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Informations about HEMS

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Informations about HEMS

Old 27th Nov 2009, 09:28
  #1 (permalink)  
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Location: FRANCE
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Informations about HEMS

Hello,
First sorry for my English, but I am French so half forgiven. Isn't it !
I am HEMS pilot in France and would like to know the different mode of operation of HEMS in other countries:
- Regulations
- Type of contract between the hospitals and companies
- Type of helicopter used
- Composition of flight crew and medical
- Licensing of pilots and crew members
- Type of flight: VFR, IFR or NGV
- Etc. ..

I am currently doing a personal study on the HEMS and would like to get an idea of the delay we have in France compared with our foreign colleagues.

Thanks for your help. Best regards.

Choppersky.
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Old 28th Nov 2009, 10:45
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This might prompt a little more interest in this thread:

In the UK, types used are in the majority MD 902 and EC135. There are a few A109s, a couple of AS365s, a couple of BK 117s and still 2 or 3 Bo 105’s around.

Except for in Scotland, all air ambulances are charity funded.

A few charities own their own helicopter and have contracts with established helicopter operators to provide the pilots and maintenance.

The majority of charities ‘wet’ lease the aircraft from an operator.

HEMS is single pilot with two medical crew on board (2 paramedics or 1 doctor/ 1 paramedic).

HEMS in the UK is daytime only, by NAA regulation.
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Old 28th Nov 2009, 12:14
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NAA? Who's that then?
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Old 28th Nov 2009, 13:47
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In the UK the NAA means the CAA.

Not quite sure that is strictly true. Apart from 2 (currently) police/HEMS units, it is true that they do not operate at night to off airfield landings.(The Scots do essentially inter-prepared site flights at night, which isn't really HEMS, of course).

I believe that JAR-OPS does not prohibit night HEMS. I suspect that the CAA/UK NAA do not exactly prohibit it. They just make their list of conditions and requirements so long, that once faced with them, no UK ordinary HEMS has yet accepted the challenge.......

That is almost a prohibition, but not quite.

Being as risk averse as the CAA is, with the US record or night HEMS, I would imagine they will try and keep thinking of extra requirements, to prevent a rise in UK HEMS accidents. In a way you cannot blame them for that.
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Old 28th Nov 2009, 14:20
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Hems at night is one thing, but Air Ambulance at night is public transport so as long as the criteria are met then theres nothing to stop a unit from carrying out an air ambulance flight at night, isn't it more of the cost/ crewing implications that mean most units don't do them.
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Old 30th Nov 2009, 09:51
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Excluding the Police.HEMS, UK HEMs is public transport carried out to JAR-OPS standards, just like air ambulance. The HEMS element is catered for with special sections with those rules. As you say, Wylie, inter-hospital transfers are possible to pre-surveyed lit sites at night. I believe the only UK operation that does this at all frequently is the Scottish setup. From what I have been told, they have an on-call pilot at night who can respond with some delay. Their situation is rather different from the rest of the UK. However, there was a suggestion that the UK was going to move to a system with fewer specialist trauma centres, rather than district A&Es. If that happened, there might be more demand for primary HEMS or inter-hosiptal transfer where the cost of the helicopter was justified by the greater distance to be travelled.
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Old 30th Nov 2009, 14:42
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I'm in my 9th year EMS-ing in the US-
- Regulations
Same regulation as what used to be called air taxi, some industry specific rules enforced by way of operating certificate approval.

- Type of contract between the hospitals and companies
I've only done non-affiliated, what's called "community based", and we're compensated 100% by fee for service, generally through the insurance coverage. Charity by accident, about half the trauma requests.

- Type of helicopter used
Single engine VFR, single pilot, AS350.

- Composition of flight crew and medical
Single pilot, IFR rated.
Flight nurse, most of ours were paramedics before nurse.
And, a flight paramedic.
Lots of initials after everybody's names. I just fly.

- Licensing of pilots and crew members
I hold an FAA airline transport rating certificate.

