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AIRMED & RESCUE MAGAZINE

magazine ISSUE 84 | JUNE / JULY 2017

POLICE AVIATION SPECIAL EDITION Provider profile King’s County Sheriff’s Office Air Support Unit

Winterblade 2017 Functional operational hoist/extrication capability exercise

Blue light drones UAVs in the emergency services

Interview: Flight paramedic TFC Jenna Turner Maryland State Police Aviation Command

ISSUE 84 JUNE / JULY 2017


SKYe SH09 SKYe SH09

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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HEMS relaunched in Provider profile Belarus King’s County Sheriff’s Office Air Rebirth after post-Soviet decline

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Functional operational hoist/extrication capability exercise

Blue light drones

UAVs in the emergency services

Interview: Flight paramedic TFC Jenna Turner Maryland State Police Aviation Command

Cover image: Tochigi Police MBB-Kawasaki BK-117C-1, courtesy Ryo Matsuki


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NEWS

Editor’s comment Welcome to Issue 84 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. This issue features a column by Stacy Fiscus, Vision Zero chair for the Association of Air Medical Services. She alludes to having been introduced to a new line of thinking about risk – as this refers to a comment I made, I thought I should explain myself. I’ll leave Stacy to explore the ins and outs of safe decision making (see p.18), but here’s what I was musing on how you define ‘acceptable’ risk for air ambulance flights. From my email to Stacy: “The risk of flying has to be lower than the risk of not flying. ‘Risk’ being an overall assessment taking into account the dangers of flying and the likely health outcome for the patient.” Let’s unpack that. First, it’s a given that all air medical transport missions involve risk. It’s unavoidable, since any transport carries risk (even ground ambulances crash, never mind aircraft), likewise medical interventions (think complications, side-effects, lack of information for proper diagnosis – heck, you could even choke on placebo pills). So why fly at all? From a philosophical, academic perspective if you like, what’s balancing this risk? In the past, when thinking about this issue, I’ve framed it in my mind as ‘risk’ vs ‘benefit’. Potential risk of something going wrong balanced against potential benefit to the patient. However, arguably that’s comparing apples with oranges. How about instead framing it as ‘risks of intervening’ vs ‘risks of not intervening’? The primary risk of not intervening is the likely adverse medical outcome if the patient is not flown and is instead transported by ground, say, or not treated at all. The risks of intervening are mainly ‘vehicular’ (e.g. risk of crashing); note that these are effectively multiplied/weighted by the number of people involved (typically three crew plus one patient). The point of this is that we now have risk on both sides of the equation, an apples-to-apples comparison. Looked at this way, the goal of air rescue is no longer about braving the odds to try to help patients, but instead acting to lower overall risk. Fly not despite it being unsafe, but because looked at in the round, it’s safer to do so. Of course, as with many a philosophical pondering, it’s unclear how this translates directly into real-life practice. But looking at things in this way might at least counter the seductive pull of the concept of ‘heroism’ and the negative impact on safety that can entail. As Stacy says, the ultimate goal for air medical crew should not be to die on duty. I say that the ultimate goal should be to maximise the number of patients treated by having a long career, reaching up to retirement. It’s a delicate topic. It’s right to honour accident victims for their service. But to find balance, you also have to honour those who turn down flights when the numbers look bad, considering their duty to do no harm and to live to fly another day. We hope you enjoy this issue of AirMed & Rescue Magazine. James Paul Wallis Editor editor@airmedandrescue.com

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AIRMED & RESCUE

American Securities completes Air Methods acquisition

KING AIR DEPENDABILITY WHEN THE MISSION IS CRITICAL

Private equity firm American Securities LLC announced the closing of its acquisition of air medical transportation and air tourism provider Air Methods Corporation on 21 April. Air Methods CEO Aaron Todd said: “As a private company, Air Methods will have greater flexibility to execute our strategy and pursue long-term growth. We look forward to partnering with American Securities to strengthen our market position in air medical transportation and air tourism.” Marc Saiontz, a managing director of American Securities, said: “We have strong admiration for the men and women at Air Methods and their commitment to providing critical access to care for patients and communities served. The Air Methods team has a paramount focus on clinical care and aviation safety, and on providing hospitals and local communities with the highest quality air ambulance services available. We are excited to assist the company in this critical mission.” Air Methods is now a wholly-owned subsidiary of ASP AMC Intermediate Holdings, Inc., an indirect wholly-owned subsidiary of affiliated funds managed by American Securities. Air Methods’ common stock will no longer trade on the NASDAQ Stock Market.

Three lost in Rico Aviation crash A Rico Aviation PC-12 plane crashed near Amarillo, Texas, US shortly after midnight on 29 April. The three crew members, none of whom survived the crash, were named by the air ambulance provider as pilot Robin Shaw and flight nurses Misty Nicholson and Scott Riola. According to local media, the plane, tail number N933DC, went down on land close to railway tracks near Highway 287. The Federal Aviation Administration (FAA) said the incident occurred shortly after the fixed-wing, single-engine aircraft took off from Amarillo International Airport. It had been heading to Clovis, New Mexico, according to reports. Rico Aviation issued a statement on Facebook: “Rico Aviation regrets to confirm the loss of three crew members last night. We are devastated by this tragedy and are mourning the loss of our team members. The families have been notified and they are in our hearts and prayers. We appreciate prayers for our fallen teammates and their families.” In a later post, the firm said: “The Rico family will always remember the impact made by these three wonderful people lost this past week. Pilot Robin Shaw, flight nurse Misty Nicholson, and flight nurse Scott Riola left an indelible mark in our hearts and will be truly missed.” Both the National Transportation Safety Board and the FAA are investigating the incident. The weather in the area at the time of the crash has been described as ‘severe’, however it is not yet known if this was a causal factor.

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NEWS

NEWS

Australian Navy awards SAR contract to CHC Helicopter

CAL FIRE receives sixth maintenance award in six years

On 7 May, CHC Group announced it had begun operating a 15-month contract to provide aviation emergency response services out of the Australian Navy base at Nowra on the south coast of New South Wales. The company will provide search and rescue (SAR), aeromedical evacuation AME and crash response services at HMAS Albatross until the proposed start of a contract covering all branches of the Australian Defence Force in 2018. An autohover-capable AW139 has been delivered from CHC’s global pool of SAR assets and is compliant and certified to the latest standards for crash resistance, said the company. The machine has previously been used to successfully operate similar SAR

The California Department of Forestry and Fire Protection (CAL FIRE) has reported that for the sixth year in a row, the US Federal Aviation Administration (FAA) presented CAL FIRE and DynCorp International with the Diamond Award of Excellence for Aviation Maintenance. The award recognises CAL FIRE’s aviation maintenance technicians after passing the difficult aircraft safety training programme, said the service. More than 75 technicians were recognised and each awarded with the William (Bill) O’Brian Award for Excellence. Chief Ken Pimlott, CAL FIRE director, said: “CAL FIRE’s aerial firefighting fleet is an essential element in combating California’s devastating wildfires. We are proud of the hard work and commitment that our aviation management staff and DynCorp International mechanics do every

crash response services to all three of the Australian Defence Force services in Australia, covering the Royal Australian Air Force, the Army and Navy bases.

CHC

services in the UK. The helicopter at the Nowra base will provide search and rescue coverage for all naval helicopter operations in support of aircrew training and Royal Australian Navy Fleet exercises in the local sea training areas. “CHC is very proud to be awarded this interim contract with the Australian Navy and to be able to stand service up quickly for them,” said Vince D’Rozario, regional director, CHC Asia Pacific. “I would like to thank [the] Navy for the opportunity to serve them and recognise our experienced team at CHC who put this service together with speed and professionalism.” With the new contract in place, CHC said it now provides SAR, AME and

Gulf of Mexico air rescue contract for Bristow

BRISTOW GROUP

Bristow US has been awarded a contract with energy company Hess Corporation for medevac and search and rescue (SAR) services in the Gulf of Mexico, the air rescue provider announced on 3 May. The deal is Bristow’s second contract to provide full SAR services in the Gulf of Mexico, said the firm.

Library image

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“We are honoured to provide this critical lifesaving service on behalf of Hess,” said Bristow Americas regional director Samantha Willenbacher. “We are drawing on our years of experience of operating SAR around the world, including for all of the UK on behalf of the HM Coastguard, and partnering with Acadian Air Med

to deliver the highest standard of rescue service and medical care in the Gulf of Mexico.” As part of the contract, Hess joins Shell Offshore as the second member of the new SAR consortium formed by Bristow, which guarantees SAR and medevac response to members 24 hours a day, seven days a week, covering their entire Gulf of Mexico operations, said Bristow. The company will operate the new service from its standalone SAR facility at the South Lafourche Airport in Galliano, dedicating a Sikorsky S-92 and a Leonardo AW139 aircraft for the contract. “We are using sophisticated helicopters to deploy multiple types of airborne rescues for the new service, with crews that are highly skilled and trained and ready to respond to any type of medical emergency,” said Willenbacher. “With our rescue fleet, all parts of the Gulf of Mexico are within reach of this lifesaving service.” The S-92 will carry two pilots, a rescue hoist operator, a certified rescue swimmer, and a critical care transportflight paramedic.

day in maintaining the largest wildland aerial firefighting fleet in the world with an award-winning safety and maintenance programme.” CAL FIRE said it maintains 22 airtankers, 15 tactical aircraft, 12 helicopters, and other fixed-wing training and administrative aircraft. All the aircraft are maintained at the department’s maintenance base at McClellan Air Park in Sacramento County, said the service, which added that since the beginning of its air programme in the 1970s, safety and superior maintenance has been a top priority. Along with CAL FIRE ’s seasonal aviation experts, DynCorp International mechanics ensure that the state’s firefighting air fleet is kept in pristine condition, said the Department. Jeffrey Cavarra of DynCorp International commented: “This award is a testimony

to the exceptional maintenance performed on all CAL FIRE aircraft by DynCorp International team members. The strength of commitment by both DynCorp International and CAL FIRE working together in a public/private partnership is a clear reflection of this prestigious award.” According to CAL FIRE, record breaking rainfall totals throughout California this year mean that the threat of wildfires during the warmer months will continue to increase as the abundant annual grass crop dries out, as more rain has produced more grass and underbrush, increasing the fuel for wildfires to burn. CAL FIRE said that over the next couple of months, it will finish the winter maintenance and safety inspections on the firefighting aircraft and staff them at the department’s airbases and helibases across the state to help assist with this year’s wildfires.

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Freedom from worry NEWS

NEWS

AAROI-EMAC and Leonardo sign agreement on HEMS Helicopter manufacturer Leonardo has signed a co-operation agreement with AAROI-EMAC, an Italian association representing over 10,000 critical care anaesthetists, in Vergiate, in Italy. Among the objectives is ‘the implementation of scientific, technical and organisational developments in the delicate and fundamental healthcare sectors in which they operate’, said Leonardo. The firm said the non-profit agreement was signed in order to develop synergies for higher levels of operational capability and safety for helicopter emergency medical personnel. The agreement, renewable for five years, includes the development of a dedicated training centre, incorporating AAROIEMAC’s Centre for Research, Training and Upgrading (SimuLearn). The organisations hope to create a national certificate for helicopter rescue personnel. Synergies agreed between Leonardo and AAROI-EMAC will also provide guidelines analysing and optimising HEMS work, taking into account, for example, the development of satellite-assisted navigation or flight in icing conditions, said the manufacturer. The organisations said they

hope to publish scientifically validated data of EMS-dedicated protocols to improve hospital systems, which are already developing according to the hub-spoke model. After defining a national standard, Leonardo and AAROI-EMAC will present it internationally, focussing on Europe, building on the extensive experience and the variety of conditions and requirements characterising helicopter operations in Italy, contributing to the potential development of a European standard, and becoming a model for countries interested in developing their own helicopter rescue service, they said. The collaboration agreement follows an agreement between Leonardo and the National Alpine and Speleological Rescue Corps (CNSAS) announced in December 2016. Prof. Franco Marinangeli, scientific director of the SimuLearn Center, said: “AAROIEMAC has been performing training and professional development activities for many years [including] with simulation tools, allowing hundreds of doctors to attend classes with advanced teaching methods and up-to-date topics. The collaboration with

Leonardo improves our training initiatives and allows the Center’s instructors to collaborate in a sector of primary relevance.” Dr Alessandro Vergallo, national president of AAROI-EMAC, commented: “HEMS doctors are almost entirely anaesthetists and first responders. Such are the skills and competencies needed to work in this field that specific university and hospital training is a must-have. The everyday experience on the most critical patients is invaluable and shouldn’t be replaced by generalist and economical solutions. This agreement is therefore an important opportunity to keep our country’s helicopter-based critical care system adapted to the real and concrete needs of the population, both today and in the future.” Daniele Romiti, managing director of Leonardo Helicopter, said: “We are convinced that synergies like the one born today through this agreement will provide a vital contribution because industry and organisations alike need to work together, joining their professionalism and skills. We are ready to work together soon towards the achievement of the first important results from this co-operation.”

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North Dakota passes law on air ambulance bills through no fault of their own, are facing insurmountable balance bills from an air ambulance company. These consumers did not have the option or ability to choose their provider, and now because of the choices made by someone else, are left facing bankruptcy.”

ROBBIE LAUF / NORTH DAKOTA INSURANCE DEPARTMENT

Lawmakers in North Dakota have passed a bill regulating how insurance companies pay for air ambulance services in the US state. Insurance Commissioner Jon Godfread praised the signing of Senate Bill 2231, which also requires hospitals to notify patients in non-emergency situations which air ambulance providers have a contractual agreement with the patient’s health insurance company. The North Dakota Insurance Department issued a statement noting that air ambulances have become a more frequently used mode of transport for individuals needing medical care. Often, these patients are then faced with ‘unexpected and outrageous’ bills for the full cost of the flight or the balance left after a partial payment is made by the patient’s insurer, said the Department, a practice known as ‘balance billing’. Insurance does not cover the cost of an air ambulance when the ambulance provider does not have a contract with the patient’s health plan, even if the patient is one of the 88 per cent of North Dakotans who have health insurance, the Department said. Godfread commented: “It’s important to know that these lifesaving flights often come with life-altering bills, and what is most frustrating to the Insurance Department is that many of the complaints we receive are from people who have insurance, have been responsible, and

Governor Doug Burgum signing Senate Bill 2231

The Department said that between 2013 and January 2017, it received 28 complaints totalling $1.66 million in charges for air ambulance services, as well as one case in which the total cost of services rendered was unknown. Based on these complaints, each air ambulance ride cost the consumer an average of $59,287, said the Department, adding that consumers in North Dakota have reported being billed amounts ranging from just $75 up to $66,597. These numbers

don’t include the ‘hundreds’ of complaints that have been made directly to insurers regarding air ambulance services, said the Department. Senator Judy Lee, the bill’s primary sponsor, explained: “It is important to protect citizens in critical medical situations from unexpected high costs beyond what insurance covers. It also is important to keep this issue visible to the federal government.” As air ambulance services are also used for inter-hospital transfers when a patient requires treatment at a different facility, Godfread said he felt it was common sense to add to the bill a requirement for hospitals to notify patients in non-emergency situations which air ambulances have contractual agreements with the patient’s insurance company: “I feel this legislation strikes a balance between ensuring we have these services in our state, while at the same time protecting our consumers from bankruptcy. Consumers in North Dakota should not have to choose between saving a loved one’s life and facing financial ruin, especially when they have health insurance. I am proud of the work we have done to find a solution by working within our insurance regulations to protect the consumers of North Dakota. I also want to commend the Governor and the legislature for addressing this critical problem that is not only affecting North Dakota, but has become an epidemic across the entire nation.”

