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Y OURONES T OPS ARS HOP Comme r c i a l He l i c opt e rOpe r a t or s , Pa r apubl i cS a f e t yAge nc i e s , a ndDe f e ns eF or c e sne e dpr ov e n, c os te ffe c t i v e , a ndi nnov a t i v et r a i ni ng c a pa bi l i t i e st ha ta r es pe c ic a l l yr e l e v a ntt ope r f or mi ngt he i rmi s s i onma nda t e s .T r a i ni ngt hous a ndsofS e a r c h&Re s c uea ndT a c t i c a l s t ude nt swor l dwi de , on26di ffe r e nta i r c r a f tt y pe s , a ndha v i nge x pe r i e nc eope r a t i ngi ndi v e r s ee nv i r onme nt sa r oundt hegl obe , Pr i or i t y1 Ai rRe s c ueme e t st hede ma ndsofourc us t ome r sbyoffe r i ngt hemos tc ompr e he ns i v emi s s i ont r a i ni ngs ol ut i onsi nt hei ndus t r y . OurS e a r c h&Re s c uea ndT a c t i c a l T r a i ni ngAc a de my( S ART / T AC)i ss e t t i ngane ws t a nda r df ormi s s i ont r a i ni ngpe r f or ma nc ea nds a f e t yby e mpl oy i ngs y nt he t i choi s t / a e r i a lgunne r yv i r t ua ls i mul a t or s ,hoi s ta ndf a s t r opet r a i ni ngt owe r s ,a ndmode r nc l a s s r oomst ha tut i l i z e c ut t i nge dget e c hnol ogyt opr ov i deouruni v e r s a l l ya da pt a bl ea nds t a nda r di z e dmul t i mi s s i ont r a i ni nga ndope r a t i ona l S ARpr ogr a ms . Whe t he ry oua r el ook i ngf orCi v i l Av i a t i onAut hor i t y( CAA)c ompl i a nta ndc e r t ie dba s i ct oa dv a nc e dhoi s tmi s s i ont r a i ni ng, ne wa i r c r a f t t y peS ARr ol ec onv e r s i on,orc ompl e t et ur nk e yAi rAmbul a nc e / HE MSa ndS AR/ L I MS ARpr ogr a mi mpl e me nt a t i onwi t hope r a t i ona l Pa r a me di ca ndRe s c ueS pe c i a l i s tAi r c r e ws t a ffing, wede l i v e rpr ov e ns ol ut i ons . Pr i or i t y1Ai rRe s c uei sde di c a t e dt opr ov i di ngunpa r a l l e l e d c a pa bi l i t y , s a f e t y , a nds e r v i c et ope r f or ml i f e s a v i ngmi s s i ons .

Pr i or i t y1Ai rRe s c uey ourpa r t ne rf orS ART a c t i c a l Mi s s i onS uc c e s s

Fol l ow Us :


AIRMED & RESCUE MAGAZINE

magazine ISSUE 85 | AUGUST / SEPTEMBER 2017

ISSUE 85 AUGUST / SEPTEMBER 2017

Oorah in the Golden State

New helos, new era

Aerial firefighting, Marines style

AW169s enter UK HEMS

Making a DIFFerence

Provider profile

Integrating automatic firefighting for hospital helipads

Angel Flight, Australia


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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Production/Subscriptions: Richard James Design: Katie Mitchell, Tommy Baker, Eli Butler, Steve Mundey, Will McClelland, Peter Griffiths Marketing: Kate Knowles Finance: Elspeth Reid, Alex Rogers, Kirstin Reid Contact Information: Editorial: tel: +44 (0)117 922 6600 (Ext. 3) email: editorial@airmedandrescue.com Advertising: tel: +44 (0)117 922 6600 (Ext. 1) email: jamesm@airmedandrescue.com Online: www.airmedandrescue.com @airmedandrescue www.airmedandrescue.com/facebook www.airmedandrescue.com/linkedin www.vimeo.com/airmedandrescue

Oorah in the Golden Making a DIFFerence Integrating automatic firefighting State Aerial firefighting Marines style

for hospital helipads

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

Printed by Pensord Press Limited © Voyageur Publishing & Events 2017

New helos, new era

Provider profile

AW169s enter UK HEMS

Angel Flight, Australia

Main stories 24 44

magazine AIRMED & RESCUE ISSUE 85

Kenya anniversary AMREF Flying Doctors turns 60

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

Lite Flite ApS Lufthavnsvej 8 6580 Vamdrup DENMARK

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30

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Why HEMS pilots do From Iran to it backwards Germany Take-off and landings explained

How not to relive the hippy trail

ITIC Asia Pacific Bangkok The air medical sessions from the International Travel & Health Insurance Conference

Cover image: The new SAS AW169s for UK HEMS charities (top to bottom) Dorset and Somerset Air Ambulance, Lincs & Notts Air Ambulance, Kent Surrey Sussex Air Ambulance (Ed Hicks)


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Editor’s comment Welcome to Issue 85 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. The 10th anniversary of AirMed & Rescue doesn’t fall until next year, but as we prepared this issue I passed my own personal decade in service at Voyageur Publishing & Events. I found myself wondering what effect observing the air rescue world might have had. Reading about countless missions has engendered a deep respect for the crews that take to the skies to save lives, but what about the take-home lessons for my home life? What stands out most clearly is the philosophy, the ‘Zen of Air Rescue’ if you like, some of which has made it into my own SOPs. Expect to fall back on your training, not rise to the occasion I’m not sure where I first saw this, but it traces back to the US Navy SEALs and ultimately an ancient Greek poet (according to an Internet search). A good motivator when training gets tiring or you’re tempted to skimp on prep. To be honest, I find I tend to fall somewhere below the level of my training, making rehearsal and practice all the more important. The Swiss cheese of safety I’ve lost count of the number of times I’ve seen this safety diagram, it’s a conference stalwart. The concept is that each line of defence can let something slip through, like slices of Swiss cheese, and if the holes line up, an adverse event will occur. The practical interpretation in my personal life is perhaps not what this model is meant for – firstly, accept that bad things can happen, and second, to adopt multiple lines of defence to reduce the risk. ‘Mission’ focus This is one of the most important lessons as well as being one of the hardest to apply (isn’t that always the case?). Don’t get into the ‘must complete the mission’ mindset, maintain a view of the bigger picture, the higher priorities. This is allied to HAI president Matt Zuccaro’s advice to ‘land the damn helicopter’ (if you haven’t read that article, look it up). To be honest, I usually remember this in retrospect, realising after something’s gone wrong that I should have aborted earlier. Something to work on. Judgment trumps skill As Frank Borman put it, ‘a superior pilot uses his superior judgment to avoid situations which require the use of his superior skill’. This is a perfect antidote to bravado. Especially apt in situations where you don’t actually have superior skill. The lesson is that if you’re looking at taking an action that will need all of your skill/energy/concentration to pull off, you might want to think again. (There is also a take-home from CRM, which perhaps doesn’t flatter me much. Thanks to having been exposed to CRM concepts, when acting as PIC in the family car, I now politely accept – even almost appreciate – advice delivered from the other seat. Thank you CRM.) How has air rescue changed you? We hope you enjoy this issue of AirMed & Rescue Magazine.

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Research published on the Air Medical Journal website suggests that the current system of passive refrigeration of medications during interfacility transport may not be effective. Study authors Jason Clancy, Cassandra Karish, Meghan Roddy and Michael Bigham of the Akron Children’s Hospital, and Judith Sicilia of Salem Health Department in Ohio, US, found that ‘the current system of passive refrigeration does not appear to be sufficient for safely storing medications or pointof-care testing equipment for our transport services’. In an article titled Temperature-sensitive medications in interfacility transport: the ice pack myth, the authors suggest that this might reveal a flaw in existing practices. The aim of the study was to examine how effective current passive refrigeration is for transporting temperature-sensitive drugs and equipment. The researchers noted that critical care transport teams use various strategies to maintain items and equipment at their optimal temperature. The authors tested various configurations and initial starting temperatures of transport cooler packs, measuring their performance with a thermal probe placed inside the packs to check the temperature was kept within the 2°C-8°C range. The average round-trip transport time of past missions they reviewed was 2.5 hours, while over 15 per cent of transports lasted longer than four hours. According to the study, with a starting temperature of −3.9°C, the cooler and ice pack maintained acceptable temperatures for three hours. When the ice pack starting temperature was −12.9°C, the set-up prevented overheating for almost seven hours, but the temperature fell by 2°C in the first three hours. iSTAT cartridges remained within range for between one and four hours if the cooler and ice pack starting temperature was -3.9°C, said the researchers. In their conclusion, the authors stated: “This study shows that the current model of passive refrigeration is ineffective, resulting in temperature excursions for commonly used medications and equipment. Further research in this area should focus on identifying a reliable strategy for maintaining medication/iSTAT temperature thresholds.”

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Would you like to contribute? Are you interested or involved in any aspect of the air medical or air rescue industry? Whether you are an industry professional or a journalist with something to say, we would love to hear from you. Contact the AMR editorial team at editorial@airmedandrescue.com

Photo Courtesy HTM

James Paul Wallis Editor editor@airmedandrescue.com

Interfacility medication cooling insufficient


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CAMTS warning on stretcher clip decks The Commission on Accreditation of Medical Transport Systems (CAMTS) has shared an urgent safety notice issued by LifePort, warning that its Clip Decks are not to be used in ground vehicle transfers. In a blog post, CAMTS stated: “[We have] received several calls on this safety issue. We have been made aware of incidents as a result of the LifePort Clip Decks. We have been told that not all parties have received [the] notice from LifePort.” The LifePort safety notice shared by CAMTS warns users that the Clip Deck ‘is designed and to be used for the purposes of non-vehicular ground transfers only’. The notice continues: “LifePort’s Clip Deck is not designed, approved and should not be used, under any circumstances, to secure or retain an AeroSled during ground vehicle travel of any kind, including ambulance travel. LifePort’s Clip Deck is not, and has never been, intended to be used in ambulances or any type of ground vehicles, under any circumstances. Any such usage will expose all persons using the equipment, including but not limited to patients, passengers and medical professionals, to possible injury or death and therefore should be ceased immediately.” One air and ground medical transport provider recently shared its experiences with the Clip Deck via a report shared through the CONCERN Network. The report said: “While travelling on a wide

curve on a county road, the LifePort sled came out of its base – a LifePort Clip Deck which is bolted to the stretcher.” The ambulance was traveling at around 50 mph (80 kph) when the incident occurred, and the patient concerned weighed 195 lb (90 kg), said the report. The incident, which took place in May, was the third occurrence of a sled coming out of a clip deck. After the second ‘very serious’ occurrence happened in 2010, the organisation decided to replace the aluminium brackets with steel units. The previous incidents involved Clip Decks that had been in use for 10 years, but the example that failed in May was just sixmonths old and the brackets had not yet been replaced. The provider further stated that it learned of the safety notice via an AAMS Critical Care Ground Safety Interest Group. The report on CONCERN Network states that Lifeport told the provider that the product is a ‘stabilising device’ that ‘had always been intended to move patients from an aircraft to an ambulance only’, and that ‘they were never marketed or sold for ground transport’. AMR spoke to Air Ambulance Technology, Med-Pac and Bucher Leichtbau, which all offer aircraft medical interior solutions. However, none said it offers a product similar to the LifePort clip deck. Alexander Hudson of Air Ambulance

Technology commented: “We don’t produce anything that is used in an aircraft and road transport. Our interiors are used specifically for air transport, and when the patient needs to be transferred into a road ambulance, they are placed onto a stretcher designed for this purpose.” Meanwhile, a representative from Spectrum Aeromed said the firm does offer ‘an interface that is intended to secure the stretcher when transferring patients from the aircraft into the hospital’. However, the company added: “We do not have a certified product for ground ambulance transport as this isn’t a market segment we have been actively pursuing at this time. There have been no issues that have been brought to our attention.”

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UK helicopter SAR stats released Helicopters operating on behalf of the UK Maritime and Coastguard Agency carried out 2,594 civilian search and rescue (SAR) missions in the year ending March 2017, according to a report released by the Department of Transport on 14 June. The tally is a 54-per-cent increase on the previous year, which the Department said is due to bases still opening during the 2015/16 period as part of the process to transition to a new, unified contract with Bristow. On average, SAR helicopters across the UK responded to seven taskings a day, and the busiest base during the year was Caernarfon, which handled 344 taskings. Prestwick claimed a close second with 342 call-outs. 66

AIRMED & RESCUE

The least busy bases were Portland and Stornoway, responding to 123 taskings each. The base in Portland is due to close on 30 June 2017. Of all taskings, 1,542 (59 per cent) were rescue or recovery missions. The Sumburgh base had the highest proportion of rescue or recovery shouts (87 per cent), with the majority taking place out at sea. The period saw the helicopter fleet complete 560 search missions and 309 pre-arranged transfers and support missions. Overall, there was an even split between land and sea-based missions, with 49 per cent occurring on land, 34 per cent in coastal waters and 18 per cent more than three miles (five kilometres) from shore.

The summer period had more taskings compared to other seasons. This is likely to be due to greater leisure activity, said the Department. In August 2016, SAR helicopters responded to 372 taskings – the highest monthly number during the period covered. The SAR helicopter services completed around 70 per cent of all taskings, said the Department, including eight per cent of missions that were completed with nothing found. Stood-down taskings accounted for just over a quarter of all call-outs. Read the full report via www.airmedandrescue. com/story/2167.

www.airmedandrescue.com/readthemag


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NEWS

AMGH to merge with AMR

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AIRMED & RESCUE

this partnership will create an exceptional medical transportation company that will allow us to provide seamless, reliable and quality patient care to communities and health systems. The breadth of this combined organisation will enhance our ability to improve patient care in the ever changing healthcare landscape.” After the transaction is completed, the combined company will adopt a new name, said Envision, while AMR and AMGH will continue to support operations from two key leadership locations in Greenwood Village, Colorado, and Lewisville, Texas. Fred Buttrell, who will continue as president and CEO of the air medical division, said: “AMGH and AMR have worked together in many markets as well as disaster response and will have more integrated service offerings in the future for patients, health systems and regions. Together we will preserve the best attributes of each for the benefit of all stakeholders focusing on local market solutions. Employees will benefit from more opportunities as we expand our footprint into underserved communities.”

