Highly regulated and often carrying high stakes, it is little wonder that aviation and medicine are often — if sometimes inaccurately — equated with one another.
Where aviation and medicine intersect, the tensions and differing priorities are just as evident as the similarities. Nowhere is this more obvious than in the field of helicopter emergency medical services (HEMS), where casualty acuity can be at its highest.
The need to balance potential improvement of patient outcome against the risk to those providing the care is uncommon elsewhere in either occupation. And nowhere is this more clearly visible than in the decisions that HEMS operators make about the technology they adopt.
In other areas, the emphasis might be on comfort, convenience or even cold hard cash. But in the cockpit or cabin of a HEMS helicopter, there is a laser focus on getting the balance right between risk and outcome.
For the Health Care District of Palm Beach County’s Trauma Hawk, the starting point is its two new Leonardo AW169 aircraft, equipped with a custom medical interior in addition to the suite of technology provided as standard on such a modern machine.
“Going from a [Bell] 412 to a Sikorsky [S-76] to the AW169 is a progression in technology,” said Jay Mazzone, associate vice president of transportation and director of operations for the Health Care District’s Trauma Hawk program.
“Just as your cell phones progress and the world progresses in technology, we progress in the helicopter world as well,” he said. “And the new helicopters have the latest and greatest in avionics and safety features.”
The phone analogy is fitting. While previous generations of helicopters were undeniably versatile, their flexibility was primarily built into the aircraft’s design. In contrast, digital helicopters like the AW169 rely more on software to enhance functionality and adaptability.
“It’s like going from a flip phone to an iPhone,” said Morgan Mallet, former emergency medical services pilot and helicopter instructor at Trauma Hawk. “The user interface is really what makes it easier for us. It’s laid out in a very common-sense kind of way, where the [Sikorsky] S-76 felt a little more pieced together. But as technology grew, Leonardo made it so there is a lot less button pushing to achieve the same thing.”
The benefits of software-defined systems and open architecture go beyond supporting new functionalities or automating sequences to reduce workload. In a confined cockpit, interacting with hardware is often dictated by its physical placement — sometimes inconvenient and, in certain situations, even hazardous. Software integration overcomes these challenges by enabling a single system to be controlled from multiple positions or allowing various systems to be managed from a central panel.
“Anything from our flight planning, performance planning, the use of the air conditioning, everything is in one central location,” Mallet explained. “Even the PFD [primary flight display] and MFD [multi-function display] screens are nicely laid out where you have all the information that’s relevant to you.”
The displays also feature touchscreen capability — a staple of consumer electronics for the past two decades but a relatively recent addition to cockpit design. One factor that the smartphone industry doesn’t yet have to contend with, though, is the need for the display screens to be compatible with night vision imaging systems (NVIS).
This doesn’t mean that the screens can be read through night vision goggles (NVGs) — almost everything within the cockpit is blurry when looking through the lenses as they are focused at infinity. It refers to the fact that the screens do not pollute the cockpit with light in a way that would interfere with the operation of the NVIS devices.
This extends to all illumination in the cockpit and cabin — which can be a challenge when the medical crew in the rear of the aircraft may need to have high levels of illumination in order to effectively monitor their patient. Here too, the AW169 benefits from the application of modern technology via its LED interior lighting system.
“The lighting in the back of the helicopter meets all of our nighttime needs,” said Eddie Rivera, a Palm Beach County Fire Rescue firefighter and registered nurse with the Trauma Hawk program.
“If it is too bright, we do have the ability to darken it. In addition to that, we have auxiliary lighting, which is more of a blue light if we don’t want the bright white lights,” he explained. “This helicopter also has UV [ultraviolet] lighting for decontamination if need be.”
Some 80 percent of the Trauma Hawk workload is so-called “scene calls,” where the helicopter flies to the actual scene of the trauma accident. The combination of NVIS for safe off-field landings and high-quality interior lighting for effective patient monitoring is essential, particularly given that the nature of those calls means that they are just as likely to be at night as during the daytime.
“Scene calls mainly consist of motor vehicle accidents as our number one reason why we would go pick up somebody, followed by shootings, stabbings, assaults, and things of that nature,” Rivera explained.
Being able to reach, extract, and monitor a casualty is one thing, but in trauma cases, early effective and continuous treatment from the scene to the hospital is also critical to improving the chances of a successful outcome.
“The patients that we encounter back here, usually their acuity level is higher, so their treatment is very time sensitive,” Rivera said. “And transports are on average seven minutes, so you have to get a lot done in a short amount of time.”
In scenarios such as these, what might seem like momentary time savings can compound in meaningful ways.
Stretcher transfers are a case in point. What seems like a simple task becomes far more challenging in real-world conditions — especially at night, with an injured patient and the medical equipment monitoring them, or even keeping them alive.
Awkwardly configured aircraft stretchers mean more time coordinating the people doing the moving, positioning the stretcher that they are being loaded from, moving equipment, and then doing it all in reverse when it comes to offloading the patient at the other end.
To solve this issue, and as part of their custom-fit medical interior, the Trauma Hawk AW169s were the first Leonardo helicopters to feature the longitudinal roll-on stretcher system, which allows the weight of the patient and any associated equipment to be borne on the stretcher itself, rather than the people moving them.
This has proven invaluable during interfacility transfers between medical facilities and is especially effective at trauma scenes, where just two helicopter crew members and two ground personnel can seamlessly transfer a patient into the helicopter for transport.
The casualty can be easily moved from the on-scene stretcher onto the aircraft stretcher, thanks to its ability to rotate fully out of the AW169’s cabin while supporting itself. After that, the patient remains on the aircraft stretcher until they are in the trauma center and ready for transfer to a hospital bed.
While in the aircraft, the AW169’s interior grants 360-degree access to the patient, as well as room for the onboard Palm Beach County Fire Rescue registered nurse and paramedic to access the suite of medical hardware the helicopter is equipped with. Here again, the selection of technology is wide-ranging.
“We have a monitor capable of defibrillation and pacing, as well as an end-tidal CO2 monitor,” Rivera said. “We can also do invasive line monitoring, including video laryngoscopes as well for airways, and we have multiple suction units and ventilators on the wall.”
There are unique dynamics, shared by both aviation and medical professions, in the way that their people must bring a lifetime of knowledge and experience to bear in a few moments. And when seconds saved at the scene could compound into lives saved and weeks less recuperation time, it’s much easier to understand why so much has been invested in not only the range of equipment on board, but its precise location and function.
“There is a learning curve when you come to the Trauma Hawk,” Rivera said. “Mainly, your timeframes are cut down to a fraction of the time in the helicopter than you have on the ground. Everything happens real fast back here.”
But much like with the smartphone revolution, it’s not always the speed with which tasks can be achieved that is the benefit. Reducing the cognitive capacity demanded by each task, and the subsequent reallocation of that attention to other areas, is often just as vital.
“I wouldn’t say necessarily a faster response time, but definitely less to think about,” Mallet said. “And with the lower pilot workload, now you’re increasing safety. Situational awareness goes up, and mission effectiveness and safety goes up all around.”
