Air Ambulance

[ARobur]

Anyone in or around Ayrshire interested in starting an air ambulance service?

[Thomas coupling]

Yeah, OK then.....................

You're not in Marketing are you?

[ARobur]

Nope. Why are you interested?

[Thomas coupling]

Christ! You're serious!
Is that it then - starting up a multi million pound org with loads of staff, rules, regs, compliances, safety plans, risk registers, sponsors, aircraft, maintenance, finances, volunteer workforce, training, real estate, pensions, insurance cover, SOP's, advertising, auditing, rostering, customers?

Anyone in or around Ayrshire interested in starting an air ambulance service?

Need a bit more to go on, methinks.........:rolleyes:

[GrayHorizonsHeli]

i spilled my coffee.....thanks a bunch

[ARobur]

Sorry bout that, wasn't deliberate :D

[HughMartin]

How much £££ do you need?

[ARobur]

I think I can keep the clinical and marketing costs below £15000 if most of the monitors, trolleys, ventilators e.t.c. are rented rather than purchased.
The aviation costs I'm not quite so sure about, one of the reasons I'm posting here is to try and find out more about it.

I forget the helicopter used by London HEMS but it uses a jetstream rather than a tail rotor for stabilization and the main rotors are higher so it can be used in urban areas without decapitating people who don't have the sense to stand back.

[ARobur]

I just looked it up. Apparently it's a Mcdonnell Douglas Explorer. It looked far too small inside to be able to carry a stretchered patient but according to one of the HEMS firemen I spoke to they do use them to extract patients as well as for rapid response.

[[email protected]]

ARobur - if that is the depth and breadth of your aviation knowledge, I suggest you do a whole lot more research before asking here. Have you tried ringing one of the many charities that provide AA in UK?

[ARobur]

I've done some training with London HEMS, although they're really established and they've got quite an extensive scope of practice. They're well funded enough to be able to operate quite routinely as well unlike other places like Oxfordshire. The delivery varies across the UK as well like up until recently in Ulster it was mainly provided by the military and in Scotland it's usually private companies.

[minigundiplomat]

I've done some training with London HEMS, although they're really established and they've got quite an extensive scope of practice. They're well funded enough to be able to operate quite routinely as well unlike other places like Oxfordshire. The delivery varies across the UK as well like up until recently in Ulster it was mainly provided by the military and in Scotland it's usually private companies.

Half right - its a private company delivering on behalf of Scottish Air Ambulance.

I am guessing you are a clinician of some form; helicopters are an expensive business, you're going to have to rattle a lot of tins, and people are probably going to ask 'why do we need another service when we already have one?'. But please, it's your time, burn through it however you wish......

[HughMartin]

In Scotland there are already two full time air ambulance helicopters ( one based at Glasgow, the other at Inverness) fully funded by the Scottish Government via the Scottish Ambulance Service. They are supplemented by two fixed wing aircraft.

The aircraft are supplied by a private company under contract but are managed by the ambulance service. There is also a charity funded helicopter based at Perth.

But I guess you know all this already.

[Thomas coupling]

Arobur (A robber?).
I'm new here too (:suspect:).
Assuming this isn't some sort of wind up, because you have nothing better to do, let me give you some idea:
Leasing a modern twin turbine helicopter to include maintenance, insurance, spares, depreciation: £3 million minimum/year.
Staff costs (IF single pilot? minimum:4 pilots/paramedics/doctors? / back room bureaucrats / CEO: £750,000/year.
Maintaining your AOC: £12k/year.
Insurance for legal liability/hull/director/product/passenger: £50k/year.
Operational equipment (medical/NVD/flying kit): Initial outlay: £2 million? Servicing: £50k/year.
Airbase: Purchase land? Build helipad and hangar? Maintain:? Lease someones helipad?
Training: £20k/year.
Then there are the volunteers who provide the income by spending their valuable spare time shaking the public down for such a good cause: Welfare/running costs/overheads?
Adverttsing and recruitng?

Apart from that it's a cinch, I guess.

Now - what was the question Mr A robber?

[homonculus]

Be gentle TC

He is going to get a helicopter with a jetstream...... never seen one of those :ok:

[GrayHorizonsHeli]

You cant start something unless you dream it first.
I give the guy the benefit of the doubt.