- Type of flight: VFR, IFR or NGV
We're VFR only. NVGs promised for years, and 2010 looks like it may happen this time.

- Etc. ..
In the US, helicopter medical transport is almost purely a commercial enterprise, very competitive in the market my program serves. I've seen single-ship shoestring operations come and go in the local area, as well as big 'established' operations.

I am currently doing a personal study on the HEMS and would like to get an idea of the delay we have in France compared with our foreign colleagues.
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Old 1st Dec 2009, 09:11
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First, thank you for your help.

Mode of operation of HEMS in France:
Contract: Tenders between 3 to 5 years between the hospital and helicopter companies.
Type of flight: VFR day and night in OPS 3. Somes hospitals are day (8h00 to 22h00) with 3 pilots and others H 24 with 5 pilots.
Helicopters: A 109, EC 135, AS 355 N, and few AS 365 and MD 902 (Belgium Operator: NHV).
Crew: 1 pilot (CPL H) employed by the helicopter company. 1 doctor and 1 nurse employed by the hospital.
Our delay: No advance on the EASA NPA regarding HEMS Crew Member, and the use of NVG. Problems with weather forecast and low altitude weather forecast.

One question about IFR: How is used the IFR ? If IFR condition do you take off or refuse the flight (In my question you are IFR rating)? Does it exist IFR emergency, meaning you take off with VFR condition and if deteriorating weather you continu the flight IFR.
Are there any hospitals certified IFR or you are landing at airports certified.
Do you have problem with low altitude weather forecast ? This will be a problem regarding IFR !
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Old 19th Dec 2009, 17:00
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This article from yesterday includes some stats that may be of interest.

Saving lives in road crashes
BBC News Friday, 18 December 2009

Four or five times a day, anyone near the Royal London Hospital in the capital's East End can hear the familiar clatter of a helicopter taking off from the roof of the Accident and Emergency wing.

On board is likely to be Dr Gareth Davies, a consultant in emergency medicine and pre-hospital care. Along with a paramedic, another doctor and two pilots, London's distinctive red air ambulance will be flying to the scene of a serious accident.

This could typically be someone who's fallen from a height, a child with serious burns, or even the victim of a shooting. Mostly however, it is to attend a serious road crash.

"Road traffic accidents are about 50% of our work," he says. "For the most part, these are pedestrians versus cars, the second most common being cars versus cars or cars versus lorries. Sadly it's a big proportion of our work load."

These are frequently life-threatening incidents, particularly when car occupants are trapped inside their vehicles.

'Car-cooned'

"Even with vehicles travelling quite slowly, in the urban environment it is very common to see serious injuries to the chest, head, abdomen and pelvis," he says.

This often comes as a terrible shock to those involved in such incidents. In today's cars, it's not uncommon to feel invincible, or "car-cooned" as one expert has called it.

Cars are quiet and soundproofed against external noise. We feel reassured that the car has seatbelts, airbags, safety zones and such technologies as electronic stability control and ABS brakes.

However, the forces involved in an impact are tremendous as can be seen in any of the videos of cars being crash tested by Euro NCAP, the European car safety agency.

"If you drive into a brick wall at 30mph or two cars hit each other at 30mph, that's equivalent to falling from a height of 10m (30 feet), a third story window," explains road safety professor Murray Mackay.

"In that sort of standard crash, you go from 30mph to zero in a matter of inches (centimetres). Even if you're wearing a seat belt and everything goes according to plan, you're feeling a force 30 times gravity," he adds.

The most serious injuries typically occur in side impact crashes. In frontal impacts the driver and passengers are protected by crumple zones, seat belts and airbags.

Shatters

In a side impact, particularly one with a lamp post or tree, there is a lot less protection. In many cars, the only thing between vulnerable areas such as the head and any hard object is the side window and this typically shatters on impact.

"As soon as occupants are struck by the vehicle hitting them, or the tree they have run into, there are literally micro seconds before that occupant impacts with the tree or vehicle hitting their head, chest, or their pelvis," Davies says.