The Delaware State Police, the National Transportation Safety Board, and the Federal Aviation Administration, are investigating a helicopter crash that claimed the life of a PennSTAR pilot on 25 May in New Castle, US. Initial investigations have determined that the crash occurred at approximately 11:55 hrs as an Airbus EC-135P2 helicopter, which was being operated by Michael R. Murphy, crashed into a drainage ditch located in the rear of the US Post Office facility, said the Police: “Upon impact, the helicopter, which is owned by PennSTAR, the air transportation service for the University of Pennsylvania Health System, 10 10

AIRMED & RESCUE

DELAWARE STATE POLICE

PennSTAR/Metro Aviation pilot dies in crash then became engulfed in flames. Responding fire services personnel from the Goodwill Volunteer Fire Company and neighbouring volunteer fire companies arrived at the scene and were able to extinguish the flames. Michael Murphy, who was employed by

Metro Aviation, was the sole occupant of the helicopter. He was declared dead at the scene.” No other persons were injured in the accident. Damage was reported to a shed and parked vehicles due to flying debris and flames. Susan Phillips, a representative for Penn Medicine, told reporters: “The pilot of the helicopter was conducting a training flight. No patients or Penn Medicine employees were onboard.” Murphy had flown from the Atlantic City Airport and was conducting ‘approach training’ in the area of the New Castle County Airport, said the Police.

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EQUIPMENT

EQUIPMENT

AAMS study identifies funding shortfalls

HEMS craft head to China

The US-based Association of Air Medical Services (AAMS) has announced the publication of the Air Medical Services Cost Study Report, which was conducted by the research firm Xcenda LLC on behalf of AAMS. The study findings include that the median reported cost of an emergency air medical transport is $10,199. Medicare payment rates cover only 59 per cent of actual costs on average, and over one third of respondents reported negative margins for emergency air medical services. The percentage of the US population covered by air medical services, within a 15-to-20minute response area, has grown from 71.2 per cent in 2003 to 86.4 per cent in 2016. Rick Sherlock, AAMS president and CEO, said that a study of this kind was long overdue: “It has been AAMS’s position for some time that Medicare payments do not adequately match costs. The results of the cost study have validated our stance. The data provides a baseline for transport providers industry-wide regardless of business model.” The Association added: “AAMS commissioned the study in response to an evident need for reputable, independent

Textron has reported on one delivery and one sale of Bell 429 helicopters for use in air ambulance missions in China. On 11 April, Bell Helicopter, a Textron company, and United Rotorcraft, a division of Air Methods, announced the delivery of a Bell 429 to Reignwood Investment. The

payer mix observed in the study sample. The median reported commercial revenue per transport fell short of this amount at $23,518, indicating that in many cases, total operating costs are not covered by payers in the aggregate. Evidence of this issue was observed in the study sample, as over one third of providers reported negative margins in fiscal year 2015 for emergent air medical services.” Xcenda contacted air medical providers billing Medicare in 2014, the most current billing information publicly available at the time of this study, said AAMS, including fixed-wing, rotor-wing, forprofit, non-profit, independent and hospital-based providers. Cost data were aggregated and analysed at a per-transport and per-base level, and the differences between programme types, tax status, size, and geographic location were also examined, said the Association. The study’s respondents represent 51 per cent of all air medical bases in the US and captured 46 per cent of air medical services billed to Medicare, AAMS explained. Read the full report via www.airmedandrescue.com/story/1999.

aircraft will serve as the first Bell helicopter for HEMS missions in China, said Textron. United Rotorcraft installed a medical interior that includes a machined aluminium floor, additional medical crew seating configurations, and product improvements for patient care and access.

TEXTRON

research, specific to air medical transport, to quantify the costs associated with providing emergent air medical transports. Further, the study examines the appropriateness of the 2002 Medicare rate-setting methodology for air medical services and current payment adequacy. The resulting report provides independent substantiation of actual costs to the Centers for Medicare and Medicaid Services (CMS) and Members of Congress.” According to the study, the shortfall in payments from some missions have a knock-on effect for private payers: “Inadequate payment from public payers and the uncompensated care costs providers incur while treating uninsured patients have a trickle-down economic effect and play an important role in rates for air medical services for private payers and patients. While Medicare may be covering between 59 per cent and 73 per cent of costs, per-transport cost deficits for Medicaid and uninsured patients are even greater. These deficits in aggregate would require private payers to cover at least $15,984, in addition to the cost of the transport, to allow providers to break even, taking into consideration the patient/

Bell Helicopter signed a purchase agreement with Beijing Yugao Aviation Group

World Food Program teams with WeRobotics

WEROBOTICS/WFP

The World Food Program (WFP) is officially partnering with WeRobotics to develop co-ordination mechanisms to guide the safe and effective use of unmanned air vehicles (UAVs) in response to humanitarian disasters. WFP was also one of the first humanitarian

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AIRMED & RESCUE

organisations to explore the use of UAVs back in 2007, stated WeRobotics. The need for co-ordination mechanisms is absolutely imperative given the increasing use of UAVs following major disasters, said the firm, adding that the lack of formal co-ordination mechanisms is already presenting ‘serious problems’ during relief efforts. A statement from WeRobotics explained: “This year-long partnership with WFP will comprise four experts meetings coupled with disaster simulations in Peru, the Dominican Republic, Indonesia and Myanmar. Each

meeting will convene key stakeholders from the host country including participants from government, civil society and the private sector. The purpose of these meetings is to develop practical co-ordination mechanisms by taking a bottom-up approach and then testing these mechanisms by applying them in disaster response simulations.” There are six ‘pillars’ to the global effort to build more effective humanitarian co-ordination systems that will form the basis of the discussions at the experts meetings, said WeRobotics: partnership frameworks; tools and solutions; technical and data standards; policy and regulation; community engagement; and advocacy and communications. The firm hopes that by the process will result in ‘jointly developed formal and practical UAV co-ordination mechanisms to enable the safe and effective use of UAVs in disaster response’.

In addition, the aircraft is equipped with a rescue hoist and other programme-specific support equipment, said Textron. “This delivery and Civil Aviation Authority of China (CAAC) validation for the medical interior represents a two-year effort to bring our product into China and we are delighted to be working with Bell Helicopter and entering this new market segment,” stated Frank Graham, senior director of global sales and marketing for United Rotorcraft. “We are confident this will be the first of many opportunities in China available to us because of our product’s CAAC validation.” On 12 April, Textron announced Bell Helicopter’s signing of a purchase agreement with Beijing Yugao Aviation Group for a Bell 429 during the Asian Business Aviation Conference & Exhibition. This is the customer’s first aircraft, said Textron, and will be used for HEMS and search and rescue transport.

AeroMD adds medevac plane to Caribbean fleet AeroMD has put a Cessna Citation Bravo jet into service as its primary and dedicated medevac aircraft. The US Virgin Islands-based air ambulance provider said the upgraded plane has been added to its fleet in conjunction with aviation partner Bohlke International Airways. AeroMD highlighted the new plane’s speed and range, which will mean patients more quickly reach specialty centres at greater distances without making a refuelling stop. Dr Brendan Anzalone, AeroMD president and chief medical officer, said: “We are pleased to introduce the Citation Bravo into our fleet. We strive to continually improve the air ambulance service we offer. This aircraft has state-of-the art medical equipment built in that is essential for successful medevac missions. In sum, this new plane goes faster and further.”

The company said the jet offers a range of up to 1,587 nautical miles; has a top cruising speed of 460 mph and a maximum operating altitude of 45,000 ft. It requires a runway of 5,000 ft for take-off or landing, which makes it ideal for the limited runways at airports in the Caribbean, said the firm. Configured as a medevac aircraft, the interior can accommodate one patient, their travel companion and the AeroMD medical team. Sam Black, director of operations and pilot for Bohlke International Airways, aviation partner of AeroMD, commented: “This Citation Bravo Jet is equipped with GNS 650 and 750 GPS navigation, with Iridium international weather and satellite telephone communication. This modern avionics package helps our pilots avoid inclement weather. It also gives the

AeroMD team the ability to consult with more medical experts and ground resources in real-time.” AeroMD said that two years into offering air ambulance services to the Caribbean, it has completed more than 400 successful medevac missions airlifting patients from the area. The firm says it is the only air ambulance service in the region accepting Medicare patients. William R. Bohlke, president and chief pilot at Bohlke International Airways, said: “This streamlined aircraft is an upgrade for AeroMD. It is already equipped with an ADS-B transponder, years ahead of the [US Federal Aviation Administration] requirement. We are proud to play a role in providing this much-needed emergency medical service for the US Virgin Islands and the Caribbean region.”

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EQUIPMENT

EQUIPMENT

USAF C-130 aeromedical trainer ready

New Zealand police test heli-borne mobile phone network person. There have been a number of cases in the past where technology could have saved us time, money and potentially lives. We are looking forward to this going further.” The idea for Search and Rescue Network came after American tourists Rachel and Carolyn Lloyd were rescued in the Tararua Ranges in May 2016, said Vodafone. The mother and daughter had been missing for several days before a rescue helicopter spotted their ‘HELP’ sign laid out in rocks on the ground. Vodafone technology director Tony Baird said: “After watching the Lloyd’s story, we figured there must be a way Vodafone innovation could help SAR teams locate missing people faster. With this innovation, it’s like we’re creating a searchlight across the bush using a mobile signal. We’re really keen to keep working with SAR to get this technology to a stage where it could be used

in real-life search and rescue operations.” In its current form, the system detects a cell phone ‘ping’ – a signal mobile phones emit when they are attempting to connect with a nearby cell site, explained the company. Once the ping is detected by equipment inside the helicopter, it shows up on an onboard computer screen, giving SAR teams a narrowed search area in which to locate a missing person. When they hear the helicopter overhead, the missing person on the ground can check for signal bars on their cell phone and make an emergency call, which would be answered by the rescue crew inside the helicopter. Further tests are required before the Search and Rescue Network will be ready to be deployed in live operations, said Vodafone. For a video on the system, go to www.airmedandrescue.com/story/2082.

CAE

Telecomms giant Vodafone has reported that it has successfully tested a system that generates a portable mobile phone network to help rescue helicopters communicate with personnel on the ground. Vodafone said it recently tested the prototype with New Zealand’s Police Search and Rescue in the Hunua Ranges, an area of bushland near South Auckland. The ‘Search and Rescue Network’ creates an area of mobile phone coverage beneath a helicopter as it flies overhead, giving rescuers the ability to communicate with cell phones below, said Vodafone. The firm said it will continue to work with the police to further develop the system, adding functionality such as GPS and call bridging. Auckland SAR co-ordinator for Police Sgt Dene Duthie said: “It is very exciting to have a two-way communications system in a zero-coverage area that actually lets us communicate directly with a missing

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patient simulators and a portable instructor operator station to provide control and

customisation of a variety of aeromedical training scenarios.

CAE

The C-130 Aeromedical Evacuation Training System for the United States Air Force (USAF) at Dobbins Air Reserve Base is now fully operational and ready for training, said maker CAE. The firm said that it believes the addition of a motion platform for an aeromedical fuselage trainer is the first in the world and will provide USAF aeromedical evacuation crews with a more realistic virtual training environment. The system is intended to train USAF aeromedical crews for pre-flight, emergency procedures and in-flight patient care. The addition of a motion platform increases the realism and enables the aeromedical crews to rehearse in a safe, immersive training environment, which will ultimately improve patient safety and survivability during rescue missions, said CAE. An electric motion system supports a fully-equipped C-130 fuselage trainer and replicates vibrations and turbulence encountered during take-off, landing, and in-flight. The trainer also boasts human

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MISSIONS

INDUSTRY VOICE

TAA flight doctor: a day in the life Professor Dr Andreas Fette is one of the most experienced flight doctors at Austria’s Tyrol Air Ambulance (TAA), with over 20 years’ experience on air ambulance missions. He recently shared a typical day in the life of a flight doctor on the TAA blog.

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Standby I am on standby to fly air ambulance missions with TAA over the coming days. It’s something I always look forward to, and I make sure that my belongings are packed in advance in case I get called. As so often happens, it doesn’t take long before my phone rings. The display shows the familiar number of TAA’s Operations Control Centre (OCC). “Hi Andreas, it’s Leonie, I have a flight schedule for you.”

Outbound flight Before we depart from home base at Innsbruck Airport, I meet my colleague Patricia, who will be the intensive care nurse onboard this mission. We perform routine pre-flight checks on our medical equipment, also discussing the extra mission-specific equipment we will need. Once this is completed, we get to work loading our equipment and setting up the aircraft for departure. We meet our pilots Artur and Christian at the hangar and have our joint briefing. “The weather is going to be bad,” reports Artur, “so we will need to be sure that the patients are stable and secure.” Destination: Highlands Our G100 takes off on time with the heading set for Scotland. As the clouds lift, the airport comes into view and our pilots land on schedule. Our taxi is already waiting to take me and Patricia to the small regional hospital. During the trip, I remark to Patricia that ‘the roads are in a bad, bumpy condition, and the transport time to the airport will be around one hour, which could be a serious issue for our patients’. At the hospital, we are brought straight to the intensive care unit, where the Danish couple is eagerly awaiting our arrival. We take the patients into our care and transfer the wife onto our stretcher using a vacuum mattress. Her husband is transported from the hospital by wheelchair. I discuss with both patients the need to administer a sedative for the transport, due to the condition of the roads and the weather, to ensure that they are not subjected to any further stress after what they have already been through. Both patients accept my suggestion and Patricia activates the syringe pump. We then proceed by ground ambulance to our awaiting air ambulance jet. Our patients take the road journey well, and their vitals are normal. Our 16 16

AIRMED & RESCUE

TAA

Mission briefing During our call, Leonie emails me the preliminary information about the air ambulance mission. It’s a double transport of two trauma patients. The repatriation will be from Scotland to Denmark. “OK, see you tomorrow, I’ll pass you to Eva for the patient assessment…” I then speak about the case to Eva, one of TAA’s team of experienced assessment doctors: “Our patients are a Danish couple who have both suffered severe injuries. They were driving on holiday in their rental car in Scotland when they suddenly found themselves on the wrong side of the road on a corner and they collided frontally with a coach coming in the opposite direction. The wife suffered a polytrauma, the husband sustained complicated eye and hand injures, as well as severe bruising. After primary care has been delivered, both patients should be transported back home as soon as possible…”

