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Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and critical care to all types of patients during aeromedical evacuation or rescue operations aboard
helicopter A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
and
propeller aircraft A powered aircraft is an aircraft that uses onboard propulsion with mechanical power generated by an aircraft engine of some kind. Aircraft propulsion nearly always uses either a type of propeller, or a form of jet propulsion. Other potential ...
or jet aircraft. The use of air transport to provide medical evacuation on the battlefield dates to
World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
, but its role was expanded dramatically during the
Korean Korean may refer to: People and culture * Koreans, ethnic group originating in the Korean Peninsula * Korean cuisine * Korean culture * Korean language **Korean alphabet, known as Hangul or Chosŏn'gŭl **Korean dialects and the Jeju language ** ...
and
Vietnam Vietnam or Viet Nam ( vi, Việt Nam, ), officially the Socialist Republic of Vietnam,., group="n" is a country in Southeast Asia, at the eastern edge of mainland Southeast Asia, with an area of and population of 96 million, making i ...
wars. Later on, aircraft began to be used for the civilian
emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
. Helicopters can bring specialist care to the scene and transport patients to specialist hospitals, especially for major trauma cases. Fixed-wing aircraft are used for long-distance transport. In some remote areas, air medical services deliver non-emergency healthcare such as general practitioner appointments. An example of this is the
Royal Flying Doctor Service of Australia The Royal Flying Doctor Service (RFDS), commonly known as the Flying Doctor, is an air medical service in Australia. It is a non-profit organisation that provides emergency and primary health care services for those living in rural, remote an ...
an
Human care
which also provide emergency care.


Advantages

Air medical services can travel faster and operate in a wider coverage area than a land ambulance. This makes them particularly useful in sparsely-populated rural areas. Air medical services have a particular advantage for major trauma injuries. The controversial theory of the golden hour suggests that major trauma patients should be transported as quickly as possible to a specialist
trauma center A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergen ...
. Therefore, medical responders in a helicopter can provide both a higher level of care at the scene of a trauma and faster transport to a trauma center. They can also provide critical care when transporting patients from community hospitals to trauma centers.


Indications for air transport

Effective use of helicopter services for trauma depends on the ground responder's ability to determine whether the patient's condition warrants air medical transport. Protocols and training must be developed to ensure appropriate triage criteria are applied. Excessively stringent criteria can prevent rapid care and transport of trauma victims; relaxed criteria can result in the patient being unnecessarily exposed to the potential dangers of dangerous weather conditions or other aviation-related risks. Crew and patient safety is the single most important factor to be considered when deciding whether to transport a patient by helicopter. Weather, air traffic patterns, and distances (such as from the trauma scene to closest level 1 trauma centre) must also be considered. Another reason for cancelling a flight is based on the comfort of the flight crew with the flight. The general rule of safety is upon the crew, when there is one pilot and two medical crew is: Some have questioned the safety of air medical services. While the number of crashes may be increasing, the number of programs and use of services has also increased. Factors associated with fatal crashes of medical transport helicopters include flying at night and during bad weather, and postcrash fires.


Air ambulance

An air ambulance is a specially outfitted
helicopter A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
or fixed-wing aircraft that transports injured or sick people in a
medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...
or over distances or terrain impractical for a conventional ground
ambulance An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
. Fixed-wing aircraft are also more often used to move patients over long distances and for repatriation from foreign countries. These and related operations are called ''aeromedical''. In some circumstances, the same aircraft may be used to search for missing or wanted people. Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes
medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...
s,
ventilators A ventilator is a piece of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators ...
,
ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...
s and monitoring units,
CPR Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore sponta ...
equipment, and
stretchers A stretcher, gurney, litter, or pram is an apparatus used for moving patients who require medical care. A basic type (cot or litter) must be carried by two or more people. A wheeled stretcher (known as a gurney, trolley, bed or cart) is often ...
. A medically staffed and equipped air ambulance provides medical care in flight—while a non-medically equipped and staffed aircraft simply transports patients without care in flight. Military organizations and NATO refer to the former as '' medical evacuation (MEDEVAC)'' and to the latter as '' casualty evacuation (CASEVAC)''. Air Traffic Control (ATC) grants special treatment to air ambulance operations, much like a ground ambulance using lights and a siren, only when they are actively operating with a patient. When this happens, air ambulance aircraft take the call sign MEDEVAC (formerly LIFEGUARD) and receive priority handling in the air and on the ground.


