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AIRMED & RESCUE MAGAZINE
magazine ISSUE 86 | OCT / NOV 2017
USCG Advanced Helicopter Rescue School ISSUE 86
Training with heavy seas and vertical cliffs
Malta air medical Civil air rescue in the land of honey
OCT / NOV 2017
Hurricane season 2017 Picking up the pieces in the Caribbean and US
Almost accredited Conditional and provisional accreditation
Editor-in-chief: Ian Cameron Editor: James Paul Wallis
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USCG Advanced Helicopter Rescue School
Malta air medical Civil air rescue in the land of honey
Training with heavy seas and vertical cliffs
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Hurricane season 2017
Picking up the pieces in the Caribbean and US
Conditional and provisional accreditation
Interview: Dr Ami Jones
Interim national director, the Emergency Medical Retrieval and Transfer Service
New medical aviation hub Aircraft spotlight Base planned for St Petersburg
magazine AIRMED & RESCUE ISSUE 86 ISSN 2059-0822 (Print) ISSN 2059-0830 (Online) S P E C I A L M I S S I O N S .T X TAV. C O M
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Boy flown after Mongolian Always the pilot’s fault horse race injury Are you fit to fly?
Learning not blaming
Urgent medevac flight from traditional festival
Johannesburg to Kansas
Partnering for ‘epic’ high-risk patient transfer
Cover image: A Beechcraft 1900
Amputee medic re-joins unit
Editor’s comment Welcome to Issue 85 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. As this edition goes to print, here at the Voyageur Publishing & Events offices we’re gearing up for our biggest conference offering of the year, ITIC Global, this year held in Barcelona from 5 to 9 November. As a gathering of travel and health insurance providers and allied suppliers, it will feature a sizeable contingent of fixed-wing air ambulance providers from around the world, who fly patients across borders on behalf of insurers and assistance companies. In honour of the fact that this issue will be distributed at the event, we bring you a higher than usual flavouring of fixed-wing content, including a note on Rega’s busy summer (see p.8), David Quayle of Air Alliance Medflight discussing Just Culture (on p.14), a preview of Heli Drive’s project to build an island base for medical helicopters and planes (see p.16), and an aircraft spotlight on the Beechcraft 1900 (p.27). There’s also a report from European Air Ambulance, which flew a victim of the Barcelona terrorist attack from Spain home to Belgium as an intensive care patient (p.29), MAF recounting the transport of a young boy injured at a tradtional Mongolian horse festival (p.31), and the story of an ‘epic’ high-risk patient transfer by Fox Flight Air Ambulance and Awesome Air Evac – the first time the Awesome team had conducted a wing-to-wing mission (p.32). But wait, there’s more – Assist America explains how it partnered with Air Link to fly a man from Peru to California, picking him up from Cusco’s high-altitude airport (see p.33), and last but not least Dr Shannon Townsend waxes lyrical on the joys of working as an RFDS retrieval registrar (on p.35). Also relevant to this sector are the feature article on civil air rescue in Malta (see p.38), a strategically located island where Air Malta takes patients onboard passenger flights and private companies are also setting up shop, and our examination of why CAMTS offers ‘conditional’ accreditation and EURAMI has a ‘provisional’ certificate. The conference itself includes a range of air ambulance sessions, including panel discussions and speaker presentations, on topics as diverse as taking drugs across borders, transporting obese patients, structured decision making and drug transfusion protocols. The industry figures on stage include Dr Terry Martin of Capital Air Ambulance, Dr Thomas Buchsein of FAI rent-a-jet, Blake Yturralde of Commercial Medical Escorts, Dr David Sinclair of European Air Ambulance, Eva Kluge of Air Alliance Medflight and Dr Yann Rouaud of Airlec Ambulance. But wait (déjà vu?), there’s more – the conference also serves as the venue for the annual EURAMI members meeting, and is topped off with the annual ITIJ Industry Awards, including the Air Ambulance Company of the Year. Tune into the live broadcast on the evening of 9 November at www.itij.com to see the winner announced!
James Paul Wallis Editor firstname.lastname@example.org
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A US Air Force rescue reservist has won his battle to re-join the Air Force Reserve after losing his leg in a motorcycle accident. Senior Airman Kevin Greene is now again a healthcare management technician with the 920th Aeromedical Staging Squadron, but had to spend two and a half years recovering and training to be physically able to re-join, pushing past three rejection letters to once again wear his Air Force blues. Greene lost the lower quarter of his left leg after a motorcycle accident in December 2014. Due to infections, he had to remain in hospital for two months, but said he never felt alone. “My immediate family was always there of course, but my Air Force Reserve family surprised me. I knew people in the unit cared, but there was no mistaking it on the drill weekends when I’d have like 40 people coming to visit me. The staff didn’t even know what to do with that many visitors. The love and camaraderie I felt within my unit is the driving factor in my wanting to continue to serve.” Greene was fitted with his first prosthetic in March 2015, but found that a return to his unit was still a long way off. Whilst recovering, Greene worked with kids at a nearby recreation centre and coached basketball at a nearby high school, all whilst trying to return to the physical fitness required to re-join. “It was discouraging at times; I’m not even going to lie,” he said. “But I knew I was meant to be a Reservist. There are opportunities to be had in the Air Force that you just can’t get anywhere else. I was thriving in the Reserve before my accident, and I just wanted that sense of purpose and pride that comes with the uniform back again.” In April 2017, Greene faced his final test. He travelled from his home in Florida to Joint Base San Antonio-Randolph, Texas, to talk to the medical evaluation board and pass the Air Force physical fitness test. He got good results in the waist measurement, push-up and sit-up portions of the assessment, but the excitement of being back in an Air Force uniform meant that he didn’t pace himself during the run, sprinting the first two laps. “The third lap I was little slower, and the fourth lap slower,” he recounts. “I picked it up a little in the fifth and that’s when an Air Force officer who just happened to be running on the track on his off day started running with me, pacing me and motivating me. I finished at about 13 minutes, and I thank him for that. He said I inspired him, but he inspired me. Just another testament to the Air Force family.” Greene passed all his tests, and received word that he had been reinstated into the air force reserves on his flight home. “Words can’t begin to describe the emotions I felt when I got that phone call from the lawyer,” he said. “This whole process and my accident has given me a new outlook on life. I just tell people to appreciate every moment; cherish every day.”
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 email@example.com
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Bristow Norway secures SAR contract in Barents Sea Bristow Norway announced on 18 September that it had secured a multi-year contract to provide helicopter offshore search and rescue and crew change services to support Eni Norge and Statoil in the Barents Sea. The five-year deal, which is a renewal of an existing contract, includes options to extend by three years, and will commence on 1 September 2018, said Bristow. Bristow Norway area manager Heidi Wulff Heimark commented: “We are honoured to earn the trust of both Eni and Statoil in the safety and quality of our operation. This contract is a result of our team’s tremendous focus to continuously improve our service delivery, and strengthens our position as the leading operator of offshore helicopter transport in the global market.”
The contract will mean a continued high level of activity at Bristow Norway’s helicopter base at Hammerfest, said the firm, where the company currently provides helicopter services for Eni and Statoil exploration and production operations in the Barents Sea. Bristow noted that Hammerfest is already an established helicopter base for Bristow Norway, with the necessary infrastructure and workforce in place. Bristow will utilise a Sikorsky S-92 in oil and gas configuration to provide crew change services for offshore platforms, and a Sikorsky all-weather SAR S-92 for the search and rescue work. Both helicopters will be equipped to the latest Norwegian oil and gas standards, with integrated traffic alert and collision avoidance system
(TCAS II), tail-mounted cameras and performance-based navigation, said the company. The AWSAR S-92 is certified for night vision goggles operations, with forward looking infrared, auto hover, twinhoist, mission management with moving map and increased onboard medical capabilities. On short notice, the crew change helicopter can be reconfigured as a back-up for the SAR helicopter with full AWSAR capability, said the firm. Heimark commented: “The Barents Sea is a strategically important region for Bristow, and we foresee continued growth of exploration and production activities in the coming years. With this contract and our Arctic experience, Bristow is well-positioned for coming exploration campaigns in the high North.”
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Helicopters | Aeronautics | Electronics, Defence & Security Systems | Space
UK celebrates National Air Ambulance Week and 30-year milestone
“Since 1987, Dr Frascone has been leading the way on bringing innovative bedside technology onboard our aircraft and driving exceptional patient care delivery,” said Kolby Kolbet, vice-president of clinical services for Life Link III. “Being named Medical Director of the Year by AMPA recognises the many contributions Dr Frascone has made, not just for our organisation, but in serving as a national thought leader in advancing critical care across the air medical industry. We are very proud to have Dr Frascone as a key part of the Life Link III team.” Edward Eroe, president and CEO of Life Link III, commented: “In addition to guiding our clinical care, Dr Frascone is
committed to bringing the safety of our crew and patients to the forefront of all decision making. As chief medical officer, a member of the Life Link III board of directors, and chair of the clinical council, Dr Frascone’s involvement and leadership [have] helped shape one of the most robust safety programmes in the air medical transport community.” In addition to serving as the chief medical officer for Life Link III, Frascone is the medical director of Regions Hospital EMS, which includes the City of St Paul, Life Link III (rotor and fixed-wing transport) and 28 other agencies. He is also a professor of emergency medicine at the University of Minnesota.
Life Link III of Minnesota, US, announced on 11 September that Dr R.J. Frascone has been named as the Air Medical Physician Association (AMPA) Medical Director of the Year. The honour recognises a medical director who has demonstrated ‘exceptional personal involvement’ in a flight programme and is considered to be an invaluable part of the air medical flight programme’s success, said Life Link III. The award is due to be presented to Frascone at the AMPA General Membership meeting in Fort Worth, Texas, on 15 October.
Official launch of Lismore helicopter rescue base The Westpac Life Saver Rescue Helicopter and NSW Ambulance celebrated the official opening of a purpose-built aeromedical base at Lismore Airport, New South Wales, Australia, on 8 September. Commissioner Dominic Morgan, chief executive of NSW Ambulance, said the facility was the latest achievement in the NSW Government’s Reform Plan for Aeromedical Retrieval Services across the state: “The communities of Northern NSW will benefit greatly from this new base, and the new AW139 aircraft that are enabling critical out-of-hospital care to be delivered when and where it is needed most. The clinical capability and aviation skill of the operational crews at this base is exceptional. With a NSW Ambulance helicopter critical care paramedic and a local health district
doctor onboard every flight, this team is delivering critical care direct to the scene of an incident and this care continues during flight back to a primary care hospital.” Since contract commencement on 27 April, the Lismore Service has completed over 150 missions. The base is operational around the clock with crews ready to respond. Richard Jones, CEO of Northern NSW Helicopter Rescue Service, which operates the Westpac Life Saver Rescue Helicopter, said the service was very pleased with the finished state of the base: “Our focus since commencement in April has been to ensure the safest and most effective service for our community. Our local team has done an exceptional job to achieve the best community outcomes possible. The Lismore base is an asset for our community and
we are delighted to deliver this facility. It provides accommodation for the crew and functional workflow and communication for local aircraft engineers and the operations team. It is also home for our local volunteers and support teams.” Jones continued: “I can’t speak highly enough of the local staff and volunteers who have worked extremely hard to achieve this milestone and I sincerely thank each and every one of them. Everyone from our service, NSW Ambulance and NSW Health have worked as one team, flexibly and committed to the best result. We are proud that local people delivered the community’s own Lismore base, and our ongoing focus now is ensuring the best possible aeromedical treatment, search and rescue services for this region.”
