After 51 years of mountain rescue missions in the Alps, Rega Air Ambulance is looking to extend its service beyond the Swiss borders to bring in extra revenue
Skiing may have originated in Norway, but Switzerland commercialised the activity and since the first package ski holidays in 1903 there has been a need to rescue stranded skiers and climbers in difficulty.
When Rega Air Ambulance was founded in 1952, parachuting paramedics into the scene of an accident was revolutionary and the idea of carrying out mountain rescue using helicopters was at the fringe of aviation thinking: today it is commonplace in the larger resorts in Europe and North America. Yet Rega, made possible by a national network of bases and a quasi-public service funding structure, developed many of the techniques that are now in use.
Rega pioneered sling load operations - the first recorded aerial rescue used a hot air balloon basket slung underneath its Hiller 360 two-seat light helicopter at Davos, in December 1952. Five years later the organisation was equipped with a Bell 47G-2 and expanded from its initial base serving the Valais canton into a national organisation.
Rega - an abbreviation of rettungsflugwacht/garde a‚rienne - is a charity, funded largely by 1.7 million Swiss residents through modest annual donations. Donors receive free medical service for themselves, their families and, in several cases, their livestock. Last year, SFr66.2 million ($52 million) of Rega's receipts came from donors, but foreign residents have to pay for the service, with SFr42.6 million coming from travel insurance companies. In recent years Rega has had to write off debts caused by an increasing number of uninsured holidaymakers, largely from eastern Europe. Despite this, it has an annual budget of around SFr110 million, making it one of the largest helicopter emergency medical service (HEMS) operators in the world.
This budget allows Rega to devote time and money to developing techniques and gives it leverage with aircraft manufacturers, says Peter Hössling, Rega's technical pilot and head of operations. For example, when replacing its Aerospatiale SA316 Allouette IIIs in 1987, Agusta responded to its request for a higher-powered version of the A109 twin-turbine helicopter with the 735shp (550kW) Turbomeca Arrius 1K1-powered A109K2 variant, previously only available as a military option. Rega then took the lead in certificating a 1,000kg (2,200lb) weight-bearing double hook for underbelly slings for its five Eurocopter EC145s.
The EC145s are deployed at Rega's bases in Basle, Bern, Lausanne and Zurich and carry out routine air-ambulance missions such as critical-patient hospital transfer and responding to road accidents. However, over 80% of Rega's work relates to accidents in the Alps and Rega has 10 A109K2 bases to serve most parts of the country.
Rega's pilots carry out around 1,000 rescue missions a year, or 10 a day during the peak period of December to April.
Most common is the airlifting of individual skiers, which usually involves dropping a paramedic who loads the patient on to a stretcher. Primary missions include offloading trapped cable-car riders and leading avalanche rescue teams. "Between 40 and 50 people die each year in Switzerland from avalanches and we are involved in the rescue missions from the first stage, when we move search dogs and their handlers into the affected area," says Hössling.
The terrain in the mountains is harsh, and most rescues involve either winching the injured aboard or transporting "human external cargo" in slings, often from sheer cliffs and ravines, says Hössling. Rock climbers getting into trouble and hill walkers suffering heart attacks are also common.
Rega led the way in moving people as external cargo, using cables up to 200m (655ft) long to pluck stranded climbers and skiers from ravines and precipices. Hössling claims Rega is the only HEMS operator in Europe to routinely use extra-long lines with a hoist, but says their use is essential in the Alps, as many ravines are inaccessible. "We can't fly into many of the narrow valleys, so we have to drop rescuers on hoists into the area. We have found the solution to mountain rescue," he says.
This kind of flying requires frequent re-training, which pilots receive during annual refresher courses in quieter periods. Pilots have to contend with snow showers, strong winds and fog. The Föhn is a warm, dry wind common on the north slopes of the Alps, caused by a pressure differential between the valleys and the peaks. Wind speeds at the bottom of valleys sometimes reach 110kt (200km/h), says Hössling. Flying in these conditions is almost impossible, but sometimes unavoidable if there is a real risk of the loss of life, he adds.
Overhead cables
Fog presents the largest danger, mainly due to the 12,000V electricity cables used in the Alps. Today Rega cross-references a database provided by the Swiss electricity supply company Strom of all pylons and overhead cables against its terrain maps. No automatic collision avoidance system is available yet for the contour-rich landscape, so pilots rely on see-and-avoid operations, even after dark, when they use night-vision goggles.
Rega has only suffered one accident in its 51-year history, in 1997, when a helicopter hit a cable in heavy fog. The cable was unauthorised. This impressive safety record is down to the 32 experienced pilots, most of whom stay with the company for their entire working lives, says Hössling. "The pilots are flying in the same valleys every day, so they have an unbelievably detailed knowledge of the region's terrain," he adds.
Each flight carries one paramedic and one assistant, as well as the pilot. For several missions, such as avalanches or long-line rescues, Rega uses specialists from the Swiss Alpine Club, the country's national climbing organisation, to reach inaccessible areas.
Rega performs repatriation and long-range medical flights with its three fixed-wing air ambulances based at Zurich Kloten airport. The three Raytheon Hawker 800s and a Bombardier 604 Challenger are flying intensive-care units, equipped with electrocardiogram monitors, blood-pressure monitoring equipment and a respirator.
Ambulance services in Switzerland fall under either the canton (state) government control or that of the town. As a result, Rega has yet to extend its operations to the entire country. In three regions including Geneva, Rega has found local partners, but it still has no presence in some parts of the country. The largest hole in its network is the canton of Valais in the south west, where two commercial operators perform air rescue. Rega's failure to corner the market here stems from a 1950s' gentlemen's agreement. The Swiss federal government, however, has been promoting a move from basic life-support provision to an advanced life-support concept, to make greater use of helicopters to get patients to the most appropriate hospital rather than the nearest. This policy shift is leading to greater use of HEMS and the two Valais operators, Sion-based Air Glaciers CH and Zermatt-based Air Zermatt, are promoting their own air-rescue operations.
Rega hopes to bring in extra revenue from flying outside Switzerland's borders. So far it has struck deals with Austria and Germany, but the two potentially more lucrative neighbours France and Italy have proved more troublesome, due to "administrative" national health insurance programmes. Through various avenues, Rega hopes to build on its history and large financial clout to grow its business.
JUSTIN WASTNAGE / ZURICH
Source: Flight International