History


Military

As with many
Emergency Medical Service Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
(EMS) innovations, treating patients in flight originated in the military. The concept of using aircraft as ambulances is almost as old as powered flight itself. Although balloons were not used to evacuate wounded soldiers at the Siege of Paris in 1870, air evacuation was experimented with during the
First World War World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
. The first recorded British ambulance flight took place in 1917 in
Ottoman Empire The Ottoman Empire, * ; is an archaic version. The definite article forms and were synonymous * and el, Оθωμανική Αυτοκρατορία, Othōmanikē Avtokratoria, label=none * info page on book at Martin Luther University) ...
when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a
de Havilland DH9 The Airco DH.9 (from de Havilland 9) – also known after 1920 as the de Havilland DH.9 – was a British single-engined biplane bomber developed and deployed during the First World War. The DH.9 was a development of Airco's earlier successfu ...
in 45 minutes
First Recorded Aeromedical Evacuation in the British Army
The same journey by land would have taken some 3 days to complete. In the 1920s several services, both official and unofficial, started up in various parts of the world. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews. Exploration of the idea continued, however, and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. In 1920, the British, while suppressing the " Mad Mullah" in Somaliland, used an
Airco DH.9A The Airco DH.9A was a British single-engined light bomber designed and first used shortly before the end of the First World War. It was a development of the unsuccessful Airco DH.9 bomber, featuring a strengthened structure and, crucially, repla ...
fitted out as an air ambulance. It carried a single stretcher under a fairing behind the pilot. The French evacuated over 7,000 casualties during that period. By 1936, an organized military air ambulance service evacuated wounded from the
Spanish Civil War The Spanish Civil War ( es, Guerra Civil Española)) or The Revolution ( es, La Revolución, link=no) among Nationalists, the Fourth Carlist War ( es, Cuarta Guerra Carlista, link=no) among Carlists, and The Rebellion ( es, La Rebelión, link ...
for medical treatment in
Nazi Germany Nazi Germany (lit. "National Socialist State"), ' (lit. "Nazi State") for short; also ' (lit. "National Socialist Germany") (officially known as the German Reich from 1933 until 1943, and the Greater German Reich from 1943 to 1945) was ...
; this service continued during the
Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposi ...
. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by a US Army
Sikorsky R-4 The Sikorsky R-4 is a two-seat helicopter that was designed by Igor Sikorsky with a single, three-bladed main rotor and powered by a radial engine. The R-4 was the world's first large-scale mass-produced helicopter and the first helicopter used by ...
in Burma during WW2, and the first dedicated use of
helicopters A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
by U.S. forces occurred during the
Korean War , date = {{Ubl, 25 June 1950 – 27 July 1953 (''de facto'')({{Age in years, months, weeks and days, month1=6, day1=25, year1=1950, month2=7, day2=27, year2=1953), 25 June 1950 – present (''de jure'')({{Age in years, months, weeks a ...
, between 1950 and 1953. The French used light helicopters in the
First Indochina War The First Indochina War (generally known as the Indochina War in France, and as the Anti-French Resistance War in Vietnam) began in French Indochina from 19 December 1946 to 20 July 1954 between France and Việt Minh (Democratic Republic of Vi ...
. While popularly depicted as simply removing casualties from the battlefield (which they did), helicopters in the Korean War also moved critical patients to
hospital ships A hospital ship is a ship designated for primary function as a floating medical treatment facility or hospital. Most are operated by the military forces (mostly navies) of various countries, as they are intended to be used in or near war zones. I ...
after initial emergency treatment in field hospitals. Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. By 1969, in
Vietnam Vietnam or Viet Nam ( vi, Việt Nam, ), officially the Socialist Republic of Vietnam,., group="n" is a country in Southeast Asia, at the eastern edge of mainland Southeast Asia, with an area of and population of 96 million, making i ...
, the use of specially trained medical
corpsmen A hospital corpsman (HM r corpsman is an enlisted medical specialist of the United States Navy, who may also serve in a U.S. Marine Corps unit. The corresponding rating within the United States Coast Guard is health services technician (HS) ...
and helicopter air ambulances led U.S. researchers to determine that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This inspired the first experiments with the use of civilian
paramedics A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
in the world. The
US military The United States Armed Forces are the Military, military forces of the United States. The armed forces consists of six Military branch, service branches: the United States Army, Army, United States Marine Corps, Marine Corps, United States N ...
recently employed
UH-60 Black Hawk The Sikorsky UH-60 Black Hawk is a four-blade, twin-engine, medium-lift utility military helicopter manufactured by Sikorsky Aircraft. Sikorsky submitted the S-70 design for the United States Army's Utility Tactical Transport Aircraft System ( ...
helicopters to provide air ambulance service during the
Iraq War {{Infobox military conflict , conflict = Iraq War {{Nobold, {{lang, ar, حرب العراق (Arabic) {{Nobold, {{lang, ku, شەڕی عێراق ( Kurdish) , partof = the Iraq conflict and the War on terror , image ...
to military personnel and civilians. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries, as does the use of fixed-wing aircraft for long-distance travel, including repatriation of the wounded. Currently, a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation.


