HEMS in India – Are we killing the golden goose?

“A product is not a product unless it sells. Otherwise it is merely a museum piece”

Theodore Levitt

Aviators Air Rescue (AAR), a Bangalore based company, proudly launched India’s first dedicated helicopter emergency service on 16 Dec 2016 in partnership with Med-Trans Corporation, a subsidiary of Air Medical Group Holdings Inc, USA. As a civil helicopter pilot and Indian citizen routinely confronted by the depressing sight of ambulances wailing away in the unrelenting traffic, I had great hope in this maiden venture and welcomed it with all round praise.

In the months since they commenced operations, I have often seen their blue & white Airbus H-130s parked in cities of Bengaluru and Mumbai. These days, their neatly covered helicopter VT-XXC parked at Indamer dispersal is a regular sight for anyone approaching to land off Runway 34 at Juhu. While returning from an offshore flight the other day, my ears stood up when I heard XXC’s radio call off Mumbai. Turned out they were on a private charter flight, far from being on any air ambulance duty.

A social media update of one of their helicopters with Bollywood star Hrithik Roshan and another with some political leaders are indications that their helicopters were recently employed for sundry duties, including election flying in Maharashtra. Another helicopter from their stable is currently positioned at Srinagar, the capital of Jammu & Kashmir – again not on any aeromedical transportation (AMT) charter but servicing a seconded state government contract. How they would respond to an air ambulance request emanating from South India (declared as Phase I of their operations) is anybody’s guess. It’s a bit like the EMRI 108 ambulances or fire trucks moonlighting as a taxi service.

For a company that ventured into the niche market of AMT as the first-ever helicopter air ambulance service in India, Theodore Levitt’s conundrum of ‘what business are we actually in?’ seems to be staring the founders in the face sooner than expected. At present, I am unable to differentiate them from other operators who take on ad-hoc contracts to remain afloat. Is it short-term ‘Marketing Myopia’ (Levitt’s best known article from the Harvard Business Review, 1960) that will correct itself after a steady revenue stream is generated? Or will they eventually join the list of poorly managed, dubious air ambulance services that are peddled by ‘agents’ for a premium?

What changed?

Is it that there is no market for AMT or Helicopter Emergency Medical Services (HEMS) in India? Certainly not. We are just getting started.

Is it that competition has driven them to the ground? A definite NO. But if they do not differentiate themselves from fixed-wing air ambulance services, it may spell trouble.

Is it that they didn’t hire the best people? I think not. I have worked with some of their pilots during my time in the navy. They may have little AMT or HEMS experience but they are the kind of people who can create magic with unremitting hard work and enterprise.

Did the aviation regulator DGCA throw a spanner in their works? Far from it. In fact, the HEMS Ops Circular 02/2016 dated 11 Feb 16 and AMT Civil Aviation Requirement dated 01 May 20016 (http://dgca.nic.in/cars/D8S-S7.pdf) was ushered in with great urgency by DGCA to bring this crucial service to India – a land where almost 400 people die on the road every day and where a pizza delivery reaches you faster than an ambulance. With experience and consensus regulatory changes, subsidies and incentives can be negotiated with the regulator. Sorry, it may be fashionable to blame the DGCA but in this case, not yet.

There could be numerous reasons that escape my casual scrutiny. But one thing is clear –lack of people who can afford this service is not the real challenge. There is little awareness of this service among the masses. The company has not capitalised on the differentiation between helicopters and aeroplanes. It could also be a business plan that took little note of the harsh realities of bringing this service to India. In the US, a HEMS helicopter is usually among the first arrivals at an accident site. In India, accident victims are known to have bled to death while passers-by filmed them on their camera phones. Last mile connectivity from ‘site to hospital’ or ‘hospital to hospital’ is a huge challenge. Process of getting clearances for off-site landing of helicopters can take several hours, well outside the golden hour. Add to all this, charter flights priced at approximately 1.5 Lacs INR per flight/hour (for a single-engine H-130!) puts AAR’s service into direct conflict with fixed wing alternates like Pilatus PC-12, Cessna Citation or Beechcraft B-200s.

Even with all these challenges, I am seriously concerned seeing VT-XXC all covered up on a bare dispersal in Mumbai when it should be out there saving lives. Hope the birds take to the skies again, not ferrying politicians or real estate goons, but getting patients and organ transplant cases from hinterlands without airstrips to the best medical facilities that are a privilege of a few in big metros. Then gradually cover the remote areas and hills where you will not be in competition with fixed-wing air ambulances; where no roads or runways exist and a helicopter can mean the difference between life and certain death. Maybe there is a pot of gold at the base of that pyramid.

In the United States it is estimated that AMT helicopters undertake over 400,000 transports each year, often in the face of adverse weather, unfamiliar landing zones, low visibility and night conditions. It is not surprising that for a long time HEMS had the dubious distinction of having the highest accident rate. It requires a certain discipline and focus to survive in this field where poor decisions or greed can kill. But they have come a long way. As of 2014, the US had over 1500 air medical helicopters out of a total helicopter fleet strength of over 10000. We have less than 300 helicopters registered in the whole of India, out of which the AAR helicopters constitute the only three ‘dedicated’ helicopter air ambulance. It’s a baby step but at least we have gotten off the blocks. Deploying these machines for election duties, routine charters or random tasks within three months of launching the service will kill the proverbial golden goose besides leaving stakeholders confused about the integrity of the whole idea.

So my honest request to Aviators Air Rescue – please reorganise yourself, don’t lose focus and utilise the first mover advantage to indeed make it ‘the preferred, most affordable and accessible air ambulance service in India’ like your mission statement reads.

We are all rooting for you.

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©KP Sanjeev Kumar, 2017. All rights reserved. Picture courtesy: www.libra.com

4 thoughts on “HEMS in India – Are we killing the golden goose?

  1. KPS …. Another important part of the helicopter industry in India that needs to grow .
    In my mind till insurance policies of people covered does not include a clause like….
    ‘ to be transported in the most expedious means including charter of a helicopter or plane to an appropriate secondary / tertiary care hospital ‘ ……it will seem impossible to break in for the AMTs ….
    And given the price of an average human life in India vis a vis in the western world …..we have many miles to go before we get there !!

  2. Very relevant and timely article. AAR may need to advertise a little more, especially to the insurance companies. The insurance companies do have a stake in keeping us alive and well.

  3. This startup can remain afloat only if its finances remain in the green. Rescue ops is riddled with regulatory frameworks and affordability issues. Finding alternate business avenues with available resources is good business sense till rescue becomes mainstream.

  4. Along with re organising themselv es, AAR needs to advertise themselves and let India know about their presence. Rescue needs to be the mainstream and our country definitely needs this. All the best to the Saviors………

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