In Canada, nearly every Astar, and Bell product is an "Air Ambulance". Throw in a stretcher and voila, even the smallest operator, with the lowest time pilot is out saving lives.

It all depends what this guys dreams are.
Is he looking to offer something simple, or is he going after a major player type operation with bases all over?

If he wrote a post explaining all his plans, should he have them, it could be pages long, and from what I have seen here, thats an impossible task to grab any one of your attentions for longer than 2 or 3 paragraphs. That's hardly enough time to explain anything. And really, unless you have the cash and dream he has, what business is it of yours to know his plan in detail?

I look at all the aviation clueless people running management positions at Airbus, and they seem quite successful. They put people in the positions with the skills they require...I have this feeling that this guy just wants to offer a service that he sees is lacking, and this is his starting point. How he gets to the end is the journey that will play out.

[Thomas coupling]

Grayhorizon: I've got a football, I'm thinking of setting up a premier division football club, any takers?
The clue is in the delivery......
If one is serious about starting an air ambulance service in the UK, one does not begin with PPrune, one would suggest :rolleyes:

PS: This is the UK, a sub district of EASAland..sticking a plank of wood in an Astar and wazzing around the country is NOT something we would permit, for obvious reasons. One being that we are so far up our Backsides with rules and regs and litigation, it simply isn't going to happen.

[GrayHorizonsHeli]

Have fun with your football team aspirations.
if im interested or can offer some services i will.
but for now...i dont care to be interested in your venture

[ARobur]

Yeh it's ARobur as in Auguste Robur from that Jules Verne novel actually. If you didn't know that.
I am a clinician and I'm trying to find out more information about it because I don't know any pilots. I would have used Linkedin but they don't let you message people you're not connected with without a pro account anymore.

[Thomas coupling]

OK, joking aside - why would anyone who is serious about promoting their profession - turn to a rumour gossip speculative forum?
Surely to goodness you would DYOR and speak to someone who is already in that position of running an air ambulance, no?
You would visit and take notes, hold meetings, speak to SME's, speak to sponsors.
In short, you'd need £5-6 million to set up a day VFR operation and require £2-3 million in donations annually to sustain it. PLUS a handful of experts in: aviation, business, insurance and law to make sure you don't come a cropper.
The good news is that this sliver of the helicopter industry attracts and commands wholehearted support from the public with their blind faith in humanity.
Value for money - it is a failed model, both practically and financially. But it tugs at the heart strings.
Good luck in your wild endeavours young sir - youre going to need it!

[ARobur]

Jesus this guy's still commenting.

[Aesir]

What "obvious reasons"?

I know a lot of pilots, myself included, who have saved a lot of of lives with a stretcher kit in a JetRanger or Astar.

In areas that cannot afford a full EMS system this is the next best alternative.

Or we could just let'm die, I suppose. 🙄


EASA and it´s minions would most certainly rather let people die than be saved in a B206 or AS350... It´s mind boggling I know but that´s bureaucracy at it finest here in EU world.

[Geoffersincornwall]

May I suggest the following as required reading. https://www.amazon.co.uk/Genesis-Cornwall-Air-Ambulance-Service/dp/1483470512/ref=sr_1_1?ie=UTF8&qid=1526020436&sr=8-1&keywords=geoff+newman

[Geoffersincornwall]

Please note that £1 from each sale will be donated to the Cornwall Air Ambulance Trust to help with the acquisition of a new AW169.

For those new to the subject, the Cornwall Air Ambulance was the first HEMS operation in the UK and was arguably the foundation stone of the nation's network of charity-based Air Ambulances.

G.