Civilian

The first civilian uses of aircraft as ambulances were probably incidental. In northern Canada, Australia, and in Scandinavian countries, remote, sparsely populated settlements are often inaccessible by road for months at a time, or even year-round. In some places in Scandinavia, particularly in Norway, the primary means of transportation between communities is by boat. Early in aviation history, many of these communities began to rely on civilian "bush" pilots, who fly small aircraft and transport supplies, mail, and visiting doctors or nurses. Bush pilots probably performed the first civilian air ambulance trips, albeit on an ad hoc basis—but clearly, a need for these services existed. In the early 1920s, Sweden established a standing air ambulance system, as did Siam (Thailand). In 1928 the first formal, full-time air ambulance service was established in the Australian outback. This organization became the
Royal Flying Doctor Service The Royal Flying Doctor Service (RFDS), commonly known as the Flying Doctor, is an air medical service in Australia. It is a non-profit organisation that provides emergency and primary health care services for those living in rural, remote an ...
and still operates. In 1934, Marie Marvingt established Africa's first civil air ambulance service, in Morocco. In 1936, air ambulance services were established as part of the
Highlands and Islands Medical Service The Highlands and Islands Medical Service (HIMS) provided state funded healthcare to a population covering half of Scotland's landmass from its launch in 1913 until the creation of Scotland's National Health Service (NHS) in 1948. Though treatmen ...
to serve more remote areas of
Highland Scotland The Highlands ( sco, the Hielands; gd, a’ Ghàidhealtachd , 'the place of the Gaels') is a historical region of Scotland. Culturally, the Highlands and the Scottish Lowlands, Lowlands diverged from the Late Middle Ages into the modern period ...
. Air ambulances quickly established their usefulness in remote locations, but their role in developed areas developed more slowly. After
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...
, the Saskatchewan government in Regina, Saskatchewan, Canada, established the first civilian air ambulance in North America. The Saskatchewan government had to consider remote communities and great distances in providing health care to its citizens. The
Saskatchewan Air Ambulance Saskatchewan Air Ambulance (also called LIFEGUARD) is the air ambulance service for the province of Saskatchewan and for the Ministry of Health (Saskatchewan). History Celebrating 75 years of service in 2021, the air ambulance program was establi ...
service continues to be active as of 2022. J. Walter Schaefer founded the first air ambulance service in the U.S, in 1947, in Los Angeles. The Schaefer Air Service operated as part of Schaefer Ambulance Service. Schaefer Air Service was also the first
FAA The Federal Aviation Administration (FAA) is the largest transportation agency of the U.S. government and regulates all aspects of civil aviation in the country as well as over surrounding international waters. Its powers include air traffic m ...
-certified air ambulance service in the United States. When the Saskatchewan and Schaefer services began, paramedicine was still decades away, and unless a physician or nurse accompanied the patient, air ambulances primarily provided medical transportation. A great deal of the early use of aircraft as ambulances in civilian life, particularly helicopters, involved the improvised use of aircraft that belonged to the military. Eventually, this became more organized. This occurred not only in the United States, but also in other countries, and persists today. Today in the U.S., helicopters and airplanes carry out approximately a half-million transports per year. Two research programs were implemented in the U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities were given the opportunity to continue the helicopter operation. Only the one located in Hattiesburg, Mississippi did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. The remaining challenge was in how such services could be operated most cost-effectively. In many cases, as agencies, branches, and departments of the civilian governments began to operate aircraft for other purposes, these aircraft were frequently pressed into service to provide cost-effective air support to the evolving Emergency Medical Services. As the concept was proven, dedicated civilian air ambulances began to appear. On November 1, 1970, the first permanent civil air ambulance helicopter, ''Christoph 1'', entered service at the Hospital of Harlaching, Munich, Germany. The apparent success of ''Christoph 1'' led to a quick expansion of the concept across Germany, with ''Christoph 10'' entering service in 1975, ''Christoph 20'' in 1981, and ''Christoph 51'' in 1989. As of 2007, there are about 80 helicopters named after Saint Christopher, like ''Christoph Europa 5'' (also serving Denmark), ''Christoph Brandenburg'' or ''Christoph Murnau am Staffelsee''. Austria adopted the German system in 1983 when ''Christophorus 1'' entered service at Innsbruck. Also in the year 1975 Hans Burghart, one of the inventor of the civilian air rescue in Germany, presented at one
Academic conference An academic conference or scientific conference (also congress, symposium, workshop, or meeting) is an event for researchers (not necessarily academics) to present and discuss their scholarly work. Together with academic or scientific journal ...
in the US the concept "Rescue Helicopters in Primary and Secondary Missions" which had impact for the aviation training at
Fort Rucker Fort Rucker is a U.S. Army post located primarily in Dale County, Alabama, United States. It was named for a Civil War officer, Confederate General Edmund Rucker. The post is the primary flight training installation for U.S. Army Aviators and ...
,
Alabama (We dare defend our rights) , anthem = "Alabama" , image_map = Alabama in United States.svg , seat = Montgomery , LargestCity = Huntsville , LargestCounty = Baldwin County , LargestMetro = Greater Birmingham , area_total_km2 = 135,765 ...
. The first civilian, hospital-based medical helicopter program in the United States began operation in 1972. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977, and featured a paramedic-based system of care, with the presence of physicians or nurses being relatively unusual. The system, operated by the Ontario Ministry of Health, began with a single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. "On scene" calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients. Operating today through a private contractor (
ORNGE Ornge (formerly Ontario Air Ambulance Corporation and Ontario Air Ambulance Service) is a Canadian not-for-profit corporation and registered charity that provides air ambulance and associated ground transportation services for the province of ...
), the system operates 33 aircraft stationed at 26 bases across the province, performing both interfacility transfers and on-scene responses in support of ground-based EMS. Today, across the world, the presence of civilian air ambulances has become commonplace and is seen as a much-needed support for ground-based EMS systems. In other countries of Europe, like SFR Yugoslavia, first air ambulance appeared in the 1980s. The most of the fleet was previously used in military service. With the increased number of car accidents in 1979 on
highways A highway is any public or private road or other public way on land. It is used for major roads, but also includes other public roads and public tracks. In some areas of the United States, it is used as an equivalent term to controlled-access ...
, the Yugoslavian government made a decision to buy new or redistribution of use of old helicopters.


