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V He ISIT li Ex US po AT 20 BO 17 OT in H Da 24 lla 17 s, TX . at

YOUR ONE STOP SAR SHOP Commercial Helicopter Operators, Para public Safety Agencies, and Defense Forces need proven, cost effective, and innovative training capabilities that are speciically relevant to performing their mission mandates. Training thousands of Search & Rescue and Tactical students worldwide, on 26 different aircraft types, and having experience operating in diverse environments around the globe, Priority 1 Air Rescue meets the demands of our customers by offering the most comprehensive mission training solutions in the industry. O ur Search & Rescue and Tactical Training Academy (SART/TAC) is setting a new standard for mission training performance and safety by employing synthetic hoist/aerial gunnery virtual simulators, hoist and fast-rope training towers, and modern classrooms that utilize cutting edge technology to provide our universally adaptable and standardized multi-mission training and operational SAR programs. Whether you are looking for Civil Aviation Authority (CAA) compliant and certiied basic to advanced hoist mission training, new aircraft type SAR role conversion, or complete turn-key Air Ambulance/HEMS and SAR/LIMSAR program implementation with operational Paramedic and Rescue Specialist Aircrew staffing, we deliver proven solutions. Priority 1 Air Rescue is dedicated to providing unparalleled capability, safety, and service to perform lifesaving missions.

Priority 1 Air Rescue your partner for SAR-Tactical Mission Success

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V He ISIT li Ex US po AT 20 BO 17 OT in H Da 24 lla 17 s, TX . at

YOUR ONE STOP SAR SHOP Commercial Helicopter Operators, Para public Safety Agencies, and Defense Forces need proven, cost effective, and innovative training capabilities that are speciically relevant to performing their mission mandates. Training thousands of Search & Rescue and Tactical students worldwide, on 26 different aircraft types, and having experience operating in diverse environments around the globe, Priority 1 Air Rescue meets the demands of our customers by offering the most comprehensive mission training solutions in the industry. O ur Search & Rescue and Tactical Training Academy (SART/TAC) is setting a new standard for mission training performance and safety by employing synthetic hoist/aerial gunnery virtual simulators, hoist and fast-rope training towers, and modern classrooms that utilize cutting edge technology to provide our universally adaptable and standardized multi-mission training and operational SAR programs. Whether you are looking for Civil Aviation Authority (CAA) compliant and certiied basic to advanced hoist mission training, new aircraft type SAR role conversion, or complete turn-key Air Ambulance/HEMS and SAR/LIMSAR program implementation with operational Paramedic and Rescue Specialist Aircrew staffing, we deliver proven solutions. Priority 1 Air Rescue is dedicated to providing unparalleled capability, safety, and service to perform lifesaving missions.

Priority 1 Air Rescue your partner for SAR-Tactical Mission Success

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AIRMED & RESCUE MAGAZINE

magazine ISSUE 87 | DEC 2017 / JAN 2018

ITIC Global 2017 ISSUE 87

Barcelona conference report

Hurricane Harvey DEC 2017 / JAN 2018

Evacuating critically-ill neonates

Helijet Air Ambulance Serving the citizens of British Columbia

Medevac advance in Ukraine Armed conflict encourages development


RAPID RESPONSE AIR AMBULANCE

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KING AIR

SPECIAL MISSIONS Learn more at specialmissions.txtav.com.

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© 2017 Textron Aviation Inc. All rights reserved. Beechcraft and King Air are trademarks or service marks of Textron Aviation Inc. or an affiliate and may be registered in the United States.


Contents

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

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

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Marketing: Kate Knowles

ITIC Global 2017

Hurricane Harvey

Finance: Elspeth Reid, Alex Rogers, Kirstin Reid

Barcelona conference report

Evacuating critically-ill neonates

Contact Information: Editorial: tel: +44 (0)117 922 6600 (Ext. 3) email: editorial@airmedandrescue.com Advertising: tel: +44 (0)117 922 6600 (Ext. 1) email: jamesm@airmedandrescue.com

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

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Helijet Air Ambulance

Medevac advance in Ukraine

Serving the citizens of British Columbia

Armed conflict encourages development

Main stories 44

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Printed by Pensord Press Limited © Voyageur Publishing & Events 2017

magazine AIRMED & RESCUE ISSUE 86 ISSN 2059-0822 (Print)

The right stuff What makes a fixed-wing air ambulance pilot?

Field notes from Belize Football and airlifts

Batteries are life Three tips for maximising your drone battery life

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

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Checklist challenge and response Start-up safety

Cover image: Coxhealth’s newly converted MD 902 Explorer, previously operated by the Dutch Police and the United States Coast Guard as an MD 900 (courtesy MD Helicopters)


NEWS

Welcome to Issue 87 of AirMed & Rescue Magazine, the definitive resource for the global air ambulance and air rescue community. As I begin to type this editorial comment, I look to my left at the Great Western Air Ambulance EC135 rising from the nearby Bristol Royal Infirmary roof-top pad in golden autumn sunshine, and to my immediate right at the files housing the past 86 editions of this publication; beyond them my cherished colleagues in the Editorial Department of Voyageur Publising & Events. If you detect a wistful note here, it’s because this is my final editorial comment. As I hand this issue over to the printers, I hand over the reins (or should I say yoke?) to your new editor, Mandy Langfield, who has been involved with covering the air medical industry for many years in her work on AMR’s sister magazine the International Travel & Health Insurance Journal and its supplement the Air Ambulance Review, and has appeared in these pages, most recently profiling Angel Flight Australia for Issue 85. Although I’m moving to a location outside of commuting range of Voyageur Towers, even by tiltrotor, this is do zobaczenia (there’s a clue) not goodbye, as Mandy has asked me to cover some issues of interest to the AMR audience from afar. If there’s anything you’d like to see in the magazine, it’s still the same contact address, editor@airmedandrescue.com – Mandy will be glad to hear from you. I wrote in Issue 85 of the ways in which a decade of reporting on air rescue has changed me. For this final column I’m moved to ask how the magazine has itself changed since it was launched as Waypoint AirMed & Rescue back in 2008. The logo and the title has evolved, and the page design has been updated over the years, but perhaps the biggest change has been in the online arena. At launch, it was easy to say what a magazine was: a glossy, printed publication you could hold in your hand and roll up to use as a splint. The website was in the background in a supporting role (check out www.waypointmagazine.com on Wayback Machine if you’re feeling nostalgic). Now I’m not so sure – although the print edition remains the core product, the website with its regularly updated news articles and the social media channels that share them (not to mention the app) are such an integral part of our output that, for me, the term ‘magazine’ now encompasses the print and online presence as a combined whole. It’s clear that the offering will need to continue to adapt as technology and the way that readers access information evolve. Having said that, for this editor at least, it’s equally clear that print will remain relevant, despite the lack of novelty. As the copy I once wrote for the website says, nothing beats the look and feel of a printed magazine. It’s been an honour to serve as your editor for the past 10 years. For one last time, let me say that we hope you enjoy this issue of AirMed & Rescue Magazine. Captain Langfield, you have control. James Paul Wallis Editor editor@airmedandrescue.com

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PSNI BVLOS drone training a UK ‘first’ Consortiq has announced that it has completed the delivery of a beyond visual line of sight (BVLOS) drone training course to the Police Service of Northern Ireland (PSNI), in what it believes is the first example of routine training of this type undertaken outside of segregated airspace for emergency services in the UK. Following a change in regulations from the UK Civil Aviation Authority (CAA) on 31 July 2017 that relaxed rules for emergency services’ use of drones, the PSNI approached Consortiq. The CAA’s Official Record Series (ORS) 4 No 1233, which outlined a relaxation of the normal operating limits for emergency service operators – subject to certain criteria being met – will apply to major incidents, said Consortiq. A major incident in this regard is defined as ‘one which is beyond the scope of business-as-usual operations and is likely to involve serious harm, damage, disruption or risk to human life or welfare, essential services, the environment or national security’. Consortiq explained: “Importantly, it states that the criteria for a relaxation of these limitations should first be in line with an appropriate decision that is taken while operating under the remit of the UK Emergency Services Joint Decision Model. This is where to act within the normal framework might unduly bring harm or cause loss of life, so a decision is taken to temporarily exceed these limitations. It is akin to the current rules which allow emergency service vehicles to proceed through a road traffic red light and exceed speed limits where the circumstances of an event dictate that it is expedient to do so.” In ORS 1233, the relaxation of the limitation on the emergency services operator may have a significant increase in the level of risk undertaken during these types of operations, said Consortiq. They must still operate within the bounds of the published operations manual, but can now fly out to 1,000 m (3,280 ft), or even beyond 2,000 m (6,560 ft) in exceptional circumstances, following a decision by the appropriate level of tactical command for the incident. The operational training involved operating a drone out to 1,000 m (and beyond), which takes the emergency services operator into the territory of EVLOS (extended visual line of sight) and BVLOS operations. To maintain a sufficient level of situational awareness for the operator to still take action to avoid collisions with other aircraft and obstacles, a network of observers may be required, all of whom must be fully trained and equipped to work as a whole team, communicating openly and concisely with the remote pilot in control, said the training company. Consortiq

Editor’s comment

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


NEWS

Med-Trans Corporation

NEMSPA names Brad Simmons as pilot of the year Med-Trans Corporation has highlighted that Brad Simmons, base manager at Erlanger’s Health System’s Life Force Air Medical in Tennessee, US, has been named 2017 Pilot of the Year by the National EMS Pilots Association (NEMSPA). He was recognised for outstanding contributions to emergency medical services defined as leadership, mentoring, technical knowledge and expertise, contributions to aviation or transport safety and/or overall personal professionalism, said Med-Trans. Selection was made by NEMSPA board of directors and presented at the annual awards dinner of the Association of Air Medical Services Air Medical Transportation Conference in Fort Worth, Texas. “As one of our most tenured Life Force pilots, Brad Simmons has shown us what a true professional pilot looks

Brad Simmons (left) accepts the NEMSPA Pilot of the Year award from NEMSPA president Miles Dunagan

like,” said Robbie Tester, vice-president of operations at Erlanger. “He goes above and beyond and has always been dedicated and committed to the profession. Over the last two years, Brad has been instrumental in ensuring that Life Force 5 is a high functioning base and continues to carry the standard of being world-class to a new market.” Med-Trans president Rob Hamilton commented: “Brad Simmons exemplifies the type of pilot leader that Med-Trans has throughout our organisation. His positive contributions to our industry serve as a reminder of the advantages of selfless service and focus on safety as a core value.” After the devastation of Hurricane Harvey, Simmons was one of the Med-Trans pilots who flew to San Antonio, Texas as part of the disaster relief efforts. His willingness to fly a Life Force helicopter to Texas in order to help more people is a true statement of his character, said the company. Simmons spent 20 years as a pilot for Erlanger Medical Centers Life Force and five years as chief pilot. He became base manager for Med-Trans as the organisation transitioned to Med-Trans flight operations supporting medical teams from Erlanger. Previously, he was base lead for Pumpkin Air for more than nine years, spent five years as lead pilot for Careflight Harris Methodist and began his flying career in the US Army. He holds a Bachelor of Science in health and physical education/fitness from Union University, where he was junior-senior class president and played baseball for three years. He also graduated from the US Army Flight School.

www.airmedandrescue.com

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NEWS

New air rescue partnership announced for Quebec Two critical care air ambulance providers from Quebec announced a new partnership on 4 October, under which they will offer solutions to residents and visitors of the Canadian province. Airmedic based in Saint-Hubert and Skyservice Air Ambulance International of Montreal-Dorval boast a combined fleet of seven medically equipped aircraft, comprising Airmedic’s AW109 and EC130 helicopters and Pilatus PC-12 planes, and Skyservice Air Ambulance International’s Learjet 45XR longrange jets. While Airmedic concentrates on providing services in Quebec and bordering towns and territories, Skyservice Air Ambulance International said it provides services on a global basis and has visited over 180 countries and territories. The joint venture will give each company flexibilities to operate the right aircraft for the right mission at the right time, they said, whether Skyservice’s long-range planes or Skyservice’s short to medium range aircraft. The aim is that customers will see a seamless operation that matches to their needs.

Both companies work on behalf of local hospitals and health boards, travel health insurers and the general public, and also maintain membership programmes that allow members of the general public to access to their services.