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One of TAA’s three G100 Aircraft

pilots have already prepared the patient loading system at the aircraft door so that boarding our ‘flying intensive care unit’ can proceed immediately. The positioning of both patients, as well as our monitoring equipment and the syringe pump, are double checked, and once the all-clear is given, Artur shuts the cabin door, and gives us an update on the situation in Denmark: “Patricia, Andreas, the weather at the airport is really very bad, you should be aware that it might be a bumpy landing. I will contact our OCC by phone as well as the tower, so that everything is well prepared for us on arrival.” Flying home: an emotional welcome Soon after, we take off and leave Scotland behind. As an ‘active hospital flight’, we normally get the overtaking lane in the sky and the highest priority for landings. Patricia and I care for both patients during the flight, in particular the husband, who continues to blame himself for the accident. Their vitals remain stable, our equipment is performing excellently and Patricia and I work hand-in-hand as a co-ordinated team to look after the patients. Half an hour before landing, some good news is delivered from the cockpit: “The weather is stable, we can land as planned. Our OCC has made arrangements with the Tower that they can disembark in a hanger, which is definitely better for them than in the driving rain on the runway.” After landing at the small Danish airport, our jet taxies to the nearby hanger where both patients are successfully transferred into the awaiting ground ambulance and into the care of the local emergency doctor. Neither patient complained of any pain during the flight and both coped very well with the transport. The local flight authorities were very understanding and allowed the patients’ extended family into the hanger, which makes for an emotional reunion. Amid these emotional scenes, our pilots are more than happy to show the grandchildren the cockpit of the G100 that had taken granny and grandad home safely. We report back to the OCC ‘mission accomplished’ and say our goodbyes before returning to base. One mission ends, another begins… Back in Innsbruck, I write up the medical report for the case. As soon as I have finished and submitted it, my phone rings again with ‘TAA OCC’ on the display. “Hi Andreas, it’s Leonie again. I have another flight schedule for you. Also, before I forget, our Danish patients contacted us and wanted to pass on their thanks for the fantastic support they received. Both of them are on the road to recovery. Please stay on the line and I’ll transfer you to Eva for the patient assessment…”

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MISSIONS

INDUSTRY VOICE

Royal Malaysian Airforce delivers first humanitarian cargo with A400M

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AIRMED & RESCUE

came to risk. “Our risk of flying the patient has to be lower than the risk of not flying,” with ‘risk’ being an overall assessment, considering the dangers of flying and the likely health outcome for the patient combined. At first glance, I would like to say that not flying is ALWAYS less risky than flying. But, if we never took calculated risk and flew our patients, then we wouldn’t exist as a profession. So, we walk a fine line as professionals making decisions like these. We must always put ourselves and our crew first and ensure that we get home safely at the end of every shift. Policy and procedure help us to draw the line with steadfast limitations on weather, weight, and fuel capabilities. But, if those rules were the golden answer, then I wouldn’t be writing this column and the article mentioned earlier wouldn’t exist. Human factor plays a role in nearly 100 per cent of air medical accidents. It is the nature of the beast; I don’t think we will ever be able to write enough rules to cover every possibility human factor creates. Self-accountability is huge when it comes to walking the line that we do. Be accountable to yourself, your crew, and your family. If you wouldn’t put any of them in the aircraft for the flight you’ve been requested to do, or the one you are on, don’t put yourself in it. I think of all the EMS families missing their loved ones and patients that could have been helped had all the clinicians and pilots killed in air medical accidents been alive to tend and to fly them. The person quoted was right; we all are the type of people that value human life and the preservation of it. We wouldn’t be in the medical field if we didn’t, but next time you find yourself struggling with saying ‘no’ because of this, remember the crews killed shortly after having this same struggle. A struggle that placed their job ahead of their own lives. After their deaths, the crews are lauded as ‘heroes’ and the industry mourns them as such, so why does this keep happening? Is that our aim, to be dead heroes? None of us want that, it is not worth it. Crews that took risks greater than their ability to handle them and that resulted in a senseless waste of lives made decisions that killed them. Make good decisions, be accountable, and draw the line for yourself and your crew.

VIGILI DEL FUOCO

Stacy Fiscus is the Vision Zero chair for the Association of Air Medical Services and is also active as a board member at large for the International Association of Flight and Critical Care Paramedics, the IBSC, and the Air Medical Memorial. She is the lead contributor to the EMS Flight Crew Facebook page, and is a certified medical transport safety professional. Stacy resides in Port-Au-Prince, Haiti, where she is a flight paramedic and clinical base manager for the country’s first helicopter air medical transport service.

Airbus has reported on a mission from 23 March where it worked with the Royal Malaysian Airforce (RMAF) and the Spanish Red Cross to deliver a planeload of humanitarian goods from Seville, Spain, to the International Federation of Red Cross and Red Crescent Societies Asia Pacific Regional Office in Malaysia. The cargo consisted of mosquito nets to be used to prevent malaria outbreaks following future natural disasters in the region, said the aircraft manufacturer. The collaboration has been facilitated by the Airbus Foundation and utilised the delivery flight of the fourth A400M to the RMAF. “For the Royal Malaysian Air Force, humanitarian missions are a key part of our mission, and we have invested considerable training and resources to ensure that we are fully able to assist in the event of a natural disaster anywhere in the region,” said Chief of RMAF General Dato’ Sri Affendi Buang.

Vigili del Fuoco assists cyclist

AUTHOR STACY FISCUS

SCOTT GORDON

Recently, after reading an article about an air medical accident, I was rendered speechless. The part of the article I am referencing was an interview with a friend of a nurse who had been killed, and went like this: “When weather’s not good, one person can refuse and you can basically call the flight off if any of your staff feel that it’s unsafe. “Being a nurse in that position, I would have never done that because that’s what you’re there to do, you’re there to go and get these babies and these kids and you’re to bring them to help. That’s why they’re calling you; they’re calling you to help them. “And she would have never said no. She knew somebody needed her and that’s just the person she was, she would never put herself above or in front of anybody else. She always put others in front of her. And that’s exactly why she died. She died putting someone else’s life ahead of her own.” Now, I understand that this was a grieving friend and they meant well with this quote, but it got my wheels spinning. After being involved in the safety side of the industry for several years, I always hoped this type of thinking was part of our distant past. The civilian equivalent of mission completion at any cost. By the time we get to our medical flight careers, we are seasoned clinicians and pilots, yes? Should we, at this point, let the condition or age of a patient influence our fly-or-not decision-making when it comes to the well-being of ourselves and our crew? We put as many safe-guards into place as we can, policies that dictate what a pilot and crew are told prior to launch. Larger companies create major distance between a communications centre and the crew. However, in smaller ones, communications or dispatch may be within hearing distance of the crew or just a short walk away. In many programmes, flight protocols require a launch when the scene or patient is 15 to 30 miles from the base and medically the launch is into the blind; eventually dispatch comes through and gives us the information we will need as the responding crew. What happens after this point is where the real crew resource management begins and brains must be used over emotion. Risk assessments are filed for each flight, but no number value can be placed on the human factor involved in these types of decisions and, in reality, should it take a number to tell a crew not to fly? At any given time, there are generally three people onboard an air medical aircraft flying a patient flight. It has been said that it takes a great deal of bravery to stand up to our enemies, but just as much or more to stand up to our friends. Nearly every day, flight crews are put in this position. We live and work with our team mates and can say nearly anything to them. However, time and time again stories are told of crews being quiet to each other when in hindsight they all agree they should have spoken their mind or voiced their decision to abort the flight. But no one wanted to be first and suffer a perceived recrimination for calling it off. I go back to the story at the beginning of this article. Though an official cause of this accident has not been released yet, ‘severe weather’ was reported in the area where they went down shortly after take-off. I wonder what the story is. It may not be pertinent to this subject. We don’t know what information the crew had or what the story was behind the scenes. But, what if they did feel such a duty to act that they decided it was worth the risk? When I was asked to author this column, I was asked to define what’s acceptable. I was introduced to a new line of thinking when it

AIRBUS

When do we start drawing the line?

At 11:50 hrs on 24 April, helicopter Drago 70 of the Italian fire service Vigili del Fuoco was dispatched to assist a 45-year-old man in the Scoglina Pass in the Chiavarese area. The rescue request came from a cyclist who had suffered an accident on a rural road. After arriving at the scene, the helicopter hoist was used to lower a medic and VVF heli-rescuers to stabilise the cyclist, who was from Bogliasco. He was loaded into a ground ambulance while Drago 70 landed at a sports field in Favale sul Malvaro, and was later handed over to carers at San Martino hospital at 13:00 hrs.

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MISSIONS

MISSIONS

Ascension Island medevac for shark attack victim

Poland, was tasked to attend an unconscious patient located in a village near Lake Solina in the Bieszczady Mountains region. After reaching the site, it became apparent

that there was no safe landing site due to the buildings and terrain at the location, said LPR. Groundbased medical responders had not yet reached the patient, and due to his condition the team elected to lower the medical crew (a doctor and paramedic) directly to the incident site using rope techniques. The patient required urgent intervention and immediate transport to hospital, said the provider. LPR said this was the first mission where its rescuers had reached a patient by rope in which not only a paramedic, but also a physician, were despatched.

GNAAS

Former patient visits GNAAS

Great North Air Ambulance Service (GNAAS) has shared the story of its rescue of a man who got stuck in factory machinery, as part of the HEMS charity’s celebrations of its 15th anniversary. A man who was crushed by a baling machine has been called ‘very lucky’ by the air ambulance paramedic who went to his aid. Peter Deadman’s close call came on 5 April after he was crushed inside a paper baler at Cumbria Waste Management in Workington, UK, while trying to fix the machine. GNAAS flew to the scene with a doctor and paramedic Terry Sharpe onboard one of its Dauphin helicopters. Sharpe said: “When we arrived, all I could see was an arm and a leg sticking out of the machine. I 20 20

AIRMED & RESCUE

expected the worst.” The patient’s wife, Christine, learnt what had happened when their son James, who also worked at the plant, called to tell her the dreadful news. She recalled: “I went down to the plant. When I saw him, paramedics were wheeling him on a stretcher with a foil blanket wrapped around him, which was black on the outside. My initial thought was that it was a body bag. I thought it was over.” She added: “I was given a police escort to the hospital.” Mr Deadman had suffered an open fracture of his arm, a crushed bicep and vein, kidney trauma and a misplaced pelvis. He said: “My arm was numb. I couldn’t feel anything. As I was being released, I thought one of the paramedics said

‘don’t forget his arm’ so I thought it had come off.” He was flown to Newcastle’s Royal Victoria Infirmary and spent nearly four hours in the operating theatre, where surgeons carried out procedures including a vein graft. He now has two metal plates in his arm with eight screws and pins in his pelvis. GNAAS paramedic Sharpe explained: “When you are crushed, circulation stops and your tissue swells. The dangerous part is when you are released from the crush, because the tissue has been deprived of oxygen and toxins flow back into the body, which can cause multiple organ failure. It is very painful.” He continued: “We gave Peter strong painkillers and fluids to dilute the toxins. We bound his pelvis in a sling and splinted his arm before getting him to hospital for further treatment. The call-out sticks in my mind because of its unusual nature. He is a very lucky man.” Deadman, who now works as a delivery driver, visited the GNAAS Langwathby airbase with his wife to thank Sharpe. He said: “GNAAS is the best thing ever. A lot of people would be dead without it.” Son James and daughter Caroline Baker ran the Hastings Half Marathon to raise funds for GNAAS, donating around £600.

A British woman swimming off Ascension Island in the South Atlantic was seriously injured when she was attacked by a shark, reports European Air Ambulance (EAA). Her husband fought off the shark, but not before the woman suffered severe bite wounds to her leg, leaving her in a serious condition. She received emergency treatment at the small hospital on the island, but needed specialist medical care. The Ascension Island Government called on EAA to urgently repatriate the woman to London, UK. The fixed-wing air ambulance provider noted that Ascension Island is not easy to reach, due to its location in the South Atlantic, roughly midway between the coasts of Africa and South America. However, this mission constituted EAA’s third visit to the island. After the call came into the EAA headquarters at Luxembourg Airport, the mission control team started planning the operation, which would involve flying more

than 7,000 km (4,350 miles) there and back onboard an LJ45XR plane. The route was planned, overflight permits arranged, and landing permits obtained for the two refuelling stops required each way – at Agadir, Morocco and Liberian capital Monrovia on the way out, and at Guinean capital Conakry and Agadir on the return flight to London, UK. After the long outward journey, the crew, which included an emergency physician and an intensive care nurse, arrived on Ascension Island to collect the patient. On 26 April, following a full handover, she was taken onboard the medically-equipped plane and flown to London, where she was transferred to the care of hospital specialists. EAA director of sales and marketing Patrick Schomaker said: “These were highly unusual circumstances, involving a patient with rarely-seen injuries (there were only 81 shark attacks reported worldwide last year), and distances that made the mission

all the more complicated. However, thanks to our state-of-the-art air ambulances and highly experienced medical and

EAA

For the first time in the history of the Lotnicze Pogotowie Ratunkowe (LPR), Poland’s national air rescue service, a helicopter doctor and paramedic have been lowered to a rescue scene by rope. On 16 May, the service’s base in Sanok, southeast

LPR

LPR

Rope-drop first for HEMS medics

The plane on Ascension Island

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INDUSTRY VOICE

MISSIONS

Mid-Atlantic rescue for US pararescuemen and Portuguese Air Force

Author

106TH RESCUE WING

Dr Bettina Vadera is chief executive and medical director at AMREF Flying Doctors.

The first ‘stick’ of pararescuemen was in the water at 19:50 hrs EDT, and by 22:00 hrs, all seven were onboard and providing aid to the injured crewmen on the Tamar, according to 106th RQW operations officials. Unfortunately, an additional sailor died of his injuries before the guardsmen could reach the ship, they said. With the pararescuemen onboard the Tamar, the aircraft recovered to St John’s, Newfoundland, Canada, to conduct maintenance. As the ship steamed to the Azores, the Portuguese Coast Guard assumed responsibility for the rescue mission, since the US Coast Guard is responsible for co-ordinating rescue operations within 1,300 miles of the US coast. On 26 April, Portuguese Air Force assets

106TH RESCUE WING

106TH RESCUE WING

Seven US pararescuemen from the New York Air National Guard provided medical treatment for two injured crewmen onboard a cargo ship in the mid-Atlantic on 25 April, after a five-hour flight and a night parachute jump into the sea. The sailors were later picked up by the Portuguese Air Force. Three crewmen aboard the Tamar, a 635-ft (194-m) bulk cargo freighter registered in the Marshall Islands, were badly burned and one was killed on 24 April when an explosion occurred in the ship’s forward storeroom early in the morning, according to the First Coast Guard District Rescue Coordination Center in Boston, US. The captain requested medical assistance. The US Air Force said it was contacted by the Coast Guard because of the ‘unique capabilities’ of the Air Force and Air Guard search and rescue wings. The 106th Rescue Wing, which is based at Gabreski Air National Guard Base, New York, was given the mission of flying help to the Tamar, which was originally heading from Baltimore for Gibraltar, but changed course for the Azores following the explosion. The wing launched an HC-130P/N King search and rescue aircraft from the 102nd Rescue Squadron carrying eight aircrew, seven pararescuemen and a combat rescue officer from the 103rd RQS, and two aircraft maintainers, at 13:30 hrs. The aircraft deployed seven pararescuemen and a rigid rescue boat into the Atlantic near the Tamar. The airmen then boarded the boat, headed to the ship, and rendered aid to the injured sailors.

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were dispatched from Air Base 4, Lajes, in the Azores to fly out the Tamar. A 751 Squadron helicopter picked up the patients as the ship was some 450 km from Lajes, along with three of the US pararescuemen. The patients were transported to Terceira Island, where they were handed over to 504 Squadron for onward flight to Lisbon, Portugal, onboard a Falcon 50 plane. Speaking of the mission, Col Nicholas Broccoli, the 106th RQW vice-commander, said: “The 106th RQW is happy to support the Coast Guard in this rescue mission. This is what we train for and our pararescuemen, pilots, crew members and the rest of our team are the best of the best.” See footage from the mission at www.airmedandrescue.com/story/2048.

