AirRescue Magazine 4/2012 by Verlag Stumpf & Kossendey

HEMS OFFSHORE

Airrescue InternatIonal aIr rescue & aIr ambul ance

M A g A zine

Interview

The new CEO of ADAC Air Rescue

Medical Care

HEMS response to the UtĂ¸ya island shooting

Technology

Bell 429 in European HEMS

ISSUE 4 | Vol. 2 | 2012

C-MAC® S - Single Use Blades

AN 37 02-2012/A-E

Familiar C-MAC® Handling in Airway Management - now Disposable

KARL STORZ GmbH & Co. KG, Mittelstraße 8, 78532 Tuttlingen/Germany, Phone: +49 (0)7461 708-0, Fax: +49 (0)7461 708-105, E-Mail: info@karlstorz.de KARL STORZ Endoscopy America, Inc, 2151 E. Grand Avenue, El Segundo, CA 90245-5017, USA, Phone: +1 424 218-8100, Fax: +1 800 321-1304, E-Mail: info@ksea.com KARL STORZ Endoscopia Latino-America, 815 N. W. 57 Av., Suite No. 480, Miami, FL 33126-2042, USA, Phone: +1 305 262-8980, Fax: +1 305 262-89 86, E-Mail: info@ksela.com KARL STORZ Endoscopy Canada Ltd., 7171 Millcreek Drive, Mississauga, ON L5N 3R3, Phone: +1 905 816-4500, Fax: +1 905 858-4599, E-Mail: info@karlstorz.ca www.karlstorz.com

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03.04.2012 11:35:20

e dI torI a l Dear Readers, You are holding in your hands the final issue of our magazine for this year. I’m addressing you again after a break, as my close colleague, Denise Eikelenboom, authored the editorial in the last issue. Before we look back on 2012, I would like to share with you a summary of the Strategic Planning Meeting, which took place in the Dutch town of Lelystad in the second half of September. We talked about the Air Safety Report project, a system for reporting events that happen during operations. We want to make this system more widespread among EHAC members, the plan being to create a central database. Other topics we discussed were the ongoing EASA Rulemaking Tasks in relation to our operations, more specifically, relating to Flight Times and Duty Limitations for EMS OPS, CRM and HEMS Performance, and Mountain OPS. In each of these processes EHAC has its own representative, namely Urs Nagel from Rega, and Bernd Lang and Hubert Becksteiner from ÖAMTC Air Rescue. As regards our relationship with EASA, EHAC will soon be applying to join the Safety Standard Consultative Committee. If we are accepted, we will get direct and timely access to important expert information. Another topic discussed was the preparations for the AIRMED 2014 conference. Intensive work on the Scientific Programme is currently underway, and two meetings have already been held. I am confident that the participants of the conference in Rome will have something to look forward to. Members of the Board and the Board’s working groups also took home two assignments from the meeting. Their tasks were to draw up proposals, firstly, for developing EHAC Principles and, secondly, in relation to possible changes to the EHAC Statutes, Electoral Rules and Internal Regulations. In this context, I would like to ask you, the

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readers – that is, members of EHAC – for your comments regarding our organization’s key documents. Please send them to the Managing Director, Stefan Becker, by the end of this year. We also dealt with the issue of relations with the New EHA and expect that you will soon be informed of significant progress. On a final note, I’d like to inform you that on 22nd and 23rd of May 2013 the first EHAC Symposium in conjunction with the Annual General Membership Meeting will be held in Warsaw. And it looks like an excellent keynote speaker will be speaking on the topic of Just Culture. I must say that I’m looking forward to reading this issue of AirRescue Magazine. I will focus primarily on the interview with the new top representative of ADAC Air Rescue, Frédéric Bruder. The interview with Patrick Moulay about the Bell 429 in Europe will also be an interesting read for me. I would like to thank the team at AirRescue Magazine for including a very engaging theme in this issue – HEMS in offshore wind farms. I am also glad to see the Hungarian HEMS Profile and Case Report by my friend Péter Temesvári. I will see many of you personally at the EASA Symposium in Cologne. And to those of you I will not see, I wish you and your families a joyful Merry Christmas and all the best for the New Year.

Pavel Müller President of the European HEMS and Air Ambulance Committee

208 | contents

Airrescue InternatIonal aIr rescue & aIr ambulance

ISSN: 2192-3167 Publisher: L. Kossendey Verlagsgesellschaft Stumpf & Kossendey mbH Rathausstraße 1 26188 Edewecht | Germany service@skverlag.de Tel.: +49 (0)4405 9181-0 Fax: +49 (0)4405 9181-33 www.airrescue-magazine.eu Medical Advisor: Dr Erwin Stolpe Medical Director EHAC

Key component of the rescue chain: HEMS for trauma patients in offshore wind parks N. Weinrich, D. Dethleff, C. Friebe, et. al.

Editor-in-chief: Dr Peter Poguntke Tel.: +49 (0) 711 4687470 Fax: +49 (0) 711 4687469 E-Mail: poguntke@airrescue-magazine.eu Editors: Tobias Bader Tel.: +49 (0)4405 9181-22 E-Mail: bader@skverlag.de Klaus von Frieling Tel.: +49 (0)4405 9181-21 E-Mail: frieling@skverlag.de Christoph Kossendey Tel.: +49 (0)4405 9181-14 E-Mail: cko@skverlag.de Marketing · Advertising · Subscription Ch. Niemann Tel.: +49 (0) 4405 9181-16 Fax: +49 (0) 4405 9181-33 E-Mail: sales@airrescue-magazine.eu Subscription Rate: Europe: (Shipping included) World: Price per Issue: (Shipping not included)

Interview with D. Bernitz on HEMS offshore: “Eurocopter is an integral part of the survival chain”

Through rough winds: HEMS missions at offshore wind parks K. Graf

35  40  9

Bank Account: Postbank Hannover BLZ 250 100 30 Kto.-Nr. 2837300 IBAN: DE08 2501 0030 0002 8373 00 BIC: PBNKDEFF Production and Design: Bürger Verlag GmbH & Co. KG Frank Lemkemeyer Rathausstraße 1 26188 Edewecht | Germany

AirRescue ist the offical publication of the European HEMS & Air Ambulance Committee (EHAC)

Case report: Road traffic collision of a 40-year-old male motorcyclist with a small van P. Temesvári

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contents | 5

42 06 14

Oslo government district bombing and Utøya island shooting: The immediate EMS response S. Sollid, R. Rimstad, M. Rehn, et al.

“Bell Helicopter is back in Europe”: Interview with P. Moulay of Bell Helicopter

SAFETY News Interview with F. Bruder, new CEO of ADAC Air Rescue: “Highest medical quality for people in distress”

OFFSHORE

HEMS in offshore wind turbines: Promising highline rescue procedure Editorial Team

IN PROFILE

33 36

CHC SAR: One of the world’s largest networks of SAR services Editorial Team

Helicopter crash in Morbegno: EMS-helicopter hits high voltage cable F. Martorana

SAFETY

Hungarian Air Ambulance and NAS: cooperation for a countrywide HEMS P. Temesvári

MEDICAL CARE

HEMS response to major incidents: Lessons from the Sierre bus accident R. Lyon, J. Sanders

SAFETY

Documentation of air rescue missions in Germany: Analysis of air rescue data set K. Reinhardt

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Helicopter safety: Everybody’s concern J. Stevens Cover Image: A. Pecchi/Eurocopter

6 | neWs “Paperless” fixed-wing cockpit at DRF Luftrettung Recently DRF Luftrettung (Germany) has begun to successfully use tablet PCs in the cockpits of its air ambulance jets. These digital devices facilitate the work of crew members on their flights to repatriate patients and at the same time save time, weight and costs. DRF Luftrettung has procured a total of seven Electronic Flight Bags (EFB) for its three ambulance aircraft. The tablet PCs contain all route, approach and departure charts, documents and the flight manual. Around 35 kgs of paper therefore are replaced by just a single tablet PC (of 600 grams). “If we extrapolate this to our annual average use of kerosene, the tablets will save about 7,000 Euros per year in kerosene costs”, says Udo Kordeuter, DRF Luftrettung Fleet Commander. In addition, the EFBs facilitate the work of the crew: “We update all the relevant data prior to every flight. This is done automatically via Internet and takes about 30 minutes”, Norbert Fleischmann, captain and head of aircraft standardization at DRF Luftrettung, explains. This eliminates the previously necessary revision of the charts, on which a pilot used to work up to four hours every two weeks. Moreover, EFBs are easier to handle than paper documents and thus increase flight safety. For more information, visit: ››› www.drf-luftrettung.de

Czech state honours awarded to HEMS doctor Rudolf Zvolánek An important event took place in the Czech Republic recently: On 28 October, Václav Klaus, the President of the Czech Republic, personally gave Dr Rudolf Zvolánek, a close colleague and friend of Alfa-Helicopter from Brno, a state decoration. He was awarded the Medal of Heroism for his courage, resourcefulness and professionalism in saving the life of a severely injured young man. According to Czech news reports, it was “thanks to his courage, presence of mind and professionalism” that Zvolánek saved the life of this seriously-injured man “who had been sucked through a narrow opening in a machine for mixing plastics. The man was subsequently operated on.” Rudolf Zvolánek was the doctor from the HEMS crew that was sent to the aid of the victim whose arm was caught in the factory machine. Politicians, cultural figures and church dignitaries gathered in the Vladislav Hall at Prague Castle on that day to celebrate the 94th anniver-

K. Šulová

sary of the birth of independent Czechoslovakia. On the occasion, President Klaus presented high state distinctions to veterans, scientists, cultural figures and sportspeople as well. It was the last time that Václav Klaus awarded state honours as president. For more information, visit: ››› http://bit.ly/Zvolanek & http://bit.ly/VKlaus

Aerosuisse Award 2012 for Rega’s chief pilot Rega’s Chief Helicopter Pilot, Heinz Leibundgut, was presented with this year’s Aerosuisse Award in recognition of his outstanding achievements. With this prize, Aerosuisse – the umbrella association of the Swiss aviation and aerospace industry – pays tribute to Leibundgut’s untiring efforts to increase flight safety and develop new technologies. For many years, Heinz Leibundgut has been actively involved in improving helicopter flight safety and reliability, particularly in the sphere of air rescue. Among other things, he worked closely with other partners to launch the highly successful “Remove” project, a free service aimed at dismantling redundant air navigation obstacles that pose a hazard to helicopter pilots. Leibundgut has also been responsible for developing the concept of all-weather GPS approach flights to hospital helipads, which is currently in its introduction phase. Heinz Leibundgut has held the position of Chief Pilot of Rega’s helicopter fleet since 2000, and has over 30 years’ experience in the field of helicopter flying. In 2011, Rega flew a total number of 14,240 missions out of which

Aerosuisse

10,797 missions were by helicopter and 1,052 by ambulance jet. Rega operates from 13 bases and employs more than 300 people (full and part time, in 2010). For more information, visit: ››› www.rega.ch

AAA-Conference (UK) a real success

DRF

Almost 300 people attended the Association of Air Ambulances’ annual conference which was held on 19 and 20 November in Telford near Birmingham. The conference was divided into three thematic fields: “Charity and Communications”, “Air Ambulance Operations” and “Clinical Excellence”.The conference was opened by the Chair of the AAA, Dr Anthony C. Marsh, who is also the CEO of West Midlands Ambulance Service. The AAA has been established as a representative body for the Air Ambulance Services in the UK

that advocates for Air Ambulances as an integral part of the healthcare provision. The success of the Air Ambulance Services in providing a rapid response to life-threatening situations has clearly been established. Clive Dickin, National Director of the AAA, also said that this conference “showed the vital impact the air ambulance community has on healthcare provision in the UK.” For more information, visit: ››› www.associationofairambulances.co.uk

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neWs | 7 HMC to expand air ambulance services

Latitude and Navicom with distribution deal

2012 Cormorant Trophy for Helicopter Rescue

The Hamad Medical Corporation (HMC) from Doha is planning to add more helicopters to its air ambulance service (LifeFlight) next year, in collaboration with the Qatar Emiri Air Force. The service currently receives and responds to an average of 80 to 85 calls each month (an increase of 25 to 30%) or about three calls a day. The vast majority of cases are trauma emergencies like road traffic accidents and industrial accidents. Since the service began in 2007, it had grown from being a daylight hours service to an 18-hour service, enabling the crew to respond to emergencies from 6 a.m. until midnight.

