Careflight Territory

CareFlight’s roots lie some 4,000km away in western Sydney, where CareFlight (New South Wales) became Australia’s first helicopter operation to introduce specialist clinical care on its missions to retrieve the ill and rescue the stranded using a single AS350 BA Squirrel in 1986. CareFlight expanded into fixedwing operations when it arrived in the Northern Territory in 2007 with the introduction of an international medical jet retrieval service.

Operating from Darwin Airport as well as its Sydney base, CareFlight International Air Ambulance flies its doctors and flight nurses on medically-configured LearJet 35s – now chartered from JetCity – to transport critically ill patients back to Australia from across the Asia Pacific. Under contract to NT Health, CareFlight also uses its jet operation to transfer patients from Darwin to more specialised hospitals in Adelaide or on the east coast.

Having established a medical retrieval presence in the Territory, CareFlight positioned one of its Sydney-based helicopters, a BK117 B2, in Darwin in January 2009 at the suggestion of the NT government as a strategy to mitigate a wallaby problem at Katherine (RAAF Base Tindal), 286km south of Darwin.

“They had ‘invaded’ the airfield and at night wallabies posed a significant safety hazard for fixedwing aeromedical operations,” said Ian Badham, a co-founding member of CareFlight. “We had the BK there as an aircraft of opportunity on an interim basis to support the government’s Northern Territory Aerial Medical Service (NTAMS). ” NTAMS has been operating in the Top End since 1946, but a NT government review identified concerns with the operation and in June 2010 the Territory’saeromedical retrieval services were outsourced. “CareFlight came in and provided the government with an interim operation using four ‘classic’ Beechcraft King Air 200s and a BK117 B2,” said Badham. “During a 12-month interim period the government ran a tender process for a 10-year Top End Medical Retrieval Service contract. In June 2011 CareFlight was announced as the successful bidder and we are now three years into that contract. ”

Super King Airs

From its new, purpose-built base at Darwin Airport, CareFlight operates three Beechcraft Super King Air 200s fitted with Rockwell-Collins Pro Line 21 avionics. Two of the Super King Airs are on a 24-hour, seven days a week stand-by while the third Super King Air serves as a dedicated back-up machine. CareFlight also has a Super King Air based out of Gove Airport, Nhulunbuy, 645km to the east of Darwin on 24/7 stand-by for faster responses to Arnhem Land and the eastern parts of the Territory. The Gove-based King Air responds with a flight nurse and pilot. CareFlight also utilises two ‘classic’ King Airs, survivors from the interim contract, with one under contract to NT Health for patient transfers between clinics and Royal Darwin Hospital. The second classic King Air will shortly be used as a back-up on a dedicated resources contract. “The government specified that the King Airs for the 10-year contract were required to be near-new, meaning they had to have less than 8,000 hours and be less than four years old at the commencement of duty, explained Badham. “We sourced one from Australia, one from South Africa and two from the US. We had to get the cargo door installed sowe booked out Hawker Pacific in Cairns and Beechcraft in Wichita for a year to get the work done. ” With a $1 million conversion cost per aircraft, the King Airs were dismantled from their wings down to install new wiring, avionics and have their medical fitout completed.

“Each of the four King Airs was needed within a very tight timeframe set by government. The last aircraft arrived only four days before we started the contract,” said Badham. “We have a fifth and spare King Air that was a former Norwegian air ambulance, but it has a narrow cargo door. The problem we had with this aircraft, initially, was the air-conditioning didn’t work because it had never been used in Norway and we’d never used the heater, which they had used all the time. ” In addition to the cargo doors, CareFlight’s Pro Line King Airs are fitted with Raisbeck propellers, wing lockers, satellite phone, TracPlus real-time tracking, a Total Aeromedical Solutions stretcher loading arm, two Spectrum stretchers and cabin seating for four medical crew.

“In terms of performance out of airfields in hot temperatures the King Airs do very, very well,” said Richard Sandford, CareFlight’s chief pilot for both its Sydney and NT operations. “The cargo doors do add a lot more weight so the maximum all-up weight is more of an issue in terms of fuel planning. In the monsoonal season there is an element of having to stop a few more times for fuel. ” Sandford, an ex Royal Air Force helicopter SAR and airline pilot, says CareFlight is looking at an supplemental type certificate for the King Airs that would allow an increase to the all-up weight above the current 12,500kg. “The increase would be of huge a benefit for us up here, but there is just an element for us on how we would look to fund it. ”

The whole emphasis was on keeping it light to maximise the range.

