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The aeromedical programs of West German
International Profile
The Aeromedical Programs of West Germany by Barney Green tD O O
IN ¢-
-r
O ffl e-Q.
O tO.
A BO-105 aeromedical crew stationed in Freiburg displays some of the equipment carried aboard their aircraft.
A couple of years before Denver's "Flight For Life," West Germany's "Rettungshubschrauber" made its debut. Both Rettungshubschrauber and Flight For Life are hospitalbased helicopter aeromedical transport services. Both specialize in rapid response to traumatic injury or illness. Both are instrumental in the saving of lives, alleviation of suffering, and reduction of time-in-hospital. Other than these basic purposes, there is little similarity between the two systems. West Germany is about the size of the U.S. state of Oregon, but twice the size of Pennsylvania. The country has five times the population of Pennsylvania, however (more than 60 million people) and more than three times the number of aeromedical helicopters. Rettungshubschrauber is the name given to the 35 hospitalbased helicopters and stations located throughout the Federal Republic of Germany. Although it is a national EMS program, the federal government exercises a limited direction or control over the countrywide operations, with most federal participation coming in the role of a contributor. The individual states within the republic, through the State Office of Internal Affairs, and sometimes the counties within the state, carry the responsibilities for the designating of stations within each respective state. In deciding the location of stations, the primary objective is to give each station a 50 km (31 mile) radius of operation and placed so that throughout the country there are no areas without protection of the Rettungshubschrauber canopy. Each state has established its own 6 HOSPITALAVIATION,MARCH 1987
regional dispatch center, designates which of four contributors will be the helicopter operator, and determines which hospital will employ or sponsor flight physicians. Individual states also enact legislation, establish regulations and guidelines to govern operations, and monitor and enforce those regulations pertaining to operations within the respective state. Each state also covers all costs associated with the placing of stations Within its boundaries, including costs for personnel accommodations and hangaring and refueling facilities.
ADAC, the West Germany automobile club, operates 8 of the country's three dozen EMS helicopters, including this BK-117.
Four contributors. The 35 Rettungshubschrauber helicopters, called "Christoph" helicopters, are provided by four separate entities within the republic. These are: 1. KATASTROPHENSCHUTZ, the federal, national disaster preparedness program. 2. ADAC, The German Automobile Association, a private, nonprofit, membership support organization. 3. SAR, the designation given to German military units participating in the system. 4. DRF, Deutsch Rettungsflugwacht, the German Air Rescue organization. Katastrophensehutz This is a nationwide emergency service set up by the federal government to respond to any disaster related need. It is not a military unit, but one dedicated to serving the public whether the need might be civilian or military. When not engaged in national disaster activities, the 17 Katastrophenschutz helicopters are committed to full time service in the Rettungshubschrauber system. The federal government owns the Katastrophenschutz helicopters, and dedicates them to the Rettungshubschrauber system. The pilots manning these "Christoph" helicopters are supplied and paid a salary by the Bundesgrenzschutz, the federal border police. The designation "Christoph" is given to all Rettungshubschrauber helicopters and each one is numbered to correspond with the region in which it is working. SAR SAR provides the military helicopters
International Profile occupying six stations within the Rettungshubschraubersystem. These units comprise the major part of HTG (Wing) 64 of the Luftwaffe. Approximately 90% of Wing 64's aeromedical missions are flown for Rettungshubschrauber. These helicopters and crews provide a valuable public service, and at the same time the operation serves as a recurrent and ongoing training program for the pilots and military medical teams. DRF The German Air Rescue is a private, non profit organization set up to build a national and international high quality aeromedical EMS network. DRF provides helicopters for five of the Rettungshubschrauber stations. It operates its own fully dedicated Lear 35, Lear 25, and Merlin IVoC fixed wing aircraft with United States registration to fly the Allied corridor into West Berlin. In addition, DRF has developed a second national net of aeromedical helicopters dedicated solely to interhospital transfer over long distances