How are police helicopters adapted for medical care?

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Insights into interiors

Law enforcement aviation divisions were at the forefront of the development of air medical services in the 20th Century, and police agencies around the world continue to fly patients by helicopter, whether as a primary role or on an occasional basis. The equipment carried and the extent to which the interior is adapted for medical use depends not least on the mission mix the agency sees, but also on the size of the helicopters used.

Hans Bretscher, Vice-President/General Manager at interior manufacturer Aerolite, has seen how varied a police operator’s requirements for a medical interior can be: “We found that the various law enforcement operators have different requirements. This ranges from a single-stretcher capability, up to full EMS capability that are the same as are on a dedicated EMS helicopter.”

Same but different

For a police helicopter configured as a dedicated medical aircraft, the considerations for the design of the interior are identical to those of any other air ambulance helicopter. Alex Hudson, who handles marketing at interior maker Air Ambulance Technology (AAT), highlighted that police services have to follow the same regulations as other providers: “As far as the aerospace rules and regulations go (whether they are from the European Aviation Safety Agency (EASA) or the Federal Aviation Administration (FAA)), the police forces have to go by the civilian regulations as they fly civilians and not military staff. This means that they need a supplemental type certificate just like any other private operator.” Any differences in interiors therefore come not from the police status, but the particular requirements of the operator – Hudson commented that AAT’s interiors are all custom built.

Wiltshire Air Ambulance (WAA), a UK HEMS charity, has experience working on both sides of the ‘blue line’. The service now flies its own helicopter, but used to partner with the Wiltshire Police and conduct joint missions on the law enforcement agency’s aircraft. Jill Crooks, Media and Communications Co-ordinator for WAA, commented on the parity of the regulatory regimes: “From an operational point of view, there haven’t been major regulatory differences between the shared and the stand-alone operation: HEMS tasking from the Ambulance Service remains the main trigger of any missions and they enjoy the same HEMS privileges accorded by the [UK] Civil Aviation Authority.”

The interior layout and equipment demands of a law-enforcement-orientated helicopter and a machine dedicated to patient care are, of course, different. Gustavo Romero, Director, Europe Region at aircraft interior maker Bucher Aerospace Corp., commented: “There are limited possibilities to reasonably adapt (in terms of cost and time) a pure police helicopter for medical use.”

There are limited possibilities to reasonably adapt (in terms of cost and time) a pure police helicopter for medical use

Where a helicopter’s main mission is observation from the air, the cabin configuration design has to bear in mind that overall weight should be minimised to allow the aircraft to stay in the air as long as possible, said Romero. In contrast, for air ambulance missions, ‘flight autonomy and duration play a secondary role compared with the medical support tools in the cabin’, he said, adding that space, cabin layout and access have to be optimised for loading and unloading a patient on a stretcher.

Where a helicopter serves dual (or multiple) roles, however, the interior design can help to promote flexibility, said Hudson: “We designed our equipment to be compatible with rappelling systems, hoists and tactical operator stations (FLIR and surveillance equipment). The seat the operator sits in is also used as a caretaker seat in the EMS role of the interior. At the same time, this is all compatible with the stretcher installation.”

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Broadly speaking, a police aviation division developing a new helicopter interior to include medical capability faces three options: to make use of quick-change installations to reconfigure the cabin ad-hoc according to the demands of each tasking; to opt for a compromise design, fitting in whatever law enforcement and air ambulance equipment is most needed; or to set up the helicopter with a full EMS interior. Of course, if the helicopter is large enough, then the operator has the luxury of having space for a full medical fit-out not instead of, but alongside, the law enforcement gear (such as a tactical station with camera and searchlight controls).

No compromise

In 1948, the New York Police Department’s Air Support Unit received its first Bell 47 helicopter, although it was operating a fixed wing division from 1929. In 1954, the fixed-wing unit was abandoned, and the department operated solely with rotor wing aircraft with a variety of mission profiles.

