Hawke’s Bay Rescue Trust – Dr Forbes Bennett

Michael Fowler: Welcome, ladies and gentlemen. Thank you for attending tonight. It’s my pleasure to welcome Dr Forbes Bennett, who’s going to talk to about the Hawke’s Bay Helicopter Rescue Trust, especially from a medical history. Forbes has been involved with the Trust … well, actually before it was formed, in the trauma area. So, welcome, Forbes.

Forbes: Thanks very much.

[Applause]

You can hear me all right? I’ve got a voice problem, so I need the amplification. It’s okay? So as you heard, my name’s Forbes Bennett. I’ve been asked to talk about this, because I was a bit slow — I wasn’t quite sure-footed enough to get away from somebody who asked me to do it. [Laughter] And the other reason is that I’ve been involved in the Trust, as you said, before it was formed. There was another organisation before that. But the hospital – I’m a full-time hospital specialist, so I don’t do any general practice, I work entirely in a hospital.

The hospital was involved in patient transfers before the Trust came here, and my involvement in the Trust has been because of my interest in moving sick people around.

To get into that state, I specialised in anaesthesia, and I’ve met some of you on the operating table! [Laughter] And I further specialised in intensive care medicine. It’s one of the training pathways to become what we call an ‘intensivist’. So we look after the really, really sick people – sometimes not very well, but we do our best … we try. The other pathway to intensive care is through general medicine, so a physician can become an intensivist as well. But I did it through anaesthesia.

It’s a loosely-put together series of recollective slides. And the other requirement for being asked to talk about a helicopter situation is that I don’t fly – I would like to, but it’s expensive to learn to fly a helicopter. But I get rides on helicopters, so I’m called a ‘skin-biter’ … it’s somebody who gets a ride at any cost at all … or a ‘rotor-head’ because I’m passionate about helicopters – I think they’re wonderful things. Planes are nearly as good, but helicopters are even better. So, there’s a little bit about helicopter usage … they’re great for CASEVAC, casualty-evacuation, and MEDIVAC rescue things.

You saw the plane that crashed in the Ruahines earlier? The Palmerston equivalent of us was involved in delivering people and bringing them back, and winching them out, and they’ve both survived so far.

Okay? You can hear me all right?

I thought that the first helicopters were used for this in Korea, in the Korean Confrontation War, but I found out just recently that it was in World War II in Burma. The first ones were in April 1944 – I don’t know anything about that – but also in the Philippines in June 1944 where the Americans were using an RV … an R-6A Sikorsky helicopter – they’re funny little things to look at. And they were used primarily for ship-to-shore transport. When the Americans were invading the Philippines, they didn’t have many wharves, and they were using the helicopters to shift equipment from the ships into the shore. But they were little helicopters and difficult to fly, and helicopters are hard to fly anyway. They’re not an easy machine.

But the payload’s two hundred pounds. Now that’s about twenty pounds more than I weigh … ninety-five kilos … that’s all they could carry. Our present one can lift – Tony Robinson, the CEO of the Trust is here – can lift a ton?

Tony: Yes.

Twelve hundred kilos? So they’ve gone from ninety-five kilos in 1944, to twelve hundred kilos in … now, 2010. In the Korean War there was much greater use – forty thousand-something transports in the American … or as I worked in Vietnam for a little while, so it’s the American War … there was a million transfers by helicopter.

Now, what we needed in Hawke’s Bay in the 1970s when I came back here, was larger aircraft and an all-weather flying capability, and also staff who are aviation-orientated. It takes a little bit to work inside a plane or a helicopter because they’re unstable, they’ve got different … they’re not as nice as a hospital ward to work in. All we had were little machines with skids on the outside and patients on the outside.

[Shows slides throughout talk]

This is my first-ever helicopter rescue. It’s 1979 … ’78-’79, maybe 1980. That’s Paul Woolf, who’s still flying for us – he flew today – an incredibly good pilot. And the patient goes out here. [Chuckles] It’s a Hiller apparently, I found out. And I sat in that seat and tried to look after the patient, who was conscious and distinctly more frightened than I was. [Laughter] I photographed it the next day, out at Bridge Pa. Gosh, that’s changed a lot in the time, too. And I just noticed this big puddle … you know, the helicopter was obviously frightened as well. [Laughter] Well after that, things began to change.