or for less than urgent cases. ADAC The ADAC is the national automobile association of which most West German drivers are members. The association's interest in promoting automotive safety and good driving practices spilled over into the support of aeromedical transport services. The ADAC provided the first "Christoph" helicopter and financial support that was the beginning of today's impressive network. ADAC provides seven chartered helicopters to cover as many Rettungshubschrauber stations, plus providing the financial administration for those 17 helicopters and stations operated by Katastrophenschutz. The ADAC formed an affiliate air rescue company, ADAC Luftrettungs GmbH, specifically to handle its EMS activities. All Christoph helicopters are either owned or leased/chartered by their respective helicopter operators/contributors. On occasion, aeromedical missions take the Christoph helicopters across the borders of neighboring countries, as needs dictate. Helicopters from Belgium, France, Switzerland and Austria also penetrate into Germany. It sounds like a real good neighbor policy. History "Of course, the German Rettungshubschraubersystem has many fathers," said Dr. Heinzpeter Moecke, Medical Director of the Hamburg station. "To me, the first sincere experiments were conducted by Dr. Feder in the Frankfurt area during September of 1967. Other regional experiments followed during the
next few years at Mainz, Nurnberg and Munich." "Today's system," continued Dr. Moecke, "was started by an initiative of ADAC in Munich in 1970. They used for the first time the BO-105 for this purpose. During the following years, the DRF, Katastrophenschntz and the SAR followed." "In giving credit for the development of this system, one person should be mentioned expressively," concluded Dr. Moecke. "The architect Siegfried Steiger founded a nonprofit organization after a fatal accident took the life of his son, Bjorn Steiger Stiftung. His objective was to raise money to improve the national EMS system and to publicly promote a better system. When the Rettungshubschraubersystem ran into
early political and financial difficulties, Herr Steiger founded, together with others, the DRF. From the beginning, he has been its president and principal supporter on a voluntary basis." Rettungshubschrauber aircraft According to Dr. Moecke, the helicopter used at most of the stations is the BO-105, in a variety of medical configurations. Each state determines the medical configuration to be installed and used in helicopters operating within its boundaries. Also used in this service are the Bell UH1D, Bell 212, and the BK-117. The Bell 206L is sometimes used as a backup helicopter. "It looks like there will be a rescue
Complete EMS H e l i c o p t e r Services... O u r o n l y business! At EMS Helicopters, Inc., EMS is our only business. Our experienced
staff is committed to providing , = complete EMS service--from / assistance in selecting the right helicopter for your needs, to total program support. EMS Helicopters is organized to provide full service
to hospitals with start-up assistance, training of hospital staff, marketing support in the community, experienced IFR pilots, and mechanics skilled in the hospital/aeromedicat environment. For complete EMS helicopter services, call or write today.
EMS H E L I C O P T E R S , INC. 800-854-7170 (except California) Corporate Office: P.O. Box 277, Laguna Beach, CA 92652, 714-497-6816 Eastem Office:
1-800-633-3818 (Except PA)
HOSPITALAVIATION,MARCH1987
International Profile knowledge, out of the 15 people killed, seven died during accidents not related to the Rettungshubschraubersystem." Flight minimums are for VFR day: 800 m (about .5 mile) visibility with a ceiling 500 ft above the highest obstacle enroute. Night flying VFR requires 5000 m (about three miles) visibility and a ceiling of 1000 ft, twin turbine aircraft only. IFR flights are permitted only above 5,000 ft from airport to airport. "Instrumentation of helicopters varies from operator to operator," said Dr. Moecke. "The same is true concerning minimum standards, e.g. ADAC and DRF have stricter regulations than SAR, such as no single turbine flight at night. No scene flights are performed after sunset, but hospital to hospital transfers are reluctantly done at night." The dispatch center offers the latest in electronic and computer-aided communications systems. helicopter station established in West Berlin in the near future," said Dr. Moecke. "Well informed sources' say the four allies have no objection to this project which will be sponsored by the DRF utilizing a BO105 with American registration." Rettungshubschrauber cost recovery Program costs not covered by the state are apportioned to a county agency which acts as the financial administrator for each station within its boundaries. Some of the operating costs are paid by the county and some are absorbed by the helicopter operator. "Most of these costs are reimbursed by health insurance companies which pay a fee per flight minute, or a fixed mission fee," said Dr. Moecke. "There is no out-ofpocket charge to the patient." Personnel salaries are paid by the respective employers. Pilots are paid by the helicopter operator, physicians and nurses by their hospital, and EMTs by their
