AirMed & Rescue April 2019 by AirMed & Rescue Magazine

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Issue 95 | April 2019

ISSUE 95

IN THIS ISSUE: APRIL 2019

Analysis: Impact of the USFS/DOI Civil Aviation Helmet Standard Feature: Essential kit for medics – what’s the best piece of kit carried? Feature: Rescue kit – an overview of stretchers, strops and baskets

Lite Flite Helicopter Rescue Equipment is used to save lives by dedicated SAR teams in more than 40 countries. Why not yours, too ?        

Hoist Harnesses Quick Release Boxes Static Discharge Wires Gunner Belts and Lanyards Guide Line Systems Sling Strops Stretchers Sea Trays

The worlds largest civilian operators, coast guards and armed forces are thrilled about the performance and the minimal maintenance required. Leading helicopter manufacturers even include or recommend our modern equipment as standard in new SAR helicopters. Lite Flite Helicopter Rescue Equipment is proudly designed and made in Denmark. For more information, please see www.lite-flite.aero, email us at info@lite-flite.aero or call us at +45 7558 3737. We will do our utmost to help you. Where applicable, Lite Flite Helicopter Rescue Equipment is manufactured in accordance with European Council Directive 89/686/EEC with later amendments, and is tested and type certified according to European Norms EN813:2008, 2 AIRMED&RESCUE EN1497:2007, EN358:2000, EN1498:2006, EN362:2005, EN365:2007, EN364:1996 etc.

Lite Flite ApS Lufthavnsvej 8 6580 Vamdrup DENMARK

EDITOR’S COMMENTS This year is already rushing past, with HAI Heli-Expo underway as we head to press – we’ve collated some of the news highlights from the event on pages 10 and 11. It’s been interesting over the past few months to talk to flight medics from different organisations about what they consider to be their most valuable piece of kit, and some fascinating insights are offered up in our feature on essential kit for medical crew, which you’ll find on p36. The ability of medics to analyse patients’ needs and treat them accordingly continues to develop with the advent of new medical technology – a topic we also cover in this month’s Medical Insight article on the transfer of neonatal patients. Best practice in the transfer of the tiniest of patients is examined by two UK-based experts on p28. If you’re involved in search and rescue – or considering adding equipment for it to your fleet – then the article on p20 is a must-read for you, where we’ve got details of all the latest stretchers, strops and baskets that patients and flight crew would make use of.

Editor

Mandy Langfield

Enjoy this issue!

CONTRIBUTORS

James Paul Wallis Previously editor of AirMed&Rescue from launch up till issue 87, James continues to write on air medical matters. He also contributes to AirMed&Rescue’s sister publication the International Travel & Health Insurance Journal.

Amy Gallagher Amy Gallagher is an internationally published journalist covering aviation, rescue, medical and military topics, including evidence-based research articles. Amy has worked in both agency and corporate communications for aviation companies such as SimuFlite Training International, K-C Aviation, Chrysler Pentastar Aviation, and McKinney Aerospace.

Ian Braithwaite (MSc BEng RN(CH)) Ian has been a children’s transport nurse for 16 years. He is currently a Nurse Educator at Embrace, the Yorkshire and Humber Infant and Children’s Transport Service. He is involved nationally in promoting best practice and assisting services with the development of their paediatric and neonatal flight programmes.

Mario Pierobon Mario Pierobon is a safety management consultant and content producer. He writes extensively about aviation safety and has in-depth knowledge of the European aviation safety regulations on both fixed and rotary wing operations. His rotary wing expertise is concerned primarily with specialised operations and the operations requiring specific approval, such as HEMS, hoist operations and performance-based navigation.

Raj Helweg Raj is the chief pilot for Air Methods. Nine months after his introductory flight in Seattle in 1997, Raj worked as a flight instructor in Atlanta. He then moved to Prescott, Arizona, where he continued to work as a flight instructor. After flying tours in the Grand Canyon, Raj began his EMS flying career. He worked as a line pilot and a lead pilot for then Omniflight’s Native Air program and PHI Air Medical. After Omniflight was acquired by Air Methods, he served in the regional aviation manager and regional aviation director roles. Today, Raj oversees the training and compliance of approximately 1,300 pilots in his role as chief pilot for Air Methods.

Dr Cath Harrison (BM BS BMedSci DTM&H MRCP FRCPCH) Cath Harrison has been a consultant neonatologist in Leeds since 2004, with training and experience from the UK, Australia and South Africa. She is the lead neonatologist for Embrace, a combined neonatal and paediatric transfer service in the UK, carrying out both road and air transfers. Prior to the setting up of Embrace in 2009, she was the lead clinician for the Yorkshire Neonatal Network Transport Service. In this role she was involved in the design, development and introduction of Embrace and currently works for the service in both a clinical and managerial role, leading on quality improvement and research.

Front page image © Bell www.airmedandrescue.com

Editor-in-Chief: Ian Cameron Editor: Mandy Langﬁeld Sub-editors: Robyn Bainbridge, Lauren Haigh, Stefan Mohamed, Sarah Watson Advertising Sales: James Miller, Kathryn Zerboni, Marlon Stanley Design: Rosi Yip, Tommy Baker, Will McClelland, Robbie Gray Web: Tom Reed Marketing: Isabel Sturgess, Kate Knowles Finance: Elspeth Reid, Alex Rogers, Kirstin Reid

IN THIS ISSUE NEWS 6 8

Contact Information: Editorial: tel: +44 (0)117 922 6600 (Ext. 3) email: editor@airmedandrescue.com Advertising: tel: +44 (0)117 922 6600 (Ext. 1) email: jamesm@airmedandrescue.com Online: www.airmedandrescue.com @airmedandrescue www.airmedandrescue.com/facebook www.airmedandrescue.com/linkedin www.vimeo.com/airmedandrescue 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.

Printed by Pensord Press Limited © Voyageur Publishing & Events 2019

AIRMED & RESCUE ISSUE 95

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

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EAAA plans for 24/7 HEMS by 2020 New helicopters for Air Medical Group

FEATURES

Flight Testing for HH60W helicopters

Cobham and Inmarsat launch new solution

ANALYSIS 12

In a holding pattern - Helmet + Standard introduction

The right tool for the job - SAR products under the microscope

Essential kit for medics

You spin me round - Avoiding spin during hoisting

INDUSTRY VOICE CASE STUDY 18

HeliMission earthquake relief

Preparing for the unexpected - Train, train, train

PROVIDER PROFILE 34

MEDICAL INSIGHT 28

Neonatal transfers

Redstar Aviation

www.airmedandrescue.com

NEWS

Flight testing for HH-60W helicopters Two Sikorsky-built HH-60W Combat Rescue Helicopters (CRH) are preparing for their maiden flights, which will take place in mid-2019 at the Sikorsky West Palm Beach site in Florida, US. Sikorsky (a Lockheed Martin company) has fully-assembled the two CRH, and the CRH HH-60W flight test team is currently preparing both aircraft for flight by conducting final installation of instrumentation and ground run testing. The aircraft will be delivered to the US Air Force, and Lockheed Martin notes that the testing which is currently underway ‘marks formal entry into the flight test program that culminates in Ready Assets Available (RAA), allowing the Air Force to declare Initial Operational Capability (IOC)’. Sikorsky Director, Combat Rescue Helicopter programme Greg Hames commented on the development: “Having these initial HH-60W helicopters in West Palm Beach for flight test is an exciting time for the Sikorsky team. It is the first step toward

a low-rate initial production decision later this year, which will allow Sikorsky to provide

the new Tactical Mission Kit the HH-60W team completed the System Configuration Test

Two fully-assembled HH-60W Combat Rescue Helicopters being built by Sikorksy

a constant production flow of aircraft to the warfighter,” he said. “This is the point in the program when Sikorsky begins providing new aircraft into the warfighters’ hands, initiating transition to the vastly more capable and reliable HH-60W CRH.” The first of the two helicopters is due to go into testing with

Readiness Review milestones for the kit last year. The integration of sensors, radar, and multiple defence systems on the aircraft will bring added intelligence into the cockpit, enhancing pilots’ situational awareness to complete missions, which is ‘key to improving aircraft and isolated personnel

survivability’, Lockheed Martin notes. In addition, the new fuel system on the HH-60W nearly doubles the capacity of the internal tank featured on a UH-60M Black Hawk, giving the Air Force crew extended range and more capability to rescue those injured in the battle space. In total, the Air Force programme of record calls for 112 helicopters to replace its ageing HH-60G Pave Hawk helicopters – a total of nine aircraft will be built in Connecticut during the Engineering Manufacturing Development (EMD) phase of the programme: four EMD aircraft and five System Demonstration Test Articles. “Our team is working every day to build and deliver a superior quality helicopter to the US Air Force for this critical mission,” added Hames. “Both Sikorsky and the Air Force remain committed to achieving a low rate initial production decision this year and getting this much-needed aircraft to our air men and women out in the field.”

Eight golden rules from IHSF The US-based International Helicopter Safety Foundation has published eight golden rules about weather and helicopter flights, the purpose of which is to re-emphasise to pilots the essential need for 6

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a detailed understanding of aviation weather. This includes the appropriate threat assessments and strategies to adopt in relation to pre-flight, in-flight and post-flight operations, so that missions can be conducted safely under visual meteorological conditions.

The eight rules are: 1. Always obtain an aviation forecast. 2. Expect conditions to be worse than forecast. 3. Check actual conditions against the forecast. 4. Identify alternative routes and

suitable diversion airfields. 5. Always carry enough fuel for unexpected situations. 6. Scan the sky and horizon for possible problems and note local surface winds. 7. Check weather reports while flying.

8. Be prepared to divert, turn around or land. (ie, Make sure there is an alternative course of action available should the weather conditions preclude the completion of the flight as planned. In other words, don’t be afraid to land and live.)

EAAA plans for 24/7 HEMS by 2020 the charity needs to raise an additional £1 million a year funding. The EAAA worked with the East of England Ambulance Service Trust (EEAST) to gather evidence to prove the need for 24/7 services. The EEAST tasked it to review incidents over the course of a year where critical care was required but unavailable, as well assessing the need first-hand by trialling an overnight service via rapid response Steve Jones’ visit. Photo Credit - East Anglian Air Ambulance vehicle (RRV) four days a week from the Norwich base. The results of that ‘these do not cease when East Anglian Air Ambulance the overnight trials, which saw the their crew go offline’. Though (EAAA), a charity based in the service attend 220 missions in the EAAA currently operates 365 UK, has launched an ambitious first 12 months, confirmed that days a year, it does not operate plan to become a 24/7 HEMS there is a need for region-wide 24 hours a day – meaning that provider by 2020. between midnight and 07:00 hrs, overnight critical care, particularly The EAAA attends serious road in rural Norfolk. The EAAA charity there is no HEMS provision in traffic collisions, cardiac arrests, stressed that it ‘could do so much the area. In order to succeed in traumatic injuries and other more with the helicopter’. becoming a 24/7/365 operator, medical emergencies, and notes

New helicopters for Air Medical Group 8

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The charity recalls the case of Steve Jones – an accident in which Jones, having had to quickly manoeuvre past a car, was flung off his motorbike while riding, landing him unconscious in a ditch filled with water after being catapulted head-first through a brick wall. Thanks to the EAAA, Jones was saved, but had the incident occurred between midnight and 07:00 hrs, ‘it is unlikely that he would have survived’, a statement noted. Matthew Jones, Director of Operations at EAAA, said: “Becoming a 24/7 service by air will provide the people of East Anglia with a service that has not previously been available. By operating 24/7 we believe that we will treat approximately 600 more patients every year. Patient care is at the heart of everything we do at EAAA, so if we can be there for 600 more people each year and further reduce the impact of trauma and medical emergencies in the community, then this is a great step forward for us. We currently need to raise £12 million a year to operate our service, and it will cost an additional £1 million a year to fund a full 24/7 operation.”

