AirMed & Rescue July 2019 by AirMed & Rescue Magazine

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AIRMED&RESCUE

Issue 98 | July 2019

ISSUE 98 JULY 2019

IN THIS ISSUE: Pre-hospital blood transfusions under the microscope What difference are drones making to aerial police SAR services? Management of assets during airborne police operations

Police Aviation Edition

AIR AMBULANCE EXPERTISE

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EDITOR’S COMMENTS It feels like we are officially entering summer in the northern hemisphere, and with the sun shining, more people are venturing outside for their adventures. Inevitably, this has resulted in more callouts for SAR and Coastguard personnel around the world. Education of the public about the dangers of heading out unprepared to conquer mountains and swim in the sea is key to preventing loss of life, and this is paramount for SAR organisations. Speaking of education, we have two articles in this issue about mental health – specifically, the mental wellbeing of the men and women who dedicate their lives to saving others. Pilots, technical crew members and medical crew are all exposed to traumatic situations when engaged on a mission, and communication with them, and with the victims, is key to making sure there are no long-lasting ill effects on their mental health as a result of their work. See pages 10 and 20 for more information. This issue is the Police Aviation Special Edition, in which we look at how police forces in different jurisdictions are making use of UAVs to bolster their efforts during search missions. We also have an analysis of police asset management systems, in which we talk to the industry’s top players about their solutions for forces who need to carefully manage how their helicopters, fixed-wing aircraft and drones are deployed.

Editor

Mandy Langﬁeld

Safe ﬂying all.

CONTRIBUTORS

Andy Elwood Andy is no stranger to traumatic incidents, with 20 years in Emergency Services, mostly as a Paramedic on Search and Rescue Helicopters. He now sits on the National Mental Health & Wellbeing Steering group for College of Paramedics, is a Patron of PTSD999, and a Mind Blue Light Champion. Andy also delivers Human Factors training to NHS clinicians and has delivered face-to-face and online medical training for responders treating civilian casualties in the Syrian crisis.

Lauren Haigh Lauren has worked in the publishing industry for eight years and reads and writes about healthcare, science and travel insurance on a daily basis.

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.

Robin Gauldie Robin Gauldie is a former editor of Travel Trade Gazette and other travel and tourism industry titles. Now a freelance journalist specialising in travel, aviation and tourism, he writes for a variety of international consumer and business publications including International Travel & Health Insurance Journal, AirMed&Rescue, and Financial World.

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Editor-in-Chief: Ian Cameron Editor: Mandy Langﬁeld Sub-editors: Robyn Bainbridge, Lauren Haigh, Stefan Mohamed, Sarah Watson Advertising Sales: James Miller, Kathryn Zerboni 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

EBACE 2019 Conference report

ASU to deliver prototype helmets to US Air Force

Bell completes AMS training in China

Coulson and NSW purchase Boeing 737 Fireliner

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 98 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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FEATURE 12

Life-giving substance Pre-hospital blood transfusions under the microscope

CASE STUDY 24

Beware the Idai of March Ace Air & Ambulance report on the aftermath of Cyclone Idai

INDUSTRY VOICES 10

Itâ&#x20AC;&#x2122;s good to talk Closure after a traumatic event

On the front line SAR personnel mental health

POLICE AVIATION 28

Drones â&#x20AC;&#x201C; valuable asset or liability? What difference are they making to aerial police SAR services?

Mission control Management of assets during airborne police operations

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NEWS

EBACE 2019 “The excitement and enthusiasm surrounding this year’s show has been palpable throughout the week,” said EBAA Secretary General Athar Husain Khan. “EBACE2019 was characterised by new products, new business models, new investment opportunities and a new generation of aviation professionals determined to make their mark.” There was a variety of panel sessions over the course of the conference, covering topics such as sustainability, handling an aviation crisis and electric vertical take and lift (eVTOL) potential.

900B aircraft. Each Falcon 900B aircraft will be upgraded to a five-display configuration and will have installed upon it UA’s dual UNS-1Fw SBAS-Flight Management System with five-inch Control Display Units, Engine Interface Unit, UniLin UL-801 Communications Management Unit, Solid-State Data Transfer Unit and dual Radio Control Units for a ‘total package’ solution. Textron Aviation and Babcock International have exhibited their first Cessna Citation Latitude configured for air ambulance operations. Selected because the contract between Babcock and Air Ambulance Service of Norway called for specific needs that only a jet could deliver, the reconfigured aircraft is part of an 11-aircraft order, including 10 Beechcraft King Air 250s, that Babcock Scandinavian Air Ambulance will use to provide air

Universal Avionics Falcon 900B

Opening talk at EBACE

Cyrus Sigari, Co-Founder of jetAVIVA, said while moderating a panel on eVTOL and urban air mobility: “This space is growing exponentially. What these companies are doing is incredible, and it’s very exciting.” Meanwhile, other announcements from the event included: Universal Avionics (UA) is to supply Gestair MRO with EFI890R Advanced Flight Display to be installed in five Falcon

ambulance support across the country. In line with the industry’s Business Aviation Commitment on Climate Change, 23 attendees flew into EBACE in Geneva on sustainable alternative jet fuels (SAJF), setting a new EBACE record and demonstrating the industry’s commitment to reducing carbon emissions, whilst promoting the safety and efficiency of SAFJ.

The annual European Business Aviation Convention & Exhibition (EBACE) event took place from 21 to 23 May in Geneva, Switzerland.

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NEWS

ASU to deliver prototype helmets to US Air Force Following its selection as one of three finalists of the AFWERX Fixed Wing Helmet Challenge in November 2018, Aviation Specialties Unlimited (ASU) has announced its delivery of four prototype helmets to the US Air Force’s Nellis Air Force Base in Las Vegas, Nevada. ASU’s AFWERX helmet prototypes were designed to address improved comfort, safety and ease of integration of future technologies. The Light Aviation Stable Ergonomic Relaxed (LASER)-Fit helmet concept is a collaborative effort with Paraclete Aviation Life

ASU’s technical and programme knowledge, we were able to produce the prototypes we feel will not only meet, but exceed, AFWERX expectations. As a retired military aviator myself, I know the importance of this project. This Support. And the solution aims helmet can keep our men and to improve the Air Force’s fixedwing helmet by reducing neck load women safer, more comfortable, and ready to take on their next mission.” and neck injury and providing ASU Chief Technology Officer improved comfort and stability, Dr Joe Estera explained that all the while integrating seamlessly with current and future technologies the helmets include the latest in impact, thermal, head-borne and attachments. weight and stability management, “Our collaboration with ASU on and that the design integrates a this project enabled our companies balance of comfort and protection. to produce an innovative solution “We feel we were able to address that we believe will become the the requirements using newer standard on the next generation of helmets,” said Paraclete Aviation Life materials for manufacturing Support Owner and President Scott that were not available in older generation helmets,” he added. Hedges. “Between our expertise in aviation helmet manufacturing and “We also designed the prototypes

Bell completes AMS training in China A collaboration between Bell Helicopter, Shaanxi Helicopter Co. Ltd. (SHC) and Shaanxi Provincial People’s Hospital had more than 50 personnel successfully complete an air medical services (AMS) training exercise in China this May. The exercise marks part of an initiative launched by the National Health Commission of China and the Civil Aviation Authority of China (CAAC) that aims to develop air medical capability for the Implementation Program for a Joint Pilot of AMS. The exercise covered aviation safety practices and culture, functions and responsibilities for medical transport, flight planning and decision making, crew resource management and flight physiology. 8

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In addition, an introduction to the cross-functional coordination among emergency response, medical care, dispatch and aviation was provided to create a safe and effective air medical network solution for China. “Together with SHC, we are excited to be leading the development of an AMS network in China,” said

Jacinto Monge, Bell Managing Director for North Asia. “During the two-week event, expertise on best practices was shared through academic seminars and practical training using real-life simulations.” Bell also revealed that research, from The Association of Air Medical Services (AAMS) and ASCEND, has shown that air medical services can significantly reduce the mortality rate of patients and improve treatment

BELL SUCCESSFULLY COMPLETE AIR MEDICAL TRAINING EXERCISE IN CHINA

to easily add new technologies that we anticipate will be integrated into the helmets of the future. This forward-thinking design mentality not only allowed us to address our current needs, but also future enhancements.” Tactical Acquisitions Corps reviewed the helmets and the final decision on the final design is expected to be made in August 2019. A production contract of up to US$20 million is expected to be awarded to the winner in the fiscal year 2021. “To be selected as a finalist by the AFWERX team is a tremendous honour,” said ASU Director of Business Development Chad St Francis. “Our team has worked on this project diligently for months to help solve the needs presented by the Air Force for the next generation of helmets.”

outcomes. At present, Bell noted, there are more than 1,200 civilian air medical helicopters serving 320 million people in the US; while China currently has less than 100 civilian air medical helicopters serving 1.4 billion people. These exercises highlight China’s central government’s plans to build a modern healthcare system, which will include an extensive air medical services network.