regional ambulance organization, such as the Red Cross. Federal regulations require an EMS qualified physician and an assistant, either a nurse or EMT, to accompany every aeromedical mission. Statistical information Statistics furnished by the German Federal Aviation Authority show that from 1973 to 1985, 24 flight accidents occurred during aeromedical rescue missions. Six were fatal accidents in which 15 people died. In 11 other accidents, the helicopters were damaged extensively and 15 people were seriously or critically injured. According to GFAA records, the accident rate during this period was 1.23 accidents per 10,000 missions. "Since the federal authority does not distinguish between primary rescue flights or missions flown by other operators with a patient on board, our figure is probably smaller," said Dr. Moecke. "To my
Hangar and on-site refueling facilities are provided ior many helicopters. 8 HOSPITALAVIATION,MARCH 1987
A narrow country road provides the best landing area to assist a patient being transferred from a freighter. In 1986, the 35 Rettungshubschrauber helicopters completed 30,276 missions, treating 26,101 patients. Patients treated at the scene and transported by helicopter numbered 8,738, while another 11,355 patients were treated at the scene by the helicopter crew and transported to hospital by other means. There were 4,930 interhospital transfer flights, 62 flights to transport donated organs, blood or drugs, and 97 for various other reasons such as the transport of surgical teams. Aborted or "Fehleinsatze" flights numbered 5,094, which resulted from the immediate departure of the helicopter to pick up a medical team, then having the flight canceled. "In maintaining a very short response time, we think this figure is acceptable," said Dr. Moecke. In its 17 years of operation, the Rettungshubschraubersystem has flown over 300,000 patients while continuing a preparedness program in support of national interests. It is a commendable record.
The Aeromedical Programs of West Germany by Barney Green tD O O
IN ¢-
-r
O ffl e-Q.
O tO.
A BO-105 aeromedical crew stationed in Freiburg displays some of the equipment carried aboard their aircraft.
A couple of years before Denver's "Flight For Life," West Germany's "Rettungshubschrauber" made its debut. Both Rettungshubschrauber and Flight For Life are hospitalbased helicopter aeromedical transport services. Both specialize in rapid response to traumatic injury or illness. Both are instrumental in the saving of lives, alleviation of suffering, and reduction of time-in-hospital. Other than these basic purposes, there is little similarity between the two systems. West Germany is about the size of the U.S. state of Oregon, but twice the size of Pennsylvania. The country has five times the population of Pennsylvania, however (more than 60 million people) and more than three times the number of aeromedical helicopters. Rettungshubschrauber is the name given to the 35 hospitalbased helicopters and stations located throughout the Federal Republic of Germany. Although it is a national EMS program, the federal government exercises a limited direction or control over the countrywide operations, with most federal participation coming in the role of a contributor. The individual states within the republic, through the State Office of Internal Affairs, and sometimes the counties within the state, carry the responsibilities for the designating of stations within each respective state. In deciding the location of stations, the primary objective is to give each station a 50 km (31 mile) radius of operation and placed so that throughout the country there are no areas without protection of the Rettungshubschrauber canopy. Each state has established its own 6 HOSPITALAVIATION,MARCH 1987
regional dispatch center, designates which of four contributors will be the helicopter operator, and determines which hospital will employ or sponsor flight physicians. Individual states also enact legislation, establish regulations and guidelines to govern operations, and monitor and enforce those regulations pertaining to operations within the respective state. Each state also covers all costs associated with the placing of stations Within its boundaries, including costs for personnel accommodations and hangaring and refueling facilities.
ADAC, the West Germany automobile club, operates 8 of the country's three dozen EMS helicopters, including this BK-117.
