HEMS A109? No thanks!

[BolkowBill]

It was with a combination of amusement and disbelief that I read the article in last month's Today's Pilot magazine regarding the A109 being used in HEMS work. I'm not sure of the journalist's background but I can't believe that any serious research was carried out before publishing what was effectively an Augusta/Wastelands press release.
Check this out (and I quote the pilot):
"I come to an OGE hover.... then I find that I have a 25kt tailwind, but the helicopter can handle it with ease" - er, shouldn't you have been aware that you were about to enter a 25kt downwind hover? I'd find that a very worrying statement from a student-pilot, let alone a qualified HEMS pilot.
and it continues (this quote from the journalist):
"Class 1 performance helipad departure profiles I had been shown were flown very slowly. I considered this normal... but (the pilot) XXXXX told me: "I've flown the EC135 and found it gutless... in the 109 I can get to 1000ft/min before we're at 100ft" - now that sounded amazing".
Again, I rather think that the word the journo should have been looking for is 'alarming' or at least 'worrying'. Why would you want to depart a hospital or HEMS operating site like a Polaris missile? I mean, horses for courses and all that, but this seems rather like over-egging the pudding.

But the best bit is the claim (lacking any details of course) that having wheels enables the A109 to land where skid-equipped aircraft would struggle, "like rocky ground or slopes". Hmmm... A109E limited to 10 degrees L/R and 8 nose-up. EC135 14 degrees L/R and 12 nose-up; Bo105 15/8 L/R and 10 nose-up. Quod Erat Demonstrandum.
Oh, and the wheels sink in anything remotely soft. And there's a cracking photo to show this but I can't work out how to load it!
And the very low and exposed tail-rotor. And the fact that despite claims to the contrary, the cabin is cramped and only allows a spine-board loaded patient to be put in diagonally!

And more: "many other air ambulances which have complicated start-up procedures keep their rotors running (at the HEMS scene) but the simple procedure on the A109 means that engines are always shut down to avoid endangering curious onlookers". At this point the interested reader would be forgiven for their amusement turning to something resembling anger - what research did the journalist carry out before making such a ridiculous comment? Did she ask any of the operators of these "many other air ambulances"? In my experience shutting down is the norm, a rotors-running pick-up only being chosen on the grounds of patient condition and urgency. I know the press are generally ill-informed and less than keen to ensure accuracy but for an aviation-based publication to print this kind of unbalanced drivel is.... (deep breath.....) disappointing.

Finally, maybe the journalist should have asked herself why there are only two A109 HEMS operations in the UK, there having only been one until very recently. Compared to 12+ EC135s, 8+ Bo105s, 5+ MD902s (there may be more but I'm sadly ill-informed myself about numbers here) and a couple of other types knocking about. That should tell its own story. But one could never expect a journalist to realise that, could one?

As for "In fact, the A109 is really a flying hospital rather than just a fast transportation facility, which is what most other air ambulances are" where do I start? Maybe the journo should have realised, as a professional writer, that you should never end a sentence with a preposition?
Or that no, the A109 is NOT a flying hospital. It is precisely a fast transportation facility which is the function for which any ambulance, road or air, exists. (there you are, a perfect example of how to avoid the preposition-at-end-of-sentence pitfall!). The idea that the doctors aboard any air ambulance helicopter could perform surgery, for that's what the title "hospital" implies, is ludicrous - we all exist to stabilise, evacuate and convey a patient to definitive care, which is a hospital. A proper one!

Ok, spleen vented, rage subsiding, laughter ensuing. Come on then chaps, let rip! (At me or them, it's your choice)

[Lt.Fubar]

Quite interesting.

Some time ago, there was a debate around purchasing of new helicopter for national HEMS service, here in Poland. There were two candidates: EC135, and A109S. And there were two requirements that were considerate controversial: one - the hight of cabin above patient, and the gear was preferred to be skids. The winner was obvious, but the fights were huge on Internet forums and in media, stating the whole thing was rigged.

The interesting part was - there was one A109E used as HEMS in Warsaw (now it will be sold) and so on the Internet one could find one pilot, and one paramedic that took two sides of that conflict - although never confronted directly. The pilot wanted Agusta, as it was smoother, and faster (and better looking) and weirdly... cheaper. The paramedic liked the Eurocopter design, as he could do CPR in it, as was his experience with A109E, that was used as a fast taxi between hospitals - could go to accident sites only if no other option was available.

