For Sam Schaab, Leonardo Helicopters’ specialist in helicopter emergency medical services (HEMS), the AW169’s story begins with the patient.
“We really wanted to have the patient be the primary focus, as opposed to figuring out how to put a patient inside an existing helicopter,” he told Vertical Valor. “From the origination of the helicopter itself, the patient has been the center focus, and you’ll see that in all the cabin configurations.”
First certified in 2015, Leonardo’s AW169 is a twin-engine, light-intermediate helicopter that Schaab described as offering the most capability in its weight class.
“We came up with something pretty revolutionary, with a wide open, modular cabin that allows for highly flexible cabin interiors,” Schaab said. “It can allow for extensive critical care access to the patient and multiple specialty team configurations, as well as utility, combination configurations, law enforcement, VIP, and passenger transport.”
Typical HEMS layouts include a transversal or longitudinal stretcher, up to four crashworthy belted seats for medical crewmembers, a medical supply rack, an onboard oxygen system, and air conditioning.
One of the AW169’s most-lauded features is its auxiliary power unit (APU) mode, which idles the left engine (with rotors stopped) to maintain uninterrupted operation of electrical systems, avionics, medical devices, and environmental controls. This improves safety when the helicopter is on the ground at a scene or hospital helipad, while allowing it to return to flight in less than 90 seconds.
Certified for single-pilot instrument flight rules (IFR) and compatible with night vision goggles (NVG), the AW169 cockpit is ergonomically designed to reduce pilot workload. Its glass cockpit integrates situational awareness tools such as a helicopter terrain awareness and warning system (HTAWS), traffic collision avoidance system (TCAS), and ADS-B Out.
In addition, the AW169 offers peace of mind with its 33-minute “run-dry” main gearbox capability — with Schaab adding that the original equipment manufacturer (OEM) recommendation in that particular scenario is to land “as soon as possible” as opposed to “land immediately,” for an added layer of safety.
Operator interest in the AW169 remains high, Schaab reported, with about 250 aircraft delivered so far, flying primarily in Europe and the U.S.
“Overall, its performance is excellent,” he said. “Hot-and-high capability is very good. It has good power-to-weight ratio and the fastest speed in its category. It has full single-engine capability and OEI [one engine inoperative] capability, meaning it can land safely or fly away safely on one engine.”
Schaab added that Leonardo continues to refine the AW169. Phase 9 improvements are underway in Europe, while Phase 8 certification is progressing in the U.S. The Italian OEM is also developing a skidded version of the aircraft, expected to receive certification with the European Union Aviation Safety Agency (EASA) within the next year. Compared to wheeled landing gear, the skid configuration will allow an increase in gross weight.
Improvements are driven by customer feedback, he added.
“We continue to work with interior providers to develop different interior configurations,” Schaab said. “We are enhancing avionics capability. The technology is already on the aircraft for patient data transfer in real time, and we are working to increase that functionality. Beta testing is going on now in Italy.”
Schaab noted that HEMS operators are being asked to perform increasingly complex missions, but not necessarily with increased funding. With its spacious cabin and single-pilot IFR capability, the AW169 provides a blank canvas for specialized services such as incubator transports, high-risk obstetrics, intensive cardiac care, balloon pumps, and impellas.
From an operational perspective, every AW169 comes equipped with a built-in health and usage monitoring system (HUMS). The system allows crucial data to be sent to Leonardo for analysis, enabling the OEM to notify customers when a component is nearing replacement. This gives operators the flexibility to order parts in advance and schedule maintenance in a way that minimizes downtime.
“We look at our customers as being a long-term relationship, finding out what their operational needs are and how they change over time,” Schaab said. “One example is that we offer two different no-lift powerload solutions. So, we are making sure we’re set up well to meet those needs.”
Checking all the boxes
Sweet Helicopters of Indiana has been operating an AW169 helicopter on behalf of Parkview Health for just over a year, during which time the new HEMS aircraft has logged nearly 500 flight hours.
Keith Shivers, director of operations at Sweet Helicopters, said the Parkview Samaritan Medical Transport service covers northern Indiana, northwest Ohio, and southwest Michigan.
Before introducing the first of two Leonardo AW169s in August 2024 — the second is expected in September 2026 — Parkview Samaritan operated a trio of Airbus AS365 N2 Dauphins. When it came time to seek replacements, Parkview wanted to retain the qualities it valued in the Dauphin: dual-patient capability, speed, single-pilot IFR operations, and wheels instead of skids.
“The AW169 checked all the boxes that Parkview was looking for,” Shivers said. “They were one of the first programs in the country to use the 169 in an air medical role.”
While awaiting delivery of its second AW169, Sweet Helicopters continues to fly one Dauphin and supplements the fleet with a Leonardo AW109SP leased back to Parkview Hospital.
Shivers added that the AW169 is one of the best single-pilot IFR aircraft he has ever flown.
