Friday, September 1, 2006
AMTC'06: REGA to the Rescue
Safety management adds to the clock-like precision of this Swiss EMS team.
Werner Marty wasn’t kidding when he said his EC145 had to be out of the hangar and into the air within 5 min. after the alarm.
At 11:45 am on Sunday, April 30, 5 min. after the “go” from Swiss REGA dispatchers in Zurich, we lifted off from the pad at the Blecherette Airport, just north of this city on the north shore of Lake Geneva. A motorcyclist had crashed about 20 mi to the west and the Blecherette-based REGA emergency medical services (EMS) team was tagged as the medical responder.
|(Above) REGA’s network of 10 bases, combined with contracted services covering mountainous or outlying areas of Switzerland, is designed so a helicopter can reach the scene of any emergency in the country within 15 min|
|(Above) REGA pairs paramedics and doctors on all its missions. At the REGA base in Lausanne, eight doctors from University Hospital work 24-hr shifts, with one Saturday and one Sunday shift a month. Of the eight, five stay on as long-term members of the team while three volunteer for six-month stints. There are more volunteer doctors than are needed.|
|(Above) Crews at the Lausanne base take calls directly from local emergency agencies. While they must await launch by REGA’s dispatchers in Zurich, the calls give them an early heads up.|
|(Above) Physician Robert Tailleur (left) and paramedic and mechanic J.L. Brodard (right) unload a patient at Lausanne’s University Hospital.|
I had traveled to Lausanne to watch Marty and his team in action, and to investigate REGA’s progressive flight safety program, administered in part by Marty, one of two safety officers in the organization’s staff of 270 employees. REGA is a publicly funded, non-profit foundation associated with the Swiss Red Cross, charged with responding to medical evacuations and hospital transfers inside Switzerland and handling air-ambulance repatriations for citizens injured outside of the country as well. Its name translates to “Swiss aerial rescue guard” in both German and French, two of the primary language groups in a country that is roughly the size of the U.S. states of Vermont and New Hampshire combined.
There was a good chance the motorcycle-accident victim was a supporter of the team sent to accelerate his trip to the hospital. Roughly 1.9 million of Switzerland’s 7 million citizens contribute 30 Swiss francs ($25) each, or 70 francs a family, to fund most of REGA’s services. The Lausanne operation is one of 10 REGA bases that provide helicopter EMS services for the vast majority of Switzerland. A partner operation in Geneva covers the southwest corner of the country, and contracted services with Air Zermatt, Air Glacier, Heli Linth and Bohag respond to emergencies in other mountainous or outlying areas of the country.
REGA itself owns five Eurocopter EC145s, stationed at the “lowland” bases like Lausanne, and eight AgustaWestland A109K2s for its six mountain bases. The network is designed so a helicopter can reach the scene of any emergency in the country—except for the sparsely populated region of Valais—within 15 min. of receiving an alarm. REGA’s fixed-wing air-ambulance operation uses three Challenger CL604 jets based at the Zurich-Kloten Airport, also home to REGA’s operations center and maintenance facility. For the helicopters, line maintenance and 50-hr checks are done at the bases while annual and 300-hr inspections are done in Zurich. The EC145 at Lausanne flies 400–450 hr a year, according to Marty.
The “15-min rule” so far was holding true. Marty and Brodard, with the help of a GPS fix from operations and arm-waving from Swiss police and onlookers at the scene, found the accident site, circled in search of the best landing zone, then touched down about 75 ft. from the victim on a paved walking trail surrounded by grass and spring crocuses. Time at landing was 11:50, 10 min. after the dispatch call and 5 min. after liftoff. Zurich tracks the exact location of its aircraft via automatic GPS position reports from them every 45 sec. through “REGA Comm,” a network of RF ground stations. Marty said the position reports can be sent out as often as every 15 sec. if the operations center requests.