September, many of the local charities organise events and initiatives in a bid to generate funds and raise awareness, said the AAA. Jim Fitzpatrick, chair of the All Party Parliamentary Group for Air Ambulances (APPGAA) and member of Parliament for Poplar Members of Parliament Jim Fitzpatrick and Mark Pawsey, chair and vice-chair of the and Limehouse, APPGAA respectively commented: “Air The Association of Air Ambulances ambulances play an essential role in our (AAA) recently celebrated both National emergency services response and the Air Ambulance Week (NAAW) and the advanced care which has recently played a 30th anniversary of the start of helicopter part in a 20-per-cent [decrease] in mortality emergency services in the UK. The first should be commended. The number of such air ambulance service began flying in incidents where the skills of the crews are Cornwall in April 1987. needed is increasing, and the types of care Since then, noted the AAA, these critical needed are becoming more complex as our life-saving services have invested funds population ages and we stay more active to expand their operations, increased into later life.” their operating hours to operate at night, As part of the National Air Ambulance upgraded to larger aircraft, increased their Week celebrations, four air ambulance medical capabilities with the carriage of charities from London and the east of blood products and invested in the advanced England came together for the first time education and training of their paramedics to raise awareness of the emergency preand doctors. The charities together raised hospital care they bring to patients in their £162 million in 2016, said the AAA, time of need. East Anglian Air Ambulance, operated 39 helicopters and fly on average Essex & Herts Air Ambulance (EHAAT), 20,500 missions each year. London’s Air Ambulance and Magpas Air During NAAW 2017, which ran from 11-17 Ambulance highlighted that in 2016 alone,
they were called out to 6,787 serious medical emergencies, providing advanced critical care at the scene. The charities joined forces to sell fundraising pin badges and to create a promotional video. Maria Alexander, head of fundraising at EHAAT, said: “This is a huge leap forward for us. We want these badges to give us the opportunity to start working together more regularly and shine a light on the larger air ambulance community and the importance of the work we do. We usually have borders to fundraising, but there are no barriers to us saving lives and, ideally, this project will be a trial to continue and grow with next year’s National Air Ambulance Week.” Debbie Florence, head of community fundraising for Magpas Air Ambulance, added: “This joint fundraising collaboration between four progressive air ambulances has never occurred in the industry before! It means so much to Magpas Air Ambulance to be working in a long-term sustainable partnership under the banner of ‘support your local air ambulance - together we save lives’; this could, and indeed should be, the springboard for all other air ambulances to join in this campaign for 2018 and beyond to have a consistent approach and share commonality in NAAW. The pin badge concept is so simple and the great British public can wear their life-saving helicopter or indeed collect all four pin badges. By working together we educate, raise awareness and much needed funds for these amazing charities.”
Rega kept busy during summer Swiss air ambulance company Rega announced that, over the 2017 summer holidays, it repatriated a total of 260 patients from abroad back to Switzerland. The majority of the patients, 190 in total, were repatriated using the company’s three Challenger CL-604 air ambulances. Rega said that the majority of patients were repatriated from other European countries, 88
AIRMED & RESCUE
with Italy, Spain, France and Greece proving the most popular places for Swiss travellers. The longest repatriation that the company had to perform was bringing back a patient from Australia. The most common reasons for repatriations this summer were diseases, followed by vehicle-related and sports injuries. The company pointed out that summer
is its busiest season, due to more Swiss heading abroad during the summer break.
DIGITAL PHOTOGRAPHY BY ROB HOLDING
REGIONS HOSPITAL EMS
Dr R.J. Frascone named medical director of the year
(from left to right) Essex & Herts Air Ambulance, Magpas Air Ambulance, East Anglian Air Ambulance and London Air Ambulance crews mark NAAW
Erickson appoints new CEO “We are delighted to welcome Doug to the team. As an accomplished aerospace and defence CEO with vast government services experience, Doug brings a unique skill set to Erickson and we feel confident he will be able to leverage Erickson’s unique capabilities into new markets while continuing to support and grow our existing relationships.”
Aerospace OEM and provider of global aviation services Erickson Incorporated recently announced the appointment of government services veteran Doug Kitani as chief executive officer and director effective from 31 August. He joins Erickson having most recently served as CEO and director of IAP Worldwide Services, a global defence services company specialising in logistics, expeditionary infrastructure, facilities engineering and power systems. His prior experience includes leading portfolio strategies and corporate development for DynCorp International, an aerospace and defence company. Eirckson highlighted that Kitani has expertise in mergers and acquisitions and quality improvement, having spent many years working in the private equity investment field and in general management at Honeywell International and General Electric. Erickson chairman Jim Continenza said:
REACH Air Medical Services to run new helo in Montana REACH Air Medical Services (REACH) has said it will place an Airbus H125 helicopter in Montana, US. The new model was purchased by REACH specifically for service in Montana because of its highreliability rates, high-altitude performance capabilities and safety features, the provider explained. The new aircraft has been outfitted for use in the air medical environment and has the capacity to transport the patient and a three-person flight team. REACH said it has also equipped the aircraft with
Kitani commented: “Erickson is a global market leader in aircraft manufacturing, MRO and air operations, and I am excited to be a part of building the business and expanding our market position in the days ahead.” Acting president and CEO Andrew Mills will continue to serve in an executive role at Erickson, said the firm. Continenza stated: “The board and I thank Andy for his leadership and guidance through this transition and know he will continue to be a valuable member of our team.” A graduate of the US Military Academy at West Point, Kitani earned an MBA in finance and strategy from Emory University. He served as a US Army helicopter pilot (qualified in the UH-1, OH-58 and UH-60 while completing 11 years of active and reserve duty), is a member of AOPA and is a supporter of the Green Beret Foundation.
Lincs & Notts Air Ambulance (LNAA) has announced that after months of preparation and training, it is now carrying blood onboard its ‘Ambucopter’, enabling crew members to undertake on-site blood transfusions for the very first time. The
the pilot was descending to about 100 ft above trees when the helicopter began an uncommanded yaw to the right and the descent increased. The pilot then released the water that was contained in the helicopter’s 450-gallon tank, but the yaw and descent continued. The helicopter then hit some trees, before the pilot was able to regain control and make an emergency landing.
AIRMED & RESCUE
a standard utility AW189 into a stretcherequipped helicopter within just five to 10 minutes, said the firm, giving the operator a true multi-role aircraft. The company plans to supply Leonardo directly, as well as providing interiors to the oil industry, private operators, and other Leonardo customers with their search and rescue medical interior.
To date, Air Ambulance Technology, located in Ranshofen, Austria, has delivered over 700 STC-based EMS, VIP and special mission kits for a range of different types of helicopter and fixed-wing aircraft. All of the company’s interiors are based on its quick change technology, said the organisation, and require no structural changes to the aircraft during installation.
EASA grants STC for AAT’s AW189 interior EASA has granted Austria-based aircraft interior manufacturer Air Ambulance Technology with an STC for its Leonardo AW189 system. The medical interior has been designed for both disaster evacuation and search and rescue mission profiles. The interior is based on Air Ambulance Technology’s quick conversion technology and can transform
of need. Going into winter, the ability of the snow pads and the light weight of this aircraft allow for increased likelihood of reaching patients when others cannot. We look forward to continuing to provide high quality medical care to patients and hospitals in Southern Montana.” REACH operates two air medical bases in Montana, a helicopter base in Bozeman and a combined helicopter/plane base in Helena. Each base is staffed 24/7 with a critical care transport team consisting of a pilot, a flight nurse and a flight paramedic.
Lincs & Notts Air Ambulance to deliver blood transfusions
LAFD helicopter lost control before hitting tree, says NTSB The US National Transportation Safety Board (NTSB) has said that it believes that the recent Los Angeles Fire Department (LAFD) helicopter accident was caused by the aircraft making uncommanded movements. The service’s AW139 helicopter was assisting with fighting the La Tuna wildfire on 2 September when it made contact with what is thought to be a pine tree. The helicopter was damaged but none of the crew was hurt. The helicopter only came into service for LAFD recently. According to the preliminary report,
night vision goggles, autopilot systems, advanced terrain awareness warning systems, and snow pads for improved winter landing ability. Vicky Spediacci, vice-president of aviation operations for REACH, said the organisation was confident the H125 will deliver safe and reliable service to the communities of Southern Montana. Sean Russell, president of REACH Air Medical Services, added: “In this rural landscape, the new H125 will increase our ability to safely serve patients in their time
UK HEMS charity said that this will significantly enhance the pre-hospital critical care it can offer at the scene of incidents or accidents, giving patients a better chance of recovery from devastating injuries. Dr David Cookson, the lead doctor overseeing the implementation of the project, explained: “Recent advances in availability and affordability of devices to keep and administer blood mean that it is now possible for blood transfers to take place outside of a hospital environment, administered by the Lincs & Notts Air Ambulance crew. Patients who are bleeding heavily and who have very low blood pressure are often not able to get sufficient oxygen to their vital organs. In these instances, giving the patient blood, as well as other treatments, can help the patient to continue to deliver oxygen around their body which buys them more time before they get to a hospital.” Charity CEO Karen Jobling added: “The blood is supplied by Lincoln County Hospital
and delivered daily by the Lincolnshire Emergency Blood Bikers to our airbase. Our crew have now undergone the specialist training required, meaning the Lincs & Notts Air Ambulance can now carry and administer blood.” Two units of type-O blood are carried by the helicopter in specially designed thermostatically controlled boxes, which maintain a temperature of two to six degrees centigrade and are equipped with a data logger and warning light. A fluid warming unit brings the blood up to the correct temperature instantly to administer to patients suffering from dangerously low blood pressure and who have or are suspected to have significant bleeding. Paul Bagwell, chairman of Lincolnshire Emergency Blood Bikes Service, said: “To be able to include the Lincs and Notts Air Ambulance in our service is an honour, providing daily transport will enable blood to be delivered to those that need it and potentially could be the difference between life and death. By returning any unused blood back to Lincoln County Hospital, we ensure that it remains in perfect condition and prevents any wastage of this essential resource.” LNAA noted that the move was made possible thanks to a donation from the Henry Surtees Foundation, which has paid for the extensive training and kit required for the crew to undertake the complex procedure.
Public safety professionals must be able to think fast and adapt to any situation in a matter of seconds. High quality performance and execution comes from training, which is not a one-time event, but an ongoing process to be prepared for any incident. Since anything is possible for these professionals, simulation training is absolutely essential, especially with the implementation of unmanned aerial vehicles (UAV). Simulating real-world situations during public safety drone training allows participants to practise all components of their jobs. Fast decision-making under real-mission stress is put to the test while still being able to learn without negative repercussions. Many public safety agencies recognise the great value in a tiered training environment that allows students to experience real-world events in a controlled environment. These training environments make the incidents feel as real as possible to help professionals adapt to the confusion of unforeseen risks and stress. Adding to the stress of a full operation is truly the best way for professionals to learn and put their training to the test. When it comes to specific public safety missions, every second counts. Professionals must be focused on fine details and prepared to react quickly to sudden and unique events. DARTdrones builds custom training programmes for every unique case a public safety team may need. DARTdrones has trained more than 30 police and fire departments from across the globe on basic flight training and mission specific operations. The training is designed to provide professionals with a strong foundation of skills while creating increasingly realistic scenarios one would encounter during a mission. Public safety departments are interested in using unmanned air systems (UASs) for many use cases, such as search and rescue, water rescue, night operations, thermal imaging, accident investigation, fire scene operations, advanced search and rescue, crowd management, and fleeing suspect pursuit. For example, search and rescue training could consist of a three-day course covering an introduction to sUAS and sUAS flight, advanced sUAS capabilities, modes, and emergency procedures, waypoints and mapping, SAR operations, manual/automatic search patterns, and thermal imaging. Each training programme is built for the specific needs of the department. For these types of public safety training, once each student has shown they are capable to safely operate the UAV, they will be asked to execute a simulated mission. The instructor will only intervene if an issue of safety is recognised. This is simulating real-world stress and allows students to have the feeling that they are now the decision maker for the success or failure of the mission. This creates that non-clinical experience in a controlled environment. During the simulated mission, the flight crew consists of a designated pilotin-command and a visual observer. These positions will change during the mission so both crew members understand each role. Prior to the mission start, the instructor places a training dummy in the field, along with additional clues that may be used to determine the location of the subject. 12 12
AIRMED & RESCUE
Sample dispatch “UAV1, respond to 123 Main Street for a missing person. The subject is a 17-year-old white male, 5’10” tall, medium build. Subject was last seen wearing a red shirt, blue jeans, and white trainers. Subject has been missing from the residence for two hours and is diagnosed with autism.”
