B-206/AS-350 for EMS?

[helopat]

This is bound to get some emotive responses (wouldn't expect it any other way :} )...I see that a lot of EMS providers in the US use Squirrels and Jet Rangers for EMS. By comparison, most operators in Australia use twins such as the BK-117, A-109 or B-412.

It seems that the Squirrel and Jet Ranger are a little small for the job. How do you manage to fit a pilot, doctor, paramedic in the aircraft (oh, and lets not forget the patient). Obviously the smaller, single engine machines are somewhat weight limited. So, are they sufficient to the task? I ask because the trend here in Australia seems to be moving toward larger machines such as the AW-139 and EC-145.

I look forward to your responses gentlemen.

HP

[Aesir]

Even a small helicopter is better than NO helicopter.

I have done EMS on both B206L & AS350B3 and the B3 is certainly not weight limited but it is space limited.

[800]

Its always funny to see the paramedics transfer to a smaller aircraft. They have to reduce their carry on baggage, so to speak.
As Aesir said; "Even a small helicopter is better than NO helicopter".
There are too many variables; sitter vs stretcher, over land vs over water, sea level vs mountainous terrain etc etc.
At the end it will depend on what the Client is willing to pay for the service required.
In the perfect world the aircraft would do the following and the client would be happy to pay for it;
SPIFR capable within the area of operation
Carry max fuel with max payload (crew compliment etc) for all ops within the area of operation
Able to conduct a vertical departure from an off site landing at gross weight
a resonable TAS (not the old 100kts)
An aircraft that ergonomicaly fits the pilot and crew
Oh well, enough dreaming - back to reality

[Hiro Protagonist]

I was talking to some folks at the PHI air ambulance near my home, and the recently traded in their bk-117 for an as350b3, and they're looking forward to being able to respond to calls in the mountains now. Not too roomy, but the B3's got what counts.

[OFBSLF]

How do you manage to fit a pilot, doctor, paramedic in the aircraftI believe that many (most?) EMS providers in the US do not fly with a doctor. Single paramedic instead.

Here in the Boston, MA, area, most of the EMS helicopters that I've seen were BK117s variants.

[Revolutionary]

The crew in the US is usually nurse & paramedic. Sometimes it's nurse & nurse or even paramedic and paramedic. Or nurse and respiratory therapist. Only a few programs have a doctor onboard. The widespread use of singles is dictated by economics. The 206 and 350 are both, I would say, adequate. The philosophy in some countries is to 'bring the hospital to the patient' (including a doctor in the crew is part of that concept). Here, we 'bring the patient to the hospital'. In other words, the emphasis is more on rapid transport to a place of definitive care.

[Jamair]

Revoluntionary & friends:
In some parts of Oz that is indeed the concept - bringing the hospital to the patient. Sadly, it is fatally flawed; the only reliable research (ie that NOT presented by the medical fraternity with an agenda) has shown that the ONLY things that make a difference to outcomes (mortality and morbidity) particularly in severe trauma, are appropriate basic care and rapid delivery to an appropriate facility. Neither of these needs a doctor; in fact some research shows that systems that have doctors on board spend far more time on scene than those without, for no better outcomes.

In the case of intensive care transfers and retrievals, a doctor is often and wisely a part of the team, likewise for known specific incidents (like an entrapment requiring amputation) but for 99.8% of out-of-hospital stuff, in near 20 years in the game I've become a firm believer that out-of-hospital emergency medicine is best managed by suitably trained and experienced paramedics.

As far as aircraft go, all the EMS birds in this State are twin IFR, as a result of losing 4 aircraft and 8 lives over 10 years, all in single-engine VFR helicopters. One (wannabe) operator is trying to get into the game in the far north, with a single Squirrel, but as all emergency services and health personnel are banned from flying in it, they are not likely to get very far.

[SASless]

Helopat,

Read up on the accident stats for EMS 206's.....and then compare the 206 to Twin engined helicopters.

206's are very limited in performance compared to the BK-117 and EC-145, 365's, and the Bell 412.

I have flown EMS in BO-105, BK-117, and Bell 412's.....hands down favorite was the 412. It has plenty of power, can carry up to four patients (number of patients is limited by the ability of the med crew to attend to the patient while in flight rather than patient weight).

The thought of flying a Bell 206 in EMS makes me shudder.....that stacks the odds towards bad things happening.

[carholme]

Ladies/Gentlemen;

Who chooses an aircraft for the medevac role? I am sure that the operators choose the aircraft suitable to answer a particular contract specification. In the case of government/municipal contracts, the threat of lowest bidder is rampant.

Oddly enough, governments write the regulations that air operators have to abide by, then at the same time, let medevac contracts which often go to the lowest bidder, who in turn supplies the least capable aircraft for the contract. And all of this is foisted upon a medical (aircrew) community who are slowly learning about aircraft but whose primary thoughts are on delivering medical assistance, rather than the airworthiness or capabilities of the contracted aircraft.
In many cases the operator is trying to squeeze every dollar out of the contract, pushing wx and crews, and providing dubious maintenance. The helicopter accident rate in certain countries is testament to this.

