Poland’s national air medical service, LPR, traces its roots back to the establishment of the country’s first civil medical aviation teams by the Ministry of Health and Social Security in 1955. These pioneers flew modified CSS-13 biplanes, altered to allow a patient to be transported in a lying-down position.

The modern organization was re-established in 2000 as Lotnicze Pogotowie Ratunkowe – Polish Medical Air Rescue – boasting a new, uniform structure funded by the Polish Ministry of Health. Today, the organization flies over 10,000 missions per year, of which 70 per cent are helicopter emergency medical service (HEMS) flights.

Comprehensive network of nationwide support

“LPR has 21 bases [that operate] all year-round – of these, four are 24-hour bases: Gdańsk, Krakow, Wrocław and Warsaw,” said Dr Adam Burakowski, LPR Deputy Director of Medical Affairs. The remaining bases launch helicopters during daylight hours, between approximately 07:00 hrs and 20:00 hrs.

Staffing the bases are LPR flight and medical crews, who are predominantly Polish – primarily due to the need to know the language, Burakowski explained, although a few members are from further afield.

The organization also operates a seasonal base in Koszalin, Western Pomerania, on the country’s sparsely populated north-west coast. It’s currently active for approximately three months a year, between the start of June until early September, during the peak summer holiday season.

However, Burakowski explained that LPR is looking to launch year-round operations from the base, due to concerns about the level of air ambulance coverage during the off-season. “Outside of the holidays, there are not many people in this place,” he said. “But really … when we have an accident [near Koszalin] and the base is not active, we have a problem, because the helicopter from Gdansk or Szczecin will take a long time to get to the accident.”

Year-round operations are expected to be launched ‘probably sometime in the next year’. The base is undergoing reconstruction to accommodate its growing operational purpose.

Core aircraft fleet made up of EC135 helicopters

LPR operates a mixed fleet of both rotary and fixed-wing aircraft, dominated by 27 Eurocopter EC135 helicopters, which serve as the backbone of its emergency response. The provider also operates several Piaggio P180 Avantis and Bombardier Learjet 75s.

When asked whether LPR was looking to further expand or modernize its aircraft fleet, Burakowski said: “Yes, it is possible, but we are dependent on the availability of funds in terms of money for new helicopters. It’s possible in the near future, but it is only in planning [currently].

“I think [in the long term] we will try to change some helicopters to be bigger, because sometimes we have a long-range interhospital transport to the burns center, or for amputation patients, and sometimes we need a helicopter with more range. And maybe a bigger helicopter would be better,” he added.

Burakowski explained that while the organization is ‘all one company’ at national level, LPR’s HEMS bases operate with a significant degree of autonomy, with aircraft dispatched on missions on a ‘regional’ basis.

I think we will try to change some helicopters to be bigger

By contrast, LPR’s international repatriation flights are managed by a central coordination center in Warsaw.

“Hospitals call to the operations center, which then coordinates to provide transport, whether that’s helicopter or fixed-wing – it’s dependent on the patient, location and situation,” he explained.

LPR also looks to upgrade its onboard equipment where possible, but said that as a ‘government organization … we can’t always get what we want’, due to the limited LPR budget afforded to it by the Ministry of Health.

“We have a new ultrasound – and are trying to change our ventilator. With our current one, we have problems with small babies and children [who weigh] below 10kg,” he explained. The organization is currently looking to acquire new ultrasound machines and respirators to replace its existing ones.

Legislation and onboard blood supplies

However, one thing LPR is currently unable to bring onboard is blood. “We don’t carry it,” said Burakowski. “National regulations mean we can’t do it in the helicopters; we can’t use blood outside of hospitals.”

This regulation is the Public Blood Service Act of 22 August 1997, which governs the management of blood products in Poland, restricting the access to formal ‘medical entities’ such as hospitals and clinics.

Such legislation is not unique. Until the end of last year, New York did not allow air ambulances to carry blood for trauma victims onboard aircraft. However, efforts to change such laws can be challenging.

While the Act has been amended 16 times since inception, Burakowski says LPR has not yet been successful at convincing the government to give them access to blood onboard helicopters.

Until the end of last year, New York did not allow air ambulances to carry blood for trauma victims onboard aircraft

“We have tried to change it, but it’s not easy due to the complicated situation and high financial consequences.”

LPR aiming for consistency

LPR tries to provide the same consistent operational standards across Poland, regardless of region, with one standard helicopter type, ‘one standard of medical equipment, flying procedures and medical procedures’.

This goal is aided by the organization’s publicly owned status, Burakowski says, giving it the financial security to maintain a stable level of service. “We are in an excellent situation, because the Ministry of Health give us a budget, and we don’t have to find the money like a charity or foundation – I know that in the UK it’s a lot more hands-on,” he said.

Despite this, there are subtle differences in how it operates. In particular, pilots operating in the country’s more mountainous regions ‘are a little different’.

“They fly into mountains and cooperate with rescuers, but don’t have a winch or a hoist cable, and we don’t do human external cargo operations,” he said, adding that mountain rescues are conducted exclusively by ‘landing on the ground’.

“We don’t have very high mountains,” Burakowski said, adding that while ‘we tried using them, and we have a program to use the cables’, however the ‘crew is not in training’, so the risks of using a hoist were deemed insufficiently safe or useful when weighed against the potential benefits – too few operations ultimately needed them.

The one exception is the Tatra mountain range, where the highest peak, Rysy, is over 2.5km in height – however, LPR does not operate there.

“In the other mountains, it’s not so high, and most operations have us landing somewhere and going with mountain rescuers,” said Burakowski.

Instead, aerial rescue operations are conducted by the Tatra Volunteer Search and Rescue (TOPR), an independent organization that flies a pair of PZL W-3 Sokół helicopters and is the primary provider of helicopter rescue services in the Tatras.