Latitude Technologies (Canada) announced that it has put in place a multi-faceted distribution arrangement with Navicom Aviation, a leading avionics solutions reseller in Japan. Under the terms of the distribution deal, Latitude will be providing Navicom with a custom version of the WebSentinel® flight following system (with all on-screen and user information presented in Kanji/Japanese writing). In addition, Latitude will broaden its partnership with Navicom for the supply of Latitude’s SkyNode® data and voice satcom solutions, and will be supporting Navicom in the EMS helicopter tracking project of the Japan Aerospace Exploration Agency. “Latitude has had a long-standing, solid, and mutually respectful business relationship with Navicom” commented Latitude President, Mark Insley. “I am very pleased to see our relationship going to the next level where we will now work together to deliver more comprehensive flight data solutions to Navicom’s customers.” Navicom Aviation is a leading avionics systems and flight-following solution provider to the Japanese market. Navicom’s moving map system, NMS-01S, is a Japanese-oriented map system with approval from the Civil Aviation Bureau.

AgustaWestland announced the winner of the 2012 Cormorant Trophy for Helicopter Rescue. The recipients of this year’s award are Captain Aaron Noble (aircraft commander), Captain Dean Vey (co-pilot), Sergeant Brad Hiscock (flight engineer), Sergeant Daniel Villeneuve (SAR Tech team lead), Master Corporal Shawn Bretschneider (SAR Tech team member) from 103 SAR Squadron at Canadian Forces Base Gander, Newfoundland. They had rescued two walrus hunters who were stranded on an ice flow in the Arctic sea near Igloolik, Nunavut. During the mission, Canadian Forces SAR Tech Sergeant Janick Gilbert died, after he had jumped into the water from an accompanying CC-130 Hercules in order to assist the hunters. This year’s awarding shall serve as a “reminder of danger and selfless dedication of SAR crews every day in Canada”. Jeremy Tracy, AgustaWestland’s Head of Region for Canada, also said: “Despite the tragic loss of life, this rescue is being recognized because of the extreme circumstances of distance, location, weather conditions and the rescue of two hunters, two SAR Techs from another squadron and the recovery of their companion.”

For more information, visit: ››› www. www.hmc.org.qa

For more information, visit: ››› www.latitudetech.com

For more information, visit: ››› www.agustawestland.com

HMC

8 | neWs New board elected at EURAMI

EHAC on the “Road to Rome” 2014 EHAC‘s Scientific Faculty met for a one-day meeting in Amsterdam on 19 September 2012 in order to plan and prepare the scientific programme of the next Airmed World Congress to be held in Rome in 2014. The EHAC meeting of European professionals (HEMS doctors, pilots, technical and medical directors, flight ops managers, directors from the air medical field) was hosted by Stefan Becker (right), Switzerland, Managing Director EHAC, and Dr Matthias Ruppert, Director Medical Operations, ADAC Air Rescue. Divided into three sub teams, participants discussed topics to be covered at the AIRMED 2014. Identified as being relevant for discussions were, among others, “building a mission”, “crew composition”, “communication and crew training” as well as “regulation issues”. Another sub team also identified “risk management”, “patient safety” and “mass casualty response” as burning issues. The third group added, among other things, “finance and sustainability”, “mission equipment” as well as “inter-organizational cooperation” to the list.

ARM

According to an official statement by the EURAMI board (posted 9 November 2012), the elections of the board „have been one of the most interesting since EURAMI’s inception in 1986.“ The interim board is said to have ensured „the continuity of the association“ with „diligence and courage“. The following five members were elected to the board: Laurent Taymans, MD (Aeromedicale), Bettina Vadera MD (AMREF Flying Doctors), Mark Jones (Air Ambulance Worldwide), Terry Martin MD (CCAT course, Capital Air Ambulance) and Pascaline Wolfermann (FrontierMEDEX). Andrew Wither, who has previously worked for EURAMI as the office manager, has agreed to stay on to ensure continuity. Being the new EURAMI president, Laurent Taymans will be stepping down as EURAMI auditor with immediate effect and for the entire period of his tenure. A short biography of all five board members will be posted on the EURAMI website in due course.

The first board meeting was held immediately after the elections and members have found an agreement on their future work. A draft shall be published before the end of this year. The statement (signed by Laurent Taymans) ends with the words: „Change is a process; to achieve success depends on our perseverance and the support we hope to receive from you, the members.“

For more information, visit: ››› www.eurami-academy.com

FinnHEMS with new base in Tampere Thursday, 8 November 2012, saw the official opening of the HEMS base in Tampere, Finland, a city situated around 180 km north-west of the capital, Helsinki. The event was attended by countless guests from the world of politics and business, as well as figures from the air rescue community itself. Following a welcome speech by CEO Jyri Örri, various speakers took to the stand to talk about the success of the work that has already been done, and the challenges that lie ahead for FinnHEMS. Finland now has a total of six HEMS bases in place. The Tampere base is situated right at the Tampere-Pirkkala airport (and military base). There’s a Eurocopter EC135 helicopter that provides emergency medical care in the first instance – only in more serious cases will the patient be flown directly to the trauma centre at the hospital. Its crew consists of one pilot, one

HEMS doctor and one HEMS crew member. Night flights using Night Vision Goggles (NVG) are also common, especially given the limited number of daylight hours in winter. FinnHEMS, a non-profit company, has been responsible for organising air rescue in Finland since 2011, with an annual budget of just over 23 million euros at their disposal. FinnHEMS is funded by Finland’s Ministry of Social Affairs and Health. State funding and administration of the HEMS system via FinnHEMS became possible thanks to new legislation which came into force in May 2011. You will be able to read more about FinnHEMS in the next issue of the AirRescue Magazine. For more information, visit: ››› www.finnhems.fi

All experts agreed that cross-professional competencies and cross-professional trainings are of major importance in the future and this should also be taken into account while planning for the AIRMED 2014. A wide range of major target groups was identified at the Amsterdam-meeting as well. These included flight ops staff (HEMS/ AEMS), “environmental stakeholders” (such as governments and rule-making agencies), researchers, dispatchers and support services (e.g., technicians, logisticians) as well as mission partners such as police, fire brigade, mountain and maritime rescue, ground EMS staff and hospitals. The next AIRMED pre-conference, scheduled for September 2013, will have to face the challenging task to narrow down the scope. For more information, visit: ››› www.ehac.eu

AgustaWestland ARM

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neWs | 9 ADAC Air Rescue and Wiking in offshore wind farms

ADAC

ADAC Air Rescue and Wiking Helikopter Service have recently agreed to pool their resources and work together on rescue missions in German offshore wind farms. The assignment will see the partners providing an ‘in-house rescue service’ on behalf of a number of wind farm construction companies and operators. Setting up and operating offshore wind farms in the North Sea and the Baltic represents a major challenge when it comes to emergency rescue and the provision of emergency medical care to

staff. Over the coming years, thousands of staff will be carrying out highly dangerous work in difficult conditions, so in order to be prepared in the event of an emergency, it was essential to draw up plans and measures in advance so that staff can receive emergency medical care by professionals should they fall ill or injure themselves (a topic also focused on elsewhere in this edition). Wiking Helikopter Service, which has 37 years of experience in offshore and winch operations at sea (equating to 43,000 manoeuvres by winch), is providing a suitable helicopter, flight crew and winch operator. ADAC Air Rescue is supplying the medical crew and equipment, and offering up their rescue expertise of course – particularly in relation to rescue using a winch and emergency medical care in difficult conditions.

Avincis

East Anglian Air Ambulance heralds “new era”

to Aberdeen, where they were installed into the gearboxes of the affected aircraft. The aircraft were then thoroughly tested and returned to service in the North Sea. All aircraft are being flown in accordance with the EASA Emergency Airworthiness Directive 2012-0225-E. Newly appointed Bond Offshore Helicopters Managing Director, Luke Farajallah, said that “there is no doubt that recent weeks have been challenging for the industry, but I am pleased that Bond Offshore Helicopters has been able to help its customers by returning our AS332 L2 fleet back to service. Our attention is now focused on the EC225’s, where we are actively participating in the industry meetings and we look forward to further developments.” Safety of the passengers and crew would always come first, Mr Farajallah added.

The East Anglian Air Ambulance’s (EAAA) most recent addition to its fleet is a new EC135 T2e which was equipped in Gloucestershire at Bond Helicopters HQ to the precise specification of the air ambulance. The aircraft will enable EAAA to attend missions at night. Tim Page, Chief Executive of EAAA, said: “Our move into night flying means that during the winter months when people drive to and from work in the dark, should an accident or medical emergency happen, we will be there, bringing the hospital emergency room to them, wherever they are in East Anglia.” Andrew Egerton Smith, Chairman and founder of EAAA said: “My vision for this vital service is that everything we do is of the highest standard and our mission is to deliver exactly what people need, when they need it. We need to constantly innovate and initiate new ideas and, more than anything, we must provide value for money. We are the very first air ambulance in the country to be cleared to fly at night and our brand new helicopter has been fitted with state of the art technology to allow night flying. Peter Rosenvinge, Director of Fundraising at EAAA, said: “I was inspired to join this charity by the passion and energy of the incredible volunteers, supporters and donors. It’s the people of East Anglia who keep us flying and mean that we can reach people in their hour of need. Their efforts on our behalf continue to inspire me. Indeed it is their generosity that has made it possible for us to extend our service into the hours of darkness.” The crews will now undergo extensive training and it is expected that life-saving missions by helicopter during the hours of darkness will begin by the end of the year.

For more information, visit: ››› www.bondaviationgroup.com

For more information, visit: ››› www.eaaa.org.uk

For more information, visit: ››› www.adac.de/luftrettung ››› www.wiking-helikopter.de

Bond returns all AS332 L2 to service Bond recently announced that it has returned six of its nine helicopters (comprising of four crew change helicopters and two SAR helicopters) back to service. Last week Eurocopter dispatched four technicians and four unaffected rotors shafts

EAAA

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For more information email ENQUIRIES@UTECSOLUTIONS.COM or visit WWW.UTECSOLUTIONS.COM

4 · 2012 I Vol. 2 I AirRescue I 213

10 | neWs ADAC Air Rescue to renew its helicopter fleet ADAC Air Rescue recently signed an order in a framework acquisition agreement with Eurocopter for the purchase of 14 EC145 T2 and three EC135 P2e helicopters, which are to be delivered between 2013 and 2017. The contract concluded at the ILA Berlin Air Show was for an EC145 T2, which is part of the renewal strategy for ADAC Air Rescue’s current BK117 inventory. “We are very pleased that ADAC Air Rescue has once again chosen Eurocopter, marking a continuation of the more than 40 years in our close and successful cooperation,” Wolfgang Schoder, Eurocopter Executive Vice President – Programs, said. “With the EC145 T2, ADAC Air Rescue will be operating the newest aircraft in the light twin-engine helicopter category. The EC145 T2 was developed in close consultation with air rescue organizations with the specific aim of further satisfying operators’ exacting safety and performance requirements.”

GNAAS with automated chest compression device Great North Air Ambulance Service (GNAAS) has equipped its aircrafts with the automated, portable chest compression device AutoPulse® that will be used on all cardiac arrest patients. The GNAAS is the first air ambulance service in the North of England to use this device, which delivers consistent, uninterrupted, high-quality chest compressions. The AutoPulse’s easy-to-use, loaddistributing LifeBand® squeezes the entire chest, improving blood flow to the heart and brain during sudden cardiac arrest. The device is especially useful when patients are being transferred from the ground to the stretcher, from the stretcher into the helicopter, and during flight to hospital. Blood flow can be continued throughout the rescue and rescuers freed up to focus on other potentially life-saving tasks. Jane Peacock, deputy director of operations at GNAAS, said: “I don’t normally get excited about medical equipment but this device is amazing. We have used this device a couple of times

now and we are seeing great results.” The GNAAS is a charity operating a fleet of air ambulances across an area of 8,000 square miles, from the Scottish Borders to North Yorkshire, from East Coast to West. On board are specialist trauma doctors and paramedics, bringing accident and emergency expertise to the scene. For more information, visit: ››› www.greatnorthairambulance.co.uk

GNAAS

Bond joins forces in “jigsaw puzzle”

ADAC

With an existing fleet of 49 helicopters, ADAC Air Rescue is one of Eurocopter’s largest European customers in the emergency medical services market segment. The new EC135 P2e and EC145 T2 helicopters acquired by ADAC Air Rescue will be fitted with medical equipment and the communication tools needed for rescue operations. Sporting ADAC’s classic yellow livery, they will be deployed as air ambulances for transporting intensive-care patients from one hospital to another, as well as in rescue missions – using a rescue hoist when necessary.