Let’s consider what is (in the US at least) the ‘original’ police medical helicopter service – the Maryland State Police (MSP). Following a mission in March 1970, the agency staked its claim as being the first civilian service in the US to transport a critically injured patient by helicopter. The organisation purchased its first helicopters, Bell Jet Rangers, specifically to fly patients such as injured traffic accident victims to hospital. In 1989, the Jet Rangers began to be replaced with Dauphins, which were in turn succeeded by AW139s from 2013 onwards.

The two main considerations that have dictated the cabin layouts were the size of the aircraft and the roles the helicopter crews are charged with performing

The two main considerations that have dictated the cabin layouts were the size of the aircraft and the roles the helicopter crews are charged with performing. While the helicopters’ role began as a medical service, it has expanded to ‘law enforcement and homeland security support, search and rescue, aerial rescue and disaster assessment’ – all performed by the same aircraft and crew. This multifunctional approach is advantageous when the character of a tasking changes mid-mission, such as when a high-speed vehicle pursuit ends with an accident and the crew transitions from assisting in tracking the vehicle to transporting injured drivers or passengers.

Bearing the above in mind, it’s clear that the optimum approach is for the helicopter to be set up for both EMS and law enforcement operations at all times, which is possible thanks to the size of the AW139s the agency now uses. Discussing Maryland MSP’s fleet replacement programme after the order for the new aircraft was placed, helicopter manufacturer Leonardo (then known as AgustaWestland) noted that the new machines’ cabins are getting on for two-thirds (57-per-cent) larger than the Dauphins they replaced.

The New York Police Department currently operates, among other aircraft, four Bell 429s, for a variety of missions including search and rescue at sea, patient transport, intelligence gathering and combating terrorism. Aerolite equipped these aircraft, the fourth of which was delivered in 2015, with stretcher capability, thus meeting New York state regulations that allow it to serve as a certified air ambulance.

Delaware State Police Bell 429 Aerolite Interior 1

For search and rescue missions, the current MSP AW139s are fitted with rescue hoists and rescue baskets to bring injured victims onboard from locations where the aircraft is unable to land, and the organisation lists the standard medical crew as one flight paramedic/crew chief and one rescue technician. On the law enforcement side, the helicopters include tactical stations at the front of the rear cabins (aft of the pilot positions) with camera and searchlight controls, as well as moving map displays. For flights where the crew care for and transport patients, the helicopters feature custom-designed medevac interiors from Aerolite, which include flight crew seats that provide fore and aft movement, as well as full rotation, enabling the crew to either operate the tactical station or provide patient care during flight. The stretcher can also swivel, further facilitating patient access. The modular medical floors come with tracking that allows the aircraft to be set up to carry a second patient if required – the AW139s can carry one or two patients of up to 600 lbs (270 kg) each. The track system also allows for a neonatal isolette to be fitted, or for the seats and stretcher to be removed to make space for tactical cargo. The medical equipment carried includes fluid warmers and suction units, and the MSP selected +LifeBlanket all-weather patient packaging systems. The comprehensive approach to the interiors reflects the fact that ‘the airborne delivery of emergency medical transportation’ is the primary role listed in the Aviation Command’s mission statement.

Shared aircraft

In the UK, the partnership between Wiltshire Police and the WAA was pioneering in its own way, Crooks explained: “Most air ambulances use their own helicopter, but in Wiltshire the police force was the first in this country to pioneer a joint helicopter with the Ambulance Service.” Crewed by a pilot and observer from the police force, along with a paramedic from the HEMS charity, the helicopter was able to fly and make landings at unprepared landing zones at night thanks to the police equipment.