Sophie LaRochelle, vice-president of Airmedic, and Sam Cimone, president of Skyservice Air Ambulance International

HNZ Group to be acquired by president and CEO Don Wall and PHI

Canadian Helicopters

HNZ Group Inc. and PHI, Inc. announced on 31 October that, together with Don Wall, the corporation’s president and CEO, they have entered into an arrangement agreement under which Wall, through a wholly-owned acquisition company, will acquire all of the issued and outstanding common and variable voting shares of the HNZ Group by way of a statutory plan of arrangement under Section 192 of the Canada Business Corporations Act for CA$18.70 per share in cash. As part of the arrangement, PHI will acquire the portion

of the corporation’s offshore business conducted in New Zealand, Australia, the Philippines and Papua New Guinea. The arrangement values HNZ Group at approximately $242.4 million. “We are pleased with the strategic review process that has led to this important transaction, which we believe to be in the best interests of the corporation and its shareholders,” said Larry Pollock, chairman of the HNZ Group board of directors. Don Wall commented: “This transaction provides significant value and liquidity for our shareholders, as well as continuity and opportunity for our employees. I look forward to continuing the operations of the Corporation in Canada, the US and Antarctica where we will continue our brand as a wellknown and respected industry participant, with an excellent safety record and reputation

Library image of a Canadian Helicopters-operated Emergency Health Services LifeFlight air ambulance helicopter

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for providing performance excellence, innovative thinking and efficient customer service.” Al A. Gonsoulin, chairman and CEO of PHI, said: “This acquisition is an important part of our plan to diversify our services and international footprint. It is rare to be able to acquire a segment of a company with whom you have such a strong working relationship, as well as deep professional and personal regard. Together, PHI and HNZ bring a unique approach and skill to the discerning international customer. We look forward to what this will mean for our company and for those we serve.” HNZ Group Inc. provides helicopter transportation and related support services, including search and rescue and disaster relief, with operations in Canada, Australia, New Zealand, Antarctica, the US and Southeast Asia. Its offshore operations are provided under the HNZ brand, while onshore charter operations are under the Canadian Helicopters brand in Canada, Acasta in Northern Canada and the HNZ brand in Asia-Pacific and Antarctica. PHI, Inc. offers services to the offshore oil and gas, air medical applications, and technical services applications around the world.


NEWS

Air Alliance and Embrace enter strategic partnership

Air Alliance Medflight

Recent months have seen Air Alliance Medflights’ in-house clinical capabilities continue to evolve, the fixed-wing air medical provider has reported. The firm said it has cemented a clinical partnership with Embrace, a CAMTS-accredited neonatal and paediatric transport service hosted by Sheffield Children’s NHS Foundation Trust, by undertaking a number of transfers since August. Embrace is working alongside Air Alliance’s UK-based teams to provide full neonatal and paediatric capabilities. The development of the service in the UK took months of planning, said Air Alliance, including the provision of in-depth aeromedical training onsite at the Air Alliance facilities in Birmingham and a joint CAMTS accreditation site survey, the results of which are due in late October. The team boasts two incubator stretcher systems: one is intensive care capable with a Ti500 isolette, while the second is high dependency capable and features a Babypod. These are supported by Hamilton T1 ventilators and Neopod humidifiers, said Air Alliance, which are capable of providing comprehensive respiratory support to the smallest of lungs, including nasal CPAP and high flow therapy. Both systems are compatible with Learjet 35A aircraft. Jane Topliss, Air Alliance Medflight’s director of UK aeromedical services, said: “We believed that it was extremely important to work with a specialised and experienced retrieval team on these types of transfers. By having this partnership in place, we can ensure that the transfer of these complex patients is done as safely as possible and is clinically managed by experts in the field”. The Embrace team is led by paediatric critical care consultant Dr Steve Hancock and neonatal consultant Dr Cath Harrison. They are further supported by a large group of senior consultants, advanced nurse practitioners and specialist nursing staff who are on call 24/7 to provide clinical advice and retrieval support. Hancock commented: “We are delighted to be working alongside Air Alliance and to be able to provide a worldwide specialist transport service. Embrace is the first joint neonatal and paediatric transport service in the UK. We undertake over 2,000 transfers a year by road, rotary and fixed-wing aircraft in the UK and Europe, so this is an excellent extension to our current capabilities.”

Embrace Senior Transport Nurse Ann Jackson during a neonatal mission www.airmedandrescue.com

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NEWS

Five important safety actions for helicopter pilots After analysing dozens of helicopter accidents that resulted in fatalities for pilots and passengers, the US Helicopter Safety Team (USHST) has circulated what it says are the five vital action items for pilots that will improve safe operations. Focusing pilots on these solutions will allow them to make better choices before and during their flights, said USHST; the facts show that failure in these areas has resulted in lives being lost. The five actions recommended by the USHST are: 1. Take time for your walk around The pilot in command is responsible for determining the airworthiness of the aircraft he or she is operating. An adequate preflight inspection and final walk around is key to determining the condition of an aircraft prior to flight. In addition, post-flight inspection can help to identify issues prior to the next flight. The USHST believes that pilots would benefit from better guidance on how and why to conduct these inspections, as well as increased attention to their importance. 2. Communicate risk issues in the cockpit The flight environment is often dynamic and not every contingency can be anticipated or scripted in advance. The pilot-in-command is ultimately responsible for the safety of a flight – however, non-flying crew and passengers can and should work with the pilot to ensure safety. When unexpected changes are encountered, it is paramount that the pilot and crewmembers/passengers try to detect the elevation of risk, communicate it to each other, and collectively work through a reasonable resolution or mitigation. The USHST believes that effective practices are needed for each stage in the process – detection, communication and decision. 3. Get solid training for make and model transitions Transition training in the helicopter community is not uniformly applied, and this is leading to accidents because of unfamiliarity with airframe and/or equipment. The USHST believes that documentation related to helicopter 88

AIRMED & RESCUE

transition training can be developed into a new, unified guide that would offer recommended practices and a ‘toolkit’ to support standardised use. 4. Understand the hazards of over-thecounter medications Because over-the-counter medications are readily available, pilots frequently underestimate the deleterious effects and the impairment caused by these sedating drugs. In spite of specific federal regulations and education efforts regarding flying while impaired, overthe-counter medication usage by pilots remains a factor in 10 to 13 per cent of aircraft accidents. The USHST believes that the helicopter community needs an increased awareness of the potentially disastrous results of operating an aircraft while taking these medications. 5. Make a safe attitude your overriding priority Safety in the aviation world can be defined in many ways. From the reactive point of view, safety essentially means a lack of accidents, an absence of injuries, and a general environment where things don’t go wrong. From the proactive point of view, this environment doesn’t exist for any consistent amount of time unless certain safety-related active principles are put in place and specific safety attitudes are fostered and strengthened. Whether we are strengthening a person’s safety attitude, bolstering a team’s safety convictions, or nurturing an entire safety culture, focusing every member of an aviation team at every level on clear and tangible convictions needs to be a central goal. The USHST said it believes that a more widespread culture of safety can be developed if the principles are straightforward and relatable to individuals. It added: “Your flight decisions need to be determined by safe actions. You need to take a proactive approach to solving safety issues. You must never carry out any unsafe actions or unprofessional behaviours. You should be continually looking for new safety knowledge and information. You need to find ways to invest in and use technology that improves safety.”

waypoints New York State Department of Environmental Conservation (DEC) has deployed a fleet of 22 unmanned aerial vehicles (UAVs) across the US state to enhance the state’s environmental management, conservation and emergency response efforts including search and rescue taskings. Aerospace product manufacturer SEI Industries Ltd of British Columbia, Canada, announced that Sergio Fukamati ioined the organisation as director of the firefighting division. Sergio Fukamati has over 25 years of international business management experience related to capital equipment sales and after-sales service, said SEI. He is also professional engineer and registered project management professional. REACH Air Medical Services, Cal-Ore Life Flight and Arcata Mad River Ambulance (AMRA) entered into an agreement that will place AMRA within the same corporate holdings company as REACH and Cal-Ore Life Flight. A joint announcement made by senior executives from all three organisations said that AMRA will continue serving the local community as it has for years. Each party expressed their belief that the transition of AMRA will not only benefit the community, but the company as well thanks to the additional support, operational knowledge, and resources provided by both Cal-Ore and REACH. Krista Haugen, director of patient safety and medical risk management for US-based Med-Trans Corporation, has been given the 2017 Jim Charlson Safety Award by the Association of Air Medical Services (AAMS). The safety award recognises individuals who make significant contributions to the enhancement, development and promotion of aviation safety, said the US-based air transport provider. Lockheed Martin has announced that the Combat Rescue Helicopter (CRH) Program Training Systems Critical Design Review (CDR) has been successfully conducted. This event prepares the CRH programme to proceed to assembly, test, and evaluation of the HH-60W helicopter’s training systems, said the firm.


NEWS

AIRBUS HELICOPTERS, INC.

AIRBUS HELICOPTERS, INC.

AAMS announces 2017 award winners

Krista Haugen, winner of the Jim Charlson Safety Award

AIRBUS HELICOPTERS, INC.

In October, the US Association of Air Medical Services (AAMS) revealed the winners of its 2017 awards at the Air Medical Transport Conference (AMTC) in Fort Worth, Texas, US. This year’s awards winners were: Life Link III – Program of the Year; Allen C. Wolfe Jr., Air Methods Corporation – MarriottCarlson Lifetime Achievement Award; Krista Haugen, Med-Trans Corporation – Jim Charlson Safety Award; DJ Lafrance, STARS – Transport Mechanic’s Award of Excellence; Life Link III’s Hospital Helipad Safety Video – Airbus Helicopter’s Vision Zero Aviation Safety Award; AirMed International LLC – AAMS Fixed Wing Award of Excellence; Ann & Robert H. Lurie Children’s Hospital of Chicago’s Transport Team – AAMS Critical Care Ground Award of Excellence; UNC Carolina Air Care Pediatric / Neonatal Team – AAMS Neonatal/Pediatric Award of Excellence; Dr Ranna Rozenfeld, Ann & Robert H. Lurie Children’s Hospital

Life Link III was awarded Program of the Year

Life Link III was awarded Program of the Year

of Chicago’s Transport Team – AAMS Excellence in Transport Leadership Award; Mandy Via, CareFlight Air & Mobile – AAMS Excellence in Community Service Award. Presented annually at AMTC, the AAMS Community Awards recognise excellence and leadership in the emergency medical services transport community. The Jim Charlson Safety Award given to Haugen recognises individuals who make significant contributions to the enhancement, development and promotion of aviation safety. Med-Trans commented: “After surviving a helicopter emergency medical service crash in Olympia, Washington in 2005, a month after three of her colleagues perished in another crash, Krista found herself in uncharted territory. She became aware that the magnitude of resources needed after this type of trauma was not available. Haugen, a flight nurse, reached out to flight nurses Megan Hamilton, Teresa Keeler and Jonathan Godfrey, also HEMS crash survivors. They shared their postcrash experiences and recognised a gap in the air medical transport industry and they filled it. The need was clear and the Survivors Network for the Air Medical Community was born.” AAMS president and CEO Rick Sherlock added: “With more than 25 years in emergency critical care and flight nursing, and as a helicopter EMS crash survivor, Krista is passionate about mitigating the

human cost of trauma stemming from incidents, accidents, illnesses and injuries. We are proud of her concern and passion for air medical transport safety.” Speaking of AirMed International being honoured with the AAMS Fixed Wing Award of Excellence, Sherlock said: “AirMed International has undergone several important quality improvements to the overall condition of their fixedwing transports, and the organisation continually recruits and develops the best and brightest for their team. Importantly, under the leadership of president Denise Treadwell and director of operations Darby Wix, the company added a highly qualified expert who is dedicated solely to all aspects of safety.” Life Link III has also been named by AAMS as the 2017 recipient of the Vision Zero Aviation Safety award in recognition of its hospital helipad safety training video. The Association said: “Life Link III continually reviews safety processes and procedures and recently identified a need for a standardised hospital helipad safety training. In 2017, Life Link III completed production of a hospital helipad safety training video, intended to educate hospital staff who assist with patient transports or maintain the helipad area. This safety training video features transport best practices that demonstrate how flight crews and hospital staff can partner to provide the safest experience possible.” For further information on the winners, see www.airmedandrescue.com/story/2491.

www.airmedandrescue.com

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NEWS

US gets first defibrillator drone delivery programme The Regional Emergency Medical Services Authority (REMSA) has announced it is partnering with drone delivery service Flirtey to deliver lifesaving defibrillators to victims of sudden cardiac arrest. REMSA said this is the first automated external

REMSA

and partnering with REMSA is another huge step towards this goal. We have the ability to deliver lifesaving aid into the hands of people who need it – why aren’t we as a society doing it already? This is one of the most important uses of drone

defibrillator (AED) drone delivery service in the US. Cardiac arrest is the leading cause of natural death in America, with more than 350,000 out-of-hospital cases each year, according to the American Heart Association. For every minute that a victim of cardiac arrest waits to receive defibrillation, their odds of survival decrease by about 10 per cent, said REMSA. The hope is that using drones to deliver AEDs will improve victims’ chances of surviving cardiac arrest and ultimately save lives. The partners explained that soon, when REMSA’s communications centre receives a cardiac arrest call, in addition to dispatching an ambulance, a Flirtey drone carrying an AED will also be dispatched to the scene of the emergency. This will allow bystanders to begin administering care while they wait for paramedics to arrive, they said. Flirtey CEO Matthew Sweeny commented: “Our mission is to save lives and change lifestyles by making delivery instant, 10 10

AIRMED & RESCUE

REMSA

Flirtey

Flirtey

delivery technology, and we believe that by democratising access to this lifesaving aid, our technology will save more than a million lives over the decades to come.” Together, Flirtey and REMSA are developing an emergency response and integration process to allow for the rapid drone deployment programme, including combining Flirtey’s flight planning software into REMSA’s specialised patient care and transport programmes. In addition to its ground ambulance system, REMSA also operates Care Flight, an airplane and helicopter air ambulance service, as well as a critical care ambulance. The partners are working together on Federal Aviation Administration approvals and a public education campaign focused on integrating emergency drone AED delivery into the community. REMSA CEO Dean Dow said: “REMSA is committed to improving the health of the communities we serve through innovative, pre-hospital care. We’re excited to incorporate Flirtey’s drone delivery technology as part of our emergency response in Northern Nevada. Providing quality, lifesaving care to patients as fast as possible is always our goal.”