NEWS

Coulson and NSW purchase Boeing 737 Fireliner Australia-based New South Wales (NSW) Rural Fire Service (RFS) and Canadabased Coulson Aviation have secured a deal that will see the NSW Government purchasing one Boeing 737 Fireliner and two Citation V Lead / Intelligence aircraft, in addition to securing Coulson as the provider of all flight and maintenance personnel with a 10-year operational contract.

The first large air tanker ever to be purchased by a country, the B737 Fireliner has multi-role capability, and it will be highlighted in this unique new operation. “When we started the B737 Fireliner programme, we set out to create a new generation of airtanker,” said Britton Coulson, Vice-President of Aviation. “The goal was to utilise the latest SMART technology in our tanking system and create a multi-use firefighting aircraft that would create the best value for our customers.” NSW RFS Acting Commissioner Rob Rogers said that the RFS had

evaluated several different large and very large air tankers over recent fire seasons and had settled on the B737 Fireliner as the preferred option. “We are honoured to have our Boeing 737 Fireliner and Citation Vs chosen by RFS to protect the beautiful state of New South Wales,” said Wayne Coulson, President and CEO of the Coulson Group. “Our C-130 Hercules fleet has supported RFS for several years, along with our first B737 Fireliner during the 2018/2019 fire season. We see the NSW government leading the industry with new creative solutions in protecting life and property.”

AirMed&Rescue attends PavCon 2019 LFRS drone

LFRS drone helps firefighters over 2,000 times Lancashire Fire and Rescue Service’s (LFRS) trusty drone has completed a landmark number of missions since its introduction in 2016 and has even helped LFRS to become the first fire and rescue service in the UK to locate a missing person using a drone. The invaluable piece of technology, which was partly funded by a £10,000 donation (partially made up of money seized from criminals under the Proceeds of Crime Act) given to the service, has completed more than 2,000 flights. It has undertaken a number of duties, including assessing buildings with fire damage (it can identify fires burning within a structure thanks to infra-red capability), identifying hazards, assisting in boat rescues and finding missing people. And the LFRS have expressed their gratitude during Dementia Action Week. “This Dementia Action Week we’re especially grateful that we have the drone as we’ve been able to find missing people who live with dementia who’ve unknowingly left the house at night and forgotten where they live,” said a spokesperson for LFRS.

The 2019 Police Aviation Conference took place in the Renaissance Hotel at Schipol Oost Airport in Amsterdam on 4-5 June, and in attendance were police aviation professionals from around the world, representing many different forces. Beginning with a police-only training day, the main focus of the conference was in providing educational seminars that stimulated debate and opened up discussions on new protocols that will enhance the safety of aerial police operations in different jurisdictions. Unsurprisingly, several speakers gave presentations on the topic of unmanned aerial vehicles / remotely piloted aerial systems, among which were Tjeerd Tiedeman and Haiko Kroeze, who offered some very interesting insights into how the Dutch police and Dutch Ministry of Defence are deploying drones in different ways, touching on the issues of training and regulation. With over 100 attendees and 25 exhibitors, the conference was a great learning experience for all involved, offering valuable industry education on topics such as global variations in system management, best practice, and the vital importance of crew resource training. The last topic was covered in an engaging presentation by Sergeant Bill Probets, Chief Pilot and Unit Executive Officer for the East Bay Regional Park District in California and showed how important it is for tactical flight officers and pilots to go through crew resource training to ensure survival during a critical incident. Thanks should go to Bryn Elliott and the organising team for a fantastic and informative event.

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It’s good to talk Essex & Herts Air Ambulance, a charitable service in the UK, discusses the need to support airlifted patients and each other after a traumatic event Whether they are helping patients with

EHAAT Clinical Director Stuart Elms explains: “We try to foster a feeling of family and belonging. It’s not easy for every single team member to get this at ﬁrst, but after a while, the team ethos and esprit de corps works and people accept that we are an organisation that genuinely

airbase visits by former patients can be just as important for the team who attended them the team can do their best for the patient. For the last two years, Tony Stone and Adam Carr have been EHAAT’s Patient Liaison Managers (PLMs). This means that they assist patients with their recovery by helping them understand what happened after someone called 999 and guiding them towards appropriate support. Adam says the PLMs ﬁll in the gaps for people who have had ‘the worst day of their life’.

EHAAT AgustaWestland 169 Helicopter

their recovery or coping with the memories of a difﬁcult case, the Critical Care Teams crews from Essex & Herts Air Ambulance (EHAAT) aim to be as open as they can be. 10 10

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cares about them.” Patient relations Looking after each other effectively means

“Most can’t remember that day, or the days leading up to that. That could be because of the incident or it could be because of the drugs and interventions we’ve performed

crew like to say thank you as well.” Physician support As well supporting patients, EHAAT takes great care to monitor the impact of its work

EHAAT’s Student Resilience Programme is designed to ensure that medical students on an elective placement are equipped with appropriate coping strategies and have access to help and support

Tony Stone and Adam Carr

patients can be just as important for the team who attended them: “Patients always come along with their families and they want to say thank you. Actually, I think the

upon its clinicians. Stuart Elms comments: “We talk about our thoughts and feelings as part of our governance, every aspect of the mission is examined, the patient care is one

INDUSTRY VOICE

that have taken away their memory. They ask questions that people wouldn’t think of. It may be something really small, but that small thing builds up and up and becomes really important to them.” Tony believes any help the pair can provide is worthwhile: “If we can make their journey and their recovery even one-percent better, then that’s a success.” As well as helping patients, a visit from Tony or Adam can provide valuable feedback which helps EHAAT’s Critical Care Team ensure future care for patients is as good as it can be. Adam says: “Even if they’re really complimentary about what we did, they can direct us as to how we can be better.” Tony agrees that airbase visits by former

part of it. How the team felt before and after is as important. Our pre- and post-shift briefs ask how we feel – are we ready to do the shift? It may seem strange at ﬁrst to open up about your feelings, it may seem to be a sign of weakness, but we all join in and it engenders a sense of trust in the team. If we need it, we have a strong team around us. “Staff are TRiM (Trauma Risk Management) trained and can signpost others to help. We have a wonderful chaplaincy team that visit and are a conﬁdential shoulder if needed. From the CEO down, we have an open-door policy. Clinical team members sit on the wellbeing team and can bring ideas to the table. “We don’t get it right every time, so we will act on feedback and make changes where possible. An example of this is as we move to a 24/7 service. We are working to produce a shift pattern that helps our team wellbeing as well as provide the care to our patients.”

Taking care of the next generation EHAAT’s Student Resilience Programme is designed to ensure that medical students on an elective placement are equipped with appropriate coping strategies and have access to help and support. Clinical Manager Laurie Phillipson says: “Because of the type of incident we target, the experience they will get on the helicopter in a few shifts could potentially take a paramedic or doctor several months or even years to acquire. But with that comes the potential to see incidents that will affect you on a personal level, and we need to do our best to prepare our students for that. “The programme includes a video, Resilience – One Team’s Trauma, a recreation of a real case which saw EHAAT tasked to attend an incident which was, unusually, described as ‘possible dead child’ rather than the more medical term “paediatric traumatic cardiac arrest.” The video (www.youtube.com/ watch?v=DY60ZOWBvDc) was created by former student Matt Walton to help others beneﬁt from the kind of guidance he received. Stuart Elms sums up the EHAAT approach: “All of us are fallible, if we are less critical of ourselves and others and more looking to solve problems together then we will learn together and not be discouraged. We have learnt that it’s ok to talk. It’s ok to ask for help. We are all one team.”

