Helicopter Air Ambulances

Helicopters have a definite role in patient transport, but they are not the single solution to all patient transfers. Like any other vehicle, their strengths and weaknesses must be considered carefully when making a selection.

Generally speaking, when one thinks of a medical helicopter, it usu­ally is synonymous with experienced transport team members who pro­vide advanced medical skills using specialized medical equipment. The vehicle itself, however, provides significant advantages over other modes of patient travel.

Helicopters provide rapid transport at speeds of 120 to 180 mph, depending on the type of helicopter, weather, altitude, and weight load. Traveling via medical helicopter often equates to a transport time of one third to one fourth that required for an equivalent distance by ground trans­port, making the helicopter very beneficial when time is critical. The service area of helicopter programs usually is up to 150 miles from the base of oper­ations; most helicopters are able to cover this distance in 1 to 1¹∕₂ hours.

The speed of travel is only one unique capability of the helicopter. The helicopter does not need a runway to land; it requires only a relatively small, flat area (100 ? 100 ft) that is clear of obstructions. The helicopter has the ability to avoid common traffic delays and ground obstacles and can fly into locations that are inaccessible to other modes of travel. This may be benefi­cial when roads become impassable because of traffic, flooding, snowstorms, tornadoes, or other disasters. Like the ground ambulance, the helicopter has the ability to go door-to-door when there are on-site helipads or landing areas at the referring and receiving facilities.

Although helicopters have distinct advantages as patient transfer vehi­cles, they also have inherent disadvantages. The limitations of helicopter transport may vary with the type of helicopter considered for use.

Weight and balance are extremely important considerations for every helicopter flight, regardless of the size of the aircraft. Every helicopter has a maximum lift capability, from which a useful payload can be calculated. The combined weight of the pilots, transport team members, patient(s), and equipment must be considered. High ambient temperatures and high humid­ity reduce the useful load that a helicopter can carry. Commonly in these conditions, pilots may choose to carry less fuel (thereby, decreasing their range) to maintain an adequate payload for each medical mission. Larger helicopters may have fewer restrictions, but the same principles apply.

Landing zone requirements for helicopters are a disadvantage com­pared with ground ambulances, but they offer an advantage over the airport requirements of fixed-wing aircraft. If a helipad is not readily available, the time needed to prepare or access the landing zone may diminish the heli­copter’s advantage of speed.

Weather considerations can significantly limit the availability of heli­copter transport. These conditions include low-lying clouds (decreased ceil­ing), limited visibility (eg, fog, sleet, heavy snowfall, and heavy rain), high winds, lightning, and high ambient temperatures that create “density alti­tude” conditions. Most helicopter programs operate under visual flight rules (VFRs), but travel under instrument flight rules (IFRs) is becoming more common. Additional recurrent pilot training and specialized aviation equip­ment are necessary for IFR missions, which may make this option costly. However, in some areas where poor visibility and low ceilings cause a signifi­cant number of missed flights, IFRs may be an important consideration.

Transport by helicopter is significantly more expensive than travel by ground. The costs related to purchasing or operating a helicopter indicates why dedicated helicopters may be cost-prohibitive to many transport pro­grams. In addition, the recurrent controversy surrounding the use of twin- or single-engine aircraft goes beyond cost. Although twin-engine helicopters are more expensive, they have an inherently larger safety margin than their single-engine counterparts. Further discussion on this complicated issue is beyond the scope of this chapter.

Helicopters have been described as a “thousand precision parts flying in close formation,” because they are extremely maintenance-intensive machines. They are more expensive per hour to operate and maintain than fixed-wing aircraft. As complex machines, helicopters have many sophisti­cated parts that are highly stressed and operating at high rate of speed.

The purchase price of a medically equipped single-engine helicopter (eg, Eurocopter A-Star [European Aeronautic, Defense and Space Company Germany, Spain, France, USA] or Bell 407, Textron, USA) averages approxi­mately $2 million. A light twin-engine helicopter (eg, Eurocopter EC 135 or Twin Star 355) may cost twice as much. The new Eurocopter EC145 and Bell 430, both medium-sized, twin-engine helicopters, cost between $4 and $7 million, and a large twin-engine helicopter, such as the Eurocopter Dauphin 365N-2, the Bell 412, or the Sikorsky SR76, costs approximately $1 to $3 million more. Of course, these prices are only for the helicopter and do not include other aviation-related expenses. Pilot salaries range from $90 000 to $125 000 annually; a staff of 4 is required to cover 1 helicopter 24 hours, 7 days a week. If the helicopter is IFR-capable, the pilot salary budget can double because of the need for 2 pilots for IFR missions. Financial concerns include fixed and variable (hourly) costs. Fixed costs include insurance, taxes, pilot and transport team member costs, overhead, interest, hangar fees, and capital equipment. These costs are irrespective of the number of hours the helicopter has flown and vary with the type of helicopter. Variable (hourly) costs or direct operating costs vary directly with the number of hours flown. These costs include fuel and oil, scheduled maintenance labor, unscheduled maintenance labor, engine overhaul, airframe overhaul, and airframe items with a limited life span.

Looking only at the aviation-related expenses for a leased medical helicopter (eg, aircraft lease, pilots, mechanics, flight time, and fuel), the annual operating expense typically starts at more than $1 million for a single-engine helicopter and increases to almost $2 million for a large twin-engine helicopter.