NEWS

(left to right) Brandon Reed, vice-president of global medevac operations at TMH Medical Services and Tertius van Jaarsveld, CEO of FlyAwesome

Awesome Air Evac, Diplomat Freight Services and TMH Medical Services have announced that they have joined forces to provide an air ambulance service based in Kabul, Afghanistan. The companies said the team brings years of experience in aeromedical evacuations, transport logistics and medical support operations in hot and hostile territories to

the sector. industry leaders have been able to come A Beech 1900D aircraft, operated by together to provide our clients with a faster, specialist operator FlyAwesome, is more cost-effective solution to patient air permanently based in Kabul to service transport needs. It’s taken quite a bit of domestic and international requirements, planning, but ultimately it’s the patients said Awesome Air Evac. The plane has who will benefit greatest. That’s what’s most been fitted with a Med-Pac 400 Aerosled important to me.” and features a standup cabin. The firms said the first air ambulance mission out of Afghanistan was successfully completed on 13 November, with the patient being moved to Dubai. Brandon Reed, vicepresident of global medevac operations at TMH Medical Services, said: “I Brandon Reed (centre) and the TMH Kabul and Dubai team, pictured after completion am pleased that three of the first air ambulance mission Awesome Air Evac

Awesome Air Evac

New partnership for civilian medevac in Afghanistan

www.airmedandrescue.com

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NEWS

ALEA releases standards for public safety drone programmes The US-based Airborne Law Enforcement Association (ALEA) has released a set of standards for public safety small unmanned aircraft system (sUAS) programmes. The standards were developed by the Public Safety Aviation Accreditation Commission (PSAAC) under contract to ALEA for use by the public safety aviation community. ALEA is encouraging public safety agencies considering drone operations to use these standards as a guiding document, while those already operating sUAS are encouraged to ‘review these standards

and perform an internal gap analysis to determine their compliance with industry best practices’. ALEA explained: “As the integration of sUAS technology into public safety operations continues to increase, the development of best practice standards that address the safe, efficient and ethical use of small unmanned aircraft for all public safety missions is vitally important. The new sUAS standards contain five sections (administration, flight operations, safety, training and maintenance) and

provide guidance on the tactical, legal and ethical use of sUAS. The standards provide a set of best practices for agencies already using, or considering the use of small unmanned aircraft. Adherence to these standards will provide assurance to the civilian community that its public safety agency is operating in accordance with well-established, safe, efficient and ethical practices. “ The standards are available from the PSAAC website, www.psaac.com.

Medical director honoured for police force project UK HEMS charity Thames Valley Air Ambulance’s medical director, Dr Syed Masud, was named Doctor of the Year at this year’s Air Ambulance Awards of Excellence. Masud won the award for the work he did leading the introduction of medical governance within Thames Valley Police. Masud’s project encompassed all aspects of the policy, training and equipment given to officers, and means that police officers can provide both basic and enhanced first aid

care. He had previously completed a similar project with the Metropolitan Police. “Providing lifesaving first aid is a critical part of the role of police officers,” Lynn Cleaver, first aid training lead for Thames Valley Police, explains. “Indeed, the first rule of policing is to protect and save lives. Not only are police officers likely to be the first responder to a medical emergency, but they might also be required to administer first aid.” Some of the actions that Masud has brought

in for the force include: placing AEDs and resuscitation equipment onto police vehicles; training specialist unit medics – including counter terrorism officers – in enhanced bleeding control; and management of causalities in different environments. Masud commented: “I am truly humbled to have been nominated by colleagues in the police service and it is an incredible feeling to have won. I am deeply passionate about achieving gold standard patient care, which is at the heart of my motivation.”

No survivors in Arkansas medical helicopter crash Pafford Emergency Medical Services has confirmed that there were no survivors of the crash of a medical helicopter flying for its sister company Pafford Air One, based in Pine Bluff, Arkansas, US. The aircraft crashed in the early evening of 19 November in an isolated area near De Witt, killing Air Methods pilot Michael Bollen, Pafford flight nurse James Lawson Spruiell and Pafford flight paramedic ‘Trey’ John Auld III. The company said the accident occurred during a response from the helicopter’s station in Pine Bluff to Helena Regional Medical Center. The Bell 407 GXP is owned, operated and maintained for Pafford Air One by Air Methods Corporation. 12 12

AIRMED & RESCUE

Dustin Ross, director for Pafford Air One, said: “We are of course all devastated and profoundly saddened by the tragic loss of these valued EMS colleagues and friends. We will continue to try and comfort the crew’s families as well as everyone in our employ.”

In a Facebook post, Greg Pafford, John Pafford and Jamie Pafford-Gresham wrote: “Pafford is devastated by the sudden loss of three of our team members. At this time we have no words, only prayers for the families and loved ones involved.”

(left to right) certified flight paramedic Trey Auld, pilot Michael Bollen, certified flight nurse-paramedic Jim Spruiell


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NEWS

Physician-led crews score high for perceived patient safety HEMS teams with a dual medical crew comprising a physician and an assistant rate highest among medical directors for perceived patient safety, according to research published by the Air Medical Journal. Researchers Dr Kristen Rasmussen, Jo Røislien and Dr Stephen J.M. Sollid, who are affiliated to the Norwegian Air Ambulance Foundation, the Air Ambulance Department of Oslo University Hospital and the University of Stavanger, found that the most common reasons for the choice of crew are ‘tradition’ and ‘scientific evidence’. They commented that crew configuration is believed to affect patient care and safety, but ‘evidence to support the advantages of one crew concept over another is ambiguous’, adding that ‘the benefit of physicians as crewmembers is still highly debated’. The researchers surveyed medical directors of HEMS providers in Europe, North America, Australia, New Zealand, and Japan, asking what crew compositions their organisations use and the rationales behind the choices, and also to evaluate patient and flight safety within their services. According to the results, most respondents said they would rather keep their current crew configuration, but some would prefer to add a physician or supplement the physician with an assistant in the cabin. The 66 responses received suggest that differences in medical staffing influence perceived flight and patient safety, said

the researchers. Of 48 services that include physicians on their crews, the most common specialty of the physicians was anaesthesiology (85 per cent) followed by emergency medicine (58 per cent). The three most common staffing models were physician and HEMS crew member (38 per cent), physician and nurse (20 per cent), and nurse and EMT/paramedic (17 per cent). Physicians were single medical care providers in 26 services and had assistants in 22 services. Nurses were single providers in two services and had assistants in 13 services. Paramedic-led services were rare – only two survey respondents used a paramedic alone, and one service operated with a paramedic and an assistant. The researchers found that overall, 30 services (45 per cent) had a single medical provider and 36 (55 per cent) a dual medical crewmember configuration. Other findings included in the study report include that systems with a single crewmember in the cabin generally assigned lower scores for patient safety during night missions than for daytime missions. In this group, there were significantly fewer respondents with perceived patient safety ‘acceptable or better’ for both night and daytime missions when compared with systems with an assistant in the cabin. The researchers suggested that future studies should attempt to isolate the effect of different medical crew models on patient safety and flight safety in an experimental scenario.

Chinese and US personnel take part in Disaster Management Exchange

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Hale, an aviation survival technician at Coast Guard Sector Columbia River, explained rescue equipment commonly found on USCG helicopters. Aviation

USCG

Representatives from the People’s Republic of China and the People’s Liberation Army met with members of the US Coast Guard (USCG) during the US/China Disaster Management Exchange held at US National Guard Training Base Camp Rilea in Warrenton, Oregon, US, on 16 November. Alongside USCG personnel, soldiers from US Army Pacific, Oregon National Guard and the People’s Republic of China, People’s Liberation Army Southern Theater Command took part in the 13th iteration of the exchange, which is designed to share real-world lessons learned about humanitarian assistance and disaster relief. The Exchange consisted of an expert academic discussion, a table-top exchange and a practical field exchange discussing humanitarian assistance and disaster relief, said the USCG. USCG Petty Officer 3rd Class Christopher

Petty Officer 1st Class Levi Read

survival technician USCG Petty Officer 2nd Class Jordan Gilbert, was hoisted up into an MH-60 Jayhawk helicopter during a search and rescue demonstration.


NEWS

Mixed CQC report for Heathrow Air Ambulance The Care Quality Commission (CQC), the independent regulator of health and adult social care in England, has issued an inspection report on patient transport service Heathrow Air Ambulance. Part of the wider Roebuck Air Services Group, Heathrow Air Ambulance Service says its offering includes air ambulance, flight nursing and ground ambulance services. In an introductory statement signed by

and non-clinical risks. The manager was able to identify a limited number of risks; however, there was limited evidence to demonstrate that all risks had been identified.” The regulator further reported that while there was a formal process for reporting patient incidents, the CQC ‘did not have assurance that Heathrow Air Ambulance was following its own policy for reporting, investigating and learning from incidents’.

The service did not have an effective system in place to identify, limit and control clinical and non-clinical risks Professor Edward Baker, chief inspector of hospitals, the CQC report lists positive findings, as well as a number of areas where the provider ‘needs to improve’, which were identified through an unannounced inspection on 25 July and an unannounced visit on 7 August. Among the issues reported by the CQC was that general governance was ‘not robust and did not demonstrate a monitoring of the quality of the service’. The report also states: “The service did not have an effective system in place to identify, limit and control clinical

The CQC also noted a lack of an appraisal process, resulting in staff having unmet training needs. However, the report adds: “We were, however, assured at the unannounced visit [that] appraisals were in progress.” Further issues listed include incomplete staff training records, and a lack of a robust medicines management system. The report continues: “However, during inspection the decision was made to remove all medicines, as these were not essential to the service provided.” Among the areas of good practice described

in the report are that staff were found to hold the manager in high regard, enjoyed working for the service and felt well supported. The service managed infection prevention and control well and followed its policies and procedures, and all vehicles were in good condition, well maintained and visibly clean and tidy. Medical gases were stored safely and securely, said the CQC, and equipment was maintained, clean and in good working order. Staff received mental capacity act training and showed awareness of consent issues, the service used its vehicles and resources effectively to meet patients’ needs, and staff described a compassionate, empathetic and caring attitude towards patients, putting patients’ best interests at the heart of their work, said the CQC. In addition, staff were clear about how they would respect patients’ dignity, independence and privacy, and were found to be focused on providing person-centred care and enjoyed working for the company. The CQC noted that Heathrow Air Ambulance has retained the same contracts with embassies and insurance companies for over 25 years. The regulator said that following this inspection, it told the organisation that it must take some actions to comply with the regulations.

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FEATURE

Hurricane Harvey: evacuating critically-ill neonates A priceless and precious parcel Fourteen hours and 29 minutes. Ten critically-ill neonates. Seven twoway flights at 425 knots. Amy Gallagher reports

H

urricanes do not discriminate. Not even for critically-ill newborns. Cook Children’s Medical Center and Metro Aviation were ready for the rescue, and Driscoll Children’s Hospital was proactive and prepared. The transport teams at both facilities understood their mission: to evacuate and transport 10 critically-ill neonates before Hurricane Harvey’s 134-mph (216-kph) winds landed in Corpus Christi, Texas, US, where Driscoll is located. Up against the clock were transport team members: Ray Crain, fixed-wing pilot, Metro Aviation, Cessna Encore+; Children’s Teddy Bear Transport Team’s programme director Debbie Boudreaux; flight nurse, Lori Hill; and Driscoll Children’s Hospital transport team director, Jeremy Goodman. Professionals and proactive planning “I actually become more methodical and slow my flight planning to ensure the crew members are briefed and understand the time constraints,”

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said Crain, who has flown for the transport team for 29 years. Metro Aviation, one of the largest EMS aviation providers in the US, operates Cook Children’s EC145 helicopter, Beechcraft King Air B200 and Cessna Encore+. With Cook Children’s Medical Center for 30 years, Boudreaux became programme director of the Teddy Bear Transport Team in 2013. “Preempting a hurricane the size and speed of Harvey requires a network of people,” he said. Through their respective administrative teams, Boudreaux and Goodman began co-ordinating the transports on 24 August. “We had FBO contacts on the ground to secure fuel and a landing in Corpus Christi,” said Boudreaux. A proactive plan was put in place as Boudreaux and Goodman began collaborating with the transport directors of Dallas Children’s Medical Center and Texas Children’s Hospital Houston to secure standby resources, if needed, she added.


FEATURE

An environment of uncertainty Working with the National Weather Association, County Emergency Command Center and Regional Advisory Committee, Goodman was informed that Harvey was only hours away and living up to its name, ‘iron strength and battle worthy’. “The storm was rapidly changing, so we prepared for a Category 1/2 storm, then shortly after, were notified that Harvey’s strengthening was imminent,” said Goodman. Harvey was an unpredictable storm that rapidly gained strength, he said. “In the past, we knew what we were going to encounter, but Harvey changed that,” he said. “It was slow moving, but intensified at the last minute, creating an environment of uncertainty. We monitored the storm and were prepared for whatever path it was going to take.”