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ÂŠ Karen Baker

Life-giving substance What is the current state of play on carrying blood products onboard to administer prehospital blood transfusions? Lauren Haigh spoke to HEMS operators to find out 12

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We all know the importance of blood; it transports essential substances around the body and removes cellular waste, it keeps the body in balance (temperature, pH) and it clots when needed to protect the body from losing blood. A number of HEMS

operators carry prehospital blood onboard, which can increase survival rates. However, others donâ&#x20AC;&#x2122;t, due to the associated risks and costs and unanswered questions about patient outcomes. Much research has been done, and more is currently underway,

on the beneﬁts and risks associated with carrying blood products onboard HEMS. For example, a 2017 study entitled Prehospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service explored the

FEATURE

characteristics of patients receiving a prehospital blood transfusion and their subsequent need for inhospital transfusion and surgery. It determined that prehospital packed red blood cells (PRBC) transfusion significantly reduces the time to transfusion for major trauma patients with suspected major haemorrhage. Another, Prehospital blood transfusion: 5-year experience of an Australian helicopter emergency medical service, identified and reviewed all Greater Sydney Area HEMS (GSAHEMS) prehospital missions involving a blood transfusion over a 66-month period and concluded that the carriage and use of blood is both feasible and safe in a physician-led HEMS. AirMed&Rescue spoke to Chris Martin, Executive Director, Airlift Northwest (ALNW), who highlighted that one of many benefits of transporting blood products is that it doesn’t deplete local hospitals’ resources: “We can bring blood products on patient transports in rural communities that often have limited or no blood supplies,” he said. “Since our products come from Seattle, we don’t depend on or deplete the existing

resources at local hospitals.” ALNW recently administered its 500th unit of blood products and said that, over the past two years, it has expanded its lifesaving capabilities by carrying two units of PRBCs and two units of liquid plasma on all its emergency medical aircraft. A challenging capability Still, carrying blood products can prove challenging, as ALNW acknowledges. “There is a push in the air medical transport industry to have the capability to carry blood products on all transports. However, having this capability is logistically challenging and not all agencies have the resources to accomplish this,” it said. The UK’s Midlands Air Ambulance Charity is one operator that doesn’t carry ‘blood’ onboard, as such, but is currently involved in a trial called REsuscitation with PreHospItaL bLood products (RePHILL) with

We can bring blood products on patient transports in rural communities that often have limited or no blood supplies a number of air ambulance organisations in the UK to identify the merits and potential risks of carrying blood to trauma patients. “The RePHILL study is the first of its kind and explores whether giving blood products in the prehospital phase of a patient’s care is both safe and confers benefit over the standard model of care. RePHILL is also important as it will help us to understand the logistical challenges of delivering blood at the scene of the accident – in effect bringing the hospital to the patient,” Jim Hancox, Critical Care Paramedic for Midlands Air Ambulance Charity, told AirMed&Rescue. “This will provide clinical evidence for the first time on the use of blood / blood products in the pre-hospital environment. The trial will be finished in a couple of years, as between the seven air ambulances taking part, we need to recruit 450 patients.” William Kelly Miller RN, CFRN, Air Methods’ Regional Clinical Manager, agrees

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that challenges abound: “There are still operators not carrying pre-hospital blood, including some Air Methods bases,” he said. “It is not because there is a lack of desire to carry pre-hospital blood products at these bases, but rather it may take years to manage the logistics within the state’s various blood centres. Air Methods currently carries blood products on each mission at more than half of our community bases. We are currently working with the American Red Cross to be able to complete our goal of all community-based aircraft having blood products on each transport through a national contract.” So, carrying blood products onboard all bases seems to be the end goal for HEMS operators, but is difficult to achieve due to logistical and financial barriers. The financial challenges associated with this can particularly affect charities, as Gary Wareham, Operational Manager for Air Ambulance Kent Surrey Sussex in the UK, highlighted: “An organisational project to put blood onboard is complex. It involves having partner organisations (local hospitals, blood bike groups) on side and is costly. Most UK HEMS organisations are charity based and the decision to carry blood onboard is not just an operational decision.” Important preparations For the HEMS operators that do carry blood products onboard, there are a number of preparations that a service must undertake to ensure that the blood is delivered in a timely manner to the base, and that it is stored and carried correctly. “The blood we carry at the UK’s Great Western Air Ambulance Charity (GWAAC) is specially prepared by the blood bank at Southmead Hospital (North Bristol National Health Service (NHS) Trust) and is stored in military grade cooling boxes to ensure it is maintained at exactly the right temperature,” noted Lead Critical Care Doctor at GWAAC Ed Valentine. “The blood supply is replenished every 24 hours by FreeWheelers, a motorbike charity that collects new blood from Southmead Hospital, delivers it to the air base and then picks up and returns any unused blood back to the hospital so it can be used in the hospital (to ensure that none of the blood products are ever wasted). If the team uses blood at a pre-hospital incident, then the blood bank at the hospital is informed and 14

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a replacement box of blood products is and to minimise wastage. The blood procedures and measures the charity is made available for us to collect within 30 to products are packed into the prepared taking as part of the RePHILL trial: “As part 40 minutes.” GWAAC has speciﬁc systems containers by the local hospital blood of our participation in RePHILL, we work in place as the blood must be carefully banks and can remain in the boxes for up in partnership with Midland Freewheelers maintained. For example, strict procedures to 72 hours without overheating. In our who deliver new RePHILL boxes every are followed to ensure that the blood is service, we change these blood boxes out 48 hours. This ensures that integrity of the always kept at the right temperature and three times per week and unused blood contents isn’t compromised and, on the the seal on the occasions when An organisational project to put blood onboard is blood boxes we don’t use is only broken complex. It involves having partner organisations (local blood products, once GWAAC they are able hospitals, blood bike groups) on side and is costly is absolutely to be returned certain the patient to the national requires a blood stock and used transfusion. in other areas of These types of healthcare,” he said. precautions and “We do not know practices are crucial the contents of the and appear to be boxes delivered standard around to the airbase, and the world. Having don’t know what carried blood the contents of products in the the box are until form of red blood an eligible patient cells onboard is recruited to the helicopter missions study. Not only in New South does this ensure Wales (NSW) that the trial is run for more than in a robust and three decades, unbiased fashion, NSW Ambulance it means that we Greater Sydney treat all of the Area Helicopter boxes delivered as Emergency if they did contain Medical Service blood products.” has extensive experience in this Partnerships area: “Initially, this and training was accomplished ALNW highlighted by having a the importance of dedicated blood a solid partnership fridge on base with a supplier with blood packed for carrying blood into temporary products: “There storage boxes when missions were tasked. goes back to the tertiary hospital blood must be a strong partnership with a This always ran the risk of losses of stores bank.” This has enabled the service to keep supplier that will not only supply the blood due to thermal irregularities or improper wastage to a minimum and to achieve a products but also ensure quality control,” packing practices and so instead, for the last current wastage rate of less than two per it said. “In our case, it was Harborview decade, we have made use of the Credo cent – even with summer temperatures Medical Center’s Transfusion Services CubeTM blood boxes (Minnesota Thermal often exceeding 40°C and some very long that was integral in helping to supply all Science). These are phase change material missions. “To reduce the risk of thermal our aircraft with two units of PRBCs and storage containers developed for military losses, we keep the Credo cubes in airtwo units of liquid plasma. The capability use,” Dr Karel Habig, Medical Manager/ conditioned environments, on base or in to carry blood products is only made Lead Clinician, told AirMed&Rescue. vehicles as all vehicles are air-conditioned,” possible through the tireless work and “We have worked closely with NSW Dr Habig added. commitment of our partners at Harborview Health pathology to develop standardised Midlands Air Ambulance Charity’s Hancox Medical Center’s Transfusions Services, protocols to enable the transport of blood provided an insight into some of the Bloodworks Northwest and UW Medicine,

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which enables us to have this life-saving resource available to our patients.” Further considerations for ALNW are the need to maintain blood products at a very narrow temperature range until they are used in order to meet the established standards of safety, which they achieve with the use of specially designed portable coolers. The coolers are able to maintain a constant temperature for an extended period of time outside of refrigeration. The team can track the temperature of the blood coolers to ensure that each one remains within the correct temperature range, and if any products are found to be outside of this range then they are discarded. In addition to these preparations and procedures, in order for blood products to be carried onboard HEMS, it is crucial that all staff and medics are adequately trained. Indeed, Air Methods reviews every aspect of its policies and procedures with clinicians and crew when a base begins carrying blood products to ensure everyone is fully prepared. “Air Methods then performs our

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quality assurance processes with the clinical teammates to review for competency,” Miller explained. “A recent, highly effective training step we added is requiring crew to carry and monitor ordinary saline for a week prior to going live with blood products. This simulation has been a great addition to our training process as it offers hands-on experience and allows clinical teammates to identify unexpected issues at their base and on missions.” GWAAC ensures training takes place regularly in order to safeguard practices. “All of our Critical Care Doctors and Specialist Paramedics who are authorised to administer blood have completed standard NHS blood transfusion training, and then undergo a training programme locally to ensure that they follow unit protocols and policies. The local training is repeated on a regular basis to make certain competence is maintained,” said Valentine. Furthermore, there are also regulations to be considered, which may vary depending on the country in question. For example, in