The single-pilot King Airs are fitted with an infra-red imaging system (IRIS) to aid pilots on landing at remote airstrips at night to check for any fauna obstacles in the landing path. “In the Territory IRIS is useful but it has its limitations,” explained Sandford. “We use it mainly on short final to clear the strip of any wildlife, but given the surface temperatures it doesn’t quite always have an effective definition. Certainly it’s very handy, I use it all the time. ”

A Top End chopper

An adjunct to CareFlight’s Top End contract is the provision of an aeromedical helicopter capability, which had never been part of the territory’s retrieval system. “Under the old NTAMS government system, and the RFDS out of Alice Springs, it was only fixed-wing in the Top End,” said Badham. “Under this new contract a helicopter in Darwin was part of that and we started the contact with our BK117 B2, VH-IME ‘CareFlight 3’ from our Sydney base which met the specifications for government. ”Since the contract commenced CareFlight and the government had been feeling their way with rotary-wing and recognised a helicopter with more superior capability would be better suited for the territory. With additional community support and local sponsorship from the Territory Insurance Office in July CareFlight was able to replace its BK with an AW139, VH-YHF, which adopted the callsign ‘CareFlight 1’.

The former Emergency Management Queensland machine arrived in Darwin reconfigured to a baseline standard by Heliflite, Australia’s AgustaWestland distributor, before undergoing a modification program specific for CareFlight’s requirements.

CareFlight had operated its BK117 with the addition of a single external tank giving the helicopter a range of about 300nm. With the wet season the BK’s range became severely limited, especially at night. “Most of our work is IFR, though we do have NVG, with the storms it really starts to limit you in terms of range,” said Sandford. “With the 139 our engineers added an extended range tank, which is another 400kg of fuel, that sits on top of the main tank. As we have the short nose version of the 139, when you fill up on fuel, the aircraft starts to reach its aft centre of gravity limit. ” CareFlight’s engineers designed the layout of the medical oxygen system, the Helimods stretcher, an overhead medical cabinet, and relocated the avionics as far forward as possible. Other local modifications to CareFlight’s 139 included a medical floor, three swiveling searchlights mounted under the forward cabin and for the hoist operator, forward and rear- facing LED floodlights, a Breeze rescue hoist and a NVG cockpit. “Our chief engineer Luke Bradshaw and his team did a brilliant job in coming up with innovative ways for cost and weight saving,” said Badham. “The whole emphasis was on keeping it light to maximise the range. ”In less than two months since coming online the AW139 has performed 25 lifesaving missions in the Territory. “The 139 is really proving what we thought it would be and that’s as a total game changer across the Top End. It has the range, the payload and the speed to deliver help to people living, working and visiting remote areas of the Northern Territory. It is allowing the Australian Maritime Safety Authority to call out a far more capable helicopter response. ” Known as the CareFlight TIO Rescue Helicopter, the IFR-equipped 139 has the ability to fly from Darwin to Gove nonstop, where previously the BK117 would require one or two refuelling stops, depending on the wind. “The BK is a brilliant aircraft but it has short legs. Up here in the Territory you need long legs. With the monsoon season, with some of theairborne holdings required, the BK was extremely limited. The 139 is the right aircraft for this environment. ” In mid-July, the CareFlight TIO helicopter crew realised the AW139’s true capabilities in responding to an accident scene where a four-wheel drive had rolled at high speed on the Stuart Highway near Daly Waters, some 500km southeast of Darwin, injuring a family of three. “With the Daly Waters response, had we used the BK, we would have needed to stop at Katherine to refuel on the way there,” said Sandford. “The 139 allowed us to fly direct to the scene which brought the medical team to the three patients about 30 to 45 minutes sooner, which is quite a considerable amount of time if you’re lying by the roadside waiting for medical care. ” The crew transported two critically injured stretcher patients back to the Royal Darwin Hospital with only a quick top-up refuelling stop at Tindal. “Not only is the new helicopter bigger, better, faster, but it has a quicker response time than the BK117 as we don’t have to put the hoist on or gear in it. The AW139 sits there ready to roll,” said Badham. “We are fortunate to have more flexibility because of greater endurance. We had pre-positioned fuel across our response area for the BK117, but we won’t have to do that as much anymore with the 139. ” Cruising at around 140kt the AW139 typically carries a flight nurse, an aircrew officer and pilot with the ability to carry two stretcher patients. “Because of the weight we can carry, there is no longer discussion of whether we can or can’t take a doctor. With the BK117 there was always a limitation in taking a doctor because it was fuel versus weight. ”Despite the perception of vastly flat terrain, the Top End has some very deep gorges, requiring CareFlight to regularly use the hoist for retrievals. In August, CareFlight TIO winched an injured man 30 metres up into the AW139 after he had dived into a shallow rock pool at the top of remote Gunlom Falls in Kakadu National Park, 250km southeast of Darwin.

