Where Now for Careflight?

Operations began with an Aerospatiale AS 350B Squirrel, replaced in October 1988 by an SA 365C2 Dauphin. Hoad believes that the current ex demonstrator Bell 412HP, which replaced the Dauphin last Christmas Eve, will remain in service for about 10 years. A more sophisticated autopilot, plus weather radar, combined with better range and speed, gives the new aircraft, and its crew, more flexibility.

For deputy chief pilot Dan Tyler, the Bell is something of a reunion, being a direct descendant of the UH-1 Huey he flew in Vietnam 25 years ago. As he puts it “those things that needed changing had been changed — the things that were great about the Huey were the same in the 412”. Dan isn’t a small man and crewman, perhaps unkindly, suggested to me that the real reason he likes the 412 is that the pilot has a door — not the case with the Dauphin!

CareFlight’s funding is partially from its major sponsor NRMA, while 26% comes from the NSW government. The majority comes from the public.

Since 1987, CareFlight’s medical component has developed to the extent that the six months that doctors, usually in their final year of specialisation, spend with the unit is accepted time toward their qualification. CareFlight believes that it is the only non hospital institution with such a teaching accreditation in this country. Twice a year, the unit takes on three registrars — usually two anaesthetists and one emergency medical. On completion, they join a pool of 20 part-time medicos who take turns on duty. Hoad says that there are difficulties keeping any more than that proficient. As an instance, he pointed out that the entire pool had to be retrained when the Bell came on line.

In terms of airmanship, since 1992 all pilots have been IFR rated. The year before, in May, IFR had figured largely in one of CareFlight’s most hazardous rescues from Bungonia Gorge, near Goulburn, NSW. On that occasion, Hoad and his crew were called out at night, after a rock climber had fallen. The immediate concerns were the length of time that a ground party would take to reach the patient and evacuate him; the possibility of internal bleeding; and the threat of hypothermia.

CareFlight agreed to take a look, arriving a little after 9.00pm on a calm and clear, but moonless, night. An initial attempt to descend into the 360 metre deep gorge, which narrowed from around three rotor diameters at the top, to about one and a half at the bottom, was abandoned due to a lack of visual cues, and the ground party was asked to move the patient 200 metres to a more open area at the base of a spur line. This was done and, as Hoad describes it, he then commenced a backward form of hover-taxi descent, down the spur line with the only visual references being those lit by his landing lights and Nightsun lantern.

Above the ground party, a paramedic was winched down the remaining 20 metres, and the patient taken aboard, after which the climbout was essentially the reverse operation. Hoad says that he and his crew were confident of their capabilities; the only concern being that something mechanical didn’t decide to quit at a critical point. Otherwise it was a question of “experimenting with controls inputs in a real exercise in seat-of-the-pants flying” or, as he puts it, “there was enough pucker factor to make it interesting”. The rescue was recognised by the International Helicopter Association’s award of the Eurocopter Golden Hour in March 1992.

In the first full year of IFR capability, utilisation increased by some 12%. Until next year, at least, CareFlight is part of an overall emergency response system, normally tasked by police, or ambulance, which sees casualties west of the Hume Highway as being the province of CareFlight, while those to the east are Westpac LifeSaver’s. The two organisations back each other up, as well as a third service, Child Flight.

With cellular phones becoming more readily available, CareFlight has actively encouraged bushwalkers to take their phones with them; the benefits are twofold; notification of the emergency is virtually immediate; and time wasted by ground units is minimised — the crew can talk to the patient, or his party, and quickly establish the location and his condition.

There’s a certain incongruity here; miles from habitation in the rugged Australian bush, you’re hiking with friends and one of them breaks a leg. You dial 000 and notify the emergency. A little later, you hear the faint noise of an approaching chopper, just as the phone rings. You answer it to hear a voice say, “Good afternoon, CareFlight here…”.

CareFlight’s Bell is kept on the line fuelled with 725kg (1600lb) of Jet A1, and set up in the most frequently used configuration, for intensive care. On average, the helo will be airborne within eight minutes for day missions; 20 minutes for night. On the day that I visited, Hoad and I had just returned from the Westmead Hospital canteen, at 12.30pm, to be told there was a woman with a leg injury at Cox’s River, near Katoomba. While the doctor and paramedic removed the intensive care stretcher, and replaced it with a more appropriate item, the pilot and crewman were consulting the maps, before hooking up the airstart, removing the tie-downs and clearing the tail rotor. The skids were off at 12.40, and the helo was back on the ground at Westmead at 2.00pm having winched the patient up and delivered her to a helipad near Katoomba Hospital.

