- Email: [email protected]
The case for airplanes
An Editorial Opinion
The Case for Airplanes by Howard M. Collett Perhaps the Wright Brothers were right. "The helicopter does with great labor only what the balloon does without l a b o r . . , and is much easier to design than the aeroplane but is worthless when done." (Wilbur Wright). Now, those of you who have followed Hospital Aviation for any length of time know about our predominant helicopter orientation. May I preface the remainder of this article with my opinion that the airplane will never replace helicopters for aeromedical transport, in spite of Wilbur's early opinion of the helicopter. (Now for the small p r i n t . . . ) But perhaps there are some things for which an airplane is better prepared than a helicopter. Cases in point - flights beyond 75 or 100 miles, and all-weather operations. It is no secret that the predominant environmental factors associated with fatality and injury-producing aeromedical helicopter accidents are marginal weather and night operations. It is in this realm that any pilot - airplane or helicopter - has the most difficulty in operating. For helicopters, this often means continued cruise flight below 1,000 above ground level (AGL). For airplanes, however, it almost always means flight above a minimum of 3,000 feet AGL. But the differences don't stop there. Most (but not all) aeromedical helicopters and their pilots have several strikes against them: (1) lack of a dynamically stable airframe (let go of the controls and most helicopters will quickly wander all over the sky or in to the ground), (2) lack of a stabilized flight control system, without which IFR flight may not legally (and sanely) be attempted, (3) no de-icing capability, (4) lack of an IFR-rated pilot, or lack of an IFRproficient pilot, and (5) no co-pilot. Conversely, most multiengine airplanes and all twin- engine turboprops were designed for flight in instrument conditions, thereby solving conditions 1-3 above. And most corporate flight departments require IFRproficient pilots and co-pilots for all flights, addressing the fourth and fifth points. (These operational considerations have been the topics of past editorials and features, and undoubtedly will be the subject of future treatments). The response of the helicopter portion of the aeromedical industry has been to acquire larger and more expensive helicopters with more equipment to solve the problems associated with instrument flight. Larger helicopters may be justified to carry out the clinical portion of the mission. In certain climatical circumstances, IFR-rated helicopters may be justified to depart a fog-laden area. In many cases, IFR capability is acquired solely to provide the pilot an autopilot for long night flights. But in
most cases for missions beyond 75-100 miles, an airplane can perform the job safer and less expensively than a helicopter. The addition of an airplane to an aeromedical helicopter program not only provides a more versatile fleet mix, but may prove to be the successful model for survival in today's competitive aeromedical environment. Growth of aeromedical helicopter programs has exceeded 20°7o per year for each of the last five years. There are currently more than 150 hospital-sponsored aeromedical helicopters flying for 130 programs in 110 cities around the United States. As most major population centers have acquired aeromedical helicopters, much of the new growth has shifted into secondary population areas, as well as additions of competing services in major cities. Many current hospital users of airplanes feel that the addition of an airplane may better serve such markets. Historically, fixed-wing aeromedical transport has been provided by local airplane operators and not hospitals or ambulance services. But nationwide, numerous hospitals are acquiring fixedwing airplanes for critical patient transport. While the majority of such hospitals have existing aeromedical helicopter services, many start their fixed-wing transport program exclusive of, or prior to, a helicopter program. The disadvantage of most (but definitely not all) operator-provided services is the lack of dedicated aircraft which include stretcher tiedowns and properly secured oxygen, suction, monitoring and other medical equipment. In addition, there often is no consistency in the capabilities of medical attendants that are hired for the transport. Ideally, hospital-sponsored fixed-wing patient transport services, however, use fully-dedicated aircraft and personnel. Such hospitals contract for a full-time medical airplane and pilots, similar to the hospitalbased helicopter concept. In tile absence of a dedicated aircraft, however, the major advantage comes in consistency of medical care, as medical teams and equipment are provided by the sponsoring hospital. During the ten years from 1968 to 1977, only ten hospitals formally adopted fixedwing aeromedical transport capability. During the next six years the rate per year more than doubled, with the addition of 14 hospital-sponsored fixed-wing services. But during the last 30 months, 19 hospitals added fixed-wing capability, bringing the total number of hospital-sponsored fixedwing services to 43. Several reasons are possible for the rapid growth of the fixed-wing component of a hospital sponsored transport business. For