Australia, where NSW Ambulance Greater Sydney Area is based, blood products are heavily regulated, and some are not available, which has prompted exciting research, as Dr Habig explains: “Blood products are highly regulated in Australia as befits a liquid ‘transplant’ donated by fellow citizens. A comprehensive tracking of all blood products administered must be maintained in case of blood-borne disease issues. Some products have not yet been approved by the Australian Red Cross but are available elsewhere in the world. For example, freeze-dried plasma and whole blood are currently not available in Australia. We have been investigating the possibility of Fibrinogen Concentrate as a treatment for those at risk for or in the early stages of acute traumatic coagulopathy. We have also been conducting pilot research into thrombo-elastography (TEG) testing in-flight in a helicopter, with initial testing conducted in our full-motion flight simulator and soon to progress to volunteers during training flights. This might open the door

to TEG-guided blood component therapy even in pre-hospital care.” Respecting regulations Air Methods ensures its policies and procedures meet or exceed all Food and Drug Administration and American Association of Blood Banks standards, as well as considering local EMS and state regulations. Miller explained: “Some state EMS regulations do not allow the paramedic to transfuse blood, which means one of our nurses needs to be available. Other states may require annual inspections of our processes. Regardless, local blood centres are always great resources to learn about any additional regulations that may need to be considered.” Valentine pointed out that, in the UK, strict legislation, as laid down by the UK NHS’ Blood Transfusion services, needs to be followed, which is particularly important as this ensures that every blood product administered to a patient can be traced and that the blood transfusion process is

always carried out safely. Ultimately, the goal behind HEMS carrying blood products is to save lives. ALNW is currently in the process of examining outcomes for patients who received blood product transfusions during transport initiated by ALNW and said that early ﬁndings are promising. Midlands Air

There must be a strong partnership with a supplier that will not only supply the blood products but also ensure quality control

Ambulance Charity’s Hancox pointed out that the impact of carrying blood products for patients is unknown and that RePHILL is hoping to shed better light on this: “At

present, we simply don’t know, and that is what the trial is examining. The use of blood products to resuscitate trauma patients in hospital is routine practice but replicating the same care outside of an Emergency Department is extremely difficult. By participating in RePHILL, we will contribute to discovering if the way blood products can be used outside of hospital confers any benefit to patients.” Dr Habig agrees that there are many unanswered questions, but that ultimately, carrying blood onboard has helped save lives: “Evidence of benefit in prehospital transfusion has been thin on the ground but those of us working in New South Wales are convinced that many of our sickest patients would not survive the distances that are required in such a big state, and there are certainly patients in outer urban areas of Sydney with severe injuries whose survival would be very unlikely without blood products to buy time. We are definitely against large volume crystalloid infusions for trauma patients if alternatives are available,” he said.

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A lifeline GWAAC’s Valentine also believes carrying blood has helped save lives, despite the lack of concrete evidence: “Demonstrating improved patient outcomes is very difﬁcult, as a prehospital blood transfusion is only one part of a whole range of interventions that the GWAAC team carries out for each patient. Anecdotally, we have several cases of patients who we feel would previously

aspect of carrying blood products at Air Methods’ bases. “We can easily capture data when patients are transferred, but to then obtain outcome data from hundreds of receiving centres across the US is not feasible at this point,” he said. “We have looked at isolated areas to recognise that initial lab results, speciﬁcally those associated with metabolic acidosis, are better in hypotensive trauma patients

not least that it can potentially save lives, as Dr Richard B. Utarnachitt, ANLW Medical Director, explained: “Prehospital transfusion of red blood cells and human plasma allows ANLW to begin reversing the deadly spiral of bleeding and clot disorders that occur in the setting of traumatic haemorrhage. By doing this, we bring lifesaving resources from the major trauma centre to our patients well before they actually arrive

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have died on scene and by virtue of having blood, have now survived to reach hospital. The vast majority of patients to whom we administer prehospital blood products go on to receive many more units of blood when they arrive at hospital (which conﬁrms that blood was indicated and appropriate).” For Air Methods’ Miller, tracking changes in patient outcomes is the most challenging

who received pre-hospital blood products compared to those who did not. Air Methods is currently conducting a largescale outcomes study, which should be helpful as more of our bases begin managing blood products.” Research remains to be done in this area and, indeed, is in progress. However, despite challenges, there are many beneﬁts to carrying blood products onboard HEMS,

at the hospital.” While replicating the level of care received in hospital onboard HEMS may not be possible, if carrying blood onboard can help provide a bridge between the HEMS and the hospital, it is surely worthwhile. It will be exciting to hear the outcomes of the research currently underway in this area and to garner more concrete evidence of the life-saving potential of carrying blood onboard.

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A GLOBAL REACH

with the personal touch

Andy Elwood knows first-hand the mental strain that emergency services and SAR personnel are under, and the effect this can have on their wellbeing. His focus now lies on delivering training for mental health first aid courses As a Search & Rescue (SAR) Paramedic, I have felt euphoria after risking my own life to save another. There is no other feeling like it, I love the adrenaline rush and the high afterwards, which often lasted for days on end. However, I have also felt the despair of arriving on scene at another suicide and having to recover a body by myself. I often wished I was able to help someone before they got to the stage of deciding to end their own life. Now I am in a position to do that. I have left the best job I ever had, because I believe that I will save more lives through speaking, campaigning, and delivering Mental Health First Aid (MHFA) training than I would by dangling under a SAR helicopter as a paramedic. This was not an easy or quick decision, but one I felt compelled to make for myself and for others out there, especially men, who are three-times-more likely to die by suicide than women. Like many people in pre-hospital care, I didn’t think about my own mental health for many years because I didn’t need to. I was ﬁt and healthy and in my prime. I was going places, I never looked back and I had felt like I had it all. My only dealing with mental health was in a professional capacity, as a paramedic, treating patients. However, after 20 years in emergency services, my personal experience is that talking has been an incredible help to me at critical points in my life. This has allowed me to share the burden of my worries and fears, gain another perspective, see a way forward and realise that I was just being 20 20

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ON THE

FRONT human. This worked for me when I spoke to a psychiatrist after a traumatic incident that occured while performing SAR duties, talking to my wife on holiday when I had a ﬂashback to Afghanistan, and to my GP last year, when I felt burnout from the cumulative build-up of life stressors since childhood. These mostly came from non-work inputs such as caring for elderly relatives, moving home, a new job with a promotion and running my own business in my spare time. Primary triggers for mental ill health Anyone can be affected by mental ill health. The World Health Organisation (WHO) reports that depression is the leading cause of disability worldwide. Many symptoms of varying conditions are similar

INDUSTRY VOICE

LINE

or shared, so let’s focus on depression for now. It is estimated that 70 million working days are lost every year to mental health, costing Britain between £70 billion and £100billion annually.(1) Depression has no single cause and often involves a complex mix of factors from biological, psychological and social factors. Mental Health England list risk factors for depression as: • Family history • Persistent stress (working in emergency services?) • Being a more sensitive person (caring professions as EMS or Paramedic?) • Adverse childhood experiences • Poverty and social disadvantage • Recent adverse life events eg: being a victim of crime, death or serious illness in the family, having an

accident, bullying or victimisation, separation or divorce • Lack of a close confiding relationship • Having a baby. This list shows a wide variety of factors and although some can be related to our work in emergency services, many are not. Work brings a lot of health benefits through offering a sense of purpose, fulfilment and being part of a team, especially in our line of work. However, mental illness is usually caused when pressures at work become more intense, coupled with factors outside work; for example, financial pressures, relationship problems, greater caring responsibilities from an ageing population etc. If the workplace is not supportive at this stage, then mental ill health can be triggered into common conditions of depression, anxiety or stress-related disorders. Spotting the warning signs and talking at an early stage Many of us may feel some of these feelings occasionally, and that is normal. However, when these feelings start to affect someone’s participation in everyday life or their ability to function safely at work, then we should reach out with support. Early signs are: • Irritability, aggression, tearfulness, • Inability to concentrate • Increased consumption of caffeine, alcohol, cigarettes or sedatives • Indecision • Difficulty remembering things • Loss of confidence • Unplanned absences • Increased errors / accidents • Arguments / conflicts with others • Negative changes to ways of working or socialising with colleagues, and • Erratic or unacceptable behaviour. Although the responsibility for noticing changes in a person often rests with line

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managers, in our sphere of work, it is often a colleague who may notice these changes and can offer support in the ﬁrst instance. Would you know what to do, how to start the conversation and what to say if your colleague shows these warning signs and decides to open up? Actions for Organisations Time to Change research(2) found that 49 per cent of respondents would feel uncomfortable talking to their employer about their mental health, and in a BUPA poll, 94 per cent of business leaders admitted to prejudice against individuals with mental health issues in their organisations.(3)

Organisational culture can change for the better, as Mind Blue Light Programme(4) recently highlighted, with these research key findings from their targeted support: • Staff improved their mental health, resilience and confidence to seek support • Managers and trainers had more confidence supporting staff in difficult situations • Stigma and lack of awareness still exists, but is improving, and • Sustained change requires practical investment, commitment, enthusiasm at all levels. Most people’s mental health issues come from a combination of factors, which may be related to work or not. However, it is in an employer’s interest to assist their staff to overcome these factors, regardless of the original trigger. Supporting staff through this journey and promoting workplace wellbeing 22 22