Organization

Air ambulance service, sometimes called Aeromedical Evacuation or simply
Medevac Medical evacuation, often shortened to medevac or medivac, is the timely and efficient movement and en route care provided by medical personnel to wounded being evacuated from a battlefield, to injured patients being evacuated from the scene of a ...
, is provided by a variety of different sources in different places in the world. There are a number of reasonable methods of differentiating types of air ambulance services. These include
military A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
/
civilian Civilians under international humanitarian law are "persons who are not members of the armed forces" and they are not " combatants if they carry arms openly and respect the laws and customs of war". It is slightly different from a non-combatant ...
models and services that are
government A government is the system or group of people governing an organized community, generally a state. In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government is ...
-funded, fee-for-service, donated by a business enterprise, or funded by public donations. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including
rotary-wing A rotorcraft or rotary-wing aircraft is a heavier-than-air aircraft with rotary wings or rotor blades, which generate lift by rotating around a vertical mast. Several rotor blades mounted on a single mast are referred to as a rotor. The Internati ...
,
fixed-wing A fixed-wing aircraft is a heavier-than-air flying machine, such as an airplane, which is capable of flight using wings that generate lift caused by the aircraft's forward airspeed and the shape of the wings. Fixed-wing aircraft are distinct ...
, or very large aircraft. The military role in civilian air ambulance operations is described in the History section. Each of the remaining models is explored separately. This information applies to air ambulance systems performing emergency service. In almost all jurisdictions, private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis.


Government operated

In some cases, governments provide air ambulance services, either directly or via a negotiated contract with a commercial service provider, such as an aircraft charter company. Such services may focus on critical care patient transport, support ground-based EMS on scenes, or may perform a combination of these roles. In almost all cases, the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. However, the government almost always takes a 'hands-off' approach to the actual running of the system, relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario's ORNGE program and the Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples of this type of operating system."History."
''ornge.ca.'' Retrieved: December 4, 2010.
The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently, there is no independent HEMS operator in
Poland Poland, officially the Republic of Poland, is a country in Central Europe. It is divided into 16 administrative provinces called voivodeships, covering an area of . Poland has a population of over 38 million and is the fifth-most populou ...
. In North East Ohio, including
Cleveland Cleveland ( ), officially the City of Cleveland, is a city in the U.S. state of Ohio and the county seat of Cuyahoga County. Located in the northeastern part of the state, it is situated along the southern shore of Lake Erie, across the U.S. ...
, the Cuyahoga County-owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro's level I trauma and burn unit. There are 5 helicopters for North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft. In the United Kingdom, the
Scottish Ambulance Service The Scottish Ambulance Service ( gd, Seirbheis Ambaileans na h-Alba) is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Healt ...
operates two helicopters and two fixed-wing aircraft twenty-four hours per day.


Multiple purpose

In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. In southern New South Wales, Australia, the helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the New South Wales Ambulance Service providing paramedics, as required. In some cases, local EMS provides the flight paramedic to the aircraft operator as-needed. In the case of the Los Angeles County Fire Department, the helicopters are brush fire choppers also configured as air ambulances with a paramedic provided from whichever fire department rescue unit has responded. Sometimes the air ambulance may be run as a dual concern with another governmental body - for example, the
Wiltshire Air Ambulance Wiltshire Air Ambulance is a helicopter emergency medical service (HEMS) serving Wiltshire and surrounding areas. The service was launched in 1990, but since 2015 it has been run by Wiltshire Air Ambulance Charitable Trust, a registered charit ...
was run as a joint
Ambulance Service Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
and
police The police are a constituted body of persons empowered by a state, with the aim to enforce the law, to ensure the safety, health and possessions of citizens, and to prevent crime and civil disorder. Their lawful powers include arrest and th ...
unit until 2014. In other cases, the paramedic staffs the aircraft full-time, but has a dual function. In the case of the Maryland State Police, for example, the flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies.