“Each evacuation is an opportunity to renew respect for transport teams that put themselves in harm’s way Time, speed, range and payload “At approximately 11:00 hrs on 24 August, we were briefed that the storm was likely to become a Category 3, so we began preparing our patients for transport to another location as a precaution,” explained Goodman. With any natural disaster, there is a degree of intensity, said Boudreaux. “Since Driscoll was proactive, we had time to plan and co-ordinate our efforts,” she added. “These types of flights bring unique challenges due to approaching weather and increased operational tempo,” said Crain. “However, the aircraft’s combination of speed, range and payload ... was ideal for these flights.” With 6,500 flight hours, Crain said on the flight to Corpus Christi, the Encore+ created an easier pathway reaching about 32,000 ft at a speed of approximately 425 knots. “Its advanced airborne weather radar system allowed us to see any convective activity directly ahead of us in real time,” he added.

just hours before Harvey’s landfall in Corpus, according to Boudreaux. “In total, the transport teams of both hospitals conducted seven flights to/from Corpus Christi and Fort Worth,” she added. Corpus Christi: home sweet home According to Goodman, the last flight transporting the 10th baby was back ‘home’ at Driscoll on 1 September. “Each evacuation is an opportunity to renew respect for transport teams that put themselves in harm’s way to ensure the safety of our most fragile patients,” said Goodman. “We have the utmost respect for Cook Children’s.” Both hospitals share a similar mission to provide access to quality care, while improving the lives of children through hope and healing, he said. Fourteen hours and 29 minutes The time to evacuate 10 critically-ill neonates from Driscoll’s NICU to safely tuck all the babies in warm blankets at the NICU Cook Children’s, approximately 400 miles (650 km) northwest of Fort Worth, according to Boudreaux, was 14 hours and 29 minutes. “It was such a relief when the last aircraft lifted out of Corpus Christi,” she said. “We were under a time crunch while the storm cell was moving closer. I kept track of planes and the storm on the weather channel and flight tracking system.” Although Hurricane Harvey set a new precedent, Boudreaux’s team was prepared. “We learned many years ago, if you’re called to help, it doesn’t matter who needs it,” said Boudreaux. “If you can help, you go. We’ve worked closely with other hospital transport teams and have learned the value of those relationships when making those important phone calls. I just wanted everyone back on the ground in Fort Worth. At the end of the day, we completed our mission of moving 10 infants safely.”

A mobile ICU for the most critical The Encore+ carries six passengers and one patient, and in some cases, two infants on the same stretcher/isolette, said Crain. Teddy Bear flight nurse Lori Hill began preparing additional supplies for the transport. According to Hill, the plane is essentially a mobile ICU that is equipped with oxygen, suction, monitoring devices and pumps to infuse the same medications patients were receiving at the referring hospital. The team has the ability to transport with high frequency ventilation, nitric oxide and even ECMO if needed, said Hill. “Some patients were ventilated and on nitric with a central line requiring frequent sedation,” she explained. Fort Worth: a home away from home Hill’s greatest concern was getting the critically-ill neonates to Cook Children’s. “We were relieved to hand our baby to our NICU staff, who we knew would give excellent care,” she said. Her greatest joy, she said, was, ‘helping out fellow Texans in their time of need’. On the pilot’s side, everything went according to plan, said Crain: “With a limited window of operations, we stayed within it.” The last plane landed in Fort Worth safely around 05:20 hrs on 25 August,

(left to right) Lori Hill, Ray Crain and Debbie Boudreaux www.airmedandrescue.com

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MEDEVAC

ADVANCES IN UKRAINE I

n August, Civil Aviation Plant 410, based in Kiev, handed over to the Ukraine National Guard a modernised AN-26 that had been re-equipped to handle ground mission calls in the area of the so-called Anti-Terrorist Operation (ATO) Zone. This was the first new aircraft fielded for this role by the State Emergency Service of Ukraine in many years, and it should mark the first step of the major reform, as the country’s officials speak of plans to double the medical aviation fleet over the next couple of years. The air ambulance department was originally established in Ukraine in 2007 within the healthcare department of the Defence Ministry. It has been operating with six Mi-8 helicopters and a ‘Vita’ plane – a re-equipped and partially modernised AN-26. There were some reports that the previous Ukraine government headed by Nikolay Azarov was considering establishing the first civil air ambulance operator in 2013. Even if those plans really existed, they were destined to not come to fruition, as after the 2014 ‘Ukrainian Revolution’, with the subsequent annexation of Crimea and an outbreak of fighting in the eastern region, medical aviation was forgotten. The country’s authorities set their sights on medical aviation again only in 2016. Local news outlet Fakty reported that the current President of Ukraine

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Armed conflict encourages Ukraine to develop medical aviation By Vladislav Vorotnikov Petro Poroshenko signed a decree on establishing a new air ambulance service in the country. Although the details of the reform remain unclear, Fakty suggested that the total medical aviation fleet should be increased to 15 machines within a couple of years, including at least three fixed-wing aircraft, in order to meet the country’s internal needs. It is believed that the Ukraine government wants to field a further five planes to carry out international rescue missions, although that part of the plan would be implemented later. Nikolay Chechetkin, the chairman of the Emergency Service, has revealed that in 2016 the country’s government allocated UAH62 million (US$2.3 million) to expand the medical aviation fleet with the AN-26. He confirmed that this is only the first step in the planned development of the air ambulance system in Ukraine, but did not provide further details. Sergey Zgurets, director of Defense Express, a local consulting agency, said that prior to 2014, the development of medical aviation was not considered a priority, but things changed with the beginning of the fighting against rebels in eastern regions. The situation substantially increased the attention government officials paid to the air ambulance system. “However, medical aviation in the country is still [in the early stages], although the real demand


FEATURE

A first private project In the meantime, Vadim Gromov says that he is working to launch the country’s first private air ambulance service. The businessman from the Odessa Oblast already owns a modernised AN-2P bi-plane that could be used to transport patients from accident sites to major hospitals in the bigger cities. “The first plans to establish medical aviation in Ukraine were originally established in Soviet times,” Gromov said. “The places where the aircraft with patients would land were laid out and these plans still can be used to transport people who urgently need help.” However, the main problem he has to face is associated with the country’s aviation legislation, which doesn’t distinguish ‘small’ commercial aviation from ‘big’ commercial aviation. As a result, to launch a private ambulance service it is necessary to match the requirements set for the huge aviation companies with fleets of Boeings and Airbuses, Gromov said. “This is one of the main reasons why small aviation in Ukraine is virtually not emerging,” he added.

VLADISLAV VOROTNIKOV

for rescue aircraft in Ukraine is enormous today,” Zgurets indicated. Alexander Daniluyk, the spokesperson of the healthcare department of the Defense Ministry, also pointed out that the medical helicopters have saved many lives in the ATO zone. At the same time, he admitted, it is risky to use them since rebels widely use shoulder-carried missile launchers to down any aircraft approaching from areas controlled by government forces. Civil Aviation Plant 410 is the major repair and maintenance facility in Ukraine’s aviation industry. It is the only company in the country that is authorised to modernise aircraft according to air ambulance service needs. The spokespersons of the facility, however, declined to reveal whether the plant is currently engaged in any new projects in the medical aviation arena.

VLADISLAV VOROTNIKOV

The Ukraine National Guard modernised AN-26

The Ukraine National Guard modernised AN-26 www.airmedandrescue.com

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EQUIPMENT

An Afghan Air Force UH-60 is towed as two AAF A-29s taxi for take-off

air force.” The UH-60s are just part of the plan to modernise and expand the AAF. Additions to its current fleet will increase strike aircraft numbers from 58 to 173, while its rotary aircraft fleet will increase from 74 to 173. “The Black Hawks will gradually be replacing the Mi-17 in the AAF inventory over the next few years,” said Brig. Gen.

Tech. Sgt Veronica Pierce / USAF

The US Air Force (USAF) delivered the first two Afghan Air Force (AAF) UH-60 Black Hawk helicopters to Kandahar Airfield, Afghanistan, in September. The UH-60s are the first to be delivered to the AAF under the Aviation Transition and Modernization programme, said the USAF, adding that the plan to modernise and increase the AAF fleet will provide firepower and mobility enabling the Afghan National Defence and Security Forces to bring a decisive advantage to the fight against anti-government forces. The primary purpose of the Black Hawks will be for troop and cargo transport, including casualty evacuation. The first group of UH-60s will remain at Kandahar Airfield. Over the coming years, additional Blackhawks will be distributed to four primary AAF bases throughout Afghanistan. “The AAF has grown in the last year and [their] asymmetric effects are changing the battlefield,” said Col Armando Fiterre, 738th AEAG commander, TAAC-Air. “As the AAF mission grows they are becoming a more modernised, sustainable and more capable

Tech.Sgt Veronica Pierce / USAF

Afghan Air Force receives casevac UH-60s

An Afghan Air Force UH-60 is off-loaded from a USAF C-17 Globemaster

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Phillip Stewart, commander of the 438th Air Expeditionary Wing and TAAC. “While the Mi-17 is one of the AAF’s most advanced programmes when it comes to aircrew and maintenance capabilities, the programme cannot be continued indefinitely. The Mi-17s are expensive to maintain, difficult to sustain and experiencing higher than expected attrition rates.”


EQUIPMENT

Babcock Mission Critical Services Onshore has become the first customer to sign up for Safran’s new health monitoring service for helicopter engines. The new service will allow customers to track engine life data and thus reduce unplanned events, said Safran. Babcock MCS will benefit from the service in relation to its Arrius 2B2-powered H135 fleet.

Babcock Scandinavian Air Ambulance has placed an order for 11 aircraft from Textron Aviation, Inc., comprising 10 Beechcraft King Air 250 turboprops and what the aircraft manufacturer said is the first medevac-configured Cessna Citation Latitude midsize jet. The planes will support Babcock’s contract with Air Ambulance Services of Norway to provide communities across Norway with vital air medical support. Øyvind Juell, CEO, Air Ambulance Services of Norway, said: “The introduction of the Latitude as the first jet aircraft in our fleet will enable us to reduce patient transfer times and operate direct flights across the entire country.” Babcock’s fleet of King Air 250 turboprops will feature CAT II capability, said the manufacturer, enabling operations in reduced visibility. In addition, the aircraft will feature steep approach landing capability and be equipped to operate in polar regions.

UK-based Specialist Aviation Services (SAS) has announced its selection as the preferred bidder by Cornwall Air Ambulance to provide an AW169 under a 10-year contract starting in 2019. The decision followed a competitive tendering process carried out by Cornwall Air Ambulance Trust ahead of the end of the existing contract with SAS. The new ship will replace the charity’s MD902 Explorer based at Newquay Airport. PZL Świdnik has completed work to modernise a W-3WARM helicopter used by the Polish Navy as a search and rescue aircraft. The Anakonda helicopter, tail number 0505, returned to the 44th Navy Air Base in Darłowo recently. It is the fifth such machine to be upgraded by the helicopter manufacturer. Two modernised W-3T transport helicopters were returned to the 43rd Navy Air Base in Babie Doły (Gdynia) as W-3WAs in February and March 2017. The next two rescue Anakondas (the W-3WARM version) returned to Gdynia and Darłowo respectively in April and June 2017.

Library image

The Latitude will also include a modified door to accommodate the loading and unloading of wide medical stretchers. Bob Gibbs, vice-president of special mission aircraft at Textron, noted that the Citation Latitude offers a steep approach capability, short runway performance and low cabin altitude. Deliveries for the 11 aircraft are scheduled throughout the next 18 months and are expected to conclude in 2019, said Textron.

H130 lightweight medical interior receives STC LifePort, a Sikorsky company, announced on 11 October that it had been granted a supplemental type certificate (STC) by the US Federal Aviation Administration to equip Airbus H130 aircraft with a lightweight medical interior. The firm

LifePort

Able Aerospace Services, a subsidiary of Textron Aviation, has signed a long-term contract renewal with Air Evac Lifeteam, part of Air Medical Group Holding. The contract designates Able as the exclusive service provider for dynamic component repair and overhaul services for the US-based air medical transport provider’s fleet of 128 Bell Helicopter 206 aircraft. The Royal Thai Police has received two H175 helicopters from Airbus Helicopters, making it the first in Asia Pacific to operate the newest rotorcraft, the manufacturer has reported. The Royal Thai Police will use the machines for policing missions and VVIP transport.

TEXTRON

Eleven medevac planes ordered for Norway

waypoints

said the modular system can be easily reconfigured, modified or removed from the helicopter in two hours after initial installation. It includes a MedPak Advanced Life Support (ALS) services module in the baggage compartment including oxygen, vacuum, and compressed air; a MedDeck rotating stretcher system; and electrical outlets and USB ports for carry-on equipment. The system uses the seat track, so that the co-pilot seat can be re-installed when the stretcher system is removed. LifePort said the interior can accommodate patient stretchers or incubators, and weighs in at some 100 pounds (45 kg) less than alternate systems.

