Designing a new model for air ambulance helicopter services

Air ambulance helicopter services are a critical part of how we respond to health emergencies in New Zealand.

The demand for air ambulance helicopter services has been rising and is expected to continue to rise. The current air ambulance helicopter fleet has an average age of 29 years. There are increasing aviation and clinical compliance requirements and many of the helicopters currently in use for medical emergencies are smaller, single engine helicopters which do not allow full access to the patient for treatment. Also, these single-engine helicopters do not meet Civil Aviation Rules, which limits flying over urban areas (eg, flying into hospital helipads). Over time these will need to be replaced with more modern double-engine helicopters.

The National Ambulance Sector Office (NASO), the district health boards (DHBs) and the air ambulance sector recognise the existing operating model is not sustainable.

That’s why the Ministry of Health, the Accident Compensation Corporation and DHBs, through NASO, have taken the first step towards ensuring every community has access to an effective air ambulance helicopter service, with the development of a 10 year modernisation programme for the country’s air ambulance services.

The intent is to build a national integrated network that covers all of New Zealand, is well linked with other emergency services, is available around the clock, is safer and is more appropriately clinically resourced. This will contribute to improved patient outcomes.

Improving patient outcomes

Patients are at the centre of defining what an effective new service model looks like and we want the best possible outcome for every patient who uses the service.

The availability of qualified clinical crew, the type of helicopter and the destination are important considerations in achieving improved clinical care and therefore improved patient outcomes. While the distance between the helicopter base and the emergency scene is important, many bases currently have a time lag between the call out and getting the clinical crew on board before they can take off, because the crew are not dedicated to the service. This adds to the response time.

A good air ambulance service has four key elements: time, clinical crew, equipment and destination. With these working together well, patient outcomes will be improved. When the new service is introduced, everyone will have access to an air ambulance helicopter service that has all these elements working well.

What are we doing?

Moving from single-engine to twin-engine helicopters will ensure flights are safe for both patients and crew and regional variability in clinical outcomes is reduced. 

Why twin-engine helicopters?

  • Clinical safety, patient safety, community and crew safety
  • Greater space to provide clinical care
    • Can carry two clinical crew and helicopter crew (or full clinical crew for IHT) and ensure full access to patient – head, trunk and all limbs
    • Can carry more medical equipment, safely restrained in a useable location
  • Meets Civil Aviation rules for flying over populated areas
    • Safety – two engines if one fails, enabling the helicopter to find a location to land safely
Image comparing the smaller single-engine helicopter with a twin-engine helicopter, which is larger and has more useable clinical space.
Helicopters shown are models of Squirrel (top, single engine) and BK117 (bottom, twin engine) popular in New Zealand.

Older single-engine helicopters will be replaced by two-engine helicopters. These will allow room for two clinical crew with full access to the patient, with space for more medical equipment on board. In the new service, there will be dedicated crew at helicopter bases. Currently this is not the case, which often results in delays while clinical crew are called in from their road ambulance duties to attend an emergency air ambulance helicopter call out.

The current service has 17 bases from which helicopter air ambulances fly from. This is high by international standards. The request for proposal proposed this be reduced to 14, as well as reduce the number of service providers (currently 10).

  New Zealand NZ (Proposed) Queensland NSW Scotland
Comparative helicopter air ambulance fleets
Length 1,600 km 1,600 km 2,030 km 556 km 410 km
Width 400 km 400 km 964 km 1,047 km 310 km
Land Area 268,000 sq km 268,000 sq km 1,800,000 sq km 809,000 sq km 80,077 sq km
Population 4.69 million 4.69 million 4.69 million 7.54 million 5.295 million
Bases 17 14 10 5 2
Helicopters 21 Estimated 19 14 9 3
Providers 10 3 1 2 2

No decisions have been made regarding where helicopters will be based. There will be coverage across the country. The locations will be determined through the request for proposal process but it is important to note there will be an improved nationwide helicopter service that can provide better clinical support for patients.

In regions which experience fluctuations in population due to seasonal tourism, the Providers will be expected to manage this by allocating resources (helicopters and staff) to meet anticipated demand.

Outcomes we are seeking

  • Effectiveness: to provide patients and communities with equitable access to care with the right skills, in the right place and at the right time.
  • Efficiency: to efficiently task air ambulances to appropriately meet patients’ social and clinical needs.
  • Risk reduction: to manage the safety risk posed to patients and staff in the use of an aeromedical service capability.

