A history of Helicopter Emergency Medical Services

In late spring of 1969, a young boy named Björn Steiger spends the day at the local swimming pool in his hometown of Winnenden, Germany. On his way home that afternoon, he is struck by a car. The local police and Red Cross are immediately contacted, but it takes almost a full hour before the ambulance arrives on the scene. Björn Steiger dies on the way to the hospital.

 

This story and many others were the reality of what emergency medical services looked like for much of the 20th century. Whether suffering an injury at the top of a mountain or in the middle of a highway, a nascent emergency medical response system meant that many victims did not receive the care they needed fast enough. 

Today, Helicopter Emergency Medical Services (HEMS) systems have matured in many countries around the world. The biggest advantage is that helicopters can reach a location three-to-five-times faster than a ground vehicle and sometimes is the only way to access inhospitable terrain. Patients receive medical treatment earlier and the chance of survival in critical cases goes up significantly. Airbus products were instrumental in the development of the HEMS systems working today.

 

HEMS for civilian use

Air medical evacuation first began its story with fixed-wing aircraft. It wasn’t until the Korean and Vietnam wars that helicopter use became standard for military medical evacuation (MEDEVAC). With such a positive impact, HEMS soon was introduced into the civilian sphere.

Several countries led the way in adopting helicopter use for civilian populations. Flight for Life became the United States’ first civilian HEMS operator in 1972, based at St. Anthony Central Hospital in Denver, Colorado. The French Sécurité Civile began rescue missions dating back all the way to 1959 when for the first time it rescued a mountaineer suffering from a heart attack at the highest resting point on Mont Blanc (and indeed the highest in all of Europe) the Vallot refuge, at 4,362 metres. The SAF Group followed suit and in 1979 began rescue operations in the French Alps. In Germany, the authorities took the decision to launch a medical helicopter trial period with a doctor and a paramedic onboard in order to shorten the response time for accidents, pioneering the concept of taking the physician to the scene of the accident. This approach provided primary care within 10-20 minutes after sounding the alarm.

The global fleet of Alouette III helicopters has accumulated more than seven million flight hours overall, with many of these rotorcraft still in operational service today.

 

Airbus helicopters that helped pave the way

The Alouette III was instrumental for the growth of HEMS and mountain rescue activities worldwide. It was the helicopter that the Swiss’ REGA, Austrian ÖAMTC, United States’ Flight for Life, France’s Sécurité Civile, and Germany’s DRF Luftrettung grew their activities on. Later the SA315 Lama, with its light airframe and powerful turboshaft engine became instrumental in rescue activities in high-altitudes, such as for the SAF mountain rescue activities.

In the following decades, the Bo 105 and BK117, developed in the late 1970s, were some of the most successful helicopters in HEMS. The special design of the Bo 105 – with features like a flat cabin floor, rear loading and a high main and tail rotor – allowed for easier patient loading, contributed to its success. When Germany’s automobile club ADAC set up its first permanent HEMS base in Munich in 1970, a Bo 105 helicopter, baptised “Christoph 1,” was used for its operations. The helicopter had been developed by Airbus Helicopters’ predecessor company, MBB, and in close cooperation with ADAC.

Today, the H135 and H145 are the standard and most popular helicopters in HEMS operations worldwide. Feedback and requests from the HEMS community were implemented in the design of the H135 in the mid-1990s and later, in the H145, which began production in 2014. Today, 55% of the total 2,750 helicopters that are in dedicated HEMS operations worldwide are Airbus Helicopters. 

The pioneering Bo 105 helicopter has been purchased by more than 300 operators around the globe, including Germany’s ADAC air rescue service.

 

Modern-day HEMS

Many different models for HEMS activities exist around the world today. In some countries, operations are government-run, in others it is based on charity or private business models – or a mix of both. The level of coverage also differs, depending on geography, financial resources and the level of the organisation’s maturity in the respective country.

The HEMS system in Europe today provides coverage in nearly all EU countries. Most of the HEMS bases work on the principle of quick intervention with specialised emergency teams to give primary care. Generally there is a ratio of 1 to 1.5 helicopters per one million residents, but in areas where populations are spread out across mountainous regions or across fjords, such as in Austria or Norway, the ratio can go up to five helicopters per one million residents.

In the United States, there are over 1,000 HEMS helicopters transporting an estimated 400,000 patients annually. HEMS models vary including not-for-profit and for-profit operators offering options from hospital-based systems, where the hospital operates the programme, to independent provider models and county-run programmes. In 2016, 86.4% of the U.S. population was covered by an air medical service, within a 15-20-minute response area. 

Launched in 1982, the BK117 became particularly popular among U.S. operators – including Helicopter Emergency Medical Services (HEMS) provider Boston MedFlight.

 

Emerging markets for HEMS

Interest for HEMS operations has grown in emerging markets. Malaysia and China, among others, have successfully started their first HEMS activities. As programmes continue to be launched in emerging markets around the world, initial challenges first need to be overcome. Before helicopters are introduced, the authorities must ensure that the infrastructure is in place, such as having qualified personnel available and informing the population about emergency procedures. Countries such as India, Brazil, Mexico and Indonesia are potential candidates for a strong HEMS development in the coming decades.

 

HEMS future improvements

An array of innovations are underway to improve the safety of HEMS missions. From synthetic vision systems to satellite communications and self-learning AI algorithms, these technologies all aim to ease pilot workload and improve operational safety. Smaller Vertical Take-Off and Landing (VTOL) platforms are being investigated for their use as “doctor shuttles” and could play a complementary role in the future of HEMS operations.

The technologies and innovations for HEMS are limitless and exciting in what they can achieve. Airbus will continue to pioneer the way forward, dedicated to reaching new heights for what is possible in emergency medical services.