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increases productivity, engagement and reduces costs in the long term. Creating a culture where people feel conﬁdent to openly discuss their problems and trust their employer to support them is key to reducing sickness absence, staff turnover, and presenteeism, and will help staff ﬂourish and thrive, improve morale and skills retention. This is the best investment any organisation can make to ensure its longevity and enduring success. Investing in MHFA training for staff and especially line managers is one very

#itsoktotalk

positive step in this direction. Traditionally, military and the emergency services world have focused systems that are geared to follow traumatic incidents eg: TRiM & Peer Trauma Support. These systems have assisted many people, but do not address the enormous impact depression is having on the population as a whole. Mental Health First Aid MHFA training provides key understanding of this complicated subject and provides the correct language to communicate and listen in a non-judgemental way, which is key for recovery. Focusing on the individual and their feelings, rather than a diagnosis, helps deliver empathy. The ALGEE toolkit (right) gives course participants conﬁdence and a simple process to support others. This training and toolkit are equally effective, whether someone is

experiencing mental ill health symptoms, is in the aftermath of dealing with a traumatic incident, or is in crisis and thinking about ending their life by suicide. Talking about suicide is essential if being considered by a person. Discussing this openly is likely to prevent a suicide and give an individual hope for their future and recovery because someone has listened, empathised and encouraged appropriate support. If you feel affected by this article, please talk about it with someone you trust in a quiet environment or a Mental Health First Aider. The Samaritans are always available to listen on 116123 (24/7 freephone).

ALGEE toolkit Assess for risk of suicide or harm Listen non-judgmentally Give reassurance and information Encourage apwpropriate professional help Encourage self-help and other support strategies

Traumatic incidents and Post-Traumatic Stress Disorder (PTSD) After a traumatic event, anxiety symptoms will fade and someone will resume being their usual self within a month. In PTSD, symptoms will continue for longer, and this is more likely if the person has experienced intense fear, helplessness or horror, even as a witness to an event. Symptoms can be: • Re-experiencing the trauma through recurrent dreams, ﬂashbacks and intrusive memories • Anxiety in situations that bring back trauma memories • Avoidance behaviour • Emotional numbing • Reduced interest in outside world and others, and • Persistent constant watchfulness, easily startled, outbursts of rage, insomnia. I recommend a fantastic booklet called Trauma is really strange by Steve Haines. Using simple illustrations, the booklet explains that weird thoughts and emotions occur for us when we go through a traumatic event, which is often our bread and butter work in pre-hospital care. One message from this comic is that this is a natural human reaction to a set of extraordinary circumstances and that nine out of 10 people will naturally grow and learn from the experience. This gives hope for recovery and the future, which is essential for progress.

References 1. Davis SC. Annual Report of Chief Medical Ofﬁcer 2013, Public Mental Health Priorities: Investing in the Evidence. Department of Health 2014 2. Attitudes to Mental Illness 2013 Research Report. Time to Change 2014. 3. Lovell, D. Mental health stigma still an issue in business. Employee Beneﬁts 2014. 4. Mind Blue Light Programme Research Summary 2016-18. London: Mind. 2018. Helpful resources & relevant legislation Reading the legislation can be tedious, so I recommend the two websites below for user-friendly guidance: • www.mentalhealthatwork.org.uk curated by Mind with Heads Together. • www.mhfaengland.org Mental Health First Aid Line Managers’ Resource (free download) Key legislation to be aware of as a leader or line manager is: • Health and Safety at Work Act 1974 • Wellbeing is now considered part of health at work and duty of care. • Equality Act 2010 This consolidates previous legislation and notes a mental health condition becomes a ‘disability’, which is a protected characteristic in the Act, when it has a long-term effect on a person’s day-to-day activity. Other legislation to note: Human Rights Act 1998, Management of Health and Safety at Work Regulations 1999 and Mental Health (Discrimination) Act 2013. Strategic guidance for your organisation can be found here: The Five-Year Forward View for Mental Health (2016), Health and Social Care Act (2012), No Health without Mental Health (2011).

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Beware the Idai of March Ann Beattie reports on how ACE Air & Ambulance (ACE) responded during Cyclone Idai In March of this year, the cerulean water of the Indian Ocean, which usually soothes and beckons beachcombers, turned into an angry tempest of destruction on the east coast of southern Africa. The warnings came too late for most, and Cyclone Idai pummelled through Mozambique with winds of almost 200 kph and continued its devastating and deliberate march through the Chimanimani and Chipinge districts in the eastern highlands of Zimbabwe, dumping over 30 inches of rain in a record amount of time and resulting in massive ﬂooding. Cyclone Idai’s track Idai began its decimation in Malawi on 15 March, and then veered back out to sea where it recharged and gained strength for a second assault; the category-three storm travelled into the Mozambique Channel, where it pounded the coast for days, hampering the efforts of any rescue operations. Having killed hundreds of Mozambicans and affected approximately 24

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three million people, Cyclone Idai then set its sights on eastern Zimbabwe, a part of the world that rarely sees natural disasters of this enormity. The carnage and ruination left in Idai’s wake was a humanitarian crisis of untold proportions, leaving the United Nations to classify the cyclone as ‘one of the deadliest storms on record in the southern hemisphere’. In the blinding rain and the swollen rivers of Chipinge and Chimanimani, thousands of terriﬁed victims were clinging to tree branches and scrambling for rooftops, if they were lucky enough to have a roof left at all. As the waters rose, Zimbabweans watched helplessly as homes, roads, bridges, animals, crops and whole mountainsides crumbled under the deluge, and cars and buses full of people were turned upside down. Driving winds and torrential rainfall hammered the area for tortuously slow hours and days, forever altering the landscape of eastern Zimbabwe. Whole villages have been erased from the map and the broken families continue to search for lost relatives buried under the rubble, debris and mammoth rocks, some the size of a canyon.

Rescue mission Natural disasters of this magnitude create breeding grounds for deadly diseases, dangerous living conditions and horriﬁc circumstances. But they also create heroes. The stories that have come out of the remote rescues executed by ACE are incredible accounts of a brave team with an unerring determination to save as many lives as they possibly could. ACE had been commissioned from the beginning of the storm to assist with rescues in Tete and Beira, Mozambique, as they already had a helicopter in the area. Circumstances prevented the pilot from departing as the cyclone hit, and for three days he was stranded without any communication. Eventually, ACE headquarters learned that the pilot was safe but that the Bell LongRanger helicopter had been destroyed. Fortunately, the global resources that ACE has at its disposal allowed for a replacement Eurocopter AS350 helicopter to be brought in immediately, which was then ﬁtted with full advanced life support equipment. As the storm dissipated and the dreadful scenario of the aftermath emerged, ACE was anxious to get help to the survivors. Working

Logistics The logistics of the operation included positioning a mobile jet A1 fuel bowser at the Command Centre in the Mutare aerodrome in Zimbabwe. Fuel drums were placed in the faraway areas for refuelling purposes. This meant that dispatchers had to camp nearby to routinely check the supply and quality of the fuel. As food and medical supplies arrived through donations, both local and from abroad, they were helicoptered in. ACE worked tirelessly flying their helicopter nonstop from sun-up to sundown. The ACE crew in the helicopter consisted of the pilot and two paramedics. The long hours of flying required carefully planned crew rotations in order to meet operational requirements. Each mission was at least 30 minutes to one hour. The lack of accommodation further complicated this aspect, and often saw crew camping with limited food resources. The team on the ground experienced communication difficulties as cell phone coverage was compromised by the storm, so ACE provided ground-to-air radios and

set up a mobile air trafﬁc control through the Zimbabwean Army in order to provide reliable communications. The handling capacity of the local hospitals and clinics had to be assessed continually as the patients streamed in. Because most of

CASE STUDY

closely with the Zimbabwe Government and military, private sector aid groups and private philanthropists, ACE helped to co-ordinate rescue missions in the most precarious situations. Gaining physical access to many areas in the expansive radius of approximately 500 km was a massive challenge; the roads and bridges were wiped out, the deep gorges and ravines were dangerous and unstable and the continuing rains impeded some of the rescue missions. The most critical and urgent need was medical aid, but stranded and injured victims also needed food, water, blankets and supplies. In a society that is not accustomed to readily available fresh water bottles, thirsty people were scratching around for containers of any kind in which to hold scarce drinking water. A well-executed plan to deliver these supplies to remote and isolated areas was arranged through a collaborative effort that included seven donated helicopters, help from volunteer groups and overwhelming donations from ordinary citizens. Wellknown businessman and philanthropist Strive Masiyiwa of Econet was responsible for funding the helicopters and the rescue mission. When his colleague asked if he was aware of the exorbitant costs his donation would incur, Strive responded by asking him what the price of one human life would be.

the local rural clinics had been destroyed in the storm, the medical facilities were critically lacking in staff, as well as the amount of equipment and medication needed to treat the high number of patients they were seeing.

