Saving lives in Saudi Arabia with Alpha Star
AirMed&Rescue spoke to John ‘Jay’ Paladino, Air Medical Consultant for Alpha Star Air Ambulance – the only commercial helicopter emergency medical service (HEMS) provider in the Kingdom of Saudi Arabia
Can you detail your fleet – what aircraft does Alpha Star operate?
Alpha Star operates two Hawker 900XPs in full ICU configuration, an Airbus A320 with a one-to-four patient capacity, and a Gulfstream G450. Additionally, we have an ATR42 and ATR72 that can be converted to hold 10 patients each, specifically for mass-casualty missions or for larger patients up to 700 pounds. To date, thankfully we have not had to use this capability.
We are also working with our sister company, The Helicopter Company (THC), which I also work for, to establish the first commercial HEMS aircraft in NEOM, a ‘cognitive and smart city’ announced in 2017. We have a Leonardo AW139 to provide a commercial HEMS response and transport for the NEOM Project that started in September 2021. This is the first commercial HEMS aircraft in the Kingdom operated by a Saudi operator.
The SAR landscape in NEOM will involve land and sea and covers several remote tourist destinations as well. It will be very interesting to see how this city (and program) develop.
The Saudi government provides some SAR support, albeit in a limited capacity. What are the most frequent types of missions flown by Alpha Star?
Intra-facility transports within the Kingdom of Saudi Arabia (KSA) is the most common mission for us, moving patients to specialized or higher levels of care.
We have started providing regional commercial charter missions, which typically involves moving expats from within KSA back to their home countries. Alpha Star is currently transporting US embassy personnel and families from KSA and surrounding Gulf Cooperation Council countries.
We work with several government facilities that provide specialty care. For example, in Riyadh, there are two facilities that we support for ECMO missions. Both are run by the Ministry of Health.
We started commercial operations in 2020 and at present we support regional countries. Covid has decreased our range as we try not to overnight crews outside KSA to avoid PCR tests, lockdowns, etc., so mainly, we are out and back.
The Saudi landscape is more complex than some might think. Is there any specific training or skills required before flying in the country?
There is a lot of regulation when flying in KSA due to the ongoing conflict with Yemen. As such, all our crews are trained in local area ops before being released to fly.
What qualifications do the medical crew need to work for Alpha Star?
Our staff are required to have a minimum of three years prior critical care transport or EMS experience, as well as either the Flight Paramedic Certification from the International Board of Specialty Certification or Certified Flight Registered Nurse specialization.
Our crew members also annually attend the University of Pittsburgh Center for Emergency Medicine, which includes field flights with STAT-Medevac. We also pride ourselves on fielding crews that speak Arabic, Hindi, and English.
With Alpha Star being the first commercial HEMS operator in KSA for a long time, Is Alpha Star primarily recruiting from KSA or internationally? Where are they getting their flight experience from, besides the FP-C/CERN?
We are the first and only KSA-based commercial operator to fly helicopters for HEMS inside KSA. Other programs before were US operators flying here. We recruit our staff from US for expats and yes, we hire lots of locals. The talent pool here for paramedics has expanded greatly and we see several of the paramedics holding the FP-C certification. As for experience, they do not get flight experience as these programs are limited. Most medics come to us from either the local EMS system or specialty hospitals that provide Critical Care Transport services (Ground).
Can you give us more information on the medical equipment? What stretchers, hoists, hooks, defibs, infusion pumps? What devices are you using to monitor patient conditions?
At present we use the Hamilton T1 Ventilator, Zoll X-Series monitor/defib and several Braun IV/Infusion pumps. We recently just upgraded our Isolette to a new Airborne Voyager that was custom made to fit our aircraft and our operations. It includes Nitric as well. We use Spectrum medical interiors for the fixed wing aircraft, and Air Ambulance Technology dedicated EMS interiors for the rotary operations. We also have five Iso-Pods for Covid patient transports.
For our commercial medical escort services, we tend to carry an Ingogen G3 Portable Oxygen Concentrator, Tempus Pro Monitor, and full medical kits.
Alpha Star is reportedly the only commercial HEMS program in Saudi Arabia, following the closure of PHI in 2016. What has been your motivation to provide HEMS, and why has there been such a long gap?
Our motivation is public service. There is a long history of commercial HEMS in KSA – since PHI closed in 2016, there was no commercial HEMS response in the entire Kingdom, besides fixed-wing service from outlying rural facilities to tertiary care facilities. I think it is due to government restrictions, as helicopters within KSA were all previously operated by the government. This is changing with the 2030 vision to privatize most government operations.
Now, the commercial HEMS program is a partnership between THC and Alpha Star. THC owns and operates the aircraft and Alpha Star provides the medical crews, and both companies are owned by the KSA Public Investment Firm. With KSA committing to opening up to tourism, we wanted to fulfil a much-needed service.
What impact has the Covid-19 restrictions had on Alpha Star’s operations in KSA?
Covid has limited our commercial operations with regards to fixed wing transports. The constantly shifting regulations across several countries, some changing weekly, have occasionally prevented us from completing several missions. We could not risk a crew getting stuck somewhere.
Are you able to provide details about the missions that were impacted by the restrictions? Which countries did Alpha Star have the most difficulty with? What happened to the patients in missions that couldn’t be completed?
Europe was really a difficult place during the height of Covid. Regulations constantly changing and PCR testing made it difficult to complete these. For patients we could not transport, we saw European operators completing the missions with larger aircraft and heavy crews. With the Hawker, we would require an overnight or have to send pilots forward on commercial planes. This proved difficult with flight restrictions as well. So basically, we just stayed regional to avoid any issues.
Can you tell us about a particularly memorable mission?
While every mission for us makes a difference here, in 2021 we have really focused on neonatal and pediatric missions as we saw a sharp increase in these transports. We invested in a new Airborne Isolette for these cases as we previously lacked the level of equipment needed, as well as provided additional training to our crews. We also partnered with a US neonatal consulting group to provide medical direction for these missions. As such, I’m proud to say Alpha Star is the only air ambulance NICU transport team in the country.