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Helicopter Emergency
Medical Services
(HEMS) in INDIA
AIR COMMODORE BS SIWACH AVSM YSM VM ®
SECRETARY GENERAL
ROTARY WING SOCIETY OF INDIA
HELICOPTER EMERGENCY
MEDICAL SERVICES (HEMS)
Mass Casualty Event
 Frequent occurrence of disasters.
 Extensive use of helicopters.
 Situation necessitates helicopters being available in the
area.
Floods are annual feature :
IAF Helicopter in a Rescue Mission
IAF Helicopter dropping the relief
material at the flood affected areas in
Gujarat on 3 July 2005
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.
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.
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.
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.
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.
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
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).
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.
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.
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
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
Overview of EMS System
 ‘Appropriate’ Hospital
 Air Ambulance
 Ground Ambulance
 First Response
Level of Care Increases as the Patient
Progresses in the System
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
Benefits
• Improves Patient Care
• Reduces Health Care Costs
• Extends Geographical
Reach of Specialized
Medical Centers
• Increases Patient Survival
and Recoverability
Helicopter Saves Lives
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
HEMS
HAL
Manufactured
Dhruv
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.
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
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
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
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.
Thank you
Remember. . .Helicopter Saves Lives