EHS LifeFlight

Quicker Trips Save Lives

Medical transport can be challenging even at the best of times. But EHS faced a particularly tough environment. In Nova Scotia, medical specialists are mostly clustered in a few cities, while many residents live in rural areas far from these medical hubs.

For example, a common procedure is cardiac catheterization. It’s a low-risk method of detecting and treating heart problems, but not one that should be delayed. “I’m a paramedic by trade,” Flynn explained. “We always say that time is muscle. The longer it takes to get that catheterization, the more at risk the cardiac muscle is.”

Previously, patients endured long trips by ground ambulance, which also wore out paramedics. “A typical one-way transport from Sydney to Halifax is a five-hour trip for a paramedic crew,” Flynn said. “The crew also has to eat at some point, and then return home. So we have to plan for a 12-hour trip to get there and back. That takes a paramedic crew out of their community for an entire shift every single time that we need to send a patient.”

Trips to and from mountainous areas, such as Cape Breton, were especially taxing. “It’s a challenging drive just on a summer day, let alone in winter and over changing road conditions,” Flynn said. The result was burnout and job turnover for paramedics who are already in short supply.

Choosing the Right Aircraft

PAL Aerospace is no stranger to challenging aviation projects. The company also develops and operates intelligence, surveillance, and reconnaissance (ISR) and other public safety aircraft for addressing today’s environmental, economic, safety, and security threats.

Indeed, PAL had already demonstrated its innovativeness and resourcefulness by reconfiguring EHS’s King Air 200 as a critical care air ambulance. The modified King Air 200 was the first aircraft of its kind to use a roll on/roll off system that allows a wheeled stretcher to be transferred from a ground ambulance to an aeromedical aircraft with minimal discomfort for the patient.  To accomplish this required the floor of the plane to be leveled to facilitate wheeled equipment, as well as designing special restraints to prevent movement of the stretcher during flight.

That same level of engineering creativity was required for the Beech 1900D. “I think the largest challenge was actually getting the patient on the aircraft successfully,” recalled Beverly Myles, the PAL design manager who played a crucial role in revamping the aircraft.

“The aircraft came to us looking brand new,” Flynn remembered. “The customization, the attention to detail and the workmanship were fantastic.”

Regional turboprop airliners – those winged workhorses that fly the world’s airways – make ideal ambulances to service small airports. And the 1900D is especially suitable: it offers a large cabin (the airline version can accommodate 19 passengers) that is tall enough for bulky equipment such as neonatal incubators, and wide enough accommodate Spectrum stretchers. “We’re able to safely and comfortably transport two stretchered patients and six seated patients,” as well as room for four paramedics, said Flynn. “It’s a great provider to patient ratio.” The aircraft routinely carries 10 passengers a day.

In addition, the aircraft offers ample space for bulky emergency stretchers and other equipment. “We can transport basically anything up to full advanced life systems,” Flynn said. “The cargo door on the back of the aircraft makes for easy loading and unloading. We can even put wheelchairs on board as needed.”

A Challenging Makeover

To the public, an air ambulance is an impressive machine. But the truth is that converting an airliner into an ambulance requires persistence, imagination, skill, and the ability to meet numerous medical and regulatory requirements.

PAL’s design and engineering team had to tear out and rebuild the 1900D from the inside. The aircraft had to be modified to allow Spectrum stretchers to be easily loaded. “Given Nova Scotia’s weather and small runways, the [Spectrum] system wasn’t quite rugged enough for what they required,” Myles said. “We had to make some adjustments to allow for more stable loading of the patient.”

Medevac aircraft also have numerous requirements not faced by normal airliners. For example, “we had to design new ways to run the oxygen lines and allow for suction of the patients,” Myles said. “We didn’t necessarily anticipate that in the beginning. And it was a bit of a challenge to try and make those types of changes, which are major when you’re looking at oxygen inside an aircraft while still meeting project timelines.”

The miracles of modern medicine rely on a huge variety of fluids and substances, from drugs to cleaning agents. If there’s a spill on a hospital floor, it’s just a cleanup. But spillage that seeps into an aircraft’s flight control systems risks catastrophe, is a potential disaster. “You’re essentially in a hospital room within an aircraft and spillage happens,” said Marco Perrella, PAL’s director of engineering projects. “We want to make sure we also protect the aircraft. So we had to seal all of the different seams in it.”