Edward Van Horne will maintain his role as president and CEO of the AMR division. He said: “Our partnership with AMGH will enable us to further expand our one-source solutions for health systems and communities. We can also continue to grow our innovative services in managed transportation, specialty fire services, mobile integrated healthcare, event medical, federal disaster response and ambulance services across the US.” The pending acquisition is subject to regulatory approval and customary closing conditions, including clearance under the Hart-Scott-Rodino Antitrust Improvements Act, and is expected to close in the fourth quarter of 2017, said Envision. Preferred equity financing for the transaction is being provided by KKR, primarily through its North America XI Fund, and by Koch Equity Development LLC (KED), the investment and acquisition subsidiary of Koch Industries, Inc. In April, AMGH announced it had agreed to acquire Air Medical Resource Group (AMRG).

Scandinavian Air Ambulance (SAA) has been awarded a new contract by the Norwegian Government to provide communities across Norway with vital air ambulance support, parent company Babcock reports. The six-year deal, with options to extend to 11 years, has a value of around £500 million, said the firm. It will see Babcock operate 11 specialist fixed-wing aircraft, including a Citation Latitude jet, giving patients critical access to specialist healthcare centres nationwide, particularly those in the north of the country. Babcock said the planes will become operational when the contract commences in 2019. Each will be fitted out with customdesigned medical interiors, featuring hospital-standard equipment. They will form a key part of Norway’s overall healthcare infrastructure, where hospitals are

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increasingly developing specialist skills and capabilities for particular areas of treatment. In a statement, Babcock said: “The introduction of a jet aircraft is a new development for the service and will dramatically reduce patient transfer times, allowing for direct patient flights across the whole of the country for the first time.” Babcock predicts the contract will create or sustain up to 100 jobs across seven Norwegian air bases – five in the north of the country, one on the west coast and one in Oslo. Marius Hansen of Babcock Scandinavian Air Ambulance said: “We are proud to have been selected to deliver this critical aspect of Norway’s healthcare infrastructure. As hospitals become specialised centres of medical excellence, it is more important than ever to have a trusted system in place to transport patients swiftly and

safely, with expert care, to where they can receive the best possible medical attention. This contract comes with a tremendous responsibility and will draw on the years of experience we have in delivering critical patient air ambulance care across Scandinavia.” The geography of the north of Norway, and in particular the archipelago of Svalbard, mean a fleet of fixed-wing aircraft are best suited to provide fast and efficient patient transport, said the firm. Hansen added: “By introducing a jet for the first time, we will dramatically reduce the time it will take to transport patients to the right hospitals. It is not only faster in flight, but it has improved range, too. This means we can provide direct flights for the first time, dramatically reducing the time it takes to move a patient to a specialist care unit – no matter where in the country they are.”

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Envision Healthcare Corporation has announced a deal that will see Air Medical Group Holdings (AMGH) join forces with American Medical Response (AMR). Envision said on 8 August that it has entered into a definitive agreement with an entity controlled by funds affiliated with KKR, under which KKR portfolio company AMGH and Envision’s medical transportation subsidiary AMR will combine to create a new medical transportation company. The transaction will be structured as a cash acquisition of AMR valued at US$2.4 billion, said Envision. In a statement, Envision said the combination of AMGH and AMR will create an integrated medical transportation company with the capability to serve patients across multiple transport modalities in the patient’s time of need. “The combined company is expected to transport more than five million patients per year through a fleet of air and ground ambulances across 46 states and the District of Columbia,” said the firm. Christopher A. Holden, Envision’s president and CEO, commented: “We are pleased to have identified a strong partner for AMR. The Envision leadership team conducted a robust process to review strategic alternatives for AMR. The agreement delivers on our commitment to continue the proud tradition of AMR and enables Envision to focus on its physiciancentric strategy and ongoing services, including facility-based provider services, post-acute care and ambulatory surgery.” Jim Momtazee, AMGH chairman and head of KKR’s healthcare industry team, said: “AMGH and AMR are pre-eminent providers of medical transportation responsible for delivering care to millions of patients every year. We are pleased to be able to bring together these two great companies and look forward to supporting the growth of the combined business.” Randel G. Owen, Envision’s president of ambulatory services, will assume the role of president and CEO of the new combined company. He commented: “We are excited to bring together 27,000 AMR team members with 6,600 AMGH team members to deliver customised solutions in the communities we support. We believe

Scandinavian Air Ambulance to operate new planes for Norway Health Service

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Experience the training that makes the difference.

Library image of Life Guard International (Flying ICU), which was acquired by AMR in July 2017

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Prince William completes last shift with East Anglian Air Ambulance

EAAA

Prince William has completed his final shift as a HEMS pilot, having worked with East Anglia Air Ambulance (EAAA) for two years. He hung up his flight suit for the last time on 27 July at Cambridge Airport, UK. On his final day at work, the Prince arrived for a night shift, and attended the hand over briefings from the day team as usual, before joining his team-mates at the helicopter he has flown for the past two years for a group photograph, the Royal Household press service reported. Prince William, also known as the Duke of Cambridge, joined EAAA as an air ambulance pilot in March 2015. After completing an initial period of job-specific training involving simulator, aircraft and in-flight skills training, he began piloting

his first operational missions in July 2015. Throughout his service, the Duke has been based out of Cambridge Airport, as part of a team including specialist doctors, critical care paramedics and pilots providing emergency medical services across Bedfordshire, Cambridgeshire, Norfolk and Suffolk, noted the Royal Household. Over the last two years, the Duke has enjoyed the opportunity to connect directly with the community of East Anglia and has valued being part of a team that provides such a critical and often life-saving public service, the Royal Household said. In article for the Eastern Daily Press to mark his last day at work, the Duke commented: “I wanted to say thank you to my colleagues, team mates and the people of East Anglia who I have been so proud to serve. Over the past two years I have met people from across the region who were in the most desperate of circumstances. As part of the team, I have been invited into people’s homes to share moments of extreme emotion, from Library image: Prince William shows his grandparents, Queen Elizabeth and the Duke of Edinburgh, around EAAA’s Cambridge base relief that we

Northern Ireland celebrates official HEMS launch have given someone a fighting chance, to profound grief. I have watched as incredibly skilled doctors and paramedics have saved people’s lives. These experiences have instilled in me a profound respect for the men and women who serve in our emergency services, which I hope to continue to champion even as I leave the profession. I am hugely grateful for having had this experience.” Patrick Peal, EAAA chief executive, said: “William has been an integral part of the EAAA team for the past two years. He is not only a fantastic pilot, but a much loved and valued member of the crew; he will be truly missed by everyone at EAAA. As one would expect, there has been a lot of excitement surrounding William and his work with the charity. To us, he has simply been another hard-working member of the team; one of 11 highly respected pilots who help us to save hundreds of lives each year. Our crews are tasked to some truly difficult and complex situations and can sometimes be subjected to harrowing experiences; it is a testament to them all how they manage these experiences on a daily basis. “We can’t thank William enough for his hard work and commitment to the charity during this time. He has been a true professional, delivering our doctors and critical care paramedics to patients under testing conditions. His dedication to the job and wonderful character will be greatly missed, and I know I speak for all of our staff when I say we wish him the very best of luck for the future,” he added. Prince William previously served as a search and rescue helicopter pilot with the UK Royal Air Force.

ITIJ Industry Awards 2017 Finalists announced The International Travel & Health Insurance Journal (ITIJ) has announced the finalists in this year’s ITIJ Industry Awards, which include an award for Air Ambulance Company of the Year. The finalists are: • Tyrol Air Ambulance • Air Alliance • ACE Air & Ambulance 10 10

AIRMED & RESCUE

Sarah Watson, editor of ITIJ, said: “I would like to take this opportunity to congratulate our finalists this year; the range of companies from all over the world that have reached this final stage of the competition is testament to the global nature of ITIJ and the industry we serve.” Ian Cameron, editor in chief of ITIJ, added:

“We are very much looking forward to presenting the awards in Barcelona on 9 November, it’s going to be a fantastic occasion, with all the major players in the industry attending the ITIJ Industry Awards ceremony.” The Awards will be streamed live online via the ITIJ website.

The official launch of Air Ambulance Northern Ireland on 2 August marked the culmination of a 12-year campaign backed by the public and driven by key individuals throughout that period, the Northern Ireland Ambulance Service (NIAS) noted in a statement. The new doctor/paramedic-

led service will be of most benefit to those whose lives are at serious risk following significant injury or trauma, said NIAS The HEMS service has already attended a number of incidents during preparatory and training periods over the last few weeks. The first call the service was

dispatched to was to help a young boy, Conor, who was injured in a farm incident in Castlewellan on 22 July and quickly airlifted to the Royal Victoria Hospital for treatment. Conor and his family attended the launch and were introduced to the HEMS crew that helped him on the day.

Knudstrup moves up to CEO of Lite Flite Danish manufacturer of helicopter rescue equipment Lite Flite ApS announced in August that Thomas Knudstrup has been appointed as CEO, managing director and accountable manager. Prior to this appointment, Thomas spent five years as senior product manager for the company, and in this position, gained a substantial knowledge about products and customers. Additionally, Thomas became co-owner

in 2013. Former CEO Søs Holstein said of the appointment: “I am excited to hand over the CEO position to Thomas, and I have decided to stay within Lite Flite and assist with administrative work. Thomas will take Lite Flite to the next level with his great experience, knowledge and, most important, drive towards todays challenging quality standards

and certifications.” Furthermore, a Board of Directors has recently been set up to strengthen the company’s development. Chairman of the Board is Folke Bjerg, and members are founder John Holstein and Christel Wienziers. Additionally, Torben Bech has been employed as quality manager to strengthen quality management even more.

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RAPID RESPONSE

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AIR AMBULANCE The US Coast Guard has reported on the Seventh Pacific Regional SAR Workshop, which took place in May 2017. By Officer 3rd Class Amanda Levasseur When a mariner is found at sea it is no accident. In fact, it is often the result of hours of deliberate search and rescue (SAR) planning and continually nurtured partnerships across jurisdictions and borders. SAR governance is an important element in the Pacific, where vast distances and limited resources make saving lives all the more challenging.

USCG / PETTY OFFICER 3RD CLASS AMANDA LEVASSEUR

The Pacific Search and Rescue (PASCAR) Steering Committee The Committee is a collective of SAR agencies from five principle nations: Australia, Fiji, France, New Zealand and the US. These nations hold responsibility for significant SAR regions of the Central and Southeastern Pacific. Each nation is committed to working with neighbouring countries or territories within or near their areas of responsibility to build SAR response capability. Communally, the committee is working to build SAR capability and co-operation across the Pacific to work together seamlessly to save lives. “By working to build capability at four levels, across governance, co-

ordination, response and prevention, we can ensure that all Pacific island countries and territories have a firm foundation for engaging in SAR response, as well as the necessary capability and capacity to do so,” said Mike Hill, manager, Rescue Co-ordination Center New Zealand and Safety Services, Maritime New Zealand. “At the core of all this work are relationships. As we build understanding and trust across the SAR agencies in the region, we will be better able to learn from each other.” A key mechanism for enhancing SAR capability and co-operation across the Pacific is the biennial SAR workshop. The workshop is hosted by one of the nations involved in the PACSAR Steering Committee and provides an opportunity for both aeronautical and maritime SAR authorities from all Pacific island countries and territories to come together and share knowledge, ideas, expertise and build collaborative relationships. “The principal nations in the region with support from the Secretariat of the Pacific Community have been working alongside each of the Pacific Island Countries and Territories over the past 12 years to collectively shape improvements to the region’s SAR system,” said Cmdr Solomon Thompson, chief of the Response Management Branch, Coast Guard 14th District. “These efforts have saved countless lives and provided an example of >>

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Petty Officer 2nd Class Mandi Stevens and Petty Officer 2nd Class Chris Parameter, aviation maintenance technician at US Coast Guard Air Station Barbers Point, point for local media in Auckland, New Zealand, 23 May

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NEWS

Members of the Pacific Search and Rescue Steering Committee share knowledge, ideas and experiences at the Seventh Pacific Regional Search and Rescue Workshop in Auckland, New Zealand, 23 May

co-operation for other countries around the globe. We have many milestone achievements, but there is still work to be done to ready our response across the region.”

USCG / PETTY OFFICER 3RD CLASS AMANDA LEVASSEUR

The Workshop This year’s Seventh Pacific Regional SAR Workshop was held in Auckland, New Zealand, jointly hosted and organised by the Government of New Zealand with support of the International Maritime Organization (IMO) and Pacific Community. The workshop was the largest attended event since its inception in 2006, with over 110 attendees representing 21 Pacific island countries and territories and another 14 regional partners and observers including International Maritime Organization (IMO) and International Maritime Rescue Federation. “This regional workshop is very vital as it provides an opportunity for those who have responsibilities in SAR to discuss their common issues and share some best practices on how to resolve them, and the IMO is proud to support this workshop and PACSAR’s vital work in the region,” said IMO’s

head of the Latin America and Caribbean section, Technical Co-operation Division, Carlos Salgado. “We discuss building up capacities and resources to improve abilities to comply with international rules and standards.” The US Coast Guard was involved in several facets of the workshop, from presentations and governance discussion to demonstrations, and as it happens, an actual SAR case. Members of the US Coast Guard Headquarters, Coast Guard 14th District response and prevention management staff and Coast Guard Sector Guam response staff participated in the week-long events. “We are beginning to see the cumulative results of all the previous workshops and collaboration amongst the many countries,” said Rich Roberts, SAR specialist, Coast Guard 14th District, and current chair of the PACSAR Steering Committee. “This by far was our most successful workshop. We look to leverage the momentum from this year’s workshop as participants gained an understanding of how they can be the catalyst to improve their countries SAR response and leave a legacy of lives saved. We will begin to work on the outcomes of this year’s workshop as we prepare and plan for our next workshop.” The 14th Coast Guard District is scheduled to host the next workshop in Honolulu in 2019. The long-term goal of these events is to further the mission of the steering committee: to measurably improve the SAR capability of each of the Pacific island countries or territories in line with international standards and the PACSAR measures of success by 2021. The workshops are not the only way this is being done. In 2016, Palau signed their own National SAR Plan and recently established a National SAR Committee as they develop a Mass Rescue Operations Plan. The workshop is a place to share these successes and continue the learning process on all sides by assessing strengths, risks and opportunities for partnerships and learning from each other. “The biennial Pacific Regional SAR Workshop is an excellent forum for improving SAR capability and capacity throughout the Pacific region,” said Dave Edwards, of the US Coast Guard International SAR Engagement and Policy office. “Coast Guard’s 14th District staff demonstrated strong leadership as one of the five principal nations working together for the numerous island states and territories throughout Oceania. The co-ordinated effort of the principals creates support from the International Maritime Organization and the Pacific Community, which enables the lesser developed states to attend the workshops and development of a strategic plan whose implementation has already shown results, especially in political will of all governments. By already planning for the next session in 2019, momentum will be sustained by all Pacific island states and territories to show their continued improvement for SAR. We in CG-SAR look forward to supporting D14.”

