New Air EMS Company

We are looking into a Eurocopter 135 p2+ with a price tag around 4.7 million EMS ready and Vip Configuration. This rotocraft will allow us to transport two patients two nurses and a pilot and get there very very fast. Take into consideration that it has the capability to be transformed into VIP configuration for, for hire luxury for Doctors or Executive transport

In theory, an EC-135 can hold 2 patients. In actuality, it is usually one. I have not seen one yet that is set up for two. There isn't a lot of room as it is when it is set up for one. Then there is the issue of weight. I noticed you referenced TDSHS, so it will be operating in Texas? The heat and/or altitude, depending on where you are operating, will also limit the weight you can take on and thus typically limit you to one patient. The only helicopter that I've seen, that regularly takes on 2 patients, is the Bell 412.
 
This is correct Longhorn we are in texas and we will just be transporting one patient at a time, its just been pre set for two and VIP configuration.
 
I see I am not the only one that noticed the TDSHS comment.

OP, sorry, but I think you need a strong dose of reality.

First and foremost, if you plan on doing scene responses, you cannot fly RN/RN, you must have a Paramedic on board. In addition, an EMT cannot be on the primary crew. they can fly third, but it is actually irrelevent as an EC-135 P2+ will not be able to carry such a load.

Speaking of load capabilities, you may wish to take a closer look at your weight and balance. There is NO way a 135 in any configuration with sufficient fuel can carry two adult patients plus a full crew in the Texas heat.

I am curious to know what rural area is underserved by appropriate resources as Texas is HEAVILY saturated with air providers. Remember, just because a helicopter isn't near by, which is usually not really needed, a fixed wing can be farther away with the same capabilities and have the same response time.

To address the billing aspect, you can fly 100 flights per month, but if your payor mix is largely uninsured or State / Federal supported, you aren't going to get nearly the reimbursement you will need. You need a sufficient volume of medically necessary flights that you can actually get paid for. Also, is your hospital connection willing to sign on as payor of last resort? Are they willing to pick up the bill? If so, then why didn't they start a service themselves? It would be a much stronger strategic marketing move for their hospital system than bringing in a private for profit service.

Then you get the funnest part of your start up; the FAA. Simply put, they can just tell you no. Simple as that. Should they see an actual need for your operation, you will then have to go through red tape like you have never experienced before, not to mention fees and total costs nearing a cool mil.

You mentioned that you hold an FAA rating. Would you care to share a brief synopsis of your qualifications and experience? Give us some details and we may be able to offer some sound advice. But with your limited posts and far fetched ideas, honestly, I think you need to go back to the drawing board.......................
 
The only helicopter that I've seen, that regularly takes on 2 patients, is the Bell 412.

You also have the S-75C++, S-76D, and AS-365N3+. All are quite capable of double loading in the Texas summer environment.

So many folks out there insist that the BK-117, EC-135, and EC-145 can also accomplish this. Apparently, they have never flown in 100 degree heat with a 6,000 foot density altitude..................................
 
I see I am not the only one that noticed the TDSHS comment.

OP, sorry, but I think you need a strong dose of reality.

First and foremost, if you plan on doing scene responses, you cannot fly RN/RN, you must have a Paramedic on board. In addition, an EMT cannot be on the primary crew. they can fly third, but it is actually irrelevent as an EC-135 P2+ will not be able to carry such a load.

Speaking of load capabilities, you may wish to take a closer look at your weight and balance. There is NO way a 135 in any configuration with sufficient fuel can carry two adult patients plus a full crew in the Texas heat.

I am curious to know what rural area is underserved by appropriate resources as Texas is HEAVILY saturated with air providers. Remember, just because a helicopter isn't near by, which is usually not really needed, a fixed wing can be farther away with the same capabilities and have the same response time.

