Frans Fuhrmann, chief pilot for ANWB Medical Air Assistance Amsterdam, was recently met with some scepticism when he revealed that his organisation’s crews achieve average start-up times of two to three minutes in daylight and eight at night. Other HEMS professionals writing on the EMS Flight Crew Facebook page cited average start-up times of around 10 minutes, and some worried about the safety of getting airborne just two minutes after a call is accepted.

But safety, Fuhrmann explains, is at the heart of all of the crews’ procedures. He says: “Speed is not a goal, it’s a result and it can only be achieved by putting safety first.”

ANWB is the HEMS operator for the Netherlands. A team of 38 pilots flies 24/7 emergency missions from four stations (Amsterdam, Rotterdam, Groningen and Volkel) with each station covering about a quarter of the northern-European country. Its fleet consists of five Airbus H135 helicopters (two T2s, two T2+s and a P2+) for HEMS and two Airbus H145 helicopters for patient transport. The second H145 is based on Leeuwarden air base in the north of the country to provide patient transport from the nearby Dutch islands.

All in the prep

As the H135 is not a very complicated helicopter to start and check, this procedure takes only one minute after getting in

So how do the crews achieve such remarkable speeds? Largely with meticulous preparation and an effective distribution of tasks. “Our crews work in two shifts; they start at 06:30 or 18:30 hrs. The crew – a pilot, a HEMS crew member (HCM) and a doctor – do the flight preparations (weather, NOTAMs, technical status, crew briefing and pre-flight). At 07:00 or 19:00 hrs, the new crew takes over and sets the helicopter ‘hot’, meaning that they do all of the interior checks and pre-starting checklists,” Fuhrmann explains. “After that the helicopter is ready to go by performing the ‘starting engines HEMS’ checklist and pre-take-off checklist.

As the H135 is not a very complicated helicopter to start and check, this procedure takes only one minute after getting in.”

After the helicopter is set to ‘hot’, the weather for each base’s designated area is monitored constantly. The helicopter is either kept in the hangar or outside on the platform with the crew stationed nearby. The way that the base is set up plays a part in achieving quick response times.

“On all of our bases, we have a large screen displaying current weather (TAF and METAR), weather radar, ground visibility, wind and cloud base maps,” Fuhrmann describes. “This really helps in the decision-making process and situational awareness. In the case of Amsterdam, air traffic control (ATC) is also a factor as Schiphol international airport is very busy and our base is close to the airport. We co-ordinate with ATC before taking off, and because we have established a very good working relationship and protocols with them, there is hardly ever a delay for us.”

Prepare for lift-off

When a call comes in, the crew springs into action with a well-rehearsed routine. Fuhrmann says: “After receiving the call by pager and deciding to go by helicopter, the pilot checks the weather first then goes to the helicopter, gets strapped in and communicates with ATC for start-up clearance. The doctor confirms the call by secure radio communication and then stands in front of the helicopter to assist during the start-up procedure. The HCM enters the destination in the (iPad-based) navigation system and then goes to the already started helicopter.” When the entire crew is onboard, pre-take-off checks are performed by the pilot and HCM and take-off clearance is obtained, he adds. The checks at this stage are quick, as the H135 has only brief manufacturer checklists. Though Fuhrmann declined to share exactly what’s on ANWB’s checklist, it’s Airbus-approved and streamlined to meet the crews’ needs.

after each flight the crew conducts a walk-around and thorough flight check

“In our operation, VFR single pilot, the tasks are shared between pilot and HCM. They work according to crew concept. The pilot flies the helicopter, communicates with ATC and performs all switch selections (beside radio settings) and the HCM is responsible for navigation and reading the checklist (normal challenge and respond procedure). The doctor assists during start-up and is an extra pair of eyes during flight and landing. He/she communicates with dispatch and also has the same navigation system on an iPad as the HCM to help with situational awareness,” Fuhrmann says.

After each flight, he explains, the crew conduct a walk-around and thorough flight check: “This way, we make sure that the helicopter is ready to fly the next mission. The helicopter is always in view of the crew/security camera and is positioned in a secured area, either airside when based on an airport or on a secured and closed off helipad when based on a hospital.”

