The operating models and their
suitability in India
Air ambulance services, are provided by a
variety of different models in different
places in the world. These models are
primarily differentiated by their mode of
funding. The most common models are
donated by a business enterprise, or
funded by public donations.
Government funded models are financed
by the government either out of a specific
fund or under the general health care
budget. The helicopter services are either
The patient's only hope provided by the state or are outsourced to
a commercial provider. The government
often lays down a rigid set of rules that
govern the use of helicopters for both
Helicopter Emergency emergency ser vice providers and
operators to keep costs in check. The
Scotish Ambulace Service and Polish LPR
Services in India
are examples of this model!
One often gets the sense that when
organizations make the plea for a HEMS
service in India this is the model in mind.
Given the current state of the Indian
H elicopter emergency services
are touted to be the next biggest
thing to hit the Indian
helicopter market. On the face of it, the
logic looks simple, in the hinterland there
origins in the military, and the concept of
using aircraft as ambulances is almost as
old as powered flight itself. During the
First World War air ambulances were
tested by various military organizations,
healthcare system this would be a case of
buying the cart before the horse.
The Indian government may decide to
fund HEMs services in a few regions but it
are areas where connectivity by road is at and were used regularly for crash rescue. remains to be seen if it can build a funding
best patchy, to get to hospital by land In 1928 the first formal, full time air model to boot !
usually requires an arduous trek over dirt ambulance service was established in the Fee-for-service
tracks to get to a road and the grueling Australian outback. This organization
journey there on. Our roads are the became the Royal Flying Doctor Service The cost of providing air ambulance
world's most unsafe roads! Every hour 14 and continues operating to the present. services is considerable, and many such
people under the age of 29 die on Indian services, including government-run ones,
These services however were fixed wing charge for service. However most of these
roads! Then there are the cities, where it is centric and it was not until the 1970s that
impossible to get an ambulance from the tend to be privately owned companies,
helicopters first began appearing on the such as aircraft charter companies,
hospital to a patient's house and back in emergency services scene. First used as
less than 2 hours! So clearly there is prima hospitals, and some private-for-profit
pilot projects based on government- EMS systems. Within the European
face a strong case for HEMS in India. funded grants, their utility in cutting down
Sadly this may be the case only in a utopian Union, almost all air ambulance service is
response times quickly became apparent. on a fee-for-service basis. Though not
world. Today helicopters form and integral part controlled by it, the government regulates
A brief history of Air Ambulances of the EMS infrastructure of developed the private HEMS industry. Rega a famous
countries. The over eight hundred Swiss Air Rescue service works on this
As with many innovations in Emergency
emergency helicopters operating in the model.
Medical Service (EMS), the concept of
United States are testament to this fact.
transporting the injured by aircraft has its A growing number of Indians now have
FIP JOURNAL |24|
the purchasing power to pay for HEMS robust business model that can capture the crews to push the safety envelope. Pilots
services. Given the density of population, right market and the right audience. Given often land in unfamiliar surroundings, in
metro cities would be a good place to the high cost of operations, HEMS the middle of expressways and highways
start. operations will first target the upper or in neighborhood parks. Helipads where
CSR funded classes and then filter down. Based on this available are to exactly to size. Flying is
premise it is fair to assume that the first usually at low levels often in areas with
Companies may choose to fund local air such HEMS operator would be based features rising high above ground level.
ambulance service as a goodwill or public either in Mumbai or Delhi. However even These factors when combined with the
relations gesture. These models are for this to happen a number of regulatory need to save time and push on in
especially popular in Europe. In London changes would have to come about! The unfavorable conditions makes HEMS
the Virgin Corporation funds the use of makeshift helipads, IFR operations, flying an extremely dangerous
Helicopter Emergency Medical Service, maintenance and FDTL limitations are proposition. No surprise then that the
and in Germany and the Netherlands a some of the topics that would need to be HEMS fatal accident rate is 1.18 per
large number of air ambulance operations addressed. 100,000 hours in the compared with 1.00
are funded by ADAC, Germany's largest for other turboshaft helicopters in the US.
automobile club. The next major hurdle is that of
The next major hurdle for HEMS
Contracts for EMS provisions are operators in India is likely to be crowd
structured in a three-way agreement control. In a country so densely populated,
between the sponsor, the EMS provider For all the noise that it being there is often a sea of people at a given
and the government. In most cases, while made around the HEMS accident site, helicopters are by nature
the sponsor receives advertising exposure fascinating and the general public with its
in exchange for funding, they take a 'hands concept and its inquisitive nature and disregard to safety is
off' approach to daily operations, relying applicability for India, there bound to get hurt sooner or later by
instead on subject matter specialists. straying too close to the machines.
has to be a set of
There are a number of corporate houses HEMS pilots in developed countries are
with the pockets to sponsor such services, organizations that back it
permitted to operate under IFR rules since
but it remains to be seen if they would like and are willing to invest the the ability to get to a patient is critical.
to associate with negative events. Also the Should the DGCA deem fit to relax its day
value proposition of advertising space
required resources to bring
VFR only ruling for helicopters, there
may be difficult to sell if the helicopters this concept to fruition would be a sudden void of qualified pilots,
have to fly above 1000 feet. procedures and equipment.
Public donations infrastructure, at the moment there are no Conclusion
In some cases, air ambulance services may hospitals that have a functional helipad. Helicopter Emergency Medical Services
be provided by means of voluntary Building such infrastructure requires not are in India a chicken and egg situation.
charitable fundraising, as opposed to just capital but dealing with large amounts The private industry has to take the first
government funding, or they may receive of red tape. step and present a credible model to the
l i m i t e d g ove r n m e n t s u b s i d y t o In addition the government would have to regulator to set the ball rolling. Therefore
supplement local donations. Some ensure a conduce environment for general for all the noise that it being made around
countries, such as the U.K., use a mix of aviation. There have been a number of the HEMS concept and its applicability for
such systems. problems with the Juhu heliport that range India, there has to be a set of organizations
Given the growing middle class it may be from a lack of space to exorbitant rents. that back it and are willing to invest the
possible to have such a model in place a HEMS operations have to be cost required resources to bring this concept to
few years down the line. Getting such a competitive to deliver services to a section fruition.
venture off the ground may be easy but it of society that would not ordinarily If the state could create a conducive
will have to touch a large number of lives charter helicopters. environment to save human lives would
in a short span of time to become self There would also be a need to import, at Indians be willing to pay the price. The
sustaining. least to begin with, the required skill sets answer is a resounding yes, but getting the
Execution Challenges for delivering the model on ground. machinery to move is another matter.
The first step to bringing a sustainable Operational challenges
HEMS solution to India is in developing a The nature of HEMS operations requires
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