The initial outbreak and uncontrolled spread of Covid-19 moved faster than most countries had anticipated. The rapidly increasing number of infected people forced countries to act fast to gain control over the virus and its consequences. In March, the Netherlands, like many other countries, was facing rapid growth in the number of critical Covid-19 patients who were in need of intensive care (IC). Hospitals in the southern provinces, where carnival festivities had recently taken place, were experiencing a high volume of patients in their available IC units. Without a vaccine to hand, there was an urgent need to come up with new solutions to effectively treat the high number of patients.

One of the ideas suggested by the Radboud University Medical Center (UMC) in Nijmegen was to consider the introduction of dedicated helicopter IC flights to transport patients from the highly affected southern provinces to other Dutch regions, where hospitals were experiencing far less pressure. By transferring existing patients to northern hospitals, the limited IC units of hospitals in the south were able to cope with new patients. Radboud UMC’s suggestion originated from its experience with medical helicopter flights – managing one of the four Dutch Helicopter Emergency Medical Services (HEMS) units. A plan was swiftly developed and approved and, by mid-March, the IC helicopter flights were operational. To find out more about this new medical service, AirMed&Rescue spoke to the specialists operating the IC helicopters.

Preparation

At Volkel Air Force Base, we met Dr Geert-Jan van Geffen, anesthetist, trauma physician and Radboud UMC medical helicopter co-ordinator. Normally, he works onboard Lifeliner 3, one of the four Dutch HEMS Airbus EC135s.

Dr van Geffen explained that the search for a suitable helicopter was in fact simpler than expected, thanks to ANWB-Medical Air Assistance (MAA). An ANWB Airbus H145 is normally available 24/7 in the Northern Dutch islands to transfer non-critical patients to shore-based hospitals for further medical treatment. For backup reasons, a second H145 is kept in reserve. On request, ANWB-MAA was able to confirm the availability of pilots for daytime IC transportation flights, seven days a week, on the reserve helicopter.

Meanwhile, the pace of new Covid-19 patients admitted to hospitals increased, and a positive governmental decision to start IC flights was agreed quickly. The H145, registration PH-HOW, was immediately prepared for its new job as Lifeliner 5, based at Volkel AFB. Dr van Geffen explained that the aircraft was equipped with an additional four medical pumps, bringing the total number to six, and also carried extra canisters for the helicopter’s internal oxygen supply system, along with equipment to monitor the patient’s condition during flight.

ANWB-MAA

Pilot Amanda Tijben, ANWB-MAA Flight Operations Manager, remembered the hectic period when the request for IC flights came in. “The team of H145 pilots was determined to guarantee helicopter and pilot availability,” she told AirMed&Rescue. Furthermore, the co-operation with other authorities to prepare this whole operation was commendable; one example was the creation of a list of potential hospitals for Covid-19 patient IC transport flights – however, it didn’t include any information on helicopter landing facilities. Undeterred, ANWB-MAA pilots jumped in their cars and visited all the hospitals to check with local security for possible landing spots close to the entrance of each IC unit. These landing sites needed to be 28-m by 28-m surfaces for daylight HEMS operations and 28-m by 56-m for night flights. When landing spots were found that were suitable for temporary usage, agreements and photos were documented for involved parties, telephone numbers were shared, and operations could commence. In all, about 90 such locations were approved.

When Lifeliner 5 became operational, the continuing increase of Covid-19 patients resulted in the request to release the other H145 from its island ambulance duties and support the IC transfer flights. Initially, EC135 trauma helicopters belonging to ANWB stepped in to operate the island flights, giving the Dutch Defense Helicopter Command (DHC) time to organize air ambulance flights to then take over from the EC135s, including a medical team with one of their NH-90s.

The second H145, registration PH-OOP, became Lifeliner 6 and was based at Groningen-Eelde Airport. This fell under the logistical and medical crew supervision of Groningen UMC, which is also responsible for the Lifeliner 4 trauma helicopter. As with Lifeliner 5, the second H145 IC helicopter was also tasked with conducting night flights, which required a cockpit crew of two, which was already present.

By late April, the IC units at the hospitals were facing a gradual daily reduction of patients, allowing Lifeliner 6 to return to its original job as Medic01, albeit on short notice to return to IC flights if necessary. To be flexible for these operational switches, the H145 remains as ‘clean’ as possible, i.e. without floats. “These floats are not prescribed in the flight regulations because the flights over water to the islands normally fit easily within time limits, but are desired as an option by the ambulance contractor. The floats weigh about 60 kg and without them, we can carry extra fuel, with an additional flight time of over 15 minutes. This gives us more flexibility when flying IC patients over longer distances (for example, into Germany) without the need to land to refuel, and arrive at the hospital faster,” explained Tijben.

Pilot’s opinion

Tijben normally flies all ANWB-MAA helicopter types on a regular basis, but now her schedule is focused solely on the H145 and she believes it is ‘perfect for the task’. She cannot choose a personal favorite helicopter, yet she says the smaller and older EC135 is lighter, and feels more ‘sporty’ and agile while flying. “In the EC135, you can do exactly what you are trained for without being interrupted by the opinion of the auto pilot,” she laughed. On the other hand, she would not be without the auto pilot system when flying the H145 on a long IC patient transfer flight from a southern Dutch hospital to Hamburg or Hannover in Germany.

Currently, ANWB-MAA is managing the replacement of its last two EC135s with H135s. By late summer this year, all four Dutch Lifeliner stations will be equipped with the updated H135, although two EC135s will be kept as backups to guarantee the 24/7 HEMS service.

Meanwhile, in the Netherlands, the peak of Covid-19 has passed, and helicopter flights have returned to a lower number, giving the operators time to evaluate their recent experiences, and discuss if and how to continue with the structural availability of IC helicopter capacity.