To address the billing aspect, you can fly 100 flights per month, but if your payor mix is largely uninsured or State / Federal supported, you aren't going to get nearly the reimbursement you will need. You need a sufficient volume of medically necessary flights that you can actually get paid for. Also, is your hospital connection willing to sign on as payor of last resort? Are they willing to pick up the bill? If so, then why didn't they start a service themselves? It would be a much stronger strategic marketing move for their hospital system than bringing in a private for profit service.

Then you get the funnest part of your start up; the FAA. Simply put, they can just tell you no. Simple as that. Should they see an actual need for your operation, you will then have to go through red tape like you have never experienced before, not to mention fees and total costs nearing a cool mil.

You mentioned that you hold an FAA rating. Would you care to share a brief synopsis of your qualifications and experience? Give us some details and we may be able to offer some sound advice. But with your limited posts and far fetched ideas, honestly, I think you need to go back to the drawing board.......................


It seems you are either very familiar with this type of business or just simply do not read well enough, either way I happy to read your comment.

Let me clarify once more to you. I will try to answer as best as I can,

I will not be doing scene responses as primary (although thanks for the idea) this business is being developed strictly as a home base operator serving a range of 120 nm radius that is greatly needed the hospital i have been dealing with have to wait a whole 30-45 min then take patient 30-45 back to where the patient needs attention. Wouldn't it be best just to have a local one?

For the crew, we have two RNs on STANDBY but we can have access to as many EMTs or nurses as we may need. The helicopter we have chosen is the Eurocopter it allows us to carry 4 crew-pilot-second pilot-two emt or nurses or dogs or whatever you like and a patient. the option of a second stretcher is availble. Why would I want to carry more load the the EC can handle? just doesnt make sense, anyways lets continue.

Billing, do you know how much an air ambulance cost? It varies what I can tell you is the AVERAGE AVERAGE including self pay, private ins, medicare, medicaid. is around 7000.00. With this being said we have noticed that to maintain this Heli and business to run it will need 24 of those 7000.00 flights. we are doing 47 flight average of the 7000.00 flights. some more, some less
but AVERAGE is 47-7000.00 flight a clear sign for us to give this company a go.

The hospital that gave me the LOI say it would give me first choice of all flights. If they don't have the resources or necessary interest in doing a heli service why would they bother even picking up my bill? It does not make sense. We will be following FAA,local,federal,guidelines to meet the requirements to develop this program.

As for my qualification I am a General Surgeon-BC, also a pilot CFI,CFII,MEI with several power ratings. Let's just say I have completed my 207.5 required hours FAA tells me I need and experiences, I think I am capable of flying out backwards of a high rise helipad as required.

I would appreciate your sound advice if you have first had experience again I am not an expert, I have never done a company like this before, what I do know is that It is needed here and have studied and both we can serve the community as well as maintain so extra cash flow in our pockets.

Thanks for your response,

Anthony
 
Unfortunately Anthony your posts seem to imply lack of familiarity with the industry.

But just to understand better - where are your medical crew coming from? What is their training?

You're a General Surgeon who's going to be a primary pilot for this organization?
 
It seems you are either very familiar with this type of business or just simply do not read well enough, either way I happy to read your comment.

Let me clarify once more to you. I will try to answer as best as I can,

I will not be doing scene responses as primary (although thanks for the idea) this business is being developed strictly as a home base operator serving a range of 120 nm radius that is greatly needed the hospital i have been dealing with have to wait a whole 30-45 min then take patient 30-45 back to where the patient needs attention. Wouldn't it be best just to have a local one?

For the crew, we have two RNs on STANDBY but we can have access to as many EMTs or nurses as we may need. The helicopter we have chosen is the Eurocopter it allows us to carry 4 crew-pilot-second pilot-two emt or nurses or dogs or whatever you like and a patient. the option of a second stretcher is availble. Why would I want to carry more load the the EC can handle? just doesnt make sense, anyways lets continue.

