Helicopter Emergency Medical Services

(HEMS) in INDIAAIR COMMODORE BS SIWACH AVSM YSM VM ®

SECRETARY GENERAL

ROTARY WING SOCIETY OF INDIA

HELICOPTER EMERGENCY HELICOPTER EMERGENCY MEDICAL SERVICES (HEMS)MEDICAL SERVICES (HEMS)

Frequent occurrence of disasters.

Extensive use of helicopters.

Situation necessitates helicopters being available in the area.

Floods are annual feature :IAF Helicopter in a Rescue Mission

IAF Helicopter dropping the relief material at the flood affected areas in Gujarat on 3 July 2005

Mass Casualty Event

“At 5:46 a.m. on January 17, 1995, an earthquake (the Great Hanshin Earthquake) with a magnitude of 7.3 hit the western part of Honshu Island near Kobe, Japan and caused severe damage at numerous locations. Damage figures from this earthquake were over 6,000 dead; 36,926 injured; and 222,242 buildings destroyed.

Exactly one year before the earthquake, at 4:31 a.m. on January 17, 1994, across the Pacific Ocean, another earthquake (the Northridge) with a magnitude of 6.8 shook the city of Los Angeles. Despite its scale, damage figures from the earthquake were relatively low, consisting of 61 dead, 9,348 injured and 5,800 buildings destroyed.

A Case Study

One of the biggest differences between the human responses in each case is the use of helicopters and the presence of heliports supporting those helicopters.

It is difficult to identify all of the factors that may have influenced the wide disparity in the extent of damage resulting from these earthquakes.

However, it is clear that the human responses altered the level of damage significantly in each case.

KEY DIFFERENCES IN HUMAN RESPONSE

In the case of Los Angeles earthquake, a helicopter from the Los Angeles Fire Department (LAFD) was airborne within four minutes of the quake to relay accurate information about the nature of damages. As a result of which effective use of helicopters was made in the early stages of fire fighting. LAFD helicopters conducted 21 flights dropping over 57000 litres of water on various sites in the early stages.

In the case of the Kobe, on the day of the quake, only one helicopter was employed for disaster relief. Even though 38 helicopters were pressed into service by the fifth day, these were not available when it was critically required on the first day.

Effective Use of Helicopters

• A lesson from these earth quakes at Honshu Island near Kobe and at Northridge, Los Angeles is that helicopter is the most effective device for emergency relief in the event of a disaster.

• It also functions well as a vehicle for emergency medical services. The helicopter therefore, becomes not just a means of transportation but also an airborne intensive care unit, thereby, diminishing the duration of the therapeutic vacuum. The result is not simply a reduction in mortality or morbidity but also reduction in disability.

• In the area of disaster preparedness, an essential element is in getting the helicopter services at shortest possible time.

LESSONSLESSONS

• Helicopters of armed forces and paramilitary are employed to provide Air Evacuation.

• Generally, armed forces helicopters are mobilized from the helicopter units located nearest to the location.

• In many cases, helicopter resources if not available with in the state take as much as 24 to 48 hours to arrive in the scene.

• State Govts opt to utilize the armed forces helicopters as the expenditure related to these spl flts is reimbursed from the central budget.

Present Status

• If helicopters of the Armed Forces are not committed, this arrangement is fine.

• In case of a conflict situation, timely availability of helicopter resources for aid to civil may become difficult.

• It is essential to strengthen the civil helicopter fleet and also have a programme to train the aircrew in the roles performed during disaster management.

• Building up civil helicopter fleet can be very handy in creating reserve heli-lift capability especially during hot war situations

Building up Civil Helicopter Fleet

Civil Registered Helicopter strength - 239

Fleet Strength available for commercial use – 180

(including heavy duty helicopters which can handle large scale Air Evacuation tasks)

(Note : Himachal Pradesh Govt. had effectively used the MI-172 helicopters during the heavy landslides caused during the monsoon in 2000).

Do we have adequate number of Civil Helicopters to handle

Air Evacuation?

Where feasible helicopter resources will need to be pre-positioned as close to the area which is likely to be affected. A net work of low cost helipads & refueling facilities are required to assist its usage.

Network of Heliports Essential

As the heliport gets closer to a metropolis, obstacle free locations are also difficult to find. In many countries heliport on top of a bridge is

opted in crowded areas.

Need for Heliports and Staging Areas In Metros during disasters , response by ground vehicles is likely to

be severely restricted due to congestion in roads . Heliports and staging areas should be developed for Air Evacuation

For roof top extraction, identification of suitable roof tops for use of helicopters is essential.

PREPAREDNESS

Air Evacuation: Mass casualty Incident

Necessary equipment including Helicopters modified for EMS & Air Ambulance roles

Trained personnel including Aircrew, Paramedics and Technicians

Infrastructures including Public Use Heliports, Roof Top Helipads, Refueling Facilities

Suitable policies in place

Why Transport by Helicopter?