[Thomas coupling]

Many charities are now coming into the firing line:

The RNLI has more than £250m invested and assets worth another £150m. Ray Kipling, the charity's deputy director, said: "It will cost us, we estimate, £80m to run the lifeboat service next year. "We can't stop the boats going out if we don't have enough money." Mr Kipling said 20 years ago "we were down to virtually no reserves and we were making plans to close lifeboat stations. That is not a situation we can contemplate now". But charity finances suffer from a chronic lack of transparency, says Guy Stafford, co-author of a report on charities for the conservative Bow Group, which seeks to influence Conservative Party thinking. He said: "A company has a clearly defined objective which is to raise money or make profits. "The problem is that it is almost impossible to know what charities do with the money that is donated to them."

https://www.northamptonchron.co.uk/news/concerns-raised-over-air-ambulance-chief-s-163-120k-salary-1-896584

https://www.telegraph.co.uk/news/health/news/6677977/Air-ambulance-chief-sacked-after-he-raised-financial-concerns.html

[homonculus]

ARobur

Afraid TC is spot on. Indeed I think he has underestimated some costs. You are mandated to using a twin. No exceptions. The fit out will cost ten times your estimate. But even if you have the money, you still need the support of the hospitals and ambulance service. Unless you can integrate into the health system with their full support, your involvement will put patients at risk. So I would go and talk to NHS Ayrshire & Arran. And come back in a few years and let us know your progress

Sorry

[DeltaNg]

I think the most appropriate solution for your proposal would be a huge, battery-powered, multirotor gyrodene called the Albatross. (https://en.wikipedia.org/wiki/Robur_the_Conqueror)

[ARobur]

^ This guy gets it

[ARobur]

Thanks Geoffers I'll give it a read.

[[email protected]]

Jesus this guy's still commenting.
And you're still not listening - there is some very good advice here................

[Hughes500]

You could probably start up an air ambulance pretty cheaply really. The current ones are going down taking taking the hospital to the patient a la Afgan. I know it is rough in some parts of the UK but you dont step on an IED
How about
Buy a Bo 105 cost £ 350k Running cost about £ 600 an hour
Insurance and annual inspection £ 40k
AOC charges £ 11k
2 pilots say £ 50 k each a year
2 paramedics say £ 30 k each
Probably get a load of help running the AOC by running off someone else's !
Obviously a few other things but a very very basic service, which would be better than nothing !

No I have never run a HEMS machine but I do know an awful lot about running machines and AOC's and all the costs that go with it

[ARobur]

This is true, unless IED stands for inclement excremental dog**** lol
Yeh I was thinking it would probably be pretty simple to start with. On site ECMO and thoracentesis have been trialled, and Spain and Italy are preparing patients for organ harvesting in the ambulance but it wouldn't have to be anything like that to begin with.

[ARobur]

Oh by the way what does AOC stand for?

[nigelh]

That’s actually very funny 😂 !!!!!
I suggest a Robinson ( without a jet stream ) . Most of your patients will miraculously recover when they see what they will be transported in !!!!! You can see it now ....broken leg , foot pointing backwards ...sees Robber in his Robbie and “ oh don’t worry ... I don’t need a lift . I think it’s only a sprain 🙈!!!). Job done !

[Geoffersincornwall]

ARobur - check your Private Messages

G.

[homonculus]

ARobur

Please do tell what sort of clinician you are. ECMO, thoracocentesis (spell it correctly please) organ harvesting...... but these are only added later on :mad:

Do you have any medical knowledge? You certainly dont have any aviation knowledge. I am happy to explain why this is a non starter in a PM if you are serious, but your posts suggest you are just a wind up

[DeltaNg]

I'm slightly worried I'm going to 'get it' whatever that means .... perhaps we should all delete our accounts and disappear !

[ARobur]

Oooookay.
So I probably won't check up on this thread too much anymore since there hasn't really been too much to glean from it. Thanks to the ones who offered advice, encouragement and some useful avenues to explore.
If any of you do know anyone who'd be keen pleeeeease tell them to get in touch because I'd love to hear from them.

[nigelh]

I hear Noddy and Big Ears have joined the new HEMS operation and have chartered Budgie the Helicoper!!

[[email protected]]

Well done Homonculus:ok: I think you called his bluff:ok:

Perhaps if he comes back he will rename himself ATosseur........

[BluSdUp]

A thin skinned Clinician, are You?
Anyway, Here in Norway we have had AirAmbulance since 1932 when Viggo Widerøe started with a floatplane saving life in remote places. The Airforce has always had the SAR capability using the Catalina initaly.
In 1978 Dr Jens Moe helped establish the Norwegian Air Ambulance Foundation, and there is a one page summary on luftambulanse.no that must be mandatory reading for a budding entrepneur like Your self !