Not included in the current request for proposal

The new service will cover accidents and incidents that require an air ambulance helicopter due to the need for medical support. If someone needs to be rescued but doesn’t have any need for medical support, (ie, a search and rescue mission), this service will continue to be coordinated through the Rescue Coordination Centre (RCCNZ) and/or the New Zealand Police and did not form part of this request for proposal.

It is also important to note that air ambulance services involving fixed wing aircraft (aeroplanes) are not included. In New Zealand approximately 75 percent of inter-hospital transfers use small aeroplanes, with helicopter services providing over 97 percent of pre-hospital (that is, emergency) transport services and around 25 percent of inter-hospital transfers.

Procurement approach

The approved procurement approach for the service is as follows:

Procurement Round One was published on GETS on 26 March and closed on Monday 7 May 2018. There will be a three year contract plus one optional year – 2018–2021/22. The aim is to:

  • improve patient outcomes
  • meet all safety requirements (removing single-engine helicopters from the service, increase clinical crew, and ensure appropriate fatigue management processes are in place for aviation crew that meet Civil Aviation Rules)
  • gather information to support the completion of a comprehensive design of the future service and inform the second procurement process
  • consolidate regions from the current 12 to three, aligned to the district health board regional structure
  • provide greater value for money by improving the efficiency of the service through better use of clinical and aviation resources.

Procurement Round Two will require further Cabinet approval before it can commence. It will be a five year contract plus five year extension – 2021/22–2031/32. A key objective of the second procurement will be to actively manage the swap out of ageing air ambulance helicopters to a higher and specified standard.

Historically communities provide support and local Trusts arrange commercial sponsorship for their local air ambulance services. This procurement is structured so that these types of arrangements will continue for the duration of resulting contracts.

Project governance

A project governance group has been established with representatives from ACC, the Ministry of Health, district health boards (including an aeromedical clinician) with international aeromedical clinical input. This provides the governance required to ensure any future service model integrates and coordinates both emergency retrievals and inter-hospital transport.

Market engagement and design

NASO has designed the future solution with stakeholders.

As part of the engagement phase, four structured regional meetings were held in June 2017. These were attended by 150 participants, including district health board planning and funding and operational managers, clinicians across a range of professions, air providers, Trusts, consumers and other government agencies such – Fire and Emergency New Zealand, New Zealand Police, Civil Aviation Authority, New Zealand Search and Rescue, and the New Zealand Rescue Coordination Centre.

Following on from these regional meetings, four issues workshops were held in in September 2017. These covered financial, technical, operational and clinical issues to identify the key things that needed addressing. More than 100 people from across the sector attended these workshops.

The project approach and timeline is as follows:

  • Stage 1: Initiation (October 2016 – March 2017) [completed]
  • Stage 2: Pre-procurement (October 2016 – March 2017) [completed]
  • Stage 3: Structured Market Engagement (Co-design) (April – February 2018) [completed]
  • Stage 4: RFP Process (March 2018 – 7 May 2018) [completed]
  • Stage 5: Implementation (August – November 2018).

Please contact if you have any questions.

Ten year story (developed with funders, clinicians, patients and providers)

The request for proposal is the first step in a 10 year modernisation programme for the country’s air ambulance services aimed at ensuring every community has access to the air ambulance helicopter.

Click to enlarge |

Theme: Safety

  • 2018–19: Eliminate single engine helicopters; increase staffing to meet safety standards
  • 2020–25: Planned helicopter modernisation, including crew training, fit-outs and aircraft maintenance standards
  • 2026–27: Safe and appropriate aircraft and crew maintained

Theme: Funding

  • 2018–19: Gather information on Trust/community funding, cost of asset base and increase government funding to begin investment
  • 2020–25: Continue investment; improve administration of Trusts and determine role; assess value of a national sponsor
  • 2026–27: Sustainable transparent funding

Theme: Data

  • 2018–19: Improved data collection and analysis of service
  • 2020–25: Improved, information led, infrastructure planning
  • 2018–25: National coordination of tasking (pre-hospital emergency and inter-hospital transfers)
  • 2026–27: Nationally coordinated, integrated Air Ambulance Service

Theme: Clinical

  • 2018–19: Finalise clinical standards; implement national clinical governance across tasking and service provision
  • 2020–25: Implement clinical standard (training and mix of staff) – based on evidence, integrate road and air service
  • 2026–27: Patient centred outcomes; 3Rs – right treatment, right time, right place
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