“It has great integrated systems and ergonomics tailored to single-pilot operations like ours,” he continued. “Another nice feature is it has the most comfortable seats I’ve ever sat in. And one of the coolest capabilities is the APU — you can have that going at a scene and not have to shut down all the way, keeping the environmental systems and avionics up. That has been huge.”
As for the cabin, Shivers described it as open and highly configurable.
While the standard setup is one medic and one flight nurse, the aircraft can carry two patients and up to three medical crew. It can also be outfitted for neonatal intensive care or other specialized equipment.
Everyone on board, he said, appreciates the smooth ride, made possible by the helicopter’s vibration absorber system.
“It counteracts any vibrations in the airframe so you don’t feel them in the cabin,” Shivers explained. “This reduces fatigue for the pilot, crew, and even the aircraft components.”
Speaking of fatigued parts, Sweet Helicopters appreciates the built-in HUMS capability that allows its maintenance team to do preventative maintenance and proactively check components for wear and tear.
Shivers added that training for the AW169 has been extensive, but Leonardo has been supportive throughout the process.
“It’s a complex aircraft,” he said. “It’s about a month [of training] for the pilots and about the same for the mechanics. Planning that out, getting the special tools, getting hangars rewired for the different types of plugs for the hydraulic mule — we had to do that at each of the bases.”
Phenomenal ergonomics
On March 1, 2025, Ascent Helicopters completed its first AW169 air medical mission — and the first on the type in Canada — operating on behalf of British Columbia Emergency Health Services (BCEHS). With support from subcontractor Babcock Canada, seven AW169s are now flying from five bases: Parksville, Vancouver, Kamloops, Prince George, and Prince Rupert.
All seven aircraft were delivered between fall 2024 and summer 2025, said Trent Lemke, president of Ascent Helicopters. When they arrived, everything except the medical interior kits had already been installed. Those were completed by HeliMods at Babcock’s Vancouver facility.
So far, Lemke said Ascent has been very pleased with the AW169.
“We really like the design and layout of the cabin,” he told Vertical Valor. “It’s a boxy, open cabin with big sliding doors and no obstructions. It’s a big working space with a flat floor, which is critical for fitting new equipment, and it’s very suitable for two to three paramedics plus a patient.”
Lemke said their top priority is maximizing unobstructed working space while ensuring equipment can be mounted easily, and the AW169 meets both needs. He added that BCEHS was particularly drawn to the aircraft’s self-loading stretcher system, which has a 700-pound (318-kilogram) capacity.
“There is no lifting involved. The stretcher system and the interior have been a game changer for BCEHS, so it saves backs as they transition away from lifting and loading.”
Since that first flight in March, Ascent’s seven AW169s have been busy. The northern B.C. bases see somewhat less activity, while the southern bases are consistently active.
Each of the five locations is home to one helicopter, with the exception of Vancouver, which has two — plus one spare. Prince Rupert and Vancouver operate around the clock, while Parksville, Kamloops, and Prince George provide 12-hour service.
Lemke acknowledged that bringing pilots, medical crews, and maintenance staff up to speed on the AW169 has been a lengthy process. Previously, Ascent operated MD 902s under the BCEHS contract.
“On the aircrew side, we’re averaging two months in indoc training with any new hires, including sim time,” he said. “The program has been a bit daunting, with 20 to 30 hours of training time before they can go online. However, this has created a high success and comfort level once they do go operational. The Babcock maintenance crew are going through factory training and indoc training. One of the positives that helped them get familiar with the aircraft is that Babcock engineers watched the interiors being installed by HeliMods.”
According to Lemke, the AW169 has made air medical missions more efficient. Its speed and spacious interior — compatible with any ground ambulance in the province — allow for seamless transfers.
“Aircraft performance is the big factor,” he said. “We’re always juggling between payload, aircraft size and H1 helipads — a lot of the helipads are built to size specifics so you can’t be over that. And the superior ergonomics and seating keep pilots and attendants comfortable during long days.”
Ascent pilots are enthusiastic about the new helicopter. Chief pilot Chad Friesen and Dean Elliot, the company’s manager of training and flight standards (IFR), shared their impressions.
“It’s a true single-pilot cabin, although we fly with two pilots,” Elliot said. “All systems and switches can be reached by one pilot. You don’t need to reach across the cockpit.”
He added that the AW169 is the first aircraft he has flown with onboard diagnostics. In the event of an electrical issue, for example, a schematic page is automatically displayed to help pilots identify the problem.
Friesen highlighted the helicopter’s “phenomenal” ergonomics.
“There are three main screens, synthetic vision, an intuitive autopilot system, altitude and airspeed protection, and unusual attitude protection,” he said. “Visibility is the best. You always struggle in an IFR helicopter being able to see, but Leonardo did a really nice job with visibility out of this helicopter.”
While both pilots praised the MD 902 for being ahead of its time, they agreed it is now a legacy aircraft — and comparing it to the AW169 is “not even apples to oranges.”
Elliot noted that the new helicopters provide added peace of mind for both pilots and BCEHS paramedics.
