Mission Ready

If Montana didn’t have a claim to “big sky country” as its unofficial motto, Quebec could easily justify adopting it or, more likely, a French translation. At 1,542,056 square kilometres (595,391 square miles), it accounts for 15.4 per cent of Canada, and is roughly equal in area to France, Germany, Spain and Portugal combined. For comparison purposes, Quebec is nearly as big as Alaska and twice the size of Texas, the two largest U.S. states.

Providing reliable aeromedical services in such a vast and mostly sparsely-populated province—especially in the north between James Bay and Labrador, where weather can be atrocious—is a challenge. But Quebec’s Ministry of Health and Social Services has risen to that challenge with four Bombardier platforms: two Challenger 601s and two Dash 8s. 

André Lizotte, deputy director of air medical and trauma services, explained to Skies that the jets are used mainly for longer-distance emergency missions, including into remote gravel strips. The twin turboprops, a 200 series and a larger 300 series, are for patient transfers in southern regions along the St. Lawrence River.

Quebec has been providing provincial aeromedical services for 33 years, initially with aircraft seconded from the government’s executive fleet before its first dedicated platform, a Hawker-Siddeley HS125, was acquired in 1981. The first Challenger 601 arrived in 1988 and the first Dash 8 in 2000. All are operated by the government’s air service from its base at Jean Lesage International Airport (YQB) on the western fringe of Quebec City. 

“It (the base) is responsible for all the pilots, flight attendants and maintenance personnel,” said Lizotte. The aeromedical flight crews also operate the government’s fleet of fire-fighting aircraft and the helicopters used by the Sûreté du Québec, the provincial police service.

Crews drawn from the 25 pilots, 20 physicians and 20 nurses available to the aeromedical service can be in the air within an hour of getting a call from the dispatcher. They are busy; the Challengers fly a combined 2,500 hours a year, and the turboprops ferry approximately 4,100 patients annually. By the time the first 601 was retired from service, it had logged nearly 30,000 flying hours. Its replacement, a used 601 returned to “green” status at Bombardier’s facility in Tucson, Ariz., has been subsequently tasked and fitted specifically for aeromedical missions. The other is essentially a backup aircraft, used for executive transport, but easily converted when needed.

All-new interior components for the jets and turboprops, such as new intensive care units (ICUs), infant incubator stations, stretchers and stowage cabinets were designed by Aerolite Max Bucher AG of Switzerland to meet the Quebec government’s requirements. Hans Bretscher is general manager of the company’s U.S. operation, Aerolite America LLC, headquartered in Fort Mill, S.C.

Bretscher told Skies that work on the new interiors began when Aerolite responded to the Quebec government’s request for proposals for new Challenger interiors. The result, he enthused, is “an unbelievably great EMS interior” that is “unique in the world,” including special stowage for a range of medical equipment. More flying hospital than ambulance, it features three ICU stations in which the doctors and nurses can place patients in what’s known as the Trendelenburg position—supine, with the feet higher than the head—and even walk around them, providing a full spectrum of in-flight care. Another unique feature is the ability to adjust incubator angles so that they remain level during all phases of flight.

In developing the interiors for the Quebec Ministry of Health and Social Services, Aerolite applied lessons learned from its long relationship with the REGA, Switzerland’s aeromedical rescue service, which not only operates in its homeland and in neighbouring Liechtenstein, but also transports clients from other countries if they need urgent care. A private non-profit foundation established in 1952, it has no government funding, relying instead on fees paid by its 2.4 million supporters. REGA is an unusual German-French-Italian abbreviation meaning “Swiss aerial rescue guard.” In addition to three Challenger 604s, it flies six Airbus Helicopters EC145 medium twins in the Jura mountains and lowlands, and 11 AgustaWestland AW109 SP Grand “Da Vinci” light twins in the Alps.

The design and manufacture of the new interiors took about two years. In all its projects, Aerolite sees itself as the “architect” that transforms concept into reality. “Medical doctors and systems companies come to us and say, ‘This is what we envision, put it in metal for us,’” said Bretscher. “That’s our forté.” The company responds to what is usually a clean-sheet proposal with suggestions of its own. With a green light from the customer, that can lead to a mockup, which paves the way for a price quote and then a purchase order. “Two years from first contact to wheels-up for a dedicated fixed-wing medical interior is not unheard of,” he added. 

As is typical within the industry, the project’s financing is key to its stability. “We try with all of these, if we can, to get progress payments,” said Bretscher. “We agree on a plan, begin with a down payment, perhaps get interim payments, and then a final payment on acceptance.” That approach also is an expression of good faith by the customer. “This is a marriage,” he added, anticipating that Aerolite will have a long-term relationship with the Quebec government.

Lizotte is equally optimistic. “With the old system, we had to take it out of the hospital Challenger to put it in the backup Challenger,” he said. “With the upgrade, every aircraft will have its own modules; there will be no delay if we need to get the backup aircraft in service. . . . There have been some changes from the system they use in the REGA, but the main functions of the module are the same.” Moreover, both Challengers could be deployed in a large-scale emergency and the fact that the Dash 8s are being similarly equipped simply adds to the system’s flexibility. “All of them can handle critically ill patients.”

The old interiors had ergonomic issues, with crews occasionally having to contort themselves around stretchers. The Aerolite solution includes a powered trolley which enables doctors, nurses and paramedics to simply roll the patients right into the aircraft. “Lifting is no longer necessary,” Lizotte explained. 

In these days of increasingly tight government budgets, the Ministry wanted to contain costs by opting for a fundamentally off-the-shelf design. “It is why we were allowed to equip this way,” acknowledged Lizotte. 

And, staggering the installations has an added benefit. “It’s like renovating an emergency room in a hospital,” he said. “We have to keep the service running while we’re upgrading. It’s not always easy.”