Bond’s offshore SAR operation comprises two dedicated and specially-modified Super Puma AS332L Mark II helicopters, made available under a long-term contract with BP to provide 24/7 airborne SAR and medical evacuation for its workforce in a North Sea system known as Jigsaw. One of the high-specification, twin-engine aircraft is based at Sumburgh Airport, Shetland, the other on the Miller platform, in the central North Sea. Joint exercises of the crews of Bond and of Lerwick harbour pilot boats take place once or twice a week, day and night, with the location – depending on weather – to the north or south of the harbour and often outside port limits. Scenarios practiced regularly with the dummies include winching a stretcher case from the deck of

the pilot boat, winching from a multi-seat liferaft and recovery from the sea. They involve either the authority’s pilot boat/tug boat or Kebister (harbour boat), each with a crew of three who are responsible for deploying a life raft and dummies, depending on the scenario. With increasingly large vessels using the deep-water harbour, the pilot boat crews undertook more than 1,200 ship movements last year, a rise of 15.5% on 2010. Jigsaw operations were launched in March 2006 and there have been around 60 winchings to date, as well as medevacs and downmannings. For more information, visit: ››› www.bondaviationgroup.com

For more information, visit: ››› www.adac.de/luftrettung

Make your ad space reservation for the upcoming

Airrescue

InternatIonal aIr rescue & aIr ambulance

Deadline: 15 February 2013

Bond

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neWs | 11 Mountain Rescue organizations equipped with AED HeartStart

certificate from Transport Canada for helicopter operations. Through the approval process, FAA officials vetted aviation documentation, including policy and training manuals, procedures, and certificates of airworthiness, and determined Ornge to be in compliance with its regulations. During the application process, Ornge PC-12NG airplanes continued to transport patients to and from the U.S.

Philips Electronics announced it donates the onemillionth HeartStart AED manufactured to Everett Mountain Rescue Unit (EMRU) of Snohomish,. EMRU is a volunteer SAR organization serving Snohomish County in the state of Washington, USA, which is also the location of Philips’ HeartStart headquarters. The one-millionth AED marks a major milestone in Philips’ more than 50-year history of cardiac resuscitation. Philips also announced that it will make AED donations to nine other local rescue organizations, including Snohomish County Volunteer Search and Rescue (SCVSAR) and eight groups associated with the Washington Mountain Rescue Association (WMRA). Philips says it wants to drive early defibrillation program best practices, and has helped to establish defibrillation programs at U.S. hospitals and airlines. The introduction of the ForeRunner AED (formerly manufactured by Heartstream, acquired by Philips in 2001) in 1996 helped to raise awareness and to improve public access to AEDs which eventually resulted in legislations to improve public access to AEDs in the U.S. and in many other countries as well.

For more information, visit: ››› www.ornge.ca

For more information, visit: ››› www.everettmountainrescue.org

Ornge

Ornge air ambulance allowed in U.S. air space Ontario’s air ambulance service, Ornge, got U.S. Federal Aviation Administration (FAA) approval to fly its helicopters in U.S. airspace. The fleet can now transport patients to or from any U.S. destination. Windsor Regional Hospital CEO David Musyj said the decision also makes it easier for Ontario residents injured or ill in the U.S. to return home once stabilized: “It strips a level of bureaucracy from the process”, because EMS staff from the U.S. are no longer needed in the transfer process. Ornge submitted its foreign air carrier application to the FAA after it was granted an air operator

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12 | neWs Avincis Group with global headquarter in London

Children’s Air Ambulance (UK) as “national” service?

The Avincis Group with operations in the UK, Spain, Italy, France, Portugal, Ireland, Norway, Australia, Chile and Peru provides safe transport for mission critical people and assets for public services. Avincis’ operating companies deliver across the service areas “Life and Rescue” (including SAR and air ambulance); “Safety and Environment” (including fire-fighting, fisheries and marine protection as well as border patrol, disaster response, civil protection and marine pilotage) and finally “Energy Support” ( that includes the transport of assets to remote locations such as oil and gas rigs and wind turbines).

Screenshot

Air ambulance charities across the UK are warning that the launch of a new air ambulance operation could lead to a reduction in air ambulance provision and cause public confusion. The concerns were raised prior to the launch of a “national” Children’s Air Ambulance (CAA) based in the Midlands. The Association of Air Ambulances (AAA), which represents the majority of air ambulance charities and ambulance services throughout the UK, says the service is a retrieval service based on the current Paediatric Retrieval Service provided by the NHS. It is not an emergency service unlike all other air ambulance operations. AAA Director, Clive Dickin, said: “There is currently no clinical evidence to support the provision of an enhanced service above the one already provided through public funding. Whilst the current service

does very occasionally request a patient to be airlifted, it always uses the established network of air ambulances, military aircraft or private air ambulances.” The CAA says it will initially transport specialist paediatric medical staff. From next year it will be used to fly patients to ICUs. The operator emphasises that the helicopter will not be used for emergency pick-ups. The pre-advertising of this service as a “national” one has led to confusion amongst members of the public. The Association of Air Ambulances forecasts a drop in fundraising for all charities and criticizes that to date, actually no clinical need for this new service has been identified. For more information, visit: ››› www.associationofairambulances.co.uk

Pub_E

Polycon waterproof SAR radio system now NVG compatible

Avincis

It operates around 350 rotary and 50 fixed-wing aircraft, from 295 bases in ten countries. Avincis employs almost 3,000 people worldwide and, at end of 2011, had an annualised turnover of 521 million euros (421 million UK-pounds). The Group is headquartered in London. The brands include Inaer, Bond, Australian Helicopters and Norsk Helikopterservice. In 2011, its companies flew in excess of 126,000 hours, conducted more than 3,900 SAR missions over seas and mountains, more than 36,000 air ambulance missions, rescued more than 7,000 people from lifethreatening situations, flew more than 8,800 fire fighting missions and flew over 180,000 people over the North Sea.

Axnes Aviation of Norway, the manufacturer of the Polycon waterproof intercom extension system for SAR helicopters, recently announced that it has developed an NVG compatible version of the system. This is in response to the SAR market upgrading to NVG compatible modern helicopter platforms and the increasing use of NVG systems in civil rotorcraft to increase operational safety. The upgrade includes the fitment of NVG compatible LED indicator lamps and NVG filters over the unit display windows on both the aircraft installed base station and the MP20 transceiver. The dual band MP20 transceiver is also available as an NVG compatible version. All the NVG compatible units have been tested and are in compliance with MILSTD-3009 NVIS radiance levels for Class B compatibility. The Polycon communications system provides the capability to rotary and fixed-wing operators to have wireless audio communications

between on and off aircraft crew members, as well as ground crews as if thy were hard wired to the intercom system. The Polycon wireless intercom extension system has been designed for the typical needs for operations in SAR as well as in EMS. In addition, it also allows the operators to improve efficiency in other areas, for example when mechanics work with running engines, in “pre-flight ground check”, while on and offloading personnel, when ground personnel uses sling loads, during inter operations with ships, boats, ground personnel, interoperations with ground rescue teams, when mechanics on ground conduct short test flights, and also for loadmasters on larger helicopter and aircraft.

For more information, visit: ››› www.axnes.com

For more information, visit: ››› www.avincisgroup.com ››› www.brunswickgroup.com

4 · 2012 I Vol. 2 I AirRescue I 216 Axnes

Max at 53

neWs | 13 KSE: rope work covering offshore The special unit of climbers (KSE) headed by Manuel Marburger specialises in work at higher altitudes – including offshore rescue. It is fair to say that this offshore service is also provided by other operators in this field, but what makes KSE different is how they provide their service. All the employees in the KSE unit are experienced altitude climbers and/or rescue workers with paramedic training, so they can provide professional assistance at the scene. The ‘standby’ nature of KSE in the wind farm itself, meaning they can be at the scene as quickly as possible, is further evidence of the special position the unit is in. Manuel Marburger and his ‘rope team’ have many years of altitude rescue experience to draw

KSE

on, which they can also successfully utilise in offshore missions. Their high level of skills and expertise is paying off: KSE is market leader in Germany for (work and industry-related) altitude

rescue and a pioneer when it comes to offshore rescue at altitude. Major companies in Germany, such as RWE and E.ON (electric utilities and service companies), rely on KSE’s know-how to ‘get the job done’. More than 50 employees ensure that a broad range of missions are covered. What’s more, Marburger has also founded a government-accredited vocational climbing school to ensure that the next generation of climbers can be given expert training. The unit also has its own specialist shop to supply the teams with high-quality equipment. For more information, visit: ››› www.kletter-spezial-einheit.de

Cega Air Ambulance expands fleet Cega Air Ambulance, based at Bournemouth International Airport (UK), has extended its international reach with the purchase of a Learjet 45, to supplement its existing fleet of King Air 200’s. “This significant investment has been made to meet the growing demand for longer distance critical care transfers, particularly from emerging and remote destinations back to Europe,” says Graham Ponsford, Cega Group Chief Executive.

Aside from its speed and range, the new jet is expected to benefit clients through its capacity to carry not just patients and medical crews, but also an accompanying relative or employer. Its generous interior also makes it suitable for the most complex critical care cases, whilst its auxiliary power unit provides a climate controlled cabin, even on the ground. Cega’s investment in the Learjet45 supports its recent launch of a

global private repatriation division. ICU equipment is supplied as standard on all flights, with additional specialist equipment where needed. Cega has been established almost 40 years ago, it has EURAMI accreditation and is CQC-registered. It operates 24/7, 365 days a year. For more information, visit: ››› www.cega-air-ambulance.com

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14 | eHac

Fig. 1: “In future, we will raise general awareness about the benefits of air rescue to the national economy.” (Photographs: ADAC Air Rescue)

“Highest flight safety standards and medical quality for people in distress” Frédéric Bruder took over as CEO of Munich-based ADAC Air Rescue on 3 September this year, having previously worked as Corporate Director of Strategy and International Business Development at Inaer. Editor-in-chief Dr Peter Poguntke interviewed Mr Bruder for AirRescue Magazine (ARM) and asked him what challenges he faced in his new position. ARM: Mr Bruder, as someone starting a new job, we inevitably have to ask you – what was it in particular that attracted you to your new role? Frédéric Bruder: The fascinating nature of air rescue is what attracted me first and foremost. The field involves a unique variety of tasks, both in a business management sense and in terms of operational aspects. The opportunity to control and shape these areas within such a professional and ground-breaking organisation as ADAC Air Rescue is incredibly exciting. It was pretty much a no-brainer for me. ARM: In your new role, you’re also inheriting the responsibility for a great legacy – the ADAC organisation’s air rescue operations in Germany began in 1970. How do you view this legacy? Frédéric Bruder: ADAC Air Rescue is renowned worldwide for its achievements – not only as one of the pioneers of air rescue many decades ago, but also as an organisation that remains at the cutting edge of technol-

ogy even today, using the latest flying procedures, as well as the latest air-based emergency medical services. It is a real honour to be preserving and continuing the success story that ADAC Air Rescue has written so far. ARM: What areas are you likely to focus on in the future? Frédéric Bruder: Our main priorities will be flight safety and the quality of the medical care we provide. After all, these are the existential pillars of our activities. Although we’ve already achieved great things, we need to keep working to make continuous improvements and pursue all necessary avenues to do justice to these priorities. Training, maintenance, procedures, but also openness to technological developments, will play a vital role here. Of course, we will also need to create the financial conditions necessary to maintain our safety standards and quality levels in the future. Compromises in those areas will not be an option. ARM: In the future, what will be the greatest challenges for air rescue at a national level?

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Frédéric Bruder: Air rescue in Germany will face a multitude of challenges. Economic conditions will have a big part to play, as will the legal framework governing aviation. Costs are rising rapidly, and these are not simply ‘inflation-related’ increases such as investments, maintenance, staffing, kerosene and so on – some increases are systemic, caused by changes in legislation and new rules and regulations. Even though the cost of air rescue in Germany is just the tip of the iceberg in relation to the cost of emergency rescue as a whole, we are still noticing the extreme cost pressure felt by our contracting bodies. In the future, it will be increasingly important to raise awareness about the benefits of a ‘well-oiled’ air-rescue system for the national economy, in addition to the medical benefits and other undisputed advantages brought by air rescue, such as the ‘First Golden Hour’ principle. ARM: The most important air rescue rules and regulations are, of course, pan-European. That said, do you have any specific requests you’d like to put to the German government? Frédéric Bruder: We see two aspects as being particularly important here: pragmatism and constructive dialogue with large organisations and operators. We need to find ways of doing things so that safety is the main focus, but which are also practicable in the day-to-day business. When drawing up, commentating on and implementing rules and regulations, it definitely helps to refer back to the extensive pool of knowledge and experience that operators have. However, we should point out here that the German government is definitely moving in the right direction, although we also believe they could still work more closely with the European bodies. One current example which urgently requires a long-term solution is the planned enforcement of ‘Rule 60’, which will ground rescue pilots aged 60 and over in a single cockpit operating environment. From a present-day perspective, this rule makes no sense whatsoever. It is our understanding that no scientific research exists to back this up and therefore any proof of an increased risk among pilots aged between 60 and 65 is lacking. Let’s not forget that our pilots undergo specialized medical screening regularly to confirm they are fit to fly – at the end of the day, we as operators are the ones with highest interest in having the best flight safety possible. ARM: If you had to sum up ADAC Air Rescue’s vision in a few words, what would it be? Frédéric Bruder: To rescue people in emergency by air, while adhering to the highest flight safety standards, and to provide these people with the highest level of medical care. ARM: Mr Bruder, many thanks for talking to us.