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MISSIONS

Sheriff’s Office drone locates man In Virginia, US, the Stafford County Sheriff’s Office located a missing Mountain View High School student with the help of its quadcopter drone. The Sheriff’s Office received a call on 18 September at approximately 17:00 hrs saying that an 18-year-old student had failed to return home after school. The missing student had no history of running away and the Sheriff’s Office had reason to believe that he was endangered. Deputies located the missing student’s book bag and cell phone in the school, which heightened the concern for his safety. Detectives interviewed associates of the student and learned that none had seen or heard from him since the end of the school day. In the belief that the missing student might still be somewhere in the area of Mountain View High School, the Sheriff’s Office Search

& Rescue Team and Drone Team were called out to assist in the search. The drone, which is equipped with a thermal imaging camera, was launched just before 21:00 hrs. By 21:30 hrs, the drone operator had picked up a thermal image believed to be that of the missing student in the far southwest portion of the school property near the running track. Drone team members directed deputies to that area and the missing student was found unharmed. “The drone has proven to be an invaluable tool for our agency,” said Stafford Sheriff D.P. Decatur. “Having the ability to search large areas of land from above in a short period of time for lost, missing and dangerous individuals has allowed us to provide another layer of safety to our citizens. I’m extremely happy that we were able to quickly locate and return this young man back to his family unharmed.”

CHP helicopter crew plucks firethreatened families to safety As fires raged in California, US, the California Highway Patrol (CHP) shared the story of a family that was rescued from advancing flames by one of the service’s helicopter crews on 9 October. An emotional reunion was held involving Flight Officer Whitney Lowe and Pilot Pete Gavitte from CHP - Golden Gate Division Air Operations, who rescued five members of the Tamayo family from the Atlas Fire. The air crew spotted eight cars in the Atlas area of Napa County, whose occupants were attempting to evacuate using Atlas Peak Road, which Lowe and Gavitte could see was blocked by fallen trees and electricity poles, Reuters reports. The pair used the helicopter’s searchlight to attract the drivers’ attention and then landed nearby. In their first rescue, five members of the Tamayo family were brought to the aircraft, but the helicopter could not accommodate them all. A seven year-old boy, his mother and two grandparents were taken onboard, while the father stayed behind, seeking the relative shelter of a reservoir, not knowing if the 22 22

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helicopter would return and whether he would survive. CBS Sacramento quoted Lowe as saying: “These are people who think they’re never going to see their family again. And at that point, to see the father put the family first, was touching. I have five kids, and that’s the same decision I would have made. But I hope I never have to make that decision.” The man was picked up later in what would prove to be just one of many rescues in a seven-hour mission that involved a second helicopter. In all, 42 people, five dogs and a cat were airlifted to safety over some 20 trips.

waypoints The Chilean Navy has reported an aeromedical evacuation carried out from the Diego Ramírez Lighthouse, located 426 km (265 miles) south of the city of Punta Arenas, after a report was received that lighthouse keeper First Sgt Marcelo Escobar had suffered a broken arm in a fall. The rescue protocol was activated and a helicopter from the Southern Navy Air Group airlifted Sgt Escobar to the heliport at Punta Arenas Naval Base. He was then taken to the Surgeon Cornelio Guzmán military hospital by an emergency services ground ambulance. Russia’s Russian Emergency Control Ministry (EMERCOM) has reported that its BO-105 helicopter has successfully carried out the medical evacuation of a child who was severely injured in the collision between a passenger train and a bus that occurred in Petushki District, Vladimir Region.The patient was transported from Vladimir to Moscow in order to access advanced medical care at the Research Institute for Emergency Children’s Surgery and Traumatology. A Portuguese Air Force C-295M plane detected 10 vessels in the Mediterranean Sea bearing a total of 182 migrants during a reconnaissance and surveillance mission under FRONTEX’s Operation INDALO17. The 10 vessels were located by the 502 (‘Elephant’) Squadron, which co-ordinated and directed Spanish rescue vesels, allowing the 182 migrants intercepted and rescued. At the end of the six-hour operation, all of the migrant had been picked up in good health. In New Zealand, the Palmerston North Rescue Helicopter was dispatched to Herbertville Beach at midday on 4 November to the scene of a motorbike accident. The patient was stablised at the scene before being airlifted to Palmerston North Hospital for treatment. The rescue helicopter was dispatched to Herbertville Beach again around 12:15 hrs, this time for a man in his 40s who had hit a drain on his motorbike while riding alongside the beach. The man had suffered multiple injuries and was transported to Palmerston North Hospital for further care.


MISSIONS

www.airmedandrescue.com

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MISSIONS

MAF

Conjoined twins, who against all odds were born naturally in the remote village of Muzombo, western Democratic Republic of Congo (DRC), survived following an epic 870-mile round trip to be separated, with the help of Mission Aviation Fellowship (MAF). Anick and Destin, two baby girls who were born naturally at 37 weeks on 23 August, endured a journey across difficult

The twins post separation

The family were monitored before making the overland journey back to their remote village. Mudji commented: “Thirty-seven-weekold, conjoined twins born naturally – it’s unheard of ! When I was told MAF could help … it was great news for us.” Pilot Brett Reierson said: “The natural delivery of conjoined twins would be rare enough in a Western hospital. But for a mum and her babies to survive this type of birth in such a remote setting followed by the long and difficult journey across the jungle to be separated – it’s unbelievable! It was a privilege to be part of their story.”

MAF

MAF

terrain, and as of October were being monitored at Vanga Evangelical Hospital, under the care of Dr Junior Mudji. Mudji first met the twins on 30 August when they arrived at Vanga Hospital with their mother Claudine Mukhena and father Zaiko Munzadi at just one week old, having travelled for 15 hours through the jungle on the back of a motorbike

wrapped in a blanket. Their village is so remote, hospital staff hadn’t even heard of it. Without the equipment or expertise to carry out the complex separation surgery in Vanga’s small hospital, Mudji contacted a team of volunteer surgeons in the country’s capital Kinshasa, who perform operations on children born with malformations. Concerned that the fragile newborns might not survive another long and difficult journey, Mudji’s team contacted MAF, a humanitarian nonprofit airline operating in remote regions across the DRC. MAF regularly fly to Vanga and deliver medical equipment and personnel to the hospital using small Cessna and Pilatus aircraft that can land and take off in remote and challenging terrain. Mudji was delighted to learn that MAF could provide an emergency flight for the family. Arriving in Vanga on 2 September, MAF pilot Brett Reierson collected the young family and flew the 1.5-hour journey to Kinshasa, saving over 14 hours compared to travelling by road. When they arrived in the capital, a medic collected the patients from the aircraft and rushed them for successful separation surgery at a Kinshasa clinic, which was performed by a team of volunteer surgeons. Almost one month later, MAF pilot Nick Frey flew the family back to Vanga, and the twins and mother were re-admitted to Vanga Hospital on Saturday 7 October.

MAF

Conjoined twins survive ‘miracle birth’ in DRC

MAF pilot Nick Frey with the family

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The twins back home in their village


MISSIONS

Motorist airlifted after driving off mountain road two Protección Civil rescuers onboard. After arriving at the scene, the pilot brought the helicopter as close as possible to the injured driver, making a one-skid hover landing to allow the rescuers to disembark. After receiving treatment, the motorist was hoisted to the helicopter and transferred to the Puerto del Pico helipad. Waiting medical personnel then transferred the man to a health facility in Salamanca.

Junta de Castilla y León

Junta de Castilla y León

Junta de Castilla y León

Spain’s Emergencias 112 de Castilla León has reported on an air medical mission to airlift a motorist who was injured after driving off a mountain road and falling some 50 m (165 ft). The accident took place on the N-502 road near Puerto del Pico in the municipality of Villarejo del Valle. The 112 operations room notified the Guardia Civil, the Ávila Fire Department and Emergencias Sanitarias – Sacyl, which dispatched a helicopter with

Utah National Guard pilots rescue injured hiker in ‘treacherous’ night mission hoist the injured hiker onto their Black Hawk helicopter at approximately 23:00 hrs. The patient was flown onboard the UH-60 to a meadow that was used as the landing zone, where he was transferred onto a Life Flight helicopter for transportation to Intermountain Medical Center. The Guard completed the mission in coordination with the Utah Department of Public Safety and Summit County Search

and Rescue. The Department of Public Safety’s helicopter was onsite, assisting on the ground, but its personnel weren’t authorised to perform the very difficult night hoist, said the Guard. The crew comprised: Sgt 1st Class Zack Kessler, medic; pilots Chief Warrant Officer 3 Brady Cloward and Chief Warrant Officer 3 Tyler Hobbs; and Sgt Jordan Archibald, crew chief.

Utah National Guard

The 2-211th General Support Aviation Battalion of the Utah National Guard hoisted a seriously injured 20-year-old man off the face of the Uintah Mountains, Utah, US, late on 18 October. The casualty was located about a third of the way up the north face of the mountain, at the bottom of Anderson Pass at Henry Fork. The Guard said the pilots and crew were able to hover in the dark canyon and

Utah National Guard 2nd Battalion, 211th Aviation pilots Chief Warrant Officer 3 Brady Cloward and Chief Warrant Officer 3 Tyler Hobbs and their UH-60 at the Army Aviation Support Facility in West Jordan after performing the rescue; Sgt Jordan Archibald, crew chief, is standing outside the aircraft 25 www.airmedandrescue.com 25


PILOT POV

Checklist challenge and response Dan Foulds presents a position paper on the incorporation of medical team members flying in single-pilot aircraft for challenge-and-response before-take-off confirmation checks Our objective is the safety and success of all HEMS/HAA flight operations. In addition to the tragedy for those involved in a mishap, the catastrophic loss of an aircraft or team significantly damages the reputation and standing of all programmes engaged in HAA operations. For this reason, we have agreed to join with other industry stakeholders and advocate for a best practice concerning the incorporation of trained and briefed medical flight team members for confirmation checks immediately prior to lift-off in an EMS helicopter. At present, most EMS helicopters in the US are flown by a single pilot. These pilots routinely start the engine(s) and prepare for take-off using a cockpit ‘flow’ or ‘wipeout’, that is to say they ‘do’ start their aircraft from memory, and one or more times during the preparations sequence they are responsible for picking up their checklist and, scanning it rapidly, they ‘verify’ that all required steps have been completed. This enables a much more rapid departure than would be possible were the pilot to proceed down the checklist line by line. While some programmes do adhere to a line-by-line method of checklist accomplishment by a single pilot, having one person responsible for doing and verifying creates the opportunity for a ‘single point of failure’ with tragic consequences. “The DV method has a higher inherent risk of an item on the checklist being missed,” according to the US Federal Aviation Administration (FAA). In HAA operations, safety is paramount, but a timely departure is important too, and do-verify (DV) has worked well for the vast majority of HAA flights over the years. Having said that, there have been instances in which a pilot, for various reasons, fails to properly configure the aircraft for departure. In response to these events, some operators have added a ‘confirmation checklist’ to be used immediately prior to lift-off. Typically included on this confirmation checklist would be items that, if overlooked, could cause the loss of the aircraft and/or the crew. A customary method of posting the confirmation checklist is for it to be printed on a vinyl sticker which is then affixed to the instrument panel in plain view of the pilot. Unfortunately, the same human-factors which cause a pilot to overlook an item on the do-verify engine start and before take-off checklist procedures can cause a pilot to overlook the same items on the confirmation sticker. Such errors of omission have resulted in damage or destruction of several aircraft, serious injury to crew members and pilots, and, in at least one incident, a fatality. The tenets of crew resource management dictate that we use ‘every resource available to us’ for the safe, orderly, and expeditious accomplishment of our assigned flight tasks. A medical team member, while not ‘flight crew’ per se, and while not regulated by the FAA (second crew member for NVG flight ops below 300 ft excepted), does, over time, become intimately familiar with flight operations. As well, these medical team members have a vested interest in safety, as their lives are on the line right next to the pilot’s. In many US flight programmes, the decision has been made to have a medical team member act as an additional layer of safety by having that person read a before take-off checklist or confirmation checklist in the 2626

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manner of ‘challenge and response’. This practice does not absolve the pilot of responsibility to ensure that all steps are accomplished. It simply incorporates a resource that is sitting there. In FAA publication 8900-1 paragraph 3-3403, the FAA refers to this method as ‘Challenge-Do-Verify’. We use the term challenge and response for clarity and brevity. A flight-team member refers to a list and issues a challenge. A second person – normally the pilot – verifies that the step is complete by looking and touching, then responds appropriately. Involving two people reduces the chance for a single point of failure. “... (This) method keeps all ...involved ‘in the loop’ ... and provides positive confirmation that the action was accomplished,” writes the FAA. At times, the medical team is busy caring for a patient – but the request by the pilot for the ‘checklist please’ is a clear alert that the aircraft is preparing to depart. This enhances everyone’s situational awareness, and in all but the most extreme patient-care situations (for example, CPR in progress), at least one team member can take the few seconds required for the challenges. Examples of the items that might be included in a challenge and response confirmation checklist are (these are only examples, your results might differ): Engine controls set to fly. At least three twin-engine Agustas have been extensively damaged for one engine at ground idle during take-off. There have been at least three instances of a twin-engine Dauphin taking off with one engine at ground idle. Hydraulic switches set and checked. At least three Astars have been damaged or destroyed for hydraulic switch(es) set incorrectly. A news helicopter in the US was also destroyed for this error of omission and a person on the ground was killed. Fuel transfer switches set ‘on’. (At least two BK-117 aircraft have been extensively damaged due to the transfer switches set to ‘off’. One pilot was paralysed. In Scotland, a police helicopter crashed through the roof of the Clutha Vaults pub after supply tanks became empty with transfer pumps off, killing several persons on the ground in addition to the crew onboard. Internal and external light switches set, caution panel checked. In a BK-117, having the instrument light potentiometers/rheostats set to ‘on’ during periods of daylight renders the caution segments and master caution lights too dim to see. This error of omission strikes in conjunction with the fuel transfer switches being left off. When the low fuel lights and master caution lights come on, the pilot can’t see this during daylight conditions. Drugs and mission equipment checked. This is an example of an optional item that may be included in a confirmation or before-take-off checklist. In more than one instance, an aircraft has departed without the required meds or equipment. This renders the aircraft and team not-mission-ready, and often requires a time-consuming delay, which is less than optimal for patient care. Obviously, the list of items on the confirmation checklist should be kept as short as possible. In this case, the medical team member calling out the challenge would either respond him or herself or would look to the second medical team member for a verbal response. In summary With the visual clarity of hindsight, it is apparent that the vast majority of