Four contributors. The 35 Rettungshubschrauber helicopters, called "Christoph" helicopters, are provided by four separate entities within the republic. These are: 1. KATASTROPHENSCHUTZ, the federal, national disaster preparedness program. 2. ADAC, The German Automobile Association, a private, nonprofit, membership support organization. 3. SAR, the designation given to German military units participating in the system. 4. DRF, Deutsch Rettungsflugwacht, the German Air Rescue organization. Katastrophensehutz This is a nationwide emergency service set up by the federal government to respond to any disaster related need. It is not a military unit, but one dedicated to serving the public whether the need might be civilian or military. When not engaged in national disaster activities, the 17 Katastrophenschutz helicopters are committed to full time service in the Rettungshubschrauber system. The federal government owns the Katastrophenschutz helicopters, and dedicates them to the Rettungshubschrauber system. The pilots manning these "Christoph" helicopters are supplied and paid a salary by the Bundesgrenzschutz, the federal border police. The designation "Christoph" is given to all Rettungshubschrauber helicopters and each one is numbered to correspond with the region in which it is working. SAR SAR provides the military helicopters
International Profile occupying six stations within the Rettungshubschraubersystem. These units comprise the major part of HTG (Wing) 64 of the Luftwaffe. Approximately 90% of Wing 64's aeromedical missions are flown for Rettungshubschrauber. These helicopters and crews provide a valuable public service, and at the same time the operation serves as a recurrent and ongoing training program for the pilots and military medical teams. DRF The German Air Rescue is a private, non profit organization set up to build a national and international high quality aeromedical EMS network. DRF provides helicopters for five of the Rettungshubschrauber stations. It operates its own fully dedicated Lear 35, Lear 25, and Merlin IVoC fixed wing aircraft with United States registration to fly the Allied corridor into West Berlin. In addition, DRF has developed a second national net of aeromedical helicopters dedicated solely to interhospital transfer over long distances or for less than urgent cases. ADAC The ADAC is the national automobile association of which most West German drivers are members. The association's interest in promoting automotive safety and good driving practices spilled over into the support of aeromedical transport services. The ADAC provided the first "Christoph" helicopter and financial support that was the beginning of today's impressive network. ADAC provides seven chartered helicopters to cover as many Rettungshubschrauber stations, plus providing the financial administration for those 17 helicopters and stations operated by Katastrophenschutz. The ADAC formed an affiliate air rescue company, ADAC Luftrettungs GmbH, specifically to handle its EMS activities. All Christoph helicopters are either owned or leased/chartered by their respective helicopter operators/contributors. On occasion, aeromedical missions take the Christoph helicopters across the borders of neighboring countries, as needs dictate. Helicopters from Belgium, France, Switzerland and Austria also penetrate into Germany. It sounds like a real good neighbor policy. History "Of course, the German Rettungshubschraubersystem has many fathers," said Dr. Heinzpeter Moecke, Medical Director of the Hamburg station. "To me, the first sincere experiments were conducted by Dr. Feder in the Frankfurt area during September of 1967. Other regional experiments followed during the
next few years at Mainz, Nurnberg and Munich." "Today's system," continued Dr. Moecke, "was started by an initiative of ADAC in Munich in 1970. They used for the first time the BO-105 for this purpose. During the following years, the DRF, Katastrophenschntz and the SAR followed." "In giving credit for the development of this system, one person should be mentioned expressively," concluded Dr. Moecke. "The architect Siegfried Steiger founded a nonprofit organization after a fatal accident took the life of his son, Bjorn Steiger Stiftung. His objective was to raise money to improve the national EMS system and to publicly promote a better system. When the Rettungshubschraubersystem ran into
early political and financial difficulties, Herr Steiger founded, together with others, the DRF. From the beginning, he has been its president and principal supporter on a voluntary basis." Rettungshubschrauber aircraft According to Dr. Moecke, the helicopter used at most of the stations is the BO-105, in a variety of medical configurations. Each state determines the medical configuration to be installed and used in helicopters operating within its boundaries. Also used in this service are the Bell UH1D, Bell 212, and the BK-117. The Bell 206L is sometimes used as a backup helicopter. "It looks like there will be a rescue
Complete EMS H e l i c o p t e r Services... O u r o n l y business! At EMS Helicopters, Inc., EMS is our only business. Our experienced
staff is committed to providing , = complete EMS service--from / assistance in selecting the right helicopter for your needs, to total program support. EMS Helicopters is organized to provide full service
to hospitals with start-up assistance, training of hospital staff, marketing support in the community, experienced IFR pilots, and mechanics skilled in the hospital/aeromedicat environment. For complete EMS helicopter services, call or write today.