This Gang is my heroes as when the sun drops and the storm leads to accidents, off they go on the VFR Night routes low level to pick up the wounded and get them to safety.
Not a place for amateurs , Son.
Its all been tried before, possible the most challenging Heli ops next to logging and Military.

Regards
Cpt B

[whoknows idont]

That’s actually very funny �� !!!!!
I suggest a Robinson ( without a jet stream ) . Most of your patients will miraculously recover when they see what they will be transported in !!!!! You can see it now ....broken leg , foot pointing backwards ...sees Robber in his Robbie and “ oh don’t worry ... I don’t need a lift . I think it’s only a sprain ��!!!). Job done !

Did you know there is an R44 providing EMS in rural NE Germany since 1995? Obviously not for patient transport, but it's quite an effective tool for getting the doc to the people that desperately need one.

[Geoffersincornwall]

It's not such a crazy idea. When I did the research for the Cornwall AA back in 1986 I found out that the then market-leaders in Germany were rarely transporting patients. Their advantage was that their crew always included a trauma trained doctor and they were hospital based. The doc would invariably have a road ambulance on hand so he cold fix-up the patient and send him/her on their way back to the GH or specialist centre. If you can start an AA operation with a standard fit helicopter delivering the doc and his kit plus maybe a paramedic, it's a much cheaper option and can give you some good data to enable the case to be made for a full HEMS machine.

If we are talking UK then it is essential to work with the local Ambulance Service and receiving hospitals. Attempts were made in those very early days to short-cut the system in Devon, London (and incidentally in Saudi Arabia). For any HEMS system to succeed it must be embraced by the entire health care system.
G.

[jimf671]

It's not such a crazy idea. When I did the research for the Cornwall AA back in 1986 I found out that the then market-leaders in Germany were rarely transporting patients. Their advantage was that their crew always included a trauma trained doctor and they were hospital based. The doc would invariably have a road ambulance on hand so he cold fix-up the patient and send him/her on their way back to the GH or specialist centre. If you can start an AA operation with a standard fit helicopter delivering the doc and his kit plus maybe a paramedic, it's a much cheaper option and can give you some good data to enable the case to be made for a full HEMS machine.

If we are talking UK then it is essential to work with the local Ambulance Service and receiving hospitals. Attempts were made in those very early days to short-cut the system in Devon, London (and incidentally in Saudi Arabia). For any HEMS system to succeed it must be embraced by the entire health care system.
G.

DELIVERING CLINICAL SKILL TO SCENE
Norwegian air ambulance managers have described how with 12 ambulance bases and 6 SAR bases they can use an ambulance aircraft to longline a paramedic to a casualty in a difficult location. The paramedic then looks after the casualty while the SAR aircraft is still en route and extraction is then by SAR aircraft with winch.

AYRSHIRE
The OP is talking about Ayrshire. Quick check of posting date: not 1st April. Proceed. It would be hard to think of a less appropriate location for such an effort. Helimed 5 is just a few minutes away, Rescue 199 is at Prestwick, there are no extreme local factors pressing for extra cover (remote rural, intense large city), several key politicians (including FM) and health service figures come from Ayrshire and would be all over this if there were a genuine requirement.

[Thomas coupling]

I think Arobur is an ambulance technicain with ambitions..............bless.

[Hawkeye0001]

If we are talking UK then it is essential to work with the local Ambulance Service and receiving hospitals. ... . For any HEMS system to succeed it must be embraced by the entire health care system.
G.

Good point! Couple years back I've been doing an assessment to establish a HEMS system in an African country. Our talks to establish a heli-base at the most modern maximum care facility shattered this plan altogether when we were told in no uncertain terms that they couldn't handle those cases because - quote - "Our patients tend to triage themselves en-route! Whoever makes it here would've survived anyway!" and if we were to bring all those critically ill patients from horrific car crashes on a daily basis it would surpass their capabilities as well as their budget in a matter of days :rolleyes:

[Geoffersincornwall]

Hawkeye - In Saudi we faced a situation where each hospital was established for a particular clientele and if you were not in that particular 'club' then the ambulance would be turned away. A 'joined-up' service requires everything else to be 'joined-up'.