The flight crew will receive a dispatch, similar to what would be received by a police or fire department (see inset). Even with this simple dispatch, many factors must be worked through: 1) Preflight planning. What UAV capabilities do we have available for this mission? Is the aircraft airworthy? How many spare batteries are available? 2) Weather planning. What weather conditions exist? What are the weather forecasted conditions? Are there weather conditions that may adversely affect UAV performance? 3) Regulatory planning. What airspace requirements exist for the flight operation area? Are any flight restrictions in place? Do any other FAA regulations need to be considered? 4) Resource availability. How many personnel are available to assist? Will additional UAVs be involved in the mission? How will the search teams co-ordinate? 5) Flight operations area considerations. Are there any hazards in the operational area? Is there any terrain that would make maintaining visual line of sight difficult? Does the visual observer have to separate from the pilot-in-command to maintain visual line of sight, or are more visual observers required for the mission? What is the proximity to airports? 6) Situational planning. Why would the subject leave the residence? Is the subject with any other people? Does the subject have special needs that may provide insight into a probable area to search? How long has the subject been missing and what is the size of search area? 7) Take-off/landing area set-up. Where will the flight crew set up their take-off/landing area? Are logistics available to provide the flight crew with water, food and rest for extended operations? Will the take-off/ landing area move during the incident? Which alternate landing area has been identified? 8) Flight operations and search. What is an appropriate search pattern? What does a human form look like from 100 ft, 200 ft, and 300 ft above the ground? How does the terrain and vegetation affect the ability to search? What speed should the UAV be flown at to maximise search area coverage? 9) Emergency situations. What actions will need to be taken if GPS positioning is lost? What actions will need to be taken if a low battery condition is encountered? What if the display device fails?
10) Mission termination considerations. Has the victim been located? Is the UAS capable of continuing with the mission? Is the flight crew capable of continuing with the mission? Should mission decisions be re-evaluated? As you can see, there are many situational factors for every mission that require quick, yet well thought out decisions. Obtaining commercial, custom, public safety drone training is vital for different departments to excel in their missions, save money and increase efficiency. Overall, drones can provide critical intelligence for public safety incidents, but no matter how advanced the technology, the human element is still the deciding factor for a successful UAV mission outcome.
Author Mike Uleski, DARTdrones chief public safety flight instructor, is an active sergeant with a public safety department in Florida, where he is cross trained as a law enforcement officer, firefighter and EMT. He has extensive aviation expertise with a degree in aeronautical sciences from Embry-Riddle, a commercial pilot certificate with single-engine, multi-engine and instrument ratings, and 17 years of experience building and flying remote controlled aircraft. He also recently received his certificate in crime prevention through environmental design (CPTED).
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Print subscription Just Culture is beginning to take root in the UK, predominantly within the aviation industry, while in the US, it has been adopted by many healthcare organisations outside of aviation – there is an increasing recognition that safety developments in aviation have strong applicability to the healthcare setting. CAMTS (the Commission on Accreditation of Medical Transport Systems) is one of a number of accrediting bodies for air ambulance and commercial escort providers and has a keen interest in Just Culture. It doesn’t yet require Just Culture to be embedded in its accredited services, but does place it high on the list of areas that demonstrate the right kind of attitudes within an organisation and it exemplifies the type of culture a CAMTSaccreditable organisation should demonstrate. Firstly, what is Just Culture? Eurocontrol define it as: “A culture in which front-line operators and others are not punished for actions, omissions or decisions taken by them which are commensurate with their experience and training, but where gross negligence, wilful violations and destructive acts are not tolerated.” While a little limited, this does at least give us something to start picking
apart the components of Just Culture. Let’s start by thinking about a nurse, working alone with a patient on a commercial airline, repatriating their patient over a long-haul route. How is their job structured? What is there to help prevent an error? What would happen if an error occurred? How would we know? In Just Culture, we expect mistakes to happen – they simply will because we’re human. We place duties on our staff to try to ensure that mistakes occur less frequently: a duty to produce an outcome, a duty to follow procedural rules and a duty to avoid causing unjustifiable risk or harm. Then systems of work which codify these duties are put into place by organisations. So when errors do occur, why does the blame always fall on the individual (in our scenario a flight nurse)? Surely the first place we should look is into those systems of work which are after all, the organisation’s primary line of defence? In my experience of some 28 years as a registered nurse, errors are often devastating to the individual. They do not require punishment, as they’re 14 14
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already punishing themselves rather harshly in any event (with a few worldrenowned exceptions, healthcare professionals rarely intend to do harm to their patients). They are extremely likely to have already learnt a lesson from the experience and are the least likely people to make the same error again. In Just Culture, consoling our flight nurse would be the correct course of action for a simple, one off, error – followed by a review of systems of work to see if circumstances/policies/procedures made the error more likely to occur, and if the system requires change. Imagine a nurse flying long haul to Australia where they will visit a hospital to collect a patient and return perhaps the following day. They will have had little rest, spent a long time at altitude and have crossed numerous time zones – exhausting work! Then they make a drug error and who gets the blame? The nurse or the organisation that failed to build adequate rest into the schedule? In Just Culture, the organisation should always look to its own systems first. If a company is to have any chance of learning and developing expertise, it needs frequent and open feedback and error reporting. As a lone worker who is remote from the organisation dispatched to undertake a repatriation, our nurse needs to be encouraged to report incidents and hazards to the employing/contracting company. It’s only in an environment where responses to reports of incidents do not come in the form of automatic blame and punishment that individual clinicians can feel safe to report. The organisation’s culture really matters! In the UK, we have a legal duty of candour. That is to say, we must tell a patient if an error has been made, thereby attempting to promote openness and transparency. However, if punishment and possible loss of livelihood is the result of candour, how often do we think individual clinicians will be truly candid? This doesn’t mean that our nurse on the commercial flight will just get a consoling hug if they keep on making the same mistake. Just Culture accepts that this will need to be rectified with coaching. Retraining may be required and, I would suggest, a bit of work on personal reflection! Furthermore, actions which are in breach of a duty to avoid causing unjustifiable risk or harm (reckless behaviour) should be met with firm action. Just Culture provides clear algorithms for how errors, repetitive actions and risk behaviours should be dealt with by managers, so it is always clear to everyone how their organisation will behave towards them. Nurses on commercial escort duties are often lone workers and always work away from the watchful eye of the company that has sent them on the job; monitoring is necessarily difficult. Just Culture provides a management system which promotes reporting by being very clear as to duties, responsibilities and where the eye of any review should look first – the systems of work of the company itself.
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Author David Quayle is clinical services manager at Air Alliance Medflight and a site surveyor for CAMTS EU.
New medical aviation hub pledged for St Petersburg Vladislav Vorotnikov reports on the new air ambulance base being planned in Russia’s second city On Kotlin Island, which separates the Gulf of Kronstadt from St Petersburg’s Neva Bay, stands Bullish Field, a former Russian Air Force base. The St Petersburg city authorities have given permission to private air ambulance provider Heli Drive to turn the base into Russia’s largest medical aviation hub,
Location location location Bullish Field occupies a strategic location at the entrance to Neva Bay. It was established back in 1930s, but abandoned by the military shortly after the collapse of the Soviet Union. The exact reasons why it was abandoned remain mostly classified within vaults of the Defence Ministry, but some environmentalists believe it may have been at least partly associated with
environmental concerns – concerns that could be a challenge for using the base as a home for medical aircraft. Alexander Karpov, director of the ECOM analytical centre, which specialises in protecting the ecological rights of Russian citizens, indicated that Bullish Field is located in the migration paths of summer birds: “In spring and summer time, thousands of birds are flying above Kronstadt, causing a threat to not only helicopters, but also planes.” Heli Drive is not commenting on these environmental issues, but it is already known that the company, which in additionally to medical aviation provides air-taxi services and landing pads for customers’ helicopters, intends to transfer all these elements from Pulkovo to Bullish Field as soon as the infrastructure is ready, so only air medical services will remain at the Pulkovo base. First federal operator In the meantime, a recent release from the Russian Ministry of Transport stated that the Russian government, in conjunction with Heli Drive and state-owned corporation Rosteh, is considering establishing the first Russian federal air ambulance operator, which is going to be ‘organised based on the principles of a public-private partnership’. Currently, Russian legislation doesn’t contain any definition of the regional or the federal air ambulance operators, so it is not actually clear what partnership this is going to be. So far, both the Ministry and Heli Drive refrain from commenting on the issue.
A new level Dmitry Krivenok, Heli Drive spokesman, explained that the company has been providing medical aviation services in St Petersburg since 2014. Over the past three years, the company has handled 582 mission calls, transported 530 patients and saved several dozen lives. During that period, the mortality rate for car accidents in St Petersburg dropped by 60 per cent, while the mortality rate on call-outs involving patients with cardiovascular problems reduced from 35 per cent to just three per cent, not least due to the efforts of Heli Drive, according to data from the regional branch of EMERCOM (the Emergency Control Ministry). The Heli Drive helicopters were also engaged in evacuating patients from a terrorist attack in the St Petersburg Metro on 3 April 2017, when an explosive device killed 15 people and injured another 45. According to Yatsenko, it took just six minutes for the two Heli Drive helicopters on duty to arrive at the scene. Heli Drive runs air medical services under several contracts with the regional authorities in St Petersburg and the Leningrad Oblast, obtained through competitive bidding procedures, information from the state procurement authorities indicates. In particular, Heli Drive holds a contract with the city of St Petersburg for evacuating victims of car accidents on the St Petersburg Ring Road for a total cost of R5 million (US$80,000) in 2017. According to Yatsenko, the project at Bullish Field is meant to bring medical aviation in St Petersburg
at a cost of some three billion rubles (US$50 million). Ivan Yatsenko, general director of Heli Drive, confirmed that the company plans to build several facilities at Bullish Field. At first, the base will include housing for crew members, a fuel quality testing lab and repair and maintenance units. In 2018, the company intends to start a major infrastructure project at the 73-hectare site, so the new base can expand Heli Drive’s geographical coverage throughout almost the entire Northwest federal district, Yatsenko asserted. “Our [medical aviation] services are based next to the Pulkovo International Airport. From that point, we are able to handle all ground mission calls in the southern area, including in St Petersburg, Leningrad Oblast, as far as the city of Novgorod. The new base in Kronstadt will let Heli Drive cover the entire north, up to the border with Finland,” Yatsenko revealed.
to a new level, as it will enable Heli Drive to not only expand its fleet of helicopters, but also to purchase fixed-wing planes to transport patients longer distances, including from remote territories where local air ambulance operators have not been established yet. “We already have plans to start transporting patients to hospitals in St Petersburg from nearby regions, including from Novgorod, Pskov and Archangelsk Oblasts. We’ve already looked at the logistics of flights and to cut the cost per flight hour, we aim to use planes. The planes will take patients to Kronstadt, and then helicopters will transport them to hospitals in the city,” Yatsenko explained. The current Heli Drive fleet consists of three helicopters, but in case of emergency, within an hour two more helicopters can be equipped with medical modules and set up to accept mission calls. Yatsenko revealed that for the new base at the Bullish Field, the company plans to purchase five more helicopters and two planes. Although he didn’t disclose what models the aircraft would be, he did say ‘it will be machines of Russian origin’.
