mental and cognitive functions were intact, but he was unable to move his lower extremities. The ambulance paramedic acted quickly to request assistance from the fire department for extrication from the vehicle. While waiting for the firefighters to arrive on scene, the patient’s neck was stabilised and he was hooked up to monitors, a 12-lead ECG was taken, his blood glucose was measured and an IV line was inserted. A 10-strong Specialist Rescue Unit (SRU) arrived within minutes. While the medical professionals monitored the patient from a safe distance, the SRU removed the doors and roof of the car. By this time, the police had reopened a traffic lane and a National Health Service (NHS) ambulance arrived. Together with the SRU team, the NHS crew removed the patient from his seat using a spine board. He was then taken to the nearest healthcare facility. Buhara Demir, key account manager for Redstar Aviation, said: “This experience was a first for our medical team, and we were impressed at the response times, dedication and the fluid co-operation between police, traffic officers, ambulance teams and the SRU, not to mention the patience of possibly thousands of motorists delayed in traffic. We hope the patient returns to physical and psychological health just as fast as all those who responded on scene that night.”

REDSTAR

Two fixed-wing air ambulance providers have reported on recent incidents where their medical crews witnessed road traffic accidents during a mission and assisted the victims. In early February, a Rega crew faced an unusual challenge during an ambulance jet mission in Gran Canaria, the Swiss rescue service reported. The crew, which comprised a doctor and an intensive care specialist, had collected a Swiss patient from hospital and was onboard a ground ambulance en route to Las Palmas Airport to meet a waiting Rega jet. Although the journey should have taken no more than 20 minutes, as the team neared the airport the traffic ground to a halt due to a serious motorcycle accident that occurred just ahead of them. With the injured rider lying on the road and no local medics yet on scene, the Rega doctor and the ground ambulance driver left their vehicle in order to provide assistance. They stabilised the patient and stayed with him until Spanish rescue personnel arrived on scene some 40 minutes later. The crew then continued to the airport and completed the mission to fly their patient back to Switzerland using a Rega jet, with only a slight delay. A Redstar Aviation crew was involved in a similar incident in March. Following a successful bed-to-bed air ambulance mission that had terminated at the Wellington Hospital in Central London, UK, the Turkish provider’s medical team were on their way back to a hotel near Luton Airport in the ground ambulance. Around 10 minutes away from the hotel, and while

INDUSTRY VOICE

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Moving towards a less binary view of operating UAVs in SAR operations There is a general view of small unmanned aircraft (SUAs) as a panacea and it’s one that I personally disagree with. In terms of search and rescue (SAR) for missing persons or a missing aircraft, people often consider the capabilities of SUAs in the abstract. For instance, with a downed aircraft you’re expecting to see a debris field and a lot of bare twisted metal that would give a wide array of reflected light. From the air this is considered, in theory, to be easy to identify. Likewise, in terms of locating a missing person, say a hill walker, it’s assumed that with an SUA you can cover a large area very quickly to find someone who’s usually wearing bright clothing and stands out from the terrain. In both instances, the SUA is thought to be a quick, effective solution because from an elevated position you can see anomalies quickly and easily. What most people don’t realise is that the SUA is often more limited than traditional search methods, such as a ground search party supported, where possible, with a manned aircraft. It’s too easy to focus on the positives abstracted from the realities of the situation. The main limitation of an SUA deployment is the weather, principally wind speed and rain. Aircraft are often lost in bad weather conditions, as are hill walkers, and these are the conditions that have a direct effect on the feasibility of SUA operations. Some people are quick to point out that you can get waterproof SUAs without, in the case of an SUA with rotors, considering the effect the rotors play in creating a wash of rain on the camera. The airflow around an SUA is different to conventional aircraft because some rotors pull air towards them and some push air away from them. The degree to which this happens depends entirely upon the onboard computer that is balancing the different rotors to create a stable flight. As such, when flying in the rain, this airflow creates a misting effect and throws water towards the camera. One manufacturer I’ve heard of that addresses this point is AscTec, which questions the benefit of flying observational missions in the rain, despite them manufacturing waterproof SUAs. From my own experience, after being involved with SUAs for several years, I’ve seen a lot of people who are keen to promote themselves as ‘experts’ in the field and who sing the praises of the technology without wishing to address its limitations. Personally, I find the best understanding of the technology comes from viewing it in the same way that aerial photographers do. They refer to SUAs as ‘tripods in the sky’, and often they’re also referred to as ‘platforms’. For me, this is the best and simplest approach to understanding the technology and its limitations, because that’s all that they are, tripods that can support different sensors and measuring devices that you can move around in the air. Once seen from this perspective it’s straightforward. How would you search an area on the ground? Why would you search it differently if you were 200 ft higher? You still overlap the areas, you just move faster and you can see more from 200 ft! SUAs can be used to oversee a ground search in terms of providing realtime footage to the ‘silver command’ who are co-ordinating the mission, ground parties, dog teams, or boat teams. They can be used to help fire and rescue services see where their water jets are hitting and adjust their aims accordingly. The cameras can be fitted with polarised filters to see through surface reflections on water to help search waterways, and they can carry thermal cameras to help detect heat sources. They can be used to direct ground responders to a specific location by hovering over it, and they can

help to enhance dynamic risk assessments by identifying dangers and safe routes for ground responders to follow. What I often see is that the collaborative approach is missing from most discussions of the technology. It’s presented as a binary choice in that SUAs will replace the need for conventional approaches. This has the effect of pitching new technology against tried and trusted methods, so it becomes a divisive subject. As such, doubts and fears regarding safety, competence, and effectiveness become a focal point and overshadow the issue. SUAs are, in my opinion, definitely not a panacea. But they are a highly effective tool that can have significant operational benefits when correctly integrated into existing responder workflows. Provided the conditions are right and there exists a potential significant benefit, they should always be deployed. Whether that benefit is in terms of direct search results, or simply observational, shouldn’t make a difference. For instance, one fire and rescue service unit used me to provide an overview of a training exercise so that ‘silver command’ could see where the search teams were operating and where their techniques could be improved. They found the footage extremely useful in their debriefs. They were able to show their staff good and bad points and improve their training results. Therefore, the effectiveness of the technology depends upon the outcomes that are required in each instance, the conditions for operation, together with an understanding by the command team and SUA operator of how they expect the SUA to perform. The technology becomes very much secondary in this equation. Hopefully, during future exercises and ‘live’ operations, this approach will become more obvious and will help move the discussion towards a less binary view of operating SUAs in SAR operations. This article first appeared on the UK Civil Air Patrol website, www.ukcivilairpatrol.co.uk.

AUTHOR IAN POVEY Ian Povey is a commercial operator of small unmanned aircraft with a UK Civil Aviation Authority ‘permission’ to conduct aerial work. Based in the north of England, he is a member of the Civil Air Patrol’s Northern Region.

Ian Povey in action with the Durham & Darlington Fire and Rescue Service.