At the same time, PAL had to test numerous materials to find sealants that met aviation regulations regarding flammability. And, the presence of bodily fluids meant that the aircraft’s interior had to be easily cleanable. “One thing that COVID taught us was the need to decontaminate the aircraft as quickly as possible to minimize the amount of downtime,” Myles said

Sometimes, it’s the small touches that make all the difference. For example, when a EHS employee pointed out that loading areas at some rural airports lack adequate lighting, PAL came up with a simple but ingenious solution. A tail light on the air ambulances was modified to provide ground illumination. “They put in high-intensity LED lights and changed how the light rotated and lit up the entire loading area,” Flynn said.

Air Ambulance Ergonomics

Ergonomics is a perpetual complaint for airline passengers crammed into small seats and overcrowded cabins. But on a flying ambulance packed with sensitive or sharp medical gear, jostling through crowded spaces is not a good idea. “Being in a close environment where items have to be accessible to the medics, you do have to be a bit creative on where you place a lot of this equipment,” Perrella said. “Between the stretcher and the seats, you have to have a minimum aisle distance. That becomes a bit of a challenge, especially with seats that require a little bit more maneuverability.”

Solving these issues required a lot of ingenuity, as well as the flexibility to solve and learn from unexpected problems. “PAL’s engineering group is amazing,” marveled Flynn. “They worked with us to talk not necessarily about what they can and can’t do, but what was in the realm of the possible.”

“Because if you want a particular item to be in a particular place on the aircraft, almost anything is possible. But if it’s going to take two years and millions of dollars to achieve, then you have to find another solution.”

Even now, EHS and PAL are collaborating to improve the 1900D. “Simple things like glove pouches, cup holders, the creature comforts,” Flynn said.

In addition to transforming the King Air 200 and Beech 1900D, PAL also provides flight crews and maintenance. This means ensuring that enough pilots are on staff – and are available on-call – for a quick takeoff.

The collaboration between EHS and PAL has been mutually fruitful. EHS gets an affordable air ambulance custom-tailored to meet its needs. And as good engineering firms do, PAL took advantage of the project to broaden its experience and strengthened its skillset.  For example, the 1900D project “taught us to make sure that for what we actually want to put in an aircraft,” Myers reflected. “Balancing what the aircraft can do, what we can physically install, and what the client wants while within budget is tricky. We learned a couple of lessons along the way.”

PAL intends to leverage this experience and expertise to further expand into the air ambulance market. Because the company has already developed and integrated special equipment and materials, reconfiguring future aircraft should be even faster. And because it knows what aerial medics need, PAL can make air ambulances even more comfortable.

For now, patients and paramedics are grateful just to get home sooner. Instead of having to return to the hospital after treatment while awaiting a ground ambulance, patients can fly directly back to their families.

“For a patient who had to be admitted to a hospital for three or four days while waiting for a cardiac catheterization, it’s wonderful to fly them directly back home,” Flynn said. “They don’t have to go back to the hospital to wait for the return trip. Their family picks them up at the airport, and they finish their recuperation at home.”

Certified, Reliably Crewed, and Proactively Maintained

Certification processes played a pivotal role in the project’s progression. PAL Aerospace navigated the intricate regulatory landscape to obtain necessary approvals for these significant modifications, ensuring each adaptation met strict safety and performance standards. This rigorous certification process underscored the company’s commitment to reliability and excellence in every facet of the air ambulance service.

Operational integration was equally vital. The deployment of a world-class aircrew and dedicated maintenance team ensured the fleet’s high performance and reliability. This comprehensive operational strategy enabled the program to achieve remarkable uptime metrics, showcasing the effectiveness of PAL Aerospace’s end-to-end solution. Feedback loops from operation back to engineering and maintenance teams facilitated continuous improvement, ensuring the service remained at the forefront of aeromedical innovation.

Collaboration with EHS was fundamental to the project’s success. This partnership leveraged PAL Aerospace’s technical expertise and operational capabilities to address the nuanced needs of Nova Scotia’s communities. The collaborative approach resulted in a service that not only met but exceeded expectations, highlighting the transformative potential of integrated healthcare and aerospace solutions.

This air ambulance program stands as a testament to the power of innovative engineering, and seamless operational integration in addressing critical healthcare needs. By bridging the gap between aerospace solutions and medical service delivery, with PAL Aerospace, EHS LifeFlight has redefined the parameters of medical transportation in Nova Scotia, delivering a service characterized by speed, safety, and unparalleled patient care.