Issue 273: Chopper Squad

Driving the growth in EMS has been a major increase in government funding for such services. In years past, most EMS services were offered by charity operators such as CareFlight, who pioneered such services in Australia. Many of these relied largely on corporate sponsorship and community fundraising to maintain their operations, while state governments have also provided some funding to ensure that their vital services can be sustained.

In recent years though, state governments around Australia have played a greater role in coordinating and providing helicopter EMS. In most states, the governments have now established fully-funded operations under their respective health departments and ambulance services, while more and more helicopters are being operated by commercial providers such as Australian Helicopters and CHC Australia.

Neil Shea, CEO of Australian Helicopters, puts this down to state governments looking to provide more professional, dedicated EMS services as is done elsewhere. “I think we’ve had some very good things to model ourselves on in Europe, the UK and the US, so full credit to the health departments, state governments and the like who have gone overseas and seen what can be done and is done elsewhere and gradually improved the scope of their tenders,” he said.

This is on the increase now, with the Northern Territory soon to announce the winner of a new EMS contract. This will change the current arrangement, where CareFlight NSW has been providing with two BK-117s to operate on search and rescue (SAR) and EMS missions on behalf of the NT government and the Australian Defence Force.

Interestingly, the NT tender calls for the provision of a combined rotary and fixed wing patient transport contract. Unlike most other contracts, it also calls on the operator of the aircraft to provide their own medical crew onboard.

Among the commercial operators, CHC Australia is the largest and now provides helicopters for a number of state governments under contract. CHC also conducts SAR/EMS operations on behalf of the RAAF nationwide, with some of the aircraft called into civilian duty from time to time.

However, last year CHC Australia started examining a potential sale of its EMS operations in Australia, with the company engaging ANZ to sound out potential buyers. At the time, it was expected that the sale would see it focus primarily on operating helicopters for offshore oil and gas contracts.CHC has now abandoned the process, and says that it still remains committed to local EMS operations, and remains the largest provider of helicopters in Australia for that role.

The other major operator of contracted EMS services is Australian Helicopters has grown its scale of EMS operations in recent years, with the company now providing helicopters on behalf of the Queensland, Victorian and South Australian governments. Shea says that his company’s approach to managing such contracts is to work closely with the customer to provide the best fit. “I think that we pride ourselves on working very closely with the client to understand their needs, particularly in terms of configuration of the aircraft,” he said.

“We find that relationship management right from the get-go is extremely important, and I think that’s one of the few factors that can differentiate.”

The number of EMS helicopters being operated around the country has grown significantly as the state government contracts have grown. “Within contracts as well, sometimes they have had one or two aircraft and they are going to additional aircraft, so additional bases are opening,” said Shea.

As an example, Shea points to his company’s base at Warrnambool, on the south west coast of Victoria. “The local community there lobbied for a decade for a service in southwest Victoria,” he said. “It was obviously serviced by road ambulance, by a bit of fixed wing and by one of the other bases in Bendigo coming down to cover it, but the growth in that area has gone to the extent that the Victorian government saw it fit to fund a new base there which has been open for nearly 12 months.”

While the fully funded models have taken over most metropolitan EMS services, Shea says that the charity funded model will still retain its place for some time, particularly in regional areas. “There are a number of communities that will probably not for a long time be able to sustain a fully funded solutions, so I think the charity based roles will have a role to play in those places for some time to come,” he said.

One example is in Mount Isa, where NQ Rescue service provides EMS and SAR services for a number of surrounding communities. While it has been solely reliant upon community support and corporate sponsorship for a number of years, the service has had a recent win with the announcement that it will be added to the Queensland Health helicopter EMS network after years of negotiations. This will allow it to carry Queensland Ambulance officers on board, while also allowing it to receive some funding from the government.

In some cases, the charity operators have taken on niche roles. Following the loss of its contract EMS/SAR contract with the Ambulance Service of NSW in 2007, CareFlight in NSW now primarily operates the specialist head injury retrieval trial (HIRT) from its base at the Westmead Hospital. In this role, the operator utilises its Agusta A109 Power to respond to some cases of severe head trauma during daylight hours.

CareFlight Queensland also operates medical training courses and facilities for specialist helicopter paramedics and doctors, as well as its international patient retrieval service. Both services help to fund its helicopter operations in Queensland.

Equipment

One of the big changes witnessed by the industry over the last few years has been the change in equipment, with an overall trend towards bigger, more sophisticated helicopters as the equipment in them has become lighter.

The biggest change in terms of the helicopters has been the move by many operators to twin engine aircraft. “If you look back a number of years, there were LongRangers, Squirrels and so on operating EMS in some parts of the country,” observed Shea. “That’s tending to disappear now, and almost every EMS contract specifies twin engine aircraft.”

