The diverse business models in North Americas helicopter emergency medical services (HEMS) sector are testament to the fact that theres more than one way to approach the market.

On one end of the spectrum is the market-driven model that is especially prevalent in the United States; it highlights cost efficiencies and operational expertise, and is run by private, for-profit companies. On the other end is the public-driven model that is more well-known in Canada; it focuses more on operational safety and overall service level provided, and is run or administered by a government agency. Both models have strengths and weaknesses, but the question that often arises is whether a model can be developed that harnesses the best of both, while eliminating most of the respective weaknesses. 

While striking such a balance isnt easy, for many years the British Columbia Ambulance Service (BCAS) which provides ambulance services throughout B.C. under the authority of the provinces Emergency and Health Services Commission has been trying to be that viable option between public and private HEMS. Its long-term, dedicated contracts with commercial operators aim to harness the talent, expertise and efficiencies of the private sector, with the standards, consistency and expectations of a public service.

Governments ebb and flow in their philosophy for outsourcing air ambulance service, said Danny Sitnam, president and chief executive officer of Richmond, B.C., based Helijet, which operates three Sikorsky S-76C+ helicopters (and a Bombardier LearJet 31A airplane) for BCAS. They recognize that outsourcing works, but at the same time they want to have a say. Success lies in finding that sweet spot between the two.

For its part, Helijet has been in business for over 25 years, and, as such, brings a range of experience and expertise to the table. That is to say, the company has the entrepreneurial agility, organizational infrastructure and operational expertise and diversity needed to make an air ambulance contract work.

Originally launched in 1986 as a scheduled passenger service between Vancouver and Victoria, B.C., Helijet diversified into the air ambulance market in 1998, operating one S-76A for BCAS on a five-year term. Since then, the company has been awarded additional BCAS contracts for both rotary- and fixed-wing aircraft the most recent of which saw the company acquire three S-76C+s for dedicated air ambulance service in Vancouver and Prince Rupert as part of an eight-year contract, with an option for a four-year extension. With three helicopters and one airplane currently dedicated to BCAS contracts, air ambulance work now accounts for a significant part of the companys operations. 

Conversely, Helijets ability to adapt to the air ambulance market had a lot to do with the hard-won business savvy and expertise acquired through its scheduled passenger service. Lean years of economic downturns forced Helijet to find creative solutions to reduce costs, and that ability to sharpen its pencil served the company well when it came to bid on air ambulance contracts, often against much larger competitors with greater economies of scale.

Helijets experience as a scheduled carrier also provided it with an operational ace: regularly operating multi-crew, multi-engine, instrument-flight-rules (IFR) capable S-76As in the inclement weather and challenging geography of the Pacific Northwest made it an ideal contender for the 24-hour-a-day/seven-day-a-week challenges associated with air ambulance operations. 

Helijet does not have a lock on dedicated rotary-wing air ambulance contracts in the province, though. In fact, BCAS recently awarded a three-year medevac contract, with an option for two additional years, to CC Helicopters (2011) Ltd. of Kamloops, B.C. (see p.12, Vertical 911, AAAA 2012). The operator had already been using its Bell 412SP to provide medevac services in B.C.s Central Interior region on an ad hoc basis for about the past two years (as the extension of a pilot project), but recent this announcement marks a significant and stable commitment from BCAS.

It just makes good business sense for the [B.C.] Ambulance Service to partner with a private operator, remarked Brad Emsland, vice-president of CC Helicopters. We already had a facility in Kamloops and we had 

experience providing service to BCAS operating the 412SP; for them to set up their own facility and service would cost millions of dollars before it ever got started. This way, they can use our services to meet their needs.

The partnership between BCAS and the private operators it contracts with illustrates many of the benefits that can arise from a combined public-private HEMS model.  

What makes our system unique is that it is fully integrated between air and ground, explained Randy LHeureux, director of critical care operations at BCAS. We dont have different agencies passing patients one off to the other. Its a seamless organization all under one roof: were able to deal with problems and system improvements if we see an issue that is global, we can change it within our own organization; we dont have to count on other agencies.

Another unique element for BCAS is the outsourcing of its provider services. For example, by outsourcing helicopter services for a particular contract to one carrier through a competitive request for proposal, BCAS is able to dictate enhanced and specific safety standards and equipment requirements. Recent contracts awarded to Helijet and CC illustrate how BCAS had that say in shaping aircraft selection, equipment and safety standards to meet its particular requirements.

Those familiar with the air medical market know the S-76C+, while sometimes used for HEMS, is not a traditional model choice in this sector. But, BCAS determined it needed more cabin space than the more common light helicopter models often utilized in HEMS, and the price tag of one obvious alternative the larger AgustaWestland AW139, which is gaining popularity in some quarters was too steep. 