It would be interesting to hear from the different countries responding, whether or not they feel the contracts themselves are funded sufficiently enough to allow quality bids, from quality operators, capable of supplying the right aircraft, well trained crews, quality maintenance. etc.

As well, how many contracts are let to one company, rather than several, where the dispatch agency will disregard one companies valid rejection of a flight and pressure the other companies until they get one to go.

Regards

carholme

[arismount]

Interesting thread. Let me tell you the way it is "over here" and perhaps you'll then understand the trend away from twins and toward singles in the U.S.

Away from the U.S., you have more government support for programs and also more regulation. The latter is evident from the fellow who stated that EMS programs were "banned" from using the guy who was trying to introduce the Single Squirrel. Such a thing would never happen in the U.S.

The subsidies and strict regulation you guys have limits the amount of jobs available. That's just a fact. The good side is, what jobs there are tend to be lucrative and "safe."

Now in the States, all you have to do to start an EMS service is have the dough. There are very few limitations on what type of helicopters and equipment can be used, and these are not rigidly enforced. Some might say, corruption plays a hand; but I'll let you draw your own conclusions.

Also there is no limit to competition. A favorite tactic is to move into an established market and undercut existing services.

Now there is a "HEMS" company in the U.S., I won't tell you the name but the initials are AEL...that uses the absolute minimally capable helicopter for EMS, namely the 206L1 & L3. They open up bases overnight in areas already well served by twins & IFR programs. They aggressively appeal to local EMS services, who make the decision at ground level which service is called, by what some might say is cheap bribery with free food. (Yes, things really get that venal and tawdry...) They can afford to run at an operating loss because of a membership "scheme" which they use to raise capital.

Now all these things taken together form their business "model," which is the lowest cost in the business. Other services flying IFR programs and operating twins have to scale down and reduce or eliminate all costs in order to compete.

In short, AEL is driving down the quality of HEMS service in the U.S. They can and will do this because that's the way business is "regulated"...or not regulated, if you prefer...over here.

The upside to the U.S. way of doing things is, there are a lots and lots of jobs over here. The downside is, they aren't so "safe," attractive, or lucrative. And, thanks to AEL, they are becoming less so all the time.

I hope this gives you some background. Lots of you would like to come and work in the States I suppose, but let me assure you that there isn't anywhere on earth to get away from problems in the aviation field. One set of problems just gets substituted for another.

[Revolutionary]

Arismount, I'm no fan of the company you mention either, but their business model is neither unethical nor illegal. In states where the EMS industry is loosely regulated (the Midwest in particular) they simply take advantage of the opportunities available. I agree that the 206 is a lousy EMS platform (I'm guessing you fly an EC135 -that's more like it!).

But as Jamair mentioned, research indicates that speed is what saves patients, more so than the level of care delivered at the scene. Looking at it that way, a large rural area may be better served by two 206's than by one EC135. Interfacility transports are a different story of course. There, you would normally require more stuff than a 206 can carry.

The helicopter EMS market in the U.S. is a product of, and can not be separated from, the health care industry as a whole, which is profit-driven, values technology over therapy and emphasizes treatment over prevention. For example, there is no concerted effort to promote healthy eating habits, but gastric bypass surgery is available to almost anyone with health insurance. Similarly, there is no standard for EMS helicopters and so they are sometimes small and ill-equipped. But an EMS helicopter is available within twenty minutes or so for almost every location within the U.S. How many countries this size can make that boast?

[Oogle]

Jamair must live in Victoria - they don't let doctors on board their aircraft for primaries down there. :{

If you are a pilot (which I assume that you are), let the medicos do their stuff and you do your pilot thing. :=

[Jamair]

What, a pilot can't have an experiential opinion? :confused: As it happens, I do more than one job (depending on the day of the week - or even the time of day:E )and so can make some fairly accurate observations and statements pertaining to more than one profession - and I try to make sure my opinions are supported by scientific research rather than emotive and annecdotal evidence.

No, not Vic.

I didn't say SPEED, I said TIME - big difference. Time from insult to definitive care is what determines outcomes.

And basic care is a vital part of the equation. (Basic care includes oxygenation, which may range from simple face mask with supplemental O2, to induction and intubation / ventilation; perfusion maintenance, which could be as simple as posturing and applying a dressing to a bleeder, through to IV fluid resuscitation and blood transfusion; maintaining normothermia, treating presenting issues with whatever interventions and pharmacologies are indicated.....so 'Basic Care' is not necessarily 'basic', but at the same time seldom if ever needs a physician to perform in this field.)

So what do you do in the US in IMC? Are these smaller aircraft IFR? Don't these contracts stipulate operational minimum requirements?