AMREF Flying Doctors is upgrading its fleet, replacing unpressurised Cessnas with pressurised PC12s, as Bettina Vadera explains Africa is the world’s least developed continent, with 70 to 80 per cent of the population living in rural areas where medical facilities are both inferior and scarce. Emergency medical services are a luxury and depend entirely on the private sector. AMREF Flying Doctors, a leading and accredited air ambulance provider based in Kenya, provides air ambulance services to an area covering five million square kilometres, roughly the size of Western Europe, with over 130 million inhabitants, an average GDP per capita of about $600 and approximately 10 physicians per 100,000 inhabitants. The not-for-profit company has become the trusted name and brand for air ambulance evacuations in and out of Africa. With a fleet of short and long-range aircraft, AMREF Flying Doctors is able to evacuate patients from remote bush airstrips as well as repatriate them by air ambulance to other continents. Beyond that, AMREF Flying Doctors is well known for its professionalism and expertise in successfully extracting patients from conflict zones like Somalia, South Sudan or Congo. Operating in Africa does not have to mean a compromise on medical standards and quality, something AMREF Flying Doctors has clearly demonstrated over the years. However, operating into short bush airstrips with marram or grass surfaces no longer than 700 m is a common

Pilatus PC 12 gives AMREF Flying Doctors new operational capability occurrence and remains a challenge. For many years, AMREF Flying Doctors relied on its unpressurised Cessna Grand Caravans for medical evacuations from the bush, but the lack of pressurisation in the aircraft was always a concern. Particularly on medevac flights, non-pressurisiation is a considerable disadvantage to both patients and medical crew. In spite of supplemental oxygen provided to the patient, it limits the aircraft to fly below 12.000 ft. EURAMI’s Accreditation Standards version 5/7.2.5 dedicate a whole chapter on regulating the use of unpressurised aircraft in circumstances where the airstrips operated into dictate the type of aircraft used. In order to ensure a world-class standard when evacuating patients from remote bush airstrips, AMREF Flying Doctors made the decision last year to upgrade its aircraft fleet and replace its two Cessna Grand Caravans with two Pilatus PC12 aircraft, a type that is not widely operated in Eastern African, although it has been operated by air ambulance operators in other regions for the last 10 years. AMREF’s first PC12 with the registration 5Y-FDP was acquired last year and had its maiden flight in late November 2016. Over the last five months, AMREF Flying Doctors has flown more than 200 hours in its PC12 on 52 medevac flights. The aircraft has quickly become a firm favourite with medical and aviation crews and allows AMREF Flying Doctors to provide a superior service to its patients that was previously not available. The pressurised cabin, which is spacious and quiet, allows the aircraft to fly up to 30.000 ft, avoiding the turbulence that the region is famous for. Combined with the large cargo door that ensures quick and easy loading of patients, the PC12 provides a much improved patient comfort and care. The aircraft is nearly twice as fast as the Caravan, with over double the range, both of which significantly extend the cut-off times when operating into and out of unlit, uncontrolled airstrips. This allows patients to be evacuated before night fall, who otherwise would have had to wait until the next morning. At the same time, the PC12 has the ability to operate in and out of the same short, unprepared airstrips as the Caravan with operating costs that are similar. All in all, it allows AMREF Flying Doctors to provide the benefits of the PC12 at no additional cost to its clients, so it is not surprising we are in the final stages of purchasing our second PC 12, which is due to arrive later this year. A member of the AFD flight nurse staff told me: “In a medevac flight the Pilatus makes me feel like I am already there, I never feel sick and have lots of space to provide care for my patient.” The pilots also approve: “The PC12 is a turbine that flies like a jet.”

www.airmedandrescue.com

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FEATURE

FEATURE

Amsterdam, air traffic control (ATC) is also a factor as Schiphol international airport is very busy and our base is close to the airport. We co-ordinate

after each flight the crew conducts a walk-around and thorough flight check

How can a busy HEMS crew achieve start-up times of just two minutes? Ella Taylor finds out how one Dutch team combines speed with safety

ANWB

Frans Fuhrmann, chief pilot for ANWB Medical Air Assistance Amsterdam, was recently met with some scepticism when he revealed that his organisation’s crews achieve average start-up times of two to three minutes in daylight and eight minutes at night. Other HEMS professionals writing on the EMS Flight Crew Facebook page cited average start-up times of around 10 minutes, and some worried about the safety of getting airborne just two minutes after a call is accepted. But safety, Fuhrmann explains, is at the heart of all of the crews’ procedures. He says: “Speed is not a goal, it’s a result and it can only be achieved by putting safety first.” ANWB is the HEMS operator for the Netherlands. A team of 38 pilots flies 24/7 emergency missions from four stations (Amsterdam, Rotterdam, Groningen and Volkel) with each station covering about a quarter of the northern-European country. Its fleet consists of five Airbus H135 helicopters (two T2s, two T2+s and a P2+) for HEMS and two Airbus H145 helicopters for patient transport. The second H145 is based on Leeuwarden

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air base in the north of the country to provide patient transport from the nearby Dutch islands.

ANWB MAA crews achieve average start-up times of two to three minutes in daylight and eight minutes at night

All in the prep So how do the crews achieve such remarkable speeds? Largely with meticulous preparation and an effective distribution of tasks. “Our crews work in two shifts; they start at 06:30 or 18:30 hrs. The crew – a pilot, a HEMS crew member (HCM) and a doctor – do the flight preparations (weather, NOTAMs, technical status, crew briefing and pre-flight). At 07:00 or 19:00 hrs, the new crew takes over and sets the helicopter ‘hot’, meaning that they do all of the interior checks and pre-starting checklists,” Fuhrmann explains. “After that the helicopter is ready to go by performing the ‘starting engines HEMS’ checklist and pre-take-off checklist. As the H135 is not a very complicated helicopter to start and check, this procedure takes only one minute after getting in.” After the helicopter is set to ‘hot’, the weather for each base’s designated area is monitored constantly. The helicopter is either kept in the hangar or outside on the platform with the crew stationed nearby. The way that the base is set up plays a part in achieving quick response times. “On all of our bases, we have a large screen displaying current weather (TAF and METAR), weather radar, ground visibility, wind and cloud base maps,” Fuhrmann describes. “This really helps in the decision-making process and situational awareness. In the case of

Prepare for lift-off When a call comes in, the crew springs into action with a well-rehearsed routine. Fuhrmann says: “After receiving the call by pager and deciding to go by helicopter, the pilot checks the weather first then goes to the helicopter, gets strapped in and communicates with ATC for start-up clearance. The doctor confirms the call by secure radio communication and then stands in front of the helicopter to assist during the start-up procedure. The HCM enters the destination in the (iPad-based) navigation system and then goes to the already started helicopter.” When the entire crew is onboard, pre-takeoff checks are performed by the pilot and HCM and take-off clearance is obtained, he adds. The checks at this stage are quick, as the H135 has only brief manufacturer checklists. Though Fuhrmann declined to share exactly what’s on ANWB’s checklist, it’s Airbus-approved and streamlined to meet the crews’ needs. “In our operation, VFR single pilot, the tasks are shared between pilot and HCM. They work according to crew concept. The pilot flies the helicopter, communicates with ATC and performs all switch selections (beside radio settings) and the HCM is responsible for navigation and reading the checklist (normal challenge and respond procedure). The doctor assists during start-up and is an extra pair of eyes during flight and landing. He/she communicates with dispatch and also has the same navigation system on an iPad as the HCM to help with situational awareness,” Fuhrmann says. After each flight, he explains, the crew conduct a walk-around and thorough flight check: “This way, we make sure that the helicopter is ready to fly the next mission. The helicopter is always in view of the crew/security camera and is positioned in a secured area, either airside when based on an airport or on a secured and closed off helipad when based on a hospital.” Top gear ANWB’s fleet and equipment help crews in this efficient response. “The H135 helps by being an easy helicopter to fly,” Fuhrmann says. “It starts

Why the rush? ANWB helicopters responded to over 8,000 taskings all over the Netherlands in 2016. Amsterdam’s Lifeliner 1 crew accounted for 2,100 of these missions. A further 1,300 were handled by specialised response cars when the weather was below safe flying limits or the incident was within short range of the station. “So with an average of almost 10 call-outs a day, we are quite busy,” Fuhrmann says. Along with the crew’s ability to get airborne quickly, the small size of the

“speed is not a goal, it’s a result and it can only be achieved by putting safety first”

Netherlands means that crews can usually reach a scene within their area of operations in 15-20 minutes. So why not save money by having fewer

ANWB

Turbocharge your HEMS start-up times

with ATC before taking off, and because we have established a very good working relationship and protocols with them, there is hardly ever a delay for us.”

fast (and we don’t even use the fast start) and is very reliable (technical uptime is more than 98 per cent). The H135 systems are easy to monitor for the pilot and it is a very stable and powerful helicopter: you know you have the performance to safely take off and land even in the case of an engine failure.” He continues: “Our iPad-based navigation system (PANDA) also helps. It’s stable, accurate, easy to use and really helps crew performance. It has all relevant aviation and road maps, a street and highway database, integrated NOTAMs and an obstacle database. Flying VFR during the day in poor weather and at low altitude, it’s a real help.”

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ANWB

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bases, covering larger patches? Why the emphasis on speed? “Speed is important to get specialised, high quality care on scene as fast as possible, which results in a better outcome for the patient,” Fuhrmann says, explaining that ANWB provides this by flying with a medical specialist such as an anaesthesiologist or trauma surgeon onboard. “Our teams are called out when dispatch is called by the public and the incident is within our scramble criteria or when the ambulance crew on scene requests our assistance. Transporting the patient to a suitable hospital is not our main goal. In the case of Lifeliner 1, we transport only one in 75 patients by helicopter. In most other cases our doctor rides with the patient in the [ground] ambulance and is picked up by the helicopter afterwards.” While patient care is certainly a priority, the safety of the crew is paramount. “I do think we have a good balance between speed and safety; speed is not goal for us, safety is! The speed is merely a result from good equipment, streamlined procedures and well trained crews. Our crews are not pushed to get airborne in the shortest time possible, but in the safest way possible. In my honest opinion we minimised the risks of starting up fast to a level where they are no greater than the risks of taking 10 minutes to start,” Fuhrmann asserts. The fact that there is no commercial, customer or company pressure to get airborne quickly helps crew performance, he adds, saying: “If the helicopter is not 100-per-cent, we don’t fly. If the weather is below limits, we don’t fly. If the crew is not happy to go, we don’t fly. Our company, crews, dispatchers and the customers we fly for (Traumacentra) all know and accept that.” Of course, not every scramble is done at top speed. Poor weather is the most common cause of slower operations. This can result in delays as

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“we minimised the risks of starting up fast to a level where they are no greater than the risks of taking 10 minutes to start”

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the crew assesses whether they will be able to get to the scene and back safely, in weather beyond its approved minimum. At night the procedure takes slightly longer too, of course. “The crew has to get up and dressed, weather is checked more thoroughly and a possible landing site is surveyed in Google Earth as we’re not allowed to land inside built-up areas outside the uniform daylight period (UDP) – unless it is on a pre-surveyed site,” Fuhrmann says. “We also need a slightly longer time to start up at night because all stabilisation systems have to be online before take-off and our night vision goggles (NVGs) have to be calibrated.” When it all comes together, getting on-scene safely and fast, completing a HEMS mission and helping as a team to give a patient the best care possible is ‘very satisfying’, says Fuhrmann. He adds: “That combined with the fact that we get to land in some pretty nice places (on a bridge over a canal in Amsterdam, for example) makes it a great job.” For other crews seeking faster start-up times, Fuhrmann says: “My advice is not to make speed an issue! Streamline your operation, share tasks, train, have good equipment, systems to give you situational awareness and speed will automatically be a result.”


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person’s arms and around their back, suspending them from a point above and in front of their head. If the casualty raises their arms, either by choice or involuntarily, they can fall through the loop. Versions are available with features such as non-slip material or the ability to cinch the loop tight on the patient. So-called ‘hypothermic’ strops have two loops – one passes under the arms while the second goes under the legs so the patient can be lifted in a more horizontal position (more on that later). Nonetheless, an uncompliant or unconscious patient can still fall through. Peter McDonnell, chief crewman for CHC Helicopters’ Australian SAR operations, told AMR that the main issues associated with the recovery of unconscious patients is their inability to maintain their own airway/breathing and the loss of muscle tone. The latter inhibits the casualty’s ability to maintain a constant body position and this can lead to a casualty ‘slipping’

the crew had no option but to attempt the simultaneous winch due to the immediate danger of both victims being washed onto the rocks

Where conditions allow, a stretcher is the safest option

What options are available to safely winch unconscious casualties into your rescue helicopter? James Paul Wallis reports In December 2015, an Irish Coast Guard rescue helicopter crew located two casualties in cold waters off County Wexford. In heavy swells and close to rocks, a 15-year-old boy was fighting to keep an unconscious 14-yearold girl above the waves. Needing to get them out of danger quickly, the winchman placed strops on both casualties (a ‘hypothermic’ double-loop strop on the girl) so they could be hoisted into the S-92A helicopter hovering overhead. As the pair reached the open door of the aircraft, the unconscious girl fell from the strop back into the sea. A second attempt was quickly made, and this time she was brought onboard and flown with the 2828

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boy to hospital, arriving less than 20 minutes after the initial call-out. Aoife Winterlich had been swept into the sea with the boy and two others during a Venture Scout expedition. Two of the four victims managed to clamber out onto rocks. The boy who was plucked from the sea survived, but Winterlich later died in hospital in Dublin. An Irish Coast Guard investigation found the crew had no option but to attempt the simultaneous winch due to the immediate danger of both victims being washed onto the rocks. Ireland’s Air Accident Investigation Unit (AAIU) issued a report on 8 March stating that CHC Ireland, operator of the country’s coast guard helicopters, did not give its crews specific guidelines to use different procedures or equipment for unconscious patients than they would use for conscious

casualties. It urged the provider to address this: “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.” (AMR 83, April/May 2017, Call for guidance on winching unconscious casualties). The AAIU did not find any evidence of wear, damage or failure of either strop used during the mission. What might such guidance cover? AMR spoke to providers from around the world, including CHC, to ask what they consider general best practice for winching unconscious casualties. Physical risks The simplest rescue sling or strop comprises a loop which passes under a

from rescue devices if not restrained appropriately. Dr Matthias Ruppert is medical director at ADAC Luftrettung of Germany. Of the organisation’s 37 bases, four conduct hoist operations, tallying some 250 to 300 hoist missions per year. He told AMR about some of the risks posed by winching unconscious patients: “The lack of actively holding down the upper extremities makes a sliding of the (wet) body out from any sling very likely if the rescuer does not hold down the patient’s arms. But if the rescuer needs one of his/her arms to do something else (i.e. when approaching the helicopter), he or she may have difficulties securing the patient at the same time.” Thomas Knudstrup, senior product manager at Lite Flite, Denmark, which manufactures air rescue equipment, commented: “All it takes is a splitsecond of unawareness from the rescuer (the winchman) – the victim’s arms may raise to a level where there is nothing to keep the victim in the sling. From what we know, such accidents happen a few times each year.” Brad Matheson, president of search and rescue training specialist Priority 1 Air Rescue (P1AR), added that not only are unconscious patients at greater risk of slipping, but there’s the added problem that they can’t speak up to alert the rescuer if they begin to do so. He mentioned that hypothermic strops provide some additional security, but will still allow the patient to fall out if their arms slip out of the strop placed around the torso. Slipping can be a risk even in compliant, conscious patients, he said, for example if they unwittingly reach up to make a grab for a helicopter skid as they near the aircraft. Medical risks Aside from the risks of unconscious casualties slipping out of rescue devices, there are also particular medical risks associated with a patient being unconscious, explained Ruppert, such as further deterioration of airway patency, respiratory function and/or circulatory status, especially in an upright position with an unsecured airway.

