Agree David.
The points I listed were actually a compilation of ideas across many of the threads at Prune coupled with some of the results of our study tour. I had started another thread with them intending them to apply to HEMS generally, not US HEMS in particular, but in error has left "US" in the title and Senior Pilot moved my post into this thread. My fault entirely, but I am afraid that these ideas will only be discussed by those interested in US HEMS.
I believe that having the discussion about HEMS from an international perspective would allow US operators to see what ideas are going on outside the US, not get threatened by external opinion.
Alo3 points to exactly my concern about the sort of momentum that is gaining credibility within the US, and until the HEMS industry can change either reality of risk or at the very least the perception of that risk, then we are not going to combat that momentum.
I am in Aus. I have been flying EMS for the past 12 years and much of it to remote small town rural communities without adequate medical facilities. Legs of 2 hours each way are not uncommon in our model. We fly twin engine IFR machines and the model works - so I am not convinced the same model is unsupportable in the US, however, there are fundamental differences in the financing structure of our model which make comparisons difficult and unreliable. This is brought out by David's post.
The intent of my post was not to compare Aus V US or Euro V US or anyone V anyone. It was to stimulate discussion about what measures any HEMS program might take. Never the less, I will answer some of the concerns raised: IFR, imposition of regulation, and 2 pilots.
IFR: the fact that there is limited current infrastructure available to US HEMS in terms of where you need it and when, was faced here in Oz. We went out and created a network of IFR infrastructure that still has a long way to go. We have established IFR approaches to hospitals (and therefore fuel) where weather or operational reasons required. Indeed, I now operate at Westmead Hospital in Sydney with a company that developed the first non-airfield, helicopter specific GPS approach, certified in 1997/8. See my earlier point 7 & 8 which were created entirely in response to the concerns you raise about the lack of current infrastructure.
Imposing Regulation: David and Gomer are absolutely right. None of these issues are insurmountable, but you are both right: overcoming them is unlikely. This is true across countries, and the US is not really a special case here - look at the evolution of NVG regulation across countries, the USA got going some 15 years ago, and some countries still don't have permission.
There are probably many ways to overcome this limitation, but the first of which is to create an industry standard. Given the gathering intervention by the medical world onto our industry, perhaps the way forward is to create a standard and present it to the medical world. The long dark winter that David refers to may be a lot shorter if the medical world drive requirements to conform with the industry published standards. This form of economic incentive is far more effective than regulation.
An example is in Australia. For the last 20 years we were stuck in the old argument that poor rural communities could not afford flash aircraft and equipment and that their only hope of life was a Longranger battling fearsome conditions to help them. Two NVFR crashes in QLD changed that paradigm. The standard imposed BY THE MEDICAL SIDE is now twin engine and IFR capable. Not imposed by the regulator, nor the industry. That meant that operators either operated (and charged for) twin engine IFR or they were out of a service! We can exploit that power by establishing standards for the medical side to grasp, adopt and then require. I don't see any other way to convince the regulators or our bean counters en masse.
See point 12 for this appearing in the list.
Two Pilots: I think we need to realise the effect of the EASA regulation: it does not have to be two pilots. Read point 4. The typical Euro crew was only three persons, the same as many of the organisations in the US saying two pilots are unsupportable. The three crew are: pilot, HEMS Crewmember, and Doctor. The HEMS crewmember is a paramedic with pilot theory passes, specific front seat training in VFR, IFR, NVG. Not necessarily flying as well. The point is that there are two aviators in the front. I know that there will be negative argument about what happens when the patient is on board, but it works very successfully in many parts of Europe. Can we learn from them?
Lastly, the implementation timeline of 10 years or so is the sort of long term thinking we need to apply. Both David and Gomer illuminate timeline issues, but perhaps the goals should be set with these firmly in mind: maybe 20 years. In those terms, some of the list points suddenly become a more realistic proposition.