hospitals that serve a vast geographical area, such as those in the Western United States, an airplane is a natural. For other hospitals in more populated areas, the addition of an airplane is a positive augmentation to existing ground and helicopter transport services. It enables the hospital to match the best possible transport resource with patient needs, distance, weather and aircraft ability. Probably the most dominant reason for adding an airplane critical care transport service, however, is medical control and quality of care. A hospital with a helicopter is already in the transport business, and has devoted considerable resources for dispatch, program management, flight crew training and direction, and marketing. The addition of an airplane maximizes the use of these resources in a cost-effective manner. The addition of an airplane also alleviates the need for a hospital to send its helicopter on long flights, which are time consuming and more expensive by helicopter. Therefore, the helicopter remains closer to its primary service area, missing fewer calls for service. Many hospitals that have added an airplane to their helicopter aeromedical service have experienced a substantial growth in fixed-wing calls with little impact on helicopter utilization. Quality assurance, including rapid response times with on-site pilots 24-hours per day, consistent high-quality medical care provided by dedicated hospital flight teams, and a completely medically-configured airplane used exclusively for aeromedical transport must be provided. Therefore, it is recommended that hospitals considering the addition of an airplane contract for an existing airplane available from selected local operators, or purchase/lease directly and set up its own flight department. In either case, the airplane would be configured to hospital specifications, and provided on contract similar to current aeromedical helicopter contracts. By acquiring a full-time aeromedical airplane, many hospitals would provide the only hospital-sponsored fixed-wing service in their state, - a perceived advantage to referring physicians over current non-hospital services. To maximize utilization, the service would be available to other area hospitals on a guaranteed payment basis. The aeromedical airplane will never replace the hospital-based helicopter. But it shouldn't be viewed as a threat to the helicopter, but an augmentation to the transport function of the hospital. Some have said that fixed-wing technology is thirty years ahead of its rotary-winged cousin. But in the aeromedical industry, the airplane is just now catching up. HOSPITAL AVIATION, SEPTEMBER 1986
The Case for Airplanes by Howard M. Collett Perhaps the Wright Brothers were right. "The helicopter does with great labor only what the balloon does without l a b o r . . , and is much easier to design than the aeroplane but is worthless when done." (Wilbur Wright). Now, those of you who have followed Hospital Aviation for any length of time know about our predominant helicopter orientation. May I preface the remainder of this article with my opinion that the airplane will never replace helicopters for aeromedical transport, in spite of Wilbur's early opinion of the helicopter. (Now for the small p r i n t . . . ) But perhaps there are some things for which an airplane is better prepared than a helicopter. Cases in point - flights beyond 75 or 100 miles, and all-weather operations. It is no secret that the predominant environmental factors associated with fatality and injury-producing aeromedical helicopter accidents are marginal weather and night operations. It is in this realm that any pilot - airplane or helicopter - has the most difficulty in operating. For helicopters, this often means continued cruise flight below 1,000 above ground level (AGL). For airplanes, however, it almost always means flight above a minimum of 3,000 feet AGL. But the differences don't stop there. Most (but not all) aeromedical helicopters and their pilots have several strikes against them: (1) lack of a dynamically stable airframe (let go of the controls and most helicopters will quickly wander all over the sky or in to the ground), (2) lack of a stabilized flight control system, without which IFR flight may not legally (and sanely) be attempted, (3) no de-icing capability, (4) lack of an IFR-rated pilot, or lack of an IFRproficient pilot, and (5) no co-pilot. Conversely, most multiengine airplanes and all twin- engine turboprops were designed for flight in instrument conditions, thereby solving conditions 1-3 above. And most corporate flight departments require IFRproficient pilots and co-pilots for all flights, addressing the fourth and fifth points. (These operational considerations have been the topics of past editorials and features, and undoubtedly will be the subject of future treatments). The response of the helicopter portion of the aeromedical industry has been to acquire larger and more expensive helicopters with more equipment to solve the problems associated with instrument flight. Larger helicopters may be justified to carry out the clinical portion of the mission. In certain climatical circumstances, IFR-rated helicopters may be justified to depart a fog-laden area. In many cases, IFR capability is acquired solely to provide the pilot an autopilot for long night flights. But in