Airbus Helicopters has sold 21 helicopters to Air Medical Group to be used in air medical transport missions. Air Medical Group currently operates a fleet of approximately 85 Airbus helicopters. The new agreement is for a mix of single-engine H125 and twin-engine H135, nine of which

NEWS

are expected to be delivered in 2019; the rest before the end of 2022. “The order supports our company’s fleet replacement and growth in the air medical market. In our operation across the US we perform a critical care transport for a patient every 10 minutes and must always be ready at any moment,” said Fred Buttrell, President and CEO of Air Medical Group Holdings. Air Medical Group recently merged with American Medical Response – another medical transport service – to form Global Medical Response (GMR), and this is the service which the new aircraft will operate under; transporting patients and continuing its life-saving work. President of Airbus Helicopters Inc. and Head of the North America region Chris Emerson said: “The GMR teams are one of the best in the business. We are committed to fully supporting their current fleet, as well as their upcoming H125 and H135 deliveries, while they focus on finding the best solutions to support their rotary-wing operations. We are extremely proud to provide them with the helicopters they rely on to save lives every single day.”

Cobham and Inmarsat launch new solution

as an enhancement of the SwiftBroadband XStreamTM service; one of Inmarsat’s streaming services offering guaranteed on-demand highstreaming data rates over its L-band network. The Cobham Aerospace Communications (Cobham) software is also free of charge. and Inmarsat, global provider of mobile satellite Todd McDonell, President of Global Government communications, have announced the launch of at Inmarsat, said: “We are very happy to antheir SB-Helo X-StreamTM helicopter satcom nounce the availability of the SB-Helo X-Stream, solution for Cobham AVIATOR Special Puran enhancement of the Inmarsat X-Stream service pose (SP) systems – an advancement which will that meets the needs of this growing sector of improve communications through rotor blades by the government market in an efficient and costreducing packet loss by up to 40 per cent. effective way. Having worked with Cobham in The development enables helicopters to transmit the development of this new protocol, we are very data such as video imagery to a satellite network pleased with the results we have seen from the trithrough rotor blades, which benefits helicopals and foresee that this cost-effective solution will ters operating in remote locations that need to be greatly sought after in the growing government transmit video imagery beyond line of sight, such helo market.” as those working in military and search and rescue Vice-President of Sales, Marketing and Support (SAR) missions. The increased resilience of the at Cobham Aerospace Communications Willem data pipeline passing through the rotors means Kasselman added: “The partnership between Cobthat the transmission of high intensity data, such ham Aerospace Communications and Inmarsat as video, will see an improvement in throughput is an important one for us and we look forward of around 37 per cent. to building on this announcement and expandInmarsat and Cobham have developed a protocol ing and improving other related services over the in network Quality of Service (QoS) selection, coming months.”

www.airmedandrescue.com

HAI Heli-Expo news round-up Sikorsky S-92 helicopter

In addition to developing its S-92 helicopter line to include the S-92A+ and the S-92B, Lockheed Martin company Sikorsky recognised the heroic efforts of a CHC Helicopter crew’s successful search and rescue mission conducted with an S-92 helicopter.

Aviation Specialties Unlimited (ASU) announced the release of its new E3 Lightweight Night Vision Goggle (NVG) and will offer a special introductory rate of US$11,995 to commercial customers eager to preorder one of the first 100 produced. ASU plans to have the NVGs in production by the third quarter of 2019, following testing completion, and down payments will be due once ASU sets the official production dates.

ASU Night Vision Goggles

Heli-One, a Universal Avionics (UA) authorised dealer, has received Supplemental Type Certificate (STC) approval for its Sikorsky S-76 VVIP helicopter flight deck upgrade. Transport Canada and the Malaysia Department of Civil Aviation both awarded the STC for the upgrades (three Advanced Flight Displays and a UA UNS-1Lw Flight Management System (FMS)) – these will replace legacy analogue Electronic Flight Instrument Systems (EFIS), reducing issues with aging and eliminating the costs of replacing and maintaining old displays.

BLR Aerospace has celebrated the continued success of its Airbus H125 FastFin Tail Rotor Enhancement and Stability System, which is installed on more than 40 aircraft across eight countries and increases operating performance and safety margins.

Universal Avionics (UA) is continuing its research collaboration with the Federal Aviation Administration (FAA) – developing new regulations to support the use of enhanced flight- and helicopter-vision systems for rotorcraft. The FAA is evaluating the use of a Heli-ClearVision as a representative Enhanced Helicopter Vision System to improve visibility during operations and helicopter safety.

Astronautics Corporation has announced its new Wireless Airborne Communications System (wACS); it launched Ibex, its new family of flight and mission-critical displays; it will be providing United Rotorcraft with its AFI 4700 RoadRunner electronic flight instruments (EFIS) – which are also scheduled to be flight tested at the end of March; and it has received a purchase order from Lockheed Martin’s P3 aircraft.

Flight deck upgrade for S-76B VVIP

Lockheed Martin.

AUTOFLUG has announced that it has signed a purchase agreement with AMS Heli Design; as well as the launch of its new AUTOFLUG FLYWEIGHT’s latest upgrade, AUTOFLUG FLYWEIGHT UP – which offers a sleek new design and folding seat cabin configurations. Andrea Girolin, Manager and CEO of AMS Heli Design LLC. Michael Paschold, Bjoern Kanstorf and Alexander Bode from AUTOFLUG (from left to right)

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StandardAero has recently developed a new safety-driven light helicopter autopilot system designed by Thales; it celebrated the success of its retrofittable crash-resistant fuel tank (CRFT) for the Airbus Helicopters AS350 and EC130 series; and it also achieved Federal Aviation Administration (FAA) certification for the new Bell 212 glass cockpit upgrade. So much to celebrate!

Flightdocs

Enstrom Helicopter Corporation - French delivery

Flightdocs, which, following its release of HMX in 2017, has seen over 200-per-cent growth in the rotor segment of the market, has announced its new, entirely cloudbased platform Flightdocs Operations. The platform utilises the latest in web and mobile technology to deliver a ‘modern, intuitive and powerful platform that can manage every aspect of a helicopter flight operation’, the company said. Enstrom Helicopter Corporation announces Copter & Dream, its new helicopter service centre based in southern France, which will extend the company’s reach to farther parts of France, as well as Italy, Spain and French-speaking countries of Africa. It has also delivered its new 280FX to French training company Golf Tango. Aero Asset unveiled its 2018 Pre-owned Helicopter Market Trends Report – focusing exclusively on twin engine pre-owned markets, it ranks the best and the worst performing pre-owned twin engine markets in 2018 and reveals that the top performer for the period was the AirbusEC135.

Launching at HAI – the Aero Asset team (from left to right: William Sturm Valerie Pereira and Emmanuel Dupuy PAC International has delivered a fourth customised Airbus EC135P2+ helicopter to Wake Forest Baptist Health’s Aircare programme. The aircraft is a dedicated spare that has a fully outfitted EMS interior with upgraded mission technology and is flight ready for when any of the primary aircraft requires maintenance. It is expected to enter service in Q2 2019. Airbus EC135 Helicopter for Wake Forest Baptist Health. Photo credit: Metro Aviation

There’s plenty of news from Safran Helicopter Engines: its Arriel 2H is now ready for service in China following Validation of Type Certification (VTC) from the Civil Aviation Administration of China (CAAC); and it has also just signed a four-year maintenance, repair and operations (MRO) support contract with CHC Helicopter.

Spectrum Aeromed continues its long-standing collaborations with both North Memorial Health and Life-Flight Network. Most recently, Spectrum Aeromed customised the interior of an AugustaWestland ASW109S helicopter, as well as recently working with Life Flight Network on its first fixed-wing jet project.

AW609 cockpit simulator

Leonardo has announced that it will be building a new Training Academy in Philadelphia, which will be in service from 2020 – hosting two Full Flight Simulators (FFS). The AW609 tiltrotor Level D FFS, which is currently in production, and the AW169 FFS, which Leonardo intends to introduce, were developed in collaboration with CAE and will meet the growing demand for pilot training on the new generation aircraft in North and Latin America. Both simulators will be operated by Rotorsim – the joint venture of Leonardo and CAE.

H125 helicopter configured by Metro Aviation

Metro Aviation recently announced the delivery of its first Instrument Flight Rules certified EC145e helicopter to GundersenAIR in Lacrosse, Wisconsin and has also outfitted a mission-ready H125 helicopter to be used by the Hillsborough County Sheriff’s Office based in Tampa, Florida.

Donaldson 525 Filter from BDN Aerospace News

Donaldson Aerospace & Defence (Donaldson) announced the delivery of its advanced filtration systems for the Bell 525 Relentless, a development which aims to protect the aircraft’s gearboxes, engines and auxiliary power unit from the corrosive effects of dirt and other foreign objects. Donaldson also began production on its factory-installed Airbus H160 Inlet Barrier Filters, configured specifically for the H160 helicopter. www.airmedandrescue.com

In a holding pattern © U.S. Army photo by Sgt. Gavin Lewis

The new Civilian Aviation Helmet Standard circulates criticism and compliments, according to Amy Gallagher Civilian aviation helmet manufacturers are circling a new standard which has generated questions of affordability with respect to the initial testing requirements leading to the certification set forth by the Office of Aviation Services [OAS] of the US Department of Interior [DOI] and the US Forest Service [USFS]. AirMed&Rescue reached out to helmet manufacturers, association members, distributors and government agencies to understand the impact on the industry. In April 2018, the DOI confirmed the approval of the 2018 DOI Handbook, Aviation Life Support Equipment (ALSE) Guide and Department of Interior/ US Forest Service Aviation Flight Helmet Standard. However, as of April 2018, there 12

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have not been any certificates of compliance, according to the DOI/USFS document.

community is void of any guidance on aviation helmet standards. As a result, the OAS determined that the ‘solution’ was to acquire expertise that can develop modern, cost-effective, proven performance standards and testing methodologies. “The OAS has a long history of collaborating with the private sector in providing DOI bureaus with safe and effective aviation equipment in support of

A mixed reaction The new helmet standard could offer the possibility of ensuring the perfect performance, pricing, and profitability for a handful of manufacturers in the civilian aviation helmet industry. For the majority, however, the new design standard is raising questions, concerns, and complaints. While revising the For manufacturers, this is an DOI US Department of Agriculture-Forest opportunity to demonstrate and Service Guide, ALSE Handbook, the DOI publicise helmet performance OAS identified the need for specific criteria to determine the acceptable hazardous missions like wildland fire, and performance level for the civilian aviation search and rescue,” stated OAS Safety helmet. According to the OAS, the Chief Keith Raley, Retired US Air Force ‘problem’ was clear: the civil aviation and US Coast Guard pilot. Unfortunately,

ANALYSIS

said Raley, a consensus on safety standards interagency partners to develop safety requirements. for the civilian flight helmet did not exist. objective, performance-based safety In April 2017, the OAS contracted with standards to evaluate civilian aviation Southwest Research the Southwest Research Institute (SwRI), flight helmets for possible use.” Institute a recognised organisation with expertise According to Raley, the published [When asked, the SwRI was not able to in the area of helmet testing to provide testing and qualification requirements provide specific information regarding the technical, scientific systems engineering (Interagency Aviation Helmet Standard) testing results of its customers.] and human factors subject matter According to Allen Beavers, It is the manufacturer’s expertise to develop modern, Research Engineer, SwRI, Mechanical cost-effective civilian aviation Engineering Division, there are current responsibility to request helmet performance standards aviation helmets that have been and testing methodologies, along certified to a now obsolete military and ensure that safety with the assistance of the US Army standard which the DOI/USFS Aeromedical Research Laboratory, standard is looking to replace. certifications are tested to the world’s foremost laboratory “This could lead to unnecessary the appropriate standard dealing with helicopter safety and design features and/or costs for helmet performance issues, per civilian use helmets, that could published DOI data. ultimately reduce the quality “For decades, the DOI and other agencies provide civilian helmet manufacturers of protection provided for helmets relied solely on helmet manufacturers with an avenue to government markets requiring protection from primary blunt already approved by the US military, previously unavailable, while ensuring force impacts,” he added. eliminating other helmet manufacturers DOI and participating interagency By incorporating DOT FMVSS No. 218 from consideration,” explained partner employees are afforded aviation helmet testing procedures into the DOI/ Raley. “To address this shortcoming, helmets that have met accepted, USFS standard, it is the intention to provide OAS collaborated with industry and independently tested, and standardised a test method that is better suited to

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of testing the HGU-56/P to the new standard,” he added. “While the DOI sets the standards and testing requirements for commercial aviation helmets, the mission at Gentex is to deliver helmet systems that provide operators with the highest levels of performance and safety,” said Robert McCay, Gentex, Vice-President, Aircrew. “To do so, we continually invest in our development, testing, and manufacturing facilities, all of which operate under the ISO-9001 Quality Management System,” he added. The intended audience for the new Avenue for non-military helmets standard is the helmet According to the DOI/ manufacturers, distributors USFS Aviation Helmets Helmet design and manufacturing is and third-party ISOSpecification, the new 9001 certified or ISOstandard provides an an industry that requires significant 17025 accredited testing avenue to allow nonlabs, said Wegge. “For military approved helmets capital and skilled technical expertise manufacturers, this to be considered for is an opportunity to acquisition within its demonstrate and publicise aviation communities. helmet performance,” he said, adding: The document also states: “Although Corporation aviation helmets for 35 “Manufacturers that choose to follow the military approved helmets will remain years. Wegge said that the military and DOI standard must make the helmet design authorised, simply adopting military commercial versions of the Gentex HGUin three sizes, design the helmet to fit 98 specifications as our own standard was 56/P and SPH-5 are identical except for per cent of men and women [equally]; eliminated as some of those specifications their colour. “Gentex is in the process ensure adequate protection from impacts, stated Beavers. “To date, I am unaware of labs other than SwRI currently performing testing to the DOI/USFS standard; however, most ISO9001 certified labs that perform FVMSS No. 218 testing could expand their capabilities to include DOI/USFS aviation helmet testing in the future,” he said. “Typically, however, it is the manufacturer’s responsibility to request and ensure that helmets requiring safety certifications are tested to the appropriate standard.”

