A Flying Life

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It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including rotary-wing , fixed-wing , or very large aircraft. The military role in civilian air ambulance operations is described in the History section.

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Each of the remaining models is explored separately. It should also be noted that this information applies to air ambulance systems performing emergency service. In almost all jurisdictions, private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis. In some cases, governments provide air ambulance services, either directly or via a negotiated contract with a commercial service provider, such as an aircraft charter company.

Such services may focus on critical care patient transport, support ground-based EMS on scenes, or may perform a combination of these roles. In almost all cases, the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. However, the government almost always takes a 'hands-off' approach to actual running of the system, relying instead on local managers with subject matter physicians and aviation executives expertise.

In the United Kingdom, the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. These represent the UK's only government-funded air ambulance service. In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required.

In southern New South Wales, Australia, the helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the New South Wales Ambulance Service providing paramedics, as required. In some cases, local EMS provides the flight paramedic to the aircraft operator as-needed.

In the case of the Los Angeles County Fire Department the helicopters are brush fire choppers also configured as air ambulances with a paramedic provided from whichever fire department rescue unit has responded. Sometimes the air ambulance may be run as a dual concern with another governmental body - for example the Wiltshire Air Ambulance was run as a joint Ambulance Service and police unit until In other cases, the paramedic staffs the aircraft full-time, but has a dual function.

In the case of the Maryland State Police, for example, the flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies.

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In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. However, the cost of providing air ambulance services is considerable and many, including government-run operations, charge for service. Organizations such as service aircraft charter companies, hospitals, and some private-for-profit EMS systems generally charge for service. Within the European Union, almost all air ambulance service is on a fee-for-service basis, except for systems that operate by private subscription. Many jurisdictions have a mix of operation types.


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Fee-for-service operators are generally responsible for their own organization, but may have to meet government licensing requirements. Rega of Switzerland is an example of such a service.


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In some cases, a local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. In these cases, the operation may vary, but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor.

In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a 'hands off' approach to daily operations, relying instead on subject matter specialists. In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as the U.

https://bergenahol.tk In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service. In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered. This organization is widely credited for having created the political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom.

In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities commissioning clinical governance services, however many air ambulances operate under the tasking ambulances services clinical governance. The AAA now publishes Best Practice Guidance on a range of operational and clinical functions and provides a code of conduct that all full members, both ambulance services and charities must uphold.

A final area of distinction is the operation of large, generally fixed-wing air ambulances. In the past, the infrequency of civilian demand for such a service confined such operations to the military, which requires them to support overseas combat operations. However, in recent years, exceptions to the "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care, or to repatriate individuals.

Air medical companies use both large and small fixed wing aircraft configured to provide levels of care that can be found in Trauma centers for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans. German Air Force Airbus A In most jurisdictions, air ambulance pilots must have a great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services.

After a spike in air ambulance crashes in the United States in the s, the U. Some air ambulance companies, realizing it is virtually impossible to have the correct medicalized aircraft for every mission, instead charter aircraft based on the mission-specific requirements. While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation to be licensed to operate. This is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights.

The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is checked on a continual basis by the accrediting organization. Accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport, with considerable input from all disciplines of the medical profession. Other U.

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The code goes further with an expectation of mutual support and working within its policy and best practice guides. The nature of the air operation frequently determines the type of medical control required. In most cases, an air ambulance staffer is considerably more skilled than a typical paramedic, so medical control permits them to exercise more medical decision-making latitude. Assessment skills tend to be considerably higher, and, particularly on inter-facility transfers, permit inclusion of functions such as reading x-rays and interpretation of lab results.

This allows for planning, consultation with supervising physicians, and issuing contingency orders in case they are required during flight. Some systems operate almost entirely off-line, using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. Some air ambulance operations have full-time, on site medical directors with pertinent backgrounds e.

Most aircraft used as air ambulances, with the exception of charter aircraft and some military aircraft, are equipped for advanced life support and have interiors that reflect this. The challenges in most air ambulance operations, particularly those involving helicopters, are the high ambient noise levels and limited amounts of working space, both of which create significant issues for the provision of ongoing care. While equipment tends to be high-level and very conveniently grouped, it may not be possible perform some assessment procedures, such as chest auscultation, while in flight.