PILOT POV

HAA flight operations are conducted smoothly, safely, and to the benefit of the patients we fly. But our goal is zero aircraft destroyed and zero teams/pilots/patients injured or killed. The cost of the recommendation we have laid out here is insignificant. The delay that this practice will entail – 10 or 20 seconds – is insignificant. The significance of not losing lives to an error of omission cannot be overemphasised. Please consider incorporating this recommendation as a ‘best practice’ for HAA operations. This practice has been endorsed by: Dan Foulds, owner of HelicopterEMS.com, owner of AMRM Training Solutions, emeritus board member at the National EMS Pilots Association, retired EMS pilot, retired Army Aviator. Miles Dunagan, current president of the National EMS Pilots Association, active EMS pilot. Kurt Williams, immediate past president of the National EMS Pilots Association, former EMS pilot, manager for a large HAA provider. Rex Alexander, past president of the National EMS Pilots Association, former EMS pilot, former regional manager for Omnflight Helicopters, industry expert. Justin Laenen, member of National EMS Pilots Association Board of Directors, current EMS pilot. Sam Matta, co-founder of E.C.H.O., active EMS flight nurse, combat veteran. Krista Haugen, co-founder of the Survivor’s Network for Air Medical transport, trained AMRM facilitator, flight nurse, crash survivor (take-off with one motor at ground idle). Colin Henry, HEMS expert, safety consultant, former director of safety at Medflight of Ohio, former chief pilot at Omniflight Helicopters. Peter Carros, retired military helicopter pilot, former HEMS pilot, safety manager at Geisinger Life Flight, Danille, Pennsylvania. Additionally, some variation of this practice is already in effect at numerous flight programmes across the US. Disclaimer This is not intended to suggest any action not in accordance with federal aviation regulations. Consult appropriate oversight personnel before implementing any change to flight procedures.

Author Dan Foulds is a retired US Army helicopter instructor pilot. He served as a flight lead with the 160th SOAR. After retiring from the Army, he flew EMS helicopters as a line pilot, training captain, aviation base manager, and travelling relief pilot for 17 years. During his HAA career, he became an Air Medical Resource Management instructor and now presents AMRM/CRM training for flight programmes across the US. He is a multi-year presenter at the Air Medical Transport Conference and speaks at safety-days and other industry events. He is also an emeritus board member of NEMSPA. He can be reached at foulds. daniel@gmail.com.

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INDUSTRY VOICE

Field notes from Belize

TJ Stewart

Touchdowns and t a ke-of f s on a Saturday afternoon TJ Stewart flying for Wings of Hope in September 2017

Saturday afternoons in the fall have always been my favourite time of the year. Growing up in Ohio, US, as a huge football fan, it meant spending a few hours watching The Ohio State Buckeyes football team play. Last Saturday (30 September) was no different as I turned on the game at the pilots’ apartment in Belize City, Belize. After a few quick touchdowns, I was feeling pretty good about our chances of winning – when the phone rang with a request for a flight to Dangriga to pick up a patient. My football addiction is often disturbed by calls dispatching me to fly, so this didn’t come as a surprise. I was especially relieved that the patient was in Dangriga, as it is only a short flight, and I figured I could get back in time for the start of the second half. The flight medic arrived promptly, and we made a hasty departure out of the municipal airport in Belize City. Twenty minutes later, we arrived in Dangriga to meet our patient: a baby girl in respiratory distress. She was intubated and unconscious, although just starting to wake up as we loaded her into the airplane. The nurses from Dangriga and our flight medic worked diligently on the hot apron for almost an hour getting the baby girl stable enough to fly. Once I got the go-ahead from the medical professionals, I quickly loaded up the worried mother and took off toward Belize City. After levelling off at 28 28

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1,500 ft above the Caribbean Sea, I heard the medic say the words that I dread the most: “TJ, the patient is crashing.” I have heard those words many times before, and I can see still the faces of the ones who did not survive the thousands of emergency flights I have performed. I prayed this sweet baby girl wasn’t one of them. I figured the only thing that had changed externally for the patient was the altitude. So I quickly descended to a few hundred feet above the choppy sea and, after a few minutes, the baby stabilised and we safely arrived in Belize City. At the airport, we were met by our ground ambulance – which briskly took the baby and mother to the hospital. After a few hours of cleaning, AUTHOR TJ STEWART refuelling and restocking the medical supplies onboard the aircraft, I stopped by the hospital to check on the baby and mother. I found them in the paediatric ward. The baby was resting, but on a breathing machine. The mother was sitting on a plastic chair with her head in her hands, completely exhausted from the day’s events. I spent a few minutes talking with her and got her a street burger from outside, after hearing she hadn’t eaten all day. As I exited the hospital with the sun setting and the ‘short flight’ ending TJ Stewart is the field director after hours of fighting to keep the for Wings of Hope in Belize. He child alive and delivering her to a spends his days flying medical capable medical facility, I couldn’t evacuation flights for the Belize help but think: “I wonder if the Emergency Response Team. Buckeyes won?”


INDUSTRY VOICE

///photo/// As an illustration, how about something stocky like http://www.gettyimages.co.uk/ license/515551285 or w

Batteries are life Three tips for maximising your drone battery life If you’ve been flying for any length of time, you’ve probably noticed that one piece of equipment on your UAV is the literal lifeblood of the entire system: the batteries. Batteries may seem simple enough; you charge them, and then use the juice. Basic, right? In reality, properly maintaining your drone batteries can mean potentially hundreds of extra hours of flight time. That’s why we’ve put together these three tips for maximising the life of your sUAS batteries. Don’t give 100% It may seem counter-intuitive, but it’s actually best for your batteries to store them as close to 50-per-cent charge as possible. Then, when you’re ready to fly, charge them to 100 per cent and go. Of course, this isn’t always possible, but it is ideal for maximising battery performance over the long term. Don’t turn up the heat...or the cold Heat and freezing temperatures are the enemy of long-lasting batteries. That’s why you always want to keep your batteries at a stable temperature when storing and transporting. A great insulated carrying case is an important investment as it will keep your batteries safe and at a stable temperature when sitting in a hot or cold environment.

Don’t drain them As a general rule, try to always keep your batteries above 20-per-cent charge. Here at Skyfire, we always ground our UAVs at around 25 per cent to ensure longer battery life, but the rule of thumb is 20 per cent. So, the recap: you should start flying with your batteries at 100 per cent, end your flight with them at about 20 per cent, and store them in a stable environment as close to 50-per-cent charge as possible.

AUTHOR TJ STEWART Dan Parker is the industrial services manager for Skyfire Consulting (www.skyfireconsulting.com), a division of Atlanta Drone Group. He is an FAA-certified commercial drone operator with over five years’ experience building, testing, tuning, and operating drones primarily for industrial applications. He’s focused on expanding drone capabilities for emergency response as well as managing projects for Aevius, another division of the Atlanta Drone Group.

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ITIC GLOBAL 2017

International Travel & Health Insurance Conference

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

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ITIC GLOBAL 2017

Transporting obese patients Blake Yturralde CEO – Commercial Medical Escorts Blake started this session by providing some health facts on obesity. For example: an individual is considered morbidly obese if they are 100 pounds over their ideal body weight, have a BMI of 40 or more, or 35 or more and experience obesityrelated health conditions, such as high blood pressure or diabetes; and adult obesity rates are highest in the US, Mexico, New Zealand and Hungary, and lowest in Japan and Korea. He then went on to explain that obese passengers are at higher risk (5.5 per cent) of deep vein thrombosis (DVT) and even more so following ortho-surgery. He said that limited movement can lead to the formation of blood clots and, therefore, it’s important to encourage exercise and movement during transfers and to ensure the patient is given anticoagulants. Another issue associated with the transportation of obese patients that Blake highlighted is maintaining hygiene. He said that changing diapers and generally maintaining hygiene can be challenging when there is limited space, and this can lead to diaper rash and discomfort. He also said that positioning and repeatedly repositioning during transport can help prevent bed sores. According to Blake, there are a number of logistics to consider that are specific to obese patients, which will need to be explored during pre-flight assessments. Key questions to ask in the pre-flight phone assessment, he said, are: measurements, including height, weight, girth/circumference; and how the patient ordinarily travels. When it comes to airline seating, Blake said, multiple seats may need to be purchased in economy in order to accommodate the patient, and girth needs to be determined in order to properly co-ordinate the transport with the airline. Seat size will need to be researched as some aircraft have seating restrictions. He also mentioned that stretcher passengers are restricted to a maximum weight of 120 kilogrammes for most airlines. Blake highlighted the importance of asking the right questions, giving an example of a patient who couldn’t fit on a flight, but it later transpired had arrived via car and boat. However, he said that even in cases where thorough planning takes place, there will remain elements that are out of your control. Moving on to explaining costs, Blake said that the cost will double for an obese patient due to the addition of a second

escort, the need for additional seats and specialised ground transportation, for example. He pointed out that if a patient is unable to fit into a commercial aircraft, they might need to be transported via road ambulance, purely based on their size rather than having a medical condition that requires an air ambulance. He concluded by saying that a morbidly obese patient may even cost three times the amount of transporting an average patient.

Dr David Sinclair Medical supervisor – European Air Ambulance To open, Dr Sinclair highlighted the rising prevalence of morbid obesity, underlining that it is rising more than other classes of obesity. He then discussed the pathophysiology of obesity, including hypertension – which can lead to heart failure – ischaemic heart disease, thromboembolism, increased metabolic basal rate, obstructive sleep apnoea, asthma, reduced lung compliance, intolerance supporting supine position and increased oxygen consumption. He said that the challenge of obesity encompasses three categories: medical, technical and logistical. The medical category comprises respiratory, cardiac and metabolic issues; the technical category involves surveillance, the necessary material for emergency procedures and treatment; and the logistical category comprises a stretcher adapted to size, pressure sore prevention and the delivery of the patient in an appropriate ambulance. Next, Dr Sinclair highlighted that ‘a danger foreseen is a danger avoided’, explaining the importance of ventilation, positioning/ bedding, and IV access. He underlined the seriousness of training, explaining that this is just as crucial as the equipment, and said that it is best for the training to be conducted inside an aircraft so that when it comes to an emergency people are comfortable with their surroundings. He also explained the limitations of aircraft in terms of size and weight. Dr Sinclair closed his presentation by discussing some of the medical devices available on the market to assist in such cases, including ultrasound. He then highlighted the need for the industry to adapt to increasing obesity and underlined that individual cases call for individual solutions.