Mark Smythe, the Operations Director of ACE and an active traumatologist who was instrumental in the task force deployment on the ground, helped rescue a seven-year-old boy with an arm broken in two places. When Mark asked the frightened boy about his family, he replied, “They’re already buried.” Mark also tells the harrowing story of a 43-year-old man whose feet were solidly trapped under a concrete slab. He held his wife and child by one hand, and his second child by the other hand. As the water levels rose steadily, the courageous man amputated both his feet in order to release him and his family from the jaws of death.

One of the most amazing stories to come out of ACE’s rescue mission was the story of an elderly lady who was riding in a commuter bus in an attempt to escape the rising ﬂoods. The bus was washed away and rolled down the river amid the snakes, crocodiles and rough waters. She was the sole survivor. For seven days, the destitute woman camped by the bus, sitting on top of a muddy anthill. She survived on handouts from villagers. When ACE recused her, they decided to break the rules of the original ﬂight plan and reunited the senior citizen with her frantic family 25 km away.

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Many volunteer doctors were helicoptered in to assist nurses and ACE set up a patient triage system to determine the severity of individual cases. The more serious cases were sent directly to the provincial hospital in Chipinge, which remained unaffected by the storm (other than the higher volume of patients), or to Mutare Hospital. Shingi Chibvongodze, Public Relations Manager for ACE, and Leader of the Command Centre,

priority one patients were ones with limb or life-threatening conditions resulting from polytrauma caused by crush injuries. The secondary cases were large numbers of compartment syndrome and secondary infection from unmanaged or home-managed fractures. After the second week, cases of dehydration, pneumonia and malnutrition rose, and later on, malaria kicked in. The complicated distribution of food, medical

is taken to an appropriate hospital in safety and comfort. We are the only helicopter in the whole province attending to medical evacuations, so the day is fully booked up with calls from all corners of the province. Our team will do all it can to get to you in the shortest time possible!” Stories of catastrophic storms come and go, but much of the devastation left in their paths is permanent. For the survivors of

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commented: “The most heartbreaking stories are the ones of women and children.” He tells the story of one courageous mother who nursed her baby while suffering the unthinkable agony of two broken femurs. ACE airlifted her to Mutare Hospital for emergency treatment. Another challenge arose when some mothers refused help or treatment in order to protect the remaining surviving children who would be left behind. It was exhausting and traumatising work for all the rescuers as they faced the difﬁcult decisions of which lives could be saved and in what order. In the ﬁrst two weeks of the operation, 26

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supplies, fuel, and medicines required constant attention and organisation, as the situation was ﬂuid and subject to availability. Recalling the triumphs and victories at the end of each day kept the dedicated rescuers inspired to continue the gruelling work. The work continues A social media post from James Halsted, Managing Director of ACE, three weeks after the cyclone, vowed: “We are here for everyone, no one is charged and no one is left behind! We will continue the operation until every ill or injured person

Cyclone Idai, life will never be the same. The ACE team has single-handedly rescued more than 250 victims. Currently, at nearly three months post-storm, ACE continues its endeavours in assisting Cyclone Idai’s many sufferers and is immensely proud of their successful rescue efforts and the valiant team on the ground given the sheer size of the area, the complexities that exist in Africa and the severity of the storm itself. For more information about ACE Air & Ambulance, visit www.ace-ambulance.com. This rescue operation is on-going. If you would like to donate, please contact ACE.

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FROM AFRICA TO THE REST OF THE WORLD 24 Hour Emergency Control Centre Tel: +254 20 6992000 / +254 20 6992299 Mob: +254 (0) 733 639 088 / 722 314 239 Fax: +254 20 344170 Email: emergency@flydoc.org www.flydoc.org www.airmedandrescue.com

DRONES VALUABLE ASSET OR LIABILITY? Drones are now in common use by airborne police forces, as they can provide significant benefits when used in support of search and rescue (SAR) missions. However, concerns exist as to whether drones are a secure technology and can be hacked, and barriers remain that are preventing drones from developing a solid critical mass. Mario Pierobon investigates

Making a difference “Having flown police helicopters for many years, I often analysed each task we were given and thought about how the task would have been suited to drone technology. The answer is very simple: drones provide a very flexible platform, but for specific missions. Helicopters provide a very flexible platform, but are also flexible in terms of the mission,” said Oisin McGrath, Owner of Drone SAR. Drones can make a positive impact on police operations by offering a very simple method of gathering aerial data. “It is a common misconception that drones will help with car chases and following suspects, but in reality, their real value will be in scenes of crime scene photography, road traffic accident analysis and for aerial recce,” McGrath noted. “These machines are not fully encrypted; hence they can be hacked – but not very easily. The cost of drones that have a bit of encryption are quite high, so police units will have to evaluate whether it is worth the expense. If the data being collected is of low value, then a number of cheaper drones will be very effective for a police unit.” “Many law enforcement agencies cannot afford the initial and ongoing upkeep costs associated with an air unit such as a helicopter or an aeroplane,” Kraig Troxell, Media Relations and Communications Manager at Loudoun County Sheriff’s Office, said. “Unmanned aerial systems (UAS) units – commonly referred to as drones – are cheaper to purchase and 28

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maintain, and are a force multiplier in SAR operations.” He noted that the security of a UAS unit will ‘depend on the software and the type of drone utilised’. “While it is possible for a UAS to be accessed by a third-party, the software associated with the drone can prevent this.” In Australia, the Queensland Police Service

It is a common misconception that drones will help with car chases and following suspects, but in reality, their real value will be in scenes of crime photography, road traffic accident analysis and for aerial recce (QPS) uses drones in a SAR capacity to assist in planning for land searches that occur on terrain that is difﬁcult to access by normal means. “Drones assist ofﬁcers in gaining situational awareness of the location and can reduce time spent searching clearings. The drones used by the QPS have a range of technological safeguards to ensure the drones are secure,” explained Rob Whittle, Chief Remote Pilot Acting Sergeant at QPS. Cost and training A key consideration that must be made by a police service thinking of implementing

drones into police SAR is the cost of the drone and the necessary training that police officers must undergo before using said drones. It should be noted that the cost of a drone is not directly proportional to its capability – cheaper drones can be equally as effective as very expensive machines, depending on what they are being used for. All police units using drones will need to take the time and incur the small – though necessary – expenses in order to become properly trained. And this could even happen before the drones are purchased, as it might help with gathering initial knowledge of the industry. A small amount of flight training is desirable, which must be followed up by continually building upon this experience. “Being in the public eye while using drones will require confident practise of procedures, accurate flying and a firm grasp of the regulation for the area,” said McGrath. “Drones can be very effective for a given mission. The day of drones replacing helicopters is, in my opinion, still pretty far away. Drones must be viewed as another ‘tool in the toolbox’ rather than a device that will solve all your problems.” Whittle observed: “The cost of drones vary depending on the platform to be purchased that is fit for purpose. The cost of drones used by the QPS range from US$800 through to $45,000. All pilots must hold an RPA Pilots Licence issued through the Civil Aviation Safety Authority (CASA), undergo initial company flight checks, annual proficiency checks, and must adhere

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to ﬂight recency requirements.” He also added that drones would likely be the preferred option compared to other aerial assets in certain situations, though they would ‘never take over from our manned aviation assets’. According to Troxell, drones are as effective as people in a helicopter, but at a much lower cost. “Drones range from $1,000-$100,000+. Training varies, but in our agency, pilots learn of the legal aspects

of the Federal Aviation Administration (FAA), basic training to obtain Part 107 licenses, applications for daylight operations waiver (ﬂying at night), class B airspace waiver, and the registration process for the UAS,” he expounded. Critical mass Whittle points out that all Australian state and territory policing jurisdictions are either commencing using drones or are currently using them. Overall, 30

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Drones must be viewed as another ‘tool in the toolbox’ rather than a device that will solve all your problems however, there are more units that do not use drones, compared to those that

do. “Police forces are bound heavily by regulation and will be especially affected by data protection regulation. The security of the captured data always causes