It was amazing of the lengths that people went to defending A109S, and bashing Eurocopter in that one, small purchase (23 airframes).

[N707ZS]

I have seen a couple of A109s in Spain with an enlarged cabin door which looked something like a house bay window perhaps with that mod they can gain an extra couple of feet across the cabin.
As for the rest of the does and don't I cannot say.

[TunaSandwich]

The modified wide cabin 109's in Spain have been replaced with new 109 powers in standard configuration. In my opinion the 109 is a terrible choice for hems, dangerously low main and tail rotor and yes, very cramped inside....super fast though..

[206 jock]

I didn't read the article, but I presume it's DRLAA?

The DLRAA does seem to be rather aggresive in its making of a case for the A109, almost to the point of being evangelical about it. I had a chat with the Chief Exec at a meeting once, and he effectively dismissed all other latest gen machines as being 'inferior'. I respectfully pointed out the wheels/small cabin/tail rotor (my old insturctor was chief pilot of the WNAA machine, so I knew the problems) of the A109, but he simply regards these as being irrelevant.

They put out this (http://www.shephard.co.uk/Rotorhub/default.aspx?Action=745115149&ID=5baf2ebc-8baf-4b97-a61b-d520fae47fd3) press release recently.

It's very common for neighbouring AA operations to ask for help if a machine is unavailable, it's certainly less common to crow about it.

The other AA operations simply regard DLRAA as a 'funny bunch'.

[Brilliant Stuff]

Bolkow Bill, I am glad I did not read that article because I would have burst a blood vessel me thinks.

That article IMHO looks rather libelous to me. If I was Eurocopter I would want some redress.
If I was Today's Pilot I would want a hole to hide in.

What makes me so sad is this industry is so small yet there is so much infighting and politics etc. it's just very disheartening. Why can we not all pull in the same direction?????:ugh::ugh::ugh: After all the cake is big enough.

Considering the distances involved normally for an Air Ambulance I can not see how the extra three knots can have any great affect on the outcome.

Funnily enough Germany from what I know only operate the MD 902 and the EC135 but they are known to use B222 for hospital transfers. That alone should say something.

The A109 as an Air Ambulance in this country is getting a very bad reputation (though I personally can not say whether it's justified but that is what I hear) because of the people running them and the job it's being tasked to do. They really should work on that.IMHO.

Think of the industry chaps.

[Cowboydave157]

North Memorial Health Care - Air Care (http://www.northmemorial.com/aircare/)

I'd rather be flying the 135.

The Mayo clinic is upgrading to the EC145
Albert Lea Tribune | Care in the air: Take a ride in the newest Mayo One helicopter (http://www.albertleatribune.com/news/2008/jul/26/care-air-take-ride-newest-mayo-one-helicopter/)

Never flown the 145. Hear it is not as comfortable to fly as the 135.

[Cov HEMS]

I just wish the folk who slagged the A109 as a HEMS aircraft, had actually flown one!!!

But then they would not be on here moaning!

You dont find the 109 boys on here commenting on 902's being grounded and the 135 gutless performance on 2 engines!

But then why would we?

Ex HEMS Pilot

[tottigol]

So how do a boisterous pilot and a journalist/reporter affect safety and performance of the 109 in EMS?
It sounds as if BBilly has never flown one, matter of fact BBilly just sounds jealous because neither of the aircraft he probably flies have near the performance the 109 has.
So BBilly quotes some random claims from '109 pilots and turns them into negative info for the aircraft.

OK, so BBilly does not want to fly an EMS '109, perhaps just another case of sticking to what one knows.:E

Fiction for fiction and this being this a Rumor Network, let's start a new one:

How would a civilian version of the Westland Lynx perform in HEMS?:O

[Bertie Thruster]

OK I've bitten!


You dont find the 109 boys on here commenting on 902's being grounded and the 135 gutless performance on 2 engines!


No. You don't comment on PPRUNE; you do it in the press! :rolleyes:

109 'unavailable' days are also noted. Perhaps neighbouring units should comment in the press on those 109 'off' days? :ok:

[Canuck Guy]

That bit about the 109 being unique in being able to be shut down fast for loading is freaking hilarious. I've never taken a patient rotors turning and never will. Even if I wanted to, they're never ready for transport by the time I get there anyways so I sit on the ground for 15 minutes at least at every scene call.

Yes the 109 is a great ship, but the best ambulance? Far from it.