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including Harvey, Irma and Maria, which caused extensive damage and loss of life in the Caribbean and into mainland US. James Paul Wallis highlights just some of the rescue and aid missions that were launched to help those affected by the winds and flooding
US CUSTOMS AND BORDER PROTECTION OFFICE OF PUBLIC AFFAIRS
Already by mid-September, the 2017 hurricane season was being described as an ‘overachiever by almost every index’ (a comment made by Bob Henson, a meteorologist for Weather Underground, to the New York Times). A number of tropical storms developed into hurricanes,
SPANISH MINISTRY OF DEFENCE
A Caribbean-based US Customs and Border Patrol Air and Marine Operations hoist operator deploys a rescue specialist (also an Air and Marine Emergency Medical Service member and EMT) on Jost Van Dyke Island, British Virgin Islands
USAF / STAFF SGT CHRIS DRZAZGOWSKI
US CUSTOMS AND BORDER PROTECTION
A T.22 (A310) from Spanish Air Force Group 45 repatriated Spanish citizens affected by Hurricane Irma from Saint Martin
US airmen from the 563rd Rescue Group out of Davis-Monthan Air Force Base unload an HC-130J Combat King II after arriving at Homestead Air Reserve Base, Florida, in response to Hurricane Irma. Approximately 80 airmen from the 563rd RQG deployed to south Florida in support of recovery operations
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US Customs and Border Protection air and marine aircrews attend a morning briefing at Kelly Air Force Base prior to starting operations to support Hurricane Harvey relief efforts in Texas
DUTCH MINISTRY OF DEFENCE
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USAF / TECH. SGT LINDSEY MAURICE
Lt Col Carla Walker (left), US Air National Guard 137th Special Operations Medical Group administration officer from Will Rogers Air National Guard Base in Oklahoma City, and Col Keith Reed (right), 137th MDG commander, support and say goodbye to personnel from the Medical Group as they board a C-130 Hercules from the 136th Airlift Wing at Will Rogers Air National Guard Base as are part of the 137th Special Operation Wing’s deployment of nearly 40 medical and aeromedical evacuation airmen and equipment in support of the Texas Military Department and their relief efforts following Hurricane Harvey
A drone’s-eye-view view of Saint Martin provided by GlobalMedic, which partnered with Aeryon Labs to provide aerial intelligence to first responders and international disaster relief teams on the ground
US CUSTOMS AND BORDER PROTECTION OFFICE OF PUBLIC AFFAIRS
US AIR NATIONAL GUARD / STAFF SGT. KASEY PHIPPS
A Dutch Ministry of Defence NH90 maritime helicopter distributes food and water in the Dutch territory Sint Maarten following Hurricane Irma
US Customs and Border Patrol agents conduct rescue operations in areas of Texas impacted by Hurricane Harvey
Rescue teams from the USAF 920th Rescue Wing, Patrick Air Force Base, Florida, survey the flooded scene below scanning for stranded victims of Hurricane Harvey over Beaumont, Texas
A US Air Force loadmaster assigned to the 164th Airlift Wing, Tennessee Air National Guard directs an all-terrain forklift onto a C-17 aircraft to support rescue operations in Texas following Hurricane Harvey, at the Kentucky Air National Guard Base in Louisville, Kentucky; more than 30 Kentucky Air Guardsmen and 90 tons of equipment were airlifted from Louisville to Houston to stand up an aeromedical evacuation and air cargo hub
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USAF / TECH. SGT ZACHARY WOLF
US AIR NATIONAL GUARD / LT COL DALE GREER
The Texas A&M Engineering Experiment Station Center for Robot-Assisted Search and Rescue (CRASAR) co-ordinated what it described as the largest known deployment of unmanned aerial systems by public officials for a federally declared disaster â€“ both serving as air operations for manned and unmanned aircraft and deploying small UAVs ranging in size from DJI Mavics to the Insitu ScanEagle
A special missions aviator from the US Air Force 41st Rescue Squadron watches as he raises an evacuee over a residence in the Houston, Texas area, following Hurricane Harvey
American Red Cross launches disaster drone pilot eventual recovery and rebuilding. The UPS Foundation is pleased to bring together, fund and support this effort, in partnership with CyPhy Works and the American Red Cross.” Brad Kieserman, vice-president of disaster services and logistics at American Red Cross, commented: “The measure of success for the American Red Cross on this pilot will be to prove that drones can help support, complement and accelerate the work already being done by our tremendous volunteers. In collaboration with UPS and CyPhy Works, we are thrilled to be conducting a pilot programme with a drone for the first time in the US. This will help us make faster assessments of affected communities that critically need our assistance.” A CyPhy Works Persistent Aerial
Reconnaissance and Communications (PARC) system was selected for the pilot. The tethered drone will go up 400 ft (120 m) to provide aerial images to ground team members. As it can be powered by a generator through the tether, the aircraft can stay aloft for days or even weeks at a time.
The UPS Foundation, the American Red Cross and drone manufacturer CyPhy Works, Inc. announced on 7 September the formation of a partnership to launch a drone pilot programme. This is the first time the American Red Cross has tested a tethered drone to assess damage after a major natural disaster in the US, the organisations said. Eduardo Martinez, president of the UPS Foundation and chief diversity and inclusion officer, said: “With such catastrophic injury and damage being caused by natural disasters, every minute counts. It’s essential that public and private organisations work together to find new and innovative solutions to support and enhance recovery efforts after a natural disaster strikes.” He added: “Accurately and quickly assessing the impact is a critical step to help save lives and lay the groundwork for
Project Lifesaver drone from Loudoun County becomes lost, the specially trained deputies with the Loudoun County Sheriff ’s Office (LCSO) Search and Rescue Team will now use the drone, equipped with the Project Lifesaver payload, to help locate the client. “Project Lifesaver continues to offer the client’s caregiver peace of mind. This new technology will allow our deputies to more efficiently search for residents in the Project Lifesaver programme and other missing persons and bring them home safe,” said Loudoun County Sheriff Mike Chapman. LCSO currently has 107 clients in the
Project Lifesaver programme. The sheriff ’s office said it implemented Project Lifesaver in 2010 and has been 100-percent successful in locating 23 missing clients over the past seven years, with many being rescued in under 30 minutes. The LCSO quadcopter is also enabled to carry infrared and high resolution video cameras to assist in search and rescue operations. The members of the LCSO Search and Rescue Team who operate the drone are all are pilots licensed through the Federal Aviation Administration (FAA).
The Loudoun County Sheriff ’s Office (LCSO) has reported how it recently acquired a small unmanned aircraft system, making it the first in the State of Virginia and the sixth in the US to be equipped with a Project Lifesaver antenna. The Project Lifesaver programme is an electronic locating system for people with medical conditions such as Alzheimer’s or autism, who are at risk of wandering from home and becoming lost. Project Lifesaver clients are equipped with a wristband transmitter that emits an automatic locating signal. If the client
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LifeFlight airlifts 10 patients in one day
dedicated air ambulance helicopters. Helijet operates the S-76C+ medical helicopters on a 24/7 basis from its Vancouver International Airport and Prince Rupert/Seal Cove base facilities under longterm contracts with BC Emergency Health Services (BCHES), which operates the BC Ambulance Service. Under an agreement with BCEHS, Helijet will install NVIS into the three dedicated air ambulances, with the $1.6-million installation cost being financed by Helijet International. Once operational, NVIS will enhance cockpit flight operations to provide greater pilot situational awareness with the objective of
Helijet International Inc. has revealed that this winter, it will install night vision imaging systems (NVIS) into all three of its
achieving safer mission completion during night flight operations, said the operator. To complete what it described as a complex installation, Helijet has partnered with VIH Aerospace, Rebtech Technologies and Night Flight Concepts. Brendan McCormick, Helijet’s director of flight operations, stated: “This equipment will significantly enhance our current air ambulance service delivery, allowing us to provide services where we couldn’t before and dramatically increasing safety where we have.” Helijet said that it plans for its flight crew to be fully ground and flight trained on the use of this technology by early 2018.
EMERCOM promises more firefighting jets by 2025
The Russian Emergency Control Ministry (EMERCOM) Minister Vladimir Puchkov has announced that the service will obtain six Beriev Be-200ChS firefighting planes before 2025. The promised planes will come in addition to the acquisition of six Be-200ChS jets by the end of 2018 that he announced in January this year.
Puchkov explained: “[EMERCOM] is going to get six Be-200ChS planes by the end of 2018 and another six upgraded amphibious planes before 2025.” He added that Ministry’s divisions across the country are already receiving new Russianmanufactured rescue tools and equipment, including multipurpose Sukhoi Superjet 100 planes, Mil Mi-8MVT helicopters, ground firefighting vehicles and UAVs.
Helijet and BC Ambulance Service to install night vison kit
It was a busy day for LifeFlight crews around the state of Queensland, Australia on 20 September, when they were tasked on 11 missions and airlifted 10 patients to hospital. The Bundaberg RACQ LifeFlight Rescue
helicopter airlifted a 33-yearold woman to the Bundaberg Hospital after she was involved in a serious motor vehicle accident on the Bruce Highway. Later that day, the same woman was airlifted by the Sunshine Coast crew to Brisbane for further specialised care. Following another motor vehicle accident, a motorbike rider in his 60s was airlifted from Glenmorgan to Toowoomba by the LifeFlight SGAS helicopter. Two patients were airlifted from north of Tin Can Bay and in the South Burnett region by LifeFlight crews after falls – one patient suffered an injury after falling from a ladder, while a man in his 70s was flown to hospital after what was believed
Trio of new helos for DRF Luftrettung
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German air rescue provider DRF Luftrettung took possession of three factory-new H135 helicopters at the Airbus production site in Donauwörth. The new additions come as part of DRF Luftrettung’s process of updating its fleet. Each boasts advanced avionics with a four-axis autopilot and improved satellite navigation, a traffic advisory system and helicopter terrain awareness and warning system. The first two machines have been flown to the DRF Luftrettung operations centre at Karlsruhe/Baden-Baden Airport, where the organisation’s technicians are installing the newly designed medical equipment from Bucher Leichtbau. DRF Luftrettung said its Part 145 maintenance operation is already certified to look after the H135s, and its pilots are receiving training on the model.
to be a fall from a horse. The Bundaberg and Sunshine Coast RACQ LifeFlight Rescue helicopters both airlifted separate patients with cardiac conditions from Fraser Island to Bundaberg and Hervey Bay Hospitals. LifeFlight crews also airlifted four more patients between different hospitals with a range of medical conditions. LifeFlight chief operating officer Brian Guthrie reflected that school holiday periods were traditionally busier for LifeFlight crews around the state: “Obviously, once the weather starts to warm up, more people are travelling on the roads and generally are out and about and are more active. But 10 patients in one day is a busier-than-usual day for aeromedical retrievals for LifeFlight, even for the holiday period.” He added: “We don’t expect it to ease up over the next few weeks, but we are well equipped to be able to handle whatever we are required to do.”
Our primary benefits at a glance ■■ Lightweight solutions ■■ Modular equipment certified under one STC ■■ Flexible usage and mission profiles ■■ Full medical certification with label ■■ Perfectly adapted for different types of deployment
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EAA flies Barcelona attack victim home
Winged-S Rescue Award to Bristow S-92 helicopter crew to his family when he did not return. Authorities were alerted the following day, and after an extensive multi-agency air and sea search lasting several hours, Bryce was found by the crew of the Prestwick S-92, call sign Rescue 999, drifting off the coast of Northern Ireland. During a mission lasting over six hours, the crew of Rescue 999 hoisted Bryce from the sea that Monday evening. He was safely transported to a Belfast hospital and later recovered.” The Winged-S Rescue Award Program honours providers who perform rescues flying a Sikorsky helicopter.
Singapore Air Force medevac five injured US sailors The Republic of Singapore Navy (RSN) and Republic of Singapore Air Force (RSAF) mobilised its airpower after a US Navy destroyer crashed into a commercial ship, killing 10 US sailors and leaving five
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injured. Four of the injured were medically evacuated by a Singapore Armed Forces helicopter for non-life threatening injuries. USS John S. McCain collided with merchant vessel Alnic MC, which sails under the
Liberian flag, whilst the destroyer was heading for a routine visit to Singapore at 05:24 hrs local time on 21 August. The USS John S. McCain then docked at Changi Naval Base. The RSAF reported that it responded to the collision, transporting the injured seamen to Singapore General Hospital in a Super Puma aircraft. The RSAF also contributed its Super Puma and Chinook helicopters in order to search for the missing seamen. The RSN meanwhile, mobilised for the search and rescue efforts, with a number of its helicopters plus its Fearless-class patrol ships RSS Gallant and RSS Resilience. There were also a number of local tugboats, plus Singaporean Police Coast Guard vessel Basking Shark in the water searching. US amphibious assault ship USS America was in the area near the collision, meaning that it scrambled its MH60S helicopter, whilst an additional MH-60S and MV-22 Osprey arrived later to join the search.
LUXEMBOURG AIR RESCUE
Atlantic. The award was accepted during the 2017 Defence and Security Equipment International exhibition. Bristow Helicopters operates S-92 helicopters on behalf of the UK Maritime and Coastguard Agency (MCA) for search and rescue. Sikorsky recounted how in May 2017, a Bristow crew operating an S-92 helicopter out of the HM Coastguard Prestwick SAR base rescued 22-year-old Matthew Bryce who was stranded at sea for 32 hours: “Bryce ventured out from the west coast of Scotland to enjoy a day of surfing on a Sunday morning, later causing concern
Luxembourg Air Rescue reports that on 11 September, one of its plane crews repatriated a victim of the Barcelona terror attack. The Belgian citizen was hit by the attacker’s van and sustained serious injuries. Her condition dictated that she could only be flown to her home country with intensive care treatment en route. She was therefore taken to a Belgian hospital by Luxembourg Air Rescue onboard a fully equipped air ambulance plane. Previously, Luxembourg Air Rescue transported a young French couple, who had received multiple traumatic injuries in the attack, back to France on 24 August. Luxembourg Air Rescue highlighted that it has previous experience with airlifting the victims of terrorist attacks. In June 2015, the organisation repatriated several tourists following the attack in Tunisia.
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Sikorsky presented Bristow Helicopters with the Sikorsky Winged-S Rescue Award on 12 September in recognition of a life-saving mission in the North
Partnering for ‘epic’ high-risk patient transfer
Boy flown after Mongolian horse race injury MAF Pilot Roy Rissanen recounts an urgent medevac flight after an accident at a traditional Naadam festival left a young boy’s life hanging in the balance As the only remaining operator to Tosontsengel’s gravel airstrip, MAF received the call for an urgent medevac flight, just before noon. A 13-year old boy named Baasandorj had been severely injured falling off a race horse during the annual Mongolian festival Naadam.