Brodard and Tailleur, with medical kit in hand, climbed out of the helicopter during shutdown, making their way to a rock wall that formed a border between the park and the road. On the other side of the wall, hidden from view, were the victim and his motorcycle, both laying on the ground.
When I’d first arrived at the Lausanne base an hour earlier, Marty explained the dispatch process as we suited up in REGA’s trademark red jumpsuits, flight jackets and white helmets. The Lausanne base is unique because it receives alerts directly from Swiss emergency services in nearby provinces, which are contacted by callers dialing “1414,” the equivalent of 911 in the U.S. Though the ultimate approval must come from REGA dispatchers at the operations center in Zurich, the local heads-up gives the team advance notice.
On April 30, the medical team consisted of Brodard, an emergency medical technician-paramedic and helicopter mechanic with 28 years on the job at the Lausanne base, and Tailleur, a doctor at the University of Lausanne Hospital, the main trauma center in the city. REGA pairs paramedics and doctors on all its missions. At Lausanne, there’s a pool of eight doctors from University Hospital who work 24-hr shifts at the REGA base, with one Saturday and one Sunday shift a month. Of the eight, five stay on as long-term members of the team while three, like Tailleur, volunteer for six-month stints. Marty says there are more volunteer doctors than are needed.
In 2005, REGA flew 12,385 missions, 8,998 of which were in helicopters. The Lausanne base flew 983 medical missions (an average of 2.7 flights a day, 20–25 min. per flight), a 2.7-percent increase over 2004. Of those missions, most were attributed to road accidents (15 percent), sicknesses (12 percent), winter sports accidents (8 percent) or newborn baby issues (7 percent). The base flew 272 missions at night, 27 percent of the total. Switzerland has about 275 helicopters in the country, and according to Marty, about 30 are used for EMS.
REGA pilots and paramedics work 24- or 48-hr shifts, with the number of shifts each month determined by the total missions each year and the percentage of night flights at each base. At Lausanne, pilots and paramedics work just 11 shifts a month, in part due to a relatively high number of night missions—about 30 percent. REGA pilots use ITT night-vision goggles. Pilot pay ranges from $6,000–$8,000-plus a month, depending on accumulated flight time, flight hours per annum and additional duties.
Marty’s “additional” duty, other than being a full-time pilot, is spending the equivalent of one day a month as a safety officer. REGA’s other safety officer, a paramedic, is able to devote 20 percent of his time to the task. Much of that effort is spent managing a four-year-old, REGA-developed, non-punitive air safety reporting system that includes incidents, accidents and safety input for flight, ground and maintenance operations.
The investment will put REGA ahead of the game next summer. Under the Joint Aviation Authorities (JAA)’s JAR OPS 3 rules expected to start in July 2007, safety officers and accident/incident reporting systems will be a required feature for all commercial helicopter operations in the European Union. While Switzerland is not part of the EU, it is following the rules of the JAA and European Aviation Safety Agency (EASA).
Marty first learned to fly helicopters in the Swiss military. Later he worked at Air Zermatt before joining Swiss Air, where he flew the MD-88 and MD-11. He joined REGA in 2000, but continues to fly helicopters in the Swiss army reserves for five weeks a year.
Other aspects of REGA’s safety program include developing and optimizing standard operating procedures (SOPs) for its more complicated rescue scenarios. SOPs are written for hoist work for the EC145 and A109, long-line work, night flights, cable-car evacuations, firefighting, water rescues and helicopter departures in the fog. Pilots who deviate from SOPs have to fill out air safety reports. Those SOPs are part of a week-long annual training camp at all bases, an investment of about 600 hr a year in training for REGA. Supervising the training is the chief pilot and others flight instructors, who travel to each base and tests crews on all procedures and mission types, including training with rescue partners like the Swiss Alpine Club, police and firefighters.
Crews also attend a night flight camp every 3-4 years, and receive human factors training every two years. Both are internal REGA requirements, though human-factors training will be required when JAR OPS 3 takes effect next July. Starting this year, REGA began sending dispatchers and maintenance engineers to human-factors training together with pilots and paramedics. Marty eventually would like to have safety officers visit each base for a 24-hr operational audit once a year, an effort that would require more time and resources than are currently available.
