Interview: Stefan Hunziker, Lead Paramedic and Hoist Instructor, Rega

With its bases throughout Switzerland, Rega boasts that it can reach anywhere within 15 minutes’ flying time. Jon Adams talks to Stefan Hunziker, Lead Paramedic on the Airbus H145 helicopter and Hoist Instructor, about his role with the Swiss rescue service

Missions can be complex in terms of flying and very demanding in terms of medicine so the helicopter crew generally comprises a pilot, a paramedic — in the additional function of helicopter emergency medical services (HEMS) crew member and winch operator (WOP) — and an emergency flight physician. The paramedic acts as the link between aviation and medicine. Their area of responsibility is very varied and challenging. For example, for a primary mission, we might take off from the helicopter base according to the ‘helicopter departure in fog’ procedures to get safely above the fog, and then head towards the incident site. Once there, the team might carry out a complex rescue hoist operation in difficult terrain and provide emergency medical care to a severely injured patient, and on our way to the most suitable trauma center, we might encounter bad visibility again and have to continue according to instrument flight rules (IFR). I rely on my ongoing training in aviation and medicine, and on my many years of operational experience to determine the best tactical procedure for rescuing the patient.

During a rescue hoist operation, I am responsible for operating the rescue hoist. One of our more challenging tasks as paramedic / HEMS crew member is to set down the helicopter rescue specialist or the emergency physician on an exact spot at the accident site and subsequently to pick up the rescuer and the patient – maneuvers that require great precision and perfect teamwork from all the members of the crew. After the patient has been evacuated with the rescue hoist, I help the emergency physician with the medical care. During the subsequent satellite-supported instrument flight, I once again assist the pilot in the cockpit during the approach to the hospital.

The paramedic / HEMS crew member therefore acts as the pilot’s right hand during the flight and supports them in navigating, identifying obstacles and talking over the radio with operational partners. On the ground, the paramedic assists the emergency physician in attending to the patient. With rescues in adverse terrain, they also operate the rescue hoist.

In view of the dangers associated with hoist operations, accreditation ensures that the helicopter hoist operations are conducted safely and efficiently, Amy Arndt, Program Director at National Accreditation Alliance of…

At Rega, paramedics / HEMS crew members already start as certified paramedics, with extensive professional experience in ground-based rescue services. In order to acquire Rega-specific skills, they undergo extensive in-house basic training comprising various training modules. During this basic training, they learn how to initiate and perform advanced medical interventions on patients, as well as how to use Rega’s emergency medical equipment. In addition, they are taught how to carry out complex primary missions and secondary missions (transfers between hospitals).

In terms of aviation, the operational training focuses on the aviation training as defined in our training manual, which is part of the operation manual approved by the Civil Aviation Authority. The paramedic / HEMS crew member must know how the pilots perform both standard and abnormal flight procedures and how to assist the pilot. They are also trained in operating the various systems in the Rega helicopter, however, without taking any direct control of the aircraft. Other focal points are instrument flight training to assist the pilot and working together as part of the team during a mission.

Almost one-fifth of all Rega helicopter missions take place at night. For this to be possible, in-depth knowledge of night flights, search flights and night vision imaging systems (NVIS) is required. Cockpit and night flight training also include exercises in the simulator and training flights at night. Even after the basic training has been completed, everything that has been learned needs to be regularly practiced.

The basic training to become a WOP includes the training of operations with the rescue hoist in different terrains. Initially, we train in the lowlands, where we work with different cable lengths and the conditions are made increasingly difficult by introducing obstacles. As the course progresses, the training exercises take place in alpine and high alpine terrain, usually with short cable lengths. Subsequently, we practice all the emergency procedures and undergo training flights using different recovery equipment and working with other rescuers. The training is concluded with a theoretical and a practical check. Only when a paramedic / HEMS crew member has gained sufficient experience as a WOP during daylight operations are they trained to also perform rescue hoist operations at night.

The WOP must be able to ‘read’ the terrain where the mission is taking place. This requires distinct spatial awareness and the ability to think two steps ahead. They need to maintain an overview of many different factors, such as slope inclination, ground conditions, objects or obstacles in the area, light conditions or the changing weather conditions at the accident site, and to come up with a strategy as to how to set down and position the helicopter rescue specialist or emergency flight physician safely. To do this, the WOP must be able to correctly estimate the distance to the set-down point, have good distance control in relation to the height of any obstacles in the terrain and, at the same time, gauge the airspeed accurately. While processing all these various impressions, they must also operate the rescue hoist correctly.

