Highly specialized vehicles, air ambulances bring emergency medical care to the air and save the lives of patients every day. To do this, air ambulances are fitted with some of the latest technology to keep patients, pilots and crew safe and, of course, retrofitted with all the emergency medical equipment needed to keep patients alive. It’s a 24/7 operation for air ambulance operators and behind the scenes, when these aircraft are in their hangar, the work doesn’t stop.
Josh Brannon, vice president of aircraft maintenance and aviation support services, Global Medical Response (GMR), says maintenance is perpetual. “How often are we performing maintenance? Every day. With the fleet size that we have, it’s a non-stop ordeal,” Brannon said.
Under the GMR umbrella are numerous different emergency medical businesses spread across the nation, encompassing both air and ground responses. Brannon says GMR’s air fleet is made up of just under 440 aircraft with fixed wing, rotor, turbo prop and jet engine craft all in the mix.
“We’ve got Lear 45s. We’ve got Bell 407s, Bell 206s,” Brannon said, noting that GMR is the world’s largest operator of Bell helicopters outside of the United States military. “We do a lot of work with Airbus products, as well. EC-135s, now called H-135s, H-145s. We’ve got an H-155, even. We’ve got several AS-350s, which now have been re-designated as H-125s. We’ve got lots of King Air B200s, C90s. Some Hawker jets. We’ve got quite a mixed fleet.”
Much like GMR, Louisiana-based Metro Aviation’s air ambulance fleet is comprised of both rotorcraft and fixed wing aircraft. The company operates 144 air medical service aircraft in 26 states, of which 135 are rotor wing and nine are fixed wing aircraft.
Part 135 Director of Maintenance for Metro Aviation, Mark Breton, said they operate the following aircraft: Helicopters – AS350B2/B3, B407, BK117 A, B2, C1, C2, C2e, EC130B4, EC135 Series and EC155. Airplanes – PC12/45 & 47, Cessna 525, Cessna 560, Lear 75 and BE-200 King Air.
“The main difference between air ambulance aircraft and non-emergency aircraft is the equipment onboard the aircraft and the qualified medical crew. The air ambulance will be equipped with a patient litter, a multitude of medical equipment, medicines and qualified paramedics, nurses, respiratory therapist or potentially even doctors,” Breton explained.
The mix of aircraft also brings a mix of missions they specialize in. Rotorcraft, for example, are used for on scene calls, transporting car crash victims off of the highway or rescuing injured people from remote areas. Fixed wing aircraft are typically used for long haul missions, carrying patients from hospital to hospital across state lines, for example. And GMR also conducts repatriation missions internationally under their Air Med International business unit.
Every 10 minutes, GMR is performing a critical intervention and the company treated 10 million patients last year. And with non-stop operations, comes non-stop maintenance. Brannon said that GMR AMT’s are trained to work within the unique structure of air medical operations via corporate training; as well as Title 14 Code of Federal Regulations, Part 135 Air Carrier and Operator regulations.
“There are a few differences in maintaining air medical aircraft versus non air medical aircraft and the main difference would be the structure of the inspection program. It is beneficial to arrange your inspection program to provide for continuous aircraft inspections to ensure greater availability of the aircraft without sacrificing the airworthiness qualities desired during inspection events,” added Brenton.
The major difference comes in making sure these mission-critical aircraft’s needs are met. “We are a 24/7 operation, every day of the year. Holidays — everything — doesn’t stop us from operating, even if it’s a pandemic,” Brannon said. “We have to have the staffing and the infrastructure to support around the clock operations. The operation doesn’t stop just because we have a maintenance vacancy. We have a team of people who are relief mechanics. AMTs that go around and provide support.”
Almost all of GMR’s helicopter bases are set up to handle a certain level of maintenance needs. Bases that are less capable are closer to a regional maintenance facility, where GMR can move the aircraft if needed, and remote locations have more resources to be self-sufficient. And as needed, GMR will move tools and people coast to coast to see that their aircraft are flight ready. Brannon said they can get anything anywhere within 24 hours, even in Alaska and Hawaii.
“Maybe we have an aircraft that had a precautionary landing out in a corn field somewhere. We just need to go out and do inspections. It’s off the beaten path. We can use other aircraft to get our people there. We can use our own internal resources to move people, equipment around. You name it,” Brannon said.
For routine maintenance, GMR categorize all of their aircraft in one of two ways — on either a progressive or periodical program.
“The periodical inspections usually go longer. Longer hours between inspection intervals. Then you have a lengthier period of time, to do more inspections all at once. Think of them as grouped up and a bulk inspection type program,” Brannon said.
“Then the progressive program, you split that up into different parts that are due at shorter intervals. An example would be perhaps 50 hour intervals, or 50 hour increments. Every 50 hours, you go out of service and perform the inspections. It’s a shorter period of time out of service,” he continued.
For Metro Aviation, Brenton said aircraft are maintained on an FAA Approved Aircraft Inspection Program (AAIP) in accordance with 14 CFR 135.419 and the maintenance schedules and intervals closely follow the manufacturer’s service and inspection intervals with some variation.
Brenton added that Metro Aviation performs daily airworthiness checks, which helps to combat the wear and tear their aircraft come under from the many starts, takeoffs and landings per hour they experience.
“Our best strategy to counter this premature wear is the performance of a Daily Airworthiness Check by an AMT each operating day. This AAIP check requires inspection of all visible areas and systems of the aircraft from front to rear and bottom to top of the aircraft without disassembly unless discrepancies are noted during the performance of the check.
“We place the aircraft out of service for the performance of this check and perform it uninterrupted from start to finish. If discrepancies are noted during the performance of the check, they are entered in the aircraft logbook and corrected or deferred prior to further flight,” Brenton said.
Metro Aviation measures the effectiveness of their Daily Airworthiness Check by periodically performing unscheduled Airworthiness Audits of their fleet. This audit consists of a Lead Technician or Regional Maintenance Manager or Airworthiness Auditor inspecting the aircraft in detail for condition and airworthiness.
“This initiative has been underway for a little over three years now and has vastly improved the condition and reliability of our fleet,” Brenton added.
GMR employs analytics with their maintenance programs, looking at data to determine when they receive the most flight requests and schedule maintenance during projected quiet periods. Hypothetically, if Wednesday evenings were the highest statistical request day for a specific location, they drive maintenance scheduling to avoid those days, for scheduled, controllable maintenance events.
“We’re not just shooting from the hip and allowing our mechanics out in the field to go and just do things whenever they feel like it. They’re following a maintenance control process that has visibility of those analytics and a management group that has visibility of those analytics, so that we’re doing things at a time where, statistically, we’re least likely to have a flight request come in. That’s not a guarantee. But that’s the best tool that we have to go by, for those strategic planning purposes,” explained Brannon.
Brannon added that GMR has several key partnerships in place for major components, such as engines. Rather than grounding an aircraft for the duration of a scheduled overhaul event, GMR will pre-position exchange assets in order to reduce unavailability of the aircraft.
One unique factor that all air ambulances will encounter by their nature is bodily fluids and the damage they can cause to the aircraft’s structure.
“The air medial aircraft cabin floors are prone to corrosion from patient bodily fluids and the cleanup of these fluids with disinfectant cleaners. Due to this issue we require cleaning of the floor surfaces after each flight. A preventative measure we employ is to seal all gaps between the medical floor and airframe interior to prevent migration of any fluid below the floor which could cause corrosion to areas of the aircraft that is not easily visible and not inspected as frequently,” Brenton described.