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Hoisting with a Priority 1 Air Rescue Ambulatory Victim Extraction Device (AVED)

Knudstrup explained in layman’s terms why hypothermic victims require particular care: “The blood of a hypothermia victim that is hoisted for just a short time in an upright position may pool up in the victim’s legs, causing lack of blood and oxygen to the brain. When the victim is saved, that is, hoisted into and laid down in the helicopter, all the blood ‘flushes’ through the arteries and veins. This initial drop of blood pressure, followed by a sudden

hypothermic strops … still allow the patient to fall out if their arms slip out of the strop placed around the torso

increase of blood pressure, may simply cause the death of the victim. We do not know how often it happens, but foreign studies suggest that this type of death can happen instantly, after a short while or even days after being rescued.” Double-loop strops have uses beyond hypothermic patients, Peter 3030

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McDonnell of CHC Australia told AMR: “Personnel on land who may be suffering from minor lower leg injuries … can also be recovered using the hypothermia strop technique.” Equipment It’s worth noting that although there are drawbacks, the single-loop strop and double-loop hypothermic strop designs have major plus points – they are simple to store, to deploy and to get onto the casualty. However, Knudstrup warned against overuse of strops: “Every SAR operator will probably look at the traditional rescue sling as a simple-to-use-product, but it really should be the last resort. Modern rescue slings can have as many features [as you can imagine], like self-securing systems, anti-slip rubber … support handles and crotch straps. But whenever possible, try to utilise a rescue device that does not include the risk of slipping.” If strops have been seen as a go-to option up until now, that’s down to the history of air/sea rescue, said TRS Canada project manager Derek Rogers: “These are legacy items that were initially designed to recover aircrew in ditching or crash situations, not as a medical evacuation devices. Research and court rulings are starting to recognise the limitations of the rescue sling/strop.” Bob Cockell, vice-president at Air Rescue Systems, concurred that collartype devices are overused, adding: “I’m not saying these devices don’t have their place. They are well made, well thought out and work well for a number of mission/victim profiles. However, the misapplication of these

have led to disastrous outcomes for the victims we work so hard to save.” Problems are not limited to unconscious patients – the ‘difficult victim list’ includes the obtunded, hypothermic, wet, elderly, young or obese, said Cockell. He continued: “Add any number of injuries and the use of these devices increase the odds of a potentially negative outcome of the rescue.” For air rescue crews looking for something more secure, there is a whole range of options available. Commenting on the gold standard where conditions allow, Rogers said: “For recovering an unconscious casualty, the best case scenario is a land-based open area hoist, with the casualty strapped in a rescue stretcher, airway secured and tag-lined during the hoist to limit turbulence and oscillation.” NSW Ambulance and Toll Helicopters told AMR of the creature comforts that patients on stretchers enjoy: “The aeromedical stretcher has been designed specifically for helicopter winching operations. A tag line (anti-spin line) is used to ensure that the stretcher does not spin under the aircraft whilst being winching up. The tag line is fitted with a release system that can be activated by the NSW Ambulance doctor or paramedic once at aircraft height … head, ear and face protection is provided for the patient as well as a patient thermal winch bag. The custom-designed sleeping bag protects the patient from the elements during the winch.” However, such stretchers can be difficult to load in the water, said Rogers, and it can be hard to control oscillations if there is no tagline or guideline being used. CHC’s McDonnell commented: “If conditions are such that a stretcher winching extraction is not achievable, other alternates available to crews are ‘fully body harness’ or similar device and the rescue strop.” Ruppert commented that the majority of unconscious patients hoisted by ADAC are winched in a supine position, not on a stretcher, but on a vacuum mattress in a ‘rescue bag’, while patients with minor injury/sickness are hoisted in a ‘rescue triangle’. However, the organisation’s crews are permitted to use strops in extreme situations such as water rescues or patients in Rescue swimmer Petty Officer 1st Class Bret Fogle from US Coast Guard Air Station Elizabeth City helps guide a rescue basket during training in 2012 acute danger. US COAST GUARD / PETTY OFFICER 3RD CLASS DAVID WEYDERT

P1AR

“the best case scenario is a land-based open area hoist, with the casualty strapped in a rescue stretcher”

Matheson said the primary device P1AR uses for minimising the risk when conducting double-up extractions, or even single-up extractions on the smaller-capacity hoists on light helicopters, is the Ambulatory Victim Extrication Device (AVED). Lite Flite offers a similar solution known as a ‘rescue wrap’, as Knudstrup explained: “A victim who is going to be rescued or evacuated from ship, ground, mountain or another hard surface can, with a lot of benefits, be winched by means of a rescue wrap. Not the triangular shaped model that has been made by several manufacturers for years, but a modern type that is carrying the victim’s weight by the back, giving support to the head and having large supporting wraps around the thighs. Such wraps have been around for a while, but most of them are actually more like soft stretchers, with multiple suspension points and complicated mechanisms.” A carefully designed rescue wrap can be folded and rolled

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up into a very small package, he added, and is easy to use. Knudstrup continued: “It will keep the victim in the same semi-sitting position as the dual [hypothermic] sling, while the risk of slipping is reduced to almost zero.” Rogers warned that a rescue vest or jacket used in the water must have been designed for this purpose, or it can effectively become a sea anchor. Returning to the simple strop design, these can be improved with a crotch strap, said Matheson: “When we employ a strop (for water rescue), we only use the LSC Quick Strop that has an integrated crotch strap to prevent the

Swedish Armed Forces applying a Lite Flite ‘hypothermic’ double sling in the water

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Rather than a stretcher, ADAC uses a ‘bag’ with a vacuum mattress inside, as shown here at a train accident in 2016 where several intubated patients were winched

parts.” Other than the additional security, he said, the advantage of a rescue sling equipped with a crotch strap is its suitability for use in water. Another option, said Matheson, is to use a rescue basket to extricate patients, especially larger individuals or hypothermic casualties. Baskets are routinely used by agencies such as the US Coast Guard, but come with a higher price tag and inevitably take up more space in the helicopter than a strop, even if a collapsible version is chosen. Rogers noted that a severely hypothermic casualty in the water is one of the most challenging situations a rescuer can face: “In this case, the fastest and most effective recovery method is a simple personnel carrying device such

these items is size and aviation certification.” Certification of equipment is an issue, said Rogers, and there can be question marks on where the scope of a provider’s air operator certificate is deemed to end – whether it ends at the rescue hook or continues to cover equipment attached to the hook. “Often it is left to the operator to seek approval for a piece of equipment,” he explained, “citing best practices or parallel industry standards. Unfortunately, this leads to older gear (often ‘grandfathered’ into service prior to formal certification) being utilised well beyond its design intent and often redundant compared to modern equipment.” Procedures What of specialised procedures, as alluded to in the AAIU’s report on the 2015 incident? McDonnell recognised that clearly defined standard operating procedures are ‘critical’, adding that so too is ensuring the operating crews have the appropriate resources available to them to make informed decisions appropriate to the task at hand: “Having more tools in the tool box, so to speak, with the appropriate training to support them. This has to be balanced with the type of aircraft being operated, the stowage and payload available, along with the operating terrain and environment, but ultimately having the right tools and equipment available to appropriately trained, competent and current crews with a wider support structure of standard operating procedures will assist in minimising the risks to both the casualty and crew.” Toll Helicopters and NSW Ambulance said they have comprehensive and advanced risk assessment procedures for all operations, particularly winching: “All other possible means of extraction will be considered prior to winching an unconscious patient. Winches only occur if a risk assessment considers that to be the safest option for the air and medical crew and the patient. In some cases, a risk mitigation measure will see the patient transported to a helicopter landing zone and not winched.” The idea that a hoist is in effect a Plan B option was also voiced by Cockell of Air Rescue Systems: “Risk mitigation and a thorough look at all alternatives to hoisting must be of the highest priority. Is a one-kilometre, overland carry-out acceptable vs hoisting? Can transport alternatives be arranged (4X4, ATV, boat etc.)? The team should always be looking for a way not to hoist and must answer the overriding question: ‘Is what we’re doing or planning to do based on convenience or necessity?’.” Training on procedures is key, said Toll Helicopters and NSW Ambulance: “All air crew and medical crew complete regular stretcher winch rescue training. Formal procedures are in place to ensure familiarity and compliance.” An operator’s procedures should include not only ‘normal’ situations, but also cover what to do in emergencies, advised Knudstrup: “These situations are most likely to put the equipment to the limitations.

MASS COMMUNICATION SPECIALIST 2ND CLASS ANTONIO TURRETTO RAMOS / US NAVY

LITE FLITE / STEFAN OLSSON (HELISAFE)

survivor from slipping out in the event they go unconscious or reach for the skid. Along with this specialised strop, our rescue specialists use a leg scissor and/or modified physical grip to the survivor depending on the type of lift.” Crotch straps have their own drawbacks, though, said Knudstrup: “The problem with this solution is that a crotch strap may harm the victim, for obvious reasons. This is true, whether the crotch strap is made of narrow webbing or a piece of wide fabric. Anything designed to support the victim between the legs should be designed in a way that does not harm their vital

“be deliberate and slow when bringing the patient and rescuer past the skid”

ADAC

“all other possible means of extraction will be considered prior to winching an unconscious patient”

So if a dual sling is used, make sure that each of the slings can carry the necessary weight.” Having a rescuer accompany the casualty during the winch is a widespread practice to enhance safety. Ruppert said that all hoist manoeuvres carried out by ADAC are performed as a ‘double winch’ with the medic being lifted with the patient. Matheson of P1AR concurred: “We would not recommend having a single person riding a strop, especially when they are not trained. If a person who appears OK to ride the strop becomes unconscious due to cardiac or breathing issues related to intrathoracic pressure or cardiac irritability (due to hypothermia), they will fall out of the strop.” He added: “Be deliberate and slow when bringing the patient and rescuer past the skid (as to not hit their head, and ensuring the rescuer has time to prevent the patient from reaching for the skid), and always use a safety (Orca) strap when transitioning into or out of the cabin during hoisting.” In the case of river, lake or coastal rescues, Ruppert said that ADAC (which does not perform offshore missions) does use a rescue strop, but minimises the risk of falling by carrying the patient just a few metres above the water to the nearest bank, shore or beach, rather than attempting to bring them up to the helicopter. Ultimately, though, it is difficult to give a definitive answer on best practice for unconscious casualty hoist procedures. Rogers of TRS Canada noted that there is a lack of established, evidence-based research in this area, a gap his organisation is trying to fill. He said: “Working with the support of HNZ Helicopters, we’ve tested a number of recovery systems in our full-effects synthetic hoist trainer at the SSTL facility in Halifax, Nova Scotia, Canada. Our informal research has confirmed that the rescue basket is the quickest and safest emergency recovery device for unconscious casualties in adverse water conditions. Unfortunately, formal research is limited on this issue and many of our procedures are opinion versus evidence-based – rest assured we are working to address this gap along with many others in the industry.” Cockell of Air Rescue Systems added that rescuers should stay open to new methods: “Don’t base your operational mode solely on ‘it’s what we’ve always done’. There is always an alternative to every action. Seek input from other teams. Network with your peers and remain open to ideas, even those outside of your organisation’s cultural norms and experiences. Look at those missions which did not go as planned, the ones that left you feeling you could have performed better, the ones where you really couldn’t put a finger on the problem, but you knew it wasn’t 100 per cent.”

as a rescue basket or Billy Pugh [‘rescue net’]. These devices are easy to use, very fast (limiting under-rotor exposure), can be utilised for passive rescue and offer full support to an unconscious casualty. The only drawback with

US Naval Aircrewmen-Tactical Helicopter 2nd Class Daniel Baskin, a rescue swimmer with Helicopter Maritime Strike Squadron (HSM-35), practises putting a survivor into a rescue strop

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infrastructure that is managed by Health Ministry, but here the exact figure remains unknown, because it is not clear how many helicopter pads should be built. Ground infrastructure needed At this stage, it is believed that the fleet of the medical service provider should be based at the Lipki Air Base in the Minsk Oblast, where most GAASU Aviation helicopters are currently based. It will also have access to seven Emergency Ministry aviation stations with helicopter pads near Vitebsk, Grodno, Mazyr, Molodechno, Pinsk, Polotsk and Soligorsk. However, the real challenge is the construction of helicopter landing pads near hospitals, as no Soviet-era pads remain in service. The first pad is currently under construction near the Minsk Emergency Hospital and is due to be completed before the end of the year. The construction of another pad is also confirmed near the Minsk District Hospital, while plans on the construction of pads for provincial hospitals have not yet been unveiled. First exercises taking place Meanwhile, Minsk City Emergency Hospital has already undertaken three air ambulance exercises since the beginning of the year, although without real patients and medical equipment as yet, the hospital’s deputy chief doctor Igor Grigoriev said. “The exercises are conducted according to different scenarios and we cover all possible situations where even a minute’s delay costs people’s lives. The time of delivery of patients from the place of accidents often plays a crucial part in saving their lives,”

The Emergency Ministry and Health Ministry of Belarus are working together to revive the country’s air medical service by the end of June, following a decree signed by President Alexander Lukashenko on 26 January. Vladislav Vorotnikov reports According to official information, an air ambulance (initially fixed-wing) service first appeared in Belarus back in 1935 and played an important role in the regional healthcare system when the country was part of the Soviet Union. The service reached its peak in the last years before Perestroika, when the medical helicopters handled nearly 2,000 mission calls per year. As with most territories in the post-Soviet Union space, Belarus’s economy was in crisis in the 1990s. Healthcare programmes in the country faced major funding cuts, and the air medical service ceased to exist. As a result, landing pads near hospitals were converted into car parks, while the helicopters themselves went to either scrap yards or the Air Force. Pledging revival The 2017 presidential decree requested that by mid-2017, the HEMS unit must be set-up and officially registered within the State Aviation Emergency-Rescue Agency (also known as GAASU Aviation), a division of the Emergency Ministry that is authorised to make rescue flights across the country. Technically, this task has already been fulfilled as GAASU Aviation was approved to act as the medical service operator starting from 15 March 2017, but no real flights in the new status have been made (at the time of writing), above all else because a legislative base for this operation has not yet been adopted. Vitaly Novitsky, assistant to Emergency Minister Vladimir Vashenko, commented: “The creation of the medical service as a branch of GAASU Aviation is pending, whilst the Emergency Ministry has already allocated one Mi-8 model helicopter for the needs of the medical service. We now look 3434

