Helicopter emergency medical service (HEMS) is an important subset of the rotorcraft industry, with hundreds of dedicated aircraft in service worldwide. Of that total, Leonardo claims approximately 20 percent of the market, noted Michael Bucari, the OEM’s head of marketing for the Americas. The company has a full lineup of HEMS-capable helicopters, ranging from the single-engine AW119 to the twin-engine AW169 to the larger AW139. This week at Heli-Expo 2024, the airframer is displaying at its booth an AW169 operated by aeromedical provider HeliService.
Which platform is selected by an operator depends on a variety of factors, according to Bucari. “One thing I want to stress is that HEMS is not homogenous from country to country,” he told AIN. “The [medical insurance] reimbursement model is very different compared to countries in Europe, Japan, or Australia where it is government-subsidized.”
“In the United States, reimbursement is a challenge, especially after the No Surprises Act in 2021,” added Sam Schaab, a HEMS specialist with Leonardo. “Basically what that means is the reimbursement is the same whether you are flying a $5 million helicopter or a $15 million helicopter, so to provide care with limited resources, there is a tendency toward using single-engine helicopters because they are cheaper to buy and also to operate.”
Also, in the U.S. there is no restriction for the operation of single-engine helicopters over populated areas, unlike in most other countries, which will certainly influence the decision over which class of rotorcraft operators will invest in, as will the amount of government operational subsidies.
While single-engine helicopters tend to lack cabin space compared to their larger twin-engine siblings, the Italy-based OEM is expecting its AW09 (the former Kopter SH09)—a mockup of which is on the show floor—will make a splash in the HEMS market when it enters service in the next 12 to 18 months following EASA certification.
“Inside the United States market, because costs and profits are something that operators take a strong look into, anything that has a much lower operational economic cost to it, like a single-engine helicopter, is probably going to be the preferred aircraft,” stated Bucari, noting that the OEM is beginning its transition to the AW09. “I personally think it’s going to be a game changer for the simple reason you have a cabin that is more typical of a twin-engine helicopter, so a much bigger platform but it’s a single engine so you have the single-engine economics behind it, and I think that’s really what is driving the demand for these operators.”
As well, the helicopter’s cabin will allow more space for equipment and even additional care providers, while offering stretcher egress through the rear clamshell doors or a side door.
Outside the U.S. and particularly in Canada, the company’s AW139 and AW169 have proven popular, with seven of the latter due to enter service in British Columbia, a factor of Leonardo’s HEMS market share in that country. “Other provinces have some of our competitors' products as well, but [it] is probably about 50 percent market share in Canada,” said Bucari.
Those primary competitors include Airbus, which lays claim as the world’s leading supplier of helicopters for emergency medical services. Its H135 family is the most widely used platform, accounting for one out of four helicopters used for aeromedical transport. Earlier this year, the manufacturer delivered the 1,500th of the H135 series to German HEMS provider ADAC Luftrettung.
The H145 follows with more than 400 in HEMS service. Airbus offers HEMS fixed provisions, a HEMS and multifunctional floor, and antibacterial paint.
Bell—with more than 85 years experience as an OEM—noted that in “specialty segments like HEMS, no two operators are identical,” which is why it provides an array of options. In October, Life Flight Network (the largest nonprofit air medical operator in the U.S.) added two 407GXis and followed that in December with the acceptance of a 429.
The Textron subsidiary continued to expand its presence in the European aeromedical market in November when it delivered a third 429 to Swiss-based helicopter rescue Air Zermatt. Even for operators not in the market for new aircraft, Bell provides constant support for their existing fleets to reduce downtime.
Outfitting a HEMS helicopter can take anywhere from several weeks to months depending on whether or not there is an existing STC, according to Leonardo's Schaab. The company provides the basic helicopter plus any kits such as searchlights or radio packages that the customer may specify.
Then it's off to the third-party completions provider, to which the OEM provides technical and engineering support during the process. “There are some smaller ones that have done one-offs for a very specific locale, but there are around 12 that we regularly work with around the world,” Schaab explained.
“We’re agnostic and it’s important for us that the customer gets the right interior, the right helicopter. When you sell a helicopter, you develop a relationship with that customer for a long time and want to make sure that it's successful,” he concluded.