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include areas that are not applicable to DOI. Some of these areas include the US Department of Defense (DoD) purchase process, design elements involving ballistic protection, and packaging/delivery. Additionally, some military helmet models were built to an American National Standards Institute (ANSI) standard (ANSI Z90.1) which is no longer supported by ANSI. As such, these obsolete standards are unusable for ISO-9001 certified or ISO-17025 accredited testing labs.” According to James Wegge, Founder and Board of Directors Member, Gibson & Barnes has represented Gentex

A it costs at least US$4 million to develop and test a new helmet test the helmet at a qualified laboratory; and establish a quality assurance programme.” Although companies that have decided not to test their helmets to the DOI Standard often criticise it, helmet users deserve to know what performance standards their helmets meet, added Wegge. McCay said that ‘Gibson & Barnes does not have exclusivity on the sale of the company’s SPH-5 Helmet System’. Some

manufacturers believe otherwise. A redesign requires capital Although the document states that the specification is a performance standard and is not intended to restrict design, some manufacturers are concerned about cost restrictions of testing each design, and rightly so. “Helmet design and manufacturing is an industry that requires significant capital and skilled technical expertise,” said Wegge. Additionally, he said, the commercial helicopter helmet market is not very big. “With total sales of about 2,500 helmets per year, Gentex accounts for about half,” said Wegge. “The other half is split among at least six other helmet sellers. Is it possible that the market is too

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small to support so many companies?” Interactive Safety Products, the US subsidiary of Helmet Integrated Systems Ltd (UK), manufacturers the Alpha line of helmets. “The manager said it costs at least US$4 million to develop and test a new helmet,” he added. “Not all companies can do that.” When the ‘other half’ speaks While Gentex may appear to be the ‘Goliath’ in the market, the industry is home to smaller manufacturers that could very well represent the ‘David.’ David Schweitzer, President and coowner of US-based Government Sales Inc (GSI), and his brother Eric, an engineer, were essentially primed as experts in the military surplus market by their father Charles who began selling Vietnam-era flight helmets in 1969. “Later, we evolved into manufacturing custom helmet models that parallel the US military specifications and performance standards,” he said. “With an engineer on board, we started marketing our own helmet. However, about 10 years ago, the second-hand flight 16

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helmets stopped showing up. We called our Congressman to ask why, but we were only given the ‘runaround’.” Schweitzer said the Defense Reutilization and Marketing Office [DRMO] declared the flight helmets ‘dangerous to the public’ then the DOI issued a warning about the presence of ‘counterfeit helmets’ circulating in the market. “About the same timeframe, Gentex began the design and testing of its currently approved helmets,” he said. “Interestingly, Gentex contracts are all government contracts.” While helicopter and fixed-wing pilots have relied on GSI for five decades, said Schweitzer, running a test on each helmet design with four different prototypes is cost-prohibitive. “Most manufacturers can’t meet the specs,” he said. According to Schweitzer, GSI’s helmets are tested at an independent lab to the exact standard set forth by the US Army Aeromedical Research Laboratory (USAARL), and he added that he will provide the test data upon request. Designed to prevent innovation? Ron Abbott, Helicopter Helmets, LLC., Melbourne, FL, believes the new design standard is designed to keep innovation out of the market. “No one can test the helmets based on the second-generation test requirements, so nothing has moved or changed,” said Abbott. “We have waited five years since the inspector general told the air branch at DOI to allow non-Gentex helmets to be listed on the approved helmet list.” Abbott said that the DOI allows Gentex with its 20-year-old helmets to be allowed with in-house testing while the other manufacturers incur lost sales until the DOI writes a test programme that can be applied to every helmet in the industry. “The standard calls for military, past or present, helmets in use; however, no one can buy a military helmet for civilian use unless they brought it with them [from military service],” he said. “So Gentex sells the copy of the military helmet with the same part number, but not made the same, not tested the same and not to the standard demanded by DOI.” A ‘reasonable’ requirement The DOI Standard is a major step forward in improving commercial aviation safety

A and injury reduction, said Wegge. “An example of the reasonableness of the new design requirement is the impact requirement, which allows a maximum of 300 g,” he said. “The military requirement for the HGU-56/P is much more stringent, allowing only 175 g. If anything, the new standard could be stricter.” The Standard also requires manufacturers to have a quality assurance [QA] system that uses recognised documentation, inspection, product improvement techniques, and record keeping, he added. “However, not all manufacturers have a QA system in place,” said Wegge. Let the end-user contribute With more questions and criticisms from manufacturers and customers, the industry should have an opportunity to participate in an interactive discussion about the helmet redesign, said Helicopter Association International Board Member Randy Rowles, Owner

and CEO, Helicopter Institute, Inc. “A customer advisory board would be a welcome initiative,” he said. “Like too many government-driven issues, the end-user often never gets the opportunity to be a

requirements,” he said. As for helmet OEM delays in design internally, said Rowles, it’s a ‘moving goal post’ issue. “No company wants to commit manufacturing processes to an

No company wants to commit manufacturing processes to an open-end standard part of the design criteria.” Additional stakeholders such as the users of night vision goggles, external-load operators, and agriculture pilots would like to have some active participation on these discussions, Rowles added. “Many will say it’s up to the helmet original equipment manufacturer [OEM] to design for the customer; however, many compromises can be made along the path to certification by open dialogue between design criteria and end-user

open-end standard,” he added. “Once this is dialed-in, the helmet manufacturers will catch up.” The next issue, said Rowles, is pricing. “Somebody has to pay for these new designs,” he said. “A price point of $2,000$4,000 for a good helmet is outside of the possibility for many pilots. Additionally, this is a non-required piece of equipment and personal protective equipment isn’t exactly an embraced item among our non-military helicopter pilot cadre.”

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Emergency aid following earthquake

Goods being distributed by helicopter

Helimission, based on the island of Sulawesi, Indonesia, played a big part in relief efforts following a natural disaster that occurred lastÂ year. On 28 September 2018, a 7.5-magnitude earthquake and the subsequent tsunami set off a humanitarian disaster on the island of Sulawesi. The epicentre was located not far from the capital city of Palu. Miraculously, none of the Helimission employees, who are situated right in the centre of the affected area, were injured. Our hangar, helicopter and all our employeesâ&#x20AC;&#x2122; houses were not seriously 18

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land, taking everything with it. Matthias Geiger, our base manager, pilot and mechanic, had returned with his family from Germany just one day before the terrible earthquake. Not imagining what would happen on the evening of 28 September, he helped finish the annual inspection of the helicopter less than one hour before the earth started to shake. Response times Helimission immediately joined forces with two other relief organisations on site to provide disaster relief as quickly as possible. Mission Aviation Fellowship MAF Disaster Response Team, who have a lot of experience with events such as these,

An injured woman was transported by helicopter to the hospital

damaged, even though countless cracks in the buildings provide a constant reminder of the quake. It was impossible for the authorities to issue a tsunami warning, as only five minutes after the earthquake, the first wave hit the town. This was followed by two more waves of up to 20-ft high, which struck hard and swept away houses, debris, cars and people in its wake. Another terrible phenomenon was the liquefaction of the ground. The shaking and jolting of the earth caused the groundwater to mix with the soil, transforming the ground under the houses and streets into a swamp, which literally drained off along the slope of the

managed and co-ordinated the relief flights. We were one of the first outsiders to reach Kulawi, an area just south of Palu. We have not seen any areas that were worse affected in this disaster. Needless to say, the people there were desperate for help when we came. Not only did we bring them food and medical supplies, along with a team of doctors, but we were also able to bring them some hope in their hopeless situation. Whole villages in that area were flattened by the earthquake and everyone was camping out in the open. Everyone was obviously traumatised, and as the men tried to build some structures to live in, the women tried to feed their families and

Making it personal I couldn’t help but think about my own son, who was in Palu during the earthquake. It

traumatised or not, find humour in the same things: funny faces and high fives made them smile, and as I pulled out a picture of my wife and family, they were all eager to see. They knew that the people who had come to help them had experienced the very same earthquake – they know, they understand, it was hard for them too; but they still came to help. It meant the world to them – and to us. Over 2,000 dead bodies have been recovered since the devastating earthquake. Because of dozens of aftershocks and another forecasted earthquake, many of Palu’s 330,000 inhabitants have moved away. Rebuilding this city will be a massive undertaking.

Pilot Matthias Geiger unloading goods from the helicopter

was very disturbing to experience the ground shaking so violently and loudly; having to sleep outside in fear of aftershocks and witness some of the damage. How much harder must it have been for these kids who didn’t only feel and witness the disaster, but lost everything in that moment and very likely lost loved ones too? Not having any resources available and being totally dependent on people from outside, they were hoping they wouldn’t be forgotten, having been told by their parents that they had run out of food. It was up to me to do whatever I could to make their misery a little easier to bear. Thank God all children around the world,

CASE STUDY

comfort the kids with hardly any resources available. Landing in Kulawi, the full extent of this disaster hit me. After we unloaded the supplies, the doctors went to see patients. Some of the villagers were so desperate that they just handed us their kids, so they would be free to receive supplies and medical help. While they were distributing everything amongst themselves, we tried to entertain the kids and help them escape their misery for just a few moments.

Helimission’s Bell 206L-3 Long Ranger transported 53 tons of material, flew 85 flights with teams of doctors, totalling 157 helicopter hours flown, 401 landings and approximately 700 people transported.

Pilot Matthias Geiger loading the helicopter

Who is Helimission? Helimission was founded in 1971 as a non-profit organisation which is registered in Switzerland. It currently operates permanent bases in Indonesia (Papua and Sulawesi) and Madagascar. It flies medical personnel and supplies into remote areas, rescues emergency patients, supports the building and maintaining of bush hospitals, carries out survey flights and much more. It also provides SOS relief in areas affected by catastrophes in co-operation with international and national relief organisations such as the International Red Cross, The UN refugee Agency, Doctors Without Borders, Humedica, Swiss Humanitarian Aid Unit, OXFAM, The German Agency for Technical Relief CARE, Tear Fund, Save the Children and Feed the Hungry.