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Grigoriev commented. The air ambulance will respond primarily to accidents where the urgent transportation of patients to hospitals is needed, as, according to Grigoriev, it takes only seven minutes to deliver patients from the outskirts of Minsk to the City Emergency Hospital by air, several times lower than the journey time by road. “It turns out that the air ambulance really helps a lot, despite the fact that we’ve got relatively good road conditions, almost no traffic jams and stateof-the-art ground ambulances,” Grigoriev added.

forward to the Health Ministry purchasing the first set of medical equipment to be installed on this aircraft, though we don’t know when it will happen.” He recalled that in the past, GAASU Aviation did perform certain air medical functions, for example transporting organs and tissues of donors, but without special medical equipment it was not able to provide a full service. The important thing now is that the legislative bodies should specify a legal framework that will allow the air ambulance provider to handle mission calls, because at the moment the Emergency Ministry cannot, as a rule, carry patients on its helicopters, with the exception of some particular cases, Novitsky stressed. Demand yet to be determined GAASU Aviation is now operating four models of helicopters, including the AS355, Mi-2, Mi-8 and Mi-26. Currently, the agency plans to install medical modules only on its Mi-8s, but theoretically the AS355 model can carry this medical equipment as well, Novitsky suggested. The size and the structure of fleet, however, will be determined at some point in future and will largely depend on the level of demand for air medical services in the country that is seen over time. “We need to figure out how many flights we are going to perform. For example, in Moscow, the authorities were planning to make only one or two flights per month, but today [they carry out] five to seven flights per day. We probably will apply the same approach, starting with a small number of flights and trying to figure out what the real demand is. If the demand proves similar to what’s seen in Moscow, we definitely would not be able to operate with only one helicopter,” Novitsky stated. It is believed that the Emergency Ministry will require no significant financial expenditure to establish the air medical service, because GAASU Aviation will not have a need to purchase new helicopters. At the moment, the major investment within this project will be the construction of the ground

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This is a physician-led and staffed service. The service does a mixture of primary missions (all ages) to both trauma and medical cases. The service is the largest in Norway, conducting secondary missions (inter-hospital transports) from all over the country. These are done by helicopter (EC135 and EC145), fixed-wing aircraft (King Air), intensive care ground ambulance or a combination of these. Neonatal transports, with incubator or baby pod, are undertaken with the HEMS physician and a flight nurse or a HEMS crew member. Of the neonatal transports, some will be to a higher level of care and some will be to take neonates to a hospital with lower level of care but closer to home. The majority of these are intubated and ventilated. A proportion of these are neonates with a weight between 700 g and 3,000 g with respiratory support by CPAP.

Intubation of premature and neonatal babies is an essential skill in an advanced prehospital and retrieval service. At the Air Ambulance Department in Oslo, this has now been addressed via the unique Neonatal Boot Camp. This article by Drs Per Bredmose and Erik Sæter is meant to inspire others to undertake similar training, which only requires minimal equipment Intubation of neonatal and premature patients is a relative rare event for the prehospital and retrieval physicians at the Air Ambulance Department in Oslo. In a large prehospital and retrieval service (PHRT) which does primary, secondary and ‘step down’ transports, including adults and paediatric patients, there is a need for the physicians to be proficient in premature and neonatal drug-assisted intubation (modified RSI). In order to practise these skills, we organised a ‘neonatal intubation boot

camp’. The rationale behind this was that repetition is the mother of learning. All physicians take part in in-situ simulation at the air ambulance base. However, in this boot camp training, the entire focus was on practical skills as well as dosing and dilution of drugs. We have encountered a need for this type of training. All retrieval physicians are senior consultants in anaesthesiology, so laryngoscopy skills seem to be excellent. There are only a few changes needed for laryngoscopy of the full-term neonate in terms of positioning. For the premature babies, differences are larger. All this was addressed in the training. There was a focus on choosing the correct size of equipment, the right dose of drugs and maintaining PEEP (positive end expiratory pressure) for those that need it. To facilitate the training, mannequins

Stations: 1. Full-term baby. Drug facilitated intubation. CRM. Drugs. Laryngoscopy skills. 2. Full-term baby. Same as for Station 1, but this time a sick baby. 3. Premature with CPAP. Need to intubate before transport due to increasing need of oxygen and higher pressures. 4. Premature. Small, 750 g. Preparation for the neonatal boot camp

Dr Per P. Bredmose is a consultant in prehospital and retrieval medicine at Oslo University Hospital. A specialist in anaesthesia and intensive care, he has worked in prehospital medicine in Denmark and Australia, as well as at London’s Air Ambulance and the Children’s Acute Transport Service in the UK. He is director of training at the Air Ambulance Department at Oslo University Hospital, as well as a full-time clinician and a part-time PhD writer. He has a special interest in the development of complex interhospital transports, ECMO, iNO, and neonatal transports.

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from Laerdal were used. These were a full-term neontate (3,500 g) and a newer premature mannequin (750g). The teaching was carried out in co-operation with in-house consultants from the neonatal clinic, as well as paediatric anaesthetists from Oslo University Hospital. Setup After a short initial lecture round (two 15-minute sessions) the rest of the afternoon was spent on practical training. Four stations supervised by the above-mentioned consultants were set up. Deliberately simple scenarios were chosen. The focus was not on pathology, but on practical skills training. One physician would take care of (train) positioning, equipment checking and intubation, and another physician would draw up drugs and dilute as necessary. The last and third physician would overlook it all and assist. In this manner, all groups undertook four sets of three intubations of neonates and premies over the course of two hours. This seems to be an effective and engaging way of training this essential skill in our service.

AUTHOR DR PER P. BREDMOSE

Per Bredmose pictured in the hospital

All physicians at the service are senior consultants in anaesthesia and intensive care (which is a combined specialty in Scandinavia). The physicians have all worked and spent time in a neonatal unit to gain proficiencies in neonatal care. They have all undergone rigorous training in neonatal intensive care medicine and do regular training within this field.

Note: Special thanks to Laerdal who lent out enough mannequins to make this happen. No financial or other support was received from Laerdal.

AUTHOR DR ERIK SÆTER Dr Erik Sæter is a consultant in prehospital and retrieval medicine at Oslo University Hospital. He holds two full specialities in both neonatology and anaesthesia and intensive care. He has a special interest and extensive experience in neonatal transport medicine. He is currently working as a flight physician at the Air Ambulance Department of Oslo University Hospital.

Preparation for the neonatal boot camp

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

Colombian National Police trials new EFI

Prince George’s County Police Department (PGPD) in Maryland, US, has ordered a new helicopter to expand its aviation section. The MD520N, which will be the third in the Department’s fleet, will feature a Block 1 glass cockpit and will be ready to join operations in Spring 2018. Headquartered in College Park, PGPD currently operates two MD520Ns that have been in service since 2000.

“As an enthusiastic advocate for police aviation, I am very pleased that our agency is expanding our fleet with MD Helicopters,” said Chief Henry Stawinski III, PGPD chief of police. “This will allow us to expand our day-to-day capabilities and ensure the future of our aviation programme.” PGPD Aviation Section will be the first law enforcement operator to fly the 450-shp Rolls-Royce 250-C20R/2-

powered MD520N with the new Block 1 all-glass cockpit, said manufacturer MD Helicopters. The cockpit features a Howell Instruments Engine Instruments Display, Garmin G500H EFIS and Garmin GTN 650 NAV/COM/GPS, as well as the Garmin GTN 635 COM/GPS. MD Helicopters plans to deliver the custom-configured machine to PGPD Aviation Section in the second quarter of 2018.

A new electronic flight instrument (EFI) has been installed onboard a Bell 212 helicopter flown by the Colombian National Police. The AFI 4700 RoadRunner, the latest product from Astronautics Corporation of America, was used during a demonstration flight on 23 May, and was left in place for viewing on static display during the Feria de la Industria Aerospacial Colombiana event in Bogota. The device offers attitude, direction and horizontal situation indicators and includes a helicopter terrain awareness and warning system and synthetic vision system.

ASTRONAUTICS CORPORATION OF AMERICA

Prince George’s County PD to expand fleet

Contra Costa Sheriff rescues hiker

MD HELICOPTERS

Contra Costa Sheriff of California, US, has shared a video from a mission to rescue an injured hiker on 6 May. At around 13:20 hrs, Contra Costa Fire Protection A PGPD MD520N helicopter

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Watch footage at www.airmedandrescue.com/ story/2060.

(20-m) hover over the scene as a CHP paramedic was hoisted down. The man was placed into a rescue harness and hoisted to H-30. The chopper and crew then flew the man to a nearby landing zone where he was transferred from the helicopter to awaiting Pacifica Police Officers and North County Fire personnel. Watch footage at www.airmedandrescue.com/story/2025.

The Brick Township Police Department in New Jersey, US, has acquired a remotely piloted quadcopter. The drone aircraft was purchased using funding from the New Jersey Division of Highway Traffic Safety’s Comprehensive Traffic Safety Grant. The Department said it has taken steps to have two traffic safety officers trained and licensed as drone pilots. Training was conducted at Eagle View Aviation in Farmingdale, after which the officers had to pass a 60-question exam that was administered by the Federal

Aviation Administration. The use of the drone must be authorised by the chief of police, said the Department. The drone will be utilised for tasks including missing persons investigations and other search and rescue missions, as well as documenting crash scenes and providing personnel ground on the ground with an aerial perspective to assist with traffic control. The Department said it hopes to expand this programme in the future

BRICK TOWNSHIP PD

and hazardous due to the steep terrain and lack of access points for a rope rescue, said CHP. The North County Fire District began to set up a rope system but due to the location of the man it was determined that a helicopter rescue would be the safest and fastest way to remove the man from the cliff. CHP’s H-30 arrived overhead and assessed the situation. At the time of the rescue there were high winds and moderate rainfall. The aircraft was manoeuvred into a 75-ft

personnel responded and staged at the end of Regency Drive in Clayton. Due to a severe broken ankle and the extended time it would take to carry the patient out one mile on the moderately steep and unstable terrain, Con-Fire requested STARR 3 lift her via short-haul to reach awaiting medical units. The helicopter’s tactical flight officer set up the aircraft for a short-haul operation and, within minutes, the victim was extracted using an air rescue extraction system bag to the awaiting medical unit and transported to the hospital for further treatment, said the Sheriff.

Drone acquired by Brick Township PD

Climber rescued from cliff face California Highway Patrol’s (CHP) Helicopter 30 (H-30) was requested by the North County Fire District to respond to a cliff rescue at Mori Point, California, US, on 16 April. A male in his 20s had attempted to climb the cliff from the neighbouring beach, said the service, when he became stranded and unable to move. He was approximately 300 ft (90 m) from the top of the cliff, which made access to the man extremely difficult

District (Con-Fire) requested assistance from the Sheriff STARR 3 helicopter to airlift the female hiker from a remote trail on Mt Diablo. The helicopter crew responded and within minutes located the casualty approximately one mile up Donner Creek Trail, lying on the ground and not moving. STARR 3 landed nearby and deployed a flight rescue technician and Con Fire captain/paramedic to evaluate the victim. Meanwhile, Con-Fire Engine 11

to include additional licensed police officers and a drone equipped with night vision capabilities.

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

Wiltshire Police special constables lead drone trial

Helicopter upgrades ordered by Columbus Police

Wiltshire Police in the UK has announced the launch of its Unmanned Aviation Support Group (UASG) pilot. The service also said that if the pilot is successful, it will work to become an accredited training centre for a policespecific UAV course. Chief Constable Mike Veale began looking into the use of unmanned air vehicles (UAVs) is 2016 to augment the manned helicopter cover provided by the National Police Aviation Service (NPAS), noted the force. He recognised that members of the Special Constabulary already had extensive experience in this area, and decided to harness their experience by asking these part-time volunteer officers to take the lead on the project. Members of the Special Constabulary and one regular police officer have been professionally trained in the use of UAVs and licences have been obtained from the Civil Aviation Authority (CAA). Special Superintendent Scott Bateman has led the

MD Helicopters, Inc. has announced a new agreement with the Columbus Division of Police, Columbus, Ohio, US, to upgrade its two remaining MD500E helicopters. The two E models will be overhauled and re-certified as F-models with zero-time engines in a period of just a few weeks, said the manufacturer. The FAA-approved factory recertification takes place at MD Helicopters’ manufacturing facility and completions centre in Mesa, Arizona, the firm explained. “Our FAA-approved E-to-F conversion programme is an outstanding way for operators to upgrade from the E-model to what is essentially a new, factory-built FAA-certified F-model at a fraction of the cost,” said Nick Nenadovic, vice-president aftermarket and customer support for MD Helicopters. “In just a few weeks, these aircraft will return to service stronger, faster and more capable of executing their mission than ever before.” As with the Columbus Police Department’s four previous E-to-F conversions, the primary enhancements will increase the hot-and-high performance capability of the aircraft as well as improve the operational range and flight time, said MD Helicopters. They include: an engine upgrade from the Rolls Royce 250-C20B to the more powerful

WILTSHIRE POLICE

A Wiltshire Police drone being flown at Avebury stone circle

windy conditions. Project lead Special Superintendent Scott Bateman said: “My team are really enthusiastic about the project and have put a great deal of time and effort into making the pilot a success … The users will comply with CAA regulations in the same way that anyone else who flies a UAV must do so. Any footage that is captured is treated in the same way as any other footage (CCTV) or still images and is subject to the same codes of practice and laws.” Bateman explained that whenever the police UAV is in use, officers will display ‘police UAV in use’ signs in the area, and the pilots will wear police uniform with ‘police UAV pilot’ marked on their outerwear. He added: “We are determined to make sure that the UASG is a valued tool for the force over the coming months.” Superintendant Dave Minty, Wiltshire Police head of HQ Operations, said: “We are looking forward to seeing the benefits of this new tool and the advantages of using UAVs in the fight against crime and to enhance officer and community safety. This is another fantastic example of the value of our volunteers in the Special Constabulary; all the work in setting up the pilot, organising training and the proper insurance and licences has been done by Special Supt Bateman and his team. They are a real credit to the Force and the communities they serve alongside regular officers and staff.” Special Constables undertake a variety of different roles in their day jobs and have the same powers as regular officers. They give at least 16 hours a month, many volunteer for many more hours, and get involved in all areas of policing.

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A Maryland State Police helicopter crew rescued an injured hiker on 1 April who

“Our thoughts and prayers are for the victims and survivors. Even though police officers are aware every day that they are risking life and limb to protect the population, an event like today’s is unexpected and hits us all the way to the core.”

US NATIONAL PARK SERVICE

the pair fell into a ravine along with the police officer. The woman and the 28-year-old policeman were killed while the second man was seriously injured. Minister of the Interior Wolfgang Sobotka said it was a tragic day for the Ministry and the Alpinpolizei, adding:

multiplication that contributes to the safety of citizens and officers alike.” The Columbus Police Department converted four of their MD500E aircraft to certified F-models via this same programme in 2015. With the completion of these final conversion efforts, the Helicopter Unit will operate six singleengine turbine MD530F helicopters flown by 16 sworn officers and supervisors, making them the second largest all-MD municipal law enforcement aviation unit in the US, said the manufacturer. The newly certified MD530F helicopters are due to be delivered this summer.