Napier and Hastings … it’s a long story, we don’t need to go into it … too much. Small population – by world standards we’re very small, with two small hospitals. And we in Intensive Care viewed it as one hospital with a twenty-kilometre corridor that we had to trot up and down. And we moved a lot of sick people, on ventilators, needing all sorts of tricks to keep them alive, to [from] one hospital to the other to get things done. We had the CT scanner … CAT scanner … in Napier. And we often had an orthopaedic surgeon on in Hastings, not in Napier, and we had to shift the patient. The scanner was immovable, and the orthopaedic surgeons really weren’t very much better. [Chuckles] But we gained a lot of valuable experience in moving the ill patients around. So it’s called ‘transport of the critically ill’ – it’s a sub … almost a sub-speciality of intensive care medicine.

And we’re distant from tertiary medical facilities – that’s the big hospitals with lots and lots equipment, and clever people in them. So we needed to transfer to them. We were using fixed wings … the aircraft … and rotary wings. We used a Bell Jet Ranger a few times for particular reasons, to shift people out.

The helicopter’s got peculiar advantages of being very convenient. It’s door to door. Our helipad’s on hospital ground. If we go by plane … we used to go through Bridge Pa; we now drive over to Napier Airport, thanks to the motorway … expressway … it helps. But there’s several different handling steps, so the helicopter’s nicer, but the downside of it is it costs. They’re an arm and a leg, they’re expensive beasts, so there’s a trade-off.

There were intensive care developments that were significant. The ventilators used to be huge, but they’ve been miniaturised. And the monitors – television screen with all of the physiologic data that was displayed about what was going on in the patient – they used to be large and unreliable – they were miniaturised. And then people started making specific ones for transport. So we now have very sophisticated ventilators that’ll cope with any sort of respiratory disease, and they’re tiny. The small … really small, small ones are about this size. The standard ones we use are about the size of that stand over there … little bit bigger than that. But they’ve been miniaturised and their power consumption’s miniaturised, so they run off twelve volts, or twenty-eight volts, depending.

We have always had to shift people in-hospital … you go to the operating theatre, you come back from the operating theatre, you need to go to X-ray … there’s policies, protocols, lots of data about how to do it properly within the hospital. Some of us transfer people between hospitals, and we’ve also developed staff who’ve been trained to work within the aviation environment.

It’s not just here – it’s not just Hawke’s Bay – it’s right throughout the world. In Australia, there’s the Royal Doctor Flying Service – that’s primarily to get general practitioners and specialists out to clinics – it’s not that involved with patient transfers. But there’s a lot of really good intensive care units in Australia. One of the secrets in New Zealand Intensive Care is that we’re tied in very tightly with the Australians for the standards and the training and the qualifications and all that. And Australia’s got the best intensive care units in the world. If we were by ourselves, being a four million population and a small country with fairly relaxed people, I don’t think we’d achieve the standard that we’ve got. But you get a bunch of Australians, and they’ve cranked it up – they just do things well. They were doing intensive care transports, but their demographics are totally different from us – they’ve got big cities with millions, and then they’ve got a lot of small towns about the size of Wairoa. There’s not the hundred and eighty thousand population. There’s one place that has a similar population to us in Australia – you’d think that our population demographic would be common, but it’s not, it’s peculiar. It is common in New Zealand but not in Australia.

Not many places had two hospitals twenty kilometres apart, and we did really get a lot of experience in transferring between the two. That was the basis on which we built up the capacity for transferring … transporting patients.

There’s increasing demand for going out for services not available in Hawke’s Bay. And we haven’t got any neurosurgeons here, we’re never likely to get neurosurgeons, cardiothoracic surgeons – we’re just not big enough. So we had to shift out to it. There’s a guy called Russell Worth, who’s a Wellington neurosurgeon, and Peter Button, a Wellington helicopter pilot – I think it was Capital Helicopters – 1981, he’d been wheeling a patient who needed urgent neurosurgery – that’s Russell Worth there, you can see there; that’s Peter Button, and Ted Ward, who was the first intensivist to come back to Hawke’s Bay and really set the place up to make it attractive for others of us to come back. Wheeling across, that’s the helicopter which is called a Bell Long Ranger taking off.