Petty Officer 2nd Class Mandi Stevens and Petty Officer 2nd Class Chris Parmenter, aviation maintenance technicians from US Coast Guard Air Station Barbers Point, Hawaii, prepare a long range deployable drop kit to a disabled vessel approximately 80 miles off Tonga, 25

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Demonstration becomes reality An HC-130 Hercules aircrew from US Coast Guard Air Station Barbers Point also deployed to New Zealand

USCG / PETTY OFFICER 3RD CLASS AMANDA LEVASSEUR

USCG / CMDR SOLOMON THOMPSON

NEWS

Hawaii. Prior to departure, the crew was notified of a Tongan vessel two days overdue. Tonga is in the Pacific region, relevant to the workshop just held and in the path of the Hercules’s flight home. Despite being eager to return home, the crew agreed to conduct search patterns off the coast of Tonga to search for the overdue vessel and the six men aboard. Four hours into the flight, the crew arrived in the area the Tongan vessel was believed to be. Though loss of daylight was a challenge, the crew began search patterns provided by Rescue Co-ordination Center New Zealand. Lt Cmdr Michael Koehler, pilot of the Hercules, wore night vision goggles while scanning the dark waters below. Other crewmembers were in the belly of the plane scanning the ocean using C-130 Airborne Sensor Palletized Members of the Pacific Search and Rescue Steering Committee stand with the US Coast Guard HC-130 Hercules airplane in Auckland, New Zealand, 23 May Electronic Reconnaissance. In less than two hours, 80 miles off Tonga, Koehler saw something in the water. The crew zoomed in on to participate in the SAR demonstration and represent the US. They were the camera monitor. A 40-ft vessel was spotted with men on top of their received warmly by their Kiwi counterparts. superstructure waving their arms and white cloths. “It’s been a long time since the Americans have managed to get to New The Tongan vessel lost power days prior and drifted off shore with no Zealand, about 20 plus years,” said Flight Lt Brett Mann, pilot, New communication capabilities. The Hercules prepared for a gear drop, Zealand Air Force 5 Squadron. “With the doors being open to this kind of much like the one they had just demonstrated the day before during the engagement, it means we have an actual opportunity to see how things have SAR workshop when they dropped a life raft, except this time they were changed from 20 years ago and rebuild our partnerships, understand how preparing to deliver a long-range deployable drop kit. The kit included we operate our aircraft and pick up where we left off.” food rations, water, a VHF radio to make contact with the vessel and a The Pacific region faces a unique set of challenges when it comes to SAR. transponder to emit their location. With small countries and dispersed island groups with diverse levels of The deployable long-range drop kit is not standard across the Coast Guard. economic growth and significant communication challenges, there is limited It is a combination of equipment customised and packaged together carried access to SAR assets and response co-ordination capabilities. Effective by Air Station Barbers Point’s Hercules crews for these exact situations. response in an already challenging field becomes even more difficult over the Best practices such as this are some of the things shared at workshops and 31 million square miles of Pacific Ocean with dynamic weather. By working professional exchanges that allow for an improved response in a region together with international partners, proficiency is established that can known for its great distances and remote areas. The aircrew once again increase successes and lives saved. performed a successful drop and the Tongan crew received the kit. They The PACSAR demonstration took place in and over the water of Waitemat confirmed they were indeed stranded and needed help. By using the Harbour while the US Coast Guard aircrew dropped a life raft from the included transponder to keep the vessel’s exact drifting location, Joint Rescue back of its plane to a simulated vessel in distress. The US plane was a single Co-ordination Center New Zealand personnel were able to pass the comoving piece in a collection of agencies demonstrating how multiple nations ordinates to a Tongan naval patrol boat launched the following morning. The can work together during the event of a potential SAR case in shared Pacific six men were successfully located and brought home safely. waters efficiently and successfully. This exercise also provided an opportunity “I am proud of my crew and how well we represented the US this past for participants who execute SAR in the field and conduct planning to share week,” said Koehler. “We were in New Zealand at the 2017 Pacific SAR real-life experiences, techniques and methods. Conference talking to delegates from Tonga about SAR capabilities, and the “If we’re up there searching, and they’re up there searching, it could cross next day we spotted a disabled vessel 80 miles off of Tonga’s shore using over an understanding of how we’re going to be searching together so we’re not stepping on each other’s toes and figure out the best way to do our job,” night vision goggles without the use of radar. The conference was designed to strengthen relationships and enhance SAR interoperability in the region said Mann. “The Herc can fly a bit lower and slower than we can, so that’s to address rescue situations exactly like this; working together, we are saving going to help with the visual searches, while we fly faster and we use our lives in the Pacific.” sensors a lot more. What we picked up was good techniques for us to use for visual searches and we can pass on good techniques for sensor searches.” Upon completion of the week-long conference and harbour demonstration, Article first appeared in Coast Guard Compass, official blog of the US the Hercules crew prepared for their long flight home, back to Oahu, Coast Guard.

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EQUIPMENT

INDUSTRY VOICE

US Army signs five-year Black Hawk deal with Sikorsky

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Best Practice, as this is often misunderstood. We define Scope of Service broadly to include the scope of care, modes of transport and mission limitations (those things the service will not do). How a programme holds itself out to the public is as important to CAMTS as it is to the requesting

agencies. The programme needs to state clearly which requests they will or will not accept. Much of the information requested in the accreditation application is reviewed as it applies to the Scope of Service and includes: advertising materials and websites; statistics; training and medical protocols; and medical equipment. The examples that follow typify the types of things found in Scope of Services that would require clarification: • Website advertising and brochures can be worded to overstate or misrepresent the scope of service. For example, we sometimes see a Learjet pictured on a website for a service that has a King Air. Yes, the Learjet is more impressive, and maybe most of the public would not recognise the difference – an airplane is an airplane - but this is still deceiving to a requesting agent that is trying to arrange

for a long-distance fixed-wing transport. • Statistics are part of the requested materials and include patient types. If a programme lists 20 high-risk OB (HROB) transports over the past year, for example, but HROB transports are not listed in the scope of care, we will need to clarify. • Training, both initial and recurrent, must include education pertinent to the types of patients the crews may encounter as identified in the scope of care. For example, if a programme states they will accept requests for HROB patients, but the crew has no training in HROB and there are no obstetric medical protocols, the programme will be asked for clarification. • Types of equipment on the aircraft or ambulance must support the Scope of Service, or there is a disconnect that requires further clarification. For example, if a programme lists they transport critical paediatrics (from 30 days to 14 years) but the ventilator on the aircraft is not suitable for infants, the scope of care may not be accurate. The mission of CAMTS is to improve patient care and transport safety. The Best Practices publication has been updated to provide many examples that support this mission. This new publication is available electronically on a thumb-drive and can be ordered directly from the camts.org website. Best Practices will also be available at the CAMTS EU exhibit booth during Helitech at the ExCel in London, 2 to 5 October. ”

up to 2022. Colonel Billy Jackson, the US Army utility helicopters project manager, stated: “This contract will provide our Army, sister services and allies with state-of-the-art

modernised helicopters to complete crucial missions and save lives. Moreover, this effort will stabilise our manufacturing base and control long-term costs, and ultimately provide significant savings to the taxpayer.”

SIKORSKY

The Commission on Accreditation of Medical Transport Systems (CAMTS) published the sixth issue of Best Practices in July 2017. The policies and practices selected for this publication are acknowledged as excellent examples of efforts to improve safety, quality and education as the CAMTS board of directors reviews medical transport services applying for accreditation. The CAMTS Best Practices publication has been collecting these special policies and practices for many years, and we are fortunate to have programmes that are willing to share their materials and contribute to Best Practices. Contributors are specific medical transport programmes and also members of the medical transport community such as private corporations and the US Helicopter Safety Team (USHST). Along with innovative practices, Best Practices also focuses on the areas that are most frequently cited as not meeting compliance with standards. This publication is not meant to endorse or recommend any particular policy or service – it is merely to be used as a resource document, especially in areas where many programmes struggle such as safety management systems, quality and utilisation management, and initial and recurrent training. Each document listed in the index is identified by its title and by the contributor. The CAMTS 2017 Best Practices includes 72 examples, under the headings of Policies, Quality Management, Utilization Review, Education, Safety, and Community Interface. These practices address many current issues facing medical transportation programmes today such as a drone safety policy; never events; risk assessment tools, including a medical escort risk assessment and an airway risk assessment; crew resource management simulator training; human factors training for mechanics; and a Ground and Air Medical Quality Transport database (GAMUT) tutorial. Also, the document includes a section devoted to preparing for CAMTS and CAMTS EU accreditation, which provides an example from a completed standards compliance tool. There is an example of a scope of Service in

Sikorsky, a Lockheed Martin company, has signed a five-year contract for 257 H-60 Black Hawk helicopters to be delivered to the US Army and foreign military sales customers. The multi-year contract will yield significant savings for the US government, said the manufacturer, compared with purchasing the same quantity across five separate annual agreements. The deal marks the ninth multipleyear contract for Sikorsky and the US government for H-60 series helicopters, noted Sikorsky. The contract value for expected deliveries is approximately $3.8 billion and includes options for an additional 103 aircraft, with the total contract value potentially reaching $5.2 billion, said the firm. Actual production quantities will be determined year-by-year over the life of the programme, based on funding allocations set by Congress and Pentagon acquisition priorities. The deliveries are scheduled to begin in October of this year and continue

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MISSIONS

MISSIONS

Afghan Air Force conducts bilateral missions with coalition forces

SERVICIO NACIONAL DE PANAMÁ

The US military has reported that personnel from the Train, Advise, Assist, Command – Air (TAAC-Air) and the Afghan Air Force conducted a bilateral casualty evacuation mission and an aerial resupply training exercise on 9 and 10 July. Afghan pilots and US Air Force (USAF) advisors from the 538th Air Expeditionary Advisory Squadron onboard a C-130 plane made a return flight from Hamid Karzai

LT CMDR KATHRYN GRAY

Panama’s Servicio Nacional Aeronaval (National Air-Sea Service) has hailed the success of one of its crews, who delivered a

International Airport to Kandahar Airfield to drop off supplies and facilitate the movement of wounded Afghan National Defence and Security Force personnel back to Kabul for further treatment. Lt Col James Torok, a USAF C-130 advisor, said: “We fly several missions per week. At this point we’re pretty much in an assisting phase. Advising mainly comes into play

LT CMDR KATHRYN GRAY

Rescuers make TV appearance after baby born in flight baby mid-flight at 3,000 ft at 12:45 hrs on 15 July. The four strong crew appeared on Jelou, a programme on TV channel TVN-2, to recount the mission. Making an appearance were pilot Major Julio Peralta, Captain Neftali Abrego, paramedic Second Lieutenant Joseph Jiménez and Dr Abdiel Garcia. “There were difficult moments,” reflected Garcia. “She [the mother] asked what was happening and I told her to stay calm.” In a statement, the National Air-Sea Service described the team as ‘heroes of the air’,

praising their swift actions. The baby, the mother’s third child, was born on plane AN-040 despite multiple complications, said the Service. The 21-year-old woman was being flown from Puerto Obaldía to Panama City following a premature rupture of membrane. The aircraft was dispatched as she was in significant pain and a discharge of meconium was detected. When the crew arrived to pick her up, they found that mother and baby had good vital signs, with contractions every 10 minutes. Both crew and patient were surprised by the baby’s arrival during the flight, said the Service. The programme’s presenters said: “It was an incredible job, they are wonderful, they are true angels of the Aeronaval.” The mother has named her new daughter Milagros, which is Spanish for miracles.

when dealing with aircrew equipment and procurement. The Afghans are no longer coalition-dependent on airlift missions.” The entire C-130 airlift mission was planned, co-ordinated, controlled and executed by the Afghan Air Force, noted the USAF. Afghan Air Force Maj. Khial M. Shinwari served as the aircraft commander of the recent mission.

Three organ transport missions in less than 36 hours The Brazilian Air Force has reported that its Fourth Air Transport Squadron (Quarto Esquadrão de Transporte Aéreo), located at 13 Wing in Guarulhos, also known as Carajá Squadron, recently participated in three separate organ transport missions on three consecutive days. On 5 July, after being tasked by the National Transplant Center, the squadron took off in a C-97 Brasilia plane in less than an hour and a half, heading for Sorocaba, where medical staff were brought onboard. The team then flew to Barretos to harvest the organ. Aircraft commander Air Captain Bruno 18 18

AIRMED & RESCUE

Pereira Orsi explained: “The extraction procedure took about three hours. The dawn was cold and the waiting made us anxious. At the time, I just hoped God was with the medical team and everything worked.” After extraction, the liver was flown to Sorocaba and the aircraft returned to Guarulhos. On 6 July, prior to the completion of ground procedures after landing, the squadron was tasked for a further transplant mission. This time, the call was to collect a liver at the Base Hospital of São José do Rio Preto and transport it to the Santa Casa de São José dos Campos.

Air Major Rodrigo Santos de Faria, commander of the aircraft involved, said: “When I was called about [05:20 hrs], I was informed that the duty crew had landed a few minutes ago, and others had already called for the squadron. Knowing this, I did not hesitate! I quickly donned the uniform to accomplish the mission. It was very gratifying to know that my work contributed to saving a life.” After completing the second mission, the Squadron received a third call on 7 July. In this shout, a liver from Ourinhos was transported to São José do Rio Preto. The three missions comprised over nine flight hours.

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MISSIONS

MISSIONS

DINO MARCELLINO

Seven Corners Assist reports on a case that garnered global attention due to the fact that their patient was none other than Buzz Aldrin, the second man to walk on the moon and a true adventurer The Italian Air Force supplied two HH-101s

Dino Marcellino reports on the Air Centric Personnel Recovery Operatives Course 2017, which took place at the Italian Air Force Base in Rivolto, Italy, from 14 to 28 June.