Recent developments, following the election of the Carr Government, now threaten the continued operations of CareFlight. In late August, the health minister, Dr Andrew Refshauge, announced that the NSW Health Department, from July 1 1996, would cut $460,000 from the $1.5 million allocation that the service receives.

Ostensibly this decision arises from an earlier one to implement the recommendations of the Reid Harris report, which reviewed NSW aeromedical service requirements after relocation of the Children’s Hospital to land adjoining Westmead Hospital, and coincides with the end of the current five year contract. The review questioned the wisdom of having two helicopter aeromedical services, viz. CareFlight and Child Flight, based virtually at the same site. Its recommendation was that Sydney helo aeromedical services be reduced to two — one at Westmead, the other at Prince Henry Hospital on the coast — and that the resultant savings be applied to the establishment of a service for southern NSW and the ACT to be based in Canberra. That service would have the use of the Sikorsky S-76 donated by Dick Smith, if it isn’t traded in on more suitable aircraft. The pressure is on for CareFlight to make the move to Canberra.

The immediate effect of the minister’s decision is to retain the existing services at Lismore and Newcastle, each of which receives a $1m yearly subsidy. Expressions of interest were called by September 20, in operating any, or all of the proposed two Sydney, and the new southern NSW, services, after which limited tenders will be called. The existing services have been invited to collaborate, and it is believed that discussions are taking place. The Newcastle service will be put to open tender.

CareFlight executive director Ian Badham points out that although the two hospitals are alongside each other, each has a vastly different role, as do the two helo services — the needs for transporting paediatric and neonatal cases differ markedly from those for the accident emergency, rescue, and intensive care transfers that CareFlight undertakes. Notwithstanding the minister’s announcement of an upgrading of all services to handle neonatal, child and adult cases, Badham is convinced that the whole exercise is one in control. He believes that the Health Department wants total control of all NSW aeromedical services and resents the fact that CareFlight trains and engages its own doctors, while the other services use departmentally funded medicos on standby.

Badham notes that the department has no complaints about the quality of CareFlight’s medical training. Nevertheless, if the funding cuts go ahead, the medico pool will go as of July next year and with it the teaching programme.

CareFlight believes that implementation of the Reid Harris report relies on flawed findings in the report itself. Apart from the review’s failure to distinguish between the different roles of CareFlight and Child Flight, and their host hospitals, Badham is critical of the report’s claim that his and the other operations’ aircraft only fly 10% of the time. He says that although, strictly speaking, the figure is correct, it fails to take account of time on the ground, away from the Westmead Hospital base, either at emergencies, or at other hospitals. Nor does it take account of training and maintenance.

Chief pilot Hoad says that the average mission is just over two hours and, in terms of block time, his aircraft’s utilisation is over 20% — double the figure quoted in the review.

Having observed CareFlight at work, this writer believes that there are dangers in the proposed arrangements as presented. Sydney’s 3.5 million residents will lose one service, which will reduce backup to one helicopter, in the event that either service is unavailable. As has been said elsewhere, emergencies won’t conveniently stop happening to accommodate the many reasons, including a mission already on, that a helo isn’t available.

In overall terms, the three existing Sydney services cost the NSW government $3.5 million per year. For Westpac Lifesaver and Child Flight, the taxpayer funds about 40% of their budgets; for CareFlight, about a quarter. The bonus, at CareFlight, is that there is an additional medical training facility provided at minimal cost. Over the state, the helo services cost the taxpayer less than $6m a year — a pittance in terms of the total health budget. The comment most frequently heard of late is “It ain’t broke, so don’t fix it”.

As Sydney’s west and north-west continues to expand it’s conceivable that, before very long, one helicopter will be insufficient to service the region. The north-west sector development, centred on Rouse Hill, is under way — new suburbs are already being occupied — with the development expected to house as many as 320,000 by early next century.

The economic recovery has seen an upturn in motor traffic. Both CareFlight and Westpac Lifesaver have noted that a rise in callouts to road traumas has contributed to an overall increase in missions flown. The very traffic in which these accidents occur, especially on weekends, hampers road ambulance retrieval, leaving helos as the only means of rapid transfer to a hospital.

Against that background, it’s difficult to escape a feeling that the southern NSW service should be in addition to, and not a relocation of, existing services.

CareFlight has publicised the proposed cuts in virtually all metropolitan media and, at writing, had gathered thousands of signatures on a petition, while a lot of CareFlight Bears have been sold, at $30 a pop, to raise funds. The evidence is that western Sydney, already angry over broken election promises, isn’t going to take this lying down. Time, as the cliché has it, will tell.