Fee-for-service

In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. However, the cost of providing air ambulance services is considerable and many, including government-run operations, charge for service. Organizations such as service aircraft charter companies, hospitals, and some private-for-profit EMS systems generally charge for service. Within the European Union, almost all air ambulance service is on a fee-for-service basis, except for systems that operate by private subscription. Many jurisdictions have a mix of operation types. Fee-for-service operators are generally responsible for their own organization but may have to meet government licensing requirements.
Rega The Rega is a river in north-western Poland, flowing into the Baltic Sea. It is the country's 24th longest river, with a total length of 188 km and a catchment area of 2,767 km2.Switzerland is an example of such a service.


Donated by business

In some cases, a local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Examples of this are common in the
European Union The European Union (EU) is a supranational political and economic union of member states that are located primarily in Europe. The union has a total area of and an estimated total population of about 447million. The EU has often been de ...
, where in
London London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
the
Virgin Virginity is the state of a person who has never engaged in sexual intercourse. The term ''virgin'' originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern ...
Corporation previously donated to the Helicopter Emergency Medical Service, and in
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
and the
Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...
a large number of the 'Christoph' air ambulance operations are actually funded by
ADAC ADAC, officially the Allgemeiner Deutscher Automobil-Club (), is Europe's largest motoring association. ADAC is the largest club (Verein) in Germany with around 21 million members. It would be more aptly described today as an individual mo ...
, Germany's largest automobile club and DRF Luftrettung. In Australia and
New Zealand New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island count ...
, many air ambulance helicopter operations are sponsored by the
Westpac Bank Westpac Banking Corporation, known simply as Westpac, is an Australian multinational banking and financial services company headquartered at Westpac Place in Sydney, New South Wales. Established in 1817 as the Bank of New South Wales, it ...
. In these cases, the operation may vary but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor. In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a 'hands-off' approach to daily operations, relying instead on subject matter specialists.


Public donations

In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as the U.K., use a mix of such systems. In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service. In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered. Great strides have been made in the UK, with the 'Association of Air Ambulance (AAA)'. This organization is widely credited for having created the political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom. In 2013, the AAA published the "Framework for a High Performing Air Ambulance Service" which details many of the developments from 2008 to 2013. In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities commissioning clinical governance services, however many air ambulances operate under the tasking ambulances services clinical governance. The AAA now publishes Best Practice Guidance on a range of operational and clinical functions and provides a code of conduct that all full members, both ambulance services and charities must uphold.


"Heavy-Lift"

A final area of distinction is the operation of large, generally fixed-wing air ambulances. In the past, the infrequency of civilian demand for such a service confined such operations to the military, which requires them to support overseas combat operations. Military organizations capable of this type of specialized operation include the
United States Air Force The United States Air Force (USAF) is the Aerial warfare, air military branch, service branch of the United States Armed Forces, and is one of the eight uniformed services of the United States. Originally created on 1 August 1907, as a part ...
, the German ''
Luftwaffe The ''Luftwaffe'' () was the aerial-warfare branch of the German ''Wehrmacht'' before and during World War II. Germany's military air arms during World War I, the ''Luftstreitkräfte'' of the Imperial Army and the '' Marine-Fliegerabtei ...
'', and the British
Royal Air Force The Royal Air Force (RAF) is the United Kingdom's air and space force. It was formed towards the end of the First World War on 1 April 1918, becoming the first independent air force in the world, by regrouping the Royal Flying Corps (RFC) an ...
. The Swedish National Air Medevac - SNAM is an exception to the military only rule where the system is owned by the Swedish Civil Contingencies Agency '' Myndigheten för samhällsskydd och beredskap'' and the
737-800 The Boeing 737 Next Generation, commonly abbreviated as 737NG, or 737 Next Gen, is a narrow-body aircraft powered by two jet engines and produced by Boeing Commercial Airplanes. Launched in 1993 as the third generation derivative of the Boeing ...
aircraft is provided under contract when so required by Scandinavian Airlines. Each operates aircraft staffed by physicians, nurses, and corpsmen/technicians, and each can provide long-distance transport with full medical support to dozens of patients simultaneously. However, in recent years, exceptions to the "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care or to repatriate individuals. Air medical companies use both large and small fixed-wing aircraft configured to provide levels of care that can be found in Trauma centres for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans.