EMS H E L I C O P T E R S , INC. 800-854-7170 (except California) Corporate Office: P.O. Box 277, Laguna Beach, CA 92652, 714-497-6816 Eastem Office:
1-800-633-3818 (Except PA)
HOSPITALAVIATION,MARCH1987
International Profile knowledge, out of the 15 people killed, seven died during accidents not related to the Rettungshubschraubersystem." Flight minimums are for VFR day: 800 m (about .5 mile) visibility with a ceiling 500 ft above the highest obstacle enroute. Night flying VFR requires 5000 m (about three miles) visibility and a ceiling of 1000 ft, twin turbine aircraft only. IFR flights are permitted only above 5,000 ft from airport to airport. "Instrumentation of helicopters varies from operator to operator," said Dr. Moecke. "The same is true concerning minimum standards, e.g. ADAC and DRF have stricter regulations than SAR, such as no single turbine flight at night. No scene flights are performed after sunset, but hospital to hospital transfers are reluctantly done at night." The dispatch center offers the latest in electronic and computer-aided communications systems. helicopter station established in West Berlin in the near future," said Dr. Moecke. "Well informed sources' say the four allies have no objection to this project which will be sponsored by the DRF utilizing a BO105 with American registration." Rettungshubschrauber cost recovery Program costs not covered by the state are apportioned to a county agency which acts as the financial administrator for each station within its boundaries. Some of the operating costs are paid by the county and some are absorbed by the helicopter operator. "Most of these costs are reimbursed by health insurance companies which pay a fee per flight minute, or a fixed mission fee," said Dr. Moecke. "There is no out-ofpocket charge to the patient." Personnel salaries are paid by the respective employers. Pilots are paid by the helicopter operator, physicians and nurses by their hospital, and EMTs by their
regional ambulance organization, such as the Red Cross. Federal regulations require an EMS qualified physician and an assistant, either a nurse or EMT, to accompany every aeromedical mission. Statistical information Statistics furnished by the German Federal Aviation Authority show that from 1973 to 1985, 24 flight accidents occurred during aeromedical rescue missions. Six were fatal accidents in which 15 people died. In 11 other accidents, the helicopters were damaged extensively and 15 people were seriously or critically injured. According to GFAA records, the accident rate during this period was 1.23 accidents per 10,000 missions. "Since the federal authority does not distinguish between primary rescue flights or missions flown by other operators with a patient on board, our figure is probably smaller," said Dr. Moecke. "To my
Hangar and on-site refueling facilities are provided ior many helicopters. 8 HOSPITALAVIATION,MARCH 1987
A narrow country road provides the best landing area to assist a patient being transferred from a freighter. In 1986, the 35 Rettungshubschrauber helicopters completed 30,276 missions, treating 26,101 patients. Patients treated at the scene and transported by helicopter numbered 8,738, while another 11,355 patients were treated at the scene by the helicopter crew and transported to hospital by other means. There were 4,930 interhospital transfer flights, 62 flights to transport donated organs, blood or drugs, and 97 for various other reasons such as the transport of surgical teams. Aborted or "Fehleinsatze" flights numbered 5,094, which resulted from the immediate departure of the helicopter to pick up a medical team, then having the flight canceled. "In maintaining a very short response time, we think this figure is acceptable," said Dr. Moecke. In its 17 years of operation, the Rettungshubschraubersystem has flown over 300,000 patients while continuing a preparedness program in support of national interests. It is a commendable record.