DINO MARCELLINO

The Air Centric Personnel Recovery Operatives Course (APROC) is held each year by one of the seven countries who are members of the European Personnel Recovery Centre (EPRC). This year’s was the second event, following the debut course held in Germany in 2017. The event is a training activity organised to

Image from a simulated recovery mission

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qualify the military crews, from the Air Forces of Belgium, France, Germany, Italy, the Netherlands, the UK and Spain, in personnel recovery, the rescue and recovery of military staff and civilians in hostile and non-permissive environments (for example, the isolation or capture of personnel during operations, or recovery of Embassy staff in destabilised countries). More than 450 military staff attended Rivolto Air Base. The first two days were spent on theoretical teaching. This was followed by simulating a complex scenario in the northeast Italian territory,

where the helicopter crews trained to conduct realistic recovery missions. In addition to the recovery areas - named PUZs (pick-up zones) - other locations were prepared to be used as forward arming and refuelling points, where the helicopters could land and refuel during operations, increasing their operational range, as can happen in a real mission. The Italian Air Force 2nd Wing, based in Rivolto, provided the operative and logistical support for the two-week-long exercise. A total of 15 helicopters were deployed: two HH-101s, two HH-139s and an HH-212 from the Italian Air Force; an EH-101 and an SH-90 from the Italian Navy; two MI-24 Hinds and two W-3s from the Polish Air Force; and two AS550 Fennecs and a pair of AS725 Caracals from the French Air Force. Also taking part were Italian Air Force fighters – the AMX from 51th Wing, Tornado from 6th Wing and Eurofighters from 4th Wing. During training, a Polish W-3 Sokol suffered a technical problem. It was forced to land in a rural location and subsequently caught fire. However, all six people onboard escaped safely. The EPRC was inaugurated on 8 July 2015, at an Italian Air Force Base in Poggio Renatico. It was established to create a viable and credible Personnel Recovery (PR) capability for European nations.

Aldrin developed serious medical issues during a trip to the South Pole this past winter, requiring an emergency medical evacuation. He ultimately returned home safe after two stops along the way, receiving necessary medical care to ensure he was strong enough for the long flight back to the US. As is the case with most emergency medical evacuations, there were many people involved throughout the process, all working to ensure a successful outcome. Buzz’s situation While travelling with a tour group and talking with scientists at the National Science Foundation (NSF) located at the South Pole, Buzz developed difficulty breathing. His oxygen saturation dropped, and the doctor there recommended he travel immediately to McMurdo base in Antarctica because the high altitude (9,300 ft) was impacting his condition. The NSF moved quickly, placing Buzz on a flight to McMurdo Station and then on to Christchurch, New Zealand. While there, he was hospitalised for several days and treated with antibiotics, after being diagnosed with fluid on his lungs.   Seven Corners learned about Buzz’s situation when the manager of the tour group called to advise us that Buzz was being flown to McMurdo and on to New Zealand. Armed with this information, the Seven Corners Assist team co-ordinated efforts with the NSF and Buzz’s manager, who was travelling with him. The

Seven Corners Assist team included international assistance co-ordinators and our staff physician and nurses. Travel insurance makes a difference Seven Corners Assist provided several benefits and services that are typically included in a travel insurance plan, including the emergency reunion benefit, which paid the cost of flying Buzz’s daughter, Jan, to his bedside. Normally, the insured chooses who they would like to travel to their side, and the cost of a roundtrip economy airfare is covered, along with a daily limit for travel and accommodation expenses. As part of the emergency medical evacuation benefit, Seven Corners Assist flew a nurse from the US to the hospital to monitor his condition and fly home with him. This benefit covered a business-class seat and the cost of the medical escort. While Buzz was well enough to travel on a commercial flight, the escort monitored his condition until he arrived home, checking his vitals each hour and administering medication as prescribed. The benefit also covered our reimbursement to the NSF for the flight from the South Pole base to New Zealand. The medical expenses benefit provided coverage for Buzz’s medical care and hospital stay. It is important to know that many medical providers require payment before they will discharge a patient. In Buzz’s case, the hospital agreed to accept a guarantee of payment, a document which states that the carrier agrees to pay for treatment. Challenges Buzz’s situation was particularly difficult because of the huge time difference (16 hours) between

his location and the assistance team, which impacted information flow. According to assistance co-ordinator Wesley Smith: “We were originally told it would take a week for Buzz to recover enough to fly home. He recuperated much quicker than expected, and while we were very happy about his recovery, we had to work quickly to get the escort to him in time.” The flight was 24 hours long! A second challenge occurred at the airport in Orlando, where Buzz drew a crowd. Wesley contacted airport security and obtained approval to park at the curb. This way, Buzz was able to go straight from the plane to his limo, without interference from the crowd.

Author Justin Tysdal brings more than 20 years of business leadership and healthcare industry experience to his role as chief executive officer of Seven Corners, Inc. As the company’s cofounder and visionary, he is responsible for setting its strategic direction and long-term growth plans. In this capacity, he leverages his vast knowledge and successful track record of developing customised healthcare solutions, creating innovative informational system concepts, designing travel medical insurance programmes, and modifying existing industry services to meet the future needs of international travellers.

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MISSIONS

MISSIONS

Marm Assistance shares details of a case in which timely organisation and foresight, in the face of various adversities, enabled a life to be saved A 54-year-old German traveller sustained life-threatening injuries in a road traffic accident in Iran, near the Iran-Afghan border, during a motorcycle group overland tour from Europe to South Asia. He was taken to a local hospital before being referred to a better-equipped facility in the nearby city of Mashhad. Marm was instructed by the primary insurer to administrate further arrangements.

necessary and complex local procedures, was completed within four and a half hours. At the same time, coordination was established with the appropriate ground handling company; and tarmac access and CIP entry was organised for the ground ambulance transfer from the hospital. English-speaking crew was also arranged in order to facilitate communication with the understandably distressed patient. Similarly, much needed patient counselling services were worked out with the only English-speaking head

Germany; and three alternative, conveniently located airports were kept on standby in case of any departure delays at Mashhad causing slot expiry for the first leg. Judgement day With watertight plans in place, and all seeming to be under control, a new complication was thrown into the merciless mix when the psychological condition of the patient began to deteriorate just as it was almost time to initiate

Challenges Initial medical reports indicated bilateral hip and ankle fractures, with the left foot posing the most serious issue owing to a compromised blood supply. Surgical attempts at revascularisation of the acutely ischemic appendage proved unsuccessful, citing a history of two previous surgeries at the same site. The patient remained in intensive care and a local medical council, including representatives from the Ministry of Health, gathered to discuss the best course of medical treatment for him. Their decision was to recommend an amputation, correlating with the expiry of a clinically narrow, limb-salvaging time window of around six hours in cases of Acute Limb Ischemia (ALI)1. The patient refused the amputation and insisted on having any further therapeutic interventions back home in Germany. This delay to his treatment now put him at high risk of progression of the ALI to life-threatening tissue necrosis (gangrene). Solutions Marm set to work, putting into place detailed logistics in a race against time to save the patient’s life. Our Istanbul and Tehran offices worked together to urgently formulate complex arrangements and crucial contingency plans that covered all possible scenarios, which involved liaising with multiple local service providers, the health ministry and German embassy officials. A landing permit and slot was acquired in a timely manner from the local airport for the incoming air ambulance. This potentially difficult and time-consuming task, considering the 22 22

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of department at the hospital. The designated air ambulance was customequipped, including a spine board and vacuum stretcher essential for an immobilised patient, along with all the other relevant therapeutic modalities the escorting medical crew might require for ensuring a comfortable and safe passage for the patient. A wing-to-wing transfer was arranged from Istanbul’s Sabiha Gökçen Airport for the second leg, with the air ambulance coming in from

the evacuation. A possible triggering factor could have been the arrival of the third party involved in the road crash, who turned up to claim damages. The local police and the German consulate were urgently involved to help resolve the issue, but it eventually cost a precious 45-minute delay during the hospital discharge process. It was then time for the ground ambulance crew to execute their part, despite the patient developing a worsening non-cooperative and paranoid attitude. The transfer was closely

monitored by the concerned Marm mission centres and despite real-time feedback from the road ambulance crew including the phrases ‘too much nervous’, ‘flushing’ and ‘too much stress’, with the patient’s vital signs shooting up to near emergency levels, we appreciated the eventual disaster-free transfer to the waiting air ambulance. There were more hurdles to overcome, however. Upon reaching the airport, it was discovered that the patient seemed to be missing his passport. The resulting intense search operation, involving all likely locations, culminated with the document being found on the patient himself. As a precaution, against a misperceived threat from the local police, he had decided to hide it. This set back the mission schedule by another 45 minutes, and the end result was the expiry of the landing permission at Sabiha Gökçen Airport. Plan B was, thus, immediately activated and the standby option for the wingto-wing transfer to Istanbul’s Atatürk Airport was approved as good to go. En route, the flight doctor and paramedic worked strenuously to keep the patient, who was also at high risk of pulmonary embolism, complication free. The specialised stretcher arrangements, close monitoring and administration of the therapeutic modalities enabled this. The patient’s mental state became calmer, which was reflected by a return of his vital signs to safer and more acceptable levels. A smooth changeover took place at Istanbul and the second leg was also concluded in a trouble-free manner. Ultimately, within two days of crashing into another motor vehicle, breaking his hip and ankles and nearly losing his life, not to mention

also splitting his motorcycle in two, the rider safely reached the sanctuary of a hospital in Nuremberg. Marm’s final job was to arrange for his belongings and what was left of the bike to be delivered to the local German embassy. Discussion As was already clinically evident, especially after the failure of the attempted revascularisation procedures, and regardless of the best possible efforts off all involved, the patient still had to undergo an immediate foot amputation when back home. Despite great advances in care, and heightened diagnostic recognition, ALI is still associated with rates of limb loss of up to 30 per cent and associated in-hospital mortality rates as high as 20 per cent2. While a very heartening and comprehensive letter of appreciation was received from the patient later, we still feel that this story did not have the ideal happy ending, as the individual will have to live with a permanent disability. At the same time, we are highly grateful that his life was preserved, notwithstanding his extremely close exposure to a potentially fatal chain of events. As may be evident from this shared experience, being able to adapt to unconventional situations, coupled with divergent thinking, especially in situations involving a life-saving evacuation, are abilities essential in this industry. Mass coordinated efforts, involving the private and public sectors, as well as other requisite local points of contact, are vital in being able to successfully run such complicated missions. And, more importantly, even with all the principal arrangements firmly in place, the foresight to

have backup plans with all participants in the mission is also a hallmark of a quintessential medical evacuation provider.

References 1 – Ken Callum and Andrew Bradbury: ‘’ABC of arterial and venous disease’’, edited by Richard Donnelly and Nick J M London. BMJ. 2000 Mar 18; 320(7237): 764–767 2 – Daniel Purcell, MD, Matthew Salzberg, MD, and Vincent Kan, MD: Acute Limb Ischemia: Pearls and Pitfalls, edited by: Alex Koyfman, MD and Manpreet Singh, MD. FOAMed Review. 35th Edition 2015 Feb 25

Author Dr Saifullah Khan is the medical manager of MENA operations at Marm Assistance. Since completing his medical training, he has worked in the humanitarian sector, corporate management and hospital administration, and is now a key member of the medical team responsible for global assistance operations at Marm Assistance.

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FEATURE

FEATURE

AMREF FLYING DOCTORS

Michael Wood loading a patient into his aircraft

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– has expanded its scope to improve healthcare for populations in many countries in Africa. At the same time, AMREF Flying Doctors has grown from the original outreach flights that brought specialist surgical skills to remote hospitals in the East African region, into a world class air ambulance service that now evacuates thousands of patients from and to destinations all over the globe. From a budget of US$14,000 60 years ago, AMREF Flying Doctors has developed into a company with an annual budget of $15 million. Funds generated by AFD’s commercial operations help finance Amref Health Africa’s Medical Outreach Programme as well as charity evacuation flights, and play a vital role in supporting Amref Health Africa achieve its ongoing mission of lasting health change in Africa. Apart from its international air ambulance services, AMREF Flying Doctors operates a successful membership scheme under the Swahili name MAISHA (meaning ‘LIFE’), which gives its members free aeromedical evacuation services from the region to Nairobi. Over 100,000 annual members have subscribed to this life-saving service to date, and more than 80,000 members per year are on temporary cover. From its humble start with a small four-seater Piper Tri-Pacer, the aeroplanes owned and operated by AFD over the years have included Piper Cherokees, Cessna 206, 210, 402 and 404 aircraft, a Rally Minerva, a Britten Norman Islander, a Partenavia and Cessna Grand Caravans. Today’s AFD aircraft fleet includes two Pilatus PC12 aircraft and one Beechcraft King Air together with Citation Bravo, Excel and Sovereign jet aircraft on exclusive lease from long-time aviation partner Phoenix Aviation, allowing AFD to provide a world-class regional and international air ambulance service. While the AFD aircraft fleet flew a few thousand miles annually in the early years, AFD’s current air ambulance evacuations cover well over one million miles each year. AMREF’s radio room, originally known as ‘Foundation Control’ was, in its time, the only radio contact serving over 100 stations in remote parts of Eastern Africa. Today, the modern, highly sophisticated Emergency Control Centre at Wilson Airport is the heart of AFD’s 24-hr air ambulance infrastructure and includes professional flight operations, satellite aircraft tracking and stateof-the-art communication equipment. Professional staff at the Control Centre not only co-ordinate medical evacuation services, but also offer a medical helpline and medical assistance services.