No ordinary accident Naadam is a traditional multiple-day festival that dates back to the times of Genghis Khan. The hugely popular cultural event was well attended, and the boy’s accident had already created a lot of media attention. The festival celebrates various aspects of Mongolian culture, but the main focus is on three national sports: archery, wrestling and horse racing. Of these three, horse racing is considered the ultimate Mongolian sport. During the horse racing, riders (boys between the ages of five and 13) race across open terrain over a distance of between 15 and 30 km. According to local custom, Scenes from the Nadaam festival they usually ride without shoes, a saddle or any protective equipment. The boy had fallen during one of these races, sustaining serious injuries to his head and neck. Dark clouds looming The team was soon busy making preparations, filing paperwork and coordinating arrangements with hospitals. The weather looked troublesome in Ulaanbaatar with ominous dark clouds and potential thunderstorm activity, but the forecast looked favourable. In the afternoon, we took off from Ulaanbaatar with two doctors for the two hour and 20-minute flight. Near Tosontsengel, we encountered heavy
A high-risk, ventilated patient was flown from Johannesburg to Kansas City in an eight-leg, two-provider mission, as Frank Condron, Fox Flight public relations officer, explains
rain and lightning. Fortunately, it was far enough away to not cause any problems for the plane’s approach or landing.
Fox Flight Air Ambulance, a Toronto, Canada-based international medical repatriation company, recently partnered with Johannesburg, South Africabased Awesome Air Evac to complete an epic 9,680-mile wing-to-wing patient transfer. The mission, which originated in Johannesburg, saw the two air ambulance operators combine to complete a journey made up of eight individual flight legs touching down in six different countries before terminating some 22 hours later in Kansas City, Missouri, US. The incredible logistical challenges of the transfer were compounded by the fact the patient was categorised as high-risk, requiring oxygen ventilation throughout. “We specialise in international patient transfer, so we’re no strangers to long flights, but this mission was especially complicated,” said Aaron Payne, director of communications for Fox Flight. “We had to work closely with Awesome Air Evac to make sure the handover in Tenerife was smooth. And both dispatch teams had to arrange landing, customs and refuelling at airports in various jurisdictions at various times around the clock to keep the transfer moving. Due to the patient’s condition, we couldn’t afford to have any delays along the way.” In addition to two pilots on each of the Learjet air ambulances, the patient was accompanied by a physician and a critical care nurse or paramedic on every leg of the journey, added Payne. For Awesome Air Evac, which celebrated its first anniversary in business this past July, it was the company’s first wing-to-wing patient transfer. “In order to complete a complex mission like this, you have to have complete confidence in your wing-to-wing partner,” said Shane Marais, general manager of Awesome Air Evac. “The fact we were able to combine our resources to complete this mission is a testament to the skill and professionalism of both organisations.” The Awesome Air Evac jet departed from Johannesburg on the first leg
Cutting it close We needed to depart again within the hour to make it back to Ulaanbaatar the same day. But on arrival, we found out that the patient was still in the local hospital. Just as it started looking like we might need to stay overnight at Tosontsengel and delay the flight until the morning, a four-wheel drive came speeding along the rough gravel road and across the bridge leading to the airfield. The doctors and family members moved the injured boy, with the greatest of care, from the back seat of the vehicle onto our stretcher and into the plane. His unconscious body was wrapped in a blanket and head immobilised with a neck support. Hospital transfer The patient safely loaded and the passengers briefed, we were soon ready to go. While radio-operator Baatarsukh climbed into the right-hand seat next to the pilot, I manoeuvred the aircraft ready for take-off. We had a clear sky ahead and managed to complete the flight to Ulaanbaatar in good time. On arrival, we were met by an ambulance and doctors, who commended Blue Sky Aviation on a job well done. Baasandorj was quickly rushed to the ambulance and advanced care. Why we fly We learned later that Blue Sky Aviation had been praised in the aftermath discussions on social media and websites – but this isn’t the reason we are flying for life in Mongolia. The boy was in such a critical condition that the outcome would have been far from certain had we been delayed and forced to stay in Tosontsengel overnight. Circumstances came together on this occasion to preserve this young boy’s life, enabled by a higher power than MAF. When people ask why we engage in activities like this, we tell them we are called to save lives. Medevacs are one of the important practical ways to convey love and care for the people of Mongolia. Let us keep on praying that Baasandorj will recover and his life will be saved.
of the transfer at around 02:30 hrs local time. The plane made its first refuelling stop about three and half hours later in Luanda, Angola. After about 30 minutes on the ground, the crew took off on the second leg to Accra, Ghana. From Accra, the Awesome Air Evac Lear made a stopover in Dakar, Senegal, before heading to Tenerife in the Canary Islands for its rendezvous with the Fox Flight air crew and medical team. As soon as the patient was safely transferred, the Fox Flight air ambulance took off on the first leg of its journey, and the fifth in the transfer, to the Azores in the central Atlantic. After refuelling there, the Fox Flight crew proceeded to St John’s, Newfoundland, Canada. Leg seven of the journey took the Fox Flight crew back for a brief stopover at their home base in Toronto. The final leg, number eight in total, took the patient from Toronto to Kansas City, where they were transferred to a local hospital. The Fox Flight jet touched down in Kansas City at about 02:00 hrs local time, which caused some logistical problems for the company dispatcher. “We had to contact US Customs and make special arrangements to land at that time and process all the required paperwork, but there was no other way to do it,” said Payne.
Author Frank Condron is a Toronto-based professional writer, editor and communications specialist. His work has appeared in newspapers and magazines and on digital channels in Canada and the US and he has been recognised by the Editors’ Association of Canada. He has also produced custom publications and corporate communications materials for numerous public and private companies.
MAF uses planes to transform the lives of the world’s most isolated people in need. Flying onto desert and jungle airstrips, lakes and rivers, tracks and roads, MAF’s light aircraft and their mission pilots go the extra miles to provide a lifeline. Working in partnership with hundreds of other Christian and relief organisations, MAF enables practical help, physical healing, and spiritual hope to be delivered to many of the most remote and inaccessible communities on the planet. 13-year-old Baasandorj is gently unloaded from the plane and lifted into the ambulance
AIRMED & RESCUE
Learjet air ambulances from Fox Flight and Awesome Air Evac meet on the tarmac in Tenerife to transfer a high-risk patient bound for Kansas City, US
Cusco to California for urgent cancer care
The air ambulance crew departing from Guadalajara
his discomfort was due to the recent long-haul flight to Lima and changes in diet, the couple decided to continue with their travel plans and travelled to Cusco with the objective of hiking to the Machu Picchu ruins. As they arrived in Cusco, the pain strengthened and the member began feeling very sick. Believing it was a simple case of food poisoning, the couple decided to go to a local clinic to seek treatment. After conducting an ultrasound and colonoscopy, the local doctors discovered a tumor that had resulted in the member’s bowel bursting, leading to septic shock. He was immediately taken into surgery to remove the tumor and perform a colostomy and biopsy. During the surgery, the surgeon found a second tumor and liver metastases. After being informed of the member’s situation, Assist America contacted the member’s fiancée and the clinic in Cusco and started monitoring his condition closely. He needed to be transported as soon as possible back to California to start a multi-specialty cancer treatment which involved surgery, oncology and intensive care. While Assist America’s medical team worked with the member’s family back in California on getting a bed secured at a cancer treatment facility near his home, our Spanish-speaking co-ordinators helped his fiancée communicate with the local treating team and translate the medical reports that were required by the physicians in California. In parallel, Assist America’s transport logistics experts worked with air ambulance provider AirLink, as the company was one of the few to have the experience and capability to fly jets at high altitudes. Cusco’s International Airport is located at 10,860 ft elevation (3,310 m) and has a longer runway – 11,155 ft long – as aircraft need more runway length to generate wing lift due to the thin air at high altitude. Other air ambulance carriers necessitated contracting a local provider for the Cusco leg of the 32 32
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trip and then transferring the member from one aircraft to another in Lima, Peru. “It was essential for this patient and this mission to quickly find a highly reliable air ambulance company that could take off and land at Cusco International Airport,” said Joe DiCorpo, Assist America’s chief medical consultant, adding, “this is why our network of providers is the backbone of our services.” The aircraft left its base in Guadalajara and arrived in Cusco the next morning. While on its way, the member was taken back to surgery due to abdominal distension. Thankfully, the surgery went well and the member’s vital signs were stable. The local attending physician cleared him for travel the next morning. After landing in Cusco, the air ambulance medical crew met with the member and the attending physician to go over all the logistics details. The next morning, the crew returned to the hospital to pick up the member and his fiancée. They were required to wait at the hospital due to inclement weather preventing the flight from taking off. After a short delay, they were finally able to drive to the airport and depart for Panama, the first leg of the journey back to California. The flight was smooth and the member’s vital signs were stable when in Ontario, California at 00:10 hrs local time. They were met by a ground ambulance to drive the member to the cancer treatment facility, about 40 minutes away. They arrived at 01:30 hrs and the patient was immediately admitted and taken to his room. The next day, Assist America reached out to the family who were informed that the member was meeting with the oncologist to go over the treatment plan and exams schedule. Thankful for Assist America’s help and support, the family shared the following comments with the Assist America team: “Many thanks for all your help and ongoing communication. Everyone from your co-ordinators to the hospital staff and air ambulance crew did an outstanding job and was very helpful and attentive. You all worked great as a team and that showed. We cannot thank you enough for the care, attention and professionalism received during this difficult time.”
Author Kip Gibbs With a degree from the University of Maryland and decades of experience in customer service and operations, Kip Gibbs took the helm of Assist America’s Operations Centers in 2003, where he is currently vicepresident of global operations. His prior work experience includes various positions at USAssist (SFA) and Berlitz International in Washington, DC, and Wayne, Pennsylvania.
A Beechcraft 1900C-1 flown by JPD France, pictured in Antwerp, Belgium, in September 2010
By James Paul Wallis The Beechcraft 1900 was designed as a regional airliner, capable of carrying 19 seated passengers. Featuring turboprop engines and a pressurised cabin, it was developed from the Super King Air with similar cockpit controls. The model’s first flight came in 1982, followed by certification by the US Federal Aviation Administration in 1983. The 1900 entered into service in 1984, and production continued right up to 2002, by which time nearly 700 examples had been completed. The original 1900 model featured stairs at both front and rear doors; only three were produced. The next iteration, the 1900C, dispensed with the rear stairs in favour of a larger cargo door. The redesigned 1900D was introduced in 1991 and boasted more powerful engines, new propellers, winglets and a larger tail to compensate for the extra drag caused by a taller cabin that allowed passengers to stand up. It is able to operate from relatively short runways, as well as from grass or rough strips. The 1900 proved popular with passenger airlines, and has also been used for corporate and cargo transport. Operators offering the model in the medevac role include Northern Thunderbird Air and EVAS Air of Canada, which both cite the cabin as being suitable for bariatric patients. It has also been adopted by military and police services, including the Swiss Air Force and the Spanish National Police.
Did you know? The US military designation for the 1900C is the C-12J. The corporate version was marketed under the moniker King Air ExecLiner.
