Helicopter Emergency Medical Services (HEMS) in INDIA

1. Helicopter Emergency Medical Services (HEMS) in INDIA AIR COMMODORE BS SIWACH AVSM YSM VM ® SECRETARY GENERAL ROTARY WING SOCIETY OF INDIA

2. HELICOPTER EMERGENCY MEDICAL SERVICES (HEMS)

3. Mass Casualty Event Frequent occurrence of disasters. Extensive use of helicopters. Situation necessitates helicopters being available in the area. IAF Helicopter dropping the relief material at the flood affected areas in Gujarat on 3 July 2005 Floods are annual feature :IAF Helicopter in a Rescue Mission

4. A Case Study “At 5:46 a.m. on January 17, 1995, an earthquake (the Great Hanshin Earthquake) with a magnitude of 7.3 hit the western part of Honshu Island near Kobe, Japan and caused severe damage at numerous locations. Damage figures from this earthquake were over 6,000 dead; 36,926 injured; and 222,242 buildings destroyed. Exactly one year before the earthquake, at 4:31 a.m. on January 17, 1994, across the Pacific Ocean, another earthquake (the Northridge) with a magnitude of 6.8 shook the city of Los Angeles. Despite its scale, damage figures from the earthquake were relatively low, consisting of 61 dead, 9,348 injured and 5,800 buildings destroyed.

5. KEY DIFFERENCES IN HUMAN RESPONSE It is difficult to identify all of the factors that may have influenced the wide disparity in the extent of damage resulting from these earthquakes. However, it is clear that the human responses altered the level of damage significantly in each case. One of the biggest differences between the human responses in each case is the use of helicopters and the presence of heliports supporting those helicopters.

6. Effective Use of Helicopters In the case of Los Angeles earthquake, a helicopter from the Los Angeles Fire Department (LAFD) was airborne within four minutes of the quake to relay accurate information about the nature of damages. As a result of which effective use of helicopters was made in the early stages of fire fighting. LAFD helicopters conducted 21 flights dropping over 57000 litres of water on various sites in the early stages. In the case of the Kobe, on the day of the quake, only one helicopter was employed for disaster relief. Even though 38 helicopters were pressed into service by the fifth day, these were not available when it was critically required on the first day.

7. LESSONS • A lesson from these earth quakes at Honshu Island near Kobe and at Northridge, Los Angeles is that helicopter is the most effective device for emergency relief in the event of a disaster. • It also functions well as a vehicle for emergency medical services. The helicopter therefore, becomes not just a means of transportation but also an airborne intensive care unit, thereby, diminishing the duration of the therapeutic vacuum. The result is not simply a reduction in mortality or morbidity but also reduction in disability. • In the area of disaster preparedness, an essential element is in getting the helicopter services at shortest possible time.

8. Present Status • Helicopters of armed forces and paramilitary are employed to provide Air Evacuation. • Generally, armed forces helicopters are mobilized from the helicopter units located nearest to the location. • In many cases, helicopter resources if not available with in the state take as much as 24 to 48 hours to arrive in the scene. • State Govts opt to utilize the armed forces helicopters as the expenditure related to these spl flts is reimbursed from the central budget.

9. Building up Civil Helicopter Fleet • If helicopters of the Armed Forces are not committed, this arrangement is fine. • In case of a conflict situation, timely availability of helicopter resources for aid to civil may become difficult. • It is essential to strengthen the civil helicopter fleet and also have a programme to train the aircrew in the roles performed during disaster management. • Building up civil helicopter fleet can be very handy in creating reserve heli-lift capability especially during hot war situations

10. Do we have adequate number of Civil Helicopters to handle Air Evacuation? • Civil Registered Helicopter strength - 239 • Fleet Strength available for commercial use – 180 (including heavy duty helicopters which can handle large scale Air Evacuation tasks) (Note : Himachal Pradesh Govt. had effectively used the MI-172 helicopters during the heavy landslides caused during the monsoon in 2000).

11. Network of Heliports Essential Where feasible helicopter resources will need to be pre-positioned as close to the area which is likely to be affected. A net work of low cost helipads & refueling facilities are required to assist its usage.

12. Need for Heliports and Staging Areas • In Metros during disasters , response by ground vehicles is likely to be severely restricted due to congestion in roads . Heliports and staging areas should be developed for Air Evacuation • For roof top extraction, identification of suitable roof tops for use of helicopters is essential. • As the heliport gets closer to a metropolis, obstacle free locations are also difficult to find. In many countries heliport on top of a bridge is opted in crowded areas.