“This is the most capable helicopter, in my personal opinion, in North America,” he said. “The performance, speed, reliability, support from Leonardo — they really want to see this helicopter succeed and are giving us the tools to do so.”
Both pilots highlighted the AW169’s APU mode as key to mission readiness.
“If we go to a scene call where someone is critically hurt, the struggle has always been to get that aircraft back up in the air quickly,” Elliot said. “This mode allows us to shut one engine down completely, and the other one is disconnected from the transmission. The gear can still run inside the aircraft, keeping operating fluids within range. The crew can do any flight planning, then all we have to do is load the patient up, get the other engine going, then take off.”
On the pilot training program, Friesen said Ascent developed a change management plan for the transition to the AW169.
“For us, it’s been a very positive experience,” he said. “Bringing pilots out of legacy aircraft, we decided to spend quite a bit of time in the sim so they can transition smoothly. There is two weeks of ground school, two weeks in the sim, then to on-aircraft training. It’s quite the investment, but in the end, we’ve had amazing success. Pilots finish training and go right to work.”
Summing it up, Ascent’s Lemke said acquiring the AW169 was a big step for BCEHS, but an important one. Now, patients on central or southern Vancouver Island can reach a critical care facility within an hour.
“This is a next-generation aircraft and we are having great success with it,” he concluded. “The provincial government stepped up with new helicopter and fixed-wing [Beechcraft King Air 360CHW] fleets. Now, we have a generation of aircraft that will have a higher level of performance. Everything is getting built up in our environment, and safety is important.”
Flexible interiors
When it comes to helicopter air medical interiors, Switzerland-based Aerolite specializes in tailored solutions designed around operator needs.
“European HEMS operators’ requirements are more differentiated than in the U.S. In particular, there are different standards for medical gas supply and outlets, as well as country-specific preferences regarding the medical devices in use,” explained Michael Maier, sales engineer at Aerolite, which was established in 1995.
The company offers customers a variety of medical interior configurations, covering more than 20 different HEMS cabin layouts with just two supplementary type certificates (STCs).
“This flexibility allows us to serve customers with different needs, as well as covering the needs of operators with fleets operating across several regions or countries,” he continued.
To date, Aerolite has installed HEMS interiors in more than 40 Leonardo AW169 helicopters. Several others have been delivered directly from the OEM with basic medevac stretcher kits supplied by Aerolite.
Options include transversal and longitudinal stretcher placements for one or two patients.
“We get very positive feedback from the operators,” Maier said. “The usability and quality of our completions is highly appreciated. We also get suggestions for possible improvements, which we systematically implement when we update our STCs.”
As for new AW169 products in development, he noted that Aerolite is discussing “interesting ideas” with customers, though he declined to share further details.
Duncan Daines, Gama Aviation’s group head of engagement, special mission, agreed that European operators have varying HEMS mission requirements. He emphasized that there is no one-size-fits-all approach, and Gama’s AW169 interior STC is often adapted to a customer’s specific needs. To date, the company has used its STC to complete nine AW169 HEMS interiors on factory-green aircraft.
“Across Europe, the role of the AW169 configurations alter significantly depending on geographic terrain and the mission requirements of the service,” Daines explained. “In Italy, you’ll see hoist operations with latitudinal lightweight stretcher configurations that are designed for the rigors of alpine operation. In these circumstances, rescue is the primary requirement, often at high altitude in a variety of weather conditions. In the U.K., the AW169 HEMS fleet has a different mission entirely, tasked with bringing elements of a hospital environment to a scene, such that the patient can be stabilized, or even in extremis, receive further clinical interventions.”
Currently, Gama Aviation is developing a lightweight, modular patient loading system for the AW169, designed to protect paramedics while minimizing stress on patients. Upgrades and a new interior are scheduled for release in the first quarter of 2026.
“The [new] interior will incorporate the new modular patient loading system which has been a research and development project with our client and one of the U.K. national heath trusts,” Daines reported. “Due to the modularity of the new system, we believe this has applicability into several different use cases, including the potential for military medevac. On completion, the system will be EN-1865-1, Patient Handling Equipment, certified with UKCAA approvals. These approvals will then be extended to EASA and FAA.”
Daines said Gama looks forward to continuing to advance the AW169’s HEMS role in the U.K., in partnership with Leonardo.
“A great example of this is Gama Aviation’s position as the U.K. HEMS launch customer of the new 5.1tn skidded AW169 variant,” he said. “In Q4, we will start work with Leonardo to develop a new interior concept that takes inspiration from clinical community feedback and additional MTOW and the evolved rear cabin environment. The opportunity here is to determine how we can add provision for bariatric patients, intra-aortic balloon pump and ECMO devices.”
First certified a decade ago, Leonardo’s AW169 has proven itself in helicopter emergency medical services. As operators continue flying the aircraft and sharing feedback with Leonardo and expert completions centers, the AW169’s role in the air medical community will keep evolving to meet the demands of tomorrow’s missions.