Health policies
  The advent of JAR-OPS 3
  Turbomeca a major player
  European operators

New modernization and economic policies in healthcare industry spur helicopter sales

"Helicopter medevac missions started in the armed forces, with the first civil applications following in the United States," explains Frédéric Dalakupeian, major accounts manager at Turbomeca. "Major American hospitals quickly acquired helicopters in an effort to improve their economics, such as Hermann Hospital in Houston, which bought 15 helicopters to increase the profitability of its intensive care units. This kind of thinking would only come to Europe much later. The development of helicopter medevac fleets in Europe was driven by two main factors, namely government support and community spirit."

Government support

Hermann Hospital’s BK 117 C-1 (2 Arriel 1E2)

In most European countries, it is federal and local governments that have taken the initiative in deploying helicopters, within the scope of a national health policy. The chosen solution was to assign the responsibility for medical evacuation operations to major state agencies and organizations - Civil Security, Gendarmerie, National Guard, Border Police, Coast Guard, etc. - in addition to their original duties. However, as demand continued to develop, various private companies also entered this emerging market during the 1980s.

"Helicopter medevac missions are now an important business for a number of our operator customers," notes Frédéric Dalakupeian. "In general, these services are provided within the scope of contracts with Regional Councils, or similar entities that are financially responsible, for periods of one to several years. This gives private operators regular business volume in terms of flight-hours, and therefore a more predictable revenue stream." In France, for example, when a private company wins a contract from a hospital, it can count on 300 to 600 flight hours a year for each helicopter. The number of private operators providing aeromedical services varies widely from country to country.

Community spirit

A 109 E Power (2 Arrius 2K1)

In other European countries, community associations stepped up to the plate, either in place of public authorities, or along with them. "The community spirit is especially strong in Switzerland, Germany and Austria," says Dalakupeian. For example, the helicopter medevac pioneer in Europe in none other than Rega, a private, non-profit Swiss foundation, which is financially independent. Rega (schweizeriche REttungsflugwacht - GArde aérienne suisse de sauvetage / Swiss air rescue guard) counts on annual subscriptions from 1.6 million donors. This money covers two-thirds of Rega’s financial needs, with the balance paid by insurance companies and various health funds for the services. Fifty years after being founded, Rega is still the predominant medevac player in the country.

Germany has its own large non-profit organization specialized in heliborne aeromedical services, DRF (Deutsche Rettungsflugwacht), created in 1972. But it shares the honors as national pioneer with another organization created around the same time, the ADAC-Luftrettung, part of the German Automobile Club ADAC (Allgemeiner Deutscher Automobil Club). Oddly enough, automobile clubs have in fact played a major role in the development of heliborne aeromedical missions in several European countries, led by Germany and Austria.

According to Gerhard Kugler, former head of ADAC and founder of EHAC (European HEMS and Air Rescue Committee), "The explanation for the German auto club’s interest in heliborne medical transport is in fact quite simple: many of those transported by helicopter are victims of road accidents. In the constant fight to improve safety, we have to improve both infrastructures and the system. During the seventies, highway accidents caused some 20,000 deaths a year in Germany. Today, we’ve lowered that figure to 6,000. Of course, the aeromedical missions carried out by ADAC are not the sole reason for this decrease, but they have certainly played a part. When an accident occurs, if help comes on the road, it takes an average of 40 minutes before medical care can start. With a helicopter, it’s 8 minutes! We estimate that about 10% of our missions help avoid a death. Out of the 60,000 heliborne missions carried out each year in Germany by ADAC and other operators, we save about 5,000 lives."

Helicopters: shaping healthcare services

Toulouse HEMS EC 135 T1 operated by Hélicap (2 Arrius 2B1)

Whether the initial impetus was from the government or a community association, helicopters have amply earned their place in a modern, effective public health policy. The time has now come for cost rationalization. "We are in the process of applying the same economic logic as in the United States," says Nicolas Letellier, president of the French association of doctor helicopter users. "It is now clear that helicopters help shape the healthcare services offering.

"In France, aeromedical transport via helicopter is clearly an integral part of the natural evolution of the hospital system. A number of small hospitals have had to shut down highly specialized services or high-tech operating rooms which were not being used to capacity. Doctors were not getting sufficient work to maintain their skills, and the operating costs of these services were far greater than the actual benefits for local populations. It was decided to group specialized services in large hospital complexes - which gave rise to the need for so-called "secondary" aeromedical transport via helicopter. In other words, these people had to be brought to the large new medical centers, which were more economically viable."

Primary and secondary flights

EC 135 T1

There are in fact two general types of heliborne aeromedical transport services, primary and secondary. Emergency transport, where a person’s life is in immediate danger, is considered "primary". He or she needs to be treated, or to be flown to a hospital. It was these types of missions that first spurred the growth of helicopter fleets. Flights of this type are known by the acronym HEMS, for Helicopter Emergency Medical Service. Because they are urgent, these flights are similar to those flown by air rescue services (in the mountains, for instance), or even Search & Rescue (SAR) missions originally performed by the armed forces. As mentioned earlier, the fact that many of these primary flights were caused by highway accidents led to several automobile clubs acquiring their own helicopters.

There are also the so-called "secondary" flights, which simply means heliborne air ambulance services. These are generally planned in advance and do not involve an emergency. The most common case is the transfer of a patient from one hospital to another, but it may also involve transporting medical personnel or supplies (equipment, blood, organs, medication). "It may seem odd to use a helicopter instead of a car or truck for non-emergency transportation," admits Nicolas Letellier. "But a helicopter lets us cut travel time in three! In cases like these, the motivating factor is not that it’s urgent, but rather that there is a shortage of doctors! Just imagine if a doctor decided to drive somewhere for a non-emergency case, and wound up stuck on the road for a couple hours. The helicopters bring our doctors back faster, so they can take care of other patients, or head off again on another mission. In other words, rotorcraft generate considerable time savings, medically speaking!"

Another benefit of helicopters is patient comfort. "In a helicopter, the acceleration/deceleration is cut ten-fold," explains Nicolas Letellier. "Transportation aloft involves much less trauma for the patient than being in a road vehicle, with all the noise and constant braking for curves. The general public always thinks that a patient’s situation must be serious if he’s in a helicopter. But you could actually say that with the helicopter, there is less chance that the situation will get worse. Since most of the helicopter budget goes to fixed costs (facilities, crews, etc.), I always tell my helicopter teams at the hospital, ’use them to the max!’"

A Rega A 109 K2 carries out a medevac operation on a Swiss highway (2 Arriel 1K1)