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The right tool

for the job

There are any number of products that a search and rescue organisation can use to extract its victims, and it depends on the mission profile and the patientâ&#x20AC;&#x2122;s condition before a rescuer is able to determine which one is right for the job. James Paul Wallis considers the options available

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ÂŠ SAR Products

Strops The rescue strop has been in use for helicopter SAR missions for decades. The basic device that passes below the arms and around the back remains a simple and effective device for winching suitable casualties. The word ‘suitable’ is important here, of course. Lifesaving Systems Corp, for example, states that its Quick Strops should only be used for ‘uninjured’ persons. In a web post for Lifesaving Systems, Mario Vittone, General Manager, qualified the restriction, saying that rescuers need to assess their patients’ injuries and make appropriate choices (for example, using a strop for a person with a broken finger might be acceptable, whereas it wouldn’t be a good choice for a patient with a suspected C-spine injury). Over the years, alternatives to the simple loop strop have been introduced. Dave Allport, Technical Director at SAR Products, states that he was inspired to add leg loops for the casualty after he witnessed the rescue of people from plane that had crashed into a river. In that case, he said, ‘the partially conscious, cold casualties kept slipping out and back into the water’. A simple adaptation to reduce the risk of the casualty slipping out of the strop is the addition of a crotch strap, as seen on the Helicopter Rescue Quick Strop offered by Lifesaving Systems, which was approved for use on UH/HH-60 Black Hawks by the US Army in 2016. Manufacturers have also explored the area between the basic strop and a litter. The middle ground is a vest or rescue wrap, such

as that offered by LiteFlite, which secures the patient in a reclined or seated position, and eliminates the risk of falling seen with a basic loop. Bob Cockell, Vice-President of Air Rescue Systems (ARS), told AirMed&Rescue that the ARV-QC ARS vest is in use with operators around the world, adding that the US Army only recently awarded an airworthiness certificate (AWR 980) for the military version following a ‘lengthy testing and certification process’. Testing is being completed with the US Navy and US Marine Corps, he said, commenting: “The overwhelming response has provided a big thumbs up to the devices design, function and use parameters.” Litters Litters and rescue bags serve the role of stretchers that hang from the winch hook. A relatively recent development is the Air Rescue Extraction System (ARES) developed by ARS in 2016, which ARS said was created out of the need for a ‘lightweight, safe,

intuitive and multi-purpose victim extraction device’. The system includes a number of design features aimed to improve function, such as the ability to use a drag parachute during short-haul operations to prevent rotation. Similarly, a sail-like fin can be used during hoisting to control spinning of the litter in the helicopter’s downwash. The bag also hangs not directly from the hook, but from separate connection points on a shaped flight bar, making it easier to set up and more stable in use. Rotation has also been addressed by Cascade Rescue, whose new EASA-certified StableFlight helicopter rescue bag features the company’s ‘revolutionary’ Rotation Breaking System, which eliminates the need for tag lines. Dana Jordan, President of the firm, mentioned Colorado High Altitude Training Center in Colorado, US, as a recent customer. Allport mentioned that SAR Products’ Alpine

FEATURE

Helicopter rescue equipment can be roughly divided into four types of devices: rescue slings, harnesses, winch stretchers and rescue baskets. They vary in size, cost, complexity and ease of use. As Sami Ollila, a rescue swimmer with the Finnish Border Guard Air Patrol Squadron, wrote in the decision to winch (Rescue Swimmer, 2018), the devices also vary in terms of the physical strain they put on a casualty, with rescue slings being best suited to casualties without serious impairments and rescue baskets being the best choice for the most injured patients. Although the rescue devices of today have a lot in common with what’s been in use for the past few decades, gradual improvements have been made to increase safety and efficiency.

litter can be lifted by SAR helicopters and is in regular use in the UK and around the world. The company is always looking to improve its range, he said, and there have been ongoing refinements over the years, such as changes to handle locations and where the optional wheel locks onto the frame. There are also those little extras that aid functionality, such as the Litter Rail Pads that Lifesaving Systems brought to market in 2017. These pads fit over litters’ metal siderails, acting as bumpers to protect airframes from damage, as well as increasing the litter’s buoyancy. Serving a similar purpose and released the same year are the company’s Skid Shoes for baskets and litters, which protect the underside of the frame, which can otherwise be damaged while dragging across rough surfaces such as tarmac. Vittone commented at the time that the shoes help a basket or litter to remain functional up to its intended service life, rather than being worn out prematurely through everyday use. Baskets As with strops, rescue baskets have a long pedigree. However, things can always be improved upon, said Lifesaving Systems’ Vittone. He said: “In the last year, we made design modifications to our rescue basket and rescue litters, both of which are over 30 years old. [In November 2018], we designed a compact titanium frame and mesh face-shield for our Medevac II rescue

litters. And [in 2017] we designed a new magnetic-ring hoisting sling that solved a decades-old problem with cable and sling management during hoisting.” The US Coast Guard (USCG) fields rescue baskets across its helicopter fleet. In 2018, the USCG reported that Coast Guard Academy mechanical engineering cadets had working with the USCG Research and

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rescuers need to assess their patients’ injuries and make appropriate choices

the space dimensions of the basket, given the dimensions of the MH-60 Jayhawk cabin. With these modifications, we have made the basket more accessible, decreased the amount of time needed per hoisting evolution, and improved upon the effectiveness of the Coast Guard during mass rescue incidents.”

the USCG confirmed to AirMed&Rescue that a patent application is ongoing. Another area of development is in multiperson rescue devices, typically connected to the helicopter’s cargo hook as a short haul set up due to the weight involved. While such systems have been available for some time, interest is growing, said Greg

The new basket can accommodate two seated individuals, potentially halving the time needed to lift a group of survivors. The cadets also reconfigured the flotation system, surrounding the casualty with buoyancy material, thereby increasing comfort, and raising the basket’s buoyancy by 79 pounds of force. One flaw of existing basket designs is the difficulty for survivors with reduced mobility, perhaps due to injury or hypothermia, to climb in while in the water. For this reason, the cadets added an access door that opens to make entry easier. It remains to be seen whether the design will be finalised and put into production, although

Yerkes, CEO of Life Support International. He added: “In light of the recent fires in California, there has been an uptick in interest in multi-person helicopter rescue or transport devices.” Yerkes described the rescue nets available from Billy Pugh Co., which are available in four or 10-person

Development Centre (RDC) on prototyping a new and improved rescue basket. According to the USCG, the new design ‘could revolutionise the way the Coast Guard conducts search and rescue missions onboard the MH-60 Jayhawk helicopters’. The improvements are in response to a 2009 RDC study that noted limitations in the USCG’s ability to quickly remove large numbers of people from hazardous marine situations. Speaking at the time, First Class Cadet Christian Breviario explained: “We have added a means of entry that is easier for people who may be injured or have limited mobility. We have also maximised 22

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A simple adaptation to reduce the risk of the casualty slipping out of the strop is the addition of a crotch strap

versions. He noted that the nets are foldable for easy storage, and even allow for secure transport of victims that have been prepackaged onto backboards or litters. Another option is the Heli-Basket HB2000, a rigid cage that can take as many as 16 people to safety. The HB1000, meanwhile, can rescue six people. Both are manufactured

rescue by agencies whose aircraft are civil aviation registered, then civil certification will be required. For operators of military or state registered aircraft, it will be for the authorities in question to certify the equipment for use.

by HeliBasket LLC in the US. HeliBasket has partnered with Integral Risk Global to market and distribute the equipment, and is also the only the company that HeliBasket endorses to deliver training using both baskets. Martin McGrath, Director of Integral Risk Global, reports that the company is pursuing approval from the US Federal Aviation Administration (FAA) for the HB2000 as a complex personnel carrying device system (PCDS). Approval is expected to be granted in 2019. McGrath explained: “The approval will allow owners and operators to pursue operational approval through their respective aviation authorities.” If the Heli-Basket platform is going to be used for human

Zephyr International was founded from our expertise gained from 37 years of rescue hoist engineering experience. With our exceptional quality and our product support culture Zephyr provides: • Rescue Hoist Ground Support Equipment which extends the life of the cable using the capstan effect vs using a free weight in flight.

Cabin Inside the helicopter, customer requirements

• MagSens Cable Inspection quickly finds internal and external anomalies. • Turnkey Rescue Hoist Test Stands at Intermediate and Depot Levels, keeping assets mission ready. • AxelCut, QuickSplice, Darklight, and Shock Absorbing Weight Stacks to enhance safety. Zephyr products are in service at major Aircraft OEMs, Military and Civil SAR Rescue Organizations worldwide.

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have changed over the past five years, commented Cher Min Teo, Chief of Strategy and Marketing at GVH Aerospace. He added: “[Customers] are increasingly asking for modular aeromedical and rescue products that can be used to rapidly reconfigure a helicopter. In the past, rescue and aeromedical helicopters used to be almost exclusively configured and dedicated to the role. With smaller helicopters, this is still mostly true. With the medium and heavy helicopters, we are seeing customers opt for role change modifications with an emphasis on being able to modify the aircraft very quickly, for example, from passenger configuration to search and rescue configuration.” A factor here is that more helicopters are being leased instead of purchased, said Teo: “Permanent rescue modifications can be very costly to reconfigure for the next operator, and modifications that are not FAA or European Aviation Safety Agency (EASA)-approved tend to require a lot of rework and recertification to EASA and/or FAA standards when the aircraft is transitioned from one lessee to another, especially when it is transitioned to a different country. From the operator’s perspective, they like to be able to reuse the equipment on a new helicopter. From a lessor perspective, the lease rates can be lowered if the operator does not require permanent aircraft modifications.” The modularity concept is enabled by GVH Aerospace’s patent pending multifit floor interface system, said Teo, which can be configured at the flight line to install stretchers, medical and rescue stowage cabinets and oxygen stowage racks. He explained: “By changing as few as two interchangeable parts, the interface system can be installed on a different aircraft type. The entire system is designed to be installed without the need for tools, and customers are often surprised by how quickly the aircraft can be configured to support a rescue mission. We are steadily expanding

future development could revolve around making devices more flexible, and perhaps simpler

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the portfolio of equipment in this product line. Apart from being a catalogue item for the RUAG Dornier 228 aircraft, we have completed Supplemental Type Certification (STC) on the EC135 and are about to complete certification on the AW139.” Teo noted that EASA and the FAA have begun tightening up the certification requirements for oxygen systems. These changes improve safety, he said, especially for oxygen distribution systems that are permanently installed behind cabin walls, where leakages or faults cannot be easily detected. He continued: “The additional certification efforts do have an impact on costs to bring products to the market.

However, our modular role-change system does not install piping and tubing behind side walls, making faults and leakages really easy to detect.” Adapting to the air At the smaller scale though, future development could revolve around making devices more flexible, and perhaps simpler. Helicopter rescue devices were first based on equipment used by ground-based teams and it’s only relatively recently that manufacturers have fully embraced the needs of aerial crews, said Adam Davis, Manager SART/TAC at Priority 1 Air Rescue (P1AR). He commented: “One of the

F greatest shifts we’ve really started to see over the past 10 years is the movement towards embracing textiles to produce SAR equipment in lieu of traditional alloy-based rescue devices. One of the best ways we can reduce the equipment weight is to move to soft-sided devices. With this movement we have seen a lot of designers and manufacturers start making a great assortment of soft-sided, easily packable, and lightweight litters as well as other modern devices for ambulatory patients to substitute rescue baskets, which are heavy and take up a lot of space, or strops, which can provide a number of safety concerns if not properly used. Two examples

of such devices are our PEP Bag (Patient Extrication Platform) and AVED (Ambulatory Victim Extrication Device). These are pieces of equipment that we have been employing and continually improving upon based on real-world use and feedback for the past 10 years.” However, Davis added a word of warning. One of the unfortunate side-effects of the movement to textile-based rescue devices, he said, is the existence of overly complicated designs with matching high prices: “Because modern materials are so easy to work with, designers and producers can bring some very creative ideas to life and then to market; however, we end up seeing some very high equipment prices along with them. Some of these designs have

been game changers, but some of them, though very neat, are unnecessary.” Davis asserted that the limited budgets of SAR agencies were a key consideration when P1AR started working with manufacturing partners to design and produce helicopter SAR equipment. He explained: “A rescue device does not require bespoke machined alloy hardware, and the price that comes with that, to be a top of the line piece of equipment.” Allport of SAR Products also noted that there may be options to adopt light, stronger materials in the future, but added that there’s a balancing act here, as such changes could increase costs. Continuing development No doubt we’ll continue to see innovations gradually being introduced into this field. Having said that, as Davis points out, the most important factor in a successful rescue is the training of the team and their familiarity with the equipment they have: “Ultimately, regardless of the equipment an agency uses, it all comes back to training. If a highly trained expert practitioner of SAR fundamentals is well versed in his equipment, even with sub-par gear, they can execute a very successful rescue. The inverse, however, is also true; you can have the best equipment available but if you are

a sail-like fin can be used during hoisting to control spinning of the litter not properly trained on that equipment, the outcome of the rescue may not be successful.” Agencies should therefore focus on balancing budget spending between being able to outfit their crews with great gear, while also not spending so much that they cannot also afford to provide proper training to their rescue crews, he added. As for whether we’ll see basic strops being replaced with more complex devices, it’s worth bearing in mind a point made by Ollila in the Rescue Swimmer article, who said that ‘helicopter rescue scenarios can be challenging and complex in a way where the rescue method posing the highest physiological risk may be the only practical option’.

www.airmedandrescue.com © ARS Products

Preparing for the

unexpected

Chief Pilot at Air Methods Raj Helweg discusses the advances in, and importance of, air medical training Every day, air medical providers help save lives. Like any type of emergency medical transportation, the work they undertake 26 26

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carries inherent safety risks. However, the benefits to patients, families and communities far outweigh these risks â&#x20AC;&#x201C; that is why safety and reducing the risk for air medical crews and patients is a constant focus and continual priority. Risk mitigation at Air Methods in 2018 took numerous forms, including enhancements

to aircraft, developing new emergency clinical procedures and improving training for pilots and clinicians. One training enhancement in particular gained steam last year and it will continue to improve the safety and success of air medical missions in 2019 and the near future: full flight simulators.

