Airbus Helicopters (AH) has provided aircraft for helicopter emergency medical services (HEMS) operations right from their inception, when the very first dedicated HEMS operation was started by ADAC Luftrettung in Munich in November 1970, when Germany faced a very high number of deaths on national highways due to the booming economy. 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. The project was managed under the leadership and operation of the German Automobil Club (ADAC). The main challenges were:
- How to finance the service
- What the operating rules were, and
- Who the stakeholders were.
The helicopter, medical equipment and training were the least of the problems, however, with some hiccups that occurred in the initial phases putting the project at risk of failure before it had even really started. ADAC eventually selected the light twin-engine BO105 helicopter, manufactured by AH’s predecessor company MBB with its – at this time – unique capabilities of two powerful engines and full system redundancies, high set main and tail rotor system, compact external dimensions with good visibility and, in particular, the unique rear loading capability via large clamshell doors. Since then, AH has been the leader in the HEMS segment with 60 per cent fleet share.
Stefan Bestle, Key Segment Manager for HEMS for AH, pointed out that these challenges that faced ADAC while the service was being introduced are still the same today in emerging markets without HEMS. Indeed, the worldwide market is very diversified. At the end of 2017, about 2,500 helicopters were dedicated to HEMS operations around the world. About 55 per cent of that fleet is light twin, 30 per cent singles and 15 per cent medium to heavy helicopters.
“In terms of geographical distribution,” commented Ralph Setz, Senior Manager Operational Marketing, “we see that 50 per cent of the overall HEMS fleet operates in North America with 53 per cent single and 47 per cent twin, mostly light twin. In Europe, about 35 per cent in operation with nearly 100 per cent twin engines (due to EASA operating rules) 81 per cent of which are light twins. There are very few EMS helicopters in the rest of the world, and many countries that have no HEMS at all.”
Bestle went on to explain that such a disparity means that the company is dealing with a variety of mature customers that have many years of experience and know exactly what they need in some areas, while on the other hand, discussions take place with HEMS beginners with whom AH needs to consult and define the right helicopter and the right equipment for them. “The success and our strong market position is due to the fact that we work very closely with our HEMS customers,” he said. “If we look back at the development of the H135, a task force was set up with many HEMS operators shaping the design of the new aircraft. We further improved key benefits such as wide rear loading, fully flat floor, protected tail rotor, medical design, layout etc.” He continued: “We are in dialogue with our HEMS customers, but also of course with our EMS suppliers for permanent improvements to our offering.” Two examples of such discussions leading to changes are that initially, there was a standard floor plus a special medical floor on top for the H135 in HEMS configuration, which resulted in weight penalties. AH developed a new design and now offers a special medical floor directly from the factory, eliminating the standard floor and providing a weight saving of up to 40kg, which allows for more payload.
Another example was the H145. “We have many EMS suppliers and we wanted to facilitate multiple new medical developments,” explained Bestle. “So, we have designed EMS fixed provisions. Those are defined together with the EMS suppliers but installed by us at the assembly line so that every customer can select his favourite EMS solution that fits easily to our airframe. By the usage of such fixed provisions/interfaces, the installation of HEMS equipment can be performed more easily and quicker. Furthermore, it improves the versatility of the helicopter.”
One of the most mature markets for helicopter sales, is, of course, the US. Bestle said that in North America, the size of the HEMS fleet in operations across the US has more or less doubled in the last 10 years. “HEMS is considered as a business and many commercial operators have developed so called ‘Independent Provider Models’,” he told AirMed&Rescue. “That means, the commercial operators are providing an equipped helicopter with complete crew somewhere in the country and anybody can order the service against payments. That trend increased the number of light twins. In recent years, the trend has been moving towards less expensive single engine helicopters in order to remain competitive, especially in rural areas.”
In Europe, meanwhile, the market for AH has been more in the nature of replacements, as most countries had already set up a mature HEMS network. “Of course,” continued Bestle, “new helicopter models and increasing safety and patient quality requirements attract the market and pave the way for fleet renewal. Furthermore, the centralisation and specialisation of hospitals is driving the demand for long-range intensive care transport capabilities. More powerful versions of H135 and H145 provided more payload and safety for complex operations such as mountain hoisting. Modern cockpits such as Helionix with its embedded four-axis autopilot system features – more on that later – and extra safety (one-line scan with blue line, recovery button, voice alarm), increase the level of safety significantly and allow for safer operations in adverse weather conditions.”
In emerging markets, AH is seeing an increasing interest in HEMS – some countries, such as Malaysia and China, have successfully started their first HEMS activities, and while such services are still being developed, initial challenges need to be overcome. Airbus Helicopters is gearing up to serve this market in a number of ways, one of which is setting up an assembly plant for the H135 in China, ground for which was broken in 2017.
Countries such as India, Brazil, Mexico and Indonesia have also been identified as potential candidates for a strong HEMS development in the next decades.
Stefan Bestle’s mission is to drive the Airbus Helicopters strategy for the Emergency Medical Services segment through the right understanding of the mission (regional specificities, business model mechanism, operational requirements, etc.) and customers’ needs to ensure the future Airbus solutions will cope with the customers and market expectations – a challenging role, to be sure: “The global HEMS market and its aircraft requirements are quite diverse due to different regional and geographical situations.
