Airborne Emergency Services – China

The recent natural disaster in China has galvanized the CAAC and people of China to develop and deploy airborne EMS. The earthquake in the Sichuan Province saw the successful call-up and deployment of general aviation helicopters to assist with emergency and disaster relief in support of the main military helicopter rescue operation. This success has seen further impetus being made for the continued development of this capability.
Airborne EMS capability has been a feature in other countries globally for many years. Historically and as recently seen in China, it was the General Aviation (GA) industry that provided the capacity and capability when required. From these small beginnings has risen a niche sector of the industry delivering EMS expertise, using high technology airborne equipment. Historical development of the industry was, in general, outside of policy or strategic initiatives. Often, the establishment of EMS has occurred due to local needs and driven by the capability of a local operator, rather than a sound model founded on best practice, efficiency and service. From using whatever resource was available at the time during a disaster, has seen a slow migration to professional aviation companies delivering contracted services 24/7/365 with aircraft and equipment that is “fit for purpose”. Now, reliance is not based on whatever capability is available, but importantly, on defining the level of service required and the equipment that provides for this level of service. The old type of bottom up development led to an EMS service configuration that inevitably had some anomalies and weaknesses from that of a top down “whole system” approach design. The Model for China China is in the unique position of establishing a GA based airborne emergency services capability without the legacy structure and operational delivery systems that are seen in other countries. China finds itself in the position where incisive thinking and decision making can pave the way for the introduction of airborne EMS through the GA industry using a whole system managed approach to development. With 23 provinces, 5 autonomous regions, 4 municipalities and 1.3 billion people, China is a large country. Along with the geography and administrative regions of China, demographics will have an influence on the deployment of services. The sheer size and aggregate number of people in each province provides, as usual, opportunities and challenges. The great opportunity for the Chinese people now is the ability to implement a structure that works for the unique China environment. The administrative regions may provide a starting point for model development and deployment of airborne EMS capability throughout the country. The delivery of services will include both rotary (HEMS) and fixed wing aircraft. Consequently an integrated approach across either a single provider or multi-providers will be needed. Inter-hospital transfer and potentially repatriation of foreign tourists and visitors will or could be required. This demands a level of capability currently not found in China. Internationally there is a mixed model in service provision of; competitive services, integrated services funded through a mix of donations and insurance, those funded solely by insurance and those funded solely by donations. Unfortunately with the mix, many appear to exist from hand to mouth, often limiting flying to meet the funds available at the time. A more mature attitude is to view the service as providing a vital public service but not necessarily relying on government resources. How this is managed in China is a complex funding and financial resourcing matter that will need to be resolved. Potential Demand Projecting future potential demand levels for missions is difficult. The current demand has been met on an ad-hoc basis. Overall, it can be assumed that demand will increase with the deployment of this capability. Performance criteria can be developed that will aid in the decision process; on the future aircraft needs and the appropriate in-aircraft equipment levels, in developing a model of future demand projections. Support Infrastructure The services provided by airborne EMS capability do not occur in isolation. There is a close relationship between all the providers in the delivery chain for this service to be efficient and viable; hospitals, medical facilities, physicians and training of personnel, to highlight a few. The management of the suppliers and the relationships will be a key feature of the model implemented. Operationally, airborne EMS services may place extra demands on the current structure used for airspace and provision of Air Traffic Services, the latter in particular for GA operations. The current provision of ATC services is via the military with financial support from the government to provide ATC services to GA. Increased demand for GA ATC might divert the military ATC system away from its core objectives. The GA demand is characterised by different requirements from that of military aviation, consequently there would be a need to manage closely the interface and transition between the current provision of ATC services and future demand. The plan to open low-level airspace for GA aircraft use in 2010 provides time for continued development in ATC technology and capability specifically for GA. There will also be increased demands on GA MRO facilities throughout the country. In other countries the MRO providers were already present as the EMS industry developed. This may not necessarily be the situation in China or there may be an uneven distribution of MRO support capability across the provincial regions. There are no current industry standards or code of operating practice, nor have minimum equipment levels, for both aircraft and patient medical care been implemented. There are complex numbers of issues to be considered with support infrastructure for the industry, from service chain providers, training of personnel through to the support of daily flight operations. Conclusion The following features are those that will be integral in the continued development and successful deployment of airborne EMS:  Administrative and Operating model;  Safety, Standards and Training;  Optimization, Efficiency and Effectiveness;  Policy and Regulatory Development; and  Emergency & Crisis Response Management  Management of the interface between GA and current ATC system structure as demand increases Taking the time now to develop a top down approach will provide longer-term dividends for China as a country. The “whole system” approach provides the opportunity to ensure implementation and deployment of airborne EMS capability delivering appropriate services that benefit China as a country, its people and its economy. One of the objectives of a China airborne EMS capability might be defined overall as missions to quickly take medically qualified rescue experts to the scene in all types of emergency and to take emergency patients to the hospitals best suited for their treatment. Over short and medium distances, such services are provided by HEMS helicopters, while long distance missions are also performed by fixed-wing aircraft. The CAAC, GA operators and people of China are converging on a critical step in the future development of Airborne EMS capability. Implementing the processes, systems and structures required to deliver these services needs to be managed such that they deliver the outcomes envisaged.