Indeed, for some charity operators this has proven to be an issue. One of the reasons NQ Rescue has had difficulties in attracting state funding was because it operated a Bell LongRanger as its primary for a number of years, while Queensland Ambulance regulations prevented their paramedics from being carried on single engine aircraft. The service is now seeking a Eurocopter/Kawasaki BK117 to allow it to resume services.

Nevertheless, a number of charity operators still maintain single engine aircraft in service, albeit usually as secondary aircraft, or when providing other services, such as transporting doctors between hospitals.

And while twins now make up most EMS helicopters, the types used have been changing. Lighter twin aircraft, such as Eurocopter/Kawasaki BK117s once were the standard for EMS services, the advent of more government funding has seen requirements move up to larger twin aircraft, with the Bell 412 now providing the mainstay of most helicopter EMS services.

“The 412 is a workhorse that has been around for some time. Obviously the variants are upgraded all the time, but it’s tried and proven,” said Shea.

“It also has a really good sized cabin for EMS services. You’re able to get multiple stretcher configurations in, all the additional equipment, plumbing and oxygen that you need and you’re able to move people in and out of road ambulances without too much hassle.”

In addition, CHC operates some of its Sikorsky S-76s in a SAR/EMS role. While primarily used for search and rescue operations from RAAF fast jet bases such as Pearce, Amberley and Williamtown, at times the S-76s have been called in to provide EMS taskings where a primary aircraft may be unavailable.

The newest type on the local EMS fleet is the AgustaWestland AW139, which is now used by Emergency Management Queensland (EMQ) and the Ambulance Service of NSW. While offering a similarly sized cabin to the 412, the AW139 flies slightly faster and farther than the 412s, offering greater flexibility when dealing with emergencies.

The introduction of those aircraft has not been without its issues, with media reports over an incident in NSW saw one of the aircraft experience a hard landing after a power system failure. Similarly, EMQ recently retrofitted new external spotlights after experiencing some issues on their AW139s.

The move into newer, more advanced helicopters for EMS has come mostly from government. Shea says that most state government contracts now specify new aircraft. “I think that’s just about the recognition of how over a long term contract that’s probably a better return for the taxpayer and the operator,” he said.

As well as the helicopters themselves, there have been advances in the equipment used in them. Most medical equipment developed for use on EMS helicopters has become lighter over the years, which provides major improvements in the performance of the aircraft. “You can go a little further without having to refuel, which means you can get back to the hospital with a critically injured patient quicker than you used to. That’s the real benefit,” said Shea.

Increasingly, the equipment being carried inside EMS helicopters has become lighter, which Shea says makes a major difference on most missions. “You can go a little further without having to refuel, which means you can get back to the hospital with a critically injured patient quicker than you used to. That’s the real benefit.”

A great example of this is a new lightweight stretcher loading system designed and manufactured by Caloundra based Helimods. The system was developed to meet Ambulance Service of NSW and EMQ requirements for use on the AW139.

“The HeliMods design option meant that we could provide input to make it perfect for our operational needs,” said EMQ chief pilot Captain Trevor Wilson. “Now that the final product is in service, we believe that it is far better than any of the comparable internationally available products in terms of overall functionality and versatility.”

Other technologies in the cockpit are also coming into play, according to Shea. “You’re seeing night vision goggles come into play which is a big step in technology. It doesn’t allow you to go further or land in a place that you really couldn’t land before – it allows you to do what you should be doing now in a much safer way, so it lowers the risk profile in that respect.”

Outlook

With new equipment coming on line, a move to more contracted services and new niche roles emerging for some services, the EMS industry in Australia has definitely come to maturity.

Increasingly, it appears that there will be a growth in fully funded operations, particularly as regional centres continue to grow. “You look at some of the smaller regional centres such as the Gold Coast, Mackay, Rockhampton and the Hunter Valley,” said Shea. “The issue is always going to be is the government going to be able to afford to fully fund EMS services in those communities, and that’s why to date those have been partially funded. My feeling is that that will drift towards more fully funded solutions, but which ones is a difficult thing to say.”

Charity funded helicopters also appear to be set to focus in either niche areas or specialist roles. “There are a number of niche roles,” said Shea. “There are a number of communities that will probably not for a long time be able to sustain a fully funded solutions, so I think the charity based operators will have a role to play in those places for some time to come.”

The requirements of state governments are also likely to keep up with the latest developments in technology, as has been the case recently. “I think generally speaking each time a new tender comes around, and they’re about five years apart, there’s an improvement in the design of the aircraft fit out and the equipment used,” said Shea.

With newer and more sophisticated aircraft, new specialised roles and a strong history behind it, Australia’s helicopter EMS industry looks set to continue its rise for years to come.