Assist America provided a critical repatriation to a 37-year-old member from Cusco, Peru back to Duarte, California, US. The member visited Peru with his fiancée when he started to feel pain in his abdomen. Supposing
SERGE BAILLEUL / AIR TEAM IMAGES
Assist America repatriated a member from Cusco, Peru back to California for emergency cancer treatment. By Kip Gibbs, VP of global operations
A 1900C being operated by the in International Committee of the Red Cross in Kenya, 2011
Speciﬁcations (1900D) Crew/passengers: Passengers: Engines: Cruise speed: Max range: Length: Height: Wingspan:
1 or 2 19 seated, 2 stretchers 2 × Pratt & Whitney Canada PT6A67D turboprops 280 knots (518 km/h, 322 mph) at 20,000 ft (6,100 m) 2,306 km (1,432 mi) 57 ft 8 in (17.62 m) 15 ft 5 in (4.72 m) 57 ft 9 in (17.64 m)
Dr Ami Jones
What do you do in your role? As a consultant, I’m part of a critical care team which takes the A&E to the patient. We’re an advanced service, so we’re able to perform immediate life-saving interventions such as putting people off to sleep, performing chest surgery and giving blood transfusions, all of which are not available to standard paramedic practice. We are also able to identify which hospital can offer the most appropriate care and transport the patient directly to that location. This ensures that the patient gets the specialist care they need as quickly as possible and also prevents costly secondary transfers between hospitals. As interim national director, I’m tasked with leading EMRTS, ensuring the Service continues to meet its very high standards and leading the strategic development of the Service as it continues to expand. How did you get into your current role? Whilst doing my specialist training in anaesthetics and intensive care, I deployed with the army to Afghanistan on the Medical Emergency Response Team (MERT), which was the helicopter service that flew to the front line to treat our severely injured soldiers. This gave me a huge amount of training and experience in treating very injured casualties outside of a hospital environment. I then used this expertise to gain civilian experience and qualifications to help the people of Wales as a doctor on the Wales Air Ambulance. Consultant doctors started working on Wales Air Ambulance Charity helicopters in 2015. I have been with the service since the start, as a consultant medic on the aircraft and also as the South Wales Base Lead. In May 2017, I was appointed EMRTS Cymru interim national director. 3434
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How would you describe your leadership style? I like to lead from the front and by example, and never expect my team to do something that I am not willing to do. I am a big believer of ‘the standard you walk past is the standard you accept’, so I always try to set a good example. What motivates you? Why do you do what you do? My team are so committed and passionate about what we do, they are probably my biggest motivating factor. The big picture when we set up EMRTS was to create and run a service which worked to the highest standard possible to give care to patients wherever they may be geographically located throughout Wales. This ensures that you are giving your patients the best possible care that’s available, affording them the best chance of making a meaningful recovery and getting them back to their families. This is what motivates me, and I’m sure the rest of my team, to always go that extra mile and pull out all of the stops to get the best outcome for the patient. What would be your ideal day off? Probably one that involved a lie-in past 06:00 hrs and didn’t involve getting hundreds of emails to read and reply to. I’m lucky that I live in a really pretty part of Wales, so an ideal day off would probably involve a walk up the mountain and a pub lunch. How do you relax outside work? I have a six-month-old baby and two Labradors, so I’m not entirely sure you could call it relaxing, but I enjoy taking the three of them out for a walk up one of the many mountains around where I live.
What do you most enjoy about your role? I’m privileged enough to be able to provide the very best care to the sickest patients in Wales and ensure that they are taken to the appropriate specialist hospital. Being able to deliver this platinum-standard care to the people of Wales gives me great satisfaction. It’s also pleasing to be part of a service that helps consultant recruitment in Wales. Emergency medicine and anaesthetic consultants are choosing to work in Wales with an eye on joining EMRTS Cymru. As a result, not only are the people of Wales being treated by the best medics, but NHS colleagues get to work with, and learn from, the top people in our fields.
review meetings and clinical governance days to learn from each other’s experiences. My term with RFDS is also accredited with The Australasian College of Emergency Medicine, so it counts towards my training time. I have been well supported by the RFDS to take study leave to work on a master’s degree, as well as exam leave. We are also funded to attend a course of our choosing. We are encouraged to take our annual leave and work/life balance is supported. I have not had any troubles in requesting days off or having annual leave approved. The lifestyle support is beyond fantastic! Housing is included in our contract, so I was able to move straight into a furnished house in a nice area without the hassle of searching. I just had to show up! Being a retrieval registrar with the RFDS is a great job – that best I’ve had. I would recommend it to any emergency trainee with an interest in retrieval medicine.
Dr Shannon Townsend, an emergency trainee in her fifth year of postgraduate study, shares why she enjoys working for Australia’s Royal Flying Doctor Service South Eastern (RFDS SE) Section I always knew I wanted to work for the RFDS, but wasn’t sure if I was ready. When I applied for the retrieval registrar position, I had completed sixmonth terms in emergency, paediatrics, anaesthetics and intensive care. But I wondered if I was capable of using these skills in remote environments as a sole clinician – which is often the case in retrieval medicine. I am so glad I decided to have a go. Firstly, the training opportunities have been amazing. In our first week, we travelled to Sydney for a week of training with the helicopter retrieval service. This was an amazing week of learning and simulation with Australia’s leaders in retrieval medicine. I was constantly challenged, inspired and had an awesome time! When we returned to Dubbo, we did a further week of induction in our home environment. This involved a simulation where we went to a paddock in the back of a ute to retrieve a motorbike accident victim. A few months later, I retrieved a young man who was combative and had a head injury from another motorbike accident. No interventions had been performed prior to our arrival. During this job, I successfully sedated, anaesthetised and intubated this patient, then inserted lines and transported him safely to Sydney. It was nerve-wracking, but I was well supported throughout by phone with my senior medical officer. We also discussed my plans prior to the retrieval and troubleshot concerns. My boss had camera access to the hospital, which meant he could jump online and have a look if I had any concerns. We are fortunate to have a 24/7 RFDS helpline. At times, this level of support exceeds what is available in hospitals. The retrieval made me realise what I am truly capable of. Every retrieval is different and poses new challenges and learning opportunities. After each retrieval I can sit down with my boss and discuss areas of improvement, I am always learning and becoming a better clinician. The education is ongoing. On weekdays when we are not flying, there is daily simulation and teaching happening at the base. We have regular
To view RFDS’s current vacancies, go to www.flyingdoctor.org.au/careers.
Dr Ami Jones is a consultant in anaesthetics, intensive care and pre-hospital Medicine. She is the interim national director of the Emergency Medical Retrieval and Transfer Service (EMRTS Cymru), also known as the ‘Welsh Flying Medics’. She is also a lieutenant colonel in the Army Reserves with 203 Field Hospital and was awarded an MBE in the 2017 Queen’s Birthday Honours List. In 2015, a partnership was created between the Wales Air Ambulance Charity (WAA), the Welsh Government and National Health Service (NHS) Wales. This resulted in the creation of EMRTS Cymru, which provides pioneering pre-hospital critical care across Wales. The Service is made up of Welsh Government-funded NHS consultants and critical care practitioners who are able to deliver innovative treatments usually not available outside the hospital environment. The WAA raises £6.5 million every year from charitable donations to keep the helicopters flying. The introduction of advanced medics means that the service is now able to conduct blood transfusions, administer anaesthetics, offer strong painkillers, and conduct a range of medical procedures – all at the scene of an incident. The Service is operational on the WAA helicopters based in Dafen (South Wales) and in Welshpool (Mid Wales), and this summer started working from the Charity’s base in Caernarfon (North Wales).
Interim national director, the Emergency Medical Retrieval and Transfer Service, Wales, UK
Read any given NTSB accident investigation and you will find that the pilot is at least partially responsible for the accident. If it is not the pilot’s stick and rudder skills, it’s the pilot’s decision-making prior to or during the flight that is identified as the cause, or a contributing factor. The pilot rarely escapes some of the blame and, unfortunately, rightfully so! Pilots need to come together to collectively – and individually – address the ‘human in the loop’. An area where human factors are repeatedly identified as contributing to the accident is in Loss of Control Inflight (LOC-I). Every four days, a fatal accident occurs due to LOC-I.1 The statistics are staggering, and although each incident could likely result from one or more primary causes of LOC-I – environmental, systems anomalies and human factors – they almost all include contributing errors made by the flight crew. As pilots, our collective reaction is often denial. Certainly, we are not the issue? Other pilots make those types of NTSB-noteworthy mistakes. It is their poor reaction to a system anomaly or their carelessness that led to flight into a convective front that put them in a position where they are left with very few options. However, the reality is that there is a human factor to almost every aviation accident, and we need to address it. Questions we must ask ourselves before every flight There are three simple questions that we must ask ourselves before every flight that can help effectively manage and mitigate the potential for degraded cognitive ability of the ‘human in the loop’: • Did you sleep for eight hours? • Are you hydrated? • How do you feel overall? 36 36
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Early in my flying career, I was working with a new pilot just prior to his Navy aircraft carrier qualifications. Let’s call that pilot ‘Blaze’. Aircraft carrier qualifications are just that: new pilots landing on the aircraft carrier for the first time. In our story, it was in an F-14 Tomcat. Carrier qualifications require very significant practice time dedicated to the landing pattern. Each new pilot flies literally hundreds of ‘passes’ at a practice field, day and night, before ever going to the actual ship. The field does not move, pitch, or roll, so overall it is generally a more peaceful experience. Every time someone mentions human factors, I think of this one flight. It was an otherwise beautiful day and we were making the base-to-final turn when Blaze announced that he did not have his normal digital cues required to make a successful landing on the carrier. I queried him on the status of the landing gear and, almost magically, his digital cues appeared and his landing systems were now in a GO status (largely because the landing gear was now extended). I had previously flown hundreds of passes with Blaze without any issues. I was certain this would just be another day of practice until it wasn’t. At 500 ft, 30-degrees angle of bank, on final approach with the gear up. In the debrief, Blaze quickly told me how he hadn’t gotten much sleep the night before, hadn’t had any water that day, and was exhausted. Blaze was officially off his game with regard to those three simple questions before we ever took off, and had failed to address his physiological status with me, his instructor.
lack of sleep on performance. There are any number of studies that all corroborate the linkage between hydration and performance. In young and old, independent of gender or physical fitness, dehydration has a direct negative effect on cognitive function and other performance metrics, especially during times of stress. “Being dehydrated impairs performance in tasks that require attention, psychomotor, and immediate memory skills, as well as assessment of the subjective state.”3 Those are the very skills that we, as pilots, rely on most, especially during an airborne emergency. In this day and age, even drinking water seems to take too much time. Really? Medical recommendations for daily water intake range around 12 to 15 cups for men and 10 to 12 for women, but all recommend drinking enough to keep one’s urine clear.4 Sounds like good advice if it keeps our cognitive function at its peak and eliminates fatigue. Howgoesit? The last significant consideration that every pilot should assess before each flight is an overarching ‘howgoesit’ regarding overall physical, mental, and emotional well-being. It is rare indeed that you will have no complaints in any of these areas, but your awareness of them ahead of your flight, and your careful and considered mitigation of them are critical to a safe evolution. You are responsible for a highly complex task while flying, and anything that reduces your substantial skill as a pilot may end up reading as a ‘contributing factor’ in an accident investigation. There are several available checklists that address human factor risk, and provide methodologies for mitigating that risk, including IM SAFE (illness, medication, stress, alcohol, fatigue, eating)5 and others. But only if you take the time to consider and address them will you remain at your peak piloting performance. “Aviation in itself is not inherently dangerous. But to an even greater degree than the sea, it is terribly unforgiving of any carelessness, incapacity or neglect.”6 We have all heard this quote at some point over the years. Every pilot has a responsibility to help eliminate carelessness, incapacity and neglect – the human factor – from aircraft accidents. Resources
The effect of lack of sleep and dehydration on pilot performance A pilot fatigue study conducted in 2012 still proves true today. John Caldwell confirmed that ‘the combination of insufficient sleep and circadian factors is at the heart of the fatigue problem in any operational context’. He later goes on to say: “As a society, we must come to grips with the fact that the average
1. Federal Aviation Administration. Fly Safe: Prevent Loss of Control Accidents. Retrieved July 31, 2017 from https://www.faa.gov/news/updates/?newsId=88467 2. Association for Psychological Science. (2012, April 24). Crew schedules, sleep deprivation, and aviation performance. ScienceDaily. Retrieved July 31, 2017 from http://www.sciencedaily. com/releases/2012/04/120424162336.htm 3. Journal of American College of Nutrition. Cognitive Performance and Dehydration. Retrieved August 3, 2017 from https://www.ncbi.nlm.nih.gov/pubmed/22855911 4. Aviation Medicine. (2014, February). Dry and High. Retrieved July 31, 2017 from http://www.
anything that reduces your substantial skill as a pilot may end up reading as a ‘contributing factor’ in an accident investigation
aviationmedicine.com/wp-content/uploads/2014/02/Dry-and-High.pdf 5. Federal Aviation Administration. FAA Fact Sheet. Retrieved July 31, 2017 from https://www.faa. gov/licenses_certificates/medical_certification/media/impairingmedications.pdf 6. Quote from Captain A. G. Lamplugh, British Aviation Insurance Group, London. Retrieved from https://criticaluncertainties.com/2015/01/22/thought-for-the-day/
Author adult needs seven to nine hours of sleep every single day… and there is no amount of willpower, professionalism, training, or money that will prevent the performance losses associated with the failure to routinely acquire sufficient sleep.”2 Each pilot needs to take responsibility for a sleep schedule that meets their flight schedule, and to understand the debilitating effects of
Vanessa Christie is vice-president, strategic development, at Prevailance Aerospace, a UPRT provider that has been working with corporate, government, and general aviation pilots to improve safety in the aviation industry.
are in place with the British Government to treat certain medical cases, which are relatively rare and therefore not as cost-efficient to treat directly in Malta. This agreement has historical origins, due to Malta having been part of the British Empire until 1964. The medical system of Malta is modelled on that of the UK and the majority of medical doctors practising in Malta undergo medical studies in the UK. For these reasons, Maltese residents can benefit from treatment in the UK; the majority of them are cancer patients who fly to the UK for treatment or babies born with complications. The transfer of patients to UK hospitals is often assigned to Air Malta, which it effects on its own scheduled flights. The state-owned national airline works in conjunction with the national health service of Malta to provide air
VITALS GLOBAL HEALTHCARE
“the airline has developed a system to dock incubators onboard the aircraft”
Vitals Global Healthcare provides a rotary-wing air ambulance service in partnership with Gulf Med Aviation Services
Mario Pierobon reports on air medical provision on the strategically located island nation Malta is a small archipelago located in the heart of the Mediterranean Sea. It lies in a strategic position between Europe and Africa – and not far from the Middle East. The country became a member of the European Union in 2004 and has managed to attract significant foreign investment that has permitted stable and solid economic growth over the last decade. 3838
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Whilst the country has traditionally been an important seaport along Mediterranean routes, its aviation industry has flourished in recent years. The Maltese aircraft registry counts in excess of 200 aircraft registered in Malta, with some 40 air operator certificates (AOC) held by aircraft operators having their principal place of business in Malta. In addition, four major MROs (maintenance, repair and overhaul providers) have set up shop in Malta handling heavy maintenance on anything from business jets to widebody commercial jets, including A380 spraying.
