Commercial

Commercial | EMS: Air Medical Operations: Pushing the Limits

By James T. McKenna | May 1, 2008

Emergency Medical Service

Demand for EMS services in Europe is growing, straining the bounds of bureaucracy and infrastructure.

Helicopter emergency medical services operators in Europe came into 2008 facing a number of challenges.

The segment is confronted by health-care systems that are evolving in a search for more efficient operating schemes. Local and regional hospitals are focusing on basic services, with specialty treatments concentrated in regional centers. That increases the need for air transports of patients in outlying areas.

Operators are going through the process of adopting and complying with the latest sets of aviation regulations and lobbying for more uniform legal and regulatory treatment of helicopter activities throughout Europe. That is complicated by the transition from the Joint Aviation Authorities to the European Aviation Safety Agency.

At the same, there is a movement to enhance the safety of EMS operations in Europe. A key element of that movement is focused on greater availability and use of simulators and other advanced training devices for the aircraft in operators’ fleets. Operators also are looking at greater utilization of night-vision systems to enhance the safety of their flight operations.

Those will be among the biggest topics of discussion as representatives of the EMS industry in Europe and from around the world gather May 20-23 in the Czech Republic’s capital of Prague for World Congress Airmed 2008.

"Above all, we will focus on safety, night-vision goggles, and training," said Pavel Müller The managing partner of Czech operator Alfa Helicopter, Müller serves as the chairman of that congress.

"I think that simulation training will be the main highlight," he told Rotor & Wing. "The introductory speech will focus on it and simulation displays will run during the whole congress."

Airmed is one of the world’s most important helicopter EMS gatherings. Closely associated with the European Helicopter EMS and Air Ambulance Committee (EHAC), the event has as a goal constantly improving the level and quality of helicopter emergency medical services. The international congress is held every 3 – 4 years. The first gathering was in Munich in 1980. Subsequent congresses have been held in Europe, the United States, and Australia. The last Airmed, in 2005, was in Barcelona, Spain.

This year’s gathering is the first to be held in a former Communist country. Its attendees will include representatives of the U.S. Assn of Air Medical Services (AAMS) and Australasia’s International Society of Air Medical Services (ISAS).

Like AAMS’ annual Air Medical Transport Conference, Airmed is an international scientific conference that includes presentations and exhibitions on aviation and medical technology and techniques. It also includes flight demonstrations. Organizers expect this month’s event to include the European premiere of Bell Helicopter’s new Model 429, outfitted with a medical interior developed by Switzerland’s Aerolite.

The event is hosted by PÅ™emysl Sobotka, chairman of the Senate of the Czech Republic’s Parliament, who is expected to welcome attendees. Müller is to join him in that welcome, as is the president of EHAC, Erwin Stolpe.

The congress is to open with a video presentation, "Reduction of Mortality in Modern Society — The Role of Air Rescue and Air Ambulance Services." That is to be followed by a presentation by German attendees entitled "Introduction in Simulation Training." On the second day, presentations will include one by the EMS operator Team DRF called "Simulator-Based Training: The DRF Experience."

Alfa Helicopter illustrates the challenges facing European EMS operators.

Approaching its 17th anniversary, the company is based in Brno, about 100 mi (160 km) southeast of Prague.

The company operates in three regions of the Czech Republic: Jihoceský Southern Bohemia) in the south; Jihomoravský Southern Moravia) in the southeast, and Severomoravský (or Northern Moravia) in the northeast.

"In all of them, there is a relatively strong net of medical facilities," Müller said. But hospital facilities in those regions are expected to increase their levels of specialization.

"That will raise the role of helicopter EMS" by increasing the need to take a patient "directly to the medical facility that will provide him with the best care," he said.

France also is moving toward greater concentration of highly specialized care in large regional medical centers, which likewise is driving the need for swift transport of patients to those centers from outlying regions. That is resulting in large increases in flight hours in France, according to industry specialists who track those numbers. It also is expected to increase the number of EMS bases in France by 15 – 20.

In Germany, too, changes in hospital organizations require emergency patients to be transported to more distant specialized clinics once they have been given preliminary care locally. This is driving up the number of interfacility transports.

Regions like Schleswig-Holstein in the North and Mecklenburg-Vorpommern in the East (which are not as densely populated as other parts of Germany) suffer from a lack of emergency physicians. As a consequence, the EMS operator Team DRF says, it is playing a more important role in emergency care in Germany.