Top gear

ANWB’s fleet and equipment help crews in this efficient response. “The H135 helps by being an easy helicopter to fly,” Fuhrmann says. “It starts fast (and we don’t even use the fast start) and is very reliable (technical uptime is more than 98 per cent). The H135 systems are easy to monitor for the pilot and it is a very stable and powerful helicopter: you know you have the performance to safely take off and land even in the case of an engine failure.”

He continues: “Our iPad-based navigation system (PANDA) also helps. It’s stable, accurate, easy to use and really helps crew performance. It has all relevant aviation and road maps, a street and highway database, integrated NOTAMs and an obstacle database. Flying VFR during the day in poor weather and at low altitude, it’s a real help.”

Why the rush?

ANWB helicopters responded to over 8,000 taskings all over the Netherlands in 2016. Amsterdam’s Lifeliner 1 crew accounted for 2,100 of these missions. A further 1,300 were handled by specialised response cars when the weather was below safe flying limits or the incident was within short range of the station. “So with an average of almost 10 call-outs a day, we are quite busy,” Fuhrmann says. 

speed is not a goal, it’s a result and it can only be achieved by putting safety first

Along with the crew’s ability to get airborne quickly, the small size of the Netherlands means that crews can usually reach a scene within their area of operations in 15-20 minutes. So why not save money by having fewer bases, covering larger patches? Why the emphasis on speed?

“Speed is important to get specialised, high quality care on scene as fast as possible, which results in a better outcome for the patient,” Fuhrmann says, explaining that ANWB provides this by flying with a medical specialist such as an anaesthesiologist or trauma surgeon onboard.

“Our teams are called out when dispatch is called by the public and the incident is within our scramble criteria or when the ambulance crew on scene requests our assistance. Transporting the patient to a suitable hospital is not our main goal. In the case of Lifeliner 1, we transport only one in 75 patients by helicopter. In most other cases our doctor rides with the patient in the [ground] ambulance and is picked up by the helicopter afterwards.”

While patient care is certainly a priority, the safety of the crew is paramount. “I do think we have a good balance between speed and safety; speed is not goal for us, safety is! The speed is merely a result from good equipment, streamlined procedures and well trained crews. Our crews are not pushed to get airborne in the shortest time possible, but in the safest way possible. In my honest opinion we minimised the risks of starting up fast to a level where they are no greater than the risks of taking 10 minutes to start,” Fuhrmann asserts.

The fact that there is no commercial, customer or company pressure to get airborne quickly helps crew performance, he adds, saying: “If the helicopter is not 100-per-cent, we don’t fly. If the weather is below limits, we don’t fly. If the crew is not happy to go, we don’t fly. Our company, crews, dispatchers and the customers we fly for (Traumacentra) all know and accept that.”

Of course, not every scramble is done at top speed. Poor weather is the most common cause of slower operations. This can result in delays as the crew assesses whether they will be able to get to the scene and back safely, in weather beyond its approved minimum. At night the procedure takes slightly longer too, of course. “The crew has to get up and dressed, weather is checked more thoroughly and a possible landing site is surveyed in Google Earth as we’re not allowed to land inside built-up areas outside the uniform daylight period (UDP) – unless it is on a pre-surveyed site,” Fuhrmann says. “We also need a slightly longer time to start up at night because all stabilisation systems have to be online before take-off and our night vision goggles (NVGs) have to be calibrated.”

When it all comes together, getting on-scene safely and fast, completing a HEMS mission and helping as a team to give a patient the best care possible is ‘very satisfying’, says Fuhrmann. He adds: “That combined with the fact that we get to land in some pretty nice places (on a bridge over a canal in Amsterdam, for example) makes it a great job.”

For other crews seeking faster start-up times, Fuhrmann says: “My advice is not to make speed an issue! Streamline your operation, share tasks, train, have good equipment, systems to give you situational awareness and speed will automatically be a result.”