“Over the years we’ve had a number of winch calls to boats and to ships that were more than 100km out to sea. Fishing is the number one pastime in the Territory so people will get into trouble and boats will break down. ”

Top End operations

Badham says rescue work in the Territory is always a challenge, especially with saltwater crocodiles in the river and estuarine systems. “We use a US Coast Guard rescue basket for recovery from the water as you’re not going to put a doctor or a nurse into the rivers around the Territory for obvious reasons,” Badham said.

With close to 120 full and part-time staff comprising flight nurses, doctors, pilots, engineers, logistic coordinators and administration staff in Darwin, an operation of CareFlight’s scale has not been seen in the Territory before. The service’s response region covers from the seas off Darwin to the north, down to Tennant Creek in the south, out and across into Western Australia and to the Queensland border to the east. The Royal Flying Doctor Service’s Central Operations at Alice Springs covers the southern half of the Territory.

“There are about 90 sites where we could be called to, 30 of which are regular sites,” said Badham. “Beyond this we are reliant on GPS coordinates. When you’ve got a moonless night in the Territory it’s zero visibility so it’s genuine NVG operations. This is just one challenge of flying up here. ”For task activations, the St John Ambulance Service receives calls for help made close to the main towns. For the majority of the Territory, the Rural Medical Practitioner, a government doctor, will take the initial call. After an assessment of the injury or illness, should a retrieval or response fall outside of their capabilities, a call is then made to CareFlight’s Medical Retrieval Consultant (MRC), a specialist doctor who then takes over the clinical responsibility of the patient.

From there the MRC sets the tasking priority for the patient and CareFlight co-ordinators will then match the retrieval with the appropriate aircraft for the mission. “We’ll use what is required to get out there and retrieve the patient within the response times set by the government,” said Badham. “Almost all of our missions return to Royal Darwin Hospital, as the only major hospital in the Top End. ” The NT government contract specifies arrangements for clinical teams to be carried on both the King Airs and the helicopter. All missions carry a flight nurse with about a quarter of missions also carrying a doctor. “About eight of our 24 flight nurses are qualified and trained to go down the wire over land and vessels at sea,” said Badham. “We’re the only jurisdiction in Australia where flight nurses are certified to do winch work, which is a requirement of NT Health. ”

Sydney operations

Back in Sydney CareFlight continues to deliver a rapid response medical service from its Westmead Hospital base in the city’s west. Following a successful Head Injury Retrieval Trial (HIRT), where rapid-response clinical care was brought to the side of ‘000’ patients with head and major trauma, CareFlight now operates a Helicopter Emergency Rapid Response Trauma Team (HERRTT)

Up here in the Territory you need long legs.

in which a BK117 B2, VH-BIF ‘CareFlight 4’, recently replaced the service’s original A109E Power used for HIRT missions.

CareFlight is also contracted to the New South Wales Ambulance to provide around half the complement of doctors on the state’s ambulance helicopters from bases at Bankstown Airport, in Sydney’s south-west and from Orange in the state’s central west, in addition also to responding with fixed-wing air ambulance and road ambulance units as required.

CareFlight also secured New South Wales Health’s newborn and paediatric emergency transport service (NETS) contract in late 2012 following the disbandment of Telstra Child Flight. CareFlight continues this unique service with a Bell 412EP, VH-LWI ‘CareFlight 5’ and with BK117 B2, VH-IME ‘CareFlight 3’ as a back-up machine.