Maryland police helicopter hoists hiker from crevasse

Fatal rope slip during Austrian police heli rescue A woman has died along with a police officer in Styria, Austria, after a rope broke away from an helicopter during a rescue operation on 4 June. A woman and a man were being rescued by the helicopter crew in bad weather at around 17:00 hrs. When the rope broke away,

RR250-C30, replacement of the blades and stabilisers, installation of the Garmin G500H dual-screen electronic flight display, and addition of a Fargo auxiliary fuel tank. Lt Jack Harris, Columbus Police Department Aviation Section, commented: “The Helicopter Unit plays a critical role in the direct support of ground patrol officers in the execution of suspect searches and apprehensions, vehicular pursuits, and delivering aid to other law enforcement agencies throughout Central Ohio. Air support for our officers delivers an invaluable degree of force

MD HELICOPTERS

project and swiftly brought the aircraft into service, said Wiltshire Police. Chief Constable Mike Veale commented: “Wiltshire Police is always looking to embrace technology and be innovative in our approach, so I am delighted to be able to welcome in UAVs. This is also a fantastic opportunity for us to draw on the skills and enthusiasm of the incredible volunteers in our Special Constabulary. They have made an outstanding effort to do the training and get the required licences to provide what can be a key resource for the Force.” Throughout the trial, the UAVs will assist operational policing, enhancing officer and public safety by giving an aerial overview and in conducting searches for missing people, said the service. Wiltshire Police noted that the drones can access areas a helicopter cannot, like low levels or densely wooded areas. The service said its vehicles can be used at night with heat seeking capability, and can fly in cloudy/

Library image of Chimney Rock

had fallen into a crevasse next to Chimney Rock, a remote area in Catoctin Mountain National Park, Maryland, US. The hiker had sustained traumatic injuries after falling into the crevasse. The service’s Trooper 3 helicopter based in Frederick was dispatched and arrived shortly after 16:00 hrs. The pilots manoeuvred the AW139 into position 100 ft (30 m) above a small rock outcropping at an elevation of 1,700 ft (520 m) above sea level, and a crew member was lowered to the scene to co-ordinate and direct

ground units. The patient was packaged and stabilised with the assistance of emergency personnel who had hiked over two miles in the rugged terrain to gain access. Due to the severity of injuries and remote location, an aerial extraction was required, said the Police. The helicopter crew member accompanied the injured hiker during the hoist evolution. The patient was subsequently transported to the University of Maryland Shock Trauma Center in Baltimore while receiving advanced medical care from the Trooper 3 crew. The flight team was assisted by the National Park Service, Frederick County Fire Department, and the Frederick County Advanced Technical Rescue Team.

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

Police pilot stable following firefighting crash

Special needs search tech highlighted

Marion County Sheriff’s Office (MCSO) in Florida, US has reported that MSCO helicopter pilot Sgt John Rawls was in a stable condition following a crash on 2 May. The incident occurred at approximately 18:30 hrs when the MCSO Aviation Unit was assisting the Florida Forest Service and Marion County Fire Rescue with brush fires in Fort McCoy. Rawls was the pilot and lone occupant of MCSO’s Air One helicopter during the operation, using the aircraft to dump water on the fire with a water bucket. As the bucket was being filled,

Sheriff ’s offices in New Jersey and Virginia County has 40 clients enrolled in Project the efficiency of search efforts compared to have added the PLI Indago drone to relying on manned aircraft. Lifesaver: 23 children who have autism their inventories, with additional first or Down syndrome and 17 adults who Project Lifesaver International said that response agencies soon to join the ranks, have dementia. to date, Project Lifesaver agencies have Lockheed Martin has reported. The Gene Saunders, founder and CEO of conducted over 3,254 successful rescues. unmanned air system (UAS) has been Project Lifesaver, added: “The Indago will Most who wander are found within a developed by non-profit organisation give Project Lifesaver agency members the few miles from home, and search times Project Lifesaver International (PLI) and ability to have an airborne asset available have been reduced from hours and Lockheed Martin, which manufactures the quickly to enhance their search capability days to minutes. Recovery times for its quadrotor, to assist in searches for at-risk clients average 30 minutes, 95-per-cent in bringing loved ones home.” missing persons. According to Lockheed Martin, the Indago less time than standard operations, said The PLI programme supports clients reduces the response time and increases the organisation. with autism, Down syndrome and dementia by pairing Indago drones with Project Lifesaver’s electronic location equipment, which is used by first responders to find special needs individuals who may wander. Upon receiving a distress call, operators can deploy the antenna-equipped drone to locate missing individuals. Sheriff Frank J. Provenzano of Somerset County New Jersey, US, oversees the first sheriff ’s office in the country to adopt the system. He explained: “The Indago UAS will allow us to increase our capabilities in locating a client who has wandered. This new asset will give us the ability to search even more efficiently over a broader area and will increase the probability Somerset County, New Jersey, is first sheriff’s office in the US to use the Project Lifesaver Indago UAS LOCKHEED MARTIN of a successful recovery.” Somerset

the helicopter experienced a malfunction and went down into the lake, said MCSO. Rawls was able to free himself from the aircraft, swim to shore and call for help. The Florida Forest Service and Marion County Fire Rescue assisted MCSO deputies in making a path to the lake to reach Rawls with heavy equipment in order to get him medical attention. He was transported to the hospital and is currently in stable condition. The Federal Aviation Administration and National Transportation Safety Board were notified,

said MCSO. Sheriff Billy Woods commented: “Our pilot is OK and, though he does have some injuries, he should be fine. The Marion County Fire Rescue and the Florida Forest Service did an outstanding job in helping us get to our pilot out there in order to get him to the hospital, and I want to thank each of them for the services that they provided to us. We are extremely grateful to everyone who worked tirelessly to make sure Sgt Rawls got the emergency care he needed.”

San Diego police helos get secure Internet comms

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The new technology can help officers locate and track the helicopters while airborne using the helicopter’s onboard GPS. It also logs and provides post-flight mission reporting, which includes helicopter coverage trails and flight paths to use in response to citizens’ noise complaints. Chris Roy, vice-president, AT&T government and education, commented: “When it comes to public safety, communication is critical. With the San Diego Police Department, we saw a real opportunity to literally take our connectivity to new heights. We’re delivering the meaningful innovations they

need to better serve the communities where we live and work.” AT&T explained that the wireless LTE network and specially-designed, highlysecure Internet connectivity now lets the tactical flight officers wirelessly connect ruggedised tablets to police communications and dispatch systems while in the air. Upon completing their mission, airborne police can use the AT&T technology to follow-up on older or overdue calls. They can handle cases that rely on visual inspection like damaged property or vehicle reports, freeing up officers on the ground to respond to other calls.

Limestone County Sheriff gains drone authorisation

AVION UNMANNED

The Limestone County Sheriff ’s Office

CITY OF SAN DIEGO

San Diego Police Department helicopter pilots are to benefit from new technology that will help them to communicate with ground support units. With police helicopters behind them ready for takeoff, San Diego Mayor Kevin L. Faulconer, Police Chief Shelley Zimmerman and representatives from AT&T showcased the new kit on 26 April. For the first time, the police helicopters will have access to a highly-secure, Internet-based network, giving them a more efficient way to conduct two-way communications and provide the GPS locations of the helicopters while in flight. Mayor Faulconer said: “When police officers are protecting our communities, I want to make sure they have the best technology at their disposal. This idea came directly from our one of our officers and AT&T was enthusiastic about working with us to make it a reality. This now gives officers in the air powerful new tools to keep our neighbourhoods safe.” Previously, tactical flight officers onboard the helicopters were unable to access the Department’s computer-aided dispatch system, which provides officers on the ground with up-to-date information about evolving incidents, said the city authorities. Chief Zimmerman explained: “With the help of AT&T, we’re able to bring innovation and efficiency to our City’s finest and improve services to all San Diegans. Our ‘Connected Copters’ are just the latest example of how we can make our city better through technology.”

(LCSO) of Athens, Alabama, US, has

obtained a Certificate of Authorization (COA) from the Federal Aviation Administration (FAA) to implement unmanned aircraft systems (UAS) into its daily operations. The application was supported by Avion Unmanned, a commercial branch of Avion Solutions, Inc., which provided training for the department’s officers and deputies to be FAAcompliant, legal, and safe UAS operators. The firm also supported the development of the

agency’s operating procedures and the COA request. The COA was issued by the FAA in co-ordination with the local air traffic organisation at Huntsville International Airport, said Avion. The Certificate authorises the LCSO to operate within Limestone County and in the surrounding areas. The aim is to use the remotely piloted aircraft for missions including critical life-saving efforts such as locating missing persons. The quadcopter models adopted by the force are a DJI Phantom 3 and a PSI Tactical InstantEye. Both sport builtin 4K camera systems.

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POLICE AVIATION SPECIAL EDITION

Flight paramedic TFC Jenna Turner Maryland State Police Aviation Command Medical Operation Section The Maryland State Police Aviation Command is a public safety organisation with a mission to protect and improve quality of life through the airborne delivery of emergency medical transportation, law enforcement, search and rescue, homeland security and disaster assessment. As a Maryland State Trooper and flight paramedic/ crew chief, Jenna Turner is the lead medical provider and mission commander onboard the aircraft responsible for all patient care, operational tactics, and communications. As a command instructor, she is responsible for the education and training of the medical crew personnel and ensuring maintenance of knowledge and skills. In addition to medical education, she functions as the air medical resource management instructor for the Aviation Command.

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What do you enjoy most about your role? Well, it’s hard not to enjoy flying in a helicopter every day, but what I enjoy most is the diversity. Since we can transition between law enforcement, search and rescue, and medevac platforms, you never know what you’re going to get.

Did you always want to do the job you do now? Growing up, I always knew I would end up in the medical field, I just didn’t know how. When the opportunity to join the Maryland State Police became available, I knew that this was my chance to be a part of something bigger than myself. I never dreamed that it would present so many amazing opportunities. The job I do now exceeds anything I could have imagined as a kid.

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How did you get into your current role? I began my career in EMS and EMS education back in 2005. I was always looking to challenge myself personally and professionally, so when I heard about the Maryland State Aviation Command, I knew that’s what I wanted to do. After a rigorous application process in 2011, I attended the sixmonth residential academy and was assigned to a traffic barrack for almost a year. Once transferred into the Aviation Command, I attended another 13-week training programme and spent the next four years assigned to Trooper 7 – Southern Maryland Section. In 2015, I applied and was selected as the Lead Medical Instructor for the Aviation Command and currently work out of our headquarters at Martin State Airport.

What motivates you? The Maryland State Police Aviation Command is built on a foundation of tradition, pride, and excellence. I’m motivated by my colleagues and by the fallen heroes that came before me. Personally and professionally, I have always strived to be a part of an elite team of professionals, and the aeromedical industry is the best of the best. As a team, we accomplish amazing missions, and it’s that drive to succeed that motivates me every day.

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*Issue 40 onwards.

www.airmedandrescue.com/readthemag How does being a flight paramedic within a police unit differ from being with a non-police provider? The biggest difference is that my primary role is being a Maryland State Trooper. While I have advanced paramedic skills and abilities, I am still sworn to protect and serve the citizens of Maryland in a law enforcement capacity. As a trooper/flight paramedic, I have the ability to protect and preserve lives through both law enforcement and air medical aspects. How do you relax outside work? When I’m not working, you can usually find me relaxing with family and friends, working out, and playing with my dogs. What’s on your bucket list? If it involves travelling and exploring, it’s probably on my bucket list. My next stop is most likely a European adventure.

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POLICE AVIATION SPECIAL EDITION

base, but NWH handles the larger aircraft maintenance jobs. Crew When out on a standard SAR mission, a Huey is staffed by two pilots, three

Based in Washington State, US, King County Sheriff’s Office Air Support Unit does exactly what its name suggests: support the police and people in the King County area. Copilot Hersh Hoaglan spoke to Christian Northwood about how the service operates King County Sheriff’s Office Air Support Unit was started in 1991, says Hoalgan, and is the only full-time rotary-wing law enforcement aviation unit in Washington State. The unit carries out numerous mission types as they support their local area and the rest of the King County Sherrif’s Office. “We fly primarily law enforcement and search and rescue missions,” says Hoaglan. “Law enforcement missions [are] primarily in King County and SAR missions are anywhere in the western half of Washington State.” This can mean flying as far as the state’s southern border with Oregon and right to the Canadian border in the north. Tracking criminals running from crime scenes, car chases and directing police from the air all fall under the remit of the law enforcement work the unit does. Search and rescue call-outs have not always been part of the Unit’s duties – it took this role up in 2007, says Hoalgan. The stunning Cascade mountain range and expansive lakes are where most of the unit’s 46 46

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crew and two medics – if they are needed. Partnerships are of great importance to King County. The service does not employ any full-time medical staff. In fact, the only full-time staff employed by King County are Sgt Reid Johnson and deputy pilots Josh Sweeney, Guy Herndon, Keith Potter and Hoaglan. “We are augmented by a group of eight King County Medic One paramedics and seven King County deputies that are hoist operators/ rescue specialists,” Hoalgan says of the staff. Although budget and time constraints can sometimes make working with paramedics from King County Medic One (the countryoperated ground EMS provider) challenging, Hoalgan asserts: “The benefits of working with King County Medic One are having worldrenowned paramedics with us on missions to bring the patient care to the highest level.” King County Sheriff’s Office Air Support Unit does not regularly engage in patient transport though, Hoalgan states. “We will only transport victims on an as-needed basis,” he adds. The Unit also benefits from other partnerships. There are several other agencies that the service helps, or is helped by, when performing its duties. “We are also a partner in Northwest Regional Aviation (NWRA), which includes entities in the region such as Snohomish County Sheriff’s Office,

rescues take place, he explains. The unit is fully equipped with NVGs, meaning that rescues can be completed both day and night. Fleet The service operates a number of aircraft from its base at Renton Municipal Airport (KRNT). Its oldest aircraft, UH-1 Huey helicopters, are single-engine machines first put into service by the US Army to assist with medevacs. King County’s two Hueys are Goodrich hoist-equipped. Hoalgan said, however, that the service hopes to replace these choppers: “We are interested in obtaining a newer medium twin-engine helicopter to replace one of the Hueys to increase our operational safety while conducting hoist and over-water missions.” The service also operates a Bell 407 and two Bell 206s, said Hoalgan. These aircraft are mostly used for aerial enforcement work. The base at KRNT ‘provides us with a central location to base our aircraft to respond county wide, but also close to the population centre of King County’, said Hoalgan. Maintenance on the aircraft is performed by Olympia-based Northwest Helicopters Inc. (NWH). Small repairs may be completed at the unit’s

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POLICE AVIATION SPECIAL EDITION

Seattle Fire Department, Pierce County Sheriff’s Office, Washington State Patrol, Airlift NW and many others, including military units, in our region,” Hoalgan explains. These partnerships are useful not only for completing missions, but also when taking part in training exercises. Hoalgan says that the unit routinely trains with its regional SAR volunteers and other members of the NWRA. Funding Like many police units, though, tight budgets affect King County Sheriff’s Office Air Support Unit, says Hoalgan, and figuring out how to navigate these issues and come up with creative solutions is key. This year, the Unit’s rescue helicopters have been threatened by budget cutbacks in the area. The two UH-1 Hueys are some of the few in the state equipped for SAR, and the worry was that the loss of these aircraft could mean lost lives all over the state. The Unit was previously told it may 48 48

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POLICE AVIATION SPECIAL EDITION

not receive any funding for its vital services come January 2017 by King County, after it was hit with a $50-million shortfall. Supporters of the unit were told in an email last year: “While we do work with other helicopter crews, there’s no guarantee those resources will be available when we need them, as they are coming from outside our county and possibly through different weather.” Luckily, however, King County did not enforce these cuts. “We very much understand budgetary constraints, but when lifesaving resources are in jeopardy it is cause for concern,” says Hoalgan. “Thankfully, the King County Council understands that we are a resource that makes a difference and truly saves lives. The council has funded us for the next budget cycle and we will get to continue serve.” Silver service Last year, the Unit celebrated its 25th anniversary, a special event for any

service. Hoalgan told me what the unit did to celebrate the occasion: “We hosted an open house that was attended by many of our regional partners, and also by some of our vendors like Bell Helicopter, FLIR, Vislink, NWH.” The Unit also had a special mini-documentary made about it by the Seattle Police Department Video Unit. The video features interviews with staff and those rescued by the service, and helps to underline how important and vital its services are to the community, from the breathtaking winch rescues up in the Cascades, to the work it does recovering dementia patients who wander out into the cold wilderness. Despite the numerous challenges that the team faces daily, Hoalgan asserts that, for him, the most rewarding part of the job is: “Being able to be part of a professional team that rescues people that are injured and in need of medical treatment.” He adds: “When someone that is skilled, prepared and has an accident needs us, they leave an impression.”

www.airmedandrescue.com

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

Winterblade 2017

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AIRMED & RESCUE

ERIK BORNEMEIER

ERIK BORNEMEIER

ERIK BORNEMEIER ERIK BORNEMEIER

Army National Guard 112th Batallion 2 Company, Army Reserves Forward Surgical Team, Utah Department of Public Safety, Life Flight, Air Med, Lakeview Hospital and South Davis Metro Fire. Numerous scenarios from previous real-life search and rescue calls were re-enacted in and around Farmington Canyon for data collection and training.

