The evolution of air ambulances through the decades
Jean Lim
For the month of August, AeroTime is exploring aviation’s capabilities beyond transporting travelers and goods. More than a means of transport, one of aviation’s purposes is to save lives.
Air ambulances, also known as helicopter emergency medical services, have been saving lives for decades. In 2020 alone, London’s Air Ambulance saved the lives of 1,494 critically injured patients. In the United States, more than 550,000 patients use the services of an air ambulance every year.
Even though the service of an air ambulance comes at a steep price (the median cost ranges from $36,000 to $40,000 in the US), it is vital.
But how did air ambulance services begin and how have they evolved over the years?
Jules Verne
The first written record of an air ambulance in literature can be found in Jules Verne’s 1886 novel, Robur the Conqueror. The protagonist, Robur, wanted to prove that an object can fly even if it is heavier than air. Robur then embarks on a journey around the world with his flying machine to prove his theory. At one point in the adventure, the flying machine rescues a group of shipwrecked sailors.
The siege of Paris
The first documented use of an air balloon as an air ambulance occurred during the Siege of Paris. In 1870, Parisians were starved into submission by invading Prussians. Confined within the city, the government began using manned balloons to get news, letters and people to the outside world.
Eventually, the balloons carried more than mail as they were used to evacuate injured soldiers out of the city and to nearby hospitals.
1900s
Aircraft were commonly used as weapons and to transport weapons and soldiers during World War One. Although incidents of wounded soldiers being transported in the fuselage of military aircraft were reported, there’s no confirmation that an organized aeromedical transport took place.
1920 Zed expedition
It is not officially recognized, but records indicate that the first aeromedical operation might have taken place in early 1920 during a frontier war in Somalia.
Winston Churchill, who was then the Secretary of State for War, authorized the formation of a special Royal Air Force (RAF) unit codenamed ‘Z’ or the ‘Zed expedition’ as a final campaign against the Somali rebels.
An RAF medical unit was created to support the Zed expedition. According to reports, 12 DH-9 De Havilland biplanes were provided for the expedition. It was suggested that one plane was outfitted as an air ambulance to enable evacuations of the sick and injured from remote areas.
World War Two
During World War Two, troops were traveling great distances as wars were being waged across different continents.
Respective armies needed a quick way to evacuate the wounded from the battlefield. Flight nurses were deployed to help with aeromedical evacuation.
One such flight nurse, who was sent to evacuate soldiers wounded in the D-Day Normandy landings, recalled delivering first aid care aboard a Douglas C-47 Skytrain transport aircraft, flying from the battlefields of Europe to the hospitals of Great Britain.
Across the globe in Australia, the Royal Australian Air Force (RAAF) formed Air Ambulance Units (AAU) and Medical Air Evacuation Transport Units (MAETU). The RAAF flew its first medical evacuation mission in August 1941. Records indicate that a male orderly would accompany the wounded on each flight.
By 1944, the war had intensified and 15 nurses from the Royal Australian Air
Force Nursing Service (RAAFNS) were recruited and trained in inflight medicine and care, emergency survival procedures, and tropical hygiene.
The inflight teams consisted of a sister and a male orderly who would accompany the wounded on board.
Korean War: 1950s
In the early 1950s, US Forces started to use helicopters as dedicated transport for medical evacuation. In 1950, the first rotor wing medical evacuation was performed with a bubble-fronted Bell 47.
The Bell 47 was popularized by the longest medical comedy-drama sitcom M*A*S*H (which stands for Mobile Army Surgical Hospital). The sitcom ran for 11 years, three times longer than the Korean War, which it was set in.
It is estimated that more than 20,000 injured soldiers were evacuated by helicopter during the Korean War.
1960s
In the 1960s, the car industry was booming in the US. In 1960, a new car cost an average of $2,752. Automobiles had never been more accessible and affordable.
Due to this, an astonishing increase in motor vehicle traffic accidents in the US occurred. This snowballed into the creation of Medicare by the US Congress, the establishment of 911 for emergency calls, and the development of paramedic programs.