In the context of an expanding aviation industry, the air rescue business is also playing a role – albeit a niche one given the small size of the country. This is in addition to the Maltese military, which is heavily involved in search and rescue operations in Malta’s vast sea territory in the Mediterranean. UK transfers The country offers comprehensive health services to its residents. However, due to its size, certain specialities are not available locally and agreements
services to carry patients to the UK either as stretcher or incubator cases. “In 2016, Air Malta handled 21 stretcher cases and 15 incubator cases, an average of approximately one case every 10 days,” says Stephen Gauci, head of corporate communications at Air Malta. Air Malta is a small regional carrier with eight Airbus A320 aircraft in operation and it has no dedicated aircraft for patient transfer. Patients are instead placed on scheduled commercial passenger flights. “The airline has developed a system to dock incubators onboard the aircraft and connect to purpose-built and certified equipment that is installed onboard prior to the flight requiring the removal of three rows of seats on Air Malta’s A320/ A319 aircraft. The airline is one of a very few that offer this service and the incubator docking system holds a unique airworthiness approval. Stretchers are also carried onboard, but do not require the removal of seats, but instead the seat backs are collapsed. Air Malta ordered its aircraft new from the factory with stretchers in mind, and the aft toilet compartment collapses to allow the stretcher to turn comfortably in and out of the aft door,” says Stephen Gauci. “The way it works is that the medical facility contacts Air Malta the day before the patient needs to be transferred to the UK. In case the requirement is to transfer a neonatal patient, during the night technicians at Air Malta reconfigure the aircraft that it is known will fly to the UK – normally London Heathrow – by removing three rows of seats at the rear of the cabin so that the incubator can fit. Once the aircraft flies back to Malta, then it is brought back to the standard configuration.” In addition, Air Malta regularly transports live human organs for transplant patients waiting either locally or somewhere in Europe. The carrier also transports daily doses of radioactive material used in PET (positron emission tomography) scanning equipment; Air Malta’s daily flights are instrumental to keeping all the local hospitals’ equipment functioning properly. Private repats Over the centuries, since the times of the Phoenicians, different powers have wanted to occupy Malta for strategic trading and military reasons. Nowadays, Malta is an independent country and attracts investors from all over the world wanting to base their businesses in this strategic location, and this includes investors in the air ambulance business. One such investor
We provide patient repatriation for these patients. Our main clients at the moment are mainly from countries in the North African Mediterranean basin and usually flown to hospital facilities in Europe. The services described are normally covered by insurance or governments, depending on the
that has started an air ambulance operation in Malta is ER24 of South Africa. ER24 is a wholly owned subsidiary of private healthcare group MediClinic.
VGH Air Ambulance is tasked with the transportation of stabilised patients between the islands of Gozo and Malta
particular arrangements.” Lee believes that Malta is a good place to operate an air ambulance. “Our experience is that we became very successful in a short period of time. In the supply of emergency air ambulance services for the international travel insurance industry, we have partnered with Aspen Medical, a global medical company that operates clinics in several parts of the world and has opened a clinic in nearby Libya,” he says. Near the Libyan capital city of Tripoli, an ‘oil and gas town’ is being unveiled. Palm City is a compound for workers of oil and gas companies, it counts
Rescue Wings Malta was recently setup by ER24 and flies for insurance companies and their designated patient assistance firms that have a client base in the Mediterranean region and in North Africa. “They rely on our services that are well known as we fly with the livery of ER24. Because we are part of ER24, the clients of Rescue Wings Malta can fly anywhere in the world with basically no restriction. The set-up of the Maltese operation is part of ER24’s strategy in expanding its network. Rescue Wings Malta has in its fleet a King Air B200GT, which has a little bit more speed and range than the normal King Air 200. It is ideal for Malta,” says Andrew Lee, international business executive at ER24, who is based in Malta. “We are in the business of transporting patients, ranging from stable cases all the way up to patients on full life support, many of which need care that
16 to 20,000 residents and offers high-quality residential facilities. Palm City has its own runway and is where the Aspen Medical clinic is located. “In my experience, Libya is a very good market, but it is also very volatile: there are times when you can fly in and help, some other times it is just too dangerous,” says Lee. “In order to reach Palm City, we have to fly to Tripoli first, clear customs there and then fly to Palm City. We are the official partners of Aspen Medical for medical evacuations. We bring back to Malta patients that need treatment which cannot be provided locally in Palm City. Once patients are in Malta, they will be accommodated in one of the local medical facilities, either St James’ Hospital, which is private, or, if necessary, the Mater Dei State Hospital, which is one of the best state hospitals in Europe. Normally patients from Libya are attended in Malta, but we have the capability to go into Europe as well, because we have other aircraft in the ER24 group that can come in: a King Air 350 and a Hawker 900XP.” In-country flights While Rescue Wings Malta operates internationally from its Maltese base, Malta also hosts an air ambulance provider that operates domestically. The VGH Air Ambulance is tasked with the transportation of stabilised patients between the islands of Gozo and Malta. Vitals Global Healthcare (VGH) runs the Gozo General Hospital, located in Gozo, the second largest island of the Maltese archipelago, and provides a rotary-wing air ambulance service in partnership with helicopter operator Gulf Med Aviation Services. The VGH Air Ambulance currently utilises a Bell 412 SPIFR helicopter operated in the
Some times, using a rescue sling strop may be the only and last way to save a life. We have all learned, however, that a traditional rescue sling strop is not always the best option.
Air Malta ordered its aircraft new from the factory with stretchers in mind
AIRMED & RESCUE
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the places they are currently at cannot provide. Patients are usually stabilised before being transported by air ambulance, transport of unstable patients is also possible but less common; it is contemplated only if treatment in the receiving facility is lifesaving, unavailable locally and transportation is achievable within an appropriate time window. This justifies the use and increased risks involved when transporting unstable patients by air. Apart from the pilots, the air ambulance crew normally consists of one doctor and one nurse,” says Chris Gauci, chief medical officer at Rescue Wings Malta. “We also fly patients that may, for various reasons, want to spend the recovery or rehabilitation period associated with their hospitalisation event in another facility, for example someone who is operated for a fracture and wants to continue the medical care in his/her home country.
SPVFR role day and night. “Although the distance between the two receiving hospitals is approximately 24 nm, the time taken to transport a patient by road is significant due to the small water sound between the two islands requiring a ferry crossing. Typically, a road transfer could take in excess of three hours, whereas instead the transfer by the air ambulance helicopter reduces this to an average of 25 minutes, door to door,” says Chris Keating, flight operations and crew training manager at Gulf Med Aviation Services. “The helicopter operates as an air ambulance and does not yet fulfil a primary response role such as in the case of HEMS. It is equipped and capable of supporting sedated and ventilated patients, trauma cases and neonatal infants.” The island of Gozo is inhabited by an ageing population, and during the summer months the population can almost double with tourists. “This presents a wide range of patient types ranging from cardiac or respiratory failures in the ageing population to life threatening trauma associated with recreational injuries amongst the local and tourist population. Medical staff from the Gozo General Hospital are utilised to support the patient in flight. The staffs have received intensive air ambulance training and can be dispatched as required to meet the needs of the individual patients being transported,” says Keating. As a small nation, Malta has a small internal air rescue market. The country, however, is business friendly, strategically located and offers opportunities for international expansion that investors in the air ambulance business are capitalising on.
Air Malta transfers patients to the UK, including neonatal patients using a custom incubator set-up
Lite Flite Helicopter Rescue Equipment is manufactured in accordance with CE Council Directive 89/686/EEC with later amendments, and is tested and/or type certified according to European Norms EN813:2008, EN1498:2006, EN1497:2007, EN358:2000, EN362:2005, EN365:2007, EN364:1996 and later changes.
Three point suspension Back and thigh support Little or no risk of slipping Safe, comfortable, sitting position Assisted or unassisted winching Conscious or unconscious victim Easy to pull victim in to helicopter
For more information, please see www.lite-flite.aero, email us at firstname.lastname@example.org or call us at +45 7558 3737. We will do our utmost to help you.
Lite Flite Helicopter Rescue Equipment is proudly designed and made in Denmark.
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The US Coast Guard (USCG) has a deserved reputation for having highly skilled helicopter crews. This is a result of a wealth of experience and constant training. Graduate-level training is conducted at the service’s Advanced Helicopter Rescue School (AHRS). The course was begun in 1996 for USCG rescue swimmers and has evolved into a school for all members of helicopter crews. The instructors come from the standardisation office of the USCG Aviation Training Center located in Mobile, Alabama, and consist of MH-65 (Dolphin) and MH-60 (Jayhawk) pilots, flight mechanics, and rescue swimmers. The actual course is held in and around the Astoria, Oregon, USCG Air Station.
the location was chosen because it consistently has the rough seas the school needs
Big waves Each morning of the class is used to talk about the evolutions that will be flown later in the day with all the possible difficulties the students might encounter. Once they are flying, the instructors will perform the first evolution to show the students what it looks like. Then, the student will take over and perform the evolution. They start in smaller seas and work up to bigger waves and breaking surf. The instructors let the rescue swimmer students know on the first day that this will be one of the most physically demanding schools they have ever attended. They are going to be deployed into very heavy seas again and again. The water temperature is very cold and they are wearing dry suits, which make swimming difficult. By the end of the week, they are very tired. The first evolution is the surf swim from shore to give the rescue swimmer exposure and confidence working in heavy seas. They may have never worked in large waves like these. They learn the techniques for swimming
This location was chosen because it consistently has the rough seas the school needs to conduct the training. Each class is five days long. There are eight classes taught each year, four in the late fall and four in late winter. Each class has 16 students – four pilots, four flight mechanics and eight rescue swimmers. The course uses an MH-
60 based at Air Station Astoria and an MH-65 from another air station. “One of our major training goals is to emphasise crew co-ordination,” explained Chief Dan Coleman, an AHRS flight mechanic (FM) instructor. “Crew co-ordination is essential for mission success. Each person on the crew has a role and input into how a mission will be accomplished. We want them to learn to trust each other and feel free to speak up if an issue arises during the training evolutions and real rescues when they return to their unit. It is important for every crew member to participate in developing the rescue plan and not have one person dominate the decisionmaking process.”