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ITIC GLOBAL 2017

Taking drugs across borders Special Agent Martin Ramirez

Gitte Bach

Diversion Investigator, Tactical Diversion Squad – US Drug Enforcement Administration (DEA)

President and CEO – New Frontier Group

To introduce this topic, where better to turn than a representative of those enforcing the laws. Special Agent Martin Ramirez summed up his job in a simple sentence: to try and keep substances in legal use, keeping them out of the hands of illegal users. In a more practical sense, his department, Tactical Diversion, carries out site visits on pharmacists and others who are legally allowed to carry controlled substances, checking that their records match up. The punishments for those caught not abiding by US laws can be severe; Special Agent Ramirez spoke of a pharmacist that was caught ‘practising out of scope’ and fined a total of US$66 million. The laws that the DEA enforces can be found in the Code of Federal Regulations handbook. Special Agent Ramirez asserted that where he finds violations, he first tries to help those breaking the code to change their practices, but also explains how and why the codes help hinder diversion of substances. “Really, when someone wants to divert a controlled substance [from legal to illegal use], they’re going to do it. But you have to have something in place to try to stop that.” For those wanting to export controlled substances from the US, the DEA is able to grant waivers for humanitarian missions, explained Special Agent Ramirez, but these are limited by time restraints. He also warned that, though the waivers will allow you to take controlled substances out of the US, they will not guarantee entry to your destination country. You will still need, he asserted, to contact your destination. “If you don’t take what you say you’re taking, or add more stuff, that’s where the problems occur,” he warned. The overriding message of Special Agent Ramirez’s presentation, however, was that the DEA was there to help and advise, not impede a company’s operations. “We want your company to have a good name for doing all the right stuff,” he insisted, before explaining that fines are issued only if practices show no sign of improving. If a substance is stolen, for example, a company needs to report it in one day to the DEA, and then show how they will stop it happening again. “We’re on the same side guys, we’re on the same team,” Special Agent Ramirez concluded. “What we want is patient care and patient safety, and for your company to be the best that you can be.” 32 32

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Transporting drugs across borders has, Gitte asserted, numerous associated challenges, especially when sending emergency medication to patients all over the world. Firstly, she said, it is complicated. An obvious complication is the language barrier, but also patients are familiar with certain products. Gitte pointed out that patients may not trust and will question medication they have been prescribed in a foreign country because they are used to receiving a certain product. “Sometimes, they can’t even communicate to the pharmacist,” asserted Gitte, and that can create a lot of confusion. Patient education levels may not be the same in other countries as well. In some pharmacies, for example, patients are able to sit down in a booth with a pharmacist and fully learn about how to take their treatment, whereas in some countries this is not an option. There are then the logistics of actually getting the correct drugs to a patient that is not in their home country. “One of the biggest things that I hear … is ‘is it even possible to send drugs to a patient that has already left the US?’,” Gitte explained. Sending drugs in this way is unreliable, and Gitte asserted that there is no ‘golden solution’ to getting drugs across borders. Shipping drugs across borders can involve no end of complications, not least because information about which drugs are legal in which countries is often hard to find. “Not every country in the world has a website that will tell you ‘this is what’s allowed, and this is what isn’t allowed’,” she explained – an issue that is made worse by how highly regulated drugs are in all countries. Expense is the final issue that many may have, with the cost for lost or seized medications making what is already an expensive option worse. There are, however, Gitte explained, some options. Onlinebased pharmacies can work; but they still suffer from unreliability. Companies deciding to use these online pharmacies will have to be careful of upfront payments, extra tariffs, quality of product and lost shipments with no replacements. New Frontier Group, Gitte asserted, does not send drugs outside the US due to all the above-mentioned complications, and though they can help to point patients in the right direction, it will ultimately fall to the patient to purchase and acquire the drugs they need.


ITIC GLOBAL 2017 Dr Terry Martin Medical director – Capital Air Ambulance Like Gitte before him, Dr Martin asserted that there is no easy solution to taking drugs across borders, but that there are some methods that his company uses that help in air ambulance missions. Dr Martin began by stating the common practices that need to be taken into consideration. The priority, he asserted, is always the patient’s needs, and the needs of the mission have to integrate with these. Air ambulance operators need to have the correct licences to hold, use, prescribe and dispense medication, while an understanding of the culture and law of the countries that will have to be entered during a repatriation is also key, though this information can often be hard to find. Dr Martin showed how these common practices work best, running through the security measures Capital Air Ambulance has in place around its medical store room and office. But is an air ambulance an extension of the office? Whilst some people may argue that an aircraft is under the jurisdiction of the country it left from, Dr Martin stated, this is wrong; an air ambulance falls under the jurisdiction of the country it lands in. This then brought about another question – whether air ambulances are importing or exporting drugs when entering a country. Technically, according to the definition that Dr Martin used, air ambulances do neither, as the drugs are not exchanged, just administered. However, he warned, some countries may not see it that way. This becomes especially prevalent when bringing in substances that may be completely illegal in a country.

Dr Martin used codeine as an example. Though the drug is one of the most commonly used painkillers in the world, its legal status in countries varies wildly. In South Africa, for example, the drug is freely available over the counter, whilst in the Maldives, the drug is highly controlled, and visitors to the country have been banned or even imprisoned for inadvertently bringing a personal supply in without correct clearance. One of the solutions that Capital Air Ambulance has adopted is to put banned substances in a locked safe and leave the drugs onboard the aircraft. Though not completely perfect, this measure shows that the substances are not intended to be used in the country they are being brought into. “Air ambulance repatriation companies do need to carry drugs across borders,” Dr Martin reiterated. “However, we do want seamless medicare throughout the mission.” He advised that speaking to other experts for advice on complex missions, immaculate documents and good drug security whilst in transport can all go a long way to making sure that missions run as smoothly as they can.

Structured decision making on air ambulance evacuations Dr Fabien Winter Head of health analytics – Munich Re Dr Fabien Winter brought a different – and at some points controversial – look at the session’s topic, adapting the data analysis methods that he uses in the health industry and trying to explain how big data can assist in the decisionmaking process, more specifically in locating waste, fraud and abuse within the process. With so much data being produced by consumers at all times, there is now an ability to do more in-depth, wider-scale analysis on cases. At the same time, there has been a rapid development in technologies such as artificial intelligence meaning that data can be processed even faster. What does this mean for insurance? According to Dr Winter, >>

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ITIC GLOBAL 2017

Structured decision making on air ambulance evacuations (continued) these larger data sets eliminate the ‘gut feeling’ that was used to develop products in the past, instead developing products that are better suited to both the customer and insurer. In terms of healthcare, Dr Winter said that big data can help to decide what the best method for treating patients is, by looking at thousands, if not millions, of past cases. This caused some stir in the room, and Dr Winter clarified that he believes that expert opinions will still be needed to treat patients, but a mix of experts and data can help to achieve a higher success rate. “All of our analytics are developed with physicians,” he added. “The power is in combining both.” With regards to fraud in the insurance industry, Dr Winter explained how they are able to use different systems to compare costs of treatments, determining from the data whether instances of treatment bundling occurred or whether certain treatments were actually necessary. There are limitations to this however; the data doesn’t take into account local best practices, which may skew the data set. “Finding fraud and abuse is like finding a needle in a haystack, but analytics makes the haystack smaller,” Dr Winter said. There seem to be many issues with using big data in medical decisions, whether it be attitudes towards its use, or the limitations of the data itself. One audience member pointed out that companies may be unwilling to upload their data into a larger central database, despite the possibility of benefits for the industry as a whole. It would seem there is still some way to go in using big data as a key factor in medical decisions.

Dr Cai Glushak International medical director – AXA Assistance USA Structure, asserted Dr Cai Glushak, is something that air ambulance operators ‘absolutely’ need, something that clients expect. It’s necessary to analyse the sheer volume of patients that are dealt with in order to justify decisions and have accountability, to justify costings, and to make good medical choices. With the constant inflation of medical prices, Dr Glushak said, structures need to be put in place to help missions be cost 34 34

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effective. “Cost effective – some people misinterpret that term. That’s not the most economical decision. The ‘effective’ part is the most important part of that phrase. It means that [a mission] accomplishes the goal with the right outcome, within a reasonable cost,” asserted Dr Glushak. Many factors come into the decision-making process when trying to work out what the most cost-effective method is. Dr Glushak used a Groucho Marx joke – ‘a hospital bed is a parked taxi with the meter running’ – to illustrate a serious point: the longer it takes to make decisions, the more healthcare can cost for an insurer or patient. Costing data, based on past cases, can be useful when determining what the best course of action can be to make a repatriation cost effective. Whilst data can be useful for a cost-benefit analysis, there are human considerations that need to be taken into account. The quality of local care is a big part of the decision to repatriate or not. If local care is not adequate, a patient should be evacuated as soon as possible. The condition of the patient is also key. If a patient is in an emergent state, Dr Glushak says that his company will get a quote within an hour, and will take the first option available. “This has helped me a lot, because by putting this structure in place, no insurance person can argue with that, allowing me to make a choice that is not the cheapest option, but the right one,” explained Dr Glushak. Ultimately, despite the increasing usage of data, the most important key factor is the medical risk to the patient – a factor that can only be assessed subjectively by highly trained professionals. It is for this reason that Dr Glushak does not believe that the air ambulance decision process can be fully automated. Cases are too individual and complicated to even consider automation, concluded Dr Glushak before adding: “I don’t see in the future that we’d have an automated process.”

Eva Kluge Director of sales and business development – Air Alliance Medflight With a background in health insurance and assistance – as well as her current position – Eva delivered a unique perspective on the relationship between underwriters/ insurers and service providers. She asserted that the relationship is a ‘natural conflict of interest’, with both sides having almost polar opposite methods of operation. Most importantly, however, Eva pointed out that both sides have limited knowledge of how the other operates. Air ambulance transports make up a minority of assistance cases – only two per cent, according to Eva. Generally speaking, hospital expenses make up the majority of claims costs, whilst air ambulance missions only make up


ITIC GLOBAL 2017 around seven per cent. The rarity of air ambulance missions, Eva explained, may be one reason why insurers/ underwriters have limited knowledge of how air ambulance services work. One of the major areas that the two sides clash over is, unsurprisingly, cost. Eva explained that insurers/ underwriters can sometimes fail to understand the high rate of fixed costs for air ambulance missions. Improving the decision-making process is a key way to make sure that a mission is not just right for the patient, but also one that will help keep costs down for insurers.

Like Dr Winter, Eva pointed toward the use of data to help make these decisions. “Experience is very good,” she asserted, “but structured data is even better … together they can be very complementary.” Eva explained that often it can be more expensive for an insurer to keep a patient in the hospital they are currently in. Although costs will spike if an air ambulance has to be called in, if a patient is relocated back to their home county then overall cost of a claim can be reduced – especially for those patients whose home countries have free healthcare services. By analysing data sets of past cases, assistance companies should be able to see a predicted costings model, based on similar cases. However, asserted Eva, assistance companies have not collected data well in the past – implementations of new systems could help track predicted costs more carefully. Empty leg systems are not being used to their full potential either, Eva stated, and despite what seems like obvious savings potential, pooling patients together may not always be a perfect solution. One way to tackle many of these decision issues is simply for assistance companies and air ambulance companies to train together, and to create interdisciplinary task forces. “Collaborations can really help [companies] to make better decisions,” Eva concluded.

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ITIC GLOBAL 2017

Industry insights: Blood transfusion protocol progress Dr Yann Rouaud

Group medical director – Airlec Ambulance As examples of situations where a mission might benefit from the air ambulance team taking blood to the patient, Dr Rouaud suggested victims of road traffic accidents or patients with gastrointestinal bleeding, particularly those in remote areas where blood supplies are limited or unsafe. He explained that the idea of transporting blood onboard Airlec’s medical transport planes arose through discussions with the organisation’s clients (mainly French medical assistance companies), who frequently asked whether Airlec could take blood onboard. Driven by this, the Airlec team decided to develop a solution. In France, only the Etablissement Français du Sang (EFS), the French national blood service, is authorised to collect and distribute labile blood products. Airlec met with the EFS and secured an agreement that allows the company to transport blood on its aircraft under strict criteria using a temperature-controlled carrying case. In order to gain this approval, the firm first had to conduct trial flights carrying the equipment in order to prove to the EFS that the blood could be maintained within the acceptable temperature range. Dr Rouaud explained that the company has also taken a number of measures to reduce any delay from transport request to take-off. These include having to arrange preauthorisation from EFS to import and export blood into and out of France, having a signed prescription on file in the office, and keeping two transport containers at the correct (chilled) temperature at the EFS office in Bordeaux. The containers, two blue ‘suitcases’ containing a special thermal gel, allow for storage of blood products for up to 12 hours at 3°C. Each contains two temperature probes – one from the EFS that can be read at the end of the mission, and one that the Airlec crew can use to monitor the temperature in real time during the flight via a smartphone app. Airlec will seek the patient’s consent before a transfusion is performed, said Dr Rouaud, as this is not a zerorisk procedure. If the patient cannot given consent (for example if they are ventilated), then consent is sought 36 36

AIRMED & RESCUE

from the next of kin. At the end of a mission, any unused blood is returned to EFS. It’s a precious, donated resource, Dr Rouaud noted, and it would be unethical for it to be wasted. At the time of the presentation, Airlec had carried out one such patient transport. A call came at around 12:00 hrs from a French medical assistance company to take a patient from Abidjan, Côte d’Ivoire, to Paris, France. The patient had a low haemoglobin count, and the malaria medical directors of Airlec and the assistance company agreed that blood was needed. EFS gave approval for the blood to be exported and the crew took off at 16:00 hrs By 00:00 hrs the patient had received a transfusion and was stabilised.