Standards


Aircraft and flight crews

In most jurisdictions, air ambulance pilots must have a great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. After a spike in air ambulance crashes in the United States in the 1990s, the U.S. government and the Commission on Air Medical Transportation Systems ( CAMTS) stepped up the accreditation and air ambulance flight requirements, ensuring that all pilots, personnel, and aircraft meet much higher standards than previously required.Davis, Robert
"Reconsidering air ambulance usage"
''USA Today'', July 18, 2005. Retrieved: November 12, 2007.
The resulting CAMTS accreditation, which applies only in the United States, includes the requirement for an air ambulance company to own and operate its own aircraft. Some air ambulance companies, realizing it is virtually impossible to have the correct medicalized aircraft for every mission, instead charter aircraft based on the mission-specific requirements. While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation to be licensed to operate. This is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights. Some examples are the states of Colorado,"Colorado House Bill 07-1259."
''State of Colorado.'' Retrieved: December 4, 2010.
New Jersey, New Mexico, Utah, and Washington.''Washington State rule WAC 246-976-320''.
''Washington: DC.'' Retrieved: December 4, 2010.
According to the rationale used to justify the state of Washington's adoption of the accreditation requirements, requiring accreditation of air ambulance services provides assurance that the service meets national public safety standards. The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is checked on a continual basis by the accrediting organization. Accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport, with considerable input from all disciplines of the medical profession. Other U.S. states require either CAMTS accreditation ''or'' a demonstrated equivalent, such as Rhode Island, and Texas, which has adopted CAMTS' Accreditation Standards (Sixth Edition, October 2004) as its own. In Texas, an operator not wishing to become CAMTS accredited must submit to an equivalent survey by state auditors who are CAMTS-trained. Virginia and Oklahoma have also adopted CAMTS accreditation standards as their state licensing standards. While the original intent of CAMTS was to provide an American standard, air ambulance services in a number of other countries, including three in Canada and one in South Africa, have voluntarily submitted themselves to CAMTS accreditation. In the UK, the AAA has a Code of Conduct that binds one of the most regulated areas of operation together. It brings the Fundraising Standards Board, CAA / EASA and the CQC together ensuring fundraising, air and clinical operations are in line with national regulation and best practice. The code goes further with an expectation of mutual support and working within its policy and best practice guides.


Medical control

The nature of the air operation frequently determines the type of medical control required. In most cases, an air ambulance staffer is considerably more skilled than a typical paramedic, so medical control permits them to exercise more medical decision-making latitude. Assessment skills tend to be considerably higher, and, particularly on inter-facility transfers, permit the inclusion of functions such as reading x-rays and interpretation of lab results. This allows for planning, consultation with supervising physicians, and issuing contingency orders in case they are required during flight. Some systems operate almost entirely off-line, using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. Some air ambulance operations have full-time, on-site medical directors with pertinent backgrounds (e.g., emergency medicine); others have medical directors who are only available by pager. For those systems operating on the Franco-German model, the physician is almost always physically present, and medical control is not an issue.


Equipment and interiors

Most aircraft used as air ambulances, with the exception of charter aircraft and some military aircraft, are equipped for advanced life support and have interiors that reflect this. The challenges in most air ambulance operations, particularly those involving helicopters, are the high ambient noise levels and limited amounts of working space, both of which create significant issues for the provision of ongoing care. While equipment tends to be high-level and very conveniently grouped, it may not be possible to perform some assessment procedures, such as chest auscultation, while in flight. In some types of aircraft, the aircraft's design means that the entire patient is not physically accessible in flight. Additional issues occur with respect to pressurization of the aircraft. Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins and those that do typically tend to be pressurized to only 10,000 feet above sea level. These pressure changes require advanced knowledge by flight staff with respect to the specifics of aviation medicine, including changes in physiology and the behaviour of gases. There are a large variety of helicopter makes that are used for the civilian HEMS models. The commonly used types are the Bell 206,
407 __NOTOC__ Year 407 ( CDVII) was a common year starting on Tuesday (link will display the full calendar) of the Julian calendar. At the time, it was known as the Year of the Consulship of Honorius and Theodosius(or, less frequently, year 1160 ' ...
, and 429,
Eurocopter AS350 Airbus Helicopters SAS (formerly Eurocopter Group) is the helicopter manufacturing division of Airbus. It is the largest in the industry in terms of revenues and turbine helicopter deliveries. Its head office is located at Marseille Provence Ai ...
, BK117, EC130, EC135,
EC145 The Eurocopter EC145 (now Airbus Helicopters H145) is a twin-engine light utility helicopter developed and manufactured by Airbus Helicopters. Originally designated as the ''BK 117'', the H145 is based upon the MBB/Kawasaki BK 117 C1, which ...
, and the Agusta Westland 109, 169 &
139 139 may refer to: * 139 (number), an integer * AD 139, a year of the Julian calendar * 139 BC, a year of the pre-Julian Roman calendar * 139 (New Jersey bus) 139 may refer to: * 139 (number), an integer * AD 139, a year of the Julian calendar * 13 ...
, MD Explorer and Sikorsky S-76. Fixed-wing aircraft varieties commonly include the Learjet 35 and 36, Learjet 31, King Air 90, King Air 200, Pilatus PC-12 &
PC-24 The Pilatus PC-24 is a light business jet produced by Pilatus Aircraft of Switzerland. Following the success of the PC-12 single engine turboprop, work on the twin engine jet began in 2007 for greater range and speed, keeping the rugged air ...
, and Piper Cheyenne. Due to the configuration of the medical crew and patient compartments, these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. Additionally, helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10,000 feet above sea level.