Team DRF also operates in Austria and Italy. It consists of the non-profit organization DRF (Deutsche Rettungsflugwacht e.V./German Air Rescue), the German partners HDM Luftrettung GmbH, the HSD Hubschrauber Sonder Dienst Flugbetriebs GmbH & Co. KG, the Austrian ARA-Flugrettungs GmbH, and the Italian organization Helitalia S.p.A. In Europe, Team DRF partners operate 43 bases with more than 50 helicopters for emergency rescue and intensive care transportations between hospitals. Eight of those bases operate around the clock.

Last year, Team DRF saw a 7.2 percent increase in its number of missions, to 39,111 missions from 36,499 in 2006. The most frequent reasons for missions, it said, were life-threatening ailments — such as heart attacks and strokes — and accidents. Alfa Helicopter operates six of the 10 helicopter EMS bases in the Czech Republic, with the other four run by the government. Müller in the near term is planning for the government to turn over two of its bases to a non-government operator. "We are expecting a reduction in the governmental operators’ share in helicopter EMS and their replacement by non-governmental operators," he said. "Alfa is interested in extending its operations."

(Six of the bases are limited to operation under visual flight rule conditions during daylight hours; the other four can operate under VFR night conditions.)

On average, Alfa Helicopter flies about 1,600 missions and roughly 1,300 flight hours a year. The company also conducts charter and air taxi operations, as well as airborne surveillance and patrolling, aerial surveying and mapping, inspection flights, aerial photography, scenic flights, and flights supporting forestry, conservation, civil engineering, construction and fire-fighting services and industries, it says.

The company’s fleet consists of the Bell Helicopter 427 and the 206L4T

If Alfa Helicopter succeeds in taking over operations of the two government bases, "we will need one more helicopter at the very least," Müller said. The operator is interested in upgrading its entire fleet, "mainly with the aim of ensuring better comfort for the patient and medical crew."

Müller also said the company wants to upgrade its operations to make use of night-vision goggles (NVGs).

"As a Bell Helicopter customer of many years, we had initially been linking our future to the Bell 429," Müller said. "Unfortunately, the current situation is not clear and I have to say that we are considering changing our helicopter supplier."

Alfa Helicopter has been operating in full accordance with JAR OPS-3 regulations since the start of January, Müller said. "This is also our main aim for the future." JAR OPS-3 is driving changes in operations. Those regulations are prompting Team DRF, for instance, to replace its Eurocopter BO105s with EC135s by next year.

Unfortunately, JAR OPS-3 is not yet being interpreted and applied uniformly throughout Europe, which can create competitive imbalances in the region. That is among the legal and regulatory issues with which the helicopter community is wrestling,

"We also support the legal reform process in order to ensure that the legal regulations correspond with operational realities and future needs," Müller said.

An underlying rationale for JAR OPS-3 is improved safety of commercial helicopter operations. EMS operators are taking other steps to achieve that goal. Alfa Helicopter’s interest in NVG operations is one example. Another is Team DRF’s development of a satellite-based tracking and communications system.

In early 2005, the DRF initiated its project Rescue Track. Based on the Canadian firm SkyTrac’s products and services, it allows dispatchers on the ground to track the mission status and position of all of the operator’s aircraft that are fitted with the necessary avionics.

The SkyTrac system provides Team DRF crews and personnel with automatic flight following, hands-free satellite phone communications, two-way text messaging and data transfer using the Iridium satellite constellation. It also provides street-level mapping and display using Google Earth. Crews can report mission data using pre-formatted messages.

On board the helicopter, a satellite telephone is linked to the navigation system EuroNav. A transceiver sends the latest GPS data on the helicopter’s position, speed, and heading. DRF’s emergency dispatch center of Freiburg receives the mission data from aircraft directly in its system. Other dispatch centers receive the data via the Internet. According to Team DRF, the next step will be to transfer data directly into the mission management systems of the control centers. DRF also sends the data to its maintenance facility.

Team DRF aims to increase the efficiency of its flight planning and management, thus lowering costs. Through near-constant tracking of flights, Team DRF can instantly know the location of flights in distress and the nature of the in-flight. Should an aircraft be forced down, a dispatch center can determine the aircraft’s location and contact the crew regardless of whether radio signals can reach the helicopter. The center’s communications are relayed by a satellite hundreds of miles overhead.

Rescue Track enables Team DRF’s control centers to check at any time where its helicopters are and their status, and thus may better plan missions. Currently, Team DRF said, about 70 mission control centers in Germany have been linked to the system.

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