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

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Fig. 1: Offshore workplaces are challenging in terms of medical emergency response because of their remoteness from medical care as well as the likelihood that poor weather may delay evacuation (Photograph: AREVA Wind/ Jan Oelker)

Authors: Nils Weinrich Dirk Dethleff Caroline Friebe Markus Stuhr Klaus Seide Christian J眉rgens Berufsgenossenschaftliches Unfallkrankenhaus Trauma Hospital Hamburg Germany

Key component of the rescue chain: HEMS for trauma patients in offshore wind parks Helicopter Emergency Medical Service (HEMS) has become a key component of the rescue chain for offshore wind industry, especially during construction and maintenance of the wind turbines. Besides issues of pre-hospital care and transport to and from the scene, accessibility of the turbines due to marine conditions is an important factor for a sufficient and successful Emergency Medical Service (EMS) for offshore workers. This article will review current findings about HEMS for trauma patients and highlight some issues that are relevant for the offshore wind sector. This work is part of an ongoing research project to develop a rescue chain concept for critically ill and injured patients in offshore wind parks in order to provide recommendations for the future development and implementation of a rescue chain. HEMS plays an important role to provide pre-hospital medical support to trauma patients at the accident scene as well as rapid and safe transport from the scene to an appropriate care facility in an environment, where travelling times may be excessive by surface vehicles or where

remote communities might be deprived of the required level of healthcare service. In general, offshore workplaces are challenging because of their remoteness from medical care as well as the likelihood that poor weather may delay evacuation (1).

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oFFsHore | 17 In contrast to the workplaces in the offshore oil and gas industry, where the work area is more compact and the establishment and maintenance of an appropriate level of EMS is easier to manage, offshore wind parks cover large areas as a certain distance between the turbines is needed to avoid or minimise the wake effects (2). The offshore wind park “Meerwind Süd/Ost” for example, located in the German Bight in the North Sea 23 km north off the island of Helgoland, will consist of 80 wind turbines and covers an area of about 42 km², which is equivalent to the terrain of a city like the small port town Wismar on the Baltic Sea Coast. Levels of MER offshore (OGP)*

Level 1

Basic first aid

Level 2

Advanced first aid

Level 3

Trained medic, paramedic or emergency medical technician

Level 4

Doctor or nurse working in a primary care facility

Level 5

Specialist doctor working in a secondary or tertiary care facility *See also Ref. (1). Medical emergency response (MER) in the offshore oil and gas industry is often divided into tiers or levels. A scheme (see also boxed text above) is recommended by the International Association of Oil & Gas producers (OGP) (3) and many companies follow a similar system to organise MERs (1). For offshore wind parks this scheme may be applicable during construction in the presence of jackup-vessels but will be inapplicable during maintenance of individual wind turbines due to limited personal and organisational resources. A main aspect for EMS in offshore wind parks will be patient safety. According to the International Classification for Patient Safety of the WHO (4), safety “is the reduction of risk of unnecessary harm to an acceptable minimum” in which an “acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment”. But what are the collective notions of “given current knowledge”, the “resources” that are “available” or have to be installed and the risk of non-treatment or other treatment in view of EMS for offshore wind parks? Looking onshore, a recently published retrospective cohort study involving 223,475 patients older than 15 years admitted to a top-level trauma center draw attention as the study found that helicopter transport supports trauma patient survival compared to ground transport (5). Analysing more than 1.8 million patient recordings listed in the 2007-2009 version of the American College of Surgeons (ACS) National Trauma Data Bank (NTDB) from more than 900 centers in the United States the result was a 1.5% increase in survival rate for patients transported by helicopter as compared to ground emergency transportation to level I trauma centers, and an absolute survival advantage of 1.4% for those patients transported

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to level II trauma centers by helicopter compared with ground transported. The authors concluded that for patients transferred to level I trauma centers this percentage means that 65 patients need to be transported by helicopter to save one life. For patients transported to level II trauma centers, the number of patients is 69. Before, Butler et al. (6) already investigated the evidence comparing helicopter and ground transfer of trauma patients from the scene of injury in a systematic literature review. The authors concluded that it remains challenging to reliably identify the effect of helicopter EMS on the mortality of trauma patients transported from the scene, and that an efficient helicopter EMS will finally depend on effective operating procedures and tasking protocols as well as clinical governance and auditing of the helicopter EMS activities. Already in 2004, Biewener et al. (7) compared in a study including 403 patients the mortality of four typical and complete pathways of polytrauma patients (Injury Severity Score [ISS] > 16) and found that primary transfer by HEMS into a Level I trauma center reduces mortality significantly. In this context, it needs to be mentioned that new German regulations for inhospital treatment in emergency situations will come into effect on 1st January 2013 (8). A new aspect is the

Fig. 2: Intensive care helicopter “Christoph Hansa” for onshore flights run by ADAC Air Rescue (Photograph: Fotoabteilung BUKH)

Fig. 3: Even under ideal conditions, most offshore rescue missions for trauma patients will take many hours to be completed successfully (Photograph: Fotoabteilung BUKH)

18 | oFFsHore

Fig. 4: Hoisting an emergency physician on board a SAR Sea King helicopter of the German Navy over the German North Sea (Photograph: M. Stuhr)

explicit designation of a third care level: Besides the levels of primary and secondary care, this new third level defines a level of maximum care in the framework of severe injury type procedure. Another working group recently demonstrated the lack of uniformity in the use of dispatch criteria for trauma assistance, both on national and international level (9). Furthermore, the group found that HEMS is not only depending on dispatch criteria protocols, but is also influenced by organisational factors like education of the dispatcher, training of the EMS personnel, familiarity with the dispatch criteria and the responses of bystanders (9). But compared to onshore (H)EMS, we have to consider some additional issues in offshore wind park (H)EMS which mainly arise from the environmental parameters in offshore wind parks, the distance to the scene and the constructional conditions in wind turbines.

Constructional conditions in offshore wind parks Constructional conditions of the wind turbine are determining factors for an effective EMS. Space in – as well as access to – the wind turbine is limited. Therefore, an adaptive strategy that considers the limited space in terms of medical and technical rescue at the scene as well as the large area with the spatial distribution of workplaces in the parks, is needed in order to provide professional and efficient EMS in offshore wind parks. Looking onshore again, Cassone et al. (10) recently highlighted both the differences and similarities between urban/suburban (“traditional”) EMS and backcountry EMS responses, and also outlined the differences in protocols. They defined a backcountry situation “as any context in which there’s little to no communication with medical centers, a limited number of available resources, susceptibility to severe environmental conditions and the possibility for prolonged evacuations”, and emphasise that these factors can present many logistical and patient care dilemmas and often require significant modifications to

traditional urban EMS standards. The authors concluded that EMS in wilderness requires special considerations (10): “Patient care and the extended-care principles associated with outdoor medicine present an important break from standard EMS practice. Patient rescue, assessment and evacuation will often be complicated due to the variability of terrain, environmental conditions and limited resources in the backcountry. Wilderness rescuers must be respectful of their environment, safety conscious, resourceful and able to apply a modified scope of practice from traditional EMS to ensure success in outdoor medical emergencies.” Warden et al. (11) currently mentioned that some of the operational emergency medical services (EMS) programs which provide pre-hospital emergency care to patients in austere and resource-limited settings “are additionally considered to be wilderness EMS programs, a specialised type of operational EMS program, as they primarily function in a wilderness setting (e.g. wilderness search and rescue, ski patrols, water rescue, beach patrols and cave rescue). Other operational EMS programs include urban search and rescue, air medical support and tactical law enforcement response” (11). They concluded that the operational EMS medical director should be as qualified as possible for the specific team that is being supervised and should train and operate with the team frequently to be effective. Furthermore, an adequate provision for compensation, liability and equipment needs to be addressed for an optimal relationship between the medical director and the team. With respect to the role of the medical doctor in mountain rescue service, Putzke concluded that the development of obligatory standard operating procedures should be the major goal of medical associations and societies (12). Schmid et al. (13) recently mentioned that there are little data on the current availability of airway management equipment on HEMS helicopters in central Europe. In a previous study, the same group found a wide variation in the advanced airway management equipment that was carried routinely on UK air ambulances (14). On the other hand it seems to be clear that – besides skilled personnel – adequate equipment is a key prerequisite for an advanced out-of-hospital airway management. Nevertheless, currently presented and practised rescue concepts for offshore wind parks vary, from a less equipped transport helicopter with portable EMS equipment to a fully equipped rescue helicopter (as known from onshore EMS). Besides technical and economical aspects, the discussion should also consider aspects of the constructional conditions in the parks and the time necessary to provide appropriate care to a patient. Transportation of equipment and limited space for medical interventions at the accident scene have also to be taken into account. In view of the entire offshore wind industry and the multitude of indications, the implementation of both concepts seems to be favourable.

Distance and time Distance to offshore wind parks is one of the most important factors for providing rapid rescue and medi-

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oFFsHore | 19 cal care to the rescue scene and for rapid transport of trauma patients to a medical facility, and hence for an effective HEMS mission. Offshore wind parks are planned to be installed at locations of up to 200 km away from the coast (especially in the German Exclusive Economic Zone) (15). Even under ideal conditions, most offshore rescue missions for trauma patients will take many hours to be completed successfully. As mentioned by Cassone et al. (10), such long ordeals can lead to stress and emotional responses from both the patient and the rescue team. From this point of view it is important for rescuers to remain calm and collected and to give the patient a positive outlook without making inconclusive promises, the authors stated. Furthermore, rescuers must pace themselves and prepare for lengthy patient monitoring. Time for bringing rescue and medical care to the rescue scene represents the total of activation time, flight time and access time to the patient. With respect to medical considerations in the use of helicopters in mountain rescue, Tomazin et al. (16) noted that activation time should be as short as possible. Activation of a helicopter for a mountain rescue should primarily include indication and assessment of flight and safety conditions, but no other mediators or delaying factors should be permitted. The main safety criteria are appropriate mountain rescue and flight training, competence of air and ground crews, radio communication between the air and ground crews, and mission briefing before the rescue (16). Flight time depends on the geographic distance and therefore can only be affected by choice of the helicopter and location of the HEMS base. Access time to the accident scene on site depends on constructional and environmental conditions as well as on the equipment and the training of the rescuers. A French study recently suggested that medical prehospital management performed by mobile emergency and resuscitation service (Service Mobile d’Urgences et de Réanimation) is associated with a significant reduction in 30-day mortality in case of severe blunt trauma (17). With the help of the German Trauma Registry of the German Society for Trauma Surgery (DGU), a study published recently investigated the impact of the rescue time on hospital survival in severely injured patients (18). It was found that within the German rescue system the length of rescue time has no relevant impact on the survival of trauma patients admitted to a clinic. The authors explained this with a higher amount of preclinical medical procedures during longer rescue times and further advocate that the necessary and suitable preclinical medical procedures be performed to stabilize the patient, even in cases that have exceeded the 60-minutes gold standard time window. They concluded that the “golden hour” concept today might be better interpreted as an individual and appropriate “golden period” of trauma. From this point of view, the time for transport from the scene to an appropriate care facility seems to be of minor priority on land. Time for bringing rescue and medical care to the rescue scene, however, seems instead to be of crucial importance. But looking offshore, we have to

4 · 2012 I Vol. 2 I AirRescue I 223

consider that the extent of preclinical medical procedures will be limited compared to onshore settings.

Environmental parameters in offshore wind park helicopter rescue Environmental conditions (atmosphere, sea surface) are of crucial importance for accurate helicopter aviation and successful air rescue in offshore wind parks. While common weather and sea phenomena like wind, rain and surface waves are well manageable in offshore helicopter flying, harsher weather conditions like snow, hail, storm and thunderstorm may cause considerable problems in rescue operations. Sea fog, closed cloud cover as well as low cloud base and high ceiling are also restricting or even limiting factors in offshore aviation rescue, while less frequent extreme phenomena like tornadoes, freak waves and various ice scenarios could cause major problems for air rescue in offshore wind parks. The elucidation of the critical character of various atmospheric and marine environmental parameters for offshore helicopter operations in different offshore wind park rescue scenarios is currently under progress.