Billing, do you know how much an air ambulance cost? It varies what I can tell you is the AVERAGE AVERAGE including self pay, private ins, medicare, medicaid. is around 7000.00. With this being said we have noticed that to maintain this Heli and business to run it will need 24 of those 7000.00 flights. we are doing 47 flight average of the 7000.00 flights. some more, some less
but AVERAGE is 47-7000.00 flight a clear sign for us to give this company a go.

The hospital that gave me the LOI say it would give me first choice of all flights. If they don't have the resources or necessary interest in doing a heli service why would they bother even picking up my bill? It does not make sense. We will be following FAA,local,federal,guidelines to meet the requirements to develop this program.

As for my qualification I am a General Surgeon-BC, also a pilot CFI,CFII,MEI with several power ratings. Let's just say I have completed my 207.5 required hours FAA tells me I need and experiences, I think I am capable of flying out backwards of a high rise helipad as required.

I would appreciate your sound advice if you have first had experience again I am not an expert, I have never done a company like this before, what I do know is that It is needed here and have studied and both we can serve the community as well as maintain so extra cash flow in our pockets.

Thanks for your response,

Anthony

Wow! Where to begin?????

Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.

I'd first like to refer you to a manual officially known as Title 14 of the Code of Federal Regulations - Aeronautics and Space. You may have some familiarity with it already as you claim to be an aviator. Pay close attention to Part 135, which will cover your commuter and on demand operation. 135.243 specifically outlines the requirements to be qualified as PIC (pilot in command). You sir, with your 207.5 hours, come no where close to being qualified. You cannot even touch the controls on a 135 certificate unless you are running dual pilots. Any medical professional that chooses to fly with a PIC that has less than 2000 hours under their belt is an absolute moron. Regardless, I'm call bullsh!t on your "ratings". First off power ratings are not applicable when it comes to rotors, neither does an MEI rating. Second, the minimum hours required for a part 141 commercial license is 190 for airplane. To add a rotorcraft helicopter rating to that requires another minimum 30 hours. So now you are up to 220. Add to that a minimum of 5-10 hours per instructor rating and you come to around the 250 hour mark. If you trained under part 61, you are required to have 250 hours just for your commercial. So there is NO WAY YOU ACTUALLY HOLD THE RATINGS YOU CLAIM WITH 207.5 HOURS.

Now to address the medical side. You cannot just have any RN or medic just jump on the helicopter and go. Another reference you wish to become intimately familiar with is Texas Administrative Code 157.12 which governs the operations of rotor wing programs. It clearly defines equipment, staffing, and educational requirements that you must have to operate. Your described plan won't fly (no pun intended).

Your above statement about the LOI is exactly why you need to rethink your business plan. You would be a complete idiot to not have a payor of last resort clause in place. Without it, you will lose your arse on the financial end. Do you really see yourself putting "extra cash flow in your pocket"? With a multi-million dollar aircraft that will cost you over a grand per hour to operate? In a rural, underserved area? SERIOUSLY?!?!?!?

I'd also be interested in knowing where you came up with your $7000 average. Show the proof as I think you have been seriously mislead.

I really don't know what to think. Honestly, I don't even know if you are serious about this or if your a troll. Regardless, I know for a fact that you will never get a provider license or a 135 operators certificate with your current plan.
 
I'm calling Troll...

I bet he pops up on a certain other forum next....
 
Wow! Where to begin?????

Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.

I'd first like to refer you to a manual officially known as Title 14 of the Code of Federal Regulations - Aeronautics and Space. You may have some familiarity with it already as you claim to be an aviator. Pay close attention to Part 135, which will cover your commuter and on demand operation. 135.243 specifically outlines the requirements to be qualified as PIC (pilot in command). You sir, with your 207.5 hours, come no where close to being qualified. You cannot even touch the controls on a 135 certificate unless you are running dual pilots. Any medical professional that chooses to fly with a PIC that has less than 2000 hours under their belt is an absolute moron. Regardless, I'm call bullsh!t on your "ratings". First off power ratings are not applicable when it comes to rotors, neither does an MEI rating. Second, the minimum hours required for a part 141 commercial license is 190 for airplane. To add a rotorcraft helicopter rating to that requires another minimum 30 hours. So now you are up to 220. Add to that a minimum of 5-10 hours per instructor rating and you come to around the 250 hour mark. If you trained under part 61, you are required to have 250 hours just for your commercial. So there is NO WAY YOU ACTUALLY HOLD THE RATINGS YOU CLAIM WITH 207.5 HOURS.