In contrast to the example of MSP’s AW139s, though, the interior of the Wiltshire Police MD902 Explorer was a compromise. Critical Care Paramedic and Operations Officer Richard Miller has worked at WAA since 2001 and leads the service’s paramedics. He explained: “The interior of the MD902 had been specified for a primary law enforcement role, giving priority of installation to its core mission equipment, including the camera system and the connected recording devices. The HEMS equipment, fixed and carry-on, was accommodated in the residual space and weight capacity of the aircraft. Position and accessibility were suboptimal and required [continual] unbuckling or removal from storage. Accessibility to the patient was also limited due to cabin space constraints.”

When police air coverage for the county was taken over by the National Police Air Service in 2014, WAA launched its own dedicated air ambulance helicopter, a Bell 429. The biggest change was that the entire interior in the charity’s new craft can be utilised for the medical role. Miller explained: “[It] was selected to deliver HEMS as its primary and sole mission; the interiors have therefore been designed and made to specs that have been developed by the clinical team to optimise the delivery of critical care, and the space and load capacity of this larger airframe. All equipment is custom fitted and it is ergonomically efficient in the delivery of pre-hospital care to the patient.” He added: “Becoming a stand-alone air ambulance was a radical change for the charity and has benefited patients. We now fly with two critical care trained paramedics and that is important because a lot of the extra medical treatment we can give to patients, such as sedation and pre-hospital blood transfusions, requires two clinicians.”

the Bell 429 cabin has a larger volume than the MD902s – large enough that Delaware State Police adopted the Bell 429 in 2014 for an upgrade to its multi-role fleet

It’s important to point out though that the Bell 429 cabin has a larger volume than the MD902s – large enough that Delaware State Police adopted the Bell 429 in 2014 for an upgrade to its multi-role fleet.

Like MSP, the Delaware Aviation Section has medevac as a primary mission, operating patient flights as well as performing search and rescue and law enforcement roles. The service’s helicopters can even accommodate two patients and two medical crew. And, as has been mentioned with the MSP example, there are benefits to having both law enforcement and medical staff onboard, as Crooks of WAA acknowledged: “Operational tasking which began as a police incident could become a medical incident. For example, a search for a missing person who, when found, needed urgent medical treatment, and this could include being airlifted to hospital.”

Leonardo AW139 MSP Aerolite Interior

Quick change

So far, we’ve considered larger helicopters that can accommodate a multi-role interior, and smaller helicopters where the police-plus-medical interior may equal compromise. The third option, of course, is to make use of quick-change systems to swiftly adapt the helicopter to either law-enforcement or medical-only use at the start of each mission.

Bretscher of Aerolite shared his experience: “[Police operators] all want to be able to reconfigure these helicopters from EMS to a strictly [passenger] configuration within minutes … for police or VIP missions.” Interiors such as Aerolite’s allow for swift swap-outs without tools. Such adaptations are essential, as without them reconfiguring the aircraft would be a lengthy process, Bucher’s Romero noted: “Unless the original police helicopter was designed for multi-purpose mission profiles and equipped with the necessary fixed provisions (e.g., pipe connectors, brackets, hooks, etc.), it is unlikely that the police helicopter can be quickly and inexpensively re-configured for medical use. Retrofit with the usual long downtime and costs would be necessary.”

It’s a different story with quick-change systems. Hudson of AAT said: “As our interiors can be installed and removed within a few minutes, when a helicopter goes into maintenance (for example) the interior is removed and installed in the next helicopter … the policing equipment doesn’t have to be removed – in fact in one of the Arabic countries, they change the interiors from one helicopter to the next quite often.”

Ongoing demand

Although solutions may vary, it’s clear that there’s a continuing demand from law enforcement agencies for helicopters adapted to provide medical care. Just last year, for example, AAT modernised a number of Czech Police helicopter medical interiors, said Hudson: “They now have the newest medical devices (ventilator, monitor etc). We have designed new holders for these devices and installed them in the helicopter.”

The decision on how to modify a police helicopter for medical use is always going to be based on mission profiles, but there is undoubtedly huge benefit in having the different options available on how far a police helicopter can be adapted for optimal patient transports.