History of Air Ambulances

If you’ve ever been near a hospital when an air ambulance is coming in for a landing, you know how powerful these jets and helicopters are. The sound of the rushing engines or pulsing rotors seems to fill the air with noise and shake everything around you.

While many people have experienced the impressive sights and sounds of air ambulances, very few have actually learned the history of how they began to be commonly used by medical hisotry. The actual story and facts behind jet air ambulance history are worth looking into for their interesting nature alone. Read on and learn more.

Military History of Air Ambulance Services

Like most technology now used every day by civilians like you, using aircraft to transport injured people to hospitals has its roots in the military. Fixed wing air ambulances were first tested and used during World War I by several different military organizations. While most people think helicopters when they think of air ambulances today, the first aircraft in this service were actually fixed-wing aircraft. Even though none of the air rescue missions took place in combat, these fixed-wing air ambulances were used by the American Army and Navy fairly commonly to rescue soldiers and personnel from crash sites.

The idea of using aircraft to transport casualties expanded and began to be used commonly by other militaries besides the United States. During the Middle Eastern and African colonial wards during the 1920s, the French and Briitish Militaries fully organized and deployed military airplanes as air ambulance services. The French military alone evacuated more than 7,000 casualties from battlefields and other rescue sites using fixed-wing aircraft. During the Spanish Civil War, organized air ambulance units were used to evacuate wounded persons from the fighting in Spain and to take them to get treatment in German hospitals.

While aircraft have been used to evacuate the wounded for almost as long as they have been in service, helicopters were not used until World War II when the U.S. Army evacuated combat casualties from Burma. Many people assume helicopters have always been used to transport wounded people to hospitals, so it’s interesting to see that fixed-wing jets and airplanes were used first. The first use of helicopters whose sole purpose was to function as air ambulances didn’t occur until the U.S. military forces used them in the Korean War in the early 1950s.

During the Korean War, the actual way jets and helicopters functioned as air ambulances expanded and increased from simply transporting casualties from the battlefield. The U.S. military used medical helicopters to transport patients in critical condition to hospital ships after the patients received enough treatment in field hospitals to put them at a somewhat stable condition. (If you’ve seen an episode of M*A*S*H, you’ve seen how helicopters brought patients to and from field hospitals.)

By the time of the Vietnam War, the actual training and expertise of the people manning air ambulances increased along with the advanced technology used in the fixed-wing aircraft and helicopters. Specially trained medical corpsmen on advanced air ambulance jets were so successful in providing medical care to wounded personnel that patients actually had a better chance of surviving being wounded in battle in Vietnam than they did being injured on a California highway. (We’re not sure what this says about driving in California, but it’s impressive nonetheless to see how quickly the technology evolved!) Based on the great success of air ambulance aircraft in Vietnam, civilian paramedics decided to implement the use of jets and helicopters in their medical service as well.

Most recently, the U.S. military uses UH-60 Black Hawk helicopters as the designated aircraft to use as an air ambulance during military operations. The Black Hawk has been a reliable aircraft to transport both military personnel and civilians to and from the battlefield, including wounded soldiers needing treatment. However, jets and fixed-wing aircraft are used to transport soldiers from the field hospitals back to the United States or to other more permanent hospital locations.

The success of American air ambulance units motivated American civilian paramedics, but it also inspired other countries to begin using military aircraft as ways of transporting wounded troops from the battlefield as well. In some instances, the wounded are even transported by air ambulance back to their home countries where they can receive proper treatment for their wounds and injuries.

Civilian History of Air Ambulance Services

As the success of military air ambulance medical jets efforts proved to be valuable and effective, civilian paramedic units began to take an interest in using aircraft in their efforts to treat sick or wounded people.

Some of the earliest incidents of using air medical transport to provide medical equipment was more incidental than deliberate. In several countries, such as northern Canada, Scandinavian countries and Australia, small towns and settlements were very difficult to reach during many parts of the year due to the conditions of the roads. This made it difficult for these towns to receive proper medical supplies and equipment. Fixed-wing aircraft were used to fly in supplies, mail and even doctors to visit the town and provide medical care. These services started off as being fairly unorganized, but they evolved into a more structured system of creating standing air ambulance services. During the 1920s, Sweden, Siam and Australia created organizations intended to provide these air ambulance plane services to remote settlements. Australia actually organized the very first full-time air ambulance service called the Royal Flying doctor service in 1928.

While the usefulness of air ambulances was recognized in remote areas and began to increase in use, the use of air ambulances didn’t take off in the developed world for some time. It wasn’t until the Saskatchewan Air ambulance service started at the end of World War II in Saskatchewan, Canada that air ambulances were used in a developed area. The United States’ first air ambulance service, the Schaefer Ambulance service, started in Los Angeles, California in 1932.

Shortly after, the use of fixed-wing aircraft expanded to regular use in the United States. A 1969 government grant was used to research the effect of medical helicopters on a region’s civilian mortality rates in Mississippi. After the grant’s funding ended, the research showed a significant improvement in the healthcare provided in the areas using medical helicopters and the Hattiesburg, Mississippi civilian air medical program became the first of its kind in the United States. The second was in San Antonio, Texas, during that same year.

