IN 1989, THE UK'S West Midlands Ambulance Service (WMAS) launched a project to provide a five-county area of the central UK with air-ambulance cover (the County Air Ambulance service). The idea began slowly, receiving no Government funding, and it took two years of planning, with a great deal of research, before the first helicopter came on line in May 1991. Since then, the service has established itself as one of the more successful air-ambulance operations.
Several helicopter types are used for air-ambulance work in the UK, including an Eurocopter Dauphin in London, with Kent and Northumbria operating Eurocopter Twin Squirrels. The WMAS settled for an Eurocopter BO105DBS (stretched model) as the best-suited and most effective light twin-engined helicopter for the job - it is also very versatile. More than 60% of the air-ambulance fleet in the USA consists of BO105s and large Eurocopter BK117s.
The stretched BO105 is 270mm longer than the standard version and gives much-needed extra space for the crew to work in, while not changing the overall size and performance of the aircraft. Its high manoeuvrability and compact design, especially the high placing of the tail rotor, are ideal for operating in the mix of urban and rural terrain covered by the WMAS.
Director of operations Bob Seaward says: "Looking around the world, the 105 is the most widely used machine for air-ambulance work because it has a very clean track record - as well as being very rugged and robust." It can carry two patients, two paramedics and a pilot. Patients can be loaded and unloaded quickly, because of the wide, rear- access, doors and the provision of sliding stretchers, which place the patient head-first opposite the paramedics for treatment during flight.
In an effort to keep costs down, Seaward worked closely with Bond Air Services of Aberdeen, which leases five helicopters to ambulance authorities throughout the UK and has two on permanent standby.
Included in a typical Bond package are two pilots (working in rotation), office space and hangarage, wherever the customer wishes the helicopter to be based, and a full-time engineer on site to speed any repairs which may be needed. Bond also provides stowage space for medical equipment, supplied by the customer. Most of the equipment is placed on the rear bulkhead - above the patient and facing the paramedics. The medical bulkhead has been a gradual development, and the one now in use is a third-generation version designed to be as compact and user-friendly as possible.
The cabin of the WMAS BO 105 has been modified so that the front seat can be turned around quickly to face a casualty. The rear seat faces sideways to give better access to patients.
The cockpit instrument panel has been redesigned to give better all-round visibility for landing in confined areas. It normally reaches further to the right of the cockpit, to contain the aircraft's navigation equipment, but this section has been removed and replaced by a small satellite navigator, which sits on top of the main control panel.
Co-ordinates of a landing area are keyed in from information supplied by the Ambulance Control Centre, while the aircraft's present position in relation to the target is constantly updated, allowing time of arrival to be established accurately. Bond acquired the system for its air-ambulance fleet, but has also extended its use to other fleets such as those covering lighthouse maintenance.
Bond's Capt Tony Stevens says: "The primary concern in landing in difficult areas is that we do not endanger anybody on the ground, so we aim for somewhere which is sealed off from the public, but which gives good access for us. We land in a safe place near the incident, then assess the scene and see if it is wise to move closer to the area. This [decision] is achieved through communications with the ambulance service, ground crews and the police - but we are shortly to have direct access to communications with the police through an air-to-ground channel."
Paramedics have to undergo a special one-week course at Pelsall in the West Midlands before flying on the air ambulance. The course is run by Bond, in conjunction with the UK Civil Aviation Authority. Paramedics learn about weather, navigation and map reading, as well as the basics of how the helicopter works.
Paramedic Kevin Dickens says: "You learn safety aspects of the aircraft and you have to give practical demonstrations of how to 'hot load' [loading and unloading a stretcher while the rotors are running], jettisoning doors, and show you are capable of putting out a fuel fire. All air paramedics must also pass a full CAA medical."
Dickens says that treating a patient in the air is exactly the same as in a land-based ambulance, but that the helicopter works well because it takes patients directly to specialist hospitals. He adds: "The only difference in being a paramedic on a helicopter is that you have got to think more about safety and plan treatment in advance because of the confined space. This usually means setting up all the equipment you will need, while in flight, before getting to the scene."
About two-thirds of work undertaken by the County Air Ambulance is transporting patients from the scene of an incident direct to the nearest hospital which can treat their specific needs. In recent years, the need to get a patient to correct medical care, within what is called the "golden hour", has become more widely recognised. Life expectancy can improve dramatically if a patient is receiving the most appropriate care within the first 60min of an incident.
The BO105 can land and take off in confined spaces, needing only an area two-and-a-half times its overall length and width. This high degree of manoeuvrability, combined with the ability to get anywhere within its operational area within 19min, ensures that precious time can be saved in the treatment of severe trauma. The other one-third of missions flown are inter-hospital transfers. A helicopter is ideal for moving patients with spinal and neck injuries quickly and smoothly from one care centre to another.
EIGHT AVAILABLE SERVICES
The County Air Ambulance is one of eight emergency medical service (EMS) helicopters now in operation in the UK - in Devon, Cornwall, Kent, Northumbria, London, the West Midlands Region and Scotland. The Scottish service is also supported by a fixed-wing Raytheon Beech King Air, based at Aberdeen, with a second as a back-up. Only three services are state funded (one in London and two in Scotland). The others survive through charitable donations.
The cost of operating an air ambulance is about £450,000-£650,000 ($675,000-$975,000) a year, depending on location and hours of operation. All air ambulances are operated independently of each other. They are fitted differently to suit each area's regional specifications. There are plans to standardise the equipment in each aircraft, however, not only in the UK, but across Europe. If need be, an air ambulance will then be able to cross a county or country border and the equipment required will be the same. WMAS chief executive Barry Johns is at the forefront of this idea as he is involved in a plan to propose a working group to the Committee for European Normalisation (CEN).
The first air ambulance in the UK was pioneered by Cornwall in 1987 and, although services are becoming established in other regions, the use of air ambulances in the UK is still in its infancy. The concept is becoming more widely accepted, however, as more ambulance services realise the need to transport patients from an incident to the most appropriate care centre within the "golden hour".
Seaward concludes: "The aeronautical industry could take more interest in air-ambulance services in UK as it is now a potentially growing market and is still new. Bond has shown an interest, but it is an area where others could get involved, giving operators a chance to expand and thus allowing for greater patient care.
Source: Flight International