The global HEMS market and its aircraft requirements are quite diverse due to different regional and geographical situations
In addition, there are different business models starting from charity, insurance based (private and/or public) up to state-funded or even driven systems. Trying to define solutions that fit all of these aspects and requirements is a challenge but has also been one of the strengths of Airbus Helicopters. Airbus offers customer-orientated mission solutions to reach the highest efficiency for lifesaving missions.”
Digitalisation is a buzzword for any number of industries right now, including the air medical sector – customers are demanding more digitalisation of services, and Airbus must step up to the plate and meet these demands. Bestle said that when talking about digitalisation, there are two distinct parts – the helicopter operation, and the medical mission. “Airbus,” he explained, “already delivers digital services and connectivity solutions like an electronic flight bag, Fleet Keeper, real-time transmission of helicopter warnings and exceedances etc. The first aircraft are already equipped with a smart communication server.” Meanwhile, the medical market is transforming. “Digitalisation projects can be seen everywhere, whether it is telemedicine, live streaming of patient data, usage of robotics and 3D-printing, up to augmented reality. In addition to the development of innovative systems and solutions, special medical care laws have already changed or are under investigation to provide a legal basis for telemedicine applications.” Especially for rural areas where the density of the emergency services systems might be lower than in urban areas, telemedicine applications could enhance the services.
Next to today’s standard training like ARCM (Aeromedical Crew Resource Management) the technology developments have allowed further improvement of the safety level for HEMS operations. A big step forward is the new Airbus avionics family called HELIONIX®. Exclusively developed by Airbus for helicopter usage, the objective of the avionics solution was to reduce the pilot’s workload and provide the pilot with more time to concentrate on his mission. This has been enabled by a new HMI concept, innovative advisory and alarm functionality, simplified indications, centralisation of vital piloting data and reducing the indicated information to the bare and essential minimum required. This HELIONIX® continuously monitors the aircraft vehicle status and anticipates if there is a negative trend regarding a certain parameter. If so, the pilot will receive a pre-information warning and will be able to anticipate in advance and act, not just to react. This reduces the pilot’s workload, which is essential for single pilot missions.
In addition to the new avionics solution, Airbus Helicopters has also designed its four-axis autopilot system, which enhances not only the mission capability, but further increases flight safety. Bestle gave more details about the system: “A button on the cyclic grip recovers the aircraft to a safe flight attitude. This can be a life saver when IMC is entered inadvertently. The autopilot also provides protection of the engine and the flight envelope.” Furthermore, new operations like low level IFR flights, LPV and point in space (PINS) approaches can be flown with a minimum pilot workload and increased situational awareness. Systems like HTAWS (Helicopter terrain awareness and warning system), SVS (Synthetic Vision System), Enhanced Moving Map and TCAS (traffic alert and collision avoidance system) can be seen as today’s standard available safety equipment.
Due to the new autopilot systems, Airbus is currently developing a truly vertical PC1 take-off and landing procedure for the H145. This, says the company, will further increase safety during take-off and landing at heliports and public interest sites surrounded by obstacles, while at the same time further reducing the pilot’s workload and hence increasing safety in case of an engine emergency.
To further improve the efficiency of the operative aircraft usage, Airbus provides, whenever possible, ‘plug and play’ designs for mission equipment. The concept comes with fixed provisions where a quick installation of mission equipment is possible without the usage of special tools. This guarantees a quick conversion to different mission scenarios whenever required.
Investment in the future
Currently, there are a number of operators around the world that wish to continue their air medical and rescue operations into the hours of darkness. AH is designing its helicopter cockpits so they are ready for when more operators decide to fly into the night. Ralph Setz told AirMed&Rescue that while HEMS operations in North America and many countries in Europe already perform day and night-time operations, some countries and operators do not provide the service at all. The implementation of night flying services (NVG) requires availability of sufficient funding and experienced pilots as well as a national legislation allowing such operations for commercial operators. He added: “Our helicopters are of course fully night operation capable and fully NVG compatible including the medical installations. We see clearly the trend towards more night operations fully supported by our NVG cockpits and goggles, e.g. the UK and Austria often perform two pilot operations.”
Bestle added: “Our new Helionix cockpit philosophy is a step further towards more night operations due to the ease of operation and integrated safety systems such as SVS, HTWAS, TCAS, etc. AH strives continuously to provide pilots with cockpits that lower their workload and this will be further highlighted by the new Helionix software steps to come in the future. As Helionix is our design, such improvements can be rolled out regularly for the benefit of operations.”
Training is also a large part of AH’s business model, into which it has made significant investments in recent times. Nearly one year ago, the H145 Full Flight Simulator (Level D) was certified by the German Federal Aviation Office in Germany and is frequently used by customers. Indeed, AH provides complete training solutions in 23 training centres throughout the world – from ab-initio up to recurrent training for both pilots and technicians. Some of these centres have state-of-the-art full-flight simulators equipped with an OEM Sim Data Pack that provides the most true-to-life experience possible. And many of them utilise full-scale mock-ups, offering trainees an experience similar to what it would be on a real aircraft.
Furthermore, Airbus Helicopters, Thales and Helisim (a joint venture of Thales and Airbus Helicopters) are going to build a regional helicopter training centre including an H145 Full Flight Simulator in Texas. Helisim will develop and operate the simulation centre, which will include the first H145 and H175 Level D simulators in North America.
Investment in future technology, then, is high on the agenda for this company, and it certainly has plans in place to face any challenges the industry – and global economics – can come up with.