Though REGA researched existing safety reporting systems for fixed-wing aircraft, as well as commercial products, it ultimately decided to build its own system with the company’s software developers in Zurich. Marty and the team started with information in ICAO Annex 13, which describes accident/incident reporting, then added REGA-specific parameters like safety input, ground operations and maintenance. As a category, “safety inputs” generate a large percentage of the submitted reports, said Marty.
After the system went live in 2001, the number of reports submitted annually has increased from about 15 to more than 130 reports last year. Marty said the reports take 5–10 min. to fill out on the company intranet, and can be submitted as “confidential,” meaning only the safety officers see the report, or “non-confidential,” meaning the chief pilot gets a copy. Regardless of the type of report, each submitter is also asked if the information can be made available to all crewmembers in a de-identified form.
In addition to immediate action for critical issues, the safety officers every four months publish a list of the reports and every six months publish a detailed discussion of certain incidents, explaining any resulting changes in SOPs or other procedures. Also, every six months, a committee made up of representatives from REGA’s flight operations and technical divisions meet to discuss the reports, which are anonymous with respect to the base and the submitter, though sometimes the aircraft type is mentioned. Marty said about 60 percent of the reports result in “appropriate measures being taken,” including immediate information bulletins to crews.
Along with helping REGA identify problematic trends, the database also provides for a safety benchmark with others who collect data. An analysis of the causes of REGA helicopter incidents and accidents since 2002 showed no major differences with data collected by Swiss aviation authorities for the entire country. REGA’s database proved to be a trailblazer for Europe in general. When safety officers from various operators in Switzerland and Europe gathered in late 2004, the group decided that a common air safety database would be useful for everyone, and that REGA’s web-based system should be the model. The resulting product, a more generic version of the REGA database, went live June 8. Eight Swiss companies and four outside that country are using it.
Back at the accident scene, Brodard and Tailleur first determined the condition of the victim. Then Brodard and Marty brought the stretcher from the rear of the EC145 to the victim. Working with police and rescue teams, the victim’s clothes were removed, monitors were installed and the patient zipped up in a thermally insulated outer blanket. Marty looked through the cyclist’s leather coat and found identification that he gave to police. Tailleur decided to medevac the patient, who was conscious but in pain, to University Hospital. We lifted off at 12:14 p.m. and arrived at its rooftop pad at 12:25, 15 min. before the close of the “golden hour” considered critical to trauma care.
For the 3-mi jog back to Blecherette, Marty climbed to 1,000 ft agl and flew in slow cruise at 100 kt. The procedure is part of REGA’s voluntary noise abatement program, developed with the help of a recent noise analysis by Eurocopter that Marty said determined that noise increases significantly at speeds greater than 110 kt, primarily on the aircraft’s left side, due to the position of the tail rotor. In addition, REGA asks crews to take different routes inbound and outbound from the hospitals, weather permitting.
Other trips that day included the evacuation of one middle-aged victim in a head-on car collision, and a hospital-to-hospital transfer for an elderly patient with a brain injury. For the car crash, total time from dispatch to delivery to the hospital was 1 hr.
Watching Marty and Brodard, it was very clear that REGA has the utmost respect not only for safety, but for its customers and benefactors—the Swiss citizens. While waiting to transfer the head-trauma patient, Marty took time to visit an injured young boy in the room next door, offering the wide-eyed youngster a REGA postcard with a picture of the EC145. Written on the back of Marty’s jumpsuit is “Pilote,” a tag that would appear to command much respect from the Swiss, young and old. Later, he spoke with a man and his daughter waiting just outside of the hospital, handing out more postcards. Brodard took part in the ritual as well. On takeoff, he waved and smiled at people assembled nearby to watch and take pictures of the red helicopter, painted with the Swiss Red Cross, departing for its home base.