[CYHeli]

I'm not in HEMS (although there is a dream...)
I remember reading recently about the increasing patient weight as the population becomes heavier, what effect is this having on HEMS Ops?
Is the A109 a lower sitting A/C and therefore easier to load?
I think if I was working in the back, I would want to have room to work easily and even have room for help if needed...

[Furia]

Each helicopter is suited for an specific operation. I am currently flying the 109E since 5 years ago and I am pretty happy with it.
My mission doers not require mountain operations and the medium flying distances to hospital require a fast helicopter.

In my 14 years as HEMS pilot I have only seen one time the medical team providing manual RCP onboard. Usually we do not fly patiens that are not stable enough for the flight. We use to wait if need till the medical team stabilizes the patient. We do have onboard a Doctor and a flying Nurse that make sure the patient is ready for air tranportation.

Besides RCP, many other complication can arouse that unless you are in a Chinook, the medical team would find the spaces cramped.

A HEMS helicopter must be not too big or you will not be able to land near many accident sites or you will create dust storm around the injured personel.

The only bad point of the 109 related to HEMS Ops is the low rotors that require that either the HEWS crew, copilot or flying mechanic, whoever is there helping the pilot, makes sure that nobody gets into them while they are rotating.
Said this, the 109 is faster and smoother, and when somebody is dying and needs to get to the hospital in a hurry, minutes count.

However if you are performing HEMS on mountain areas or where distances to hospitals are small, maybe the EC135 would be a great choice.
All in all both are great machines. It just takes to select the one more fitted to the operation you do.
Not all HEMS programs are the same so there is not a "better" helicopter but a "better suited for that mission".

[FairWeatherFlyer]

Reanimación cardiopulmonar (RCP) - Wikipedia, la enciclopedia libre (http://es.wikipedia.org/wiki/Reanimaci%C3%B3n_cardiopulmonar)

[TOMMY1954]

If the patient is beeing transfered from a hospital to another more specialized one, yous must stabilize the patient the best you can, for example if the patient has an hipertensive pneumotorax you must treat that potencial lethal situation before you put the patient inside the Helicopter, if the patient has signs of high intracraneal pressure with detiorating neurologic condition, you must start the treatment immediatly, if the patient is agitated you have to sedate him before going to the heli , even in the scene of an accident if you must intubate and do other invasive procedures, you do it outside of the helicopter. Yes if possible and without loosing to much time, the more the patient enters the helicopter stabilized the better the outcome. Sometimes this is not possible and as once happened to me, I had to transport a patient with a severe heart disease witch the only solution would be cardiac surgery in a Central Hospital in Lisbon, so I made the 1h helicopter trip providing CPR, in a cramped Bell 222. When there is no other way you do amazing things even in a Bell 222, but I admit, in a 412 it would be easier but not easy.
Regards, Thomas

[ecureilx]

From my eeny meeny bit of french, RCP = CPR for us

[TOMMY1954]

Well I think that the first thing to stablize a patient is to start treatment, and probably the important thing is to optmize the patient for transport even if we can't fully stabilize all parameters. When I worked as an HEMS doctor I didn't like to waist time and "stay and play", I would clinically evaluate the patient and do what had to be done for the safety of the patient and the crew. I also think that the expertise of the medical crew ,nurse, doctor,paramedic is very important. As you say there is probably a problem of terminology here, and I guess this is getting a bit offtopic.
Regards, Thomas

[Tarman]

I may be wrong but I think that BolkowBill’s gripe was more to do with the standard of Flying/Journalism rather than which machine is better than the other (I’m sure there are numerous opinions on that). I too read the article and thought that it read as if it was written for a Sunday supplement rather than a dedicated aviation magazine. I have also read other articles written on rotary aircraft by the same writer/Mag and came to the same conclusion. Maybe her brief is to keep it interesting to those other than Rotary Pilots, I don’t know. A few months ago there was an article/test flight involving (I think) a MD Explorer that she wasn’t allowed to fly !!:bored:

[Lt.Fubar]

Is the A109 a lower sitting A/C and therefore easier to load?The stretcher in 105, 135, 145, 902 etc. "lies" on the floor. In 109 it have to be raised because it have to be over the fuselage fuel tank, that is actually inside the cabin (normally directly bellow passenger seats). Therefore the lower ground clearance in A109 gives no advantage.

A109S:
http://www.izzyfly.org/foto/hems/070621%20225.jpg

EC135:
http://www.airambulancetechnology.com/BILDER/bilder/he_ec135_17k.jpg

[Bertie Thruster]

But the best bit is the claim (lacking any details of course) that having wheels enables the A109 to land where skid-equipped aircraft would struggle,

This claim has been heard elsewhere around the hems bazaars.