In some types of aircraft, the aircraft's design means that the entire patient is not physically accessible in flight. Additional issues occur with respect to pressurization of the aircraft.

Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins, and those that do typically tend to be pressurized to only 10, feet above sea level. These pressure changes require advanced knowledge by flight staff with respect to the specifics of aviation medicine, including changes in physiology and the behaviour of gases. There are a large variety of helicopter makes that are used for the civilian HEMS models.

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Due to the configuration of the medical crew and patient compartments, these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. Additionally, helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10, feet above sea level.

Beginning in the s, the number of air ambulance crashes in the United States, mostly involving helicopters, began to climb. By , this number had reached a record high. Crash rates from to more than doubled the previous five year's rates. As a result, nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes.

Whilst some air ambulances do have effective methods of funding, in the UK, they remain almost entirely charity funded, as improved cost-benefit ratios are generally achieved with land based attendance and transfers. Health outcomes, for example from London's Helicopter Emergency Medical Service , remain largely the same for both air and ground based services. In Australia, where aeromedical retrieval medicine is a well-established medical field, retrieval doctors must be experienced in a critical care specialty i. Flight Paramedic — A licensed paramedic with additional training as a certified flight paramedic FP-C.

The flight paramedic is usually highly trained with at least 5 years of autonomous clinical experience in high acuity environments of both pre-hospital emergency medicine and critical care transport. Some hold certificates as instructors in various fields and educational topics. Flight Nurse — a nurse specialized in patient transport in the aviation environment. The flight nurse is a member of an aeromedical evacuation crew on helicopters and airplanes, providing in-flight management and care for all types of patients.

Other responsibilities may also include planning and preparing for aeromedical evacuation missions and preparing a patient care plan to facilitate patient care, comfort and safety. Civilian flight nurses may work for hospitals , federal, state, and local governments, private medical evacuation firms, fire departments or other agencies.

They have training and medical direction that allows them to operate with a broader scope of practice and more autonomy than many other nurses. Some states require that flight nurses must also have paramedic or EMT certification to respond to pre-hospital scenes. The military flight nurse performs as a member of the aeromedical evacuation crew , and functions as the senior medical member of the aeromedical evacuation team on Continental United States CONUS , intra-theater and inter-theater flights - providing for in-flight management and nursing care for all types of patients.

Other responsibilities include planning and preparing for aeromedical evacuation missions and preparing a patient positioning plan to facilitate patient care , comfort and safety. Flight nurses evaluate individual patient's in-flight needs and request appropriate medications , supplies and equipment , providing continuing nursing care from originating to destination facility.

They act as liaison between medical and operational aircrews and support personnel in order to promote patient comfort and to expedite the mission, and also initiate emergency treatment for in-flight medical emergencies. Transport Therapist — A highly trained respiratory practitioner also called a respiratory therapist , typically utilized in long-distance transport situations, though able to provide care during shorter transfer.

From Wikipedia, the free encyclopedia. Airco DH. Mobiel Medisch Team - Netherlands. Main article: Flight nurse. Main article: Respiratory practitioner. Amer College of Surgeons. Ann Emerg Med. Fatal crashes provoke debate on safety of sky ambulances. New York Times, February 28, Surge in crashes scars air ambulance industry. USA Today, July 18, Retrieved: December 4, Gazette and Herald. Retrieved 1 February Vertical Magazine. Retrieved 22 April Retrieved: November 12, January 25, Here, he shares his wisdom from the cockpit. On arrival into Manchester on his final flight, from Cancun, Steve was greeted by the surprising sight of his son, Dan, marshalling him to his gate.

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Dan had to undergo special training to be able to take part in the farewell treat, but is no stranger to the industry, being a Thomas Cook captain himself. It may not feel it to passengers but Steve says landing a plane at some of the more tricky airports on the planet injects a little excitement into the job. We urge you to turn off your ad blocker for The Telegraph website so that you can continue to access our quality content in the future. Visit our adblocking instructions page.