An Cosantóir

www.military.ie THE DEFENCE FORCES MAGAZINE | 15 Having been fortunate enough to be involved from the very beginning of the service, this is my own experience of flying HEMS in Ireland. WHAT IS HEMS AND WHY IS THE MILITARY DOING IT? The short answer is that HEMS or Helicopter Emergency Medical Services allow clinical care to be delivered to scene of illness or injury at speed and allows patients to be moved from areas that would otherwise be too distant from defini- tive care or inaccessible by land. HEMS is usually broken down into three types of calls: Primary, Secondary and Tertiary Calls. A Primary Call is when the aircraft is tasked before any other emergency service has reached the scene i.e. help is also on the way in the form of an ambulance but it's far away. Secondary HEMS is when an ambulance crew or other clinical practitioner is at scene and decides that HEMS is needed. To a pilot, there's really no difference between the two except that the Advanced Paramedic will probably be longer at scene in a primary call if we arrive before everyone else, as the patient hasn't been treated yet. Tertiary HEMS is either the prearranged or short notice transfer of a patient between two medical centres. This last category is also vari- ously called Air Ambulance or IHT, Inter Hospital Transfer, and is usually but not always the most benign category of aeromedical job to fly. But why use a helicopter at all? Treating patients at scene and moving them to hospital is surely ambulance work, right? Sure, it is. And if everyone lived beside a hospital with every conceivable medical treatment available that would work just fine. However, most hospitals will have a certain amount of skillsets and services available and outside of that you will probably be looking at initial treatment at the nearest centre, before being subsequently moved to defini- tive care. So, if you need, for example, cardiac care and you live in Galway City, good for you! If you need cardiac care and you live in Clifden, well let's hope you make it through the journey of over an hour on secondary roads. Using a helicopter can overcome some of the problems with this scenario, which is replicated all over the country. A helicopter doesn't mind about potholes, it doesn't worry about the icy roads or flooding, and boggy or mountainous terrain is not much of an issue either. The travel time over any distance is remarkably shorter – 12 minutes in an AW139 vs over an hour in the example above – and what this means is that the chance of you being flown directly to definitive care – the care you need for your particular illness – is much higher. So, for example, you live in Galway but you don't need cardiac care, you have a severe isolated head injury. Now you need to go direct to Beaumont Hospital in Dublin. Instead of crossing the country by road, a helicopter will take you from West to East in just under an hour. WHY THE AW139? From an aeromedical utility standpoint, the real game changer of the 139 is the cabin: it's big, rectangular and modular. For purely CASEVAC missions, you can have four stretchers plus attendants. It can comfortably carry neona- tal kits with full medical teams and ample onboard oxygen. International air ambulances by day and night came within reach for No 3 and for the first time, we were able to pick up patients directly from Irish hospitals and fly them to the UK if that's what their clinical needs dictated. 'Big enough to carry a lot of people, fuel and equip- ment, but small enough to land just about anywhere. The 139 is in the Goldilocks zone of HEMS heli's.' For EAS, it means that we can carry all the clinical equip- ment we might need (the boot is fairly full in addition to the cabin space) a full crew, patient, a family member or medi- cal team and, critically, a full three hour fuel tank while still allowing an ample power margin. It's a 'smiles all around for everyone' kind of helicopter and the more I fly it the more I like it. Cruising at 150kts, the 139 brings almost the entire country within range of a PCI lab in less than 90 minutes for STEMI calls and even the most remote areas are not much further away than that. I mentioned earlier that we ended up doing jobs on EAS that were very different than anyone ini- tially expected. Some of those have been tasks that the 139 makes easy work of, while the EC135, as good a machine as it is, would definitely not have been able to carry out. People are alive who otherwise wouldn't be purely because of the quality this machine brings to the service. Disclaimer: Any per- sonal views expressed in this article are those of the author alone. This article first ap- peared in the Winter 2019 edition of Signal, the magazine of the Representative Associa- tion of Commissioned Officers, and is reprint- ed by permission.

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