Preparing for the unexpected Air Methods devotes considerable training resources to implementing flight simulators in our training. We believe simulators have many benefits over traditional lecture and live, inflight training alone. Hence, more than 85 per cent of our 1,300 pilots – both rotorwing and fixed-wing – now receive initial and recurrent simulator training in Level D simulators, in partnership with FlightSafety International, an aviation services training provider. This gives our pilots the most realistic – yet safest – in-flight experience available. Our check pilots provide the training for the AS350, EC130, EC145, EC135 and the Bell 407. We contract our fixed-wing training for the Pilatus PC-12 and King Air 200 to FlightSafety, with our instructors having the final look during the route check portion of the required training. All our pilots in command (PICs) join our organisation with a minimum documented 2,000 total flight hours for visual flight rules (VFR) and 2,500 total flight hours for

instrument flight rules (IFR). Retraining them for the unique high-risk scenarios is essential for their safety and success on missions – that is why a key aspect of our simulator training involves avoidance of controlled flight into terrain and inadvertent instrument meteorological conditions (IIMC) scenarios. Prior to their annual evaluation, each pilot completes at least two simulator training sessions lasting up to two hours. During these sessions, pilots encounter numerous scenarios that require them to apply their knowledge of day, night and night vision goggle-aided night flight in VFR and IFR weather conditions. Simulated emergency experiences could include an engine or transmission problem, a rotor system caution light or another

pilots have the luxury of repeating malfunctions until the correct reaction becomes automatic malfunction that the pilot must react to while protecting the safety of the crew and patient. Like any major mechanical error, pilots are not warned what will happen, nor when it will happen. Unlike in real life, pilots have the luxury of repeating malfunctions until the correct reaction becomes automatic. Hands-on without harm All air medical pilots must know their aircraft and be capable of flying in varied weather conditions across numerous urban, rural and mountainous environments. We strive to set our pilots up for success by exposing them to potential problems within the simulator – so if something happens during a transportation operation, they will react appropriately. Seeing a malfunction or dealing with an emergency for the first time whilst on a mission is not the ideal way of learning. The ability to realistically repeat the experience of serious mechanical

INDUSTRY VOICE

Flight simulators offer pilots training experiences that would be otherwise impossible outside of real-life emergency situations, seeing as they would rarely occur outside of these. Instead, simulators deliver the experience without the risk and help pilots develop the decision-making skills and muscle memory to automatically and correctly respond should these situations ever happen during patient transportation.

simulators deliver the experience without the risk

malfunctions or other unexpected situations builds confidence and ingrains muscle memory. This all occurs in a safe environment that eliminates the possibility of harm to personnel or damage to the aircraft. Pilots can also review recordings of how they reacted in the simulator, this allows them to visualise how they performed and identify any improvements they may need to make. Research has highlighted that this type of learning is highly effective, particularly in training for unexpected events. A recent study compared how two groups of airplane pilots reacted to unpredictable and variable mechanical failures in simulators. The group that had practised in unpredictable and variable environments had higher situational awareness and thus performed better during simulated mechanical failures than the control group who were trained in a predictable and invariable manner. Another significant benefit of simulator training is cost. When we use a simulator, we are not occupying a helicopter that may be needed for an air medical emergency, and so can avoid spending money on fuel and other valuable resources during training exercises. Annual training dovetails with safety In 2019 and beyond, simulator training should be implemented throughout the year as part of air medical providers’ safety culture. At Air Methods, the team continues to train every year following all Federal Aviation Administration (FAA) guidelines and Commission on Accreditation of Medical Transport Systems (CAMTS) standards. Dedication to training in this way ensures that pilots’ skills are aligned with the latest standards and best practices. It also simultaneously helps our crew and patients avoid unnecessary risk – guiding them toward safer missions and clinical pathways with better preparation, decision making and consistent execution.

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27 27

Neonatal patient ÂŠ Embrace

Ian Braithwaite and Dr Cath Harrison, both members of The Yorkshire and Humber Infant and Childrenâ&#x20AC;&#x2122;s Transport Service (Embrace), discuss the requirements of neonatal air transportation, outlining some of the conditions and factors which affect the systems already in place Transporting neonatal patients by air Neonatal transport is common in the UK. Around 15,000 babies move between UK hospitals each year, the majority by road1. A baby born prematurely may not necessarily be unwell, but may require an increased level of support which cannot be provided locally. Where possible, high-risk 28

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pregnancies are managed in tertiary centres with neonatal intensive care facilities, usually located in major cities. If babies are delivered in local district hospitals, they may require transport to specialist centres where they can receive life-saving therapies. An otherwise normal pregnancy may proceed uneventfully but during or shortly after birth, problems may become apparent requiring specialist input. Some congenital defects, such as some disorders of the heart or metabolism, are challenging or sometimes impossible to detect by antenatal screening and only become evident after birth, where the appropriate treatment centre and the patient are separated by distance. After appropriate and specialist treatment, once medically and socially able, the health system may

organise repatriation of the baby back to their local hospital, for care to be continued closer to home. This article will focus on the baby who requires a flight transport between healthcare facilities rather than the child who is born compromised outside hospital and requires a primary response. Why fly? Although the majority of babies moved by the authorsâ&#x20AC;&#x2122; transport service go by road, any of our patients may be flown if they need definitive emergency treatment within a specific time window, or when their clinical condition requires the journey time to be minimised. Journey times have the potential to be extended if there is no local bed or specialist treatment availability and if the

MEDICAL INSIGHT

transport service needs to transfer patients out of their normal geographical region. When done by road, these journeys can be physiologically demanding for the patients and logistically complex for the transport service; air transport can make these transfers much easier and quicker. Location plays a part too; international and over-water flights are usually always considered for air transport. Around the world, differences in geography and healthcare organisation lead to global variations in neonatal air transportation. In the UK, only around one per cent of all neonatal transports are performed by air1. Both authors have previously worked in Australia where, in contrast, air transport accounts for an estimated 30 per cent of neonatal transfers2.

Rotary and fixed wing no small part to the efforts of the HELP The choice between rotary and fixedAppeal: a UK based charity supporting wing may be a pragmatic one based on hospital helipad development3 â&#x20AC;&#x201C; yet still the aircraft and remain a relative The premature infant experience rarity. In other available, the countries such requires a stable route and the as Australia, weather. The environment in the hospital the helipad importance of infrastructure is setting that takes huge infrastructure more advanced. cannot be effort to replicate in the air In a remote and underestimated rural context, â&#x20AC;&#x201C; if the helicopter fixed-wing landing sites require secondary road aircraft may be the primary transport transport, the team is faced with a longer, vehicle. However, they may not start to more complicated transfer, which reduces demonstrate benefit for neonatal transport the utility of air transport. The number of until the destinations are at least 200 miles hospitals in the UK with on-site helicopter apart (depending on how close to the landing sites are increasing â&#x20AC;&#x201C; thanks in airports the hospitals are).

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Service models Globally, excepting the occasional neonatal transport service that operates both their own aircraft and medical teams, a clear

and familiarisation with an air operator, but are classed as medical passengers for the flight, with no aviation responsibilities. Team members would replace or supplement

division in organisation falls between the use of specialist and non-specialist teams to move patients. Specialist teams are dedicated neonatal transport services that provide occasional air transport alongside predominantly ground-based transfers. Medical teams undergo regular training 30

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the air operator’s regular medical crew for the journey. Alternatively, patient care may be provided by a generalist medical flight crew who are experts in flight medicine and familiar with the aviation environment. These personnel would have received additional

training to facilitate the safe transfer of neonatal patients. Local circumstances will dictate the choice between the model used, and it will always be a balance between aviation and neonatal experience. Despite training and competency challenges for both models, either can provide safe and effective care. Accreditation with an organisation that has standards for neonatal transport is a useful way of demonstrating a commitment to safety and quality. In the UK, NHS commissioned, geographical neonatal transport services have agreed a set of standards for the transport of the neonatal patient by air. Due to the small numbers of neonatal air transports undertaken, the need to benchmark services against other providers increases in importance. The Ground Air Medical qUality Improvement Collaborative (GAMUT) database is another governance tool allowing international comparisons on agreed performance indicators4. Neonates should not be considered small children, or even tiny adults – they are physiologically distinct and physically fragile. The premature infant requires a stable environment in the hospital setting that

MI takes huge effort to replicate in the air. The integration of their required medical equipment into an appropriate flight-worthy system is a challenge. The appropriate composition, training and experience of the medical team is crucial, especially if neonatal transport is considered a low-frequency, high-risk event in your context. When undertaking neonatal air transfers we must strive to match the quality and characteristics of the care the patient receives on ground transfers. Equipment The scope of neonates that may be transported by air may range from the term infant with an isolated medical complaint, who can feed and receive cuddles in the air, to the extreme premature baby who weighs less than 500 grams, and requires complex and intensive support. The catalogue of equipment available to a neonatal transport team overlaps with that routinely taken for adult transports, but the technology required for some neonates can seem out of proportion with the tiny patient that it surrounds. The best equipment available on a neonatal intensive care unit may not be appropriate for the transport environment in terms of size, weight, power requirements, medical gas usage

or fixation. Babies are a vulnerable group requiring protection from their surroundings. A warm

an aspect of neonatal transport that must not be overlooked is their family

environment is critical, especially given the exposed nature of landing sites – all but the most robust infants will require some type of incubator. A lightweight, carbon fibre ‘pod’ is a popular choice for babies weighing over two kilograms,

which is supplemented with electrical or chemical warming technology. For smaller babies, a more complex incubator becomes necessary: one that can maintain a warm, humid environment irrespective of the external climate. This complexity