A PC12 with Mt Kilimanjaro in the background

Over the years, AMREF Flying Doctors has attracted the attention of a wide circle of international VIPs, including European royalty (the UK’s Prince Charles, Holland’s King Willem-Alexander, the Swedish King, the Danish Queen), film celebrities (Robert Redford, Meryl Streep and Paul Newman) and many others. AFD’s history would be incomplete without acknowledging the lifetime’s work of the legendary Dr Anne Spoerry, the pilot doctor who started AMREF’s Medicine by Air programme to Northern Kenya, the Lamu Coast

AMREF FLYING DOCTORS

Lifting off from runway 14 at Wilson Airport Nairobi on a day in July 2017 in one of AMREF Flying Doctors’ PC12 aircraft on another emergency medical evacuation mission, it is interesting to reflect on how 60 years ago, Sir Michael Wood was taking the same course but in a much smaller, slower Piper Tri-Pacer aeroplane. Michael was one of AMREF Flying Doctors’ three founders. Sir Archibald McIndoe, a New Zealander who was famous for his successful pioneering techniques in reconstructive surgery on the Battle of Britain pilots during the Second World War and the creation of his Guinea Pig Club, was another founder of AMREF. Archie, as he was fondly known, co-owned the farm next door to Michael Wood on the slopes of Mt Kilimanjaro. The third founder was Tom Rees, also a brilliant reconstructive surgeon from the US and a former pupil of Archie’s. It was in 1957, when the three men discovered that 75 per cent of all the children they consulted in the region suffered from burns mostly incurred in domestic accidents, that they decided to make their surgical and reconstructive skills available to help these and many others who suffered similarly and lived in the region’s remote rural areas. From this ‘meeting of minds’ of three selfless, extremely skilled surgeons, AMREF Flying Doctors (AFD) was born. Since then Amref Health Africa – AMREF Flying Doctors’ parent organisation

AMREF FLYING DOCTORS

Dr Bettina Vadera, chief executive and medical director of AMREF Flying Doctors, Kenya, writes of the service’s 60th anniversary

as well as the Magadi district in 1964. Anne (Mama Daktari as she was affectionately known) continued with AMREF as both pilot and doctor until she passed away in 1999 at the age of 80. Sixty years after the Tri-Pacer’s first flight, the mission of the three Founders to take medical care to Africa’s people in remote areas remains, although if Archie, Michael and Tom were alive today they would find the plans they drew up on the slopes of Kilimanjaro transformed beyond their wildest imagination. AMREF Flying Doctors and its parent organisation Amref Health Africa have become, through their humanitarian focus and efforts, the leading, internationally recognised healthcare and air ambulance providers in Africa.

A King Air in Ngorongoro

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Trust (EHAAT) and Lincs & Notts Air Ambulance (LNAA) are also benefitting from the model’s enhanced capabilities. DSAA highlighted the machine’s advanced avionics, good turn of speed and enhanced endurance, meaning pilots can fly further, for longer, without needing to refuel. Among the other benefits of the model highlighted by SAS is the APU (auxiliary power unit) mode, which provides on-scene power while the helicopter is on the ground without rotors turning. As the operator, SAS has trained its pilots, while the charities’ doctors and paramedics have also undertaken extensive ‘conversion’ training to ensure their skills and expertise can be transferred seamlessly to working with the new aircraft, noted KSSAA.

New helos usher in new era in UK HEMS

DSAA

British helicopter air ambulance charities are getting to grips with their new AW169s, as James Paul Wallis reports

SAS

DSAA

UK HEMS charity Dorset and Somerset Air Ambulance (DSAA) has heralded the arrival of its new AW169 helicopter, saying the delivery marks a new era for patients. The medically configured helicopter became the first AW169 to enter air ambulance operational service in the UK on 12 June, said DSAA. The Dorset and Somerset craft may have been the first AW169 to go ‘live’, but it’s not the only example that Specialist Aviation Services (SAS) has brought in for service with air ambulance charities in England – Kent, Surrey & Sussex Air Ambulance (KSSAA), Essex & Herts Air Ambulance

Onlookers view EHAAT’s new AW169 for the first time

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DSAA’s new medical interior

Interiors The machines have all been given medical fit-outs at SAS’s base at Gloucester Airport. The firm described the interior solution as ‘highly innovative’, adding that it went through a ‘lengthy certification process’. SAS stated: “The aircraft are equipped with individually customised and fully adaptable medical interior layouts all under the same STC, with each customer benefitting from a spacious, bright cabin, easy loading and allround patient access.” Regarding the work done to obtain the STC, Henk Schaeken, SAS managing director, explained: “The regulation on carriage of oxygen is being interpreted more strictly than in the past and proved to be a challenge as we wanted to continue to use the bottles and regulators currently in use in the National Health Service system, and integrated in the logistics system of the air ambulances, to avoid having to go to special aviation-approved bottles as used on some of the competing interiors and the complications that would bring to the operation.” He added: “The requirement to have an attendant at the head of the patient during all phases of flight, i.e. also during take-off and landing, also involved a considerable certification effort.” DSAA said the medical equipment on its new craft, tail number G-DSAA, will be similar to the kit that was carried on the previous aircraft, G-DORS, an EC135 T2+ that was operated by Babcock. However, a more spacious cabin will afford the critical care team better access to patients – a significant benefit if a patient needs further intervention or treatment en route to hospital, said DSAA, adding: “The new helicopters will provide many enhanced benefits to patient care, allowing medical crews 360-degree unobstructed access to their patients, greatly increasing the >>

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DSAA DSAA

The cockpit of DSAA’s new AW169

A DSAA/AgustaWestland signing ceremony held at Farnborough Air Show, 2014

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KSSAA said that its operational team completely redesigned the medical kit bags used by crews to be perfectly compatible for use with the new aircraft. All of the medical kit was integrated into six response bags that fit into specific areas of the AW169. This allows more patient intervention in flight, said the charity, as well as ensuring faster and more instinctive use at the scene. Night flight Another string to the new helicopters’ bow is their suitability for night flight. Bill Sivewright, DSAA CEO, said recently: “The AW169’s night flying capabilities mean that we can now move forward into providing full night HEMS missions. Our team will have the ability to fly directly to the patient without the need of any fixed or pre-established lighting, which is a significant advantage. We are now looking forward to completing night HEMS training and subsequently operating the new aircraft for 19 hours a day.” EHAAT is also exploring its options for night flights. Its AW169 is being joined by a matching NVIS-capable MD902 Explorer, also completed by SAS. The pair will replace the charity’s two older helicopters and will enable it to evaluate the possibility of providing a 24/7 service, said SAS. Discussing the adaptations for flying at night, Schaeken of SAS commented: “The interior STC ran in parallel with our nose-mounted Trakka searchlight STC, improving visibility at night when landing based on our experience with the MD902 with a searchlight in a similar position, rather than the traditional sidemounted lights, and the NVIS STC which certified the white phosphor NVGs we use on the MD902s for the AW169.” Instant success In an article published on 25 July, LNAA said its new AW169 was already exceeding expectations of reduced flight times, increased space and greater range. The service said: “After launching our brand new, state-of-theart helicopter to the media on 13 June, it was ready to become operational two days later following essential crew training. Within just three minutes of being on-line, the first call came in. Time was a vital factor in this first mission, and our crew was able to transport a critically ill man suffering from a cardiac arrest from Spalding to the Lincoln Heart Centre in just 10 minutes. When faced with a cardiac arrest, every single minute matters and the speed at which we get our patients to specialist help really can make the difference between life and death. Over the last month, our helicopter was dispatched to 64 missions across

wind, but this shaved five minutes off our previous flight time.” Speaking of the benefit of the APU mode, Linnell said: “As we look towards the winter months, we also have the added benefit of having heat and light inside the helicopter whilst on the ground, meaning that we can treat patients in a warm and dry environment while we stabilise them ready for transportation to hospital. All of this will help to give our patients the very best chance of survival possible from some of the most serious and lifethreatening injuries and illnesses.” Worth the wait DSAA said its new helicopter’s arrival was the culmination of years of planning and development. The charity placed an order for the machine with manufacturer Leonardo, then known as AgustaWestland, back in July 2014, at which time it was expected to begin carrying patients by 2016. KSSAA also selected the AW169 in July 2014, and had announced the craft would enter service in Autumn 2015. The AW169 had to undergo ‘intense scrutiny’ by the European Aviation Safety Agency (EASA), said Sivewright, adding: “This is why it has taken a little longer than we had hoped for the aircraft to become operational, however it has certainly been worth the wait and we are delighted to now have clearance to fly.” As for the future, SAS is already working on preparing three further AW169s for delivery by April 2018 (back-up aircraft for SAS, KSSAA and The Children’s Air Ambulance) – and it has signed orders for more deliveries in 2018.

EHAAT

specialist critical care that can be delivered in flight and positively impacting upon a patient’s chance of survival and recovery. These outstanding characteristics, superior capabilities and first-class safety standards will ensure unprecedented levels of mission effectiveness and provide an enhanced life-saving service for patients.”

Lincolnshire and Nottinghamshire. Ten (16 per cent) of these involved children or teenagers, including a teenager who suffered serious head and chest injuries in a karting accident, and a young boy who suffered a back injury at school. During all of these missions, our crew was able to get to these children sooner because of the speed of the AW169, allowing our medical teams to deliver advanced pain relief and specialist medical

“the aircraft are equipped with individually customised and fully adaptable medical interior layouts all under the same STC”

The international community for air medical professionals Brought to you by magazine

interventions to these young and vulnerable patients much quicker.” LNAA paramedic Roger Linnell noted: “Our new helicopter gives us new options with regards to patient care that we have never had before. One of the major benefits is 360-degree access to the patient, meaning that we can perform life-saving procedures such as a thoracostomy – used to inflate a collapsed lung or drain fluid from a lung – while in flight. This is something that we would never have been able to do before.” Tim Taylor, LNAA pilot, added: “Our new helicopter is undoubtedly much faster; and flying at speeds of up to 190 mph, we are already reducing our flying times to the scene. I don’t think the crew could quite believe it on our second ever mission when we went from our base at RAF Waddington to Mablethorpe on the east coast in just 12 minutes! Granted we had a tail

ADVERTISE YOUR CREW VACANCIES AND REACH 74,000 INDUSTRY SPECIALISTS VISIT WWW.EMSFLIGHTCREW.COM

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ITIC Asia Pacific Bangkok 12th – 14th June I Mandarin Oriental Hotel Review Travel insurance professionals from around the world gathered in June at the Mandarin Oriental Hotel for the ninth annual ITIC Asia Pacific conference – ITIC Bangkok 2017 – to address the challenges facing the industry. AMR’s sister publication ITIJ was there to report on the speaker sessions and share insights from those operating in this diverse market. Read on for synopses of the sessions touching on air medical transport (for a review of all sessions, see ITIJ 198, June 2017).

Fitness to fly Dr Sommart Somsiri Medevac consultant & assistance hospital director – Samitivej Srinakarin Hospital The first of three doctors to tackle the ever-present question of fitness to fly, Dr Somsiri approached the issue logistically. First, he highlighted the points of concern that should be considered when evaluating fitness to fly: the patient and their condition; the environment; what treatment they need; flight time; booking and loading; aircraft types; and unexpected situations. The patient, Somsiri insisted, is the first and most important concern. Whether the patient can sit or needs to lie down must be evaluated before take-off. If a patient is unable to sit during the take-off procedure, for

oxygen saturation in blood goes down by between three and five per cent when in flight example, they are unlikely to be fit to fly on a commercial flight, he said. The pressure changes in a cabin must also be assessed before take-off. Somsiri pointed out that oxygen saturation in blood goes down by between three and five per cent when in flight, and for some patients, this could prove complicated. One issue raised later in questioning is that those transporting patients must have full knowledge of the patient’s condition on the day they are travelling, and sometimes this can be hard to acquire. It is, however, very important, noted Somsiri. Loading a patient into a commercial flight with a stretcher can also cause issues. There is a lot of equipment needed to keep a patient stable while 3030

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ASIA PACIFIC

International Travel & Health Insurance Conference

in the air. As Somsiri later pointed out in the panel discussion, some planes may not have the onboard power needed. Stringent rules put in place by the IATA guidelines and MEDIF forms mean that flight diversions should be avoided. However, as Somsiri pointed out, the most common reasons for flights being diverted are medical, especially on commercial flights. Somsiri finished by outlining the necessary information needed to complete a MEDIF fit-to-fly form, including whether or not there needs to be a medical escort and the need for a specialist opinion. A member of the audience pointed out during the panel session, however, that MEDIF forms are still difficult to complete for those with chronic conditions. Dr Ulrike Sucher Medical director – Allianz Worldwide Care Dr Sucher’s discussion on fitness to fly came from an insurance and assistance perspective, and centred around managing patients’ expectations and picking the most cost-effective solution. She boiled this down to one choice: do you ‘scoop and run or stay and play’? Which of these choices an insurer picks depends on four things, said Sucher: the patient’s condition; the infrastructure in the country; whether it will be a commercial or air ambulance evacuation; and what kind of insurance the patient has. She explained that Allianz created its own guidelines in order to assess each of the above variables, and used two situations to explain. One patient had a non-emergency injury – blood neoplasia. The matrix displayed by Sucher explained that a non-emergency patient would need far less equipment to travel, and would therefore be more likely to be flown home. Lengthy treatment for illnesses such as leukaemia is cheaper in a home country, and being back near family for a lengthy illness can make patients much happier. The emergency patient matrix that Sucher showed had, understandably, far more information on than the non-emergency.

lengthy treatment for illnesses such as leukaemia is cheaper in a home country, and being back near family for a lengthy illness can make patients much happier

During the panel session that followed, Sucher was asked how best to manage a patient’s expectations, especially when that patient may want to go home immediately. “Most patients want to go home to be treated … we are quite tough [at Allianz],” she said. If there are suitable hospitals or treatment centres in the place where a patient is, then they will keep them there. “We’ll show them the accreditation, the accreditation helps,” she added. “I know it can be difficult, but we do it all the time.” She further explained that if a patient wants to move to another treatment facility then Allianz will pay for care, but it will not pay for the transport to get them there. She was as pragmatic when she was asked if the decision to leave or evacuate the patient came down to money: “To be honest, if it is not medically necessary to go in an air ambulance then they won’t.” Dr Sutuspun Kajornboon Director of aviation medicine – Bangkok Hospital Coming from the vantage point of a doctor trained in airborne medicine, Dr Kajornboon’s presentation went more in depth on the medical considerations that need to be taken into account when assessing fitness to fly. According to Kajornboon, there are two types of patients who may need to be evacuated. The first is the pre-treatment patient, who has suffered acute illness or an accident and needs to be taken to another facility for the bulk of their care. Getting up-to-date information on these patients is vital – but, Kajornboon pointed out, up-to-date medical information in Southeast Asia is ‘like gold dust’. He stated that sometimes his crew is given medical information from the patient’s day of admission, not their current status. This has often meant the crew has prepared for a full ICU mission, only to find the patient is walking over to the helicopter. To tackle this, his department often hires a doctor to go and get the medical report for the patient in the country from which they are evacuating. The second patient type is the post-treatment patient. These patients are

up-to-date medical information in Southeast Asia is ‘like gold dust’

more stable, so missions are easier to plan and medical records easier to obtain. More and more post-treatment patients are being transported via commercial flight, said Kajornboon, due to the fact that money can be saved. The considerations that Kajornboon said would need to be accounted for when determining fitness to fly were similar to Dr Somsiri’s: the patient’s safety overrides everything; the risk of patient deterioration; and the nursing need of the patient. One medical professional is never enough, he said, recounting a story of a 24-hour repatriation he undertook with a patient where his tiredness got the better of him, and the patient ended up being caught smoking in the airplane toilet. The airline’s viewpoint must also be taken into consideration, said

Kajornboon. They have to make sure that the case will not risk a diversion, that there will be no delay to flight time or disruption of the cabin crew’s routine, and that other passengers will not be disturbed. There does have to be a human side however, as Kajornboon showed through a repatriation of a moribund case he took part in. The patient was unconscious and there was no chance of making a recovery. However, due to his condition, there was no risk of diversion, so it was decided that he could be repatriated from Bangkok Hospital to his home in Canada. In this case, Kajornboon said, humanitarian reasons dictated fitness to fly.