Challenges

Beginning in the 1990s, the number of air ambulance crashes in the United States, mostly involving helicopters, began to climb. By 2005, this number had reached a record high. Crash rates from 2000 to 2005 more than doubled the previous five year's rates. To some extent, these numbers had been deemed acceptable, as it was understood that the very nature of air ambulance operations meant that, because a life was at stake, air ambulances would often operate on the very edge of their safety envelopes, going on missions in conditions where no other civilian pilot would fly. As a result, nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes. In 2006, the United States National Transportation Safety Board (
NTSB The National Transportation Safety Board (NTSB) is an independent U.S. government investigative agency responsible for civil transportation accident investigation. In this role, the NTSB investigates and reports on aviation accidents and inci ...
) concluded that many air ambulances crashes were avoidable, eventually leading to the improvement of government standards and CAMTS accreditation.


Cost-effectiveness

Whilst some air ambulances do have effective methods of funding, in England, they remain almost entirely
charity Charity may refer to: Giving * Charitable organization or charity, a non-profit organization whose primary objectives are philanthropy and social well-being of persons * Charity (practice), the practice of being benevolent, giving and sharing * C ...
funded, as improved cost-benefit ratios are generally achieved with land-based attendance and transfers. Health outcomes, for example from London's
Helicopter Emergency Medical Service Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
, remain uncertain.


Personnel

The medical personnel of a helicopter ambulance has historically been a Physician/Nurse combination, Paramedic/Nurse, or a Nurse/Nurse combination. The need for a Physician/Nurse combination has diminished with more protocol and evidence-based applications for care by nurses and other clinicians and so the inclusion of respiratory therapists in all modes of air transport is becoming more prominent.


Retrieval doctor/physician

Retrieval doctor/physician: Criteria for working as a medical doctor (known as "physician" in the USA) in aeromedical services depends on the jurisdiction. In Australia, where aeromedical retrieval medicine is a well-established medical field, retrieval doctors must be experienced in a critical care specialty (i.e.
anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...
, emergency medicine,
intensive care medicine Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes pro ...
) as fully qualified specialists; specialty registrars in advanced stages of training; or general practitioners (i.e. family physicians) with broad experience in critical care and obstetrics. In the UK doctors working in HEMs are usually experienced in anaesthesia, emergency medicine, acute medicine or intensive care medicine. Some general practitioners also work for air ambulances. A formal training programme for pre-hospital emergency medicine (PHEM) in the UK now aims to produce formal PHEM consultants who have underdone specific training in working in pre-hospital care and transfer medicine.


Flight paramedic

Flight paramedic: A licensed
paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
with additional training as a certified flight paramedic ( FP-C) or a
master's degree A master's degree (from Latin ) is an academic degree awarded by universities or colleges upon completion of a course of study demonstrating mastery or a high-order overview of a specific field of study or area of professional practice.
. The flight paramedic is usually highly trained with at least five years of autonomous clinical experience in high acuity environments of both pre-hospital emergency medicine and critical care transport. Flight paramedics in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
may be certified as a FP-C or a CCEMT-P.


Flight nurse

Flight nurse: a nurse specialized in patient transport in the aviation environment. The flight nurse is a member of an aeromedical evacuation crew on helicopters and airplanes, providing in-flight management and care for all types of patients. Other responsibilities may also include planning and preparing for aeromedical evacuation missions and preparing a patient care plan to facilitate patient care, comfort and safety. Flight nurses may obtain certification in Emergency Nursing ( CEN), Flight Nursing ( CFRN) or Critical Care ( CCRN).


Civilian flight nurses

Civilian flight nurses may work for
hospitals A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
, federal, state, and local governments, private medical evacuation firms, fire departments or other agencies. They have training and medical direction that allows them to operate with a broader scope of practice and more autonomy than many other nurses. Some states require that flight nurses must also have paramedic or EMT certification to respond to pre-hospital scenes.


Hospital flight nurses

The military flight nurse performs as a member of the aeromedical evacuation
crew A crew is a body or a class of people who work at a common activity, generally in a structured or hierarchical organization. A location in which a crew works is called a crewyard or a workyard. The word has nautical resonances: the tasks involved ...
, and functions as the senior medical member of the aeromedical evacuation team on Continental United States (CONUS), intra-theater and inter-theater flights - providing for in-flight management and nursing care for all types of patients. Other responsibilities include planning and preparing for aeromedical evacuation missions and preparing a patient positioning plan to facilitate
patient care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profess ...
, comfort and
safety Safety is the state of being "safe", the condition of being protected from harm or other danger. Safety can also refer to the control of recognized hazards in order to achieve an acceptable level of risk. Meanings There are two slightly dif ...
. Flight nurses evaluate individual patient's in-flight needs and request appropriate medications, supplies and
equipment Equipment most commonly refers to a set of tool A tool is an object that can extend an individual's ability to modify features of the surrounding environment or help them accomplish a particular task. Although many animals use simple tools, onl ...
, providing continuing nursing care from originating to destination facility. They act as liaison between medical and operational
aircrews Aircrew, also called flight crew, are personnel who operate an aircraft while in flight. The composition of a flight's crew depends on the type of aircraft, plus the flight's duration and purpose. Commercial aviation Flight deck positions ...
and support personnel in order to promote patient comfort and to expedite the mission, and also initiate emergency treatment for in-flight
medical emergencies A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified p ...
.