It came down to space, cost and performance, said Sitnam. The 139 model is an expensive proposition. On the other hand, cabin space was extremely important to BCAS, and in that regard the [Eurocopter] EC product line was less desirous. They also wanted to fly farther 240 nautical miles with 30 minutes reserve and carry more payload without having to refuel as often.

BCAS also wanted the performance necessary to access H1 (multi-engine-specific, non-instrument) heliports and to operate in mountainous environments. Furthermore, it wanted an aircraft equipped with enhanced navigation and safety systems, including a helicopter terrain awareness and warning system, traffic alert and collision avoidance system, enhanced ground proximity warning system, and enhanced vision system, among other things. 

In the end, Helijet felt that the aircraft best suited for the Vancouver and Prince Rupert contract was the S-76C+. 

Likewise, the Bell 412SP was ideally suited to BCASs contract in the Central Interior: It had the price point, performance, cabin space, range and remote ability BCAS wanted, said Emsland. The 412SP has a ton of space for paramedics and the range to cover vast distances. It was the right platform for the job: were not pavement-to-pavement; were landing at unprepared sites, often picking up injured snowmobilers and horseback riders. 

The public-private relationship also works in that it takes a longitudinal view, providing long-term contracts that offer air service providers the security necessary to make significant capital investments in equipment, infrastructure and organizational systems.

The BCAS contract is huge for CC Helicopters. Its going to be our future, said Emsland. It will be a huge boost for three years, and it will give us a good foundation. We were providing the same service on the pilot project, but this gives us the stability to carry on. Plus, with contract in hand, Emsland said CC will now be able to commit to investing in BCAS-required, upgraded equipment for its 412, particularly with regard to avionics, a secondary stretcher system and transitioning to IFR operations.

Governments looking to outsource air services need to think long-term, said Sitnam. Big investment is required to buy equipment and improve systems, and in the grand scheme, short-term contracts dont provide a lot of time to amortize those costs. 

Knowing BCAS is in for the long haul also gives Helijet the incentive to develop new heliports in communities where air ambulance access is either limited or non-existent. We see communities as our customers, as well as BCAS, said Sitnam. We have a background developing and managing heliports, and we spend a lot of time working with communities to develop access, particularly in the B.C. Interior and Gulf Islands, where there is little or no access.

In turn, BCAS values this expertise and commitment. Said LHeureux: Helijets understanding of the mission profile has been demonstrated by their offer to work with communities to come up with appropriate locations, and plans to access communities after hours. Over the last several years, weve worked with Helijet and Helijet has worked with the communities to develop heliports so we have 24/7 access. 

Helijets investment in enhanced navigation systems and safety equipment for the S-76C+ has also enabled BCAS to provide a greater level of service and reliability. Weve been able to go places where previous contractors couldnt, said Brendan McCormick, chief pilot, rotary-wing, Helijet. He attributed this to the companys strong set of standard operating procedures and the level of IFR proficiency acquired from scheduled passenger service, but also, more recently, to new equipment, such as the Max-Viz EVS-1500 enhanced vision system that provides greater situational awareness for flight crews. Our air ambulance flight crews are reporting that not only can they see terrain features and manmade structures at night, but they are seeing fog and cloud formations and concentrations of precipitation during the day, thus enabling them to pick safer routes ahead.

McCormick also noted that simulator training both initial and recurrent is a big part of Helijets air ambulance program.

Advanced technology, flight crew proficiency and the capabilities of the S-76C+ inspire confidence among BCAS critical care flight paramedics, like Robert Wand, unit chief, Station 280 at the Vancouver International Airport. With 24 years paramedic experience, 11 spent providing airborne care, Wand said he and his fellow flight paramedics are thrilled with the new S-76C+s Helijet acquired: Its an excellent platform for air ambulance. Its not too big, or too small, and the center-mount stretcher allows us to work on both sides of the patient. Its also fast for a helicopter, and it is very safe, with two engines and two pilots. 

That safety and speed are important in a big, rugged province like B.C., where flight times to remote parts of the province and back to major care centers can be as long as three or four hours. 

Wand noted that the close working relationship BCAS paramedics have with the flight crews inspires mutual trust and confidence: Helijet has been doing this for so long, they are now a part of our team. Their people embrace the air ambulance program just as we do.

Sitnam echoed that sentiment: Our people have depth of experience and a strong appreciation of the mission  what the paramedic and the patient need, and the importance of the relationship between flight crew and paramedics. 

In the same vein, Sitnam said many of BCASs representatives have a profound understanding of aviation issues and work closely with their contractors at all levels from pilots to senior management personnel to find solutions and system improvements. 

While BCAS is still fairly unique as HEMS models go in North America, it may end up being an example for the U.S. and Canada in the future, especially as U.S. governments begin playing a greater role in their countrys healthcare, and Canadian governments seek more private-sector partnerships. In other words, the public-private partnership model BCAS has been developing for many years may provide the answer to the question of how one can maintain the expertise and efficiencies of a for-profit model, with the standards and control of a government one.