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When survivors of air ambulance accidents share stories and their burden of having experienced accidents, errors and close calls, it can facilitate healing in more ways than one, as Femke van Iperen reports It’s an unpalatable but unavoidable fact that sometimes medical aircraft crash or suffer hard landings. Errors can be made. There can be close calls. Occasionally, some members of a crew lose their lives while others survive. For those that live to tell the tale, sharing their stories can be a vital part of the recovery process, benefitting both the crew members directly affected and the wider community. Aside from what could be described as therapeutic benefits, survivor stories may hold invaluable information for air ambulance companies to learn from and act as accident prevention tools. After transporting a patient from a road accident one day in September in 2012, US air medical crew member Stacy Fiscus was flying in ‘100-per-cent hail probability’. When the situation worsened, Fiscus and her partner urged the pilot to land, and the time that followed during the approach to landing became, as she described, the ‘longest of their lives’. In the silence, Fiscus and her partner ‘knew this was it’. But, in an ending that seemed against all odds, they managed to land safely, and that day, said Fiscus, who today is the clinical base manager for Haiti Air Ambulance, became her ‘changing day’. For her, one of the lessons learned regarded the value of speaking up, and she felt stronger than ever before about wanting to tell the world that message. The healing process So, why do accident survivors share their accounts of what happened? First, there are clear personal healing benefits for people who have survived a serious accident, many of whom reportedly suffer from post-traumatic stress disorder (PTSD). Tania Glenn, the principal of a US private practice that for 25 years has been providing counselling services to the air medical and military sector, has found this personal benefit to be one of the key motives to share. “It helps [survivors] process what has happened and come to terms with it,” she said. Sharing their burden of what happened helps survivors in their human need to be understood, explained Krista Haugen, a registered nurse and former flight nurse who co-founded the Survivors Network for the Air Medical Community. In 2005, Haugen was involved in a helicopter crash while on duty, after which she experienced symptoms of PTSD. “We all

there are clear personal healing benefits for people who have survived a serious accident

survived, including the patient onboard,” she said. “It was a surreal time, to say the least. I felt like I’d been shot out of a cannon into a totally different perspective; any pre-existing naïveté was gone instantly. I knew there were valuable lessons to be learned from this accident, both in terms of what went well and what needed improvement, and I truly felt compelled to share them with my friends and colleagues.” She formed the Survivors Network initiative with other HEMS crash survivors to help spare professionals across the air rescue sector from >>

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“it helps [survivors] process what has happened and come to terms with it”

which makes them less open to sharing information and stories about an incident than their couterparts might be in Europe. They may, for example, be concerned that their account of the accident that will be used for the investigation may contribute to the air ambulance operator they work for being sued for its involvement in the accident by either the survivors who were onboard or by the families of those that didn’t survive. As stated on websites from US-based aviation accident law specialists such as Baum Hedlund and Kreindler & Kreindler LLP, ‘EMS aviation is some of the most dangerous non-military flying in the US’, bringing with it hazards unique to the sector, and in the US it is particularly EMS aviation cases that present ‘extremely complex and difficult challenges and litigation’, with ‘more than one cause and more than one responsible party, multiple plaintiffs and thirdparty actions’, and the involvement of ‘dozens of people and companies’. And yet, added Haugen, the opportunity for air ambulance and similar accident survivors to show vulnerability, to tell the world they are struggling, in need of help, or even that their PTSD was successfully treated, has the power to let colleagues in similar positions know that rather than having to ‘suck it up’, they are not alone in their experience and can move forward instead. Said Glenn: “The air medical community is very small, and when an accident happens, the ripple effect is felt very deeply. But the lessons learned from crashes instil knowledge, understanding and hope.”

The power of prevention The reasons survivors tell their stories extend beyond personal benefit – sharing can provide survivors with a sense of comfort that they may be helping someone else, and that their reports may even help prevent similar accidents from occurring in the future. Through her experiences as the primary trauma co-ordinator for air medical organisations such as PHI Air Medical and Air Evac Lifeteam, a variety of US fire and police departments, airlines, the Marines and defense contractors, Glenn has found that telling the world about an accident can help survivors to ‘pay it forward’. “This is what so many survivors do in the aftermath of a trauma. By sharing their stories, it helps others learn about surviving and the experiences and wisdom they have gained,” she said. Following the mission described at the start of this article, Fiscus posted a video account as part of the Digital Safety Stories initiative on the MedEvac Foundation International website, which provides those working on the front line of the medical transport industry an opportunity to share their experiences. ‘Mitigating future risk by raising awareness of past mistakes’ is a key motivator for people posting the videos, explained Fiscus, who today also functions as chair of Vision Zero, an initiative that aims to address the prevention of air medical accidents, and whose vision is ‘a symbol of the medical transport community’s safety awareness and vigilance’ and ‘an elimination of unnecessary errors of consequence’. “The purpose of a survivor telling their story often has far less to do with themselves, and far more to do with trying to educate others,” agreed Haugen, adding that it can help to ‘open the door to a plethora of lessons that can be learned from incidents and accidents’: “Whether related to risk mitigation, preparedness for accidents, making sure financial and legal affairs are in order, or how to talk to someone who’s been in an accident, there is invaluable information to be shared. Often, others don’t know they need it … until they need it, and we can’t fix what we don’t know about.” She continued: “Most accidents have human factors cited as causal or contributory to the accident. Who better to help us improve our understanding [of] how those human factors played out, than the people involved in the accident, if they are so inclined to share?” said Haugen, explaining that to fully understand accidents it is up to the industry to ‘delve further into the complexities of these accidents’, to study the human factors, and to extract the lessons that can be applied forward in the spirit of preventing future occurrences. For Taymans, company testimonials of flight and medical crew following an accident are of vital importance to future safety. “Improving safety includes the gathering of data of adverse events (crashes, crew death, near misses), and following these events it is key how the information about what went wrong is being collected and used. When investigating, testimonials of the medical teams should be collected; they are an important part of the investigation process,” he said. Speaking about a personal experience during an air ambulance mission

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was able to find out why the incident happened and implement appropriate policy afterwards. The testimonials made a significant difference to this.”

