Tony Mallett reports on the operations of helicopter emergency medical services in Finland
Since 2011, FinnHems has been funded by the Ministry of Health and Social Security, working in partnership with university hospital district organisations. There are six bases that serve the length and breadth of Finland – Helsinki, Turku, Tampere, Kuopio, Oulu and Rovaniemi. In the southern area, flight operations are carried out by Skärgårdshavets Helikoptertjänst Ab (SHT), a company specialising in HEMS and air ambulance operations. SHT belongs to the Åland-based Wiklöf Holding Ab group. In the northern area (Oulu, Kuopio and Rovaniemi), flight operations are carried out by Babcock Scandinavian AirAmbulance AB, which is part of Babcock SAA FW AB, part of the global Babcock corporation.
SHT began its operations in 1990 in Åland. It has operated HEMS flights in Turku since 2000 and in Vantaa since 2001. At present, the SHT fleet comprises Eurocopter EC135 P2 single pilot instrument flight rules helicopters, and the crews began using night vision goggles (NVG) with these aircraft in 2011. In February 2015, Babcock Scandinavian AirAmbulance AB became the first flight operator in the world to operate HEMS flights with a modern EC145T2 fleet.
FinnHEMS can respond to medical emergencies for 70 per cent of Finland’s population within 30 minutes of dispatch. All FinnHEMS bases have on-duty physicians, or in the case of Rovaniemi, on-duty paramedics. The on-duty crew consist of a pilot, a HEMS crew member and a doctor. At the Helsinki base, there are usually two more doctors working during office hours too. Doctors are specialists in anaesthesia, intensive care and pre-hospital medicine and work full time in the pre-hospital setting both in administration and clinical work. HEMS crew members are firefighters or paramedics with extensive training in aviation and emergency medicine. Pilots, meanwhile, are very experienced with backgrounds in commercial aviation, teaching, military or the border guard.
The current FinnHEMS base at Helsinki Airport has been in operation for three and a half years, launching on average eight missions a day (2,918 missions in 2017, of which 1,433 were performed by helicopter). The base is fully equipped with its own refuelling station, living quarters, lecture rooms, gym, lounge, kitchen and even a sauna!
The three emergency crew members (pilot, doctor and paramedic) receive the call to scramble from a wireless device carried within their uniform, and can be in flight within approximately five minutes. Quick start and full authority digital engine (or electronics) control (FADEC) technology means all the pilot’s attention can be focused on monitoring the gauges while the computer system does the rest. Laser gyros are used in the instrument panels. While en route, the doctor continues to collect additional information as the alarm centre provides the crew with patient risk assessments. The doctor carries a laptop onboard, which is connected to a panel in front of his seat. From this position, consultation calls from the paramedic at the scene of the incident can be monitored. Physicians are further contacted for advice on medication or most appropriate hospital to which a casualty can be transported.
The crew at the Helsinki base is also on standby to attend to passenger medical emergencies within the airport terminal or Finavia staff emergencies on the airfield. Tuomas Suominen (FinnHEMS Head of Flight Operations and Quality Unit) elaborates: “Occasionally the central emergency call dispatches the HEMS unit to the airport area if the medical criteria are fulfilled. The HEMS unit can operate by car inside the airport area because the HCMs have special driving training and licence to drive there. There are 20 to 30 missions a year to the airport area (aircraft accident risk alarms not included). The HEMS unit also receives alarms related to technical problems in aircraft and the HEMS unit is a part of the airport accident preparation organisation. We get those alarms about 30 times a year.”
Pilot Jouni Romppanen offered his insights into his work with FinnHEMS
Romppanen pilots the EC135 helicopter, the quietest helicopter in its class, equipped with IR, NVIS, HTAWS (terrain avoidance), TCAS (traffic collision avoidance), SSR, and autopilot, but as yet no radar. Night vision technology is of key importance, as the crew operates so far into the Northern Hemisphere. “Our darkest point in the year is winter with only five and half hours of daylight,” said Romppanen. “FinnHEMS have added specific design features to the helicopter. This particular helicopter was made in 2005. We use the same type of helicopters across the three most southern bases of FinnHEMS which help when it comes to maintenance, parts and servicing. We have another spare helicopter on the other side of the airfield. This spare helicopter serves all our bases. We also co-operate with the border guard helicopter base that carries out operations at sea.”
He emphasised the great communication and bond that FinnHEMS has with the airport, and how this eases the fast dispatch of the crew: “We have a co-operation agreement with the tower so they know exactly what I’m going to say and where we will appear within their airspace during a scramble. The co-operation between the tower and us works fantastically.”
Extreme weather can obviously affect the team’s ability to do their job: “Icing conditions, heavy snow, low clouds and poor visibility and fog are the main restrictive elements that may prevent us from flying. Of course during the winter icing is quite a problem. IFR during winter is out of the question but [it works] for Summer time.” There is an emergency land vehicle the team can use if they need to, said Romppanen: “If the weather is really bad we always use the car. The weather cannot stop us because someone somewhere urgently requires our help! Once in my career we’ve had to take our backpacks and walk as the accident happened very close to our base. On board the helicopter, we have a minimum fuel window of 200 km with one hour of endurance or 400 km with maximum fuel. We can take extra fuel, but we also have to consider the weight increase carrying a patient and sometimes an extra doctor.” Ninety per cent of flights are within 30 minutes or about 100 km of a base.
As regular readers of AirMed&Rescue know only too well, quiet days are few and far between. “Interestingly,” said Romppanen, “Christmas Day is a busy time for us. I have been working for FinnHems for 16 years and in all that time have only ever known four or five really quiet days.” Time off, then, is even more important for crewmembers. “I fly two days, then have minimum two days off and after that a few office days. As with any pilot, rest periods between flying are very important as this is the only way to keep my mind alert and focused.”