China – insurance and healthcare Dennis Lu Chairman and CEO – Deer Jet Medical Co., Ltd Dennis Lu imparted his wisdom on the Chinese medical market from the perspective of an air ambulance provider. For Deer Jet Air Ambulance, he said, the main customers are not insurance companies, but instead the ‘very rich Chinese’ that want to be transported to better medical facilities. As a high-cost provider, Dennis acknowledged that his company was probably not appealing to the assembled insurers in the crowd, but he did say that the company had made a strategic decision to become more competitive in the market. These high costs allow the service to operate at a high level of quality, he added. Deer Jet Air Ambulance deals with ‘around 99 per cent Chinese customers’, said Lu, but operates with doctors and nurses from all over the world in order to maintain a high level of international service. The service also works with a large number of hospitals to complement its fleet. The relationships created by this network allow Deer Jet to transport patients quicker than usual. This has also allowed Deer Jet to respond to Chinese nationals who were caught in Nigeria during the Ebola outbreak. No commercial airline would let them onboard, but Deer Jet’s facilities allowed them to be safely evacuated. Lu then divulged details of one of the company’s recent cases, involving a woman who had to be evacuated from Tibet to her home in Australia after suffering acute mountain sickness. It served to highlight how providers obtain flight permits in China, as he ran the audience through one of the several permits that Deer Jet required. After also having to perform several stop-offs, the patient was transferred to another air ambulance company for the final leg from Manila to Sydney, illustrating the importance of being able to co-operate smoothly with other air ambulance companies. This can also reduce risk, as crews will be allowed necessary rest time, without making the patient wait, he said. “This was a simple procedure,” said Dennis of the mission. “But it took a lot of work from both the operational and medical team.”

Dennis Lu’s fellow panellists were Lily Chen, managing director, employee benefits at JLT Insurance Brokers Co., who spoke on reform in the Chinese healthcare system, and Michael Hu, managing partner at International Insurance Solutions, who discussed the country’s insurance market.

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Two industry professionals gave their insights on the benefits of companies in the fixed-wing air ambulance and travel insurance sectors working well together in a strong relationship. By Mandy Langfield, for ITIJ TV Organising and carrying out a medical flight that can cross continents and oceans is a complex business, and unless all parties are on the same page, things can go wrong. Chris Carnicelli, CEO of Generali Global Assistance, believes that selecting the right air ambulance partner for an assistance company’s business is absolutely essential to a smooth repatriation. Carnicelli said: “We have clear and rigorous standards for accreditation of our [air ambulance] partners, keeping up the highest quality.” Secondly, Generali aims to build on those partnerships that have previously worked well, visiting providers around the world, making sure that there is a clear understanding of their operations and capabilities. Building relationships between the insurance companies paying the bills and the air ambulance companies carrying out the flights are key to a smooth repatriation process, said Dr Bettina Vadera, chief executive and medical director of AMREF Flying Doctors, which is based in Kenya and carries out dozens of flights on behalf of international insurance companies each year. She said: “I think a lot of the [most effective] collaboration and working together comes from having positive experiences. We have always seen that if we have a good relationship and a long-standing relationship with an insurance company, who know our capabilities as an air ambulance provider, who know how we work, at what standards we work, that we are reliable, then it works on both sides.” Managing expectations is essential for both the insurance company and the air ambulance operator. If one side has false expectations of the other, then that is usually when relationships fall apart, and this can happen to the detriment of patients going forward, as there will not be an opportunity for

Bettina Vadera

the companies to work together again. The insurance company understanding where the air ambulance company has its bases, and how this can affect operational capability, is one area highlighted by Vadera as being very important. In Africa, for instance, the 3232

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time of day at which a request for transport comes through is very relevant. With unlit bush airstrips being in common use, there are no options for landing at night. And sometimes in this situation, an insurer may not be able to give a guarantee of payment in time for an aircraft to take off, retrieve the patient and deliver them to hospital before night falls. Vadera said: “We know this, and therefore, when the job is on behalf of an insurance company with which we have worked for a long time, and with whom we have a contract, we take the risk of making that call very quickly to dispatch the aircraft and go, even though we are still going through the bureaucratic process. We can do this because we know that the insurance company will value the fact that we have responded quickly to look after their patient,

Chris Carnicelli

the patient will be very happy and this will reflect well on the insurance company.” This was just one of the examples she gave of where both companies having confidence and trust in one another can improve the patient transfer process. Another example of where a good relationship between an insurer and their air ambulance partner can come in useful is where a quotation for a flight is given to an insurer, and accepted, but certain circumstances change and the cost of that flight goes up or down. A transparent approach to this situation is key, said Vadera, because if the provider is honest with the payer when the cost has gone down and the insurer can save some money, when the opposite occurs, the insurer is more likely to understand what has happened, and when reasonable explanations are offered as to why the costs have risen, the insurer will pay what is necessary. Sometimes, going above and beyond expectations can be worthwhile for an air ambulance operator. But being able to do this relies on the air ambulance provider knowing the insurer or assistance company, and the payer trusting the air ambulance firm to do what is best for the patient and take their word that the action they took was necessary and reasonable. “In the end,” said Vadera, “the patient is the one who will benefit if the air ambulance and insurer have a good and trustful relationship.” See Chris Carnicelli and Bettina Vadera discuss this topic in ITIJ TV News Update 31 May at https://vimeo.com/219518364.

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Angel Flight, an Australian charity that was the brainchild of Bill Bristow, co-ordinates non-emergency medical flights to help people living in remote areas of the country to access the medical care they need. Since its inception, 14 years ago, Angel Flight has completed 20,583 flights. By Mandy Langfield

Danielle Sanchez, Flight Coordinator

YVAN DRAKE

In 2003, Bill Bristow created Angel Flight, launching a network of aircraft and pilots that he made available to patients travelling to far-flung medical facilities around Australia. The aircraft are not air ambulances, and do not carry medical staff – instead they allow patients of any age to travel as passengers to get to the medical care they need. The aircraft will carry blood and blood products, and medical drugs, to patients who need them. Because there are no medical staff onboard, patients must be ambulatory and medically stable, as well as physically able enough to climb into and out of the aircraft. In order to gain access to the service, a patient must be nominated by a health professional familiar with the patient’s condition. There are over 3,000 health professionals registered with Pilot Mike McFarlane, patient Alan Simpson, Earth Angel Les Aisen at Essendon Airport Angel Flight who are able to make a referral. pilots own or have access to more than one aircraft. The Australian aviation In order to be eligible for referral, the patient has to be either medically community are a generous bunch of people who always volunteer their or financially disadvantaged – so, for example, the family might have been time and aircraft when the need arises.” devastated by medical bills, accidents or other chronic conditions. In 2003 when the charity first began operations, pilots volunteered their The flights are general aviation light aircraft; most have between four and time, planes and fuel. Thanks to private donations that fund the charity, six seats, and will either be high wing or low wing – hence the need for the the fuel, which costs around AU$200 per flight hour, is now covered. The patient to be physically able to climb into and out of the aircraft doors. Juliedonations come from a number of sources, including clubs, companies, Anne Scott, flight co-ordinator and media officer for Angel Flight, expanded: estates and individuals. Not only are the donations used to pay for fuel, but “We have 3,200 registered pilots and aircraft Australia wide. Some of these also to provide a discount towards the cost of providing a commercial flight to a patient if poor weather means that the light aircraft typically utilised can’t take off. Approximately 85 per cent of its revenue is spent on the delivery of

the service. Angel Flight’s ground volunteers (Earth Angels) provide car transportation between the city airports and medical facilities or accommodation. Most drives occur in the capital cities or some of the larger regional towns. Scott explained: “It can be a great support to the passengers to have a friendly face waiting to meet them at the airport, saving the passenger the hassle of trying to navigate public transport in a strange city. Volunteer driver registrations are over 4,500.” The charity operates out of a small rented office in Fortitude Valley in Brisbane. “Angel Flight CEO Marjorie Pagani oversees the operation,” said Scott, “and there are six paid staff including the CEO.” Four full-time flight co-ordinators – Jasmine Thomas, Riana Brown, Fiona Soderberg and Danielle Sanchez; and media officer/flight co-ordinator Julie-Anne Scott. A volunteer called Maurie Hand has been coming into the office every Tuesday for 10 years to do the mail. In recent years, Angel Flight has expanded its assistance to the disadvantaged rural people by offering compassionate flights for those who don’t have the means to travel to see loved ones in distant hospitals, often with terminal illnesses. Said Scott: “We have been able to fly children to hospitals to see ill parents or siblings, and others who want to return home for their final weeks.”

Fiona Soderberg, Flight Coordinator

Left to right- Fiona Soderberg, Flight Coordinator; Riana Brown, Flight Coordinator; Marjorie Pagani,-CEO; Julie-Anne Scott, Media Officer/Flight Coordinator; Danielle Sanchez, Flight Coordinator

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Marjorie Pagani CEO, Maurie Hand Dispatch Volunteer

Julie-anne Scott, Media Officer/Flight Coordinator

Bill Bristow spoke to AMR about the charity What made you want to start Angel Flight? I was flying in the US with other pilots and they were sharing with me the extraordinary feeling they experienced through charity flying. They are able to fly – their greatest love – while at the same time help people going through hard times. I realised then Australia badly needed a similar service. With about 30 per cent of the Australian population living outside metropolitan areas, a very large number of people do not have easy access to major hospitals and treatment centres. I decided I had to do something about it and returned home with a new sense of purpose. Was it a complicated process gaining the necessary permissions to fly? Angel Flight is a charity which co-ordinates private, noncommercial, flights; it is not an aviation organisation. The flights are undertaken by pilots, on a private basis, who are flying their own aircraft. Angel Flight relies on the Civil Aviation Safety Authority (CASA) for proper licensing and testing of pilots according to the statutory requirements set by CASA. All pilots are required to have substantially more than the minimum experience required by CASA for the carriage of non-paying passengers on private flights. Prior to the commencement of the charity, I obtained a ruling from CASA to the effect that the proposed service and flights did fall into the ‘private flight’ category, so with CASA’s positive ruling, the charity was able to refer the passengers to the pilots, who would then volunteer to undertake the flight for those people. What are your hopes for the future of the charity? Angel Flight is supported tremendously by community organisations, private donors, and bequests – often from people we have helped. We do not receive, nor ask for, government funding, and nor do we spend any monies on fundraising, marketing, promotions, or company assets (other than our staff, computers, and the necessary facilities to operate out of our rented office in Brisbane). Our donor funds are spent on the provision of the flights and drives undertaken by the volunteers. This support is increasing as our flight numbers increase. We have now flown about 60,000 people from areas across Australia, and I know that this service will continue to grow, as it has for the past 14 years. The future looks very bright for Angel Flight’s long-term future, continuing to assist more and more of our rural friends to access city medical treatment without the necessity for arduous and costly road trips.

Riana Brown, Flight Coordinator

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Because of the amount of rotor downwash with the MV-22, a 130-ft (40-m) cable is used between the bucket and the aircraft to prevent the proprotors from fanning the flames (the length of cable used for standard sling loads would be just 10-20 ft). The fact that the bucket is significantly lower than the aircraft is a factor when the pilots are manoeuvreing close to the ground, requiring a little more piloting skill and finesse during the fire missions. More power and time is needed to slow down and make turns – any quick

“we have to be aware of how that bucket and load affects the aircraft performance at all times”

>>

BARRY D SMITH

movements will cause the load to pendulum and pull the aircraft off the intended flight path. Each Osprey squadron averages three trained crews, which is six

The USMC works closely with air and ground units of CAL FIRE, the state civilian firefighting agency

With over 125,000 acres of range land, wildfires are a common occurrence at Camp Pendleton Marine Corps Base in Southern California, US. In addition to the base’s fire department, US Marine Corps (USMC) helicopters are used to fight these fires. They can also be called upon to assist local civilian fire departments during large wildland fires throughout southern California. The USMC uses the CH-53E Super Stallion, the UH-1Y Huey and the MV-22 Osprey aircraft models to fight these fires. Squadrons of these helicopters based at Camp Pendleton and Miramar Marine Corps Air Station, located a short distance from Pendleton, rotate firefighting duty on a monthly basis. They use underslung water buckets filled from a lake, pond, or other source to drop on the fire. Depending on which aircraft used, the buckets can hold from 320 up to 900 gallons (1,450 to 4,090 l) of water. All three types of aircraft are equipped with forward looking infrared (FLIR) turrets, which the crews use to see through the smoke to locate firefighters on the ground and see exactly where the fire is located. In addition, the pilots can also see other aircraft better with the FLIR. Use of all available sensors makes operations safer and more effective with better situational awareness. Super Huey Pilots report that the performance of the UH-1Y helicopter has been 3636

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outstanding during the fires. The UH-1Y has a 4,000-pound (1,800-kg) maximium load on the cargo hook; a full 320-gallon water bucket weights about 2,500 pounds. “We usually took about a 90-per-cent fuel load, which left us with a comfortable power margin,” commented Major Jeff Barnes, a UH-1Y

all three types of aircraft are equipped with forward looking infrared turrets instructor pilot. “Some of the major lessons we learned is that using the Bambi Bucket is not like other external load operations. In firefighting operations, we have a constant load that reaches 25 ft below the aircraft and changes weight by 2,500 pounds when we fill and release the water. So, it takes a different mindset where we have to be aware of how that bucket and load affects the aircraft performance at all times. It is very dynamic.” Full tilt The Osprey uses a 900-gallon bucket – thanks to its high lifting capacity, the crews can carry a full load of fuel and still be below maximum weight.