The way forward When it comes to tragedies in the air ambulance sector and sharing stories, what would be the best way forward? Taymans observed that following an accident or near-accident investigation, it is key for an air ambulance organisation to follow A story of survival the guidelines and protocols provided in the certification standards (to be ethical, ensure A recent example of a survivor sharing their story is the book Max Impact records are straight, learn the lessons to avoid published in January by flight nurse Jonathan Godfrey and journalist MJ Brickey. the same scenario from happening again), and The book details the lead-up and to help with this process the company should aftermath of the crash of air ambulance not only ensure the crew involved in the mission EC135 P2 helicopter LifeEvac 2 into will be given the opportunity to give their the Potomac River in Maryland, US, in testimonial, but also make sure that all staff, from January 2005. The opening chapters pilots to medical staff, should be able to read vividly detail how flight nurse Godfrey this information. found himself underwater, severely Haugen argued there needs to be a back-up injured and strapped into his seat, system – some type of crew support structure but managed to reach the surface and that would contradict the current prevailing climb onto a section of the wrecked ‘suck-it-up’ mentality in the air rescue sector. She helicopter’s tail until he was picked up listed as essential ‘recurrent resilience training, by a rescue boat and then flown peer-support teams, and streamlined access to hospital by Maryland State Police helicopter Trooper 2. Pilot to quality clinicians who specialise in trauma Joseph Schaffer and paramedic and PTSD, especially for high-performance Nicole Kielar were killed in professionals in high-risk professions’. “Along with the crash. stories, data can be collected and trends can be In an epilogue, Godfrey writes established to help the organisation understand on the motivation behind Max how to provide quality tools, training, education, Impact: “This book is less and support to those who are carrying out the about a crash and more about organisation’s mission,” she said. remembering Nikki and Joe’s In addition, argued Haugen, other than a memories and learning from their support system, there also needs to be a culture loss. Remembering them not that promotes the right message. She said: “I because they died, but because look forward to the day when resilience and they lived big, giving selflessly psychological well-being are comfortable topics to their community. We say … That takes patience, time, practice, and ‘Never forget’, well this will make cultural shifts. If we can create a culture of both sure that has less of a chance learning and accountability, the stories of those to happen.” involved in close-calls, near-misses and incidents He continues: “Some who read this book will recall sitting in an are extraordinarily valuable in helping to predict audience and hearing part of this and prevent future occurrences system-wide. book in person. Many of those This is true for both the aviation side and the Jonathan Godfrey (right) with Dave Svites (left) who was on individuals come to me after clinical side of air-medical transport.” Trooper 2 the night of the rescue attending the presentation and Fiscus commented: “My video highlights the share how much they reference necessity of each crew member onboard the lessons learned and increased their safety mindset. That has many times to speak up when they feel uncomfortable, fuelled me to keep pressing on knowing that lives are still being influenced and regardless of the collective years of experience possibly lives being saved. I hope that many more lives are positively impacted by belted into that aircraft. I learned how to speak the words and openness written in these pages.” boldly without hesitation and to keep speaking In conclusion, Godfrey lists his three goals: “One, prevent trauma and tragedy up until I am heard. Many crews that have been from ever happening. Two, support survivors of trauma and tragedy. Three, placed into a similar situation have not had their inspire survivorship and encourage those who have survived to use their story to next day to wake up on this earth and influence make the world a better and safer place.” others to change habits and behaviours that can lead to disaster, but I did. Having the opportunity Max Impact: a Story of Survival is available from TheMaxImpact.net. to create this video and deliver that message has been one of the highlights of my career.”

J GODFREY

Sucking it up “Although there has been progress, our society and many in our industry don’t have a good handle on managing our own trauma, promoting resilience, and preventing PTSD yet,” Haugen said, adding that traditionally there has been an expectation that those working in EMS, aviation, and related professions are ‘tough’. “We are the rescuers, the caregivers, and yet we pay little conscious attention to the toll that exacts on us. In some cases, we have been taught, either tacitly or explicitly or both, to ignore the fact that we are human and to adopt a ‘suck-it-up’ mentality, even when faced with horrific traumatic scenes or our own morbidity and mortality when it comes to accidents.” Even though thousands of people in this and comparable professions endure daily physically and emotionally demanding shifts, said Haugen, ‘they do their work quietly and keep the pain to themselves’. She added: “This takes a significant toll and is often unsustainable.” According to EURAMI president Dr Laurent Taymans, US air ambulance crews operate in an environment full of the potential for complex litigation,

Taymans took part in, during which the aircraft lost power on ascent, made a hard landing and left everyone onboard (though unhurt) shaken and scared (in fact, he said, “I was glad I came out of it alive”), he explained it was crucial that the air ambulance organisation ‘knew what they were doing’. “Everyone had their testimonial taken, we were all able to give an account of what happened, tests on the helicopter were done and so on, and the company

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what she termed the ‘most brutal teacher: experience’, and to ‘restore their independent functioning, hopefully resuming their life’s purpose’. Society and companies can be inherently lonely places for those suffering with PTSD and related conditions, but this is particularly the case in emergency services and the air medical industry, observed Haugen, where people can not only find themselves on the ‘other side of incidents and accidents’, and with an oftenoverlooked great ‘potential for preventable pain and suffering’, but also in a culture where such issues are often under addressed, taboo even.

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Things are heating up in the world of helicopter ice protection systems, as Mario Pierobon reports Flight in icing conditions is a significant safety threat affecting EMS and SAR helicopter operators. However, it’s difficult to quantify exactly how many missions are lost during the winter months because of ice. “In the old days, it was the case that when the helicopter pilot faced icing conditions, s/he would not fly at all, and therefore historically there have not been reliable data collected as to how operationally significant the icing threat is,” say Luca Medici, head of helicopter system design, and Matteo Ragazzi, chief of airworthiness, at helicopter manufacturer Leonardo. As ice protection system installations were made available by helicopter manufacturers, operators started to aggregate more data. “There is, however, a significant degree of variation amongst the different providers as to the number of missions that cannot be flown due to icing conditions. In the North Sea, an operator has estimated somewhere in the 10 to 15-per-cent range the amount of lost missions because of ice

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during the winter months. In the area of the Russian island of Sakhalin in the North Pacific Ocean, the estimate is in the range of eight per cent. These are significant values in terms of aircraft productivity. There is no consolidated figure yet, however operators are starting to be more concerned and aggregating more solid data,” say Medici and Ragazzi. Rega’s experience Helicopter rescue provider Rega realised that there are hundreds of missions that it was not able to perform across Switzerland every year because of weather conditions. The service therefore approached Leonardo Helicopters to highlight the need for an intermediate light helicopter that allows operations under all conditions, and Leonardo launched the development of a full ice protection system (FIPS) for the AW169. At the time of writing, there are no Rega helicopters equipped with FIPS – or even a limited ice protection system (LIPS). Heinz Leibundgut, chief pilot (helicopters) for Rega, comments: “As Rega operates no helicopter with FIPS or LIPS, there are no operational [existing] practices. As flying in icing conditions is not an option, we have

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to cancel or abort missions during icing conditions. Today, we are able to perform IFR in non-icing conditions only.” Rega maintains a positive outlook on the future availability of FIPS on the AW169 and it foresees being able to perform many more missions safely. “Every year, bad weather currently prevents around 600 people in Switzerland from receiving emergency assistance from the air. Rega wants to change this situation and in future help even more people in distress. It has therefore launched a series of measures that will enable its helicopters to also be able to fly when visibility is poor,” says Leibundgut. “Rega is, among other things, working closely with the Swiss Air Force and the Skyguide air navigation service to establish a network of instrument flight routes. This so-called Low Flight Network (LFN) is based on satellite navigation (SBAS and RNP 0.3) and will link [with] airfields with permanent IFR infrastructures, as well as hospitals and smaller airfields with specially designed approaches. In December 2016, the two main routes of the LFN (south to north and east to west) were finally established and operational. Two weeks later, Rega flew its first patient from the southern part of Switzerland on the LFN over the Alps.” Another important piece of the puzzle is the purchase of a helicopter that is all-weather capable, but within an acceptable weight range, which will take Rega a major step closer to its vision of performing all-weather rescues. “As of 2021, it is foreseen that the new FIPS-equipped AW169 helicopter will initially be stationed at two Rega bases and deployed to defy the harsh weather conditions,” says Leibundgut. “In contrast to the actual fleet of AW109s and EC145s, the AW169 will be able to perform IFR flights in icing conditions. With regard to the topography of Switzerland with alpine mountains and peripheral valleys, the AW169

will be very useful for performing IFR flights in icing conditions on the Low Flight Network (LFN), for example flying patients from a regional to a central hospital.” Ice protection systems Leonardo Helicopters has committed to differentiate its products by equipping them with ice protection systems and it was the first manufacturer to bring a FIPS to the market for light and medium category helicopters. “The AW139 was the first intermediate helicopter to make it to market equipped with a FIPS. The same holds true for the larger AW189 and the light intermediate AW169. The latter will be the only light helicopter to come equipped with a FIPS,” says Medici. “Paradoxically, the smaller the helicopter, the higher the negative impact of icing. Once there [is] certification of the AW169’s FIPS, it will be indeed an industry first as there is no other small helicopter equipped with a FIPS.” The AW189’s FIPS was certified by the European Aviation Safety Agency (EASA) in mid-2016, allowing the aircraft to operate in full icing conditions when other helicopters would be grounded. The EASA certification came after three years of flight trials in Northern Europe and North America during the winter months to gather data and test the effectiveness of the system. Leonardo Helicopters’ experience with ice protection systems stretches also to the military domain, where its ice-protected AW101 can fly in temperatures down to -20⁰C and with ice accretion of up to 80 mm (more than three inches). There are currently 15 AW101 units operated by the Canadian Air Force for SAR purposes and equipped with ice protection systems. And there are over 70 ice-protected AW139s >>