Even more horrifying, the chances of being ejected from the vehicle are also higher, especially if the occupant isn't wearing a seat belt, he adds.

That sudden deceleration imposes enormous strain on your body, says Dr Davies.

Damage

In any road crash there are three 'crashes', he explains.

First, you have the vehicle hitting another vehicle or solid object such as a tree or piece of street furniture. Then, the occupant hits the steering wheel or other internal part of the car. But it is the third accident that does the damage.

"This is where the internal organs of the body move forward and decelerate, hitting the inside of the chest, rupturing lungs, perhaps damaging the heart, rupturing the stomach or liver, and it's that third crash that causes the injuries or morbidity," he says.

It's why the air ambulance service is of such importance. It was created in the 1980s over concerns that too many people were dying at the scene of a road crash because it so long to reach them.

There are now 32 air ambulance services in England and Wales flying 19,000 missions a year, 40% of them to road traffic collisions.

In effect, the air ambulance brings the highly skilled doctors and the latest portable medical equipment to the roadside.

"For many people involved in a road crash, they are trapped perhaps by the vehicle, under the vehicle, or within the vehicle," Davies explains.

"Obviously their injuries continue to deteriorate all the time so it really is important to take as much of the hospital to the scene of the accident and to give patients who are in the process of dying the treatment they need to try and reverse that process as soon as possible."

Sadly many involved in road crashes die at the scene. Research indicates that 70% of road crash fatalities are declared dead at the crash site. The figure is higher for children.

A similar percentage of multiple serious injuries, known as 'polytrauma' cases are inflicted in road traffic collisions. As such, according to the Trauma Audit and Research Network at Manchester University, road trauma is the major cause of death and disability in the young.
I/C
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Old 19th Dec 2009, 17:33
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Devil 49,

- Type of flight: VFR, IFR or NGV
We're VFR only. NVGs promised for years, and 2010 looks like it may happen this time.
I take it you mean VFR by night also? If so, there is a significant difference to your terms of reference to the ours on this side of the Atlantic.. In UK there is no night VFR per se.

Police operators, over here classed as Public Transport, have a term known as VCF "visual contact flight" with its own set of weather limits and separation from obstacles, which exempts them from certain parts of the IFR.
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Old 19th Dec 2009, 17:34
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For now there is no HEMS in Denmark but the goverment has put out an tender for HEMS based on 4-5 helicopters, Day only, SPIR ect. Supposed to start up in 2010 but.... let see.
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Old 19th Dec 2009, 18:24
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Unhappy

Croatia
Sort of secondary medical transport performed by Mil M8MTV on famous
calculation price of 1.500 USD per block hour, no insurance, no proper
pay for pilots.Area covered only Dalmatia (part of Adriatic seaside and islands).
Golden hour rule, only in exceptions, one heavy train incident only 6 km
from helicopter base performed 1h 15 min response in summer 2009.
thanks to very complicated (difficult) system of public-military dispatching

During year 2005. canceled tender for real HEMS, winner company
Hiko left business 2 years after. One EC145 and one BK117C1 used,
AOG support from EC Donauwörth assumed like very poor.

In 2009. new Air traffic law strictly prohibit charity HEMS, only
commercial JAR Ops 3 with AOC allowed.

Local medical law regulations strictly insist on medical crew of one
doctor and one medic wich in case of night JAR OPS3 means minimal
crew of 4 plus one patient, therefore some smaller twin like 902 or 135
can not be used.

In Emergency situation on 50.000 km2 of land, more than thousand
islands and 1500 km of highways, can be best described like: not very promising...