Things are happening overseas as well. In Sweden … Sweden’s a little bit like New Zealand in that it’s spread out, long distances to travel; a weather problem that’s worse than ours. It’s about twice the length of New Zealand, so they have a lot of air travel that they do. I worked for a year in Denmark … and that isn’t a misprint, [discussing slide] Felt is the name of an organisation that does the transports, and it’s like St John’s Ambulance, the Fire service, the AA and all the tow trucks all under the one roof. So they don’t have a communication problem between them – they’ve got it sussed. It’s wasted in Denmark, really – I’d love to see the same sort of thing here. Denmark has shorter distances ‘cause it’s quite a small country and they don’t have the long-haul problems that we have.

And Britain again, this big hospital’s just around the corner, they drive to everything except Scotland, where they have quite a bit of flight medicine.

Australia, Flying Doctors, the IC transfers – they were only shifting small numbers, and when we added up our Hastings to Napier and back again transfers, we had numbers that were more than what was going on in Melbourne and Sydney. So we figured we were doing well at the start. But that’s, of course, not helicopter transfer. They wouldn’t let us use the helicopter to go from Napier to Havelock to … We did have another problem with Napier Hospital – we couldn’t put a helipad on the hill. And that straight away mitigated or biased against using the helicopter for going to Napier because you’d have to land at the bottom of the hill in South Pond … safety reasons … and you then had to drive up. And that fifteen … twenty minutes loses time, and where time’s the essence of [to] get to urgent surgery, that fifteen minutes really costs; whereas Hastings, the helipad was on the hospital grounds. But that’s another story that I think you’re going to traverse later on, about the hospital developments.

We worked for planes with the Hawke’s Bay and East Coast Aero Club, with the Napier Aero Club, HeliSpray. And Whanganui Aero Work actually provided us with helicopters, which we rang around to find. We wanted to use a helicopter – occasionally going to Wairoa we had to use helicopters in a hurry. Te Onepu Helicopters helped occasionally.

And this isn’t an aviation body – Waimarama Surf Life [Saving] Club. They were interested in helicopters for water rescue. And they started talking to people, and out of their talking … that it was too slow for water rescues, or even us getting to Wairoa quickly if something was wrong in Wairoa. So, the Waimarama Surf Life [Saving] Club started talking to a police inspector called Paul Wiseman, and I don’t know the details of the conversation, but they started bouncing ideas around – ‘wouldn’t it be nice if …?’ And I came up with this … [laughter] which is called ‘Start Me Up’, by Desmond Ford Sculpture in Whangarei – it’s unfortunately not for sale, but never mind. [Laughter]

Paul Wiseman was the ‘get-up-and-go attitude’; Gary Griffiths and Noel Houston in the Waimarama Surf Life [Saving] Club [?] and some other members from [?] Boating Club started up the Hawke’s Bay Helicopter Rescue Organisation – not the Trust, but an organisation. They didn’t have a plane … no dedicated aircraft. They used whatever was available, and it was like us organising our intensive care transport – so we’d ring around and find somebody – there wasn’t dedicated aircraft.

But we started developing training programs, as did the Waimarama guys. To do water rescues you’ve got to be fit, and their fitness programme was such that I wouldn’t have qualified by any means. But they needed to have doctors, so that was helpful. It was all volunteers and they were … they were seriously enthusiastic, and they lobbied for a helipad at Memorial Hospital in Hastings, which made a lot of sense. Hastings had the space, and we started land the helicopter without trouble.

We started accumulating equipment. There was a lot of fundraising; there were survival suits purchased; there were monitors for measuring what the patient’s doing. But it was realised that a dedicated aircraft was needed – we needed to have our own helicopter. And I looked at the costs involved and thought, ‘oh! We can’t afford this – it’s just beyond our resource’. But not everybody agreed with that.