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operated all over the world: these include seven units operated by Sweden’s SMS for SAR and 10 units operated by Canada’s ORNGE for EMS. There are more than 20 ice-protected AW189s, and they include 11 units operated in the UK and two operated in the Falklands for SAR. An ice protection system is made of several interconnected components.

“an AC/DC electrical power generation system brings electrical power to the main and tail rotor blades”

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an ice and snow detection system which [assesses the] severity of the icing conditions where flight is being undertaken and leads to the heating of the main rotor and tail rotor blades.” Full or limited? There are two main categories of ice protection systems available from Leonardo Helicopters – FIPS and LIPS. “As far as the FIPS is concerned, the Ice Control Box (ICB) component works as the brain of the system and it has the function of managing all the components that make up the whole,” say Medici and Ragazzi. “From the cockpit, the ICB allows [the helicopter] to accomplish automatic and manual FIPS operations. Automatic operation requires, for example, an ice detection system which provides information as to the icing severity and, based on certain conditions, informs the operator how much the blade heating system must be active. The whole is connected with the air data system through the outside air temperature (OAT) sensor and the pitot tube, and we have an AC/DC electrical power generation system which brings electrical power to the main and tail rotor blades.” The difference between a FIPS and a LIPS is that the limited version does not have the components to create the electrical power needed to heat up the blades. “The blades are not heated, and a certain amount of ice accretion is tolerated under certain relatively high temperature conditions (up to minus 10⁰C) and, once the limitations are exceeded, the aircraft must get out of the icing conditions – it has to reduce altitude and reach areas where there is warmer air,” say Medici and Ragazzi.

REGA

First of all there is engine anti-icing. “We have an anti-icing system that does not allow any ice accretion on the engines and this works by means of valves which make hot air circulate through the compressor blades and the particle separator,” say Medici and Ragazzi. “An anti-icing role is played also by the air vents, which are heated, as well as by the windshield. In addition, we have

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There is an important component that is common to both the FIPS and the LIPS: the SLD (super-cooled large droplet) marker. The SLD marker is an icing condition detection system and it requires pilot monitoring. “It is a visual indicator, a simple sphere with some coloured strips: black, yellow and red. If you have ice accretion on the black or yellow strips it means the helicopter is still being flown in normal ice accretion conditions. If you have ice accretion on the red strip, it means that the conditions are severe and the helicopter must leave these conditions,” explain Medici and Ragazzi. The LIPS systems are sold in particular in Northern Europe, say Medici and Ragazzi, where typically a pilot can simply reduce altitude to escape icing conditions – any ice accretion then either melts or detaches from the aircraft. Operators who want a FIPS-equipped helicopter tend to be those that operate in more extreme weather conditions, they add: “The FIPS is critical for operators flying in Canada, Russia and the northern US, where icing conditions are common during the winter months. There are also, however, other operational conditions that may dictate the choice for the FIPS instead of the LIPS. EMS and SAR operators, for example, may not be able to plan or forecast icing conditions and the related need to reduce altitude, and therefore prefer the FIPS because it allows flight in ice without limitation, except for flight above 10,000 ft and in SLD conditions, where droplet size is large and ice extends to unprotected parts of the aircraft and forms larger shapes.”

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Operational benefit Rega believes that it can provide improved emergency medical care from the air by equipping its future AW169s with the FIPS. “Among those who will profit from instrument flight routes and FIPS are people living in the

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peripheral regions, who in a medical emergency can be flown to a central hospital no matter what the weather. For example, even despite low cloud cover and icing conditions, Rega will be able to fly premature babies from Samedan, which is located in the mountain valley of Engadin, via the instrument flight route over the Julier Pass to Chur or Zurich. Babies that are born before the 34th week of pregnancy need to be transferred to a central hospital. In such cases, it is vital that the patient spends a minimum amount of time away from the hospital, so the fastest transport possible is of key importance. Until now, with icing conditions, the only possibility has been a lengthy journey by road. Other intensive care patients will also benefit from the new flight procedures of the AW169,” says Leibundgut. “The AW169 will help us to expand our scope of operations and bring us closer to Rega’s vision for an air rescue of ‘anytime, anywhere, any conditions’. It will also improve primary healthcare in Switzerland, as if necessary we will be able to fly patients from remote regions such as mountain valleys to a central hospital, even if the mountain passes are covered in cloud or if visibility is poor.” As it approaches its AW169 experience, Rega will develop best operational practices for dealing with ice in EMS and SAR operations in the alpine environment, including training. Leibundgut says: “It is too early to be specific, as requirements depend on the outcome of the AW169 certification process. Once we have all the data, we will be able to design and define our standard operational procedures for the AW169.” Although Leibundgut acknowledges that there will still be conditions where missions are impossible even with ice protection-equipped helicopters, such as freezing rain or very strong winds, Rega is en route to a greatly enhanced service.

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organisation can be recouped when others make use of it. Jones of Midlands Air Ambulance said: “While other organisations have not used the simulation room with SimMan yet, as part of our commitment to fellow members of the Association of Air Ambulances, cross-border training could include the use of SimMan.” According to LAR, flight medics find that the most important aspect of >>

Time pressure, seriously injured patients and minimal equipment mean that medical crew members onboard air ambulance helicopters have to think fast, adapting to their given mission parameters in seconds. While much can be learnt in a classroom, simulation training is an essential part of ongoing education. Simulation allows participants to practise the non-clinical parts of their jobs in addition to taking care of a patient – so medical procedures, crew communication, situational awareness, and the need for fast decision