BARRY D SMITH

Barry D. Smith profiles how the US Marines Corps fights fires in California using helicopters and tiltrotors

MV-22 pilots must make careful power and control adjustments due to the long cable used to attach the bucket

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The USMC works closely with air and ground units of CAL FIRE, the state civilian firefighting agency

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“The biggest challenge I see is the congested airspace with many aircraft operating in a small area with degraded visibility due to the smoke,” explained one pilot. “So, situational awareness is key. We also have to make sure we aren’t pressing too hard. We want to save people’s homes, but we have to take a step back every once in a while to make sure we don’t compromise on safety.” The crews continue to work with CAL FIRE and expand and increase their training opportunities and expertise. For example, they have training exercises with CAL FIRE representatives on the ground giving them

Super Stallion The CH-53E Super Stallion also uses the 900-gallon water bucket, which doesn’t even put it close to its maximum load carry capacity. The pilots say the firefighting mission is not all that different from their regular military role; they do a lot of external load work with the 53 at low altitudes, doing the weight management and power calculations. Fire runs involve members of the crew taking the lead at different times, explained Barnes: “I put together a class to teach crews how to fly firefighting missions and I made a comparison to a WWII bomber crew. The pilots get the aircraft to the target and then hand over the ship to the bombardier to fly the bomb run and release the bombs. That is what we do on fire missions. The crew chiefs in the cabin have much better visibility than the pilots as the aircraft comes over the fire and are the ones that actually drop the water.” He continued: “When we are coming into a dip site to get water, they are calling out any obstacles and tell us how low to go to get the bucket in the water. When we are dipping out of lakes, they also watch for civilian boats that might get too close and be damaged or sunk by our rotor downwash. The pilots can’t see the bucket, so the cabin crew tells them where the bucket is in relation to the ground and any obstacles and when they are clear to fly away from the dip site.” The situation is reversed while flying to the fire, said Barnes: “En route to where the aircraft is going to drop the water, the pilots will paint a picture of the drop area for the cabin crew as they can’t see forward as easily as the pilots can. … There is a constant conversation between the pilots and cabin crew to co-ordinate their efforts to get the water on the fire. When we drop the water we are typically flying at about 50 knots with the bucket about 50 ft above the ground.” Civilian co-op Due to the large size of the base, Camp Pendleton has a mutual aid agreement with CAL FIRE, the state civilian firefighting agency. Any major wildfire will bring CAL FIRE air and ground resources onto the base. CAL FIRE has a helicopter co-ordinator position that usually flies in a light helicopter from a local law enforcement or fire agency. Called the MILCO, or military helicopter co-ordinator, he/she assigns the military helicopters their drop missions and does airspace co-ordination so they don’t conflict with civilian helicopters and air tankers working on the fire. The MILCO helicopter will also act as the communications relay between the civilian air and ground firefighting forces and the military helicopters. Talking with several pilots, they say the difficult part is integrating into the civilian system working with the firefighters on the ground. They will review those policies and techniques more often in the classroom setting. On an actual fire, they usually arrive and shut down to talk with the firefighters on the ground before starting to drop water. They also have the command and control aircraft that tells them where to drop and what the aircraft traffic pattern over the fire is.

any major wildfire will bring CAL FIRE air and ground resources onto the base

guidance and advice on drop techniques and procedures. This also improves air-ground co-ordination during a real fire. In addition, they help the Marines with set up, break down, and troubleshooting the water buckets. “It was a great experience and I look back on it as one of my favorite things I have done as a Marine pilot,” commented Captain Donald Carlsen, a CH-53E pilot. “You are doing something good for your community as well as doing something you don’t normally get to do. Overall, it is a very satisfying mission. This mission is very similar in concept to what we do as Marine aviators. Our main mission is the support the Marines on the ground however we can. When we are fighting fires, our job is to support the firefighters on the ground by delivering loads of water how and where they need it. So, it fits our normal mission profile like a glove.”

BARRY D SMITH

BARRY D SMITH

any quick movements will cause the load to pendulum and pull the aircraft off the intended flight path

pilots and nine crew chiefs. They can train more personnel as they perform actual firefighting missions, as long as there is at least one pilot and one crew chief qualified on the fire mission in the aircraft.

The crew chief can hang out of the cabin to accurately deliver the load of water on the fire

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ELLIE MORTON

Thanks to this new technology, dedicated elevated heliport firefighting systems, whether DIFFS or FMS, should have a response time of not greater than 15 seconds after release, as recommended by CAA in Chapter 5 of CAP 1264 for integrated heliport firefighting facilities. As reported on Bayards’ website, tests on its own systems have shown that in most cases a fire is extinguished in less than 10 seconds, and the system at KHC is reported to guarantee to extinguish a blaze within eight seconds. FEC Heliport’s DIFFS works in a similar way. Engineering manager Jeff Sterwerf explains: “They are activated via a manual pull station. Then, an electric solenoid valve is released on the skid and water flows into a bladder tank squeezing the bladder and injecting the foam concentrate into the passing water stream. Once mixed, the foam water solution is delivered to the helipad at a three-per-cent concentration.” According to point 5.10 of CAA’s CAP 1264 (Standards for helicopter landing areas at hospitals, published February 2016), the number and lay out of nozzles must be ‘sufficient to provide an effective spray distribution of firefighting media over the entire Final Approach and Take-Off Area (FATO)’, with a ‘suitable overlap of the horizontal spray component from each nozzle, assuming calm wind conditions’. But DIFFS are even designed to help a hospital ensure that ‘protection for the range of weather conditions is prevalent at the heliport’, as is clarified in the CAA documentation. With hospital rooftops such as Kings College, positioned on top of the hospital’s 10-storey Ruskin Wing, that could prove to be particularly helpful in windy conditions. The Kings College Hospital helipad during one of the test landings by Kent, Surrey & Sussex Air Ambulance

King’s College Hospital (KCH) serves a trauma population of some 4.5 million people across southeast London and Kent, UK. In October 2016, the hospital introduced to the UK the first Civil Aviation Authority-certified onshore rooftop helipad with a deck integrated firefighting system (DIFFS). In the event of a fire, the new system will automatically spray a foam and water mix from a series of nozzles installed in the helipad, aiming to bring a fire under control within a minute. It’s a proven technology that not only increases safety, but also reduces staffing costs. System types There is a range of integrated firefighting service (FFS) systems to choose from, and they can vary in design according to national standards. Older-style jet foam or water monitor systems, such as fixed monitor systems (FMS), incorporate oscillating foam-dispensing monitors, and have to be manually operated and aimed. The newer DIFFS typically consists of a series of ‘pop-up’ nozzles with ‘both a horizontal and vertical component’ designed to provide ‘an effective spray distribution of foam or water to the whole of the landing area’, and they are able to guarantee an automatic response with a firefighting agent that covers the whole helideck in seconds, UK Civil Aviation Authority (CAA) documentation explains. Although FMS is an acceptable means of CAA compliance, authorities such as the CAA recommend hospital heliport operators make use of the newer DIFFS to deal with hazards such as post-crash fire on an elevated helipad. 4040

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aluminium helipads can normally be retrofitted with a DIFFS

$25,000. He adds: “Technically, there is not a lot of difference as both [foam and water-only DIFFS] require similar flow requirements.” Construction A hospital looking to get a DIFFS installed can, of course, opt for one as part of a complete new hospital rooftop helipad. For example,

>>

Helipad firm Bayards Aluminium Constructions works with a third-party manufacturer that supplies firefighting systems to install DIFFS. Carlo Padoa, product manager helidecks at Bayards, explains how they work: “In case a fire is detected, our system can be activated via push buttons on the main control panel or the local push buttons at access points. The pump then starts feeding the water through the foam skid. Thanks to an inductor, the foam is mixed with water before reaching the helipad surface; it is distributed through several pop-up nozzles distributed around the helipad area in order to cover it completely. The Dutch manufacturer, which has constructed over 600 aluminium helipads worldwide, is behind KHC’s new helipad and DIFFS. Now, in case of a rooftop fire, KCH is able to rely on a three-per-cent foam or water

“our system can be activated via push buttons on the main control panel or the local push buttons at access points”

mix ‘within seconds across the entire 25-m [82-ft] square deck’. This will be ‘out of a water storage facility of 20,000 l [4,400 gallons] and a 600-l [130-gallon] foam tank, delivering the mix for at least five minutes, up to a height of three metres [10 ft], said Ian Taylor, head of security and local security management specialist CEF Directorate at King’s College Hospital NHS Foundation Trust.

HELP APPEAL

Integrated automatic firefighting systems, already known in the offshore fire protection market, are increasingly being used on hospital helipads. Thanks to recent technology, foam or water, usually sprayed from a series of nozzles integrated into the helipad, will help keep the helipad and building safe in the event of a fire. How do such systems work, and what are the benefits? Femke van Iperen found out

Water vs foam DIFFS can employ a mix of foam and water or water only. Whilst foam is

recommended as the primary medium by authorities such as the CAA, there can be exceptions where ‘a passive fire-retarding system is used in lieu of a solid plate’, says Kevin Payne, policy specialist helidecks and heliports at the CAA, and the author of CAP 1264. “AFFF (aqueous film forming foam) creates a thin film layer on top of the burning fuel, preventing oxygen from reaching the flame and suppressing it within seconds,” explains Jelle van den Oever, system engineer at Bayards. He says a system with a foam-mixing inductor requires more components, which makes them typically more expensive. Sterwerf comments that the difference in cost between a water system and a foam DIFFS is roughly

(left to right) Malcom Tunnicliff, clinical director for emergency medicine at King’s College Hospital; Adrian Bell, Kent Air Ambulance Trust chief executive; Rob Bentley, clinical director of the King’s Trauma Centre and South East London Kent and Medway Major Trauma Network; and Robert Bertram, chief executive of the HELP Appeal

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“we are seeking to influence the international standards and recommended practices in ICAO Annex 14 Volume II” Aluminium Offshore’s website also points out that DIFFS, being automatic, allows ‘less chance of human error in traumatic situations’, and that the multiple nozzles are ‘less affected by blockages caused by debris’. Taylor says a DIFFS solution was chosen for KCH as it was considered a safer operating system compared to its FMS predecessor: “Not having a firefighting team having to get on to the deck or to stay at their stations to fight a fire is a plus, as all the competent person is required to do in the event of a major fire is activate the DIFFS and retreat to a place of safety.”

RACQ CAPRICORN RESCUE

Financials Considering the cost of a DIFFS set-up, FEC Heliports gives an example of a foam system, including all piping and electrical work, that would cost a hospital approximately $100,000 to $150,000. But, says Padoa: “Overall,

the costs for personnel and for their training are dramatically reduced, and the savings in terms of operational expenses positively tip the scales.” Finance was a strong factor at KCH. Robert Bertram, CEO of helipad fundraising charity HELP Appeal, which donated £2.75 million ‘in part to fund the amount required to integrate the DIFF system into the helipad’, says: “[The new] state-of-the-art system will save the trust approximately £200,000 each year, compared to employing firefighters, providing a safe and efficient method in the event of a fire.” Going forward According to Payne, some hospitals building helipads in the UK are currently looking at both DIFFS and FMS, and he says: “With the publication of CAP 1264, [the] CAA is positively encouraging the use of DIFFS on rooftops.” He also adds: “We are seeking to influence the international standards and recommended practices in ICAO Annex 14 Volume II, which is reviewing the critical area calculation assumptions for heliports, in particularl on rooftops.” For Bertram, the benefits of a DIFFS for hospitals are clear: “Going forward, should more DIFF systems be installed, they will be beneficial to a number of hospitals and major trauma centres across the UK, and King’s College is just the start of this process. They will help to ease the pressure on our emergency services, and ensure our hospitals are equipped to quickly and safely control a situation in the event of a fire, protecting all those within close proximity, and prevent further damage or evacuation to the rest of the hospital.”

The Fire Deluge System at Rockhampton Base Hospital during testing in June 2015

according to Aluminium Offshore, the ‘XE enhanced safety helideck’ that was built for Rockhampton Hospital in Australia by the Singapore-based manufacturer included a ‘passive fire-retarding system incorporated into its aluminium decking’. Alternatively, a DIFFS can be retrofitted into an existing hospital roof pad, such as was the case at KCH in London. The Bayards’ aluminium helipad itself was installed in 2014, and two years later a DIFFS was integrated into it. Some of the changes in line with CAP 1264 involved the replacing of the previous fixed monitor system (FMS) with 25 pop-up DIFFS nozzles. Payne says: “At KCH, there was the challenge of providing an additional water storage tank to accommodate extra requirements for primary water media [mixed with foam] as the total requirement of water for foam rises significantly.” A bigger foam tank was also installed inside the firefighting container. An integrated DIFFS, says Padoa from Bayards, is ‘easier to install’ with ‘reduced lead times for the conception and delivery’. Nonetheless, he also adds that retrofits are ‘usually very possible’, although they are ‘highly influenced by the material of which the helipad is constructed’. An aluminium helipad, for instance, normally allows for an easier retrofit than a concrete one, which may present difficulties. “Another important factor for rooftop helipads is the accessibility of the bottom surface of the helipad to install the nozzles and the branch pipes of the fire water,” Padoa further explains. Benefits There are a variety of practical and financial benefits for a hospital that incorporates DIFFS into its helipad. Stewerf lists ease of use, instant 4242

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operation with complete coverage and increased safety, and financial benefits with fewer personnel required at each take-off and landing. In fact, Payne, who has witnessed the wide use of DIFFS on helidecks in the offshore environment since the early 1990s with ‘many hundreds of installations worldwide’, said that CAP 1264 was published because the CAA ‘was keen to introduce this tried and tested best practice from the offshore sector into the onshore environment’. He adds: “In Australia, the DIFFS solution is now being applied as the standard for all new-build

“in Australia, the DIFFS solution is now being applied as the standard for all new build rooftop heliports”

rooftop heliports.” According to Bayard’s van den Oever, DIFFS is more effective than, for example, the older monitor water-jet systems, as the latter needed ‘firemen or helipad operators to manually operate the monitors and direct the water jet in the right spot’, with ‘fire blazing and possible parts of crashing helicopters flying around’.