Conclusions The outcome of patient care can be fundamentally improved by bringing rapid rescue and medical care to the offshore scene if a sufficient amount of preclinical medical procedures are performed to stabilise the patient. A helicopter is the rescue vehicle of choice. Helicopters must be operated and staffed by appropriate offshore aviation-, rescue- and medically trained personnel and should be integrated into the existing emergency medical system. Activation times of a helicopter for a rescue mission in offshore wind parks should be as short as possible. Further criteria for a helicopter used for rescue missions in offshore wind parks like onboard medical and rescue equipment, load capacity, adequate space and others need to be investigated in the future. It is obvious that all helicopter equipment must be safe to

Fig. 5: Super Puma helicopter of German Federal Police during operational flight over the German North Sea (Photograph: M. Stuhr)

20 | oFFsHore

Fig. 6: Air medical programs operating offshore must deal with additional regulatory requirements and develop operational procedures to ensure safety during flights (Photograph: AREVA Wind/ Jan Oelker)

the patients transported, and must not be hazardous to the aviation safety. Using the words of Tomazin et al. (16), in principle, there are two main groups of indications for the use of a helicopter in offshore wind park rescue missions: the patient’s condition and the circumstances at the accident scene. All persons responsible for the helicopter rescue operation should be aware of specific problems in the offshore wind park environment. Finally, air medical programs operating offshore must deal with additional regulatory requirements and develop operational procedures to ensure safety during these flights.  For more information, visit: ››› http://bit.ly/O6gGj8

Acknowledgements The ongoing project work is supported by the Berufsgenossenschaft Handel und Warendistribution (BGHW). We thank our scientific advisory board and the offshore wind industry as well as authority officials for their candour and support and especially for the useful discussions and comments.

References: 1. Ponsonby W, Mika F, Irons G (2009) Offshore industry: medical emergency response in the offshore oil and gas industry. Occup Med 59 (5): 298-303 2. European Wind Energy Association (2009) Oceans of Opportunity. Harnessing Europe’s largest domestic energy resource. Available from Internet: http://www. ewea.org/fileadmin/ewea_documents/ documents/ publications/reports/Offshore_Report_2009.pdf. Accessed 13 October 2012.

3. International Association of Oil & Gas producers (2011) Managing Health for Field Operations in Oil and Gas Activities. OGP report no 343. ICIEPA OGP, London 4. World Health Organization (2009) Conceptual Framework for the International Classification for Patient Safety – Version 1.1. Final Technical Report. Chapter 3. The International Classification for Patient Safety. Key Concepts and Preferred Terms. Available online: www.who.int/patientsafety/ taxonomy/icps_chapter3. pdf. Accessed 24 October 2012. 5. Galvagno SM, Haut ER, Zafar SN, et al. (2012) Association between helicopter vs. ground emergency medical services and survival for adults with major trauma. JAMA 307 (15): 1602-10 6. Butler DP, Anwar I, Willett K (2010) Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence. Emerg Med J 27 (9): 692-701 7. Biewener A, Aschenbrenner U, Rammelt S, et al. (2004) Impact of helicopter transport and hospital level on mortality of polytrauma patients. J Trauma 56 (1): 94-8 8. Kranig A (2012) Zukünftiges stationäres Heilverfahren – Aus Sicht der DGUV (Deutsche Gesetzliche Unfallversicherung) [Future in-hospital treatment. From the perspective of the DGUV (German statutory accident insurance)]. Trauma Berufskrankh 2012/14: 263-267 9. Wigman LD, van Lieshout EM, de Ronde G, et al. (2011) Trauma-related dispatch criteria for Helicopter Emergency Medical Services in Europe. Injury 42 (5): 525-33 10. Cassone M, Sagalyn E, Dickinson ET (2012) Far from care: EMS in the wilderness requires special considerations. JEMS 37(4): 38-40, 42-47 11. Warden CR, Millin MG, Hawkins SC, et al. (2012) Medical direction of wilderness and other operational emergency medical services programs. Wilderness Environ Med 23 (1): 37-43 12. Putzke M (2008) Medical doctor in mountain rescue service – a profession’s perspective. [Article in German] Anasthesiol Intensivmed Notfallmed Schmerzther 43 (1): 74-7 13. Schmid M, Schüttler J, Ey K, et al. (2011) Equipment for pre-hospital airway management on Helicopter Emergency Medical System helicopters in central Europe. Acta Anaesthesiol Scand 55 (5): 583-7 14. Schmid M, Mang H, Ey K, et al. (2009) Prehospital airway management on rescue helicopters in the United Kingdom. Anaesthesia 64 (6): 625-631 15. Altmann M, Schmidt P, Weindorf W, et al. (2010) The assessment of potential and promotion of new generation of renewable technologies. – Study requested by the European Parliament’s Committee on Industry, Research and Energy (ITRE). Available online: www. europarl.europa.eu/document/activities/cont/20110 6/20110629ATT22895/20110629ATT22895EN.pdf. Accessed 14 October 2012. 16. Tomazin I, Kovacs T (2003) International Commission for Mountain Emergency Medicine. Medical considerations in the use of helicopters in mountain rescue. High Alt Med Biol 4(4): 479-483 17. Yeguiayan JM, Garrigue D, Binquet C, et al. (2011) French Intensive Care Recorded In Severe Trauma Study Group. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care 15 (1): R34 18. Kleber C, Lefering R, Kleber AJ, et al. (2012) Rettungszeit und Überleben von Schwerverletzten in Deutschland [Rescue time and survival of severely injured patients in Germany]. Unfallchirurg [Epub ahead of print: DOI 10.1007/s00113-011-2132-5]

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22 | oFFsHore

Fig. 1: Rotorcraft and energy production are two very complex technologies that were fused at a very early stage in the development of wind-energy generation (Photographs: Eurocopter)

Offshore wind farms: „Eurocopter is an integral part of the survival chain“ The activities of the energy companies in the field of offshore wind farms are increasing continuously. The oil platforms off the coasts are constantly tapping into new deposits of oil and gas. In addition the number of offshore platforms for the harvesting of wind energy is also growing. This trend also means that there is also a major challenge for helicopter manufacurers, because their aircraft supply these platforms with material and consumer goods, transport staff - and are ready for rapid action in the event of an emergency. On behalf of AirRescue Magazine, Dr Peter Poguntke spoke with Dennis Bernitz, Eurocopter, responsible for the market segment Offshore Wind, about the offshore activities and the role of HEMS in the survival chain. ARM: Mr Bernitz, is offshore a market of the future and in which regions do you expect an above-average growth? Bernitz: I can answer the first part of your question with a resounding ‘yes’. Oil and gas platforms are still being used as much as previously; the only thing is that they have to keep going further and further out to sea, where the new deposits are located. In addition, there are now more and more wind energy farms coming up. The nuclear catastrophe of Fukushima has led to a worldwide boom in the field of renewable energy. In this case, France and China, due to the topographic nature of their coasts, have

the advantage that they can always operate with platforms relatively close to the mainland. It is however in the UK and in Germany, where we see the highest growth rates in the field of wind energy. ARM: Could you elaborate on this? Bernitz: In the UK, 62 wind farms have been authorized and in Germany almost 30 – so far. But ultimately there will be 80 in the North Sea and 30 offshore wind farms in the Baltic Sea. The distance of these wind farms from the coast will range between 35 and 100 nautical miles.

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oFFsHore | 23 ARM: What are the present implications of this development for Eurocopter as a helicopter manufacturer? Bernitz: First of all, did you know that the first large-scale wind energy plants, ‘Growian 1’ and ‘Monopteros’, were built in collaboration with our German Eurocopter headquarters? Since this time, Germany has had a technological lead in the field of wind energy. Ever since that time, two very complex technologies have become connected to each other: rotorcraft and wind energy harvesting. In order to meet the technical challenges in the field of ‘offshore’, we have been working in this market for approximately the last three years. We attend all the conferences in this sector and present our products. This relatively new mission makes it necessary to transfer the knowledge gained from other helicopter missions, such as SAR, HEMS or freight transportation, to the field of ‘offshore wind’. We have this know-how. In addition, the objective is to create a structure in the wind farms, which would ensure the safe use of helicopters – mission navigation for flying through wind farms, for example. ARM: What does the future look like in the field of HEMS services? Bernitz: We are in a constant dialogue with HEMS services and platform operators working in this field. Centralized emergency and dispatch centres with comprehensive

facilities and services will definitely be installed on the coastline in the near future. In addition, there are clear demands on us as manufacturers, both from the market and from the aviation safety authorities. Here is an example: During autumn and winter, an extended deployment time window for HEMS flights becomes essential, because strong winds restrict shipping in these periods. On the other hand, visibility at this time of the year is very poor, and so the helicopters have to operate under IFR-conditions. So far, there has no permission been granted and rules need to be defined clearly here. One thing is however clear: We are an integral part of the survival chain in the offshore industry.

Fig. 2: “This relatively new mission makes it necessary to transfer the knowledge gained from other helicopter missions, such as SAR, HEMS or freight transportation, to the field of ‘offshore wind’.”

ARM: Mr. Bernitz, thank you very much for the interview.

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CH-8117 Fällanden Phone +41 44 806 24 24

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24 | oFFsHore

Fig. 1: At present there are no regulations on minimum standards, nor are there binding definitions for HEMS operations at offshore wind farms (Photograph: H. Janssen)

Through rough winds: HEMS missions at offshore wind parks from a German perspective Author: Klaus Graf Manager, IQmed GmbH Aigenstadl 103 94078 Freyung Germany klaus@iq-med.ca

The transition to alternative sources of energy has become a topic that is keenly and extensively discussed – not only in Germany. In addition to several other projects, large wind parks, which will play a significant role in energy generation in the future, are under construction in the North Sea and the Baltic Sea. The responsibilities in case of emergency situations have not been spelt out with an equal degree of clarity. This article provides an overview of the special challenges for HEMS missions operations at offshore plants and a perspective of an effective design of this special field of emergency medical service. A glance at the configurations of the offshore EMS that are common from an international perspective – especially in the commercial oil and gas sectors – reveals the options available at present, and, in addition, also indicates the need for optimisation. At present, 29 wind farms with over 2,000 wind turbines have been approved (1). In addition, there are four locations within the 12-mile zone of the North Sea, as well as three on the Baltic Sea. Two plants are already in operation here and several are under construction or will be commissioned in the next few months and years. First and foremost, at present there are no regulations on minimum standards, nor are there binding definitions for HEMS operations at offshore wind farms. In addition to a wide variety of political discussion and problem areas, the questions of the day-to-day operation – organizationally as well as economically – play an important role for the operators of (wind) energy generation plants.

The German waters in the North Sea and the Baltic Sea are divided into the 12-nautical mile zone (the so-called territorial sea) and the EEZ (Exclusive Economic Zone). The 12-nautical mile (NM) zone is German territory and is under the responsibility of the respective federal state. Seawards of the 12-NM boundary, up to a maximum of 200 NM from the coast, lies the Exclusive Economic Zone (EEZ), which adjoins the high seas. In the North Sea and the Baltic Sea, the German EEZ is, in effect, identical to the so-called German continental shelf. This comprises of the seabed and subsoil of the submarine areas, located seawards of the 12-nautical mile zone (territorial sea) up to a distance of a maximum of 200 nautical miles (2).

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oFFsHore | 25 Concepts for Health, Safety and Environment (HSE) After completion of all the offshore wind energy parks, more than 2,000 people will (temporarily) live and work there. They will have to be transported to and from their places of work by ships and helicopters. The operators have sophisticated logistical plans for this purpose. Obviously, there are similar plans for medical care and evacuation in case of emergency situations, illness or injuries. However, in most cases these plans were in the initial stages, based on the availability of government forces (SAR commands and civilian SAR institutions for example), such as the German Maritime Search and Rescue Service (DGzRS). According to professional assessments of the present HSE (Health, Safety and Environment) concepts, it was clear that merely the provisions covered by public funding are far from being sufficient for effective medical care in case of acute and emergency medical situations. This leads to the fact that the operators of the construction sites or wind farms would need to provide their “own”, company-run EMS. Due to the significant distances between the coast and the wind farms, HEMS has a major role to play here. While HEMS operations onshore are – to a great extent – effectively and efficiently organized and have recognized standards, there are no binding specifications for offshore HEMS at the open sea. Consequently, their configurations currently vary widely and are not subject to adequate quality control measures.