“recording the in-flight simulations gave faculty the ability to review and debrief scenarios with students”

making under stressful conditions, are all being practised at the same time. Training courses that provide simulation scenarios are indispensable for air ambulance operators, notes Brad Matheson of US-based Priority1 Air Rescue, as it’s difficult in the commercial HEMS world to provide pilots and

helicopter medical personnel with the flight-time experience they need to practise all the skills that enable them to perform as an effective aircrew member, such as crew resource management, situational awareness, confined area landings, scene location/searches, landing zone selection and co-ordination and night vision goggle operations. Celeste Alfes is associate professor and director of the Learning Resource Center at the Frances Payne Bolton School of Nursing at the Dorothy Ebersbach Academic Center for Flight Nursing at Case Western University in Cleveland, US. She wrote in Taking Simulation to New Heights: Designing a Flight Simulation Center that simulation scenarios specific to medical transfers allow teams to practise effective communication handoffs, develop a plan of care for a critical ill patient, and implement real-time interventional procedures. The Dorothy Ebersbach Academic Center for Flight Nursing prepares acute care nurse practitioners to work in unstructured environments, organises inter-professional disaster response training during its annual summer camp, and conducts research to build the evidence base for practice in air medical services. Alfes spoke to AMR about why simulation training is essential for HEMS medical crew.:“Flight simulations of critical care air transport differ from other simulation exercises in that noise, light, vibration, time constraints, mission progression, and electronic communication need to be combined with the clinical demise of the patient. High-fidelity simulation can be instrumental in training inter-professional flight teams to improve competency through quality and safe patient care during medical transport.” Sim kit Taking pride of place in the Dorothy Ebersach Academic Center’s training facility is a Sikorksy S-76 helicopter fuselage that has been adapted to provide professional education opportunities. Motion, visual and sound

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equipped with video and audio installations; helicopter sounds, control tower noise, etc. is transmitted to the crew helmets.” Luxembourg Air Rescue (LAR) offers full-scale simulator-based crew resource management training courses for all medical crewmembers, in addition to a medical simulation room in which courses are offered on advanced resuscitation, difficult airway management techniques, major bleeding incidents and paediatric resuscitation. Crew members also benefit from practising the parts of a mission that occur outside the aircraft, especially treating patients at the scene of an accident. For example, in the UK, the Midlands Air Ambulance Charity has opened an Education and Training Centre, complete with scenario simulation room, at the Tatenhill airbase. Ian Jones, the aircrew supervisor for the charity, said that the simulation room includes medical equipment and props, which enable flight paramedics and doctors to act out various scenarios as part of their advanced medical training; the room allows for the simulation of both indoor and outdoor environments, and is ‘one of a kind’ in the UK’s air ambulance sector, according to Jones. Medics are put through their paces using a Laerdal 3G Trauma SimMan and a Laerdal SimBoy, allowing for cannulation, intubation, and ventilation, among other procedures. Speaking to the paramedics who have trained using the mannequins in the simulation arena, they say that modern versions are ‘a huge step closer’ to real human patients. Jones said: “For example, with a respiratory examination you would go through the motions on the mannequin and then the simulation driver or trainer would tell you what you found. With SimMan, the simulation driver can change the parameters remotely, and we are able to [match] the findings with our [clinical] assessments. It is currently as close as we can get to being able to create a real patient.” The sharing of training facilities means that original investment made by one

EBERSACH

The leap from classroom learning to real-world practice can be bridged using simulation training, as Mandy Langfield explains

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“helicopter sounds, control tower noise, etc. is transmitted to the crew helmets”

EBERSACH

effects are all integrated into the fuselage, and the windows were replaced by LCD video monitors to display real-world images of the different phases of flight. A Federal Aviation Administration (FAA)-approved medical interior completes the training environment. During training, the trainer has the ability to observe and evaluate participants’ ability to manage the patient, providing prompts and re-directions as needed, with the aid of two interiormounted GoPro cameras and aviation headsets. “Recording the in-flight simulations gave faculty the ability to review and debrief scenarios with students, optimising their learning experience,” said Alfes. Also making use of a full-scale mock up of a helicopter interior is the ADAC HEMS Academy in Germany. While currently the Academy is unable to offer training courses to third parties due to the installation of its third full-flight training simulator (an H145), normally there are mock-ups of an EC135 and BK117 available in which paramedics can train. Thomas Gassman, director of business development and sales for the Academy, said that both helicopters are fully equipped with all the typical gear found on a rescue helicopter. “Both equipment and mannequins are remotely controllable from a hidden directors room,” he added. “In addition, the mock-ups are

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FEATURE

FEATURE

ADAC

Even as digital solutions develop, traditional analogue simulation – for example mock vehicle crash scenes using real cars and actors as patients – remain a useful tool. The Pre-Hospital Emergency Medicine Crew Course provided by the UK’s Great North Air Ambulance Service offers participants the opportunity to take part in a large-scale tactical multi-agency exercise involving the fire service, police, ground ambulance service and traffic officers. Another element of the course gives medics the chance to practise their skills in low-light conditions, with a night-time scenario with multiple casualties involved in a car accident, which tests situational awareness, crew resource management and critical care skills.

ADAC

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.”

>>

Simulation matches Reality on H145! Our new H145 Level D Full Flight Simulator completes our training portfolio for EMS, Law-enforcement, VIP and Offshore operators. State-of-the-Art quality and performance, combined with advanced technology, an intuitive onboard IOS and dual channel LED projection with NVG stimulation will enhance the quality of your training. Ready for Training as from mid June 2017. ADAC HEMS Academy: Your competent partner for training on EC135, EC145 and H145 FFS. MIDLANDS AA

the company’s courses is ‘the combination of a strong theoretical element with regular practice/recurrent training in a realistic environment’. The courses were developed by LAR when it found a lack of adequate courses available elsewhere for its staff. Over time, said Schomaker, the courses have been adjusted and enhanced, with trainers from both the medical and aviation sides of the business, allowing them to offer ‘true aeromedical courses’. “Having put so much time, effort, money and resources into developing these training courses,” concluded Schomaker, “we are confident enough to offer these courses to external organisations to share our knowledge and help to save more lives by training others to increase their aeromedical skills.” Another UK HEMS charity that has developed a similar set-up is Hampshire and Isle of Wight Air Ambulance, which recently opened a new simulation training facility that has the ability to project a series of mock incidents, complete with movements and sound. The crew members are 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 locations 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.” 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

Flight tasks HEMS missions are not just about the medical crew treating a patient – taking off and landing helicopters can be a dangerous business, and keeping the whole air crew up to date with the latest safety techniques is an essential part of training. Brad Matheson of Priority1 Air Rescue offers simulation training that addresses this aspect of operations. He said: “For us, this component is essential, as probably the most dangerous job in HEMS is getting there (especially landing) and returning, and to provide the maximum level of safety, the entire crew should be contributing, not just the pilot(s).

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Experience the training that makes the difference.

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FEATURE

With our helicopter simulator we can provide our own EMT/paramedics and customer with helicopter simulation and incorporate our Helicopter Emergency Medical Responder (H/EMR) course which includes our ground school training into the synthetic flight training environments.” With its simulator, Priority1 has the ability to replicate 20 different types of

“flight students become efficient in managing time-sensitive critical conditions”

helicopters, incorporating realistic synthetic modelling specific to airframe, internal/external communications, weather conditions, day/night (aided/ unaided). Matheson went on to say: “Something as simple as spotting [an] air traffic collision course, rotor obstacle clearances, spotting land marks en route, CRM and [tasks that] people often learn reactively in the field, we can proactively input into the synthetic learning environment for our customers and provide an ‘actual’ HEMS mission scenario and practise situational awareness that can keep a HEMS crew safe.”