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comes at the price of weight and power requirement, ruling out many smaller airframes as being suitable for neonatal transport. An appropriate means of patient restraint is an essential component of any transport system and is no different for neonates. This requirement generally precludes the possibility of transporting twins inside one incubator (certainly in the UK). However, this may be the only option available in some international situations, depending on local resources. A capable ventilator is also essential – one that offers intelligent support to the smallest lungs. It is desirable to have a means of actively heating and humidifying the inspired gas. This is essential when non-invasive respiratory support modes such as High Flow or Continuous Positive Airway Pressure (CPAP) are used. High concentrations of oxygen in the youngest and smallest neonates can lead to over-

be inversely proportional to their weight. Safely securing these to a stretcher is a design and certification challenge. Forces It must be assumed that neonates are at least as susceptible to the physical forces experienced in transport as adults – potentially more susceptible. Practitioners should consider how acceleration and vibration forces of all modes of transport might affect their patients. Acceleration forces in a helicopter are lower than those experienced in road transport or a fixed-wing take-off and landing, but the vibration exposure is greater. The dose of forces that is acceptable to patients is a complex equation to which there is no easy guide. The greater noise and vibration amplitudes of air transport must be balanced against shorter journey times, and thus reduced period of exposure. Pilots should consider how they can minimise the effects of vibration and acceleration on their charges through judicious choice of flight routing, cruise speed and takeoff and landing profiles. These variables should be discussed with the medical crew with the aim of optimising the patient’s comfort. Every effort should be made to load and unload the patient in sheltered conditions – such as in a hangar, if at an airport. The next development in transport research and equipment design will hopefully involve mitigating the physical effects of the journey on these vulnerable patients. Vibration damping and hearing protection tailored to the most vulnerable patients would be high on most flight teams’ wish-list.

for mother and baby to be flown in the same vehicle. Alternatively, a return trip or additional resource may be required; family separation, especially soon after birth, should be minimised. Where this cannot be avoided, information about the medical condition, the journey and the destination

The importance of infrastructure cannot be underestimated – if the helicopter landing sites require secondary road transport, the team is faced with a longer, more complicated transfer, which reduces the utility of air transport vascularisation of the retina, with long term visual complications. Therefore, all modes of ventilation and resuscitation must be available with variable oxygen concentrations. This may require pressurised air cylinders or a compressor, both of which add weight and complexity to the transport system. Neonatal medication volumes are tiny in comparison to adult therapies. Fluids require precise and measured dosing, so it is not acceptable to hang a bag of intravenous fluid up and allow gravity to deliver it to the patient. The number of medical devices – such as syringe pumps – required for a sick infant often seems to 32

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Family Finally, an aspect of neonatal transport that must not be overlooked is their family. There are often two patients to consider; the mother and the baby. Mothers may be unwell post-delivery and also require transfer. In a remote setting, the transport system may be configured

MI hospital should be provided. The transportation of neonatal patients by air is challenging. It relies on the right combination of airframe and equipment, as the sickest and smallest of these patients can present considerable technical challenges; they also demand a high level

of training and experience from those on the transport team. The care of neonates in the air requires a distinct mix of aviation and medical skills that should work together to make the transition from hospital, to aircraft, to hospital as smooth and uneventful as possible.

Resources 1.Data from the UK Transport Interest Group ukntg.net 2. Estimate extrapolated from data obtained from www.nets.org.au 3. helpappeal.org.uk

4. gamutqi.org

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Redstar Aviation

Starting operations in 1989, Redstar Aviation (RSA) was one of the pioneers of air ambulance services in Turkey, being the first local company to be granted an Air Operator Certificate (AOC) licence for air ambulance services from the Turkish Ministry of Transportation. In 2003, four ICU-equipped PZL Swidnik Mi-2 helicopters were added to the firm’s fleet, thus introducing HEMS to the country. In 1994, another first was added to the list, when RSA was granted the first Private Ambulance Service Operating Certificate in the country. The Turkish Ministry of Health now covers helicopter air ambulance services so RSA is focused on its fixedwing business. 34

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Redstar’s shares were taken over by Gulf Helicopters Company (GHC) in 2014, which led to a series of structural and management changes. With the involvement of GHC, RSA has adopted a new business strategy, a fresher brand image and improved operational capabilities, which is now resulting in an increased scope of operations, and a widening customer base. Fleet RSA has four Bombardier Learjet 45s, two of which are XRs, and all are dedicated air ambulances. Due to an increasing volume of flights, there are plans to increase this fleet over time, with a longer-range aircraft

to be added at some point in the future, according to Ozan Alemdaroğlu of Redstar. There are also plans to work with Gulf Helicopters, which operates 60 rotary aircraft, to offer maintenance and training services. Redstar’s aircraft are based at Istanbul’s Ataturk International Airport. Medical kit

• 2x Spectrum Aeromed stretchers • Corpuls3 Slim (Transport Monitor/ Defibrillators)

• Hamilton T1 (Transport ICU Ventilator) • Weinmann Medumat Transport with •

Neonatal Option (Transport ICU Ventilator) EPOC (Blood Gas Analyzer)

Device)

• Oxylog 3000 (Transport ICU Ventilators)

• David Medical TI-2000 (Transport Incubator)

• Welch Allyn Propaq LT (ECG, NIBP,

SpO2)

• Braun Perfusor (Syringe Pump) • Braun Infusomat Space (Infusion Pump) Staff There are 68 full-time staff working at Redstar, which includes pilots, medical crew and office-based staff. Key senior staff are: Celal Emre Dursun (Accountable Manager); Ozan Alemdaroğlu (Business Development Manager) and Adnan Bölükbaş (Operations Manager). Flying in the face of danger Operating out of Turkey, Alemdaroğlu explained, means that the company is well placed to operate flights into Libya, Iraq, Iran and Afghanistan. Such flights are undertaken

PROVIDER PROFILE

• Stephan F-120 Mobil • Weinmann Accuvac Pro (Suctioning

only after thorough risk assessments have been carried out, usually undertaken by members of staff that are ex-military and are thus familiar with these regions and the risks they represent. When patients are collected from high-risk countries, RSA has an agreement that it will only do tarmac transfers, where the patient is brought to the aircraft, to minimise risks to

Assistance Group (IAG), has ISO9001-2009 accreditation, and has also recently finalised its audit with EURAMI – the European Aero-Medical Institute, and is just awaiting its paperwork. While such accolades demonstrate a commitment to quality and safety, Alemdaroğlu told AirMed&Rescue that,

the crew. There are no overnight stops, and a maximum waiting time of four hours. As ever with air ambulance flights, though, there have to be contingency plans in place for alternative arrangements, because if there were to be, for instance, a problem with the aircraft, it can be difficult to quickly source spare parts and perform the necessary maintenance.

in reality, clients do not often ask whether or not the company has such accreditations. Being a provider for IAG, however, has changed the company’s business – with a client portfolio spanning the world, this gives RSA a higher profile on the international market, and makes it easier to reach clients directly, according to Alemdaroğlu.

Quality Implementing and then maintaining high standards is crucial to the safe and successful operation of any air ambulance firm, and accreditation is one of the ways in which firms can show clients that they are a highquality organisation. RSA is an accredited service provider for the International

Future With plans to extend maintenance capabilities and expand the fleet in order to cover more regions, there is no doubt that RSA has ambitions for the future. Keeping quality high while expanding, said Alemdaroğlu, is key to maintaining the success it has seen in the past 30 years of operations.

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Essential kit for medics AirMed&Rescue contacted air medical operators around the world to find out from their crewmembers what is carried, and what they wouldn’t ever leave base without

Midlands Air Ambulance Charity Aircrew Kit The charity’s three aircraft each carry a crew comprising pilot and two paramedics or flight doctors, plus full life-support medical equipment. Operating from strategically located regional airbases, 90 per cent of the region is reachable within eight minutes. Ian Jones, Critical Care Paramedic My favourite piece of kit is the aircraft itself. Without the helicopter, we wouldn’t be able to reach some of the most critically ill patients and offer advanced clinical intervention within minutes of the time of their incident. After that, my next favourite kit is the critical care drugs pack. This is a small bag of pharmaceuticals, which significantly changes pre-hospital care. Basically, it

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contains anaesthetics, which in small doses give pain relief; medium doses provide sedation; and in large doses mean full anaesthesia. In addition, we carry sedatives, paralysing agents, inotropes to increase blood pressure by increasing cardiac output, and vasopressors to increase blood pressure by vascular constriction, magnesium and IV antibiotics. The presence of these drugs in pre-hospital care enables us to perform a number of procedures alongside a doctor. This includes treating acute pain, sedation of patients when we need to manipulate significantly displaced fractures, or those with agitated head-injured patients. We can also sedate and paralyse patients who have suffered an out-of-hospital cardiac arrest, where we have achieved a return of spontaneous circulation, but with a hypoxic brain. These drugs are not used every day, but when they are, they are quite often the difference between life and death and can assist in patients’ overall outcomes.”

Luxembourg Air Rescue Luxembourg Air Rescue, which celebrated its 30th anniversary in 2018, currently has three EMS helicopters in service. While Air Rescue 1 and 2 are operating within the country, Air Rescue 3 is functioning as a cross-country EMS helicopter to provide the adjacent rural region of RhinelandPalatinate and Saarland (Germany) with a physician staffed EMSHelicopter. Dr David Sinclair, Medical Supervisor Since Air Rescue 3’s inauguration in 2005, it underwent several changes in configuration. It is used for primary retrieval and secondary transfer missions. Therefore, it holds all necessary medical devices for these missions ready. Some devices, such as the ICU respirator, the monitoring system or the syringe pumps are attached by a quick release function to the cabin. This ensures safe operation in turbulent weather conditions, while at the same time they can be easily removed and taken to the scene on primary rescue missions. LAR has recently replaced the BREAS LTV1200 ventilator with a Hamilton T1. This brings great advantages because of the setup and the improved user-friendliness. Patients are monitored with a Corpuls C3. This monitor also brings several advantages: the parameter box can be detached from the defibrillator/screen unit and carried separately, as the vital signs are transmitted via bluetooth to the unit. Especially when loading/unloading the patient, or extracting the patient from a difficult or constricted environment, it is helpful to have fewer cables. All other material we have stored in a modular configured set of backpacks. As German ambulances are DIN standardised, we know exactly what we can find onboard these ground ambulances, so it seemed quite unnecessary to bring exactly the same items to the patient for missions where an ambulance is already on the scene. In these cases or in ‘minor’ emergencies, we simply bring the ‘red bag’ (with or without the Corpuls C3, depending on the presence of an ambulance) to the scene. It contains an IV set, gloves, disinfection and airway sets,

contains all necessary equipment needed to treat major trauma or bleeding, such as: amputation set, burn set, bleeding control kit (e.g. tranexamic acid, pelvic sling, CELOX gauze, Israeli bandage, tourniquet) and a broad variety of sterile gauze and bandages. LAR has recently invested in the medical equipment for their helicopters and fixed-

Corpuls C3

suction pump and ventilation kit, monitor and invasive BP set, antidotes and thrombolysis set (Metalyse). For paediatric patients, we have the paedia bag, which is configured according to the Broselow tape. The principle of this is that

Broselow tape

the measuring tape gives an estimate of the child’s age, size and weight, which provides medical instructions including medication dosages, the size of the equipment that should be used, and the level of shock voltage when using a defibrillator. Each weight group is colour coded and the according devices can be found in a colour corresponding pocket. This immensely reduces stress-related mistakes. The final backpack is the trauma bag, which

wing aircraft. They are all now equipped with a high-end video laryngoscope to manage difficult airway situations, an ultrasound device (Lumify, Phillips) for EFAST protocol examinations, and last but not least, the new Corpuls CPR device, which allows non-stop chest compressions even in the constricted environment of a helicopter. This makes sense as we have co-operation agreements with Level One hospitals, which have established special eCPR procedure, to treat patients with cardiac arrest delivered with CPR devices (special and limited indication). The Air Rescue 1 and 2 helicopters are configured slightly differently, as all physician staffed EMS vehicles must be arranged the same way in Luxembourg. The fixed-wing aircraft have a similar modular system, adapted to fixed-wing missions. Pinpointing my favoured ‘kit’ is a tough question, as this obviously depends on the matter of the emergency. However I am extremely happy that due to the Corpuls CPR, we now have the possibility of transporting patients with persistent ventricular fibrillation to a cardiac centre under continuous CPR. Furthermore, the videolaryngoscope makes intubation in the constricted environment of a Learjet or helicopter so much easier and safer for the patient.