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To an ordinary member of the public, or even members of the emergency services that aren’t versed in helicopter practices, the way that pilots take off and land can seem peculiar. Ian Lewis reveals why HEMS pilots do it backwards They say a good pilot is one who has the same number of take-offs as landings, and HEMS flying is considerably more challenging than, say, driving a helicopter air taxi. HEMS operations are about safety above everything. And, generally speaking, it’s for safety reasons that pilots do some things that can be difficult to understand if you’re not an aviator. Here’s a look at some pilots’ procedures and requests that might seem mystifying to a non-flyer. BUILDING MATERIALS The layman would naturally expect a helicopter to arrive at a landing spot, hover, and land vertically. Similarly, you might expect a take-off to be a simple matter of lifting off the ground vertically and then flying away. While that can sometimes happen, there are lots of reasons why it’s rare to arrive and depart quite like that.

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Although it seems counter-intuitive, helicopters are able to glide. But autorotation, as it’s called, just like gliding a fixed-wing aircraft, requires a minimum forward airspeed to create the necessary lift. True, you can only go downward, but you can do it under control to a more or less normal landing. In a vertical take-off or landing, of course, there is no forward motion, but if you are high enough above the ground, you can convert the downward (falling) energy to forward flight and land gently. However, if you lose power at too low an altitude through total or partial engine failure, the helicopter takes on the flying characteristics of an unusually large housebrick. The idea is to reduce time spent in this danger zone. Lorena Knapp, HEMS pilot with LifeMed, Alaska, explains: “A prudent pilot is always assessing and mitigating risk. One risk would be the amount of time spent in the height velocity curve (H/V curve). This is a chart created by the helicopter manufacturer to illustrate where a safe landing (autorotation) could theoretically be made if there was an engine failure. There are areas of the curve – often referred to as the shaded area of the H/V curve – where a safe landing may not be possible (low altitude and low airspeed). For many helicopters, the shaded area is somewhere around less than 400 ft and less than 40 kt. To minimise risk, one would attempt to minimise the amount of time spent inside of this curve. This is why helicopters don’t often take off vertically and land vertically as it would maximise the amount of time in the H/V curve.” FLYING BACKWARDS So-called Category ‘A’ take-offs and landings are one solution to minimising the time spent inside the danger area of this curve for twin-engine helicopters, and involves taking off by flying backwards, which looks extremely odd to an untrained observer. The procedure was originally developed for use in restricted areas – on oil platforms, rooftop helipads, or

simply confined spaces – where the small landing area might be the safest (or only) available place to go in the event of an emergency during take-off; so the pilot needs to keep it in sight as they depart. As an aside, there’s an urban legend that the procedure was developed in the 1970s for landings on top of the International Press Centre building in London, but in fact America’s Federal Aviation Authority had published the profile 10 years before. In the US, ex-military HEMS pilot and aviation consultant Ed MacDonald says: “In Category A take-off procedures, a twin engine helicopter takes off

“if one engine fails at any time during this procedure, the helicopter can safely land in the previous take-off area”

in such a manner that if one engine fails at any time during this procedure, the helicopter can safely land in the previous take-off area or, at a certain point during the take-off, fly away from the point of engine failure and continue in stabilised single-engine forward flight. Similarly, the landing profile is such that a pilot can determine the decision points on landing. Generally, the take-off is steep and backward, always keeping the take-off point in sight, then a normal take-off profile from that point.” Whether or not the pilot uses Category ‘A’ procedures depends on >>

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One of the most important things on first arriving at a scene is to pause and take a good look before committing to a landing. “When we arrive on a HEMS scene, we arrive overhead and orbit,” says Mark Dennis. “Obviously we don’t arrive straight in and land because we need to make sure it’s safe to land.” So those on the ground might wonder why the helicopter is staying aloft, instead of coming down to land Ed MacDonald teaches: “[A pilot should always] conduct a high

“one never exactly knows how well trained and competent the person(s) setting up the landing zones may be and whether or not it is truly safe”

the requirements of the operating company and also, of course, the kind of flying they do. Since the profiles are designed for minimising risk in confined areas, if you have plenty of space, you won’t need them. Some pilots we spoke to have never flown a Category ‘A’ take-off or landing. As far as Lorena Knapp is concerned: “These are most often used in the oil and gas industry when departing from a platform.” On the other hand, Mark Dennis, HEMS pilot with the Midlands Air Ambulance in the UK, uses Category ‘A’ profiles most of the time: “When people see us depart … which nine times out of 10 is from a restricted site, about the size of a tennis court – the question people ask is ‘why do you take off backwards’. It’s the safest way of getting in and out.” Taking off from an ad-hoc landing site in a confined space, he will typically lift

“it’s important that nobody goes into the departure area until they see the aircraft fly away, because there’s a chance that we may come back down and land” to a hover, perform a clearing turn to ensure that there’s nothing behind and then climb to about 120 ft backwards, because should he have an engine failure, he has already cleared the area he is going to land into and he knows it’s safe. Once he’s reached the safe height, he then commits to forward flight. At that point he knows he has enough height to increase speed and 4646

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climb away safely on a single engine should one engine fail. “That’s why it’s important that nobody goes into the departure area until they see the aircraft fly away,” he adds, “because there’s a chance that we may come back down and land. And that might not be an engine failure. It may be some other malfunction or something that means you want to land to check it out.”

reconnaissance (usually at 500 ft AGL) in a pattern that allows good visualisation of the landing area, approach and departure paths, landing zone surface, obstacles, LZ size, winds, slope, and other potential issues (such as vehicles, animals, personnel, security, approaching weather, etc.).” However well-meaning people on the ground can be, they often miss things that can make a crucial difference to a safe arrival. “There are always wires,” Ed MacDonald adds. Just recently, Lorena Knapp says, she aborted a landing due to a four-legged friend: “Because the homeowner’s dog (we were landing in their yard) was coming up the driveway towards the house. Had I landed, the dog would have been behind the helicopter and separated from the homeowner. Although the dog probably wouldn’t have gone into the tail rotor, I was concerned about the homeowners attempting to catch the dog and running

around the spinning helicopter. The noise of the helicopter tends to make everyone a bit frantic and it is extremely difficult to get someone’s attention if needed. It was easy enough to do a go around and wait until the dog was reunited with [its] owner and restrained prior to landing.” Animals of all kinds can be a hazard under-appreciated by people on the ground. Several pilots mentioned the need to secure horses or cattle near the scene of an accident before a helicopter can land. Dennis even talked of problems with elephants in a safari park where he was expected to land. Differing expectations and communication problems can also mean trouble. He tells of an occasion when he flew to an accident during a motocross competition: “Obviously, motocrosses are very busy and often they don’t stop the race, and obviously I can’t land until it’s stopped, because the patient is on the track and they seem to think they can just carry on racing around the aircraft. So then we’re going round and round and round trying to get communication with them to tell them to stop the race, and they’re thinking, well why isn’t he landing?” So, even though helicopter pilots sometimes appear to be performing strange manoeuvres, or not to be doing what’s expected of them, there is (normally) a good reason for their behaviour. Julian Spiers, aircrew supervisor and critical care paramedic at Midlands Air Ambulance, UK, observes that in their area, the rural (ground) ambulance crews are used to dealing with helicopters and understand what’s needed, whereas city ambulance crews who rarely see an air ambulance are not so aware of the safety requirements of helicopter operations. Perhaps one answer is more training for everyone. A final word from Ed MacDonald: “EMS operations tend to be more hazardous because one never exactly knows how well trained and competent the person(s) setting up the landing zones may be and whether or not it is truly safe. We train and incorporate the team concept on every flight to empower medical crews to speak up when any hazard or hazardous behaviour is observed. Training and incorporating all aspects of air medical resource management is critical to safe air ambulance operations. Initial and continuing training of flight and ground crews must be done to help reduce risks of all phases of flight.”

NEW ARRIVALS The Category ‘A’ procedure for landing is more straightforward – and doesn’t involve flying backwards. The Landing Decision Point is likely to be slightly lower than the Take-off Decision Point, and the approach steeper than for a normal landing, and slow. If engine failure should occur above the Landing Decision Point, there’ll be enough height for the pilot to gain speed and climb on one engine. Below the Decision Point, you’re committed to landing. NO ROOM FOR THE ELEPHANT Whether or not Category ‘A’ landing and take-off profiles are being used, there’s a great deal that pilots have to think about when arriving at a new site, and medical and ground crew should be aware of what’s involved. Lorena Knapp says: “In my job flying medevac, we are often flying into scenes. Although these are often secured, sometimes they aren’t. In a typical scene on the highway, in addition to the performance considerations, I’m also considering the bystanders, vehicles, first responders, wires, and debris on the road. I often think about the downwash of the helicopter as well as how to protect my tail rotor. I try to position the helicopter relative to the ambulance or patient. All of these factors would mitigate risks to ground personnel as well as enhance my visibility on scene and lessen the risk of someone inadvertently walking into the tail rotor. It might also create an approach path that doesn’t look like a typical vertical take-off and landing that many people have in their minds when they think of a helicopter.”

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BIGGLES GIGGLES

Droning On

Loose change has loads of great uses. You might realise you have enough to buy a chocolate bar, or pay for that

Drones may be one of the most game-changing technologies to have impacted the search and rescue world in recent years, and with the technology evolving quicker than anyone can keep up, it looks like this is only the beginning for the use of unmanned aerial vehicles for rescue uses. Lochaber Mountain Rescue Team, which performs rescues up the slopes of Ben Nevis, UK, is one of many rescue organisations that have invested in drone technology to assist their SAR efforts, and recently found another way to make good use of this technology.

BEN SHEPPARD, SPIDER UAS OPERATIONS LTD

Coin copter

diary dates

BIGGLES GIGGLES

Send your diary dates to: info@airmedandrescue.com

28-31 August Project Lifesaver Conference Project Lifesaver Embassy Suites Hotel, Orlando, Florida, US www.projectlifesaver.org

4 September Critical Care in the Air Royal Aeronautical Society London, UK www.aerosociety.com/criticalcare

5-7 September Advanced Seminar CCAT Aeromedical Training Cumberland Lodge, Windsor, UK www.ccat-training.org.uk

20-21 September The Emergency Services Show

Send your diary dates to: info@airmedandrescue.com 13-17 June Safety Management Training Academy

Rewarding excellence in the travel and health insurance industry

AAMS Carlsbad, California, US www.aams.org

24-29 July ALEA EXPO

Air Ambulance Company of the Year

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

FINALISTS

Broden Media Hall 5, NEC, Birmingham, UK www.emergencyuk.com

26-28 September Interaerial Solutions

The kids hard at work

Hinte-Messe Berlin Exhibition Centre, Berlin, Germany www.interaerial-solutions.com

parking space you need. Of course, the best use for spare change is to donate it somewhere, and – not that we’re biased – but air ambulance charities seem like a pretty good place to put those jangling coins. Pupils from Belmont School and Moon Hall School in Dorking, UK, not only collected money for their local air ambulance charity, Kent, Surrey and Sussex Air Ambulance, but they also created a special piece of art in the process. The schools appealed for 10p coins to be donated to

27-29 Sept Safety & Quality Summit CHC Dallas-Fort Worth, Texas, US www.chcsafetyqualitysummit.com

30 Sept-1 Oct Operators Conference Europe

Sponsored by

Goodrich Hilton Canary Wharf, London www.goodrichhoistandwinch.com

2-4 October Drone World Expo

BEN SHEPPARD, SPIDER UAS OPERATIONS LTD

LOCHABER MOUNTAIN RESCUE TEAM

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

3-5 October Helitech Reed Exhibitions Excel London, UK www.helitechinternational.com The team’s drone in action

The finished helicopter from the air

the air ambulance charity, and when they had enough, laid them out in their playground in the shape of a huge helicopter. All in all, the schools raised £520 through their creative money-raising scheme and Kent, Surrey and Sussex Air Ambulance said how grateful it was to all the pupils and staff for their hard work.

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A team was out attempting a rescue when it decided to use one of its drones to locate a fallen walker. After the team located the walker, it found that if they put its drone in sport mode and flew the device round quickly in a tight circle around the casualty, it was able to keep midges away. As one commenter on the Lochaber Mountain Rescue Team Facebook page pointed out, a drone is a pretty expensive midge repellent.

Join the celebration, in Barcelona or online at itij.com/awards to find out who wins!

7 October Flights Nursing Workshop Royal College of Nursing London, UK www.rcn.org.uk

16-18 October Air Medical Transport Conference AAMS Fort Worth, Texas, US www.aams.org

16-19 October Public Safety Drone EXPO ALEA New Orleans DoubleTree Hotel, New Orleans, Louisiana, US www.alea.org

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PRODUCTS & SUPPLIERS

PRODUCTS & SUPPLIERS

IAFCCP

Alpine

USA

Switzerland

ASU

USA

SCHILLER

Switzerland

BCCTPC

USA

Air Ambulance Technology

USA

Heli Tow Cart

EMS Flight Crew

SCHILLER’s reliable solutions for extreme needs on land, at sea or in the air.

Canada

Efficient Solutions

New! Combi for Wheels + Skids

WWW.EMSFLIGHTCREW.COM

Spectrum Aeromed

USA

Aerolite Max Bucher AG

Switzerland

FEC

helitowcart.com

UK

+1 418 561 4512

AMPA

USA

FEC Heliports Worldwide Ltd

www.heliportsequipment.com www.fecheliports.com +44 (0) 1494 775226

Med-Pac

USA

AAMS

USA

Elliott Aviation

• Aluminium Helipads & Helidecks • Offshore & Onshore Rooftop Designs • Enhanced Safety - Fire Retardant Helideck Systems • In-House Design, Manufacture & Installation • Support Structure Design & Manufacture

USA To advertise here please contact James Miller +44 (0)117 922 6600 Ext. 217 jamesm@airmedandrescue.com www.airmedandrescue.com

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AIRMED & RESCUE

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Saving Lives. Anytime, Anywhere.

ADVERT LEFT

169 Lives depend on you. The AW169 is ideally suited to life-saving primary and secondary EMS missions anytime, anywhere. Easily adaptable, rapidly configurable and uniquely designed around patients’ needs; the AW169 ensures that air medical professionals can provide the best care at the most critical moments. Inspired by the vision, curiosity and creativity of the great master inventor - Leonardo is designing the technology of tomorrow.

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AirMed & Rescue Aug / Sep 2017  
AirMed & Rescue Aug / Sep 2017