Now to address the medical side. You cannot just have any RN or medic just jump on the helicopter and go. Another reference you wish to become intimately familiar with is Texas Administrative Code 157.12 which governs the operations of rotor wing programs. It clearly defines equipment, staffing, and educational requirements that you must have to operate. Your described plan won't fly (no pun intended).

Your above statement about the LOI is exactly why you need to rethink your business plan. You would be a complete idiot to not have a payor of last resort clause in place. Without it, you will lose your arse on the financial end. Do you really see yourself putting "extra cash flow in your pocket"? With a multi-million dollar aircraft that will cost you over a grand per hour to operate? In a rural, underserved area? SERIOUSLY?!?!?!?

I'd also be interested in knowing where you came up with your $7000 average. Show the proof as I think you have been seriously mislead.

I really don't know what to think. Honestly, I don't even know if you are serious about this or if your a troll. Regardless, I know for a fact that you will never get a provider license or a 135 operators certificate with your current plan.


It's pointless talking to someone like you, if you are in the industry like you say you are you would understand that you were in my shoes at one point.....with that being said I will purse this, I will happily offer my services to you if you ever need them.

Worst case scenario Ill just turn the heli into Vip Configuration and back lease.

Thanks Again for your response.

Anthony
 
Wow! Where to begin?????

Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.

I'd first like to refer you to a manual officially known as Title 14 of the Code of Federal Regulations - Aeronautics and Space. You may have some familiarity with it already as you claim to be an aviator. Pay close attention to Part 135, which will cover your commuter and on demand operation. 135.243 specifically outlines the requirements to be qualified as PIC (pilot in command). You sir, with your 207.5 hours, come no where close to being qualified. You cannot even touch the controls on a 135 certificate unless you are running dual pilots. Any medical professional that chooses to fly with a PIC that has less than 2000 hours under their belt is an absolute moron. Regardless, I'm call bullsh!t on your "ratings". First off power ratings are not applicable when it comes to rotors, neither does an MEI rating. Second, the minimum hours required for a part 141 commercial license is 190 for airplane. To add a rotorcraft helicopter rating to that requires another minimum 30 hours. So now you are up to 220. Add to that a minimum of 5-10 hours per instructor rating and you come to around the 250 hour mark. If you trained under part 61, you are required to have 250 hours just for your commercial. So there is NO WAY YOU ACTUALLY HOLD THE RATINGS YOU CLAIM WITH 207.5 HOURS.

Now to address the medical side. You cannot just have any RN or medic just jump on the helicopter and go. Another reference you wish to become intimately familiar with is Texas Administrative Code 157.12 which governs the operations of rotor wing programs. It clearly defines equipment, staffing, and educational requirements that you must have to operate. Your described plan won't fly (no pun intended).

Your above statement about the LOI is exactly why you need to rethink your business plan. You would be a complete idiot to not have a payor of last resort clause in place. Without it, you will lose your arse on the financial end. Do you really see yourself putting "extra cash flow in your pocket"? With a multi-million dollar aircraft that will cost you over a grand per hour to operate? In a rural, underserved area? SERIOUSLY?!?!?!?

I'd also be interested in knowing where you came up with your $7000 average. Show the proof as I think you have been seriously mislead.

I really don't know what to think. Honestly, I don't even know if you are serious about this or if your a troll. Regardless, I know for a fact that you will never get a provider license or a 135 operators certifwith your current plan.