FAI Aviation Group

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including a C-Mac videolaryngoscope (Stor), surgical and decompression set, intraosseous access kit (ez-io), diagnostic pocket, stiffneck and AMBU bag. For ‘greater’ emergencies, or when an ambulance is not on the scene, we take the additional ‘blue bag’ along. This contains a sterile surgical set (including chest tube),

Based in Nuremburg, Germany, FAI operates a fleet of 10 dedicated intensive care air ambulance jets. Its group fleet of 26 jet aircraft and one turboprop includes seven Bombardier Global Express, five Bombardier Challenger 604s, one Challenger 850, 11 Learjet 60 series, plus one Premier 1A and one King Air 350. Dr István Lunczer Since our mission profile is so vastly different, which means we need very different kits for the individual cases, I can’t really choose the ‘most essential’ piece of equipment that we carry in general. Instead, I would rather choose the one I consider to be the best of our stuff, which is undoubtedly our transport ventilator (Hamilton T1). The reason I’m saying this is because this ventilator has been designed from scratch to be used in transport – it is not simply a miniaturised hospital ventilator. The main features that are very useful for us (besides the broad spectrum of ventilation modes, including intelligent ventilation, of course), are the built-in turbine, and the long-lasting, hot-swappable battery, which guarantee a long-lasting, autonomous use. Furthermore, it features a low-pressure oxygen connector, which could potentially tackle all the compatibility issues of the different oxygen connections worldwide. All in all, in my opinion, this is the best piece of equipment that we carry. Simon Schloth, Paramedic In my opinion, the best and most valuable piece of equipment we carry is our ventilator, the Hamilton T1. Very easy to use, it operates with a turbine so no external oxygen is necessary. Also, it is worth noting its durability, long-lasting battery and convenient ventilation modes, like active support ventilation (ASV). But probably for me, the most essential piece of kit we carry is a high-performing monitor like our Zoll X, because even non-ventilated patients can be monitored neatly. It is mandatory to have an overview on the patient including all vital signs.

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Adapter for Hamilton TI

Not just saturation and ECG, but invasive blood pressure and CO2 as well. Only by using these tools in this way are we able to intervene immediately in critical situations. Michael Trautner, Flight Nurse For me, the most essential piece of kit is the Hamilton T1 Ventilator. With it, and

Hamilton TI

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the neonate software and the special ventilating tubes, we are able to ventilate all kind of patients, from adults to extremely small paediatric and neonatal patients. Furthermore, the battery capacity is big enough to last for several hours without any external power supply, so lengthy ground transports are not a problem. However, for me, it is not just the ventilator – in fact, my favourite piece of kit is a very small, but essential, part of it: a low-pressure adapter. Normally to operate a ventilator, we have to use lowpressure oxygen from specific bottles, and all around the world there are different adapters for these bottles that enable the flow of pressured oxygen to the ventilator. Carrying dozens of different adapters on the plane isn’t sensible, but with this specific piece of kit, the T1 is able to work without pressured oxygen. All we have to do is plug this low-pressure adapter into the T1, connect a regular oxygen line to it, press some buttons to switch it into lowpressure mode, and voila, theT1 is able to continue its work. I carry one of these with me on all my missions – in fact, it’s attached to my crew ID so I can’t lose it!

Haiti Air Ambulance HAA is a non-profit organisation dedicated to providing emergency helicopter services to the people of Haiti. It operates two Bell 407 medical helicopters leased from Air Methods Corporation. Stacy Wolf, Current Board Member and former flight paramedic in Haiti

In Haiti, we carried a general medical equipment list similar to any other North American air medical aircraft to include all the necessary medications, two IV pumps, a full functioning monitor, and ventilator. We carry a few items not commonly found on the majority of aircraft; due to the austere environment and scarcity of certain types of rescue or medical equipment on the ground in a developing nation such as Haiti. For example, we carried a bonesaw kit onboard due to the chance we may respond to an entrapped patient and there was no availability of Fire Department’s hydraulic rescue tools like we might have in America. We carried other items like chest tubes as well, as sometimes we had to provide more definitive treatment out in the field prior to transporting the patient. The two most important and very different

F items we carried were our survival kit and our start stick battery pack in order to jump start the aircraft if necessary. Our survival kit is made up of many extra items due to the remoteness of the countryside we were flying over. We carried extra water, food, and camping materials if possible. Our kit was at least twice as robust as that of most helicopter services in America. As far as my favourite or most useful piece of equipment? Most flight crew

at the overall picture, I would say that, operationally, the most important part of equipment would be the survival kit due to the reassurance it would provide me flying over the terrain and areas Haiti offered. Medically, I really relied on our monitors, as sometimes we were helping patients that might’ve been sick for days but had never had a good look at vital signs or any other information the monitor would provide answers to. They gave me a great picture of what had been

AirEvac Lifeteam Air Evac Lifeteam is the largest independently owned and operated membership-supported air ambulance service in the US. Jon Fannin, flight paramedic/ Base Clinical Lead at the company’s West Liberty, KY air medical base

members would say the most important piece of kit they carry are the snacks in their flight suit pockets for those times

going on prior to our arrival and what to expect through the transport. Along with the monitor, and my EMT translator partner

It’s difficult to say whether I have a ‘goto’ piece of equipment I use in every situation, but if I had to pick a favourite piece of equipment, it would be one of our newest tools – the IntuBrite. Even more than the tool, I like the teamwork it promotes, because everyone involved in the patient’s care at that point can visualise the intubation process.

Survival Kit

you are out all day without the ability to eat. I tend to agree, but if I’m looking

on board, I could learn what was going on both outside and inside very quickly!

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You spin me round Spinning avoidance is a vital skill for hoist operators. Mario Pierobon talks to experts in the industry about tactics and tools that can help mitigate the risk of spinning Helicopter hoist operations (HHO) can involve either humans or cargo. In either case, the load is suspended under the hovering helicopter and unless specific measures are taken to counter it, there is a strong possibility that the load will start to spin. Apart from being very unsettling, especially to the human at the end of the line, there is the possibility that some very real dangers develop from the spinning load. “Spinning is a potentially very dangerous situation that could lead to, at best, extreme disorientation and/or injury to the winchman/casualty or, at worst, the hoist cable being cut, with little control over the consequences to the winch man/ casualty,” said Andy Tillion, Senior Pilot at 40

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search and rescue (SAR) training specialists HeliOperations. “Spinning can become violent and potentially cause damage to the cable and the helicopter. There is also a risk of the rescue swimmer/ winchman losing consciousness due to rapid spinning,” explained Kim Gardberg, SAR Standard Pilot at CHC. The main cause of spinning during HHOs is the effect of the downwash from the helicopter on the individuals or the other loads attached to the hoist cable – usually in low-wind conditions – in combination with the load’s aerodynamic shape. According to Bob Cockell, President of Air Rescue Systems (ARS), most of the time issues with spinning and conical rotation can be directly attributed to just a few factors: • Misunderstanding of the physical laws affecting the drivers, creating unwanted load movement • Misunderstanding of the techniques

A spin that involves oscillation may result in an object strike for the load • • •

involved in HHOs No training process to achieve desired results Lack of technical expertise/experience Organically grown training and operational modes – aka ‘the way we’ve always done it’.

The risks of spinning According to Rob Thomas of the School for Mountain Leadership in South Africa, the main safety risks associated with spinning are vertigo, disorientation and nausea, object strike or entanglement, centrifugal forces, skid/ step rub and force inputs onto the aircraft. While vertigo, disorientation and nausea are unpleasant, they are not really life threatening – at least, not until a person is put down onto terrain that is itself hazardous, i.e. where the person either needs to fend off objects during the hoist, or needs to be agile and spatially aware once s/he is down. “Then the disorientation may become life threatening. It may also become problematic for the aircraft if the person is unable to fend off sufficiently to avoid entanglement of the hoist cable with obstacles,” said Thomas. “Nausea itself does not become problematic until a person is unable to protect the airways, such as when immobilised and strapped down on a stretcher, which is often the case during an air rescue. Apart from the obvious risk of drowning, there are other problems which may arise and impair, or even cause the death of the patient, i.e. lung damage from stomach acids or lung infection from fermenting and partially digested foods.” HHOs very seldom occur in wide open spaces. Even maritime hoisting operations

are subject to the hazards of a ship’s superstructure, masts, derricks and the likes. A spin that involves oscillation may result in an object strike for the load. “If it is cargo, you may end up damaging the load. Having a human load suffer an object strike is undesirable – especially since a fair number of the people we load onto hoists are already injured and are being rescued. Equally undesirable is to have a stretcher attendant getting crushed between a stretcher and an object. Some spins can be so fast that an object strike could cause serious injury,” Thomas explained. As the load spins faster and faster, the centrifugal force increases the forces exerted on the body. These forces can get to the point where a load can start to disassemble mid-air if the forces are experienced in a direction not

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He said: “We have to do a better job of educating the rescue community and providing a clear path to both solutions and alternatives for these input factors that affect their operations.” Rotor flow, he added, is a patterned output that can be anticipated and therefore the unwanted effects of it can be mitigated.

anticipated in the assembly of the package. “There is at least one recorded case of a patient being ejected from a stretcher because of a violent spin, resulting in a 30 ft ground fall and a prolonged stay in hospital,” noted Thomas. “Prudent rescuers now secure their patients in such a way that they cannot be ejected from the stretcher, regardless of the centrifugal force. A sufficiently violent spin can have such outward pull, that any stretcher attendant is pulled horizontally outward from the stretcher and may sustain injury from attempting to hold on instead of relying on their tether to the stretcher package.” When the load starts to spin, there is a possibility that the hoist cable will start to rub on a step or skid. The conical rotation is the most destructive aspect, and individual

Spinning can become violent and potentially cause damage to the cable and the helicopter www.airmedandrescue.com

strands of the cable can be parted. “While the damage to these individual strands is not likely to cause the cable to weaken sufficiently to break, they do create flying ends. These strands might become sufficiently pronounced to snag on the hoist assembly during the retrieval of cable, rending the hoist unable to retrieve the full length of the cable and therefore making it effectively inoperable,” warned Thomas. “If you do not have a dualhoist installation it becomes particularly problematic if there is no opportunity to land nearby (i.e., within ±10 newton metres) to recover whoever may be on the hoist. It may even force you to abandon whoever is still down below waiting to be hoisted.” At any point in the oscillation, an oscillating load generates a horizontal force, he explained: “This force will be in the same direction, as the load is relative to the centre of gravity of the aircraft. While it may not be great, it is an additional ever-changing force to be countered in addition to having to keep the aircraft stable, often in alreadydemanding conditions. The smaller the aircraft, the greater the effect of this force input will be.” Spinning prevention techniques The techniques to use to avoid or prevent spinning during HHOs fall mostly in the prevention category and include a safety assessment, a reduction of the surface area and making the load symmetrical. According to Tillion of HeliOperations, a safety assessment of the downwash effects should be made as part of the pre-hoisting 42

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F brief. “If, due to the wind conditions and the given situation, the downwash effects are manageable, the hoisting will be conducted in the normal fashion without any modification to the profile. If, however, the downwash is considered an issue, the common preferred technique employed is to deploy the winchman in an offset position with the aircraft moving forward to effectively create wind and push the downwash behind the aircraft.” Any surface area provides something for the airflow to push against. This surface area can be reduced either by making it permeable to air or making it smaller. As an example, Thomas pointed out that a person being hoisted has a better profile for downwash if they are sitting upright with their legs hanging down and the arms at the sides than if they are angled backwards at 45° with the legs sticking out straight in front and the arms outstretched. “Another example is a rescuer with a backpack, who presents a smaller profile to the downwash if the backpack is suspended from the hoist hook but hangs directly under the rescuer’s backside than if they have it on their backs,” said Tillion. “A wire basket stretcher allows air to flow directly through it, while a solid plastic tub stretcher acts as a scoop for the wind. An empty stretcher hoisted down to the ground in a vertical orientation offers a smaller surface area than a stretcher already horizontally configured

the common preferred technique employed is to deploy the winchman in an offset position with the aircraft moving forward to carry a patient. Similarly, where possible, cargo loads should be configured to present a small surface area to the downwash. Cargo nets allow for better airflow than cargo bags,” he said. Bags that fly like doors, rescue vests that mean the victim is lying back too far, and the use of litters that were designed for ground rescue are all factors contributing to spin, said Bob Cockell. He told AirMed&Rescue: “Good rider position should bring the body’s centre of mass in towards the centre axis of the cable with the head at the bumper, arms in and legs tucked under your butt to create a cannonball

so to speak. It is hard, if not impossible, to get a cannonball spinning because of the concentric, balanced nature of its mass.” According to Gardberg, there are also ways to avoid the downwash altogether: “The more wind, the further aft the downwash will move. At around 1020 knots, the effect from the downwash is almost completely mitigated. If there are light winds, you can add some forward speed to the helicopter after the lift (after confirming that the rescue swimmer/winchman are free with no obstacles in the way). A forward speed of about 10-15 knots will, in most cases, eliminate the risk of spinning, or even stop the spinning if it has started. There are also dynamic hoisting techniques, which require flying with the rescue swimmer/winchman already in the hoist to the pickup position, leaving them in the static hoist position as short a time as possible,” he said. “Moreover, using a high line will give the rescue swimmer/ winchman something to hold on to or make a stretcher fixed during the hoisting. When hoisting with a stretcher, there is also