Matheson of Priority1 Air Rescue summed up the real value that simulation training has for the entire crew of an air ambulance helicopter: “Using simulation, we can put crews in high-risk situations, and purposely set them on a course to having a tail rotor strike during a confined area landing, or radio tower collision and night to see if they identify and act accordingly, or set up other scenarios that we would never replicate with live flight training. The next [benefit] is cost savings, [because] commercial (and military for that matter) operators do not have the budget to provide all the hours required to conduct the optimal amount of flight hours to perform all these training modules, however with simulation, we can accomplish the training in a shorter amount of time and without all the associated helicopter flight time, maintenance, scheduling, and possibly having an aircraft out of service that would be on an alert/in service type status.” Alfes of the Frances Payne Bolton School of Nursing concluded: “[Our] simulator has been a tremendous learning tool, providing faculty with a structured environment for training related to stressors of flight, patient packaging, radio communication, crew resource management and situational awareness. Flight students become efficient in managing time-sensitive critical conditions and performing advanced procedures with limited clinical resources while in motion.” There is little doubt that mission simulation training for flight medics is of huge benefit to all crewmembers. Whether it is the use of a full-scale mock-up of a helicopter, or a room in which a situation is projected on the walls and a mannequin with simulated injuries, the myriad of options available to flight medics is impressive and essential to their continued professional development.

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FEATURE

FEATURE

The Northern Ireland countryside includes dramatic coastline

Should helicopter air ambulance services be paramedic or physician-led, and which is the safest and most practical? The global HEMS community has differing opinions, as Lucie Wood finds out The Northern Ireland (NI) health authorities and Air Ambulance Northern Ireland (AANI) made headlines in the local and industry press recently. The two organisations have been working together to set up HEMS coverage for Northern Ireland. The reason that this was particularly newsworthy was that in the interim period before the service was approved by NI’s Minister for Health Michelle O’Neill, there was debate about the necessity of flying with a doctor onboard. O’Neill received an open letter signed by 25 pre-hospital specialists from HEMS organisations around the world who expressed their concern that ‘NI paramedic HEMS experience in this high acuity and high consequence environment is limited’, and who feared that ‘the Service will not be capable of providing the best life-saving care possible to the people of N.Ireland from the outset if a doctor is not onboard the helicopter’. In the event, Northern Ireland’s new HEMS will have two EC135 helicopters and pilots supplied by Babcock Mission Critical Services, while medical staff and equipment are provided and funded by NI’s Health and Social Care Services, and the service will have doctors onboard. But would the service have been short-changed by a paramedic model? And is it true that most paramedic-led services in the UK, Europe, Eastern Europe, Asia,

much of Australasia are moving towards a physician onboard as standard for HEMS, as the letter stated? Tim Rogerson, doctor for the Emergency Medical Retrieval and Transfer Service (EMRTS) in Wales, UK, was a signee of the letter calling for a doctor-led HEMS. He says that doctors and paramedics bring different and complimentary skills and knowledge. “A doctor-paramedic model as part of a pre-hospital critical care team is delivered in most UK pre-hospital services,

“doctors don’t come cheap – costs ranging from £500 to £1,000 a shift”

and, if not, is in the planning stages. It is the standard of care provided by many HEMS providers across the world. The addition of a doctor to the team allows full provision of life and limb saving interventions which would not be possible with a purely paramedic model in the UK.”

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Rogerson, who has worked with HEMS in the UK and Sydney in Australia, says: “The addition of a physician in a pre-hospital critical care team allows the full provision of life and limb-saving interventions in the prehospital environment. This includes blood and clotting products, general anaesthesia, pre-hospital amputations and clam-shell thoracotomy. Some services are adding advanced resuscitation techniques to this including REBOA [resuscitative endovascular balloon occlusion of the aorta]. With these additional interventions, the HEMS is becoming a delivery tool for the pre-hospital critical care team, who can deliver many of the interventions available in the resus room at the scene.” But should having a doctor onboard HEMS be seen as a gold standard rather than a necessity? Chief executive of Wiltshire Air Ambulance (WAA) David Philpott, who is responsible for a paramedic-led service funded solely by charitable donations, thinks so: “It is the platinum standard and very expensive. If the NHS funded doctors on helicopters, one would be a fool not to want them. However, doctors don’t come cheap – costs ranging from £500 to £1,000 a shift.” As with many services in the UK, WAA has access to paramedics seconded from the state-funded National Health Service (six of its 11 paramedics are funded by South Western Ambulance Service). Philpott continued: “Charitably funded air ambulances have a duty to their donors to ensure that donations are being properly spent. A few air ambulance charities (including Wiltshire) have a small cohort of doctors

“there are not enough doctors to have one onboard every helicopter or critical care ground ambulance transport”

who work onboard the helicopter from time to time as unpaid volunteers.” Using doctors onboard could also damage the reputation of Wiltshire Air Ambulance, explains Philpott, if allegations of clinicians profiteering from charities were ever upheld. As for the medical limitations posed by a paramedic-only service, there are some impediments, Philpott says, but they are rarely seen. This is backed by NHS tasking data, he said: “From the data, we see that in 2016, Wiltshire Air Ambulance with a [critical care paramedic]/paramedic team were deployed to traumas on 361 occasions, whereas another air ambulance in the region using the physician/paramedic model was deployed to 260.” Rick Sherlock, president and CEO of the Association of Air Medical Services (AAMS) in the US, explains that fielding a physician onboard >>

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every HEMS flight is not pragmatic or feasible in every situation in the US. “As an example, the state of Minnesota has about six million people and is roughly two-thirds the size of Germany, which has about 81 million people,” he says. “The US has vast distances and many areas with low population densities. There are not enough doctors to have one onboard every helicopter or critical care ground ambulance transport under these circumstances.”

“a combative, agitated patient would never be placed inside the aircraft without first being sedated with paralytics for rapid sequence intubation”

Should HEMS be doctor-led ideally, though? “Actually, HEMS services in the US are ‘doctor-led’,” Sherlock explains, “the clinical guidance is simply done remotely during transport of the patient. Medical control is always available and involved for any issues that are encountered by the crews when caring for the patient on the flight.” He goes on: “AAMS does not believe that there must be a doctor as part of the flight crew, but does believe that programmes need doctor-led medical direction and oversight. The most common HEMS crew in the US consists of a nurse and a paramedic. Only about five per cent of US programmes have a physician onboard. Given the

scope-of-practice for nurses and paramedics, proper training and with good medical oversight, it has not been shown that a crew with a physician has better outcomes.” Eileen Frazer, executive director of the accreditation body Commission on Accreditation of Medical Transport Systems (CAMTS) based in South Carolina, US, refers to a study backing this: “The University of Wisconsin (physician-led flight teams) and Mayo Medical Transport (nurse/paramedic teams) compared transports events and hospital outcomes of 398 STEMI [ST-Elevation Myocardial Infarction] patients. This study found that both had zero-per-cent deaths in transport, and no statistical difference in the rate of in-hospital deaths or length of stay. There were higher rates of nitroglycerine and opioid administrations in the nurse-paramedic teams, which could have led to a higher rate of adjusted in-hospital events. But more study is needed.” When looking at HEMS models in the US and the UK, it’s important to note the differing training and background of the professions. “In the US, nurses are more highly trained and experienced to conduct interfacility transports than paramedics and therefore, critical care nurses are found on most critical care teams,” Frazer explains. “Physicians, unless they are in an Emergency Department Residency (and air medical transports are part of their rotations) are rarely part of the team with nurses operating under medical protocols from the medical director. We encounter physician-led teams in most other parts of the world where the culture has developed with physician/ paramedic teams and where nurses may not have the same level or scope of practice as paramedics.” Sherlock of AAMS says the two disciplines of nursing and paramedicine are mutually supportive by their skill sets and experience. “For example, paramedics often have extensive experience with scene calls, while nurses have ICU experience for inter-facility transports. Here in the US, there are differences in state law as far as scope of practice for each discipline. In some states, medics can intubate and nurses cannot, while it is the reverse

