Military Aeromedical Evacuation By Helicopter – Implication for Urban Australia

In round figures, 480 Australian soldiers lost their lives during the years in South Vietnam (1965-1971). During those same years, more than 2500 males aged 17 to 29 years (combat age group) for instance, lost their lives on the roads of NSW. During those same years, almost 223,000 civilians were injured on our roads and of these some 72,- 000 were males in the 17 to 29-year age group.

During the Vietnam conflict, the prospects of survival of those injured in combat was 41 per cent better than those injured on the highway in Indiana, USA. This was largely due to the speedy evacuation of casualties by helicopters.

In November 1967, the Medicopter Airborne Intensive Care Unit commenced operations in Columbus, Ohio, USA. Eleven months later it had been estimated that 48 per cent of patients who would potentially be dead on arrival at hospital by usual means of transfer, survived to leave the hospital.

In October and November 1968, trials were conducted in Victoria to assess the possible advantages of transporting patients by helicopter to and from Melbourne hospitals within a hundred-mile radius. The results of that trial showed that from an operational point of view the helicopter was an efficient air ambulance and that patients reacted well to this method of transport.

In West Germany more than 5000 lives have been saved since 1970 by helicopter-borne rescue, with crews able to initiate prompt life support procedures and with a capability to evacuate the critically injured or ill to hospitals alert and prepared to receive patients transported by helicopter. West German figures represent actual lives saved and not merely the number of patients transported during the years of helicopter operations. The West German Helicopter Rescue Service has an impressive record.

Most recent statistics confirm that the fatality rate of critically injured or ill patients transported by this helicopter service is a mere 0. 4 per cent, as compared with the fatality rate of 23 per cent in those transported by road ambulance. These statistics refer to a comparable group of patients in each case. Such has been the record of the West German Helicopter Rescue Service that almost all the country and its population are now served by a network of helicopter rescue stations.

In December 1970, a Helicopter Ambulance Service commenced operations on the Mornington Peninsula in Victoria. Statistics published in 1977 revealed that this service had flown more than 1506 accident cases and seriously ill people to hospital. The Peninsula Ambulance Service is only one of a few services in the world that operates a helicopter ambulance in conjunction with its road ambulance service.

In October 1973, The Wales Helicopter Rescue Service (WHRS) was conceived and commenced operation in Sydney, NSW, sponsored as the name implied, by the Bank of New South Wales through its donations to the Surf Life Saving Association of Australia – Sydney Branch (SLSA). During the first four years of service, 1973 to 1977, 464 missions were successfully completed.

The WHRS was introduced for the primary role of surf rescue. However, even if an Emergency Medical Helicopter Service similar to that operating in West Germany were established there would still remain a need for a Surf and Coastal Helicopter Rescue Service such as the WHRS. This is because such a helicopter requires different rigging and equipment from other rescue helicopters. In addition, the crew members of a surf rescue helicopter need to be well trained surf lifesavers, who are able to safely secure patients in heavy seas, which have prevented rescue by other more conventional means.

Early in 1977 the Tasmanian Government called tenders for the establishment of an Emergency Helicopter Service to provide a vehicle for all emergency purposes on the island of Tasmania. In that island State, an Emergency Helicopter Service has operated since May 1977. Since the inception of the service in Tasmania the emergency helicopter has been used constantly for a wide variety of emergency purposes. This helicopter has been utilised for search and rescue, medical evacuation during times of weather isolation and in taking aid to ships. in distress, and medical evacuation from remote areas to major hospitals. The State Emergency Service in Tasmania is the coordinating authority for the helicopter – in that all requests for the use of the helicopter for emergency purposes are directed through a 24 hour operations centre.

I believe there is sufficient evidence now to confirm the benefit of translating Military Medical Helicopter Operations to the civilian environment. There is no doubt that the helicopter has already clearly established its civilian role both here in Australia and overseas, and importantly in the State of NSW. This observation was no more tragically confirmed than at the Granville train disaster in Sydney in 1977. The Granville train disaster demonstrated the great potential of the helicopter for aeromedical evacuation of injured and for the transportation of key personnel and supplies to the scene.

Whilst the helicopter drives over the rush hour traffic, not through it, it is in no way envisaged that the Helicopter Medical Service should replace the role of the Road Ambulance Service. More importantly, it is envisaged that the Helicopter Medical Service should not only complement but should also be part of the State Ambulance Service. Co-operation and integration with the Ambulance Service will be a significant factor in the success of the Emergency Helicopter. Co-operation with all State Emergency Services and Police is no less important in this success.

In order to improve the chances of survival of emergency patients, the time span intervening between the occurrence of the emergency and the delivery of medical treatment must be as brief as possible. The saving will be not only in lives but also in time. Mortality varies inversely with the length of time intervening between injury and definitive therapy. Two-thirds of all traffic fatalities occur within 25 minutes of the accident; transporting medical crews by helicopter may be the only way to turn back the numbers.

The injured Australian soldier in Vietnam enjoyed the best ambulance service in ·the world. There can be no reason why the injured Australian in peacetime does not deserve the same. If we are to achieve the saving of life that has been achieved elsewhere in the world, there is only one answer. It is for the cities to have an Airborne Urban Ambulance Service. This service can be provided by the establishment of an Emergency Medical Helicopter Service. The aim of this service will be to save lives. The philosophy of the service must be medical.

Dr Robin Higgs’ Interest in helicopter medical transportation dates from his service in the British Army In which he spent 10 years. He served with 28 Commonwealth Infantry Brigade In Malaya and his last tour of duty was with the Parachute Brigade.

He saw much aeromedical service, including parachuting from aircraft and helicopter work and for a period was Officer Commanding No. 5 Field Parachute Surgical Team.

This eight-man operating theatre team, capable of dealing with up to 80 major surgical cases in a 72-hour period and designed to support a battalion, was then part of the 23rd Parachute Field Ambulance.

Retiring from the Army in 1974 as Major, Dr Higgs specialised In orthopaedic surgery. After coming to Australia, he worked with the Wales Helicopter Rescue Service in training, rescue duty and, later, as Medical Director of the Service. He resigned to practice as an orthopaedic surgeon at the Repatriation General Hospital, Concord.