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Maritime Search & Rescue Tallinn Estonia Aerospace Mental Health and Wellbeing Royal Aeronautical Society London UK

JUNE a small triangle (like a sail) that the rescue specialist can use to stop the spinning by contracting it with the ‘sail’. Even fins can be used in the downwash, at times, to control the movement.” Making a load symmetrical as a technique to manage the risk of spinning may sound easy, but sometimes the implementation can be tricky. “In order to find the centre of gravity of a stretcher with a patient in it, for example, we have to lift it off the ground. That can be tricky if the patient weighs over 100 kg. Furthermore, a stretcher may be symmetrically configured on the ground, but hoisting it together with an attendant will nearly always tilt the stretcher towards the attendant. People being hoisted need to configure themselves (or be configured) for symmetry. When hoisting in pairs, it helps to try to match pairs for size so that there is not a big size discrepancy,” advised Thomas. ARS has designed a product specifically to counter the risk of spinning – the Spin-Fin, said Cockell, is ‘100-per-cent effective’ and works on the majority of bag and litter type devices on the market. Designing a rescue device, he said, should result in a product that specifically solves a problem. “For example,” he added, “as stated before, there are bags that are designed like flying doors and have huge problems when it comes to unwanted load movement. Problems which, when these poorly designed and tested systems are exposed to the large rotor-flow influence of modern SAR aircraft, become immediately apparent 44 44

and can catch teams off-guard.” Handling an emergency In any case, according to Tillion, there is little the winchman can do to prevent the spin once it has started; the responsibility lies with the hoist operator and the options open to him are to recover the winchman/ casualty to the aircraft or, if possible, put the winchman/casualty on to the surface to stop the spinning. “With the advent of modern SAR helicopters with a higher rotor disc loading, this issue has become increasingly more prevalent and SAR operators have had to adapt their winching techniques accordingly,” he told AirMed&Rescue. “If spinning occurs, there are three major actions determined by the hoist operators evaluating each specific situation. The procedure requires, as needed, asking for speed forward if possible (discussed during prebriefing), lowering the rescue specialist back into the water or down to the surface, and continuing to pull the hoist up as quickly and/or carefully as possible,” according to Gardberg. Sharing best practice There are some organisations that discuss SAR issues, such as the European Rescue Swimmers Association (EURORSA) and Helioffshore, which has recently created a SAR forum for a range of technical discussions. “The greater SAR community is dedicated to sharing information, identifying best practices and setting common standards,” concluded Gardberg.

6-7

Australian & New Zealand Search &Rescue Conference RACV Royal Pines Resort, Gold Coast Australia World Maritime Rescue Congress

15-19 Vancouver Canada

JULY

15-20

APSCON CenturyLink Center Omaha US

AUGUST

AAMS Safety Management Training Academy Pittsburgh US

NOVEMBER

4-6

5-7 AIRMED&RESCUE

International Conference on Urban SAR San Francisco US

Air Medical Transport Conference Atlanta, Georgia US Vertical Flight Expo & Conference Farnborough UK

Medic’Air International

Ace Air & Ambulance (Pvt) Ltd. 2 Mount Road, Avondale, Harare, ZIMBABWE

+263 (4) 302 141

AMREF Flying Doctors Dr Bettina Vadera Medical Director

Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA tel: +254

20 6000 090 fax: +254 20 344 170

email: emergency@flydoc.org website: www.flydoc.org

medic-air.com

+212 5 24 38 13 88

Asia Air Ambulance Asia Air Ambulance Co. Ltd., Bangkok599/59 Ratchadaphisek Road, Jatujak, Bangkok 10900, THAILAND

+668 9896 9000

asiaairambulance.com

EDS AVIATION PTE LTD 33 Ubi Avenue, #08-13, Vertex Tower B, SINGAPORE, 408868

+65 9836 3265

eds-aviation.com

+65 6483 5412

flyingdoctorsasia.com

Flying Doctors Asia A’Posh Bizhub, 1 Yishun Industrial St 1, #08-03, SINGAPORE, 768160

LifeFlight

Awesome Air Evac Hanger 104C, Gate C, Lanseria Airport, Lanseria, SOUTH AFRICA

Dar El Bacha - Tizougarine 5, 40000 Marrakech Medina, MOROCCO

ace-ambulance.com

(ASIA-PACIFIC)

AIR AMBULANCE (AFRICA)

SERVICE DIRECTORY

+27 11 430 1777

awesomeairevac.com

+61 7 5553 5955

LifeFlight.org.au

Medic’Air International 每递安国际

ER24 Cambridge Manor Office Park, Manor 1, Stone Haven Road, C/o Witkoppen & Stone Haven Roads, Sandton, Paulshof, SOUTH AFRICA

PO Box 15166, City East, QLD 4002, AUSTRALIA

+27 (0) 10 205 3100 er24.co.za

885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

+86 2163 558289

medic-air.com

www.airmedandrescue.com

Medical Wings 222 Don Mueang International Airport Office Building 3rd Floor, Vibhavadi Rangsit Road, Sanambin, Don Mueang, Bangkok 10210, THAILAND

+662 247 3392

medicalwings.com

Air Alliance Medﬂight GmbH SIEGERLAND AIRPORT, Werfthalle G1, 57299 Burbach, GERMANY

+49 170 366 4933

air-alliance.de

AIRLEC Air Espace Zone Aviation Générale, 33700 Mérignac Cidex 05 FRANCE

+335 56 34 02 14

AIR AMBULANCE (EUROPE)

AIR AMBULANCE (EUROPE) (APAC)

SERVICE DIRECTORY

airlecairespace.com

quickair.de

+49 2203 955 700

Hangar 3, Cologne Airport, 51147 Cologne, GERMANY

Rescue Wings Malta +356 2703 4129

186 Ix Xatt Santa Maria Estate Mellieha MLH 2771, MALTA

Swiss Air-Rescue (Rega) Rega-Center, PO Box 1414, CH-8058 Zurich, SWITZERLAND

Capital Air Ambulance

+41 44 654 33 11

rega.ch

Tyrol Air Ambulance capitalairambulance.co.uk

DRF Luftrettung / German Air Rescue +49 7007 3010

drf-luftrettung.de/air-ambulance

EURO LINK GmbH +49 89 6137 2103

Allgemeine Luftfahrt, D -85356 München Flughafen, GERMANY

FlyEuroLink.de

European Air Ambulance Luxembourg Airport, B.P.24, L-5201, Sandweiler, LUXEMBOURG

+352 26 26 00

air-ambulance.com

FAI – rent-a-jet AG

taa.at

+43 512 22422 100

Fuerstenweg 180, A-6026 Innsbruck-Airport, AUSTRIA

AIR AMBULANCE (NORTH AMERICA)

+44 845 055 2828

Airport House, Exeter International Airport, EX5 2BD, UK

Rita-Maiburg-Str. 2, D-70794 Filderstadt, GERMANY

Quick Air Jet Charter GmbH

Aeromedevac Air Ambulance Gillespie Field Airport, 681 Kenney Street, El Cajon, CA 92020,USA

+(800) 462 0911

aeromedevac.com

+1 619 754-6755

aeiamericas.com

AirEvac International 8001 South InterPort Blvd., Suite 150, Englewood, CO 80112, USA

AMR Air Ambulance 001 South InterPort Blvd., Suite 150, Englewood, CO 80112, USA

+1 720 875 9182

AMRAirAmbulance.com

Global Jetcare, Inc.

Flughafenstasse. 124; 90411 Nuremberg; GERMANY

+49 911 36009 31

fai.ag

GlobalMed International

+1 352 799 7771

globaljetcare.com

Helidosa Aviation Group +212 5 24 38 13 88

Auf Roedern 7c, 56283 Pfaffenheck, GERMANY

15421 Technology Dr. Brooksville, FL 34604, USA

Karla Viñas

medic-air.com

Air Ambulance Account Executive

Jet Executive International Charter Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY

+49 211 602 7775

jetexecutive.com

Malteser Service Center Malteser Service Center Kalker Hauptstr. 22-2, 51103 Köln, GERMANY

tel: +1

+49 221 98 22 333

AIRMED&RESCUE

email: k.vinas@helidosa.com website: helidosa.com

Jet-Rescue Air Ambulance +33 141 72 1414

medic-air.com

Suite 100, 7777 Glades Road, Boca Raton, Florida 33434, USA

+1 786 619 1268

medjetsUSA.com

Skyservice Air Ambulance

North Flying a/s North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

(829) 345-7219

malteser-service-center.de

Medic’Air International 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

Hangar 1 10 & 14 La Isabela Airport Santo Domingo Dominican Republic

+45 9632 2900

northflying.com

Montreal/PE Trudeau Int Airport, 9785 Avenue Ryan, MONTREAL (Quebec), H9P 1A2, CANADA

+1 514 497 7000

skyserviceairambulance.com

Latitude Air Ambulance Diana Iaquinto

Director Sales & Medical Ops

John C. Munro/Hamilton International Airport, 9300 Airport Rd. Mount Hope. Ontario, L0R IW0, Canada tel: +1

ASSOCIATIONS

fax: +1

289 426 1133 289 426 1132

email: 24.7@latitude2009.com website: www.latitude2009.com

AAMS 909 N. Washington Street, Suite 410, Alexandria, VA 22314, USA

tel: +(703)

836-8732 fax: +(703) 836-8920

website: www.aams.org

MEDICAL ESCORT ON COMMERCIAL AIRLINES

AIR AMB. (N. AMERICA)

SERVICE DIRECTORY

AMREF Flying Doctors Dr Bettina Vadera Medical Director

Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA tel: +254 fax: +254

20 6000 090 20 344 170

email: emergency@flydoc.org website: www.flydoc.org

European Air Ambulance

+49 6742 897 425

Auf Roedern 7c, 56283 Pfaffenheck, GERMANY

Graham Williamson CEO

VANCOUVER – TORONTO – HONOLULU

Executive Director

4835 Riveredge Cove, Snellville, GA 30039, USA website: www.iafccp.org

GROUND TRANSPORT - MEDICAL

fax: +770-979-6500

tel: +1 fax: +1

250 947 9641 877 288 2908

email: graham.williamson@LifeSupportTransport.com

website: www.LifeSupportTransport.com

Medical Wings 222 Don Mueang International Airport Office Building 3rd Floor, Vibhavadi Rangsit Road, Sanambin, Don Mueang, Bangkok 10210, THAILAND

Gateway International EMS +1-202-499-2294

globalmed-international.com

LIFESUPPORT Patient Transport

Monica Newman

600 Pennsylvania Ave SE, Washington DC, 20003, USA

air-ambulance.com

GlobalMed International

IAFCCP

tel: +770-979-6372

+352 26 26 00

Luxembourg Airport, B.P.24, L-5201, Sandweiler, LUXEMBOURG

+662 247 3392

medicalwings.com

Prime Nursing Care, Inc. gateway-ems.com

1918 Harrison Street, Suite 215, Hollywood, Florida, 33020, USA

+1 754 999 0460

primenursingcare.com

One Call Medical Transport 24hr Worldwide Ground Transports 3815 E Main St., Suite C St. Charles, IL 60174, USA tel: +1 fax: +1

630 444 2100 630 823 2900

To have your company listed in our service directory contact the sales department now: sales@airmedandrescue.com +44 (0)117 925 51 51 (opt.1)

email: ops@ocmt.com website: www.ocmt.com

www.airmedandrescue.com

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