Rescue swimmer on the hoist cable uses hand signals to tell the flight mechanic where he wants to go; that’s the reason for the contrasting color of the swimmer’s sleeves
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A group of rescue swimmer students prepare for a surf swim off the Oregon coast
this will be one of the most physically demanding schools they have ever attended The rescue swimmers will be picked up by the helicopter and moved into the waves just outside the surf. There, the rescue swimmers will take turns being the rescuer and victim for hoist evolutions. The FM is taught to watch the wave sets and anticipate how they will impact the people in the water. That is one of the biggest challenges for the students, reacting to what hasn’t happened yet by anticipating the wave action. It is a very dynamic, three dimensional environment. The FM also has to monitor the rescue swimmer to makes sure they aren’t getting tired or beaten up by the waves and might need to come back up into the helicopter and re-evaluate the rescue plan. “When the student pilots start getting into larger seas, it is important they
learn how to manage their hover height,” stated Lt Damon Thornton, an MH-60 AHRS instructor pilot. “The radar altimeter is not a good tool in heavy seas because they will yo-yo up and down as the waves pass under the aircraft. So, we have tell them to use more of a visual scan to maintain the proper height as well as depend on their flight mechanic to guide them. That is a big adjustment for many pilots.” The pilots begin to learn how to evaluate the waves, which often come in sets. They figure out the time interval between waves to determine if there is time to insert or extract the rescue swimmer between waves. They may have to wait until an entire set goes by because the interval is too short to work with. Cliff work For vertical surface rescues, the FM role is to place the rescue swimmer on the cliff and then position the helicopter closer to the vertical surface so there is tension on the hoist cable ,which will keep the rescue swimmer in contact with the surface and he can then just walk to the victim. The rescue swimmer is positioned below the victim and the FM then uses very small movements of the cable to lift the swimmer to the victim. The goal of this evolution to is teach the FM how to make very small helicopter and hoist cable movements to accomplish the rescue. The FM also has to keep the helicopter main and tail rotors clear of obstacles at the same time. The key element here is that the helicopter is used to move the rescue swimmer along the cliff both vertically and horizontally. The rescue swimmer is not moving themselves. The swimmer is keeping positive contact with his feet on the surface, sitting back in his harness, and using hand signals to
in heavy surf and how to tow a victim through the water in these conditions. It also gives the students exposure to swimming in a dry suit in cold water, which they may never have done if they come from an air station in a warmer climate.
The flight mechanic instructor acts as a safety lookout during training missions as the student focuses on a rescue swimmer on the hoist
the flight mechanic to tell the helicopter where he wants to be moved. The swimmer is never off the hoist cable and uses the rescue strop to secure the victim to him/herself. In this section of the class, the pilots are taught how to analyse the winds
rescue swimmers learn how to reach a victim stranded on a rock surrounded by water
and how they will be affected by the terrain. They also discuss some lessons learned from past vertical rescues that went wrong. They learn how to use their instruments to determine the wind patterns and how to develop safe exit routes in case of an engine failure or other mechanical issues. They fly by the cliff at a specific airspeed and altitude and see how the aircraft reacts. Power management is very important during these evolutions, especially for the MH-65.
Rescue swimmer being hoisted into MH-60; the AHRS course is physically very taxing on rescue swimmers
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Caves and rafts The final major event for the rescue swimmers is the cave and wet rock exercises. These evolutions don’t involve the helicopter. This gets rescue swimmers in a cave so they can see how the water moves and how to navigate inside caves safely. The wet rock exercise involves the rescue swimmer learning how to reach a victim stranded on a rock surrounded by water and being swept by waves. It teaches them how to use waves
to help them climb a rock outcropping and how the waves act around a solid obstacle. The last day involves the entire crew being put in a raft as if their helicopter has ditched in a heavy sea environment. They learn about how to use the raft and the survival equipment. While this is annual mandatory training at every air station, it is often done in a pool, not heavy seas in cold water, which is much more realistic. The pilot and FM students are also hoisted up and down into the water to give them a better idea of what the rescue swimmer goes through. Feedback Every morning of the class, the instructors will critique the previous day’s flights. They have an audio/visual department at the Aviation Training Center that will come out to the school and video tape every training evolution. Each helicopter also has a video camera located on the hoist that looks down and also records the audio conversations among the crew. They use these recordings to debrief every mission and to show the students how they are progressing from day to day. At the conclusion of every week of class, the instructors sit down and do what they call a ‘hot wash’. They review the comments and critiques from the students and talk about what they, as instructors, did right and wrong. They can change things quickly based on this review, even as soon as the class that will be taught the next week. The students also fill out electronic surveys when they return to their home station, which are collated and used to change the course to make sure it is meeting the student’s needs. This course is considered one of the best of its kind found anywhere. Some classes have slots allotted for US Navy rescue swimmers; US Air Force pararescuemen have also attended. The Royal Canadian Air Force has brought helicopters and crews to the course several times. This type of standardised training for hazardous rescue situations is part of why the US Coast Guard helicopter rescue crews are among the best in the world.
December 2015, Bangkok Dusit Medical Services & Bangkok [Helicopter] Services received their accreditation certificate with the additional requirement that a one-day onsite visit must take place. The purpose of this one-day visit was to ensure that the post-audit updates provided have been implemented and understood by the staff. Unfortunately, the Bangkok Dusit Medical Services & Bangkok [Helicopter] Services board refused to comply with this requirement.” He said that because the board refused this site visit, the company was no longer compliant with the EURAMI standards, hence their accreditation was revoked ‘with immediate effect’. AMR alerted EURAMI that as of June 2017, the organisations’ websites (www.bdms. co.th/about -bdms and www.bangkokhelicopter.co.th/home.aspx) continued to suggest they were EURAMI-accredited.
MJ Brickey asks why CAMTS offers ‘conditional accreditation’ and EURAMI gives ‘provisional accreditation’ and how they differ Catch 22 The Commission on Accreditation of Medical Transport Systems (CAMTS) added conditional accreditation to its policies and procedures more than
some US States require companies to be CAMTS-accredited as soon as they begin operations
a decade ago, but only awarded its first conditional accreditation in 2016, granting the status to US-based Air EMS of Tulsa for its fixed-wing and medical escort services. The body created the category as a way to assist start-up medical transport companies to get themselves out of a legislative Catch-22 situation. While CAMTS requires companies to have been in operation for a year before they apply for standard accreditation, some US States require companies to be CAMTS-accredited as soon as they begin operations. “Which CAMTS asked (the government) not to do,” CAMTS Executive Director Eileen Frazer stated, “because when the government requires accreditation by a specific agency, it puts that agency in a potentially litigious position, because we cannot accredit something that hasn’t happened yet.” She said conditional accreditation is not full accreditation, is only offered to new companies and can only be awarded once. “Our whole purpose is to assist programmes in developing and improving,” she said. “Conditional accreditation means the companies are developing their policies and practices by following the standards, and that the company is going in the right direction. After four months of business, they can apply for the conditional accreditation. We cannot award full accreditation until we have more information on quality and safety management, training, and have a year of statistics.” The application process for full CAMTS accreditation takes four to six 4646
AIRMED & RESCUE
months on average. “Conditional accreditation lasts a year from the date that they achieve conditional status, but they must submit a programme information form (PIF) if they want full accreditation, or the accreditation will expire,” Frazer explained. CAMTS will not accept the PIF for full accreditation until a company has been in business for a year. Frazer commented that it generally takes a company a full year to figure out the range of care they will be providing to the area of service. “For example, some rotor-wing programmes start off responding to only interfacility transports, and then find they are needed to respond to scene transports, therefore, changing their scope of service,” she said. CAMTS extends the opportunity for conditional accreditation to all new companies, but thus far, companies not in a US State that requires immediate accreditation have chosen to wait out the one-year CAMTS requirement for full accreditation and then submit the PIF. CAMTS has been an accrediting organisation since 1990, the European Aeromedical Institute (EURAMI) since 1992, and National Accreditation Alliance Medical Transport Applications (NAAMTA) since 2009. US states’ legislation calling for companies to be CAMTS accredited came before NAAMTA established. However, a portion of the several states that historically required CAMTS accreditation have now opened up to NAAMTA. Colorado is currently the only state to have opened up all three including EURAMI, although other US companies within the other 49 states choose to be EURAMI accredited.
All or nothing NAAMTA also has a minimum period before a company can begin the accreditation process. “We require that companies be in service for six months before they apply for full accreditation,” NAAMTA executive director Roylen ‘Griff’ Griffin said. “If they apply just after six months of service, by the time they go through the process, paperwork, and an audit, they have usually been in service about a year and a half.” Griffin said NAAMTA does not offer conditional or provisional accreditation and sets a bar with criteria and standards that ensure the quality of patient care, management, and compliance for safety that the applying medical transport company must meet. He added: “We do not see conditional accreditation as a benefit to the safety and well-being of the patients being
“[provisional accreditation is] given after a company has gone through the accreditation process, but failed to meet the minimum pass rate”
transported. You are either meeting our standards and are accredited, or you are not.”
accreditation offered full
Provisional The terms may sound similar, but CAMTS’s ‘conditional accreditation’ is not to be confused with the ‘provisional accreditation’ that EURAMI gives after companies go through the full accreditation process. “EURAMI does not award a conditional accreditation,” the Institute’s managing director Andrew Wither confirmed. “We do offer provisional, but it is not the same as CAMTS conditional accreditation.” The grading is granted to a company to give it more time to meet compliance after falling short of the accreditation standards, but meeting a predominance of them. “Provisional accreditation is given for only a six-month period,” Wither said. “[It’s] given after a company has gone through the accreditation process, but failed to meet the minimum pass rate.” There has been only one example where a company was granted provisional accreditation and then had it revoked. Wither explained: “In
Airlift me up, Scotty
emergency response’). And taking the cue from the competition to name the UK’s recently launched Arctic exploration vessel (poll winner ‘Boaty McBoatface’ was unfortunately vetoed by the judges), SCAA’s supporters did not disappoint, with Ricky Ascension offering up Pilot McPilotface. We tried to find a name that would be an anagram of AirMed & Rescue Magazine, but could only come up with Americanized Smudge Arena or I Am Undersized Acreage Man. Probably best to leave it as Scotty then.
NZDF makes boy’s wish come true In the words of the New Zealand Defence Forces (NZDF), 10-year-old Alex Bowmar and about 220 schoolmates clapped, waved and shrieked in delight 48 48
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As the day breaks, you cross the tarmac to the standing air ambulance helicopter, ready to prepare the ship for a day saving lives. As you slide back the side door, a fleshless hand reaches out from inside. You look up to see a seven-foot-tall figure in a flight suit, with staring eyes and a fixed grin. So far, so Stephen King, but we’re actually referring to the latest addition to the Scotland’s Charity Air Ambulance (SCAA) team, a foamheaded mascot. SCAA asked its supporters to suggest a name for the friendly figure, who has now been dubbed Scotty, appropriately enough. Among the other suggestions were Christopher (an acronym inventively formed by Moira Ross from ‘charity helicopter rescuing in Scotland, transport offering paramedic and helicopter
as one of the Royal New Zealand Air Force’s NH90 helicopters landed on their school’s playground in early September. It was a dream come true for Bowmar, who wrote to the Chief of Air Force Vice-Marshal Tony
Air Component Commander Air Commodore Darryn Webb and Alex Bowmar, 10, with the letter he wrote to the Chief of Air Force Air Vice-Marshal Tony Davies
Davies to ask if one of the NH90s could visit his school. He said: “I’m very happy. Dreams really do come true, though I still cannot believe it’s happening.” The year-five student from Kelson Primary School said he wrote the letter after watching a TV news report about how the NH90s delivered aid to earthquakestricken Kaikoura and evacuated residents: “When I wrote that letter, I hoped to give everyone in school a surprise. I wished so much that they would read my letter and have one of the helicopters drop by for a visit. So I am very happy that they did.” NZDF sent one of the NH90 helicopters, which was on a scheduled training sortie in the area, to make a surprise visit to the Lower Hutt school. The NH90 visit was originally scheduled in March, but was postponed because of poor weather conditions at that time Air Vice-Marshal Tony Davies wrote in a letter to Bowman: “While I was unable to come along today, I have asked No.3 Squadron to drop into Kelson School with one of their helicopters to show you and your classmates around it. I wish you all the best for the future and it would be great to see you and your classmates in the Air Force when you have finished school.” Air Component Commander Air Commodore Darryn Webb, who was on the NH90 representing the chief of Air Force, said he hoped the visit would encourage some of the students to consider joining the Air Force some day: “It’s great to inspire others and help to make people’s wishes come true. My earliest memories are of aeroplanes and the excitement of living on an Air Force base, because my dad was also a pilot. It’s great to be able to showcase the Air Force of today to the next generation and hopefully ignite the same aviation spark.” Bowman said he and his eight-year-old younger brother James dream of becoming Air Force pilots some day: “I’d like to fly planes and help people like they did in Kaikoura.”
Royal College of Nursing London, UK www.rcn.org.uk
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