Our equipment comprises functional work clothing that can be worn in several layers, a lightweight, heavy-duty aircrew helmet with a hands-free microlight lip light, and a restraining safety vest with an adjustable tether. The attachment point of a WOP harness is on the upper body, rather than a harness over the pelvis, as a vest is easier to put on in flight if it has not already been put on; also at night, the vest is easier to control with the respective buckles and safety straps. The cabin tether also features a quick release mechanism, which allows the WOP to swiftly remove themselves from an emergency situation if necessary.

All our rescue helicopters are equipped with a rescue hoist with a 90-meter-long cable. The downwash of the helicopter rotor is a major source of danger for rescuers and patients at the accident site. In order to prevent the horizontal load from turning, we carry out most rescue winch operations with a rope length of over 50 meters and fly the rescue winch operation dynamically and not statically. During a winch operation, we often face obstacles 45 meters high, such as trees. If they are in a ravine or on a steep slope, the length of the rescue winch is usually 70–80 meters.

Mario Pierobon examines the rescue process of hoist cable management – detailing the inherent dangers of this crucial procedure

When the alarm is raised at the helicopter base or when navigating the helicopter to the accident site, the detailed data delivered by both our Rega app and the in-flight map displaying obstacles in the area provide us with a great deal of information about what we can expect in terms of topography and possible hazards on location while we are still in the air. Rega uses aviation obstacle data from the Federal Office of Civil Aviation, which is processed by the Aviation Data Collection Service (DCS). In addition, we collect aviation obstacle data that we incorporate into our maps.

We use the standard intercom system supplied by the helicopter manufacturer (Airbus and Leonardo), and outside the helicopter we communicate using a hand-held Motorola GP360 radio with a monophone, which is connected to the crew members’ helmets. Consequently we are always linked to a communication system and can be contacted by the other crew members, as well as by mission partners.

Not personally, thankfully. However, our crews train on emergency procedures to deal with such occurrences. In order to learn and be prepared for emergency situations during hoist operations, we analyze and discuss incidents that have happened on past missions, as well as those reported by other helicopter operators.

Rega has been flying rescue missions with rescue hoists for more than 50 years. We have steadily improved our specialist knowledge thanks to professional and standardized procedures, and to regular training. Regarding rescue hoist operations at night, we have made great advances in recent years with high-resolution NVIS and ultra-modern helicopter external lights designed in close cooperation with Airbus and partly manufactured especially for our needs. This has significantly increased safety during missions. Illuminating the terrain and the set-down point or pick-up point of the rescuer/patient is one of the key elements of a rescue hoist at night. We use the Airbus external multipurpose light, installed on the tail boom, for rescue winch operations at night; with a good setting of the lights, the WOP always has the rescuer in a light cone in the range between 30 and 70 meters.

Every mission is different and there have been some very challenging ones. These include, without doubt, the missions with the rescue hoist at night while in adverse conditions. At night, you may lose some of your spatial vision and particles (rain, snow, dust etc) moving in the air reduce visibility when the headlights are on. During a rescue winch operation at night, orientation is difficult when switching from night vision goggles to naked eye in flight, which we do when we perform reconnaissance of the accident site if the helicopter headlights perform well to take advantage of spatial vision and illumination of the terrain.

All Rega rescue helicopters are equipped in the same way. The rescuer always wears a full-body harness. The horizontal rescue equipment comprises a rescue bag and a horizontal net. For vertical rescues, we generally use the rescue triangle, which is at the same time the most frequently used rescue device on the rescue hoist. The emergency physician and the rescue equipment are always attached to the rescue hoist hook by means of a steel carabiner (triple locked and with a load limit of 50kN as standard), which significantly increases safety. The rescue devices have different colors with various luminous or reflective surfaces, which makes it easier to prepare and handle these pieces of equipment in the field and to work safely at night.

Teamwork between the pilot, paramedic / HEMS crew member and emergency flight physician needs to be trained regularly. Standardized operating procedures, which are precisely defined in our manuals, also enable our crews at different bases to perform difficult and complex rescues in a variety of terrains. In addition, this standardization makes it possible for crew members from different bases to work together on a mission without a problem as they all operate according to the same procedures.

We train five different occupational groups on the rescue hoist – pilots, paramedics / HEMS crew members, emergency flight physicians, helicopter rescue specialists and other technical crew members. The procedures are repeatedly reinforced with the appropriate rescue hoist checks during the day and sometimes also at night.

Jon is the Editor of AirMed&Rescue. He was previously Editor of the Clinical Medicine and Future Healthcare Journal for the Royal College of Physicians before taking over as Editor in November 2022. His favorite helicopter is the Army Air Corps Lynx that he saw his father fly while growing up on Army bases.