Distances and effective ranges Offshore wind farms located closest to the coast (situated at a distance of about 40 km) can be reached within a reasonable time frame, without any problems. In the near future however, there will be construction sites of offshore wind energy plants that will be situated at distances of 150 km (and more) off the coast. This gives rise to the question of suitable helicopter types, since certain models are not suitable – due to their size and weight – to access offshore wind farms. In summary, the operation of helicopter types that are suitable for offshore rescue missions require a sufficient “endurance” capacity, but at the same time their dimensions should be suitable for safe operations (including hoisting) within the environment of offshore wind farms. In this respect it is important to note that even reasonable time windows for search flights in the vicinity of wind parks or for operations of support vessels and of a following transport to a trauma center or a suitable clinic should be possible without stopping for refuelling. In addition, there must be sufficient accommodation capacity available for the operating crew, which, as a rule, consists of five people (two flight crew members, one hoist operator, one paramedic/HEMS, one HEMS doctor and at least one patient). This clearly shows that conventional helicopter types are not really suitable for HEMS assignments.

Qualifications of flight crew and hoist operator Obviously, the companies responsible for the implementation of HEMS on the open sea must have the necessary authorisations such as Helicopter Offshore Operations

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Geodetic datum: WGS 84 · Map projection: Mercator (54°N)

(HOO), (Helicopter Hoist Operations (HHO) and HEMS. In addition, company-specific training modalities on JAROPS-regulations should ensure safe flight operations, including winch operation, under difficult HEMS conditions. It is here that the experience level of the crew implementing the operations assumes substantial importance. In this respect the standards of the OGP (International Association of Oil and Gas Producers) can be used as guidelines. In comparison with the companies that are internationally active in offshore HEMS/SAR operations, the following criteria can be applied as a minimum requirement for the flight crew:

Fig. 2: Map of offshore wind farms in the North Sea Borders Continental shelf /exclusive economic zone 12-mile zone/coastal waters International borders Offshore wind farms Planned Under construction Approved In operation Platforms Transformer platform, in operation Transformer platform, under construction

PIC (Pilot in Command)

Co-Pilot

ATPL/CPL

Instrument flight license (IR)

Converter platform, under construction

Offshore-Training

Converter platform, planned

> 2,000 flying hours

> 500 flying hours

at least 100h on type

at least 50h on type

Transformer platform,, planned

Grid connections In operation Under construction

The experience of and team work among the crew plays a substantial role for hoist operations carried out on platforms of offshore wind turbines, on ships, in poor weather conditions and rough or very rough seas with high waves – even more than in case of hoist operations on land. This is why the selection of well-versed hoist operators is as important as employing an experienced HEMS flying crew. Since such specialists, as is the case for pilots, are not available in sufficient numbers on the (civilian) job market, the majority – on an international scale – comes from the field of military services and, therefore, has sufficient experience in the implementation of such demanding tasks. Similarly, members of the medical crew must be experienced, educated and trained on the requirements of HEMS operations since in this process they must be

Approved Planned

26 | oFFsHore able to react to emergency medical situations with the same level of safety and efficiency – even under more difficult conditions. In order to be able to carry out demanding HEMS operations in offshore wind farms that are safe for the crew and for patients likewise, appropriate attention must be accorded to effective crew resource management (CRM). A helicopter underwater escape training (HUET-training) is mandatory for all crew members.

Helicopter types and configuration If one compares global offshore SAR/HEMS services, it is striking that in this field rather large helicopter types (such as the S92, the AS332 Super Puma, Sea King or SH60 Seahawk, etc.) are being operated. This is mainly due to the fact that priority is mostly given to a multifunctional configuration capability (including evacuation assignments). By having a closer look however, one may arrive at the conclusion that – for a pure rescue configuration – smaller and thus faster and more flexible helicopter models such as the EC155, the AS365, S-76, etc. offer more advantages which are particularly predominant in case of winching manoeuvres at offshore wind energy plants. Classical EMS helicopter models such as the EC135 or BK117/EC145 come into the picture at wind energy plants which are located relatively near the coast, due to their low payload capacity and low range, as well as rather limited space and loading capabilities for patients. However, there are no differences in the configuration of the helicopter. The following features are considered to be the “gold standard” in this respect:

Fig. 4: Transportation times of offshore HEMS taken to get the patient from the emergency scene to a suitable hospital (trauma center) differ significantly from onshore HEMS (Photograph: H. Janssen)

1. An adequate, mission-specific range for SAR applications, depending on the distance between HEMS base, the operating area, and a hospital of maximum care. Worst-case scenarios should be envisaged here. 2. An instrument flying license is advisable since it guarantees – in combination with respective pilot qualifications – a higher level of flight safety. In Germany (and also in most other countries) it is not possible to execute IFR-landing approaches on offshore

wind turbines, platforms, nor on ships or hospital rooftop helipads. There is a lack of regulations and controlled air space required for this purpose. In this context one must also refute the widespread misconception that flights under IFR offer more flexible flight operation options in poor weather conditions and that they are thus ideal for HEMS applications under offshore conditions. While considering weather minima for HEMS, it becomes clear that JAR-OPS permit significantly greater leeway than IFR-regulations would. The equipment for hoist operations is obligatory for offshore HEMS and should be available when required. It is of utmost importance to be able to hoist a patient on board the helicopter – without any intermediate landing (equipment with redundancy). A collision warning system (Traffic Collision Avoidance System, TCAS) and AIS transponder (Automatic Identification System) raise the level of safety, when viewed against the background that in complex rescue situations, as also in everyday air traffic conditions, several helicopters are on the move between the offshore wind farms. An autopilot system (see IFR) should also be mandatory for these missions. In addition to a significant stress reduction on the part of the crew during flight ops, the newer systems provide significant advantages in hovering. In case of a mission configuration of this type, modern helicopters should have a 4-axis-system and a control system option for the hoist operator. Powerful searchlight, perhaps even in combination with a FLIR (Forward Looking Infrared) camera, not only offer advantages in the search for people in the water, but also in cases of night landing approaches etc. Mission-specific communication facilities are of significant importance for a safe and effective implementation of rescue operations. In addition to the conventional VHF-radio devices, aircraft used in offshore applications require a marine radio for communication with maritime facilities. Furthermore, tactical radio devices of the BOS (security authorities and organizations in Germany) as well as digital radio (TETRA etc.) are essential for HEMS assignments in this sphere of work. In addition, the fixed installation of a satellite telephone is absolutely essential, as this is also used for the transmission of tracking information. If there are still more special communication channels to be linked – such as specific operational wireless devices of the wind farm operator –, their accommodation in the cockpit will become a real challenge, in addition to the licensing scenarios. Of no less importance is also the consideration that a surfeit of communication facilities does not impair safe execution of the missions. Tracking systems, in addition to their functions in aspects relevant to flight safety, offer significant advantages in deployment, and are standard prerequisites today.

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oFFsHore | 27 9. Having a closer look at night missions, the use of Night Vision Goggles (NVG) needs to be considered in the near future. This would result in a significant increase in safety, in particular for low altitudes operations between the wind farms. In the meantime, the use of NVG devices has now become international standard practice in case of SAR/HEMS missions. 10.The future will reveal whether helicopter rotors deicing systems will become obligatory for use in the German EEZ as in other SAR/HEMS units in the international context. At present, there is very not enough experience from which one may draw appropriate conclusions. From the point of view of meteorological and marine technology, the issue of iced rotors has not yet been finally adjudicated upon.

Medical interior Regarding the question of what constitutes the best configuration for a mission-specific medical interior, a general distinction must be made as to the purpose for which the helicopter is being used. In case of a complex rescue operation, when (additional) medical personnel and equipment is to be transported to the scene as fast as possible, retrofittable helicopters, normally used for passenger transport, but capable to accommodate (additional) medical crew (paramedics and HEMS doctor) together with the corresponding medical equipment, are appropriate here. In case of this exceptional application, even the associated disadvantages can be acceptable. Criteria valid for HEMS onshore should be the minimum requirements for HEMS at offshore wind farms (HEMS service contracted by the offshore wind farm operators): • DIN 13718-... RTH (HEMS) • Compliance with the German Medical Devices Act • Mounting systems and operating systems certified for medical equipment used in aviation (Supplemental Type Certificate) However, offshore HEMS differs significantly in one aspect from land-based EMS. These are the transportation times taken to get the patient from the emergency scene to a suitable hospital (trauma center). While HEMS onshore require an annual average of about 10 to 14 minutes for this purpose, transport interval in case of offshore applications is more than 40 minutes. In the case of remotely located wind farms, mere transportation time could even be more than one hour. Combined with the fact that the flight to an incident scene itself takes up a considerable amount of time, it is necessary to make provisions to enable special procedures and sufficient capacities (e.g., oxygen supply) for diagnosis and therapy of casualty patients on board, in case of relatively long distances. This can be ensured only by means of specially configured EMS helicopters.

Medical crew The question of the medical and professional qualifications of the medical crew is viewed differently in different countries – depending on the country-specific practices

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as well as legal conditions. In many other countries it is widely common that offshore SAR/HEMS services operate with paramedical staff (flight nurse, paramedics). Here again, this results in considerable disadvantages in the individual emergency medical procedural strategies. Here too, the standards of air rescue onshore procedures established by statute and by convention of the concerned are to be adopted for offshore missions, and to “add on” mission-specific supplementary standards for offshore HEMS. Due to the demanding requirements in terms of the diagnostic and therapeutic treatment expertise of the medical crew, at least the qualification criteria of HEMS should apply. Additional qualification characteristics – in terms of advanced education and training – must also be met.

HEMS doctor The requirements in terms of qualifications of the HEMS doctor include: • Specialized medical qualifications in an ICU and a department relevant to emergency medicine • At least one year of intensive care medical practice • Active and regular participation in the medical emergency services • Experience in onshore-based air rescue missions • Access to an intensive care medical center or an advanced care hospital • Training and hands-on handling in procedures of rescue from great heights • Training and hands-on handling in procedures of water rescue • Training in hoist operations

Paramedics/HEMS crew members (HCM) The HEMS crew members should comply with the following prerequisites: • • • •

Fulfilment of the qualification requirements for HEMS Experience in onshore-based HEMS missions Training in rescuing from great heights Training and hands-on handling in procedures of water rescue • Training in hoist operations

Fig. 5: A helicopter underwater escape training (HUETtraining) is mandatory for all crew members (Photograph: Falck Nutec)

28 | oFFsHore Both members of the medical crew must be able to contribute the appropriate physical and psychological characteristics required for the fulfilment of their tasks and must, together with all the other crew members, continuously perform training exercises. Due to the international nature of the employment on the offshore wind farms, all crew members should be able to communicate bilingually.

The time factor ... emergency medical and mission-related aspects Due to the considerable distances that have to be covered in the event of an emergency in offshore work locations, the mission-related procedures represent an exceptional challenge. In addition to safety and quality, it is the time factor that plays the leading role here. It is critical to gain time for emergency patients and thereby at least to the extent possible, to comply with the time-window determined on the basis of medical evidence. In this process, improvised medical-technical facilities as well as improvised rescue procedures are to be avoided. In order to ensure the shortest possible reaction times and quick interventions, the time factor must be accorded the highest level of priority in consideration of all missionrelated aspects. Due to the offshore-specific circumstances, such as wearing a wetsuits, preparatory time frames for medical procedures cannot be maintained, as they would be in case of land-based air rescue missions (< 3 minutes). However, no more than 10 to 15 minutes may elapse between an emergency call and the time an offshore rescue helicopter is airborne. On an average, this also corresponds to international specifications. Obviously, this is predicated upon the whole medical crew being present at the HEMS base. Triangular flights to pick up the medical staff are as unacceptable as retrieval via the land route. This requires a sophisticated deployment disposition in a dispatch centre that is appropriately equipped, both technically and in terms of personnel as well as helicopters configured specifically for this task, which are set up in such a manner that all possible diagnostic and therapeutic procedures can be executed both directly at the site as well as on board the helicopter.

