EMS Helicopter Operations Remains a Risky Business

Searchers last week found the remains of a flight nurse and some wreckage of an emergency medical services helicopter that crashed Monday, Dec. 3 while enroute from Cordova, AK for the Providence Alaska Medical Center in Anchorage. Still missing at presstime were the patient going to Anchorage for cancer...

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Searchers last week found the remains of a flight nurse and some wreckage of an emergency medical services helicopter that crashed Monday, Dec. 3 while enroute from Cordova, AK for the Providence Alaska Medical Center in Anchorage.

Still missing at presstime were the patient going to Anchorage for cancer treatment, a paramedic and the pilot of the BK 117.

The LifeGuard Alaska helicopter--one of two leased from Evergreen Helicopters of Alaska--disappeared in blowing snow. Evergreen also provides the pilots and maintenance. LifeGuard Alaska is an air ambulance service operated by the Providence Alaska Medical Center.

It is reported that the crew on an Alaska Air National Guard Pave Hawk helicopter spotted the debris while searching for the LifeGuard Alaska rotorcraft. The Pave Hawk then flew closer and confirmed the human remains, and the left sliding door from the BK-117.

The medevac helicopter went down on its way to Anchorage from Cordova Monday evening about 40 minutes into a 90-minute, 150-mile flight. An Alaska ANG C-130, a Coast Guard cutter, HC-130 turboprop and Jayhawk helicopter, and the Civil Air Patrol participated in the search and rescue effort, among others.

The helicopter debris was turned over to National Transportation Safety Board investigators.

It is possible that recent flight trials in Europe might make EMS operations safer to conduct at night and in adverse weather.

Successful trials were recently conducted at Lausanne, Switzerland, using the European Geostationary Navigation Overlay Service (EGNOS) to guide a helicopter as it approached and touched down at an emergency medical service (EMS) landing pad in the city.

The adaptable, go-anywhere characteristics of helicopters make them ideal for emergency services, but when visibility is poor their operations are limited by aviation regulations. The accurate position reporting and navigation system integrity checking offered by EGNOS can be a vital service for anywhere, anytime rescue services - as was demonstrated during the trials.

The Lausanne trials were performed by Eurocopter, using their EC155 experimental all-weather helicopter (H�licoptere Tous Temps - HTT). The trial program was coordinated by Skyguide, the Swiss air navigation service provider and consisted of a number of validating approaches performed by the HTT to a Helicopter Emergency Medical Services (HEMS) pad located on the roof of Lausanne University Hospital.

The test team was hosted in Lausanne's La Bl�cherette aerodrome by the Swiss medical air rescue agency (Schweizerische Rettungsflugwacht - Garde A�rienne Suisse de Sauvetage - REGA) who also participated in the flight tests.

The trial approaches were designed by Skyguide for 6 degrees and 9 degrees approach angles. Initial feedback from the test pilots indicates that, despite of the steepness of the approaches - the standard approach angle is 3 degrees - they are easy to fly thanks to the three-dimensional guidance provided by EGNOS. Vertical guidance for the pilot is a major advantage EGNOS offers over standard GPS.

The increased approach angles also reduce noise nuisance on the ground as the helicopter can remain at high altitude until it is closer to its destination before commencing its final descent. In addition, a steeper descent angle reduces the noise generated by the rotor blades as the craft nears the ground.

The implementation of instrument approaches for HEMS operations will allow the emergency services to continue their operations in weather conditions that would otherwise ground their helicopters.

The trials were performed as part of the GNSS Introduction in the AviatioN secTor (GIANT) project. GIANT is a European Commission Sixth Framework Program (FP6) project with the aim of supporting the introduction of EGNOS and Galileo services into the aviation market while demonstrating to the responsible authorities that the required safety levels are achieved.

The helicopter trials follow on from the fixed-wing EGNOS/GIANT trials held at Valencia, in Spain, during late 2006. Additional GIANT flight trials will be performed in 2007, at other European airports and on an oil rig in the North Sea.

EGNOS is a joint program of the European Space Agency, the European Commission and Eurocontrol. EGNOS is made up of a network of more than forty elements all over Europe that collect, record, correct and improve data from the US Global Positioning System (GPS). The modified signals are then relayed via geostationary satellites to user's terminals, offering a positional accuracy of better than two meters compared with 15 to 20 meters for GPS alone. In addition, EGNOS gives a guarantee of quality for these signals that GPS does not provide.

Meanwhile, research recently published in the Emergency Medicine Journal say The further seriously ill patients have to travel by ambulance to reach emergency care, the more likely they are to die.

People with respiratory problems seem to be at greatest risk, the study indicates.

The findings have implications for the UK government's proposals to close local emergency care departments in favor of fewer more specialised centers, in a bid to save lives, say the authors. Local closures will inevitably spell longer ambulance journeys for critically ill patients, they say.

The findings are based on a review of life-threatening (Category A) calls to four ambulance services in England, representing urban, rural, mixed, and remote areas, between 1997 and 2001.

Only those patients who were unconscious, or not breathing, or who had chest pain were included in the study.

Almost 12,000 patients fell into this category over the five years, but the final analysis included 10,315 as not all the distances could be calculated accurately.

Distances covered ranged from zero to 58 kilometers, but the average was 5 km.

In all, 644 patients (just over six percent) died during the five year period, but the further patients had to travel by ambulance to hospital, the more likely they were to die.

In all, the risk of death rose by 1% for every 10 kilometers (six miles).

But compared with patients with chest pain, injuries/poisoning, or other types of trauma, those with breathing problems were most at risk.

Their chances of dying were 13% if the distance to hospital was between 10 and 20 km, and 20% if this was 20 or more kilometers.

The findings held true even after taking account of age, sex, and illness severity.

"Our data suggest that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for a small number of patients with life-threatening medical emergencies, unless care is improved" conclude the authors.