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60 YEARS

ITIC GLOBAL 2017

OF AIR AMBULANCE & MEDICAL ASSISTANCE LONDON

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PROVIDER PROFILE

Helijet Air Ambulance

JOETEY ATTARIWALA

Serving the citizens of British Columbia

Helijet utilises a Learjet for longer-distance aeromedical transports

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PROVIDER PROFILE

Helijet Air Ambulance provides rotary and fixed-wing air medical transport from its bases in British Columbia, Canada, as Joetey Attariwala explains Helijet International Inc., was co-founded in 1983 by Alistair MacLennan and Danny Sitnam, who both have over 40 years of practical business experience in the aviation industry. As president and CEO, Sitnam oversees the affairs and operations of the company and guides the 160 professionals who generate Helijet’s CA$35 million in annual sales revenue. In 1986, Helijet launched scheduled helicopter flights between Vancouver and Victoria, British Columbia. Since then, Helijet has grown steadily, with over 250 weekly flights connecting Vancouver, Victoria, and Nanaimo. Based out of Richmond at the Vancouver International Airport, Helijet is now recognised as one of the world’s largest scheduled helicopter airlines. In 1998, Helijet secured a contract to provide advanced care adult and infant air medical transport for the British Columbia Emergency Health Services (BCEHS) organisation, which operates the B.C. Ambulance Service (BCAS). Building on the original BCEHS contract, the company was selected in 2011 to provide a similar air ambulance service from the city of Prince Rupert on the north coast of British Columbia, thereby adding another Sikorsky S-76C+ air ambulance to its fleet. The BCAS Airevac Ambulance Program is one of the largest in North America, with approximately 7,000 patients flown every year. Pilots often navigate rugged terrain and adverse weather, day or night. In total, Helijet currently provides air ambulance service to BCEHS using a fleet of three Sikorsky S-76C+ helicopters. Two are based in Richmond with one in Prince Rupert. An S-76A serves as a back-up. Of the two

Helijet provides air ambulance service to BCEHS using a fleet of three Sikorsky S-76C+ helicopters helicopters stationed in Richmond, one is typically configured with an incubator for neo-natal/infant transport. Helijet’s Sikorsky S-76C+ air ambulances are configured to accommodate up to two stretcher patients and four medical attendants. The aircraft are primarily used in patient transfers within a 125-mile (200-km) radius of its Richmond or Prince Rupert bases. Typical missions include transfers from hospitals or airports, and on-scene emergency calls for service. The aircraft are configured with a searchlight to facilitate landing at night – Helijet air ambulances operate at night in IFR and use the searchlight to illuminate a ‘scene’ landing zone prior to touchdown. Flight and maintenance personnel for the air ambulance service are based out of the company’s Richmond headquarters. This 24,500-square-ft (2,275-m2) hangar facility is a modern office, hangar and workshop complex located on 2.5 acres (10,000 m2) of unobstructed land with a dedicated ramp area with taxiway access to helipads and the main runways. The building is configured with work spaces and living quarters for the air ambulance flight crew. In Prince Rupert, the company owns and operates an 8,000-square-ft (750-m2) hangar and office complex to accommodate aircraft, crews and

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associated air ambulance support facilities, including parking for BCAS ground ambulances. Helijet crews are stationed at the bases in Richmond and Prince Rupert where pilots, engineers and paramedics are on call 24/7, 365 days a year. All air medical flights are flown with two pilots from a team of highly experienced captains and first officers, averaging in excess of 8,100 and 3,100 hours total time respectively. Mission dispatch is provided by BCAS, and upon acceptance of a mission, the air ambulance is usually airborne within 10 minutes. Danny Sitnam spoke to AMR to describe the enthusiasm of Helijet air ambulance pilots for their missions: “Our aircrew and maintenance personnel are extremely professional, and many have shared with me the pride they have in flying the ambulance because it’s a rewarding feeling to help others in need. Our guys like flying the sched, but there’s another level of pride and professionalism when you’re flying to an area or to a scene that you’ve never been to. It’s eyes-wide-open flying, which is very gratifying.” He continued: “Since 1998, we’ve flown over 25,000 flight hours and facilitated more than 50,000 patient transfers with BCAS, using the Sikorsky S-76 series helicopter.” Additional aeromedical expertise Leveraging its nearly two decades of aeromedical management and service, the company now also provides consulting around the world for those seeking knowledge on aeromedical aircraft requirements, training, operations and management of equipment through its air medical operations team. Helijet also manages and operates an air medical charter with its medicallyconfigured Bombardier Learjet 31A and a Hawker 800A turbojet aircraft for government and private medical service providers throughout North America and around the world. The Helijet Learjet 31A is stationed at the company’s Richmond base and is configured to accommodate up to two stretcher patients and three medical attendants.

JOETEY ATTARIWALA

STC for S-76C+ In response to Transport Canada requirements issued in 2016, Helijet worked to test and compile new operating information for the Sikorsky S-76C+, which served to formalise air operations around certain hospitals in British Columbia. The resulting supplemental type certificate (STC) has been added to the aircraft flight manual documentation, clearing Helijet’s aircraft for flights to all H1-designated helipads – the most restrictive type on

Helijet CEO Danny Sitnam

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JOETEY ATTARIWALA

PROVIDER PROFILE

Helijet air ambulances stand ready for 24-7 response at the corporate headquarters in Richmond

the books. This development may be of benefit to other operators using this aircraft in similar ways. Night vision In late August, BCEHS announced that the three Helijet S-76C+ air ambulances will be enhanced with the addition of a night vision imaging system (NVIS), with the $1.6-million installation cost being financed by

All air medical flights are flown with two pilots Helijet International. To complete this complex aircraft installation, Helijet has partnered with VIH Aerospace, along with Rebtech Technologies and Night Flight Concepts, both of which are NVIS technology installers and service providers to the global aviation community. The aircraft installation and associated ground and flight training for approximately 40 flight crews is scheduled to be completed in early 2018. The company’s longer-term goal is to eventually have all its helicopter pilots trained for NVIS, so they’re able to cross-pollinate across business units and provide flexibility in crewing. Sitnam discussed the impetus for adding NVIS: “There’s been specific instances, especially up in Prince Rupert, where it’s quite dark at night, and the missions which the aircraft are going into are typically small First Nations villages which are typically very dark areas with little illumination. We see similar missions in some of the outer islands in Southern British Columbia. These first responder missions are very taxing for pilots and also paramedics, and there’s been a number of missions that we haven’t completed due to poor illumination or poor reference to the ground. So, we determined that night vision will go a long way to achieve mission success and increase flight safety, and it will also increase the Government’s reliability for service levels to outlying communities.” Brendan McCormick, former chief pilot and current director of flight operations at Helijet, added: “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.”


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FEATURE

Italian inferno by Dino Marcellino Over 300 separate forest fires burned 1,600 hectares of land in the Piedmont region of Italy throughout the month of October. Canadair fire fighting aircraft from France, Switzerland and Croatia supported efforts by the Vigili del Fuoco (Italian Fire Service) to contain the blazes, which took the life of one man. All images have been taken on October 2017 in the northwest Italy, Piedmont Region; in particular in the following Alpine Valleys: Noce Valley, Chisone Valley, Germanasca Valley, Susa Valley and Moncenisio Lake in France. All images by Dino Marcellino.

Airgreen Company. A Lama filling the bucket on an artificial basin in Cumiana city area. A lot of these basins have been built on valleys mainly to be used as water resource in case of forest fires.

The mountain over Frossasco and Roletto villages, Noce Valley. Impressive the dimension of the fires.

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Heli West Company. An Ecureuil approaching the filling area on Germanasca Valley


FEATURE

Italian Civil Protection. Erickson S-64F filling up on a private fishing lake and dropping.

Fire Brigade Canadair CL415. Scooping from Moncenisio lake, at an altitude of 1,974 meters, in French territory.

The Canadairs in action

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INDUSTRY VOICE

The right stuff Malcolm Humphries of Capital Air Ambulance writes on what it takes to make it as a fixed-wing air ambulance pilot I was recently asked to give a presentation at the Royal Aeronautical Society Critical Care in the Air conference regarding what makes a good air ambulance pilot. It struck me that this is a subject that rarely surfaces in our industry. We tend to concentrate on the aircraft, medical equipment and the medical staff. No one pays much attention to the crew flying the machine. It is assumed that the pilots have been trained to get the aircraft from A to B, but what else do they do? I have been involved in this section of the aero industry for over 40 years, having never been interested in joining the airlines. I flew my first solo in a wooden glider on my 16th birthday, gained my gliding ‘Silver C’ badge and obtained my private pilot’s licence by the time I was 17. Soon after, I was a full-time glider tug pilot and flying instructor, before studying for the commercial ground school subjects at the suitably named London School of Navigation. Once I had gained my commercial licence, the only job available at the time involved flying a small aeroplane for six hours per day with one hand, while at the same time taking aerial photographs of farms and houses with the other hand. The route to my commercial licence was protracted and the pay was poor, but the most important thing I learned was to be able to fly an aeroplane with my eyes closed. One of the most important skills an ambulance pilot needs to learn is to be able to get ahead of the aeroplane that they are flying. By this I mean the ability to fly and operate the aircraft while also being able to devote important thinking time to other matters relating to the flight. Many pilots can manage this, but others really struggle and some will never be able

to do it. Without this important skill, pilots can’t devote precious time to other considerations, something the air ambulance pilot must do more than most. My career took me from cargo to VIP and finally air ambulance, but these days, budding pilots have a much more structured approach to the industry, either through scholarships, sponsorship or parental funding. Many kids dream of being a pilot, but what does being a pilot mean to them? It normally involves a Boeing or Airbus and a large airline. It’s only once a pilot starts their training that the various paths within aviation become clear. Some pilots will take the VIP route instead of an airline and still be able to fly a big shiny private jet, however it soon becomes clear that this kind of life is not all it’s cracked up to be, living life at the behest of the aircraft owner. I get CVs from pilots who are currently in the airline or VIP industry, fed up with what they do and looking for a change; maybe they are heading towards the end of their career and want a slower pace of life. Once they understand what our pilots put into their job, most will decide to stay where they are. I have no doubt that they may be extremely proficient pilots, but they have been used to sitting in the cockpit and closing the door behind them, allowing the airline’s dispatch to take care of everything. Some may make the transition from the airlines to our world, but I have found that good ambulance pilots are best home grown, enthusiastic and empathetic. Much of my flying was single crew. Invariably, the patient would be on a stretcher and the medical crew would ask if the accompanying relative could sit up the front with me. Once the usual flying aspects had been covered, the conversation would move on to what had occurred to these people and more importantly what was going to happen to them on returning to the UK. For many transfers, it’s the beginning of a life changing experience for the whole family, and the fact is that the medical crew and also the flight crew are a big part of this process. The standard of care that the returning patient and family receives on the flight home will have a big impact and the flight crew must play a big part in this care, not with just the loading and unloading but with their general demeanour and understanding. Flight medical crew deal with serious injury and illness almost daily, and I am in awe at their ability to get the job done with a certain degree of detachment. In contrast, pilots are expected to take charge of the delicate loading process and then climb into the cockpit to fly the aircraft. That’s a big ask, especially when the patient may be an infant. Inevitably, some flight crew will decide to move on into the airline world, but the ones who stay within the ambulance field will become extremely dedicated people that have that extra capability which enables them to fly the aircraft – but also do so much more. I have always believed that you can teach almost anyone to fly a plane, but that’s not enough.

AUTHOR MALCOLM HUMPHRIES Malcolm Humphries is the managing director and chief pilot of Capital Air Ambulance. He is a training captain and flight examiner with over 18,000 hours of flight experience.

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diary dates

2-4 October Drone World Expo JD Events San Jose Convention Center, San Jose, US www.droneworldexpo.com

3-5 October Helitech Reed Exhibitions Excel London, UK www.helitechinternational.com

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

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

16-19 October Public Safety Drone EXPO ALEA New Orleans DoubleTree Hotel, New Orleans, Louisiana, US www.alea.org 17-18 October Aerial Firefighting Europe Tangent Link Nîmes Airport, France www.tangentlink.com

New crew ‘mem-bear’ joins Wiltshire Air Ambulance team Wiltshire Air Ambulance has shared the news that its newest recruit – a female pilot bear mascot – has been in demand attending fundraising events across the county. The new captain has been learning from her paramedic bear crewmate Wilber, the UK-based HEMS charity’s other mascot. The duo teamed up for the pilot mascot’s first public appearances over the weekend, at the switching on of Melksham’s Christmas lights on 2 December and at the Swindon Santa Run on 3 December, and received a great reaction from the public. The air medical service has asked the public to suggest a name for the new mascot. Entries can be made via the Wiltshire Air Ambulance Facebook page until 12:00 hrs on 11 December. The winner will be invited to meet the mascot at the charity’s Operations Centre in Devizes. Rebecca de la Bedoyere, senior fundraising manager at Wiltshire Air Ambulance, said: “We’re thrilled to have our new mascot join the team. Our other mascot,

Wilber, has been in incredible demand ever since he first joined us in September 2016 – so much so that we were having to turn requests down.” She added: “As Wilber is a paramedic, it was the obvious choice to make our new mascot a pilot, as both roles are critical to the operation on an air ambulance service. We didn’t set out to make Wilber a male bear, but he has adapted that persona, so it made sense to have a female mascot this time, especially as our own pilot, Nicky, was the first female air ambulance pilot in the UK!”

Wiltshire Air Ambulance

Send your diary dates to: info@airmedandrescue.com

BIGGLES GIGGLES

19-20 October Search and Rescue 2017 Tangent Link Nîmes, France www.tangentlink.com

27-29 October ECHO Annual Conference East Coast Heli Ops Philadelphia, US www.eastcoastheliops.com

5-9 November ITIC Global Voyageur Publishing & Events W Barcelona, Spain www.itic.co/conference/global

2018 13-14 June AIRMED World Congress EHAC Warsaw, Poland www.ehac.eu/

9-14 July ALEA EXPO Airborne Law Enforcement Association Louisville, Kentucky, US www.alea.org

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AirMed & Rescue Dec / Jan 2018  
AirMed & Rescue Dec / Jan 2018