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Helicopter emergency medical service: motivation for focused research

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Abstract

Since the early helicopter developments, there has been tremendous progress in performance, handling qualities, comfort and efficiency. This is why helicopters have conquered their niche in the aircraft market despite their very limited capabilities in terms of maximum speed and range or fuel efficiency, especially when compared with modern fixed wing aircraft. However, some features make helicopters very useful for many missions, which to date cannot be performed by any other contemporary series production aircraft. These features include their capability to hover, to climb or sink either vertically or almost vertically, to fly slowly in any horizontal direction (even backwards) and still maintain good handling qualities. When compared to other aircraft which are able to hover (e.g. tiltrotors or fixed wing vertical take-off and landing aircraft), they even show in that flight regime superior flight performances. These features allow helicopters to fly “nap of the earth” at low altitudes within an obstacle backdrop and land almost anywhere, even in confined areas (provided any obstacles do not present a threat level which is too high). These capabilities make helicopters prone not only to simply rescue people in distress (e.g. from mountains or ships in emergency situations), but also to provide full emergency medical service. This service is called helicopter emergency medical service (HEMS). No other aircraft is more suitable for such a service than helicopters. This is why many nations have established professional HEMS systems in their countries; ranging from young systems such as that adopted in Japan to the oldest one, located in Germany. This paper aims to first give an overview on some historical aspects on the development of HEMS. Secondly, it outlines HEMS Systems established in various nations like Germany, Switzerland, Japan, and the United States of America. Next the paper gives a short survey on statistical data on rescue helicopters and to some extent on noise aspects of helicopters in general. The latter topic will be discussed briefly, since noise problems are linked to all helicopters not just to rescue helicopters. Following this, some sobering facts on HEMS will be reviewed, more precisely the high number of accidents. Finally, the paper concludes with some remarks and gives a brief outlook on a research concept dubbed the “Rescue Helicopter 2030” which has been started recently at the Deutsches Zentrum für Luft- und Raumfahrt (DLR, German Aerospace Center).

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Notes

  1. A trauma center is a hospital equipped and staffed to provide comprehensive emergency medical services to patients suffering from traumatic injuries. Trauma centers are classified as Level I, II, III or IV, Level I being the highest.

  2. The S-97 Raider focusses on military customers and civil variants are not foreseen so far.

  3. The exact date is not quite clear. In most sources April 26–27, 1944 is being mentioned. Some sources mention the 23rd of April, others simply refer to April.

  4. Hans-Helmut Gerstenhauer died in October 23, 2014 at the age of 99 years.

  5. Saint Christopher was a Christian martyr (third century) and is patron of travelers. The name means carrier of Christ.

  6. G. Kugler (1935–2009) was one of the pioneers of the German HEMS system. In 1971, he took over the position of the head of the young air rescue department at ADAC. From 1990 till his retirement in 2000 he was CEO of the ADAC Luftrettung GmbH and author of [30].

  7. The exchange rate was taken on Dec. 7, 2014.

  8. The numbers sum up to 77 instead of 76, since DRF Luftrettungs counts its station in Halle only once, although two helicopters with different call signs are operated at this station. Usually, this is counted as a separate station, but the figures of the operator were used in Table 2.

  9. The mission number of JUH can be found at the web site given for Ref. [29].

  10. The average number of patients flown in the US from 2002 till 2007 was about 410–460 patients and the average flight hours about 580 h per helicopter. The number of missions has steadily gone down since 1990 from an all-time high of about 690 patients per helicopter [155]. In recent years, these numbers are even lower (about 340 patients and 490 flight hours per helicopter).

  11. Shown here is the T2 model. The P2 model shows a noise level in approach which is 2.2 EPNdB below the T2 [142]. In approach with its low power requirement, the engine should not have such an impact on noise. It is quite likely that flight certification of the T2 have been conducted under less optimal conditions than for the P2.

  12. Numbers have to be taken with some care, since accident and fatal accident numbers or rates vary, depending on the report.

  13. In this context it might be helpful to refer to other industry sectors like the automobile industry. The traffic fatalities have been reduced significantly, see e.g. Fig. 5, despite an enormous increase in registered motor vehicles and hence driving hours.

  14. Regulations allowed US HEMS operators to conduct work under FAR Part 135, Commercial Aviation Operations, or under Part 91, General Aviation Operations. Flights with patients on board have to be performed under Part 135, but without patients on board they were allowed to be operated under Part 91, which is less stringent than Part 135 [160]. The latter rule has been aggravated in-between, see below.

  15. Dual-purpose helicopters in the US are helicopters combining dedicated EMS with other services. This differs from the definition given above.