Trauma (Golden Hour)Trauma (Golden Hour)Cardiac (Time is muscle)Cardiac (Time is muscle)

Strokes (Time costs brain cells)Strokes (Time costs brain cells)High Risk OB/NeonatalHigh Risk OB/Neonatal

Organ TransplantsOrgan TransplantsRemote AreaRemote Area

Saving time… Saves lives

First First ResponseResponseFirst First ResponseResponse

Ground AmbulanceGround AmbulanceGround AmbulanceGround Ambulance

Air AmbulanceAir AmbulanceAir AmbulanceAir Ambulance

‘‘Appropriate’ HospitalAppropriate’ Hospital‘‘Appropriate’ HospitalAppropriate’ Hospital

Level of Care Increases as the Patient Progresses in the System

Overview of EMS SystemOverview of EMS System

Air AmbulanceAir Ambulance(Criteria for activating helicopter)(Criteria for activating helicopter)

Multiple patientsMultiple patients Remote accessRemote access Traffic congestionTraffic congestion Severity of injuries exceeds Severity of injuries exceeds

capability of smaller hospitalcapability of smaller hospital

“Golden Hour”

A Totally Integrated System Saves Time – Saves Lives

Appropriate HospitalAppropriate Hospital Emergency DepartmentEmergency Department Specialist Available Specialist Available

24 Hrs/Day24 Hrs/Day Invasive Treatment, Invasive Treatment,

Recovery and Rehab Recovery and Rehab

EMS SystemEMS System

• Improves Patient CareImproves Patient Care

• Reduces Health Care CostsReduces Health Care Costs

• Extends Geographical Extends Geographical Reach of Specialized Reach of Specialized Medical CentersMedical Centers

• Increases Patient Survival Increases Patient Survival and Recoverabilityand Recoverability

BenefitsBenefits

Helicopter Saves Lives

Large Rural Population and Congested Large Rural Population and Congested Urban AreasUrban Areas

High Tech Hospitals only in Urban High Tech Hospitals only in Urban CentersCenters

Small percentage of insured populationSmall percentage of insured populationSpecialty HospitalsSpecialty Hospitals

Qualified ParamedicsQualified ParamedicsGrowing Middle Class Rising ExpectationsGrowing Middle Class Rising Expectations

Growing Tourist Population - Requires Growing Tourist Population - Requires Robust Healthcare SystemRobust Healthcare System

HEMS will require some level of HEMS will require some level of Government SupportGovernment Support

Challenges Creates Opportunities

Challenges for IndiaChallenges for India

HEMS

HAL Manufactured

Dhruv

Seats designed to traverse longitudinally to a suitable position for treatment of the patients.

The medical equipment rack should house a Comprehensive monitor to monitor the patient's BP, ECG, temperature etc. Hand held pulse oximeter to monitor the patient's oxygen content in the blood, and an Emergency medical kit for treating the patient.

A Defibrillator for defibrillation of patients and monitoring, a ventilator with oxygen cylinders for supply of air/oxygen or mixture of the two to the patients. Infusion pump for infusing liquid at a required rate and in large volumes, Syringe pump to administer drugs in small volumes and a Suction apparatus to remove waste fluids from the patient.

HEMS REQUIREMENTS Cabin Space for stretcher patients & medical attendant / doctor.

Telemetry facility for medical data, for expert advice from the Specialists in the hospitals if possible.

cabin should be well lit and aided with Intercom facility for the doctor to communicate with the medical attendant.

Dhruv - 14 passengers or 2/4 stretcher patients and 4 sitting casualties in ambulance version.

Various Types Available for Air Ambulance Role

MI-172 s - over 26 passengers or 12 stretcher patients in ambulance version.

It is possible to evacuate up to 1200 people per hour from high rise rooftops to nearest safety areas /helipads in a heavy duty helicopter. High density packing of occupants is permissible.

DhruvAir Ambulance

version

EMS

In densely populated cities, specialised helicopters will be able to perform missions such as

Emergency Medical Services and

Air Ambulance Efforts

Role for Specialised Helicopters

NDMA should consider inducting civil registered commercial helicopters for handling the following roles:-

Recommendations

Emergency Medical Services and

Air Ambulance

It is important that the Disaster Management Plan integrates helicopter fleet of Defence , paramilitary forces and civil into the response plan in every state.

For quick response ,the civil helicopter resources available in the state should be incorporated, so that it can rapidly self deploy in the event of a disaster.

NDMA ,State Govts should co-opt professional agencies like RWSI in the identification of suitable sites for public use heliports and suitable buildings with roof tops for use by helicopters. Its services can also be availed in building awareness related to Mass air evacuation process amongst people.

For Mass Air Evacuation from high risk population centres, suitable public use heliports may be constructed preferably on higher ground, away from possible flooding.

For roof top extraction, identification of suitable buildings with roof tops for use by helicopters is essential.

Periodic Air Evacuation drills from public use helipads and roof tops would help build efficiency amongst the operating crew besides building awareness amongst people on the use of it.

Recommendations

Thank you

Remember. . .Helicopter Saves Lives