most cases for missions beyond 75-100 miles, an airplane can perform the job safer and less expensively than a helicopter. The addition of an airplane to an aeromedical helicopter program not only provides a more versatile fleet mix, but may prove to be the successful model for survival in today's competitive aeromedical environment. Growth of aeromedical helicopter programs has exceeded 20°7o per year for each of the last five years. There are currently more than 150 hospital-sponsored aeromedical helicopters flying for 130 programs in 110 cities around the United States. As most major population centers have acquired aeromedical helicopters, much of the new growth has shifted into secondary population areas, as well as additions of competing services in major cities. Many current hospital users of airplanes feel that the addition of an airplane may better serve such markets. Historically, fixed-wing aeromedical transport has been provided by local airplane operators and not hospitals or ambulance services. But nationwide, numerous hospitals are acquiring fixedwing airplanes for critical patient transport. While the majority of such hospitals have existing aeromedical helicopter services, many start their fixed-wing transport program exclusive of, or prior to, a helicopter program. The disadvantage of most (but definitely not all) operator-provided services is the lack of dedicated aircraft which include stretcher tiedowns and properly secured oxygen, suction, monitoring and other medical equipment. In addition, there often is no consistency in the capabilities of medical attendants that are hired for the transport. Ideally, hospital-sponsored fixed-wing patient transport services, however, use fully-dedicated aircraft and personnel. Such hospitals contract for a full-time medical airplane and pilots, similar to the hospitalbased helicopter concept. In tile absence of a dedicated aircraft, however, the major advantage comes in consistency of medical care, as medical teams and equipment are provided by the sponsoring hospital. During the ten years from 1968 to 1977, only ten hospitals formally adopted fixedwing aeromedical transport capability. During the next six years the rate per year more than doubled, with the addition of 14 hospital-sponsored fixed-wing services. But during the last 30 months, 19 hospitals added fixed-wing capability, bringing the total number of hospital-sponsored fixedwing services to 43. Several reasons are possible for the rapid growth of the fixed-wing component of a hospital sponsored transport business. For
hospitals that serve a vast geographical area, such as those in the Western United States, an airplane is a natural. For other hospitals in more populated areas, the addition of an airplane is a positive augmentation to existing ground and helicopter transport services. It enables the hospital to match the best possible transport resource with patient needs, distance, weather and aircraft ability. Probably the most dominant reason for adding an airplane critical care transport service, however, is medical control and quality of care. A hospital with a helicopter is already in the transport business, and has devoted considerable resources for dispatch, program management, flight crew training and direction, and marketing. The addition of an airplane maximizes the use of these resources in a cost-effective manner. The addition of an airplane also alleviates the need for a hospital to send its helicopter on long flights, which are time consuming and more expensive by helicopter. Therefore, the helicopter remains closer to its primary service area, missing fewer calls for service. Many hospitals that have added an airplane to their helicopter aeromedical service have experienced a substantial growth in fixed-wing calls with little impact on helicopter utilization. Quality assurance, including rapid response times with on-site pilots 24-hours per day, consistent high-quality medical care provided by dedicated hospital flight teams, and a completely medically-configured airplane used exclusively for aeromedical transport must be provided. Therefore, it is recommended that hospitals considering the addition of an airplane contract for an existing airplane available from selected local operators, or purchase/lease directly and set up its own flight department. In either case, the airplane would be configured to hospital specifications, and provided on contract similar to current aeromedical helicopter contracts. By acquiring a full-time aeromedical airplane, many hospitals would provide the only hospital-sponsored fixed-wing service in their state, - a perceived advantage to referring physicians over current non-hospital services. To maximize utilization, the service would be available to other area hospitals on a guaranteed payment basis. The aeromedical airplane will never replace the hospital-based helicopter. But it shouldn't be viewed as a threat to the helicopter, but an augmentation to the transport function of the hospital. Some have said that fixed-wing technology is thirty years ahead of its rotary-winged cousin. But in the aeromedical industry, the airplane is just now catching up. HOSPITAL AVIATION, SEPTEMBER 1986