Could you share some background information about the EASA South East Asia Aviation Partnership Project?
The European Union-South East Asia Aviation Partnership Project (EU-SEA APP) is an EU-funded action implemented by EASA that aims to improve institutional and industrial relations with partner countries in South East Asia in the civil aviation context. It started in 2018 and has since supported more than 100 activities including regulatory developments, technical trainings, and high-level conferences, in all areas of the aviation sector.
The project is very much welcomed and appreciated by the partner countries and organizations, and the implementation strategy is to seek for the collaboration with regulatory and industry third parties to contribute to achieve common goals.
How has the partnership project helped countries with forming pre-hospital emergency medical networks?
The partnership project is primarily focused on the aviation sector but if a request is received for the provision of support in other areas that complement the partnership project and helps with achieving common goals, then appropriate introductions are made. The National Institute for Emergency Medicine (NIEM) is responsible for Thailand’s pre-hospital care and emergency service response.
Establishing HEMS operations will help foster the pre-hospital emergency medical network, creating substantial pre-hospital interest across South East Asia, the Asian States and much further afield. The eyes of the region and beyond are watching developments with interest and successful implementation will have an extremely positive impact on pre-hospital emergency medical networks.
How has your background in HEMS helped in developing the Thai HEMS project?
I have been a helicopter pilot for 30 years and flown HEMS for 22, experienced in both single and multi-pilot operations in urban and rural environments. In that time, I have been fortunate enough to build knowledge and expertise from working alongside a fantastically diverse group of professionals, including my time joining London’s Air Ambulance in 1999 and being appointed Chief Pilot in 2006. I held this post for seven years, which included responsibility for the day-to-day running of the aviation department and working closely with the UK CAA ensuring regulatory compliance.
Delivering HEMS in a capital city amidst some of the busiest airspace in the world has its challenges. Over time, I have experienced every facet of HEMS and have a detailed understanding of what is needed to develop a sustainable, efficient HEMS system. However, we are always learning and striving to do things better.
Providing a safe, efficient HEMS system requires a large, co-ordinated team effort. There’s an awful lot of training, checking, and education required to create a robust, sustainable system to achieve and maintain the high standards expected. As with any successful team, there’s a high proportion of support work that takes place behind the scenes. This includes skilled engineers maintaining aircraft serviceability and office staff responsible for a host of administrative tasks, to air traffic co-ordination and liaison with other emergency services and hospitals with the relevant procedures in place allowing them to receive a patient by helicopter.
I have access to a large network of contacts and connections from across the HEMS sector that I am fortunate enough to call upon for support and help when required. HEMS is a close community where friends and colleagues are only too happy to share experiences, knowledge, and expertise from which our Thai colleagues can benefit enormously.
But not everything readily translates to Thailand’s operating environment, and it’s important to recognize and respect our cultural differences. Sharing collective experience of success, failures, and knowledge gained, our Thai colleagues must use the resources available to create a system suited to their environment. There will be many similarities but there will also be inevitable differences to learn.
The common ground for HEMS operations is the safe delivery of the best medical care and affording the patient the greatest chance of survival at their time of need whilst remaining within the parameters published. Without experience of HEMS operations, the systems, processes, and procedures adopted by European HEMS operators must be taught. Given the emotive nature of flying lifesaving missions within a civilian environment, HEMS is categorized as a specialist operation. There must be a healthy awareness of the operational threats that can arise during a HEMS mission, and these must be managed correctly through the application of appropriate tools and training, thus mitigating risk.
Do you have experience in setting up new operations?
Across Europe, we’re extremely fortunate that HEMS operations have existed in various guises for many years and the sector is now pretty much saturated with little scope for additional growth. When I joined London’s Air Ambulance in 1999, the service was approximately 10 years old and whilst not a new operation at the time, from humble beginnings it has come a long way and matured substantially as an operation. London’s Air Ambulance is globally recognized as one of the world’s preeminent pre-hospital care organizations and the standards of medicine are extremely high with aeromedical training programs to complement and support this.
Aviation as an industry is permanently evolving, regulation is constantly being amended and updated, and the HEMS sector especially continues to innovate, always striving to introduce the latest most advanced technical developments to enhance the aviation experience, clinical intervention, and patient outcome. I remain at the frontline of HEMS operations maintaining license currency and keeping abreast of developments and have been fortunate enough to implement some of the changes over the years.
For how long has EASA been working with the Thai government on its HEMS project?
Since 2018, albeit with occasional interruption.
What progress has currently been made in Thailand?
There has been excellent progress. Amendment to the Air Navigation Act (ANA) was one of the earlier and more significant obstacles to overcome.