Local air ambulance jet, fixed-wing and helicopter programs began to spread throughout the U.S. gradually after the success of the first few programs. Countries including Canada and Germany also starting using medical airplanes and helicopters regularly, increasing the number of aircraft in their programs. As the years passed, medical helicopters began to be commonplace in major metropolitan areas and soon spread to other areas as well. Now, air ambulances are a common sight and part of most paramedic programs.

Standards for Air Ambulances

As the air ambulance program grew in popularity and use, standards naturally developed which helped ensure the aircraft staff were qualified to meet the medical needs of their patients.

Air Ambulance Aircraft and Flight Crews

The pilots of air ambulances such as medical flight helicopters and fixed-wing ambulances need to have enough experience piloting to handle the aircraft in unusual flight conditions. Many emergencies requiring patients to be air lifted from an accident site take place in weather that’s not ideal for flying aircraft. While most pilots get plenty of experience in good weather situations, the pilots of air ambulances need to be prepared for almost any flying environment.

Due to the need for highly skilled pilots, the U.S. Government and the Commission on Air Medical Transportation Systems (CAMTS) set accreditation standards for medical aircraft and air ambulance pilots. This made sure that all aircraft pilots, personnel and the aircraft themselves met high regulatory standards.

The CAMTS accreditation is voluntary in principle, but several states and jurisdictions have passed laws that require companies that provide medical transportation services to be accredited by CAMTS. This is to make sure the companies offering air ambulance services (sometimes called “life flights”) can actually meet the quality standards the public expects. Pilots, personnel and aircraft are checked and accredited by CAMTS more than just once. The professionals who conduct the CAMTS accreditation perform regular checks to make sure everything is continually up to standards. The standards are also updated periodically to make sure the people and organizations they accredit reflect the most up-to-date medical technology standards.

Air Ambulance Medical Staff

The actual medical crew serving as staff on an air ambulance depends on the type of aircraft, the location, which company is acting as the service provider and a few other factors. A typical American air ambulance jet or helicopter is likely to be staffed by emergency medical technicians (EMTs), paramedics, flight nurses, a physician in some cases and a respiratory therapist. If the service is focused primarily on providing critical care to severely injured or wounded patients, it’s more likely that the staff will be mostly physicians and nurses. Sometimes the medical staff on an air ambulance will simply support the ground based EMS (emergency medical service) technicians at the patient’s location.

Medical Control on Air Ambulances

The medical control on air ambulances usually needs to have greater skills and training than normal paramedics. The greater training and skills by the air ambulance staff, however, allows them to have more freedom of decision when it comes to how the patients will be treated. For example, the staff on medical fixed-wing aircraft is sometimes able to read x-rays and interpret lab results to give the patient the best care as quickly as possible. Sometimes the companies providing air ambulance services actually hire full-time doctors to be on staff in case of emergencies.

Challenges for Air Ambulance Services

Even though air ambulance programs are very successful and responsible for saving the lives of thousands of people, there are some challenges to running a program. During the 1990s, air ambulances began to crash at an alarming rate. This is because air ambulance pilots usually fly in less than ideal situations and push themselves to the limits of safety because a patients life is at stake. The number of air ambulance crashes reached a record high in 2005, causing the United States National Transportation Safety Board to conduct research and conclude that many of these air ambulance accidents were avoidable. This improved government safety standards and CAMTS accreditation for air ambulances and their crews.

Another challenge is how civilian air ambulances are funded. While military air ambulances are financed through military funds, the civilian services usually have to find their own ways to provide the money for their programs. There are three basic ways civilian air ambulance services fund their programs.

Business Donations

A local business or even a company can fund an air ambulance service as a way to get publicity or to just perform some act of good will. For example, the Virgin Corporation funds the Helicopter Emergency Medical Service in London, both allowing patients to get the urgent care they need and improving the good publicity for the company. In German and the Netherlands, the automobile club ADAC funds many air ambulances, allowing their logo to be placed on jets and fixed wing aircraft designated to rescue patients. When businesses fund air ambulances, they must work carefully between government, emergency medical services and hospitals to make sure patient care still comes first. Usually, the companies sponsoring air ambulances don’t have any control over how the service operates.

Public Donations

Air ambulance services can also be funded through public donations. Charitable fundraising has been shown as a way to supplement government funding or even stand alone by itself as a way to pay for air ambulance services. Some governments such as Scotland finance the Scottish ambulance service directly using public funds. Other organizations such as the Association of Air Ambulances are collections of charities whose purpose is to raise funds for air ambulance programs.

Paid for By Fees

Finally, some air ambulances are paid for by fees. Running an air ambulance service is very costly as several highly trained staff members are all needed to properly crew an aircraft. Imagine trying to have a jet air ambulance without a doctor or qualified pilot on board! Many private companies run air ambulance services and then charge insurance companies or patients for service.

There is so much more to air ambulance jets than what’s in this article but hopefully you’ve been given some idea of the history of air medical transport and how they came to be commonly used by medical programs all over the world. Now the sound of an air ambulance jet coming in for a landing has much more history behind it!

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