It was early days in the … well, not early days really. As part of the progression of the Hawke’s Bay District Health Board we had a guy called Andy Train as the CEO – he was one of these ‘get-it-done’ type of people. And he went and saw another guy who gets things done in town – a bloke called Mike Toogood – you’ve probably heard of Mike Toogood – about establishing a dedicated helicopter rescue service. And Mike … this community … I think he said it, I’ve got a pretty clear recollection. But I’ll quote him as saying it anyway – “We can get it if we use the community support.” And Hawke’s Bay’s a great community in that regard. It was the Hastings Karamu Rotary Club, and they ran this fantastic cocktail party and they raised an awful lot of money for it. And with Mike’s direction, the Trust started to form in 1991. But one of the problems was to get somebody to pay the big money for running it. And Mike did a lot of hard talking to people; worked his way round the various businesses and came up with what’s called a ‘Principal Sponsor’, as well as approaching a lot of other people.

We also got full-time pilots. Our first pilot was Bruce Harvey, and following Bruce was Paul Woolf. And both of them are … they’re really inspirational people – quite interesting as well. They bought this machine, which is called a Squirrel helicopter. It’s made by Aérospatiale in France; its designation is Hotel-Foxtrot-Zulu, and it’s a very nice type of helicopter. I think these for us are ideal, but the Civil Aviation doesn’t agree … the Civil Aviation Authority in Wellington says you’ve got to have bigger and better. And that’s part of the story.

Mike Toogood ran a firm called Skyline Aviation – I think almost as a sideline, but it was one of his interests. He’s another rotor-head. That’s his true name and he is … he’s got a lot of money and he can fly a helicopter. [Chuckles]

I was on the medical side and doing the medical things. But Mike’s visionary – he could also see how to make it work financially without getting … ‘Cause they’re so expensive they can … buying these planes … they can bankrupt companies if you start trying to run them. You’ve got to be very careful about the finances of it. Well, Mike spoke to Graeme Lowe – originally Lowe-Walker Corporation, but then it became the Lowe Corporation – Andy initiated it, Mike ran with it, Graeme Lowe funded it. Alistair Bowes followed Andy Train and was also very supportive of it. We had people at the top of the administrative side of the hospital hierarchy, whom we as clinicians have very little to do with, but they control the money and they could see the long-term advantages of this. And another person to mention was Peter Kidd, who was the fixed wing aviation side of it. The planes also were tied in with this development.

‘Main sponsor organised’… [reads from slide] Mike … very industrious individual … had been involved with the construction firm, forget its name, but he called in a lot of favours owed to him and got a hangar built on the hospital grounds.

And we started accumulating more equipment. And as we started to use it more, we had to train people. We had to get our staff safe to work in the helicopter. We had to get the ambulance safe to work on the helicopter. We had to have a training programme established.

The original hangar was on the eastern side of the hospital. [Shows position on slide] Havelock’s out here; that’s Cashmore Nursing Home; and this is now a carpark because the helipad’s been shifted. It was a little bit noisy for the front of the hospital. They are noisy beasts … they attract attention, and there was quite a lot of resistance to having it in the front of the hospital so it’s moved around the back. We were a bit worried, we thought the principal sponsor might lose interest, but not having his name, and the noise out the front, but it didn’t seem to concern Graeme. And as you can see, the Squirrel’s nicely garaged on a trolley in there. It was done properly.

We also had the delight of refuelling flights – no fuel was kept on site with this hangar. And so we had to … once we’d done a job we had fly over to Bridge Pa, refuel and fly back – or the pilot and crew did. And we cottoned on as a hospital that this could be used as a training flight. So we just talked about it, and people who wanted a free ride in the helicopter – it’s only about three minutes. But we got a lot of people. ‘Course, doing that, you get them interested and you can talk about the dangers of helicopters: “you’ve got to do it right around them – if you muck it up, they’ll kill you – they’re quite quick at that. And it’s the whirry bit at the top and the little whirry bit at the back – you forget that they’re there. You can hear the noise – you’ve just got to have your head switched on all the time when you’re around them”. So there was a safety component that we had to work our way through.

There was a phenomenon called the Trauma Team, where as a group of doctors we went out with the Ambulance Service before paramedics were really on the scene.