ERIK BORNEMEIER

ERIK BORNEMEIER

On 11 February, a multi-agency/multi-service, functional exercise took place in the Farmington area of Davis County. The aim of the exercise was to test the operability of hoist and extrication assets along the Davis County mountain range, including private and military organisations. Agencies involved included the Davis County Sheriff’s Office Search and Rescue (DCSO SAR), Utah Air National Guard 151 MDG DET 1, Utah

ERIK BORNEMEIER

ERIK BORNEMEIER

ERIK BORNEMEIER

ERIK BORNEMEIER

Functional operational hoist/extrication capability exercise

www.airmedandrescue.com

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

DJI Inspire 1 or 2 The inspire has been around for a couple of years now, which in UAV terms is an eternity. A number of iterations of the Inspire 1 were released, followed by the Inspire 2 in early 2017. The Inspire 1, in its most basic format, can be purchased for £1,800, but this rapidly increases towards £13,000 by the time a thermal camera has been added to the daylight camera, and spare batteries and associated equipment have been added. The Inspire 2 offers longer flight times (up to 27 minutes), much higher flight speeds, intelligent obstacle avoidance and higher quality optical/thermal sensors. By the time an Inspire 2 has been equipped with spare batteries, quality daylight and thermal sensors and so on, £15,000 will be easily spent.

UAVs in the emergency services

Bryce Allcorn, service delivery manager for UK-based Consortiq, which offers UAV training and consultancy services, considers the variety of drones now on the market that are suitable for emergency services use Since 2008/9 in the UK, unmanned air vehicles have started to be used by the emergency services to provide aerial situational awareness at large, complicated, or protracted incidents. This started off with one or two fire and rescue services using relatively basic (by modern standards) single or quad-rotor systems to provide both live video and thermal imagery feeds to support incident resolution. As time progresses, there has been a very traditional approach with regards platform selection, with a couple of platforms in the lower price bracket and one main contender in at the very high end of the market. The last year has seen a large development in the UAV platform market, mostly taken from the excellent innovation and utilisation within the commercial operators market sector, and which has led to extremely compelling improvements in UAV technology to the benefit of all market sectors, not least the emergency services. Commonly used platforms tend to include the DJI Inspire 1, which has an excellent range of sensors (cameras) including good quality thermal and zoom sensors. Yuneec provides the very affordable Typhoon H with both good quality 4k/HD camera and basic thermal capability, but at a price point well below the DJI Inspire. Then the sector generally jumps to the Aeryon Sky Ranger, which tolerates much harsher weather conditions, provides longer flight times and provides a range of quality daylight and thermal integrated sensors, but at a cost that reflects its military sector background. This traditional approach does tend to sit around the quadcopter (four motors/rotors) methodology, with the exception of the Yuneec range of hexacopters that provide a degree of redundancy that a quadcopter traditionally cannot offer should a motor or prop fail mid-flight. The last year or so has seen great steps when it comes to UAV innovation – companies like DJI being able to produce a platform like the Mavic which has an amazing specification for its size and, while not necessarily suited to the emergency services sector (though you’d be quite blinkered if you dismissed it from every scenario), does highlight how quickly technology advances and how sectors such as

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AIRMED & RESCUE

the emergency services need to be receptive to this technology and consider different options. UAVs fit into two main categories (multirotor and fixed-wing) and each of these is split into two main weight categories (0-7 kg and 7-20 kg). Most emergency services use a multirotor in the 0-7 kg category, mainly because it allows them to be operated in controlled airspace without the requirement to gain permission from the controlling air traffic centre, although good practice is to advise the ATC of the deployment. In addition, sub-7 kg allows deployment within congested areas (50 m from vehicles, vessels and property not under control). Fixed-wing UAVs offer much greater flight duration, can carry greater payloads, have obvious redundancy that a multirotor can’t offer and prove very useful in large-area search deployments. Developments for hybrid platforms allow the advantages a multirotor provides, such as vertical take-off/landing and the ability to hover if required, but also provide long flight duration along with loiter modes that allow them to circle a particular point for very long periods of time. Looking at the available multirotor platforms, we have selected six that offer different opportunities to the emergency services, all multirotor and below 7 kg, with approximate prices in UK pounds.

Author

As service delivery manager, Bryce Allcorn is responsible for ensuring the smooth integration of Consortiq’s software systems into organisational operations as well as supporting the development of the product range. Bringing expertise with him from his service as a crew manager in the fire and rescue industry, Bryce is also an expert in emergency services and plays a major part in helping these organisations implement drones into their operations.

About Consortiq Consortiq are cutting edge innovators in drone and unmanned aircraft systems (UAS). We transform business through drone consultancy, aerial filming, hardware and our UAS management system software, CQNet.

Positives

Negatives

Flight duration 27 minutes*

Weather capability max wind 10 m/s*

Variety and quality of sensors

Security of downlink (live feed link)

Deployment time

Regular firmware updates

Ease of waypoint flying

Limited operating temp of Smart batteries

*Inspire 2

Yuneec Typhoon H (or H520) The Yuneec Typhoon H was released to the UK market in June 2016 offering an immediate degree of redundancy not seen with the current ready-to-fly products, in addition to the ability to have a separate camera operator using a second controller. The full three-axis gimbal at this price point was extremely impressive. The Typhoon H offers similar flight times to the DJI Inspire 1 while at a similar price point the Phantom 3 and the Phantom 4. The H520 is due for release imminently. While prices have not been released, it’s expected to compete directly with the DJI Inspire 2, but be aimed at the industrial end of the commercial spectrum, which could be good news for the emergency services as it will be offered with a superior range of sensors, both thermal and video, compared to the Typhoon H.

Positives

Negatives

Flexibility and ease of use of the sensors Weather capability (Basic Typhoon H) Deployment time

No live streaming function

Ease of waypoint flying

Flight duration just under 20 minutes

Value for money

Lower resolution of thermal camera (H)

Dual image with thermal camera (HD and Thermal) overlaid UK-based Yuneec support/repairs

www.airmedandrescue.com

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POLICE AVIATION SPECIAL EDITION

POLICE AVIATION SPECIAL EDITION

Aeryon SkyRanger

DJI M210

Considered the ultimate platform by some emergency services, the SkyRanger offers a solution for most needs, can operate in heavy wind and rain, boasts high-quality optics (30x optical zoom/60x digital zoom) and offers advanced thermal capability. A genuine military sector product which has obvious benefits in the emergency services sector and, until recently, limited obvious market competion. The price is in the range of £55k.

DJI recently launched the MATRICE 200 series and the M210, priced at over £15k, is considered the most appropriate of the range for emergency services use due to the flexible payload mounting, ability to fly in light rain, ADS-B receiver and separate ‘FPV’ camera to aid the pilot. In addition, the M200 series uses a dual battery system that has been stated to offer greater redundancy than most quadcopters. DJI’s extensive experience will undoubtedly push further development of the M210 and hopefully this will be to the benefit of the emergency services.

Positives

Negatives

Flight duration

Lack of downlink options

Quality of sensors

Cost

Weather capability

Possible reluctance to deploy due to cost

Ease of waypoint operation (not physically flown in the traditional UAV sense)

Waypoint flying (not physically flown in the traditional UAV sense reducing the need for pilot skill)

Onboard no-fly-zone configuration UK-based Yuneec support/repairs

Aerialtronics is well known within the commercial sector and is also very popular with emergency services globally. The ATX4, which comes in at around £25k, has been built from Aerialtronics’ wealth of experience, and the ability to add individual payloads (rather than being limited to manufacturer-supplied options) opens up different uses, such as gas/air quality monitoring and chemical detection at HAZMAT incidents.

Positives

Negatives

Flight duration (30mins)

Wind capability ATX4 max. 8 m/s

Deployment time Can be deployed in light rain/snow Onboard no-fly-zone configuration UK-based Yuneec support/repairs

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AIRMED & RESCUE

Negatives

Flexibility of payload fixing

Wind capabability 10 m/s

Variety and quality of sensors

Security of downlink (live feed link)

Deployment time

Flight duration (24 mins with payload)

Can be deployed in light rain

Potential for very regular firmware updates

Dual battery system (redundancy)

Dual battery system (additional cost)

UK manufacture and support

Aerialtronics Altura Zenith ATX4

Ability to install any payload/sensors

Positives

Evolve Dynamics SkyMantis A left-field option here – Evolve Dynamics is a small UAV company based in Guildford, UK, and has been involved in the drone industry for several years. It recently developed a UAV aimed specifically at emergency services and search and rescue teams around the world. Evolve Dynamics is planning to launch the SkyMantis in summer 2017, with a price tag of around £15-20k. Specification includes a high standard of sensors, dual 30x HD/640x512 Flir IR/thermal, capable of deployments in high winds and rain, and sensors than can both look up vertically as well as straight down, a unique feature which provides ultimate flexibility when deployed.

Positives

Negatives

Flight duration (1 hour)

New player to this market sector

Variety and quality of sensors Deployment time (fold-up design) Weather capability (22 m/s and IP67 rating) 5 km video streaming (secure/encrypted) UK manufacture and support

www.airmedandrescue.com

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diary dates

diary dates

Oinkredible stuff. Lewis Hamilton and, err, Seboarstian Vettel, eat your heart out.

Send your diary dates to: info@airmedandrescue.com

Send your diary dates to: info@airmedandrescue.com

Two go to Malta

13-17 June

13-17 June

AAMS Carlsbad, California, US www.aams.org

AAMS Carlsbad, California, US www.aams.org

BIGGLES GIGGLES

RACQ LIFEFLIGHT RESCUE

The seventh annual Sandy Creek Pig Races raised some $8,000 for Australia’s RACQ LifeFlight Rescue helicopter service, making it one of the region’s most successful fundraisers for the charity. Hundreds of Darling Downs locals attended the popular in Warwick to cheer on eight fit little pigs that raced each other to bring home the bacon for LifeFlight Rescue patients. Organiser Jodie Crowley said the event continues to grow in popularity, with many locals knowing firsthand the importance of getting patients to emergency specialist medical care fast. Her granddaughter Summah is a past patient who has been urgently airlifted by the

RACQ LifeFlight Rescue helicopter twice – once when she was four days old, then again six months later, both times for lung trouble. Jodie said: “We started this event as we really wanted give back to LifeFlight because so many of us in the community have been airlifted and we are grateful for their help.” Now a healthy six-year-old, Summah looks forward to watching the Sandy Creek Pig Races every year. “She just loves everything about the races. She especially loved cheering on her favourite little pig dressed in a pink jacket,” said Jodie. LifeFlight’s South-West Community Engagement Coordinator Nikki Bloom said she was overwhelmed by the ongoing generosity of Darling Downs, who had supported four major fundraisers for LifeFlight in two weeks: “We are very grateful for the community’s ongoing support so we can continue to keep the Toowoomba based RACQ LifeFlight Rescue helicopter flying in the region.” 56 56

AIRMED & RESCUE

Getting to Malta without spending any money is an impressive feat. But one woman from Bristol, UK, managed it, and even raised money for her local helicopter air ambulance charity at the same time. Josie Ellen took part in a jailbreak challenge with the University of the West of England. The aim was to get as far away from Bristol as possible in 36 hours without spending any money. Along with her friend Freya, she ended up on Malta in the Mediterranean, and through their journey raised money for the Great Western Air Ambulance Charity. At first the pair, nicknamed ‘Frosie’, found the challenge difficult, having to try and blag themselves on to transport for free. However they eventually managed to reach London, thanks to the kindness of strangers who offered them lifts. Here their luck took a turn for the better as one good Samaritan bought them plane tickets to Malta. Josie said: “We made it into London, and into the worst situation we could. It was hopeless. No one would look at us, let alone buy us flights. However someone took pity on us and before we knew it we had been booked onto flights leaving the following morning from Gatwick Airport going to Malta.” Josie chose to support GWAAC as it is the local air ambulance for Bristol. She said: “I would honestly hand on heart recommend this challenge to anyone who has the opportunity to take part. I had the most fun time; it was scary and a bit mad at times, but I loved every second and it’s such a fantastic way to raise funds for charities and to see the world at the same time. I chose to support GWAAC as it saves lives and needs money to stay operational. It’s donations that keep the ambulance in the air, so they can keep saving lives.” GWAAC community fundraising co-ordinator Sam Roberts said: “Thanks to team Frosie for choosing GWAAC as their charity! Hopefully this will inspire other people to come up with wacky ways to raise money for us!”

Safety Management Training Academy

Safety Management Training Academy

21 June

24-29 July

Essex & Herts Air Ambulance Chelmsford, UK www.ehaat.org

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

Aeromedical conference – minds matter

ALEA EXPO

24-29 July

ALEA EXPO

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

21-25 August

CCAT Foundation Level Course

CCAT Aeromedical Training University of Surrey, Guildford, UK www.ccat-training.org.uk

26-28 August

Helicopter Medical Flight Crew Course

CCAT Aeromedical Training University of Surrey, Guildford, UK www.ccat-training.org.uk

5-7 September

Advanced Seminar

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

20-21 September

The Emergency Services Show Broden Media Hall 5, NEC, Birmingham, UK www.emergencyuk.com

27-29 Sept

Safety & Quality Summit

CHC Dallas-Fort Worth, Texas, US www.chcsafetyqualitysummit.com

2-4 October

Drone World Expo

JD Events San Jose Convention Center, San Jose, US www.droneworldexpo.com

3-5 October

Helitech GWAAC

Formula pork

BIGGLES GIGGLES

Reed Exhibitions Excel London, UK www.helitechinternational.com

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AirMed & Rescue Jun / Jul 2017  
AirMed & Rescue Jun / Jul 2017