Prior to commencing the project, civilian aircraft were only permitted to fly aerodrome to aerodrome. Changing this to permit aircraft to land off aerodrome required a change to air law. The amended ANA was lodged with the courts, subsequently receiving approval and, as a result, aircraft are now cleared to land off aerodrome for the sole purpose of saving lives, clearly a key factor in delivering HEMS.
Separate missions to Germany and the UK have seen delegates from Thai organizations, including representatives from Government, experience HEMS operations first-hand through visits to HEMS bases, hospitals, Airbus Helicopters, and ADAC. Flight ops inspectors from the Helicopter Division of the Civil Aviation Authority of Thailand (CAAT) received in-depth ground school training provided by the UK CAA covering every aspect of regulatory oversight of HEMS operations under EASA rules, and visits to two different HEMS bases for an overview of UK CAA HEMS base audit procedures.
A couple of days were also spent with an urban HEMS operation and a visit to UK National Air Traffic Services to learn how Category A HEMS aircraft are co-ordinated in UK airspace, particularly within busy areas. CAAT was able to return to Thailand to create their own HEMS regulation in line with their own Helicopter Operator Regulation with the ongoing support, advice, and guidance from EASA, another major milestone achieved in the development of HEMS.
Aside from the excellent regulatory progress, a further important milestone was the HEMS table-top exercise organized by NIEM. This allowed emergency service personnel to experience a multi-agency response in a controlled environment to a simulated major incident on the highway. The response required the use of HEMS, including a civilian AOC operator with its EMS configured H145D2 along with the Royal Thai Police and a HEMS-configured B429. Following this, a simulated HEMS demonstration took place in December 2019 on the highway utilizing the civilian H145D2, which is currently used for inter-hospital patient transfer services, and the Police B429.
Permission was granted for both aircraft to land on the highway at a CAAT and NIEM co-ordinated event watched by members of the Thai Government, the EU Ambassador, other dignitaries, invited guests, and the press. The intention was twofold: to highlight the significant benefits of HEMS whilst raising project profile and the HEMS concept to the wider public, and putting the table-top exercise into practice enabling the emergency services to respond collaboratively in a controlled environment.
Following this, operators would be invited to apply for HEMS AOC approval with the introduction of HEMS operations to be a phased approach commencing with a rendezvous system. The patient will be transported to the helicopter from the incident at a pre-determined landing site alongside (off) the highway. A select, localized network of community landing sites would be identified, surveyed, and approved for this purpose.
The phased rendezvous introduction is to allow enough time and opportunity for all emergency service personnel operating within the selected geographical area to gain invaluable HEMS experience prior to commencing the second phase, which would permit ad-hoc landings direct on the highway with day Visual Flight Rules.
With the HEMS regulation approved in early 2020, it was widely anticipated the civilian AOC operator with the EMS configured 145D2 would be the first to formally apply for HEMS approval and the CAAT application process would commence.
Sadly, the Covid-19 pandemic escalated soon after and the project lost months. Thankfully, activities have recently recommenced, initially through online meetings and re-connection with various stakeholders. With ongoing travel constraints, support and interaction has shifted to remote online workshops and training activities. It is reassuring to note the project is once again active and there remains a strong desire to pick up from where we left off and push ahead with establishing HEMS across Thailand.
In terms of infrastructure like helipads, number of aircraft, and trained personnel, what do you foresee as the biggest challenge for starting the new Thai HEMS operation?
The biggest challenge for any HEMS operation is the creation of a sustainable funding model. HEMS can be highly emotive and has a strong following around the world. Once operations begin and lives are saved, the service will expand. Rarely does it go the other way. When the value of the service is realized, it becomes self-perpetuating. Many lives in Thailand will be saved, it’s hard to put a value on this.
One challenge is to overcome the impact of Covid-19. There will undoubtedly be a recovery and, when it comes, there will be an operational HEMS system in place supporting the growth and anticipated surge in visitor numbers.
The area identified to commence operations should not require much development; a suitably configured helicopter is already flying in the region and the appropriate hospital helipads would support an early HEMS operation. But personnel training is required, and dedicated HEMS operational expertise is currently lacking.
For the start-up phase, I would recommend investing in operational expertise. Sitting alongside and learning from an experienced HEMS operator would prove invaluable to crews currently tasked with the responsibility of establishing the service. This approach would help develop confidence and expedite the process in a safe, controlled manner.
What are your hopes for the future of Thai HEMS operations?
The development of a HEMS system across Thailand will have a positive impact on aviation safety standards in general, in turn raising the profile of helicopter operations, creating opportunity, investment, and ultimately jobs. I would like to see Thailand become a center of excellence for HEMS operations in the region, creating the blueprint for HEMS across the ASEAN states.
Ultimately, my wish for Thailand is that the Kingdom finds itself in the enviable position we find ourselves in across Europe; fortunate enough to take HEMS for granted whilst going about our daily business, knowing the very best care is only minutes away giving us the greatest chance of survival.