Helicopter Transport

The history of air evacuation is closely connected to the history of warfare. Igor Sikorsky's invention, the helicopter, first flown on September 14, 1939, was used for the first rotor-wing medical evacuation in Burma in 1945. From this small start in World War II, helicopter usage blossomed extensively in the Korean war, when more aircraft of sturdier construction were available. About 20,000 patients were transported by helicopter in the Korean war. During the Vietnamese war, about 370,000 patients were carried by helicopter from 1965 to 1969.

The first hospital-based civilian program began in 1972 in Denver. Currently, there are 385 air medical service providers identified by the Association of Air Medical Services (AAMS), 362 domestic and 23 international.1 Most of these programs are run by hospitals or groups of hospitals. Helicopters are expensive, ranging from $750,000 to $5 million. Because of the high cost of purchase, maintenance, and pilot training, most programs lease their helicopters from aircraft vendors. In this arrangement, the air medical program provides the medical personnel (paramedics, nurses, physicians, and dispatchers) and medical supplies, while the aircraft vendor supplies the helicopters, pilots, and maintenance personnel. The annual cost of operating a rotor-wing service typically exceeds $2 million.

For safety reasons, air medical services have increasingly moved toward using two-engine helicopters with instrument flight rating (IFR), rather than single-engine helicopters with visual flight rating (VFR).2 Twin-engine helicopters have greater lifting capacity, range, and speed. They are also safer if one engine fails in flight; the helicopter can make a more controlled landing on the remaining engine. Under similar conditions, a single-engine helicopter must make an autorotation landing with a dead engine. A VFR aircraft can only fly with good visibility, whereas an IFR craft can fly under conditions of poorer visibility. Both VFR and IFR helicopters have strict visibility limitations imposed by the Federal Aviation Administration (FAA), but the IFR helicopter has fewer restrictions. If the pilot unexpectedly encounters bad weather during a flight, an IFR helicopter has a better chance of successfully (and safely) completing the mission than does a VFR helicopter. 3 In areas with frequent bad weather periods, some programs have elected to use two-pilot IFR.2 The addition of more sophisticated equipment, a second pilot, and a second engine increases both initial and ongoing costs for a helicopter air medical program.

As technology becomes increasingly available to civilian aviation, air medical services often incorporate the newer avionics. A survey from 115 domestic air medical services found that 78 percent of services were using the gobal positioning system (GPS) in 1997. 2

A survey of 126 United States air medical programs found that the mean number of patients transported in 1997 was 827 per program; this figure has been generally stable since 1992.1 Programs that responded to this survey were generally the larger programs. Total estimates of annual air medical transports are in the range of 150,000 to 300,000 patients.

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