Which Air Medical Provider in El Paso are you? I would like to research and learn more about your company, that is if you do have a company or maybe your just a paramedic that goes along for the air ride.......
 
Importance of crew

You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.

First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.

The nurses you will be getting from the hospital will have no knowledge of flight physiology, CRM, AMRM, or other topics that are flight specific. Also, keep in mind that you may be a good pilot, but do you have the knowledge necessary to be a HEMS pilot? Have you flown SIC with a HEMS operation, worked with medical personnel in emergencies in the field, etc.

Also, you have notnfactored in the cost for a full time medical director, maintenance, engineering, consumable medical supplies, equipment, and the lost goes on and on. For consumable supplies and medical equipment alone you are looking at $200,000 at least...

Also, do you have any idea what it takes to obtain CAAMTS accreditation? If you want to be taken seriously in the aeromedical industry, CAAMTS is becoming a must have.

I am helping set up the medical side of a HEMS operation in Saudi Arabia, and we literally have an unlimited budget, and we are still having issues (albeit some are political) but the point I am trying to make is simply having the financial plan to make it work is not enough, and I think if you were to actually begin making purchases for this operation you would realize that you estimates are grossly under the mark and short sighted.

It looks like you intend to lead the aviation side of things, but do you have anyone giving you input on the medical side? You need someone full time just to plan and administrate the operation. Simply coming to a forum does not cut it.

Anyway, I have said enough already...the list of issues with this plan literally is endless. If you are serious about this, forget this idea for at least the next 5-10 years, build your time and get a job as a HEMS pilot, and you will begin to understand how much is actually involved in this industry. It is more than having a few medical people, an aircraft, and a place to lift off and land....mentalities like the one you are exhibiting are what causes the inexcusable number of fatalities in the aerated industry each year.

I say all of these things with the utmost respect for your altruistic ambitions....
 
Importance of crew

You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.

First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.

The nurses you will be getting from the hospital will have no knowledge of flight physiology, CRM, AMRM, or other topics that are flight specific. Also, keep in mind that you may be a good pilot, but do you have the knowledge necessary to be a HEMS pilot? Have you flown SIC with a HEMS operation, worked with medical personnel in emergencies in the field, etc.

Also, you have notnfactored in the cost for a full time medical director, maintenance, engineering, consumable medical supplies, equipment, and the lost goes on and on. For consumable supplies and medical equipment alone you are looking at $200,000 at least...

Also, do you have any idea what it takes to obtain CAAMTS accreditation? If you want to be taken seriously in the aeromedical industry, CAAMTS is becoming a must have.

I am helping set up the medical side of a HEMS operation in Saudi Arabia, and we literally have an unlimited budget, and we are still having issues (albeit some are political) but the point I am trying to make is simply having the financial plan to make it work is not enough, and I think if you were to actually begin making purchases for this operation you would realize that you estimates are grossly under the mark and short sighted.

It looks like you intend to lead the aviation side of things, but do you have anyone giving you input on the medical side? You need someone full time just to plan and administrate the operation. Simply coming to a forum does not cut it.

Anyway, I have said enough already...the list of issues with this plan literally is endless. If you are serious about this, forget this idea for at least the next 5-10 years, build your time and get a job as a HEMS pilot, and you will begin to understand how much is actually involved in this industry. It is more than having a few medical people, an aircraft, and a place to lift off and land....mentalities like the one you are exhibiting are what causes the inexcusable number of fatalities in the aeromed industry each year.

I say all of these things with the utmost respect for your altruistic ambitions....
 
Interesting comments...you have been given great information from some very informed people.

I invite you to visit flightweb.com if you have not done so already. They will be much more helpful. :)

Might I also recommend John Wade being hired as a potential consultant as he has a lot of experience in air operations start up. You will find him on flight web.
 