In 1960, R Adams Cowley, an American surgeon considered a pioneer in emergency medicine, started creating his legacy: an organized approach to trauma care. Cowley created standards when responding to medical emergencies. One of them included trained paramedics at the scene of the accident as well as on the helicopter. Cowley also established a Shock Trauma Center in Baltimore, Maryland with a helicopter landing zone near the building.
1970s / Vietnam War
The first permanent civil air ambulance helicopter, Christoph 1, entered service at the Hospital of Harlaching, Munich, Germany in 1970.
Civilian air ambulances became more common in the 1970s. Starting in the late 1970s, air ambulance services began to be staffed with paramedics. Until that time, aircraft pilots or air ambulances were not expected to be involved with medical care or treatment.
Meanwhile, as the Vietnam War raged on, the role of Medevac units proved immeasurable. Medevac teams heavily used the Bell UH-1 helicopter.
Nicknamed the ‘Huey’, the aircraft was spacious enough to transport medical personnel, equipment, and the wounded. The space meant that medical personnel could start triage treatment for the wounded as soon as the aircraft took off. It is estimated that, during the Vietnam War, helicopter ambulances moved more than 900,000 wounded troops.
1980s-1990s
The 1980s saw the rapid expansion of air ambulance companies in the United States as well as in Canada and Germany. The increasing ‘popularity’ of air ambulances stemmed in part from government studies which showed the positive effects of the air ambulance as well as the production of increasingly reliable and secure aircraft that could accommodate more advanced medical equipment.
By the late 1980s, the importance of air ambulance services had truly been recognized. At the Calgary Winter Olympics in 1988, Canada’s Shock Trauma Air Rescue Service Foundation (STARS) received a formal recognition as an essential service when the olympic committee incorporated the service as part of emergency planning for the winter games.
Meanwhile, during the 1990s in France, Mont Blanc began providing services for aerial work, firefighting, and medevac missions – rescuing stranded or injured skiers from remote mountainous regions.
By the early 2000s, France’s emergency medical services started organizing air ambulance services. Mont Blanc also soon became one of the first operators providing helicopter-based emergency medical services (HEMS) services in the country.
2000-2010s
At this stage, helicopters continued to play an essential role in military medical evacuation. In Iraq and Afghanistan, the UH-60 Black Hawk was used extensively by the US forces.
Black Hawks are large enough to accommodate several medical personnel and advanced field equipment - enabling trauma care to begin the moment the helicopter is in the air.
A 2012 study by medical publisher Hindawi showed that patients transported by helicopter displayed a better chance of survival, got to the healthcare facility faster, and were treated more quickly.
Present - the pandemic years
Air ambulance operations are now an integral part of society, with medevac services extending to urban areas and not just to remote locations.
A recent incident occurred in April 2022 when the Metropolitan Police and the London Ambulance Service used an air ambulance to land in the middle of Trafalgar Square to rescue an 81-year-old man who had been hit by a vehicle.
The pandemic led to a shift in medical repatriation as commercial flights were grounded. Financial and insurance company Allianz reported that, from March to August 2020, its air ambulance transports increased by 25% compared to the same period in 2019.
During the pandemic, air ambulances also had to adopt modern medical technology in order to keep up with the complications of Covid-19. The pandemic years led to a surge in demand for on-board medical equipment, in particular quarantine equipment.
Norwegian medical equipment maker EpiGuard experienced a 2,000% increase in sales during 2020-2021 for its EpiShuttle isolation pods to transport Covid patients.
The EpiShuttle was designed to transport highly infectious patients. The pods come with interchangeable operator ports which enables intensive care treatment of the infected patient with room for procedures such as intubation and inserting central venous lines.
Technology and design may have changed the appearance of air ambulances through the years, but the purpose remains the same: to save lives fast.
While Jules Verne’s concept of a flying machine was a flight of fancy in 1886, he would no doubt be proud that, nearly 140 years later, his idea of saving lives is an everyday part of aviation.
(Jean Lim writes for the aerotime.aero, a multi-channel aviation digital hub)
August 07 2022