The challenges

CareFlight’s chief pilot, chief engineer and check and training staff oversee operations in Sydney and in the Northern Territory services. With set crews for Sydney and Darwin, aircrew can interchange between the two bases, as can a small number of pilots. With such a diverse flying operation, Sandford manages it all from Darwin. “It can be challenging with the NETS and the rapid-response HERRTT helicopter down in Sydney, and with the King Airs and the helicopter up here,” said Sandford. “We have fixed-wing and rotary-wing fleet managers, then the bases themselves have their senior base pilots, so that makes a big difference in terms of the workload that you would normally have on a chief pilot’s desk. ” Flying in the Top End occasionally throws up a few challenges, particularly when there’s a major military exercise going on. “Exercise Pitch Black has just completed and it really does have its challenges,” said Sandford. “The RAAF controllers are as helpful as they can be and they do their best to assist when we have a primary mission. They’ll open up the airspace for us and we get direct routings. For priority two and priority three tasks then there is a considerable amount of preplanning to get around the airspace. It’s manageable, but like all operators we put up with it while the exercises are on because there is a lot of restricted airspace to the south and south-west of Tindal and Darwin. ” From an engineering perspective, ‘showstopper’ issues for chief engineer Luke Bradshaw and his team of 15 engineers in Darwin are mainly during the wet season. “With all the moisture and the rain around, keeping it away from the avionics is probably our biggest challenge,” said Bradshaw. “That, plus the heat that is generated in the cabin when the crew is on board, on the ground with engines running. ” While acknowledging a likely shortage of skilled engineers around the country in years to come, Bradshaw has not found it difficult to find qualified LAMEs to live and work in Darwin. “I expected a high turnover of staff when we were first looking at the tender, but we haven’t had many problems attracting staff. Over a three-year period, for example, I’ve only had one engineer move and that was for family reasons. ”

Contracts

In late August CareFlight was awarded a six-year, $45 million aeromedical support contract to the INPEX-operated Ichthys liquidnatural gas project. This will see a Business Aviation Services (BAS) aeromedical-configured Beechjet 400A based at Darwin which will operate independently of CareFlight’s Top End Medical Retrieval Service contract.

The INPEX contract will see CareFlight launch a Beechjet from its Darwin base to rendezvous with a contract helicopter transferring the patient from an offshore rig to either Broome Airport or Truscott, a staging post for offshore helicopter operations.

“If they have a single casualty or a major emergency they know they have transport available to move patients without the need to rely on regular aeromedical retrieval services,” said Badham. “As a result of the contract, 20 new clinical positions for doctors and flight nurses will be created. The proceeds from this contract will help us continue to expand our aeromedical and trauma training services across northern Australia. ” Under this latest contract, BASwill provide the Beechjet while CareFlight will supply a classic King Air as the back-up machine. BAS’s flightcrews will operate both the Beechjets and the King Air.

Badham confirmed CareFlight is also one of the parties bidding for the New South Wales aeromedical retrieval tender, due to be announced in December. “Bidding has closed and we’ll wait and see what comes out of that process in due course. The Victorian aeromedical contract has just been let, South Australia has just closed and Western Australia is largely finalised. So, whatever comes out of these tenders they will largely seal the country for the next decade on the helicopter side of things. ”

A pioneering role

“What we’ve achieved in the Territory goes to the broader objective of making the north of Australia a more attractive place tolive because people feel safer,” said Badham, who has just stepped down from his full-time role at CareFlight to enter into semi-retirement. “The response from the community about our services has been overwhelming. ” Badham, the brainchild behind Australia’s first civil helicopter rescue service in 1973 with the then Wales Bank-sponsored (now Westpac) surf rescue helicopter, will continue to support CareFlight’s Darwin team on a part-time basis from next year.

“What we’ve also achieved in the Territory takes me back to the early days when, as a volunteer, I was responsible for nine surf rescue helicopter operations around Australia and then moving out of that to set up CareFlight. It’s a pioneering role and it’s an exciting role working with good people who are really doing everything they can for the community and putting in place a better system than existed before. It really is an inspiration and it has kept me young. ”