Which Air Medical Provider in El Paso are you? I would like to research and learn more about your company, that is if you do have a company or maybe your just a paramedic that goes along for the air ride.......

Native Air, an Omniflight Helicopters company. www.omniflight.com

I am the Clinical Specialist for the three medical platforms based at Ft. Bliss and El Paso International Airport.

Drop me a PM, i'd be happy to share any further information that may be beneficial to your cause.
 
You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.

First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.

The nurses you will be getting from the hospital will have no knowledge of flight physiology, CRM, AMRM, or other topics that are flight specific. Also, keep in mind that you may be a good pilot, but do you have the knowledge necessary to be a HEMS pilot? Have you flown SIC with a HEMS operation, worked with medical personnel in emergencies in the field, etc.

Also, you have notnfactored in the cost for a full time medical director, maintenance, engineering, consumable medical supplies, equipment, and the lost goes on and on. For consumable supplies and medical equipment alone you are looking at $200,000 at least...

Also, do you have any idea what it takes to obtain CAAMTS accreditation? If you want to be taken seriously in the aeromedical industry, CAAMTS is becoming a must have.

I am helping set up the medical side of a HEMS operation in Saudi Arabia, and we literally have an unlimited budget, and we are still having issues (albeit some are political) but the point I am trying to make is simply having the financial plan to make it work is not enough, and I think if you were to actually begin making purchases for this operation you would realize that you estimates are grossly under the mark and short sighted.

It looks like you intend to lead the aviation side of things, but do you have anyone giving you input on the medical side? You need someone full time just to plan and administrate the operation. Simply coming to a forum does not cut it.

Anyway, I have said enough already...the list of issues with this plan literally is endless. If you are serious about this, forget this idea for at least the next 5-10 years, build your time and get a job as a HEMS pilot, and you will begin to understand how much is actually involved in this industry. It is more than having a few medical people, an aircraft, and a place to lift off and land....mentalities like the one you are exhibiting are what causes the inexcusable number of fatalities in the aeromed industry each year.

I say all of these things with the utmost respect for your altruistic ambitions....



There is a company about 140nm away that hardly ever use their HEMS. I spoke to the Medical Director and Administration and they are willing to transfer or to give me operations for our community since paper wise we will be doing way more flights than what they use. Can you tell me pros and cons should i join with them or simply make my own from scratch?



I want to thank you for you post, this is the type of information I need to proceed in this. I will research a little more in these areas you have mentioned. For the Medical Director part I like to think I have an advantage I have had my own practice for over 20 years in a small 38000 town. Speaking to current HEMS pilots and people in charge for the current service provided to our city they are excited and willing to be more home based. We are in great need of nurses heck even DR. we only have 2 surgeons myself included So the nurses will work for whatever we can pay them at the moment. I brought this idea up with fellow workers and including an ambulance group and everyone seems to be liking the project. you are correct I have no clue what I am doing hence I have never done it before. Everyone locally including the city, county the region are opening arms and letting this idea slowly turn into a reality. Again, I will research your ideas and comments and get a little more familiarized.

This is a project that I feel will serve our local and surrounding community and with the right qualified crew and qualified equipment I think we can proceed.

Thanks,

Anthony
 
This is single-handedly the most disastrous idea I have ever heard of.......There are a million HEMS setups in regards to medcrew staffing but your plan to have 2 RNs on standby with an unlimited supply of other nurses and EMTs just waiting to fly for whatever you pay them is just simply laughable. Please don't follow through with this ridiculous plan....
 
This is single-handedly the most disastrous idea I have ever heard of.......There are a million HEMS setups in regards to medcrew staffing but your plan to have 2 RNs on standby with an unlimited supply of other nurses and EMTs just waiting to fly for whatever you pay them is just simply laughable. Please don't follow through with this ridiculous plan....

He asked for helpful ideas, not criticism.
 
If they are crazy idea's and you have more informative idea's then why not try and tell him those instead of just laughing at him.
 
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