Deployment scenarios and mission areas Experience with offshore HEMS bases that are already in operation reveals a virtually identical picture with regard to the frequency of deployment scenarios in comparison to land-based rescue services. Offshore too, emergency cases in internal medicine predominate over work-related accidents on the plants, platforms or ships. According to current surveys – there are two to four instances of HEMS deployment per week (at two offshore wind energy farms presently in operation and at three construction sites). If this is extrapolated in proportion to the planned wind farms and the resultant increase in the staff complement, a frequency of approximately 20 deployment instances per week can be expected. It may be assumed that the frequency of work-related accidents and the need for rescue procedures involving hoist operations during the construction phase of the wind

farms will be higher than it is in the actual operating phase. However, it is important to point out that, even in the operational phase, maintenance activity and assembly as well as dismantling of segments of the plants will result in a constant state of change, which, on an annual average, is expected to result in a high degree of continuity of rescue operations. Added to this, there will be an increase in the number of transfer trips and flights. Rescue operations with the use of technical equipment represent challenging requirements in this connection. So on the tactical deployment planning, the fire brigade for example cannot be called on for assistance – as would be conventional on land and be on the spot in less than 10 minutes. Here, it is important to develop procedures, which ensure safe rescue in a reasonable time frame. Even this would not be possible without the flexible use of helicopters. Therefore, a significantly higher degree of importance is to be accorded to the time factor in tactical considerations of deployment than is actually the case at present. Existing plans are based too heavily on standards of disaster medicine. In the context of offshore rescue, we are however concerned not only with disaster medicine, but rather with emergency medicine that rather focuses on single cases. Merely the fact that greater distances have to be taken into consideration in cases of deployment does not justify any reduction in the level of emergency care or tactical standards, applicable to the country. With regard to the locations of deployment, the present experience reveals that there is an approximately even distribution over the areas of the offshore wind energy plants’ living and working platforms and ships. Deployment instances with persons in the water have been relatively rare in the recent past, but are becoming increasingly probable with the basic location having become “the sea”. Rescue services provided by the offshore operator, and, in particular offshore HEMS and their crews, must therefore be prepared to handle these deployment situations safely and efficiently and should be in a position to react to them quickly and safely. In this respect, it is of considerable importance that in case of water rescue deployments under offshore conditions, the HEMS crew can execute an essential intervention under their own steam, without having to take outside specialists on board. Appropriate procedures must be developed for this purpose and continuously practiced and improved. There is an even greater probability that during rescue deployment instances at offshore wind farms components of the system for rescue from great heights will come into play. It is therefore of advantage if both members of the medical crew are trained in operations involving the specific methods for rescue from great heights and are able to safely carry out rescue measures at heights in cooperation with the workers from the offshore wind farm itself. Hoist operations on offshore wind energy farms are a challenge to the entire team, medical and flight, of a HEMS crew. On the one hand, there are several different models of the tower foundations and the towers themselves, all of which do not have an extra hoist unit on which an easy placement is possible. In addition, there is the fact that the location of the rescue procedure obvi-

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Fig. 6: Helicopter types suitable for offshore require a sufficient “endurance” capacity, but at the same time their dimensions should be suitable for safe ops within the offshore wind farm environment (Photograph: Bond)

ously depends upon where the emergency patient to be offloaded is located. For this purpose, special procedures with rope procedures must be continuously practiced in order to ensure safe implementation.

Weather conditions Obviously, weather-related factors have a decisive influence on flight operations. In order to be able to make safe evaluation of whether a rescue mission is feasible under existing weather conditions, pilots on duty must be provided with a permanent overview of the current weather situation, both at the HEMS base as well as at possible operational sites. Reliable sources of information on the prevailing weather parameters are therefore tools of enormous importance for the fastest possible decision-making and should be accessible at any time. In addition, there are automatic weather stations available on the offshore wind energy farms, and there is recourse to various other sources for sea and flight-related weather data on the publications of international (aviation) weather services that are also globally accessible. In addition to the usual WX-parameters, other factors – including the direction of the motion of the sea, oceanographic data such as significant wave height, water levels etc. – play an important role in HEMS offshore missions. Whether and how an instance of deployment is to be undertaken can be safely decided upon only if all weather data is at hand. In case of data that require clarification, contact with control rooms is of great importance to wind farm operators and captains of ships. Staff of the control rooms has adequate maritime experience and can exchange the information necessary with the HEMS flight crew. The maximum wind speed at which a landing can be made on the landing deck of a ship depends on various parameters. Therefore, no generally applicable statement can be made in this connection. Here too, it is important, obviously, to land in the direction of the wind and in par-

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ticular, to take into consideration turbulences which may occur partially due to the height of the ship’s structures (3). In case of wind force >11 and correspondingly high waves, rolling of the ships would be too intense to permit a safe landing. Landings on prepared offshore platforms are possible at wind speeds of up to 60 knots, and hoist operations at speeds of up to 50 knots. Offshore HEMS may be deployed up to a cloud base of 600 ft. and visibility of up to 1,500 m. Under certain circumstances it is possible to undercut this for short periods.

HEMS and SAR Helicopter emergency medical service provided by the offshore wind park operator also means that there is a highly qualified and rapidly deployable civilian SARcomponent available. This could (as a supplement to the government’s service) cover – in collaboration with existing sub-facilities and at low cost – a variety of the usual (H)EMS tasks at sea and in coastal waters. This model of transferring (former) government SAR-assignments to already existing private resources is already common practice in many countries. Even if many of the questions concerning standards of offshore HEMS missions in Germany are still debated at the moment, there are promising dynamics and projects, which will lead to an effective and efficient emergency medical service at offshore wind farms. 

For more information, visit: ››› www.bsh.de ››› www.havariekommando.de ››› www.offshore-windenergie.net/windparks ››› www.ogp.org.uk ››› www.uscg.mil ››› www.bondaviationgroup.com ››› www.chcsar.com ››› www.norskluftambulanse.no ››› www.offshore-rettung.org

Author‘s Declaration The author declares that he works as a consultant for companies that undertake offshore flight operations as well as for companies dedicated to emergency management.

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Fig. 1: Injured persons can be rescued from an offshore wind turbine either from the helihoist (HH) platform or the transition piece (TP) (Photograph and figures: OffTEC Base GmbH)

HEMS in offshore wind turbines: Promising highline rescue procedure Authors: Editorial Team AirRescue Magazine

Hundreds of people are already employed on the gigantic offshore wind turbine construction projects off the North and Baltic Sea coasts. Soon there will be thousands: fitters, divers, welders, service technicians and engineers. In the workplace they will be exposed to accident hazards with potentially serious consequences. So how can they be rescued quickly and, more importantly, safely in an emergency? The so-called highline rescue procedure seems to be very promising, and is aimed at making it easier for the HEMS crew to rescue and evacuate injured employees. The highline rescue procedure was recently presented at the WindEnergy 2012 trade fair by the OffTEC Base company. Managing director Andreas Rauschelbach emphasises that the highline procedure is the first time that a variety of procedures, such as those used in mountain rescue and rescue from height, have been combined and adapted for offshore rescue situations.

Highline rescue procedure On an offshore wind turbine there are two points from which the injured party can be rescued: these transfer points are the helihoist (HH) platform on the roof of the nacelle, and the transition piece (TP), a balcony-line access platform for supply vessels around the bottom of the tower. Assuming the accident has occurred in the lower part of the turbine and the injured person cannot be conveyed to the roof platform, evacuation is only possible via this platform. In this case the highline rescue procedure would be as follows:

1. After the first rescue measures have been taken to evacuate the injured person from the immediate danger zone and an emergency call made to the rescue services, the injured person is treated directly at the scene of the accident. If the patient is not fit to be transported, he or she will be cared for by team colleagues in the wind turbine until the HEMS arrives (see Fig. 1). 2. The rotor and the nacelle of the offshore wind turbine have to be correctly positioned and secured in preparation for the arrival of the helicopter. The nacelle and the rotor both have to be brought into park position, to enable a safe approach of the helicopter. This so-called orientation stop is a turbine control procedure triggered by remote monitoring, a control room, or by service staff on site, to bring the offshore wind turbine into park position, and which can be achieved semi-automatically with the aid of a few commands. 3. The HEMS crew member and the emergency doctor are lowered down to the helihoist platform by winch. The helicopter hovers in standby position, though

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should ideally temporarily land on the helideck of a transformer platform. The rescuers are lowered, care for the patient and – if he is fit to be transported – prepare him for transport (e.g. using a spine board or rescue sack) and transport him to the transition point (TP). The helicopter then approaches again. 4. There are two options for the highline procedure: Either the winch operator throws the end of the highline – weighted with a sandbag – onto the transition

point (TP), or – the preferred method – the emergency doctor, or a member of the HEMS crew, shoots the highline from the transition platform (TP) with a suitable device (similar to an air gun), whose range – depending on the projectile – is between 50 and 100 metres, into the water. For this application, the line (approximately 100 metres in length, 3-5 mm thick, and with a tensile strength of 2 kN) is furnished with a float (1) that keeps the line on the surface so that

Fig. 2: Nacelle and rotor have to be brought into park position in order to ensure that the helicopter has a safe approach Fig. 3: After the rescuers are lowered, the helicopter goes to standby position, ideally on the roof of a transformer

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32 | oFFsHore

Fig. 4: The highline is shot into the water from the transition platform using a pneumatic line thrower (range between 70 and 100 metres) Fig. 5: Once the line has been picked up by the helicopter and the winch operator has attached the winch rope to the highline, the helicopter ascends to winch height – maintaining sufficient distance to the offshore wind turbine

Footnote (1) The pneumatic line thrower used in the demonstration is made by Nautilus Marine Service GmbH. It has various projectiles for different applications. In this case the float is the appropriate solution.

the rescue line can be fished out of the water from the helicopter using an appliance similar to a grappling hook at a safe distance from the offshore wind turbine. 5. The winch operator now attaches the winch rope (50 to 90 metres) to the highline, the helicopter rises to a winching height of around 40 to 60 metres to create a diagonal connection of the winch rope

Who carries out rescues from offshore wind farms? Although the general euphoria surrounding the expansion of offshore wind farms has dissipated somewhat – in recent weeks there have been reports in the press about cash-strapped operators, problems with stability during foundation construction, procedures when erecting wind turbines, and also failures by government – in general the expansion seems to be unstoppable. The Offshore Stiftung expects that the completed wind farms will be the best argument in favour of the development of more farms. There are plans to erect wind turbines with a capacity of 11,000 megawatts in the North Sea alone by 2022. But who is responsible for offshore rescue and evacuation in case of an accident? To date there is no law that is generally binding as to which organisation is responsible when a technician has an accident on a windmill offshore. Below a certain level of complexity, the wind farm operators are themselves initially responsible for the safety and rescue of employees, and have to determine who carries out the rescue within the scope of a risk assessment – possibly using a company rescue service – although as yet no standardised offshore rescue chain has been established. In serious cases rescue is by helicopter as this guarantees shorter response times. This relative timesaving should be weighed against the complexity of the operation and the difficulty of access to the person to be evacuated from the turbine.

between helicopter and the rescuers on the TP platform. The ascent of the helicopter to winch height ensures a small winch and highline connection angle of c. 20 degrees between the helicopter and the obstacles presented by the offshore wind turbine. A special requirement for the pilots is to keep to a safety distance of c. one rotor diameter between the helicopter rotor and the WT rotor blades (which can be up to 60 metres in length), the tower and the nacelle of the wind turbine – whereby under certain circumstances the pilot does not have a direct view of all obstacles. During the ascent to winch height, the winch rope is lowered and then pulled over to the TP by the HEMS crew. After the injured person in the rescue sack is securely attached to the winch rope, he or she is supported and winched up into the helicopter – guided by the highline. Once the patient is safely in the helicopter, the winch operator releases the highline and the helicopter flies to the helihoist platform again to collect the rescuers. HEMS crew and emergency doctor go back up to the helihoist platform from where they are hoisted back up to the helicopter.

Realistic training scenarios The offshore wind farms off the German coast are new territory even for experienced doctors, pilots and rescuers from height. HEMS crews must therefore regularly practise rescue and evacuation of injured persons. OffTEC relies on realistic training scenarios on wind turbines, and offers these in collaboration with Heli Service International. Various hoisting, rescue and evacuation training exercises can be carried out on a training and test wind farm (onshore) specially set up with two Siemens SWT-3.6-120 wind turbines fully equipped for offshore application (90-metre tower and helihoist platform) and two Siemens SWT-3.0-101DD (80-metre tower, gearless turbine – a technology that will in future also be used offshore). The highline rescue procedure, for which courses will be provided from next year, will for the foreseeable future be for “offshore only”. 