We can all sit back to a certain extent and rest on our laurels for enough time has passed - 31 years now - to forget just how hard it was to get HEMS off the ground in the UK. No sooner had the announcement that we would begin the service here in Cornwall than the naysayers were at it. There were doctors and clinicians of all kinds taking up the cudgels. There was a bitter struggle to get through to the start-line on April 1st 1987 intact and it is down to the fortitude and clever political manoeuvring of the local NHS managers that we survived. At one stage even the D & C Police tried to head us off before the start date. The deployment of the Air Ambulance apparently threatened their plan to acquire a second machine for use in Cornwall (their B0105 was based in Devon at that time).

It wouldn't surprise me to find that similar tales of tribulation involving the kind of internal and external battles we experienced also featured in all the other Air Ambulance Units. One day someone will document the pathway our HEMS services have taken. They have apparently created a new branch of UK medicine called PREHOSPITAL CARE. Their story deserves to be told.
G.

[ARobur]

A thin skinned Clinician, are You?
Anyway, Here in Norway we have had AirAmbulance since 1932 when Viggo Widerøe started with a floatplane saving life in remote places. The Airforce has always had the SAR capability using the Catalina initaly.
In 1978 Dr Jens Moe helped establish the Norwegian Air Ambulance Foundation, and there is a one page summary on luftambulanse.no that must be mandatory reading for a budding entrepneur like Your self !

This Gang is my heroes as when the sun drops and the storm leads to accidents, off they go on the VFR Night routes low level to pick up the wounded and get them to safety.
Not a place for amateurs , Son.
Its all been tried before, possible the most challenging Heli ops next to logging and Military.

Regards
Cpt B
I guess that explains why all these old guys **** themselves at the thought lol

[DOUBLE BOGEY]

I think some of the costs quoted on this thread are a tadge excessive. Lease purchase a decent second hand 135 or equivelant and for day VMC OPS a budget of £1m p.a would easily suffice with a contracted AOC.

if it saves one life.................

We all pay insurance for vehicles, homes etc and very few ever claim. if we added £3 to every vehicle insurance policy sold the kitty would be big enough to cover UK with AAs without charity or hand to mouth existence.

[OvertHawk]

I think some of the costs quoted on this thread are a tadge excessive. Lease purchase a decent second hand 135 or equivelant and for day VMC OPS a budget of £1m p.a would easily suffice with a contracted AOC.

if it saves one life.................

We all pay insurance for vehicles, homes etc and very few ever claim. if we added £3 to every vehicle insurance policy sold the kitty would be big enough to cover UK with AAs without charity or hand to mouth existence.

I really do hear where you're coming from DB and in a perfect world it might well be the best thing, however...

What would actually happen is this: There would be a massive bun fight for the resources to run this uber-AA service. It would end up going to a single large operator who would then run it his own way to the advantage of the vested interests and the disadvantage of everyone else. Very soon it would not be £3, it would be £10 and there would be less aircraft.

At the moment the UK has superb AA coverage. yes it's spotty in places and it's sometimes inconsistent. Some of the charities and operators are "different" to the rest but there is a huge variety of operators and charities rather than one single overarching administrative behemoth. The charities generally have good relationships and recognition within their areas of operations and there is a sense of "ownership". Merging independent local AA into one single entity - Have a wee look at the NPAS thread to see how that's likely to turn out!

OH

[DOUBLE BOGEY]

OH I hear you. I think ADAC are funded as I suggest. Maybe an ADAC driver could confirm?

[Radgirl]

Merging independent local AA into one single entity

That is what we did 60 years ago today with hospitals. We call it the NHS. Not perfect, but at least we have integrated health care to a common standard, with common oversight for all the population. It covers all health care except.......air ambulances, where some are financially fine, others less so. Some are 24/7, others not. Some have doctors, others not. Some are well integrated into trauma care, others..... some do interhospital ITU work below recognised medical standards etc etc

I agree NPAS has been a disaster but surely we can do better

[Professor Bublinsky]

You won't go far wrong with the Bell 429, very big cabin. Wiltshire AA operate one, give them a call they will be happy to talk to you.

[ARobur]

You won't go far wrong with the Bell 429, very big cabin. Wiltshire AA operate one, give them a call they will be happy to talk to you.
Cool, thanks for the tip. I'll check it out.