Drones assist officers in gaining situational awareness of the location and can reduce time spent searching clearings

delays in the introduction of drones into policing. Units should take the time to pick the tasks for which the drones will be useful without having a huge impact on privacy concerns and use them for those tasks initially,” said McGrath. Additional current barriers to drones developing critical mass in police SAR operations concern the fact that due to safety issues, ﬂying close to airports or noﬂy zones is restricted. “Costs and privacy

issues have been raised as barriers to drone adoption by other entities,” noted Troxell. Mission to enable in the future Looking at how drones can be made more useful, Troxell detailed that Loudoun County Sheriff’s Ofﬁce is currently reviewing utilising UAS to capture aerial photographs at crash scenes. “This could enable deputies to capture the scene in a more efﬁcient and effective manner, allowing deputies to clear the crash scene

more quickly and helping alleviate traffic issues. Traffic and traffic congestion is a significant issue in the Washington, DC Metropolitan area,” he said. “Some drones do have the capacity to carry small items such as space blankets, emergency rations, radios, mobile phones and medications, and drop them safely to stranded people. Technological advances such as better battery life for extended flight operations, with smaller,

protocols – although a lesser-known pitfall, this is very important for units to

more versatile drones would be useful in these situations,” commented Whittle. Indeed, drones are already carrying supplies and dropping off rescue aids. “As the technology develops, this will increase their use, but the major developments will need to occur in the battery technology. Longer flight time and large-lift capacity will help bring these machines into our daily lives. Having software that can hone the machines by integrating them into already-existing

who make the decisions (command and control). Transmission of drone data, including video, position, chatting to the pilots and using multiple drones will help increase the effectiveness of a drone system once it is set up.”

the cost of a drone is not directly proportional to its capability realise,” said McGrath. “Drones need to fit into the policing system and provide increased situational awareness for those

Ever-evolving technology Technological development will be of further help in terms of locating missing persons and alerting the appropriate rescue organisations. According to

Troxell, drones are an evolving technology that will continue to advance. “Drone technology has come ahead in leaps and bounds – just in the last three years – with thermal cameras and speakers becoming smaller and lighter, which allows them to be attached to drones. Future technological advancements mean that possibilities for the use of drones are potentially endless. The QPS will continue to utilise this technology in the

SAR space and looks forward to expanding its capability with drones as technology advances,” remarked Whittle. “The technology has evolved at a massive rate. DJI, with an 86-per-cent market share in the commercial drone sector, have had numerous iterations of their machines and continue to do so. Better gimbal, sensors and, of course, better software to drive the machines, have continued to drive the industry,” concluded McGrath.

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MISSION CONTROL Police aviation asset management Airborne police services around the world are tasked with an enormous variety of missions, ranging from surveillance and crimefighting to rendering emergency assistance. To manage those missions, manufacturers and systems developers offer an ever-growing range of solutions. Robin Gauldie warns that buyers of such systems need to be aware that investment may be wasted if not accompanied by a commitment to ongoing training Police aviation can be a powerful, highly visible hearts-and-minds tool for police departments and the local and national politicians who are ultimately responsible for them. Helicopters orbiting over an incident or providing emergency assistance at an accident scene provide visible evidence to communities that their police department is on the job. And, at least in theory, patrolling aircraft remind potential perpetrators that the eye of law enforcement is watching them.

Operator overload is still a huge issue That can backﬁre. When tensions between troubled communities and law enforcement tip over into outright street violence, police aircraft orbiting a disturbance may be seen not as a force for peace, but as a target for resentment or simple malice. Police aircraft are sometimes shot at or – more frequently – targeted by lasers. More than 70 such laser attacks were reported in the UK alone 32

AIRMED&RESCUE

last year. In 2012, two men were convicted and jailed after ﬁring handguns at a police helicopter in Birmingham during riots the previous year. Camera images from the helicopter enabled police to identify the men, then use cameras on the ground to track them to an address

and arrest them – an example of how efﬁcient integration of airborne and groundbased systems can achieve a positive result. There are, of course, two sides to the coin. “When police helicopter missions go wrong, they can generate a disproportionate level of embarrassingly negative publicity for

Ready for anything Being mission ready means having no maintenance that is outstanding or upcoming. Kyle Vergeer, Managing Director at WinAir, explained that by using the company’s software solutions, ‘law enforcement agencies can accurately track and manage maintenance activities and maintain inventory control to ensure that aviation assets are always ready for the next emergency’. He added: “WinAir provides the ability to determine a maximum mission proﬁle, which means that operations can

determine how long a particular aircraft can fly for a specific mission before maintenance requirements result in a compliance issue. This benefits police aviation units and other law enforcement agencies, as it assists them with ascertaining the most appropriate aircraft for each mission.” Commonly, law enforcement agencies require the addition of components that further complicate the aircraft maintenance programme. The fact of the matter is

that the more bells and whistles that you add to your aircraft (cameras, hoists, and searchlights), the more this affects the overall maintenance on your aircraft. Through the use of software such as that offered by WinAir, law enforcement agencies can manage all assets, maintenance tasks, and aircraft efﬁciently and effectively, concluded Vergeer. Wide-ranging responsibilities Missions range from responding to crimes

POLICE

the operator,” said Bryn Elliott, Editor of UK-based Police Aviation News. In February this year, three South Yorkshire Police helicopter crewmen faced a misconduct hearing after being accused of making illicit recordings from their helicopter of naked sunbathers and of a couple having sex in the garden of their home. Media reports have given the story a comic twist – but such behaviour needs to be taken seriously as a clear invasion of privacy. Other mission failures are tragic. In Glasgow, feeling still runs high over the November 2013 incident in which a Police Scotland helicopter crashed onto the Clutha Vaults pub, killing seven patrons and all three ofﬁcers onboard. A Fatal Accident Inquiry is ongoing. “More effective use of better mission control systems might help police services demonstrate a sense of accountability and avoid reputational damage in cases like these,” said Elliott.

in progress or potential terror incidents, vehicle pursuit, surveillance and traffic control to monitoring large-scale public events such as political rallies, concerts, parades and sports fixtures. With paramedics on board, police helicopters may also be called upon for casualty evacuation, especially at night when mainstream medevac fixed-wing and rotorcraft air ambulances are less able to operate. The terrain in which pilots and crew must operate can range from densely populated urban areas to vast areas of sparsely populated nearwilderness, often operating at night and sometimes under challenging weather conditions. Major players in the mission control sector continue to tweak their systems to meet the constantly evolving requirements of police helicopter clients. But clients need to be aware that there is a potential downside to investing in too many ‘bells and whistles’, suggest some suppliers. “Operator overload is still a huge issue, especially when a small aircraft is equipped with radar, EOIR (electro-optical infrared), ESM (electronic support measures), AIS (automatic identification system) and other sensors,” according to Katrin Gruber, spokesperson for Vienna-based Airborne Technologies, which builds the LINX mission control system. “The airborne operator has almost reached the limit of the amount of data he can see, acknowledge, process and

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turn into the next action. There is a need for even more automation for speciﬁc tasks that are repetitive and have known parameters.” System adoption “We will need systems that learn from past operator actions, so they can predict events and foresee actions to be taken, or scenarios to be set up, and remove this burden from

shorter due to promotions, retirement, burnout or family pressure,” Gruber noted. “You can buy the smartest equipment off the shelf and operate it for a long time, but you cannot ‘buy’ the smartest operator crew in the same time period and keep them for the same length of time.” “Not only police, but also all entities that operate ISR (intelligence, surveillance,

urban areas – such as London or Los Angeles – may have a different array of needs and missions from an operator serving communities across an entire US state or a country the size of Scotland. “Many law enforcement agencies have complex domain awareness, centralised command and control systems,” says Dave Blackwell, CEO of Spidertracks. Based in

reconnaissance) systems will have to address the never-ending need of training and upgrading skills. The best performing equipment is slowly rendered useless when subjected to operator skill atrophy.” Ease of use and simplicity are common requirements, but individual police operators may have differing priorities depending on their speciﬁc mission statements and the geographical areas that they cover. A police department that operates predominantly in densely populated but relatively compact

Auckland, New Zealand, Spidertracks is the creator of a real-time aircraft tracking solution which can be accessed from mobile devices including phones, tablets and laptops, and has recently rolled out an Android app that makes the platform even more widely accessible. “Real-time situational awareness provides significant value across many levels of the operation,” Blackwell says. “When you can see your operation, you can manage your operation. Our Spiderwatch feature provides an active monitoring mechanism that enables robust flight following and emergency response capabilities in crosscountry flight operations.” Spidertracks’ clients include the Arizona Department of Public Safety (AZDPS)

Real time situational awareness provides significant value across many levels of the operation the person at the controls. LINX is working more and more as the ‘operator processing brain’ for mission control, so the real [human] operator can concentrate on what actions to take,” Gruber said. Suppliers also agree that ongoing operator training should rank high on any airborne police department’s list of priorities. “An item of equipment may last 15 years, but the average operator’s service life may be much 34