13. Air Evacuation: Mass casualty Incident PREPAREDNESS • Suitable policies in place • Necessary equipment including Helicopters modified for EMS & Air Ambulance roles • Trained personnel including Aircrew, Paramedics and Technicians • Infrastructures including Public Use Heliports, Roof Top Helipads, Refueling Facilities

14. Why Transport by Helicopter? Trauma (Golden Hour) Cardiac (Time is muscle) Strokes (Time costs brain cells) High Risk OB/Neonatal Organ Transplants Remote Area Saving time… Saves lives

15. Overview of EMS System ‘Appropriate’ Hospital Air Ambulance Ground Ambulance First Response Level of Care Increases as the Patient Progresses in the System

16. EMS System • Air Ambulance (Criteria for activating helicopter) • Multiple patients • Remote access • Traffic congestion • Severity of injuries exceeds capability of smaller hospital “Golden Hour” • Appropriate Hospital • Emergency Department • Specialist Available 24 Hrs/Day • Invasive Treatment, Recovery and Rehab A Totally Integrated System Saves Time – Saves Lives

17. Benefits • Improves Patient Care • Reduces Health Care Costs • Extends Geographical Reach of Specialized Medical Centers • Increases Patient Survival and Recoverability Helicopter Saves Lives

18. Challenges for India Large Rural Population and Congested Urban Areas High Tech Hospitals only in Urban Centers Small percentage of insured population Specialty Hospitals Qualified Paramedics Growing Middle Class Rising Expectations Growing Tourist Population - Requires Robust Healthcare System HEMS will require some level of Government Support Challenges Creates Opportunities

19. HEMS HAL Manufactured Dhruv

20. HEMS REQUIREMENTS • Cabin Space for stretcher patients& medical attendant / doctor. • Telemetry facility for medical data, for expert advice from the Specialists in the hospitals if possible. • cabin should be well lit and aided with Intercom facility for the doctor to communicate with the medical attendant. • The medical equipment rack should house a Comprehensive monitor to monitor the patient's BP, ECG, temperature etc. Hand held pulse oximeter to monitor the patient's oxygen content in the blood, and an Emergency medical kit for treating the patient. • A Defibrillator for defibrillation of patients and monitoring, a ventilator with oxygen cylinders for supply of air/oxygen or mixture of the two to the patients. Infusion pump for infusing liquid at a required rate and in large volumes, Syringe pump to administer drugs in small volumes and a Suction apparatus to remove waste fluids from the patient. • Seats designed to traverse longitudinally to a suitable position for treatment of the patients.

21. Various Types Available for Air Ambulance Role MI-172 s - over 26 passengers or 12 stretcher patients in ambulance version. It is possible to evacuate up to 1200 people per hour from high rise rooftops to nearest safety areas /helipads in a heavy duty helicopter. High density packing of occupants is permissible. Dhruv - 14 passengers or 2/4 stretcher patients and 4 sitting casualties in ambulance version. Dhruv Air Ambulance version

22. Role for Specialised Helicopters In densely populated cities, specialised helicopters will be able to perform missions such as • Emergency Medical Services and • Air Ambulance Efforts EMS

23. Recommendations • It is important that the Disaster Management Plan integrates helicopter fleet of Defence , paramilitary forces and civil into the response plan in every state. • For quick response ,the civil helicopter resources available in the state should be incorporated, so that it can rapidly self deploy in the event of a disaster. • NDMA should consider inducting civil registered commercial helicopters for handling the following roles:- • Emergency Medical Services and • Air Ambulance

24. Recommendations • For Mass Air Evacuation from high risk population centres, suitable public use heliports may be constructed preferably on higher ground, away from possible flooding. • For roof top extraction, identification of suitable buildings with roof tops for use by helicopters is essential. • Periodic Air Evacuation drills from public use helipads and roof tops would help build efficiency amongst the operating crew besides building awareness amongst people on the use of it. • NDMA ,State Govts should co-opt professional agencies like RWSI in the identification of suitable sites for public use heliports and suitable buildings with roof tops for use by helicopters. Its services can also be availed in building awareness related to Mass air evacuation process amongst people.

25. Thank you Remember. . .Helicopter Saves Lives