Focus on air ambulance flight crew safety and protection

Recent years have seen a considerable expansion in the number of helicopters being deployed by the 27 air ambulance (AA) organisations across the UK. Through a combination of charitable contributions, commercial sponsorship and funding from ambulance services their capabilities have been expanded to the point where many of the helicopters average several missions daily. Many of the AA trusts have been able to re-equip their response teams with new, faster helicopters and improved personal protection to provide them with a safer working environment.

Words: Philip Tasker, National Sales Manager, Bristol Uniforms.

Although the public’s perception of air ambulances is associated with road accident emergencies owing to their visibility, the range of missions for which they are deployed ranges broadly across traffic accident emergencies to sports injuries, climbing accidents and taking other medical emergencies for specialist hospital treatment. Speed of delivery to hospital can be vital in minimising the long-term prospects of recovery for accident victims – in some cases lives are saved which would have been lost had getting individuals to hospital depended on routine emergency ambulance services. Although air ambulances up and down the country are heavily dependent on public donations, the vital work that they do is widely recognised and the funding raised through charitable giving and sponsorship, often in kind, has grown to enable the trusts which run the services to do so on a very professional basis. This is particularly true of the crews which operate the services and which typically include a pilot, doctor and a small number of paramedics, some of whom provide their services on a voluntary basis.

Helicopters provide flexibility and access

Cornwall Air Ambulance became the first air ambulance service in the UK when it started operations in 1987. Eleven more were formed and became operational by 1999, including the Scottish Air Ambulance and the Welsh Air Ambulance. 2007 was a particularly busy year during which four new services began operations covering Dorset and Somerset, Hampshire and Isle of Wight, Cambridge and Bedfordshire (a helicopter shared with the police) and Surrey and Sussex.

There are over 35 air ambulance helicopters in regular use across the UK, all of which are liveried in either yellow, red or orange. The helicopter of choice is the Eurocopter EC 135, which forms a little over 50 percent of the stock, with the McDonnell Douglas MD 900/902 making up a further 30 percent. Both models have operational airspeeds of 150-160mph, which allows most of the operators to be within 30 minutes flying time from any incident, whether in urban areas or remote and difficult terrain.

Organisation and operations As the air ambulance network has grown steadily over the last 25 years, so has the organisation and structure as new sources of funding and sponsorship allow the resources available to individual charitable trusts to develop improved levels of service. One of the longer established trusts is The Lincolnshire and Nottinghamshire Air Ambulance, which provides a dedicated medical air service and which first began flying operations in Lincolnshire in April 1994. Inaugurated by Lincolnshire, Nottinghamshire became a partner in the trust in 1997. Based at RAF Waddington, south of Lincoln, the response capability is unaffected by road congestion, country roads, heavy vehicles or road works. Their helicopter, an MD 902 Explorer, can fly at just under 160mph to any point in the two counties in less than 20 minutes. It is fully equipped and staffed by two paramedics. Annual running costs are around £1.8m, which all has to be raised from public donations and commercial sponsorship.

The crew

The flight crew is routinely comprised of a pilot and two paramedics. At Lincoln and Nottinghamshire the paramedics are selected from the East Midlands Ambulance Service, while the pilot is provided by Medical Aviation Services. In addition, volunteer doctors regularly form part of the medical aircrew. These doctors, with a special interest, and qualifications, in pre-hospital care, are an asset to the operation, bringing additional expertise to the response teams. All Helicopter Emergency Medical Service (HEMS) paramedics undergo a comprehensive selection process, which includes rigorous medicals, physical fitness tests, in-depth interviews and appraisals. Successful HEMS paramedics are also expected to have detailed knowledge of aviation topics including flight safety, communications, map reading, principles of flight, aircraft navigation, emergency in-flight procedures and HEMS rules.

Exposure to risk

For the crew, the risks associated with responding to a wide variety of emergency situations can vary considerably. However, in common with their ground- based colleagues, the teams are increasingly called upon to access hazardous areas such as serious road traffic accidents, where personal protection is vital for the health and safety of the paramedics and doctors. Rescuing the injured from road and industrial accidents exposes the teams to risks from metal and glass wreckage, fuel and chemical spills as well as flames from fires caused by explosions. These hazards have been nationally recognised by the UK’s ambulance services, which have formed HARTs (Hazardous Area Response Teams) who are now provided with special protective garments designed by Bristol.

Protective garments

Air ambulances have begun to recognise the need to provide more comfortable and better quality protective garments for their air crews and Lincoln and Nottinghamshire, who have recently begun night flying to increase their hours of operation during the winter months, have now equipped their teams with 28 distinctive green one-piece coveralls, which have been generously sponsored by the Nottinghamshire Air Ambulance Countryside Appeal. Designed by Bristol, the single-layer flame retardant Protex Max garment shares the same outer layer as the HART kit supplied to their ground based colleagues. Technically the garment meets BS EN 11612, has knee padding and incorporates breathable tape, which provides greater breathability and wearer comfort as well as Trimsaver, which encapsulates the sewing threads within a meta Aramid braid to protect it from abrasion and minimise the need for repairs. The pilots are equipped with similar kit in blue.

Roger Linnell, the service’s Unit Manager, commenting on the new garments, said, “As we had been given clearance by the CAA for night flying, we had to make sure that the new suits were designed with added protection for both pilots and paramedics attending night time operations. The fluorescent strips make it easier for the aircrew to be identified at night – especially if we are attending road traffic accidents.

“The suits are much warmer but they also protect us from temperature variation when we have to move from indoor to outdoor, which means we can stay much more comfortable throughout the shift. It was important to us that the suits incorporate knee padding for added protection as we can spend the majority of our time on our knees treating casualties. We asked for additional zips and pockets to be added to give us the ability to store extra equipment so we have as much to hand as possible when we are working in time critical situations. “We opted to stay in the green flying suits to fit in with our colleagues from other ambulance crews at the scene.”

Design differences

Elsewhere around the UK, alternative flame retardant solutions have been designed to meet individual requirements. Essex and Hertfordshire have, for example, opted for a Nomex® Comfort one-piece coverall, similar in construction to the Lincoln & Nottinghamshire kit but with added protective padding to the elbows. To match their flight colours these are made in a red fabric. Warwickshire and Northamptonshire Air Ambulance have chosen to use Bristol’s bright orange USAR (urban search and rescue) kit. Yorkshire Air Ambulance (YAA) were the first to use specialist protective garments when they adopted the same USAR kit, which can be used as coat and trouser separately or zipped together as a single garment. The programme makers of the BBC series Helicopter Heroes, made with YAA, purchased matching garments for their film crew.

Future developments

Comfort, durability and individual design considerations are expected to continue to expand the demand for more specialised protective garments for air ambulance crews to allow them to undertake their stressful jobs in greater comfort. The air ambulance trusts, looking to improve operational costs will continue to seek out, and use, garments that can offer greater longevity and reduced maintenance costs, which also provide access to bespoke styling to match their corporate identities and accommodate their chosen range of accessories.

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