FEATURE

AANI

FEATURE

An artist’s impression: AANI will have two EC135 helicopters and pilots supplied by Babcock Mission Critical Services

in other states. Thus, the nurse and paramedic are mutually supportive in taking care of the patient.” Procedures onboard that would not be possible without a doctor would include a REBOA, lateral canthotomy, and a left lateral thoracotomy. But the letter to O’Neill said that without a doctor onboard, HEMS at times becomes unsafe. It said: “Placing a combative, agitated, head injured or bleeding patient in a helicopter without a general anaesthetic is unsafe,

“the geography of Northern Ireland will dictate which clinical model is preferable”

both to the patient and the crew.” But Sherlock disagrees that you need a physician in this instance, in the US at least. “It doesn’t matter who is onboard in this particular situation. A combative, agitated patient would never be placed inside the aircraft without first being sedated with paralytics for rapid sequence intubation, as well as agents like ketamine for agitation. This has become standard of pre-hospital care in the US and it does not require a physician to administer the drugs.” In conclusion, context is all in this debate. The funding model of the service, which country the HEMS is operating in, or even which region – rural or metropolitan – will in part determine the kind of service is safest and most practical. While Sherlock, operating in the US, sees no reason to move to a physician onboard every HEMS flight (“Our nurses and paramedics provide excellent patient care. HEMS providers in the US do have strong medical oversight, including intense continuous quality improvement and training overseen by the medical director”), in the UK Philpott of WAA appreciates the benefits of a physician but funding precludes it: “Yes, this is the direction [HEMS services are moving towards] and if funded by the NHS we would embrace it. However, we are already funding 50 per cent of our paramedic costs because the NHS has a budget crisis, so I think government-funded doctors is therefore unlikely.” As for the Northern Ireland HEMS service, again it must be viewed in context, Philpott says: “The geography of Northern Ireland will dictate which clinical model is preferable. With tens of thousands of people living at great distance from A&E services, there may be compelling reasons to use the physician onboard the aircraft to guarantee equity of health provision.” Read the letter in full via the link at www.airmedandrescue.com/story/1721.

Philpott: tens of thousands of people live at great distance from A&E services

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PROVIDER PROFILE

PROVIDER PROFILE

Queensland Government Air, based in Australia, gives a whole new meaning to versatility with the numerous and varied mission types it undertakes on a day-to-day basis. Troy Alder, one of QGAir’s helicopter pilots with Rescue 510 based in Cairns, spoke to Christian Northwood Queensland Government Air is the aviation division within the Public Safety Business Agency of the Queensland Government, says Alder. It’s been through a few name changes over the years, such as EMQ and Queensland Rescue, however the rotary-wing side has been operating continuously in Queensland for over 30 years. This section of the service fields a fleet of three AW139 and two Bell 412EP helicopters from its bases in Brisbane, Townsville and Cairns. Alder explains why the service favours these models: “QGAir have been operating the Bell 412 for many years. At the time, the aircraft was state-of-the-art with an electronic flight instrument system cockpit and a flight management system. QGAir were one of the first operators of the AW139 in Australia … I believe the choice was made to acquire the latest technologically advanced platform on the market to achieve all the missions the Queensland Government require of us.” Alder revealed that this drive to have the most appropriate aircraft on the market will see it replace its last two Bell 412EPs with two more AW139s, ‘not only for fleet commonality but to ensure we are operating the latest

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versatility is one of QGAir’s strongest assets

generation EMS/SAR aircraft’. “The AW139 is considered the benchmark for EMS operations in Australia with NSW and Ambulance Victoria selecting the 139 as their platform across both states,” adds Alder. QGAir also operates a fixed-wing service, including one B1900 plane, a B350, a Hawker 850XP, one Cessna Citation jet and a number of Cessna Caravans operating from bases all over Queensland, said Alder. Versatility is one of QGAir’s strongest assets. The operator’s helicopters are equipped for several mission types, including SAR, EMS, police k9, specialist police ops and swift water rescue. The fixed-wing side of the operation also has several responsibilities, including police surveillance and prisoner transport. The service is able to operate VRF, IFR and on NVGs, notes Alder. The variety of mission types means that QGAir has to have a fast, but >>

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PROVIDER PROFILE

the service is able to operate VRF, IFR and on NVGs

effective, procedure when it receives a call. Alder explains the process: “The emergency call will come through on the ‘bat phone’ and the crew will assemble in the operations room for a mission briefing. Once accepted, the crew will separate and commence their individual readiness processes. The pilot submits a flight plan and updates the weights and balance load sheet whilst the aircrewman and rescue crewman prep the cabin, re-configure if necessary, tow the aircraft out and top up the fuel if necessary. During this time, the intensive care flight paramedic will grab the bloods and the emergency doctor will try and get a medical update from the clinical coordinator, though often we may be first on scene.” Before the aircraft takes flight, safety and equipment checks are also performed. “Usually we are airborne within 15 minutes. However, this may vary according to flight and mission planning requirements,” Alder says.

QGAir operates a crew of five members for its SAR and HEMs operations. This includes a pilot, an aircrewman, a rescue crewman, an intensive care flight paramedic and an emergency doctor. The rescue crewman also has additional training as a rescue swimmer, meaning that he or she will have a wealth of skills on top of the winching, underwater escape training, crew resource management, dangerous goods awareness and other responsibilities and training that are expected. The rescue swimmer has to pass a rigorous fitness assessment every four months including a 2.4-km (1.5-mile) run in under 10 minutes and a 1.5-km (0.9-mile) swim in under 30 minutes (the last 500 m wearing fins), an oceanic responder course, cliff-edge fall restraint training, specialist water-based rescue training and a pre-hospital trauma life support course, explains Alder. QGAir’s staff ‘comprises a really good mixture of ex-military and civilian personnel’, though almost all have prior EMS experience before joining the company. Over its years of service, QGAir has been involved in numerous missions, including assisting with the 2011 Grantham Floods and the 2013 Bundaberg Floods. The floods in 2011 saw over 200,000 people affected, with many having to be evacuated by the service. Then known as Emergency Management Queensland (EMQ), the service worked together with Surf Life Saving Queensland to establish rescue co-ordination centres in Brisbane. For Alder, there are a few missions that stick out: “Personally, with two young boys, I find EMS missions involving children the worst. Motor vehicle accidents involving alcohol or drugs impacting innocent families and so unnecessarily taking away the life of a child always pull at the heart strings, but that is part of what we do as rescue crews.” One such mission involved Alder and his crew being tasked with the rescue of a family of seven who failed to return from a weekend trail bike ride in the forebodingly named Death Valley, which is situated about 30 minutes from Cairns. The family managed to get an emergency call out to say they were lost before losing contact. Rescue 510 was tasked with finding the family late in the evening. “As with most overland SARs, we configured for a winch and launched on NVGs, initially landing in the town where the party of seven originally left from to speak with the police co-ordinator and to family in an effort to try and minimise the search area,” Alder explains. The chopper crew was able to utilise its thermal imaging camera and NVGs to spot a small fire on a steep slope in a valley. This turned out to be where the group had taken refuge. But the lack of moonlight, combined with the steepness of the terrain meant that the crew decided it would be better to return at first light. “We returned at first light and safely winched all seven in two iterations back to their home town and awaiting families. We dropped our paramedic into the township before the winch evolutions, and so they were given a quick medical check as we brought them in. There were no injuries, [they were] just tired and thirsty.” Alder explains why the mission was so special for him: “The families were so thankful and have since kept in contact with us. It makes our job even more special knowing we rescued seven, including kids, and delivered them to their awaiting families in a small country town.” For Alder, what really makes QGAir is the people. He explains the company has ‘an amazing mix of talented, dedicated, experienced personnel who strive to perform their individual roles to the highest standard to achieve one common goal – saving lives’.