AIRMED&RESCUE

aviation bureau, which operates a fleet of five rotorcraft and nine fixed-wing aircraft from four regional locations. Missions range from law enforcement surveillance to SAR, technical rescue services and wildland firefighting. “What was initially sought as a tracking system to hedge against the potential of missing or overdue aircraft has become an invaluable operational tool,” AZDPS Aviation Commander Terry Miyauchi told AirMed&Rescue. “Not only do we always know where our aircraft are, we strategically dispatch and reroute specific aircraft based on the live tracking.” Spiderwatch has moved efficacy of traditional aviation emergency beacons from 25 per cent to 99.9 per cent, Blackwell claims, by removing the critical component off the aircraft and embedding it in secure cloud-based software. In addition, Spidertracks has elected to use a dedicated Iridium channel which ensures high-fidelity data is delivered on time, every time, without exception. “This gives the customer assurance of receiving highquality data every time without reliance on the availability of a cellular signal or an SD card,” Blackwell told AirMed&Rescue. Avionics communication manufacturer Flightcell International has ‘covered all bases’ with an offering that provides defence-grade asset tracking hardware that switches automatically between the Iridium satellite network and commercial cellular networks, explained Marketing and Communications Manager Michael Eddy. The equipment allows one-onone telephone conversations between air crew and ground personnel from any location, and mission data is transported to and from the aircraft with no operator intervention required. Eddy added: “Ease of use and simplicity is at the forefront of product development with a telephone keypad that can be used with gloves, a common-sense menu structure and a night-vision display screen. Built-in WiFi and Bluetooth makes for easy integration with onboard equipment and smart devices.” Flightcell’s solution is built to MILSPEC standards and is used by defense forces worldwide. Many law enforcement organizations are also using this technology; including Texas Department of Safety, California Highway Patrol, Israel

Police and the Australian Federal Police. A global demand For police aviation operators, fundamental requirements have changed little over the years, said Gruber. “They want to ‘see and know’ 24/7 in all kinds of weather, from safe and long ranges, with the highest deﬁnition, the lowest SWAP (size, weight and power consumption) and at a very competitive price. In reality, equipment suppliers show clients what’s possible with modern hardware and sophisticated software and guide them towards what will come closest

to their requirements. It’s not always high-tech that the customer demands, it’s sometimes pure and simple common sense.” Police operators increasingly want ‘defensegrade’ systems, but the US International Trafﬁc in Arms Regulations (ITAR) – a US Government measure designed to prevent US military grade technology falling into the wrong hands – can create complications for buyers outside the US. US technology in the ﬁeld has few rivals, although French, Israeli and South African suppliers are contenders. But issues may arise with long-term support. Returning

equipment to the US for repair or upgrading involves time-consuming paperwork, as does importing spares from US suppliers. “The German Federal Police (Bundespolizei) prefers working with nonITAR equipment. That is for the evident reason of simplifying and accelerating the supply chain and maintenance with the

effect of an improved availability of our equipment and aircraft,” said Bundespolizei spokesperson Indra Loose-Sommer. That has encouraged European suppliers such as Airborne Technologies to boost their systems, according to Gruber. The Bundespolizei’s decision to mandate nonITAR equipment to meet its technical and operational requirements was ‘a very bold move’ that forced suppliers to either replace ITAR components in their systems or to ‘spec up’ non-ITAR systems with more powerful components, Gruber explained. “It was a good move and gave a shot in the arm to traditional non-ITAR ISR manufacturers who saw a level playing ﬁeld developing in their favour.” ITAR, though, is not an obstacle for US manufacturers such as CNC Technologies, a US aviation technology and wireless 36

AIRMED&RESCUE

communications company serving law enforcement, government and military markets. It has launched CNC.LIVE, a defense-grade online aerial downlink footage portal which was deployed for the first time in January by the Atlanta Police Department, Georgia State Patrol, and other agencies of the US state’s Urban Area Security Initiative, one of several funded by the US Department of Homeland Security. The platform is housed on secure servers used by the US Department of Defense and other government agencies and provides ‘seamless and secure access to live video intelligence on any Internetconnected device’, said Ron Magocsi, Founding Partner and Chief of Technology at CNC Technologies, which also works with agencies including the New York Police Department, Los Angeles Police Department, Texas Department of Public Safety and Michigan State Police. The company has recently showcased airborne mission suites for Airbus H125 helicopters operated by the Broward County (Florida) Sheriff’s Office (BSO). Built from the ground up to match the BSO’s specific mission requirements, the surveillance and downlink solution was designed around Churchill Navigation’s ARS700C augmented reality moving map system and other key components including the FLIR Star SAFIRE 380-HDc imager, Spectrolab SX-16 searchlight and Troll microwave video downlink system. CNC has also signed contracts with the Orange County Sheriff’s Office, also in Florida, and the Florida Highway Patrol. Rising to the challenge For police aviation services, mission control is an ongoing challenge. For manufacturers, providing solutions that make life easier and less complicated for airborne operators is equally challenging.

SAVE THE DATE 2019 JULY

15-20

APSCON CenturyLink Center Omaha US

AUGUST AAMS Safety Management Training Academy Pittsburgh US

SEPTEMBER

18-19

The Emergency Services Show Birmingham UK

24-25

Aviation Health Conference London UK

OCTOBER

28-30

ITIC Air Ambulance & Medical Assistance Forum Malta

NOVEMBER

4-6

Air Medical Transport Conference Atlanta, Georgia US

5-7

Vertical Flight Expo & Conference Farnborough UK

The Air Ambulance Conference London 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 +27 (0) 10 205 3100 Witkoppen & Stone Haven Roads, Sandton, Paulshof, SOUTH AFRICA

PO Box 15166, City East, QLD 4002, AUSTRALIA

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

AIR AMBULANCE (EUROPE)

AIR AMBULANCE (APAC)

SERVICE DIRECTORY

airlecairespace.com

+335 56 34 02 14

capitalairambulance.co.uk

+356 2703 4129

186 Ix Xatt Santa Maria Estate Mellieha MLH 2771, MALTA

Swiss Air-Rescue (Rega) +41 44 654 33 11

rega.ch

+49 7007 3010

drf-luftrettung.de/air-ambulance

EURO LINK GmbH Allgemeine Luftfahrt, D -85356 München Flughafen, GERMANY

FlyEuroLink.de

+49 89 6137 2103

European Air Ambulance

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

Director Sales & Marketing

Luxembourg Airport, B.P.24, L-5201, Sandweiler Luxembourg email: alert@air-ambulance.com

+(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

Patrick Schomaker

taa.at

+43 512 22422 100

Fuerstenweg 180, A-6026 Innsbruck-Airport, AUSTRIA

AIR AMBULANCE (NORTH AMERICA)

DRF Luftrettung / German Air Rescue

26 26 00 fax: +352 26 26 01

Rescue Wings Malta

Tyrol Air Ambulance

Airport House, Exeter International Airport, EX5 2BD, UK +44 845 055 2828

24hr tel: +352

quickair.de

+49 2203 955 700

Hangar 3, Cologne Airport, 51147 Cologne, GERMANY

Rega-Center, PO Box 1414, CH-8058 Zurich, SWITZERLAND

Capital Air Ambulance

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

Quick Air Jet Charter GmbH

+1 720 875 9182

AMRAirAmbulance.com

Global Jetcare, Inc. 15421 Technology Dr. Brooksville, FL 34604, USA

+1 352 799 7771

globaljetcare.com

Helidosa Aviation Group

website: air-ambulance.com

Karla Viñas

Air Ambulance Account Executive

FAI – rent-a-jet AG Flughafenstasse. 124; 90411 Nuremberg; GERMANY

+49 911 36009 31

fai.ag

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

+49 211 602 7775

tel: +1

AIRMED&RESCUE

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

Jet-Rescue Air Ambulance

+49 221 98 22 333

malteser-service-center.de

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, DK9400, Nørresundby, DENMARK

(829) 345-7219

jetexecutive.com

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

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

European Air Ambulance Patrick Schomaker Director Sales & Marketing

Luxembourg Airport, B.P.24, L-5201, Sandweiler, LUXEMBOURG 24hr tel: +352 fax: +352

26 26 00 26 26 01

Monica Newman

Graham Williamson

4835 Riveredge Cove, Snellville, GA 30039, USA

VANCOUVER  TORONTO  HONOLULU

CEO

Executive Director

GROUND TRANSPORT  MEDICAL

fax: +770-979-6500

website: www.iafccp.org

Gateway International EMS 600 Pennsylvania Ave SE, Washington DC, 20003, USA

+1-202-499-2294

gateway-ems.com

24hr Worldwide Ground Transports 3815 E Main St., Suite C St. Charles, IL 60174, USA

fax: +1

630 444 2100 630 823 2900

tel: +1

fax: +1

250 947 9641 877 288 2908

email: graham.williamson@LifeSupportTransport.com

website: www.LifeSupportTransport.com

Medical Wings

One Call Medical Transport

tel: +1

email: alert@air-ambulance.com

website: www.air-ambulance.com

LIFESUPPORT Patient Transport

IAFCCP

tel: +770-979-6372

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

email: ops@ocmt.com

website: www.ocmt.com

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

+662 247 3392

medicalwings.com

Prime Nursing Care, Inc. 1918 Harrison Street, Suite 215, Hollywood, Florida, 33020, USA

+1 754 999 0460

primenursingcare.com

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)

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