The Republic of Singapore Air Force (RSAF) provides 24/7 helicopter search and rescue (SAR) and helicopter medical evacuation (heli-medevac) coverage for the Singapore Flight Information Region and Aeronautical Search and Rescue Region (ASRR), which spans 840,000km2 of the South China Sea.

This region contains busy international shipping and air traffic routes, with the Port of Singapore being one of the busiest ports in the world. Up to 70 per cent of the global maritime shipping volume transits through the Straits of Singapore annually. Every year, the RSAF’s capability is activated multiple times to rescue personnel lost at sea, or to evacuate ill and injured ship sailors or passengers to tertiary hospitals in Singapore for stabilization and advanced care.

Every year, the RSAF’s capability is activated multiple times to rescue personnel lost at sea, or to evacuate ill and injured ship sailors or passengers to tertiary hospitals in Singapore for stabilization and advanced care

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RSAF rescue missions are operated by fleets of H225M and CH-47 helicopters

RSAF’s SAR and heli-medevac capability was first introduced in 1971, and has since been continuously enhanced, both in terms of equipment and training in the four decades since its inception.

The helicopter platform utilized has evolved from Alouette IIIs to Bell 212s and UH-1Hs, to the AS332M (H215) Super Puma. Newly delivered RSAF Airbus H225M medium-lift helicopters took over SAR standby duties earlier this year.

In addition to the H225M, longer range SAR capability to rescue casualties up to 300 nautical miles away is provided by RSAF’s CH-47 Chinook helicopters.

RESCUE 10, the H225M helicopter designated for SAR, always sits at high alert and will take off within 15 minutes of scramble activation. The helicopter is operated by a team of two pilots and two air crew specialists from 125 Squadron, along with a medical team comprising a doctor and a medic from 1 Medical Squadron. The SAR and heli-medevac team is always on standby 24/7 in the event of a distress call.

The vast majority of rescues are for medical emergencies onboard civilian and commercial ships transiting through the South China Sea. Patient extraction is typically performed via winching due to a lack of suitable landing spots.

On arrival at scene, the SAR flight doctor is winched down onto the ship deck with an aircrew specialist for initial casualty assessment and stabilization while the helicopter hovers at scene. Using the few minutes he has on deck, the doctor will obtain a concise history, perform a quick examination, and carry out immediate life-saving interventions. Meanwhile, the aircrew specialist will prepare the rescue litter, rescue basket, or strobe for casualty extraction. The method of extraction depends on various patient and situational factors.

After winching the casualty back onboard the rescue helicopter, the flight doctor and medic will then stabilize the casualty during the evacuation to a major tertiary hospital in Singapore.

All SAR medical crew must undergo underwater training

All SAR medical crew must undergo swim tests and helicopter underwater egress training prior to starting SAR and heli-medevac medical training. All flight doctors are qualified in Basic and Advanced Cardiac Life Support, Advanced Trauma Life Support, and Advanced Pediatric Life Support training in addition to winch training.

Medics also undergo a six-month long training course before being SAR-qualified through a live sortie with in-flight assessment. Between performing SAR standby duties and executing rescue missions, the aircrew and medical teams undergo rigorous day-to-day training to ensure their mission readiness to handle complex rescues in difficult circumstances with severely ill patients. After each scramble, a debrief is also conducted to share and disseminate lessons learnt from the mission.

RSAF rescue missions carry a range of equipment

SAR and heli-medevac medical teams are equipped with a full suite of medical equipment and drugs for the management of a wide variety of conditions and casualty types. The basic load-out for a SAR mission includes:

• A patient monitor defibrillator
• Video laryngoscope
• Suction device
• Intra-osseous needle drill
• A wall bag containing equipment
  and drugs
• Personal protective equipment
• A drop-leg pouch with commonly
  used medical equipment.

With a full range of airway equipment, intravenous devices, chest seals, limb tourniquets, Celox dressings, pelvic binders, hydrogel burns dressings, resuscitation medications, and intravenous fluids, the team is well placed to handle any trauma cases, medical or surgical emergencies.

 In 2021, RSAF also added a portable automated cardio-pulmonary resuscitation (CPR) machine to strengthen the chain of survival for cardiac arrest cases in-flight.

RSAF also added a portable automated cardio-pulmonary resuscitation (CPR) machine to strengthen the chain of survival for cardiac arrest cases in-flight

SAR crew members are also equipped with flight helmets, life preserver units, communications equipment, and harnesses.

Mission call-outs to coronary and gastro-intestinal conditions are common

The most common types of casualty profiles encountered were acute coronary syndromes, gastrointestinal conditions such as upper gastrointestinal tract bleeding, acute appendicitis, and intestinal obstruction, and neurological conditions such as stroke. There were also a significant number of trauma and burns patients. During the Covid-19 pandemic, there were a number of casualties evacuated for severe Covid-19 pneumonia and respiratory failure. RSAF implemented safety protocols during the winching of Covid-19 patients, the use of personal protective equipment, as well as post-mission decontamination procedures to safeguard the health of the crew.

One of the more notable rescues done by RSAF was for John Low, a 60-year-old

Singaporean diving enthusiast who was pulled from the sea in critical condition by a passing commercial ship after being lost at sea for three days. The medical team provided lifesaving support to Low en-route to hospital. He survived and made a full recovery.

Another notable rescue involved two consecutive distress calls with a total of four casualties evacuated in a single mission. While en-route to the first casualty who sustained severe burns, the SAR team was informed of another activation for three men overboard due to a ship fire. After extracting and stabilizing the burns casualty, the SAR team flew to the next location to rescue the next three casualties floating in the sea. All four casualties were successfully rescued in this eventful sortie.