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INDUSTRY VOICE

diary dates

BIGGLES GIGGLES

Beach holiday with a model anyone?

Send your diary dates to: info@airmedandrescue.com

Field notes from Nicaragua

23-28 April

Medical Transport Leadership Institute

If anyone was asked to imagine a perfect holiday setting, it would most likely involve sun, sea, sand and friendly companions. Few would leap at the chance, however, to spend their time in this tropical paradise if it meant scavenging for your own food, building a shelter and battling against extreme weather, all whilst competing against nine other teams. Sgt Ben Domian is not your usual guy, however. A US Air Force Reserve trained in survival, evasion, resistance and escape (SERE) with the 920th Rescue Wing (RQW), Domian has put himself forward as a challenger on new reality TV show Kicking and Screaming. With a $500,000 prize as an incentive, Domian must partner with Juliana Herz, a professional model from New York, and survive in a tropical jungle in Fiji. Along with Domain, nine other expert survivalists and their chosen partners will be battling against the extreme conditions of the jungle for as long as they can. Domian was spotted by the show’s producers because of something that Herz would be more familiar with – his Instagram posts. He was hesitant at first, but decided that the show would allow him to push his skills to the limit. “I try to live a deliberate life with adventure in it,” he said. “This was a good opportunity to do that and travel to a place I’d never get to visit otherwise – actually putting my skills to the test in a legitimate jungle.” Domain has more than enough experience to take on the show’s challenge, said the 920th RQW, having spent eight years within the Air Force, becoming a SERE specialist during his career. He has also taught Air Force pilots, air crews and special operations airmen survival skills – perfect training for working with his partner on the show. Domain said that he lucked out when he was partnered with Herz, saying that they made a good team during

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

2-4 May

Northeast 2017

Airborne Law Enforcement Association Annapolis, Maryland, US www.alea.org

10-12 May

15th Airborne Neonatal & Pediatric Transport Conference

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

15 May

Flight Medical Crew Study Day – and never froze. I’ve disassembled and reassembled an aircraft engine, installed it on an airplane and flown it without hesitation. In high school, with my basketball team down by one point – and me on the free throw line with seconds left to play – I didn’t freeze. But with the sun setting quickly and the engine start checklist waiting, the care and love that this young teenager had for her son froze me. After I don’t know how long, I mumble something along the lines of ‘yeah, he’s getting better’, while restarting my checklist. The engine fires up, and we take off toward Belize City. A few days later, I step into the children’s ward of the hospital in Belize City to check on the two patients. The mother has already been cleared, and I find her diligently adjusting the clothes of her baby in a hospital bed. She excitedly tells me that her son was removed from the breathing machine today and is expected to make a full recovery. This time, her voice is not only filled with the same care and hope that stunned me a few days before, but it has another element: pure, unfiltered joy. If I was frozen before, the joy on her face literally melts my heart.

CCAT Aeromedical Training Cumberland Lodge, Windsor, UK www.ccat-training.org.uk

22-26 May

Tactical Flight Crew Academy

ECHO Gwinnett County, Georgia, US www.eastcoastheliops.com

1-3 June

Heli UK Expo

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

East Anglian Air Ambulance supports Red Nose Day Anglia One, an East Anglian Air Ambulance (EAAA) helicopter, has had a makeover for Red Nose Day in support of UK charity Comic Relief. Engineers from Babcock, which supplies the EAAA’s aviation services, applied the red nose livery on the H145 helicopter, ready for unveiling at Norwich Airport in March. EAAA CEO Patrick Peal said: “We recognise that people do often give to more than one charity, and we are happy to show our support for Comic Relief this Red Nose

Day. The work of Comic Relief helps a wide variety of people within the region and the assistance they give can ultimately help improve health and well-being.” Every two years, Red Nose Day is an opportunity for people to ‘do something funny for money’. The Comic Relief charity spends the money raised to help people ‘living tough lives across the UK and Africa’.

5-7 June

PavCon

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

AUTHOR TJ STEWART TJ Stewart is the field director for Wings of Hope in Nicaragua. He spends his days flying medical evacuation flights for people who need emergency medical care. Many would not survive if they had to make the several hours’ drive over bumpy terrain or equally long boat ride down the Rio Coco River.

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13-17 June

Safety Management Training Academy AAMS Carlsbad, California, US www.aams.org

24-29 July

ALEA EXPO

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

JEFF NEIRA COURTESY OF FOX BROADCASTING COMPANY

From the cockpit I can see the sun setting as the plane starts descending into Dangriga, a small town on the coast of Belize. I am responding to a call about a boat that capsized with a young mother and her infant son onboard. Reportedly, the infant was under water for 20 minutes. The biggest goal is to get the patient onboard and airborne before dark. I can go to the lighted international airport outside of Belize City after dark, but I would prefer to go to the smaller, unlit airstrip located inside Belize City. This would make the trip from the airport to the hospital for the young boy and his mother five minutes instead of 25. I start my landing sequence with all of this in my mind. Before the flare, I tell the flight medic that if we can get airborne in 10 minutes, we can make the unlit airstrip inside Belize City before dark. Luckily, the ambulance with the baby is at the Dangriga airstrip and, as the flight medic assesses the baby, I start to help the mother onboard. She is maybe 17 years old with damp clothes and a dazed look. I can only imagine that the fresh memory of being thrown from a boat into the Caribbean Sea is overtaking her thought process. She mentions to me that this is the first time that she has ever been in an airplane. Usually, I take a few minutes to ensure first-time flyers that there is nothing to worry about – but I don’t have time for that this evening. I quickly usher her to the copilot’s seat and strap her in. Looking over, I see that the baby is secure in his plastic carrier and the medic is taking her seat as well. We’re set to take off. As I am performing my pre-start checklist, the medic tells me that the baby is responding to our care. The mother looks up at me and asks: “He’s getting better?” For the first time in my life, I freeze before starting up the engine. I have had many flights like this before, where every minute means the difference between life and death. I am very accustomed to performing my checklist safely and quickly, but never in my life have I heard a question asked with so much care and hope. I have done hundreds of flights with patients who are minutes from death

the course of the show. “Life’s full of opportunities; you just have to be willing to go for it,” concluded Domain.

Domain and Herz battle the elements

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AirMed & Rescue Apr / May 2017  
AirMed & Rescue Apr / May 2017