Abbreviations

ABC:

Advancing blade concept

ACN:

Automatic crash notification

ACT/FHS:

Active control technology/flying helicopter simulator

ADAC:

Allgemeiner Deutscher Automobilclub (General German Automobile Association)

AE, AME:

Aeromedical evacuation

AH:

Ambulance helicopter

AHS:

American Helicopter Society

AMPA:

Air Medical Physician Handbook

ANWB:

Algemene Nederlandse Wielrijders Bond (Dutch Automobile Association)

BMI:

Bundesinnenministerium (German Federal Department of the Interior)

BVI:

Blade vortex interaction

CARESOM:

Coordinated Accident Rescue Endeavor—State of Mississippi

CFIT:

Controlled flight into terrain

DLR:

Deutsches Zentrum für Luft- und Raumfahrt e.V. (German Aerospace Center)

DRF:

Deutsche Rettungsflugwacht (German Aviation Rescue Guard)

EDH:

Emergency doctor helicopter

EHEST:

European Helicopter Safety Team

EPN:

Effective perceived noise level

ERATO:

Etude d'un Rotor Aéroacoustique Technologiquement Optimisé

FAA:

Federal Aviation Administration

FAR:

Federal Aviation Regulation

FW:

Fixed wing aircraft

GPS:

Global Positioning System

HCM:

HEMS crew member

HELLAS:

Helicopter laser radar

HEM-Net:

Emergency Medical Network of Helicopters and Hospitals (Japan)

HEMS:

Helicopter emergency medical service

HICAMS:

Helicopter Intensive Care Medical Services

HOGE:

Hover (altitude) out of ground effect

HTAWS:

Helicopter Terrain Awareness and Warning System

ICAO CAEP:

International Civil Aviation Organization Committee on Aviation Environmental Protection

IFR:

Instrument flight rules

IHST:

International Helicopter Safety Team

ISA:

International Standard Atmosphere

ISS:

Injury Severity Score

ITH:

Intensive care transport helicopter

JUH:

Johanniter-Unfall-Hilfe e.V. (Johanniter-Accident-Care)

MAC:

Moscow Aviation Center

MAST:

Military Assistance to safety and traffic

MEDEVAC:

Medical evacuation

MTOW:

Maximum take-off weight

NOTAR:

No tail rotor

NTSB:

National Transportation Safety Board

NVG:

Night vision goggle

ÖAMTC:

Österreichischer Automobil-, Motorrad- und Touring Club (Austrian Automobile, Motorcycle and Touring Association)

REGA:

Rettungsflugwacht Garde Aérienne (Air Rescue Guard)

RTH:

Rescue transport helicopter

RW:

Rotary wing aircraft

SAR:

Search and rescue

SEL:

Sound exposure level

SRFW:

Schweizerische Rettungsflugwacht (Swiss Air Rescue Guard)

TCAS:

Traffic Alert and Collision Avoidance System

TCS:

Touring Club Switzerland

USA:

United States of America (short US)

USAF:

US Air Force

VFR:

Visual flight rules

VTOL:

Vertical take-off and landing

WAH:

Wide area helicopter

WW:

World War

ZSH:

Zivilschutz-Hubschrauber (Civil Protection Helicopter)

DL:

Disc loading

H :

Impact factor for price estimation in Eqs. (1) and (2)

m e :

Empty weight

m f :

Fuel weight

m TOW :

Take-off weight

m UL, ff :

Useful load mass at full fuel

N BL :

Blades per rotor

l FW :

Fuselage width

l FL :

Fuselage length

R :

Rotor radius

P total,Engine(s) :

Total engine/engines rated power in shp

S :

Rotor disc area

V cab :

Cabin volume

V Cruise, econ :

Economic cruising speed

µ :

Advance ratio µ = V/(RΩ)

Ω :

Rotor rotational frequency

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Acknowledgments

The author likes to thank Wolfgang Gastorf of the Helicopter Museum Bückeburg, Germany, Vincent Devine of the Igor I. Sikorsky Historical Archives, Connecticut, USA, as well as Teri Thorning of the Olympic Flight Museum, Washington, USA, for supporting the historic review of helicopter rescue missions with information and photos on the Fl282 Fa223, YR-4, R-5, and HH-43 Huskie. The author also likes to thank Prof. Ira Blumen, University of Chicago Medicine, Illinois, USA, ADAC Luftrettung, Air Zermatt, CUBRC, DRF Luftrettung, Bundespolizei-Fliegergruppe (engl. Federal Police Air Support Group), REGA, and RUN Rettungswesen und Notfallmedizin GmbH for supporting this paper with very valuable information.

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    Christoph Kessler

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Where possible, English literature has been quoted. However, much of the literature on German and Swiss HEMS have not been published in English and it was not always possible to refer to international publications. The author is aware, that the quotation of web pages bears some problems. Web pages may be withdrawn ore may contain unproven content. Regardless this issue, some web pages have been included in the literature list. The contents of each web pages has been cross-checked with other web pages to prove the quality of the quoted web page. The author felt that the reader might be interested to study also the quoted web pages and some material has simply not been published elsewhere except in the web.

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Kessler, C. Helicopter emergency medical service: motivation for focused research. CEAS Aeronaut J 6, 337–394 (2015). https://doi.org/10.1007/s13272-015-0157-0

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