Transport respiratory practitioner

Transport therapist: A highly trained respiratory practitioner (also called a
respiratory therapist A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respirator ...
), typically utilized in long-distance transport situations, though able to provide care during shorter transfer. Transport therapists may obtain Adult Critical Care Specialist (ACCS), Neonatal Transport Specialist ( NPT) and Neonatal Pediatric Specialist (NPS) certifications from the
National Board for Respiratory Care The National Board for Respiratory Care (NBRC Inc. is a non-profit organization formed in 1960 with the purpose of awarding and maintaining credentialing for Respiratory Therapists in the United States. The NBRC is the only organization in the Un ...
.


Associations and organizations

*
Aerospace Medical Association The Aerospace Medical Association (AsMA) is the largest professional organization in the fields of aviation, space, and environmental medicine. The AsMA membership includes aerospace and hyperbaric medical specialists, scientists, flight nurses, ...
: an umbrella group providing a forum for many different disciplines to come together and share their expertise for the benefit of all persons involved in air and space travel. * Association of Air Medical Services: a non-profit 501C (6) trade association that represents and advocates on behalf of our membership to enhance their ability to deliver quality, safe, and effective medical care and medical transportation for every patient in-need.


Air medical organizations

* BCAS -
British Columbia Ambulance Service The British Columbia Ambulance Service (BCAS) is an ambulance service that provides emergency medical response for the province of British Columbia, Canada. BCAS is one of the largest provider of emergency medical services in North America. The f ...
* HAI -
Helicopter Association International The Helicopter Association International (HAI) is a not-for-profit professional trade association of over member organizations in more than 68 nations. Since 1948, HAI has provided its membership with services that directly benefit their operat ...
* IAFCCP
International Air Ambulance Association of Flight & Critical Care Paramedics
(formerly NFPA) *HC
Human Care
* RFDS -
Royal Flying Doctor Service The Royal Flying Doctor Service (RFDS), commonly known as the Flying Doctor, is an air medical service in Australia. It is a non-profit organisation that provides emergency and primary health care services for those living in rural, remote an ...


See also

* Air ambulance services in Greece *
Air ambulances in Poland Lotnicze Pogotowie Ratunkowe is an air ambulance service subordinate to the Minister of Health of Poland. The Independent Public Health Care Institution ''Aviation Rescue Service'' was established in 2000. Additionally, the Search and rescue s ...
* Air ambulances in the United Kingdom * Air ambulances in the United States *
CareFlight CareFlight is an air medical service headquartered in Westmead, New South Wales, Australia. History CareFlight was founded in Sydney, Australia in May 1986 as an aeromedical charity. Its mission is to save lives, speed recovery ...
*
Casualty evacuation Casualty evacuation, also known as CASEVAC or by the callsign Dustoff or colloquially Dust Off, is a military term for the emergency patient evacuation of casualties from a combat zone. Casevac can be done by both ground and air. "DUSTOFF" i ...
*
Commission on Accreditation of Medical Transport Systems The Commission on Accreditation of Medical Transport Systems (CAMTS) (pronounced ''cames''), is an independent, non-profit agency based in Sandy Springs, South Carolina, which audits and accredits fixed-wing, rotary wing, and surface medical transpo ...
*
Emergency Medical Retrieval Service The Emergency Medical Retrieval Service (EMRS) provides aeromedical critical care to people in Scotland. It provides patients in remote and rural areas with rapid access to the skills of a consultant in emergency medicine, intensive care medic ...
*
Emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
*
Golden hour (medicine) The golden hour is the period of time immediately after a traumatic injury during which there is the highest likelihood that prompt medical and surgical treatment will prevent death. While initially defined as an hour, the exact time period depe ...
* Medical escort * Medical evacuation * Norsk Luftambulanse *
Royal Flying Doctor Service of Australia The Royal Flying Doctor Service (RFDS), commonly known as the Flying Doctor, is an air medical service in Australia. It is a non-profit organisation that provides emergency and primary health care services for those living in rural, remote an ...
* Safety of emergency medical services flights *
Westpac Life Saver Rescue Helicopter Service The Westpac Lifesaver Rescue Helicopter Service is a helicopter surf lifesaving service that operates in Australia. Founded in 1973 by Surf Life Saving Australia, a not-for-profit organisation, the service has carried out more than 80,000 fli ...

Air Ambulance Service in India


References

{{Authority control Emergency medical services
Medical services Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profess ...