Their 'logic' is explained (by them) thus: a tricycle undercarriage gives 3 points of contact and is therefore more stable on rough or sloping ground than a skids undercarriage that has 'only 2 points of contact'.

(The fact that the 2 'points' of contact of each skid are about 2.5 m long is conveniently forgotten!)

[What Limits]

Hey Bertie, howzitgoin' eh?

Back to the thread, having seen a HEMS A109 sink into the mud above the axle, must make for some interesting takeoffs!

[TOMMY1954]

It was once used by portuguese HEMS, in 2000, but it didn't last for long.It had spanish registration has it belonged to Helisureste.
http://i259.photobucket.com/albums/hh285/Thomas_Ferreira/Heli-HSCruz.jpg
http://i259.photobucket.com/albums/hh285/Thomas_Ferreira/A1093.jpg

[FloaterNorthWest]

Lt Fubar,

The stretcher you show in the picture of the EC135 is the Casevac fit found in most Police EC135s (in the UK) and not a dedicated HEMS fit. The stretcher in a dedicated HEMS EC135 and MD902 (in the UK) is elevated on a mount that can slide and swivel for ease of loading.

FNW

[Ptkay]

Polish HEMS was (is) flying 109 (just one) since years, nevertheless
the recent tender for the whole fleet was won by Eurocopter.

Agusta protested in court, but failed.

Generally the main argument was the impossibility to do CPR in 109 in flight.
(as already mentioned above)
The speed advantage of 109 in the country the size of Poland
was irrelevant, on any usual mission you can win only 5 to 10 minutes against 135.

And don't forget, that the paramedics and docs were used to Mi-2, still the
main HEMS helicopter in Poland, cabin of which is huge compared
even to the 135, not speaking about 109.

[Rocket2]

The Swiss Air Ambulance Service has a fleet of A109-K2's if that counts - they seem pretty happy with them as far as I know.
Happy Landings
R2

[Lt.Fubar]

Lt Fubar,

The stretcher you show in the picture of the EC135 is the Casevac fit found in most Police EC135s (in the UK) and not a dedicated HEMS fit. The stretcher in a dedicated HEMS EC135 and MD902 (in the UK) is elevated on a mount that can slide and swivel for ease of loading.

FNWYou may be right, this is the Irish helo, not really dedicated HEMS machine - as there is no medical equipment. Couldn't find photo of the fit Poland is going to get. Although the stretcher and its mount is in fact different, its height is not that much.

Ptkay maybe you have the photos from press displays of CPR practice in EC135, just before winning the contest ?

[victor papa]

Correct me if I am wrong, but the Swiss use the 109 for rescue and confined areas and ALSO have a fleet of 145's for long interhospital/site transfers? Why the combination? With the Arriel 1 the 145 is limited on Cat A either high or hot. Stuck in Arriel 2's maybe the gearbox will suffer?

[helmet fire]

Never thought I would...but I have to defend the 109 here!

CareFlight have been using a 109E in the HEMS role very successfully for three years. The aircraft is used for rapid response to trauma and was only rarely used in the air ambulance role of secondary retrieval. It is now exclusively primary response.

Generally the main argument was the impossibility to do CPR in 109 in flight.

Ummm....rubbish!
Last night CareFlight lifted a paediatric female post immersion. The 15 minute flight involved continual CPR and bagging throughout the flight - with a stretcher kit fitted and three medical personnel in the back (Specialist Doctor, SCAT Paramedic, and a Registrar). Plus pilot and Crewman up front. And Category A!!!

One of many instances of successful CPR in flight in our 109.

Having said that, we conducted a detailed type analysis for our particular role and the 135 did come out ahead. Factors such as protected tail rotor, very high main rotor, digital autopilot, cockpit ergonomics and displays as well as noise signature bought the 135 to the fore, but the 109 still scored very well.

The 109E is not the perfect HEMS machine - but it does extremely well in our particular role. Is labelling the 109 a crap machine for HEMS because it does not suit a particular HEMS mission profile a tad narrow minded perhaps?

[Darren999]

This is ours. Its fast, ideal for organ harvest flights. Doors leak :ooh:

http://i222.photobucket.com/albums/dd91/DarrenELucas/2007-12-08_06_Darren_Lucas_in_PennS.jpg