Unseasonably heavy monsoon downpours hit southern Thailand last January, causing tremendous flooding that affected nearly a million people in 10 provinces. Medical emergencies became critical as many villages were left partially submerged, cutting off access to hospitals, clinics, and medical personnel.
Thailand’s only helicopters equipped for emergency medical services (EMS) literally came to the rescue. For four days, Bangkok Helicopter Services (BHS) — known locally as Sky ICU — flew medical supplies and personnel to stranded citizens, also providing medical evacuations to critical patients.
“When flooding happens in Thailand, many villages are cut off with no transportation, except maybe boats,” said BHS managing director Kirati Kraiprasit. “We work with hospitals and organizations to transport the supplies and medical staff the people in villages need, as long as there is a safe place to land. This year was bad, but it wasn’t the worst. Five years ago, rains in the north flooded much of the country and we were very busy for two months helping in many provinces.”
A subsidiary of Thailand’s largest healthcare provider, Bangkok Dusit Medical Services (BDMS), BHS is Thailand’s first and still only provider of helicopter emergency medical services (HEMS).
The helicopter operator began contracting with Bangkok’s largest medical facility, Bangkok Hospital, in 2007, with a Eurocopter (now Airbus Helicopters) EC145 to provide 24/7 day and night, visual flight rules (VFR) and instrument flight rules (IFR) HEMS to Thailand and surrounding countries.
In 2016, the operator expanded, adding a brand-new Airbus H145. Both aircraft are completed with EMS conversion kits and can carry up to two patients. Onboard advanced life-saving equipment includes the Braun Perfusor Space Infusion Pump, Dräger Oxylog 3000 ventilator, Weinmann Accuvac Rescue suction pump, Schiller Argus Pro LifeCare 2 (defibrillator, pacemaker, patient monitor, and 12-channel ECG) and a Newport HT-50 ventilator.
The aircraft operate with two pilots and typically carry an aviation doctor (emergency medicine doctor or specialist with HEMS training), and one to two flight nurses or paramedics depending on the severity of the patient.
“We’re equipped to transport all kinds of patients who need further treatment in higher level medical facilities,” Kraiprasit said. “However, most transfers are trauma, cardiac, neonatal, burn patient care, and other types of emergency cases.”
The aircraft are equipped with glass cockpits (including the Helionix flight deck in the new H145), autopilots, and weather radar.
“We are one of the only operators allowed to fly at night here,” Kraiprasit told Vertical 911. “More than half of our operations are at night, usually VFR or special VFR. Though we can fly IFR. However, the IFR routes aren’t convenient for the places we fly. They’re set up between airports only.”
When an emergency call comes in, the helicopter is set to launch at a moment’s notice with pilots based with the aircraft at Don Mueang International Airport, a 10-minute flight north of Bangkok Hospital. After a quick trip to the hospital to collect medical personnel, it is off to the scene.
BHS helicopters boast a 2.5-hour endurance and a more than 150 miles per hour cruise speed (246 kilometers per hour), allowing the aircraft to reach areas as far as 75 miles (123 kilometers) from the hospital in 30 minutes.
Expanded Service
While aircraft are based in Bangkok, the service is set up to support any hospital or patient who makes a request. In addition to operating throughout Thailand, BHS has conducted EMS flights in Cambodia, Laos, and Myanmar (Burma).
“We are here to support whoever needs the service,” Kraiprasit said. “Of course, that is dependent on our ability to get to the patient.”
In addition to distance, BHS’s team must overcome additional obstacles to HEMS, including mountainous terrain, landing site identification, government agency permissions to fly and land, and even some areas of political unrest where the helicopter could be targeted by ground fire.
“When we know a region, hospital, or community wants access to our service, we go out in advance to identify obstacles and train first responders, help identify safe landing zones, and gain permissions to operate and land,” Kraiprasit said.
“We do a lot of public relations, building goodwill and laying groundwork for operations in areas that have never had access to HEMS. We are a life-saving operation and people understand that. We have to do a lot of education to assure we can operate, and operate safely.”
The program has made significant inroads. When at all possible, BHS will call ahead and receive permissions to land and navigate airspace. However, emergency response doesn’t give the operator the luxury of time. BHS has negotiated several agreements through which paperwork can be filed after the fact in instances where emergency life-or-death situations require immediate launch.
Despite its growing popularity, the service still remains the only HEMS provider in the country, 10 years later.
“There are fixed-wing transport services in Thailand and surrounding countries, but we’re still the only HEMS operator,” Kraiprasit said. “It is very expensive, and a great deal of work must be done behind the scenes to make it successful. Having a large parent company is what makes it possible in Thailand.”
Financing HEMS
Dr. Prasert Prasarttong-Osoh is a majority shareholder of BDMS, a public company that manages the Bangkok Helicopter Network. He encouraged adding helicopter emergency medical services to BDMS and Thailand.
“Dr. Prasarttong-Osoh had a mission that there should be this kind of equipment available to support the hospital and the people,” Kraiprasit said. “He and the hospital had been receiving requests from people in Thailand — patients who needed to be transported, insurance services, and even other hospitals. Sometimes the request is for transport to Bangkok, and sometimes it was to transport a specialist to a remote area with medical equipment.”
Being the largest hospital system in Thailand, Bangkok Hospital Networks was in a position to support bringing HEMS to the country.
Bangkok Helicopter Services Co., Ltd., was created as a privately owned company within BDMS to serve Bangkok Hospital and its surrounding network.
Through a three-year, renewable contract, BHS provides HEMS to Bangkok Hospital, greater BDMS facilities, and any other hospital or patient requesting HEMS transport — scene to hospital, hospital to hospital, and even airport to hospital to retrieve patients flying in via fixed-wing EMS transport.
The HEMS service is basically funded through guaranteed revenue from Bangkok Hospital to assure basic operating costs are met to maintain the operation, while the hospital directly bills patients and insurance companies to recover costs. The guaranteed revenue covers the service’s annual 300 to 350 flight hours per helicopter as well as public relations and training with hospital and emergency personnel.
When it comes to serving other hospitals and regions for patient transport, funds are pre-authorized to assure payments.
“This service is a very small percentage of BDMS’s overall revenue so it becomes feasible for the system to support it,” Kraiprasit said. “One person in a remote area isn’t going to be able to pay the price to cover an emergency transport. This type of service wouldn’t be possible without the support of a large parent company.”
While the aircraft are first and foremost on call for EMS, their EMS conversion kits can be quickly removed should one of the aircraft be needed for commercial operations such as VIP transport, aerial filming, or newsgathering.
“It takes about 20 minutes to reconfigure the aircraft for non-medical uses,” Kraiprasit said. “Being able to offer these services helps supplement our basic revenue guarantee from Bangkok Hospital to support the aircraft.”