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In ProFIle | 33

CHC Search & Rescue: One of the world’s largest networks of SAR services Helicopter search and rescue (SAR) is a unique service performed in the most challenging circumstances. From the biting winds of the North Sea to the perilous sea conditions of the South Atlantic and the busy coastal environments of Australia, pilots, crews and aircraft must be capable of operating in the harshest of remote and often difficult to access locations. As the largest commercial operator in the world, CHC Helicopter operates one of the biggest networks of SAR services with one of the most modern helicopter fleets. The company’s aircraft and crews work across the widest range of geographical and climatic conditions, providing services for civilian, military and industrial partners. CHC’s SAR operations span Norway, Australia, Brazil, Tanzania, the South Atlantic and Kazakhstan. It is contracted to the Maritime Coastguard Agency in the U.K. since 2007 and recently renewed its partnership with the Irish Coast Guard. SAR activities are just one arm of the services the company provides. The market leader in offshore transportation for the oil and gas industry, CHC also transfers hundreds workers to and from offshore installations and ships across the world every day. Providing additional helicopter maintenance repair and overhaul services, the company operates more than 250 aircraft in about 30 countries

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around the world overall. “SAR is the really tangible part of everything we work towards in terms of safety, training and technology,” said Nick Mair, CHC’s regional vice president. “When an emergency call comes in, these individuals, who are by their nature all intelligent problem solvers, quickly come together and work as a team. Day in, day out, our people display their skills, courage and

Fig. 1: CHC’s air-crews participate in live training exercises or challenging simulator work, many also routinely augment their formal medical skills (Photographs: CHC Helicopter)

Authors: Editorial Team AirRescue Magazine

34 | In ProFIle professionalism. They don’t hesitate to safely work to the limit of their training and the aircraft’s capabilities, but they have a clear focus on achieving the aim of bringing people home, often from life-threatening situations.” Underpinning these attributes is a rigorous training and exercise programme that keeps the crews ready to react, regardless of the challenges that may be posed. When they’re not out on missions, air-crews participate in live training exercises or challenging simulator work. Many also routinely augment their formal medical skills. “Our focus today, as it always has been, is upon safety, reliability, performance and delivery,” added Mr Mair. “This is nowhere more apparent than in our SAR fleet. Our people routinely demonstrate skill, courage and dedication in undertaking missions in the most testing of conditions. “The right aircraft, the best people, the latest technology, the most extensive experience. Whatever it takes, we’re ready.”

Busy Irish Sea CHC has provided SAR services to the Irish Coast Guard since 2001, deploying a fleet of six Sikorsky 61N aircraft from four bases strategically placed around the country and averaging around 500 missions a year. With the renewal of their contract in 2010, CHC has embarked on a significant programme of investment to further enhance the fleet and achieve significant new levels in this vital life-saving service. The arrival of the first of five state-ofthe-art Sikorsky S92 aircraft in Shannon in January this year marked the beginning of a new generation of SAR services in the country. The S92, which CHC also operates for the SAR in the U.K., is blazing a trail in terms of technological capabilities, possessing the speed, range and equipment to deliver a SAR service that meets modern-day needs. The S92s are equipped with high-speed dual hoists and transformative technology, including: Fig. 2: In the U.K., HM Coastguard operates a 24-hour-a-day service covering more than 19,000 km of coastline and approx. 3.2 million km2 of sea

• • • •

Maritime Automated Identification System (AIS) Powerful searchlights Satellite communications with flight following Advanced medical equipment for paramedics

“S92 aircraft will be introduced to the other bases at Dublin, Waterford and Sligo in the coming months, replacing the existing S61s which have been a familiar sight in the skies for more than 21 years,” said Mark Kelly, managing director of CHC Ireland. “The landscape of each base showcases the diverse capabilities of S92s custom-made for SAR activities. The most northerly base in Ireland, Sligo deals with the stern challenges posed by the Atlantic Ocean and a clifftop environment along the northwest coast. “Missions often involve rescuing casualties from remote rural areas in the west of Ireland, greatly reducing the time needed to transfer patients to a hospital. The base also carries out rescues from the many islands of the west coast and also within Northern Ireland.” Dublin’s patch includes a port which features high levels of ferry and merchant vessel activity on the busy Irish Sea. This includes the world’s largest car ferry. Another active area for the crews is within the Wicklow Mountains to the south of the city, which have the highest concentration of mountain rescue incidents. Located in the southeast, the Waterford base serves the area’s numerous popular beaches and challenging coastline. The base also covers the busy maritime areas of the Celtic Sea and the South Irish Sea with crews occasionally called upon to support operations in the west of Wales. “The introduction of the S92s is just one of a number of improvements that Irish citizens will see in the SAR service. In February 2011 our crews were upgraded to paramedic status some 14 months ahead of schedule, said Mr Kelly. “In a remote environment, this can be the difference between life and death.”

As far as the Faroe Islands • Thermal imaging and high-definition, low-light sensors • Direction-finding equipment

In the U.K., Her Majesty’s Coastguard as part of the Maritime and Coastguard Agency operates a 24-hour-a-day service covering more than 19,000 km of coastline and approximately 3.2 million square kilometres of sea. The four coastguard helicopters operated by CHC are staffed with a captain, a co-pilot, a winchman and a winch-operator, with at least one fully qualified paramedic among them. They carry out an average of around 750 missions a year. As well as operating S92s from Stornoway and Sumburgh in Scotland, CHC has Agusta Westland 139 aircraft at two bases in the south of England, Portland and Lee-on-Solent, which it operates on behalf of the Maritime Coastguard Agency. The AW139 helicopters are fitted with high-speed dual hoists as well as: • Thermal imaging and high-definition, low-light sensors • Direction-finding equipment • Maritime Automated Identification System (AIS) • Powerful searchlights • Satellite communications with flight following • Advanced medical equipment for paramedics

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In ProFIle | 35 Ian McLuskie, the U.K. SAR business unit leader, said: “With an average of around 120 missions per year, the service frequency from the Sumburgh base in Shetland, for example, is relatively low, although the total number of flying hours is comparable with those of other bases.” This is due, among other factors, to the long flight distances the crews cover, which range from the oil fields in the northeast of Shetland to as far as the Faroe Islands on occasion. For this reason, during missions it can be necessary to plan for refuelling stops. “To ensure we continually operate at the highest possible standards, training flights that include a wide range of tasks, including winch operations and special approaches,” said Mr McLuskie. “After every mission, we undertake a full analysis to see if there are opportunities to further improve the service.”

Australia: A mighty challenge for SAR The sheer scale of the Australian coastline presents a mighty challenge when it comes to SAR coverage. Unlike many European countries, there is no network of government-run SAR bases and aircraft to provide cover for shipping, sailors, walkers, etc., who are the traditional ”customers” of SAR crews worldwide. Instead, there are a number of contracts set-up around the coast which provide assistance on a regional/state basis. In contrast to the European approach, the SAR crews also tend to provide air ambulance services and are routinely manned by a combined crew of CHC (pilot and winch operator) and medical personnel (e.g. a paramedic and doctor team). The medical professionals would be the ones who would go down the wire, as needed, to provide medical assistance and lead removal of injured people. In addition to the SAR/EMS arrangements – which see AW139s employed in single-pilot, night (NVG), IFR operations –, CHC Australia also provides SAR resources to the Royal Australian Air Force. These crews commonly include two pilots and two other colleagues to provide SAR support to both fast-jet bases during at-home training and whilst deployed on exercises around Australia.

notoriously hazardous, with fast flowing tides, heavy seas and strong south-westerly winds. The 27 ft yacht “Blu Argent” had run aground and was in a very dangerous position. Part of its keel was embedded in the bank and it was being heavily pounded by the wind, waves and tide. The four sailors on board were clinging to various parts of the vessel. As the helicopter hovered, the “Blu Argent” took a particularly large wave, heeled over to about 70 degrees and started dragging over the bank. Debris from the yacht started appearing and its hull was becoming substantially submerged. Not only were the yacht crew in danger of being washed off at anytime, there was potential for them to be hit by parts from their own boat or tangled up in the rigging lines. A decision was made to attempt a rescue. Helicopter crewman Simon O’Mahony was winched out and slowly manoeuvred towards one of the members of the yacht crew. The situation, with the boat moving about in an uncontrolled way, dragging broadside on the bank, and being pounded by the wind and waves, presented a very challenging task for the winch operator, Dave Peel.

Norwegian fleet CHC Norway aircraft and crews provide dedicated capability with offshore-based SAR assets. Ready to respond to emergency situations, the SAR crews can also be used for less serious medical evacuations for which more than routine offshore transit is required. They are also used in a controlled manner to shuttle oil-and-gas personnel and equipment between offshore platforms.

Sailors being rescued from 27 ft yacht SAR crews often view what they do as ”just part of the daily job,” but there are frequent examples of their commitments to teamwork and continuous improvement. In one such case, coastguard helicopter “Rescue 104” from Lee-o-Solent (south of England) was scrambled to a report of a vessel that was taking on water and had put out a Mayday call in the vicinity of the Shingles Bank, near the Isle of Wight. An area of shifting sand and shingle located before the narrow entrance to the Western Solent, it is

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Winched crewman entangled Due to the yacht’s further movement, Simon became entangled in the sheets of the yacht. He was unable to reach the intended crewman and could not make any headway in the conditions. This situation not only endangered Simon, but the aircraft as well. It was at this point that Dave considered cutting the cable, but he held his nerve and managed, using the winch, to thread Simon clear and back out of danger. One by one, the helicopter and lifeboat crews were able to remove all the sailors from the stricken vessel. The heli soon made its way to the Isle of Wight hospital-landing site and handed the yacht’s crew over to the ambulance. The men were shocked, cold and bewildered about how it all went very wrong so quickly. Dave ‘s and Simon’s courage and professionalism were recognised when they were presented with The Billy Deacon Search and Rescue Memorial Trophy for 2011. 

Fig. 3: The situation, with the boat moving about in an uncontrolled way and being pounded by the wind and waves, presented a very challenging task for the winch operator

Fig. 1: Hungarian HEMS has seven bases around the country and employs 50 doctors, 44 paramedics and 19 pilots (Photograph: Hungarian Air Ambulance)

Author: Dr Péter Temesvári Medical Director Hungarian HEMS peter.temesvari@airambulance.hu

Hungarian Air Ambulance and NAS: cooperation for a countrywide HEMS Hungarian Air Ambulance Nonprofit Ltd. is a government-owned, not-for-profit organization covering the whole country as a sole provider of HEMS in Hungary. It has close ties to the National Ambulance Service (Országos Mento´´szolgálat). This organization (NAS) is the countrywide provider of pre-hospital care, rescue and emergency ambulance services in Hungary and is also responsible for dispatching land resources and HEMS helicopters alike. The NAS has about 7,000 employees and is the founder of Hungarian HEMS. This article gives an introduction to Hungarian HEMS, its organizational structure, its missions and history. Hungarian HEMS has seven bases around the country, serving the population of around ten million people. Hungarian Air Ambulance operates five EC135 and two AS350 helicopters all year round in VFR conditions and got its own Part 145 organization for maintenance of the AS350 helicopters. The duty hours follow the daylight hours of Hungary, summer operations being longer with 14 hours, coming down to 7 hours in some winter months. Hungarian Air Ambulance Nonprofit Ltd. is also a member of the

European HEMS and Air Ambulance Committee (EHAC). Hungarian HEMS employs 50 doctors, 44 paramedics and 19 pilots.

Missions The duty crew composes of a doctor, a paramedic and a pilot. All doctors and paramedics are trained HEMS crew members and pilots fly single pilot operations. The main task of HEMS in Hungary is to complement the work of the

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In ProFIle | 37 land resources of the NAS. Helicopters are mostly tasked to serious incidents where HEMS can provide a high level of medical care to patients and provide a fast and nontraumatic transport platform for seriously injured patients. Hungarian HEMS is also called to incidents, where land resources are not available within 15 minutes due to road conditions, remoteness of the location, or in special situations like floods and heavy snowfalls. Among the more regular missions are serious trauma missions, transfers of STEMI patients to PPCI centres, cardiac arrest care and transfers of burn patients. Another use of the helicopter is major incidents, where rapid evacuation of patients can be achieved. Hungarian HEMS is also tasked to every aviation-related accident in the country. Hungarian Air Ambulance’s seven helicopters complete around 2,500 missions per year. Most of them – around 90% – are primary missions. Geography and the road network in Hungary usually allow inter-hospital transfers to be performed by land ambulances. However, the benefit of a helicopter transfer is obvious in some time-critical conditions and helicopters are in fact used for these transfers. Certainly, helicopters and crews are ideal for primary missions. Both helicopter types are suitable to land in tight places and the skill and experience of the pilots allow doing just that. Flight safety of course will always remain the organization’s highest priority. Fortunately the number of hospital landing sites and rooftop helipads is increasing despite the unfavourable financial climate. Medical equipment is standard on all seven helicopters with slight variations between the two types, but absolutely standard within the type. Medical equipment is up to the European standard with complex monitoring capabilities, including NIBP, etCO 2 and temperature. There is no need of invasive blood pressure monitoring at Hungarian HEMS as there aren’t many secondary transfers. Ventilators are Draeger Oxylog® 2000 and 3000

Year

Primary Missions

Secondary Missions

Flight Hours (h:min)

Average Time per Mission (h:min)

2006

866

452

1,006:44