PS SAR and Fire Fighting on Adriatic performed with same Mi8MTVs from above

Last edited by 9Aplus; 19th Dec 2009 at 19:48.
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Old 20th Dec 2009, 13:58
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Shy Torque-
Yes, night VFR.
So far no NVGs at my base, although they've been promised and declared a priority for approximately 5 years. Our night VFR WX minimums are significantly increased as a consequence of these limitations, and those limits have not had statistically significant consequences yet (regards IFR capability).
NVGs are different safety and economic factors. We operate into mountainous areas with no cultural lighting. Expensive as NVG kit are, we're losing much more by not having them, the most conservative response rule means we don't even consider requests where NVGs would make an immediate difference- and the company knows it.

Last edited by Devil 49; 20th Dec 2009 at 14:10.
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Old 21st Dec 2009, 09:00
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What is the percentage of IFR HEMS flight in U.S ?

How do you use IFR in US ? Do you take off in IFR weather condition ?

In case of NGV use, what is the flight rate of the crew ? IR or VFR ?
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Old 23rd Dec 2009, 17:13
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I will pitch in what I may

I fly in a VFR only program day and night. It is community based but referred to as a hybrid program because it is based at a hospital with the hospital name on it. The hospital subsidizes the program with some annual financial contribution. The crew is one paramedic, one nurse, one pilot.

We fly a BK-117 B-2 and NVGs should be here installed soon. The whole company is slated to be NVG equipped by the end of 2011. About half way there now. Mountainous, remote area bases getting them first.

In our IFR programs many of the hospitals have an IFR approach, some contain a VFR final segment, also used on departure. Low level wx reporting is pretty good here, but not everywhere. All of our IFR programs are single pilot, just like our VFR programs. Pay isn't much more for IFR. I would rather be VFR with NVG's. Also we have no autopilot and our GPS doesn't even have a moving map. We also will be soon upgrading avionics to Garmin 430's and the GMX-200 HTAWS. Very nice piece the 200 is.

We also have another aircraft in this program based about 20 minute flight north which is an AS-350 single engine with same crew compliment. The crew all work for us, no hospital affiliation. Just uses the same program name and is subsidized by the hospital.

As for the amount the IFR programs use the IFR. Some do quite a bit, others not that much. Much depends on how well developed the local low level IFR infrastructure has been developed, as well as hospital approaches. Hope this helps.
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Old 17th Oct 2011, 08:44
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Without wishing to seem rude, what are pilot's getting pay-wise these days with HEMS?
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Old 20th Oct 2011, 15:55
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In Queensland, Australia.

We have three types of HEMS operation. The primary operation is a State Government run service called EMQ (Emergency Management Queensland). It has three Agusta AW139s based at Brisbane, Townsville and Cairns, supported by three Bell B412 as standby/maintenance spares. These aircraft are staffed by a pilot, an internal crewman, a rescue (external) crewman, and an Intensive Care Paramedic. They will also take a doctor when indicated. They are fully IFR. They are airport based. They have and do use NVGs.

Another HEMS op in Queensland is Community Helicopter Service Providers (CHP). They have a range of aircraft including BK117, B407, B412. They rely on community funding plus fee-for-service from the Health Dept, Emergency Services etc. They are mostly IFR, since NVFR ops have been responsible for the only HEMS fatalities in Australia - which were also CHP. The Government funding only applies to aircraft that meet the minimum criteria of multi-engine and IFR, with suitable crewing. They mostly have a pilot, 2 x crewmen, paramedic and doctor as required.

The last lot are contracted EMS providers to specific locations / tasks, such as a couple of B412s based in the southern inland gas drilling area contracted to the exploration company, and a B412 in the Torres Straits in the far north, contracted to the Health Dept, IFR, and carrying pilot, an internal crewman, a rescue (external) crewman, and an Intensive Care Paramedic.

Pilots in the full-time professional shows are on $A110K to $A120K+/year, as well as significant salary packaging benefits. They need an Aus ATPL(H) with 2500 min, 1500 PIC (H), 500 turbine, 200 muti-turbine PIC, 100 night, CIR(H).

The paramedics are on around $A90K. The Crew - dunno.

Last edited by Al Fentanyl; 20th Oct 2011 at 16:55.
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