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It is unusual to find the subject of helicopter emergency medical services (HEMS) at the center of national policy. However, such is the reputation of FinnHEMS, Finland’s state-funded HEMS operator, that the current government has made continued support for the organization a priority in the country’s ongoing social and health care reforms.
Finland has a widely dispersed population of 5.5 million — just over half the population of New York City — but more than a quarter of Finns live within the capital city of Helsinki or the greater metropolitan area. Thus it was from here that the nation’s first air ambulance operations began in 1992. With a clear need for national HEMS infrastructure, other operations soon appeared and adopted a charitable model that, while able to maintain a capability, was reliant on donations and grants that were highly variable and, in some cases, open to misuse.
By 2011, Finland was ready for change and new legislation offered the opportunity to rationalize HEMS operations, improve oversight, and stabilize the balance books with funding from the country’s purse.
The five university hospital districts in Finland together formed the FinnHEMS corporation, which is now responsible for providing complete national HEMS coverage with just six bases and eight helicopters. FinnHEMS answers about 14,500 calls annually and can reach over 70 percent of the population within 30 minutes.
Leadership and strategic oversight of FinnHEMS is carried out from the organization’s headquarters at Helsinki Airport at Vantaa, while flight operations are performed by private contractors. In the south of Finland, Skärgårdshavets Helikoptertjänst Ab (SHT), a company specializing in air ambulance operations, supports three helicopter bases. In the North, Babcock Scandinavian AirAmbulance AB is responsible for a further three.
Operations vary widely between the bases. While all HEMS missions are demanding, the more populous and temperate south of the country offers what might be considered a more conventional flying environment, although with urban landing sites and only a seven-minute average sortie length, the pace of flying is intense. The crews in the south operate the Airbus EC135 P2+, a Pratt and Whitney-powered variant of Airbus Helicopters’ ubiquitous H135, crewed by a single pilot, an EMS physician, and a HEMS crewmember who also has paramedic or firefighter training.
A ‘hostile environment’
Things are different in the north of the country, where in winter the sun doesn’t come up for two entire months and vast distances between population centers require an aircraft with much longer legs. This capability used to be fulfilled with Airbus AS365 N2s, but in 2015 FinnHEMS became one of the first customers of the Airbus BK117 D-2, better known as the H145. The aircraft operated from FinnHEMS’ Rovaniemi base is the only one in the world to be fitted with a proprietary 800-kilogram (1,765-pound) extended-range fuel tank.
The Rovaniemi base covers all of Lapland in the far north of Finland, and here it is the environment that provides the challenge, with winter temperatures plunging to below -30 C (-20 F). Snow is a mixed blessing as it reflects the ambient light, improving terrain definition through night vision imaging systems (NVIS), but can also create a blizzard-like snowstorm in the helicopter downwash during takeoffs and landings. As the snow melts so does the reflected ambient light, and the lack of cultural lighting in remote areas delivers darkness like putting a bag over your head, even through NVIS.
FinnHEMS classifies the environment and climate around Rovaniemi as “hostile,” so twin-pilot operations are mandated, while in the cabin an advanced paramedic joins the crew in place of a physician.
“I’m responsible for everything medical in the aircraft,” explained advanced paramedic Janne Lindström. “During takeoff and landing the other paramedic will be assisting the pilots. I will do any advanced techniques like intubating the casualty; after that I take my hands off and he leads with the patient care.”
As well as being medical professionals, the paramedics have a range of other duties both within the aircraft and — in the case of water rescues — well beyond. Rescuing those unfortunate enough to fall through ice is the responsibility of the fire and rescue services, but in remote areas a helicopter is often the only way to reach them. If a specially equipped Border Guard helicopter is not available, the job falls to a FinnHEMS crew from Rovaniemi.
Average sortie lengths here are 30 to 40 minutes, with 90-minute flights not unusual, so the aircraft is always hangared with full tanks. With four crewmembers and medical equipment, this puts the aircraft only a few kilograms under its maximum all-up mass (MAUM). Even so, pilot and HEMS Captain Tatu Laurila explained that the aircraft is more than up to the challenge.
“It’s a very nice machine, I like it a lot,” he said. “There’s so much power, even at max takeoff weight, and the single-engine performance is unbelievable. It’s like the second engine is just for show.”
The aircraft is also fitted with Helionix Step 2 avionics, which includes a terrain and obstacle database, but Laurila said that the most important feature to him is the autopilot: “It’s four-axis so you can control everything. For approaches you load up an IFR [instrument flight rules] approach and it will fly it down to 50 feet without you having to touch any controls.”
Given the longer sortie times in the north, decreasing the workload in the air also allows the crew to respond more efficiently to calls by conducting some of their flight planning while en route. Laurila explained, “We plan the first leg in the briefing, but after takeoff we can put the autopilot in and start calculating fuels or whatever.”
Even with all the modern equipment, the flying is still demanding, and shift patterns are 48 hours on during weekdays and a grueling 72-hour duty time during weekends. Laurila told me that managing fatigue can be a challenge in itself.
“We have to be careful about the amount of time we spend on duty, but in the HEMS role that’s not always easy. When your shift time is over you can’t just say, ‘I’m off duty now’ and drop your gloves.”
Unsurprisingly, FinnHEMS operations require experienced crews. At Rovaniemi, most pilots come from the Finnish Border Guard with in-depth knowledge of the local area (see p.50, Vertical 911, Spring 2018). FinnHEMS requires its pilots to have a minimum of 1,000 flying hours as pilot in command, and many have much more than that.
The costs of building such experience, not to mention maintaining such a modern fleet of advanced aircraft, are high but are reflected in FinnHEMS’ safety record — since its formation, there have been no accidents that have resulted in injury to a crewmember or loss of an aircraft. Even in an age of perpetually tightening treasury purse strings, Finland has made a substantial investment in order to provide its residents with safe, high-quality emergency medical services.
Indeed, the Ministry of Social Affairs and Health has stated that helicopter operations are Finland’s top priority in the field of emergency care. Any future threat to the continued support of FinnHEMS is bound to make headlines, given how vital its eight aircraft are to Finland’s emergency care system, and the millions of people that the system supports.