Greg Beacham was instrumental in setting that up, and most enthusiastic. And Colin Jones and Murray Wiggins contributed to it for a long time. There were other practitioners involved, but Greg was really the driving force of that. And attached to that were hospital specialists … Mary Brooker, Ross Freebairn and myself … as anaesthetists we participated in that as well. That general practitioner or hospital specialist side of it hasn’t continued. It was quite disruptive – Colin lost of lot patients because he’d be conducting his surgery; the whistle would go; he’d have to drop the patient and disappear off to do something with the helicopter. And you only put up with that three or four times before you go to another doctor, so it had its cost. At the same time, St John were developing paramedics who’ve become much more able and capable, to do what the ambulance people do. They’ve become very, very good at it, the pre-hospital care of the sick patient. So I’ve felt some reluctance that I relinquished my involvement in that, but it conflicts – I couldn’t leave the intensive care unit and go out on a call, so that was another duty roster that I had to work on. So with some relief, we’ve had the paramedics take up that.

The Trust itself is voluntary. The members of the Trust are local community business members – it’s run as a business. They give their time for free. And the growth and the direction that it’s gone has been because these individuals have made the right decisions because of their business skills. And it’s aided again … Michael [?] Toogood comes back … Skyline Aviation, his firm, did the administrative work, which is the logging on and off; the hours run; ordering the fuel; keeping track of what’s going on; keeping track of the maintenance.

Our advantage really, has been having a hard-nosed businessman running it. Because we looked at Life Flight which has a huge administrative staff – it is a much bigger organisation, but there’s an awful lot of administrative people – whereas Mike Toogood’s attitude is to keep the administration costs as low as possible.

In 1996, the Trust combined its business interests with the Hawke’s Bay and East Coast Aero Club. That was Peter Kidd’s involvement, and they bought a Piper Navajo. And there’s a lovely promotional photograph of the two together.

The difficulties in getting that photograph were enormous, because they fly at quite different speeds, and to get them side-by-side by a third plane took, I think five passes before they got it together. And if you bump into anybody, you get such enormous publicity that you don’t really need … [Laughter] I think in the background is Kahuranaki too, isn’t it?

The demand for services has continued. People seem to like using it, mainly ambulance for pre-hospital. That’s a training photograph, on top of the Kawekas. It’s a bit of scary photograph, but I’ve put it in anyway – it’s scary because there’s no pilot, and I presume the pilot’s locked the controls that move, and trotted around to take the photograph. It’s also scary because you can see the tail rotor and see where it bites into somebody who steps around. The crew … these people are in a safe position, but the other scary thing is, they’ve both got hats, and he’s carrying an ice axe. And if he puts the ice axe above his head, it’ll get into the rotor above you. We’ve had people throw blankets, which get into the rotor wash and get thrown up in the air. If a blanket gets on a rotor, it’ll destroy the machine.

We’ve had one person nearly walk into the fan at the back, and one of the crew men spotted this person going towards the back and just tackled them – knocked them to the ground. You’ve really got to have this [points to head] when you’re around them.

St John ambulance attending a car accident. You wouldn’t think that was a person in there, but there he is wearing an oxygen mask and being cut out of the car.

Fire, ambulance, police, helicopter, Paul Woolf – and that’s at Te Haroto where somebody was changing a tape cassette and ran into the front of a [?] truck – and survived. They were fifteen minutes back to hospital from there.

Seven minutes to Kairakau – it’s nearly an hours’ drive because you have to go down and around and back out again – but you just hop over the hill and you’re in Kairakau in two minutes. They’re wonderful machines.

We use it for the hospital quite a lot – we get called to Wairoa. They have … again, problem up there … I’ve twice gone up under duress, wondering whether I should be carrying a gun as well, and I would’ve looked horribly out of place if I had been.

[Chuckle] It gets fairly hot in Wairoa, and there’s a lot of use that we can do by going up there. We’ve put intensive care teams up there on the average probably once a week, to bring people back. There’s an awful lot of people in Wairoa who don’t come and see a doctor until it’s really late, and so we get quite advanced pathology.

We do quite a few transfers from Gisborne, but Gisborne tends to transfer to Hamilton which is right, ‘cause it’s a bigger hospital than ours.

We send complex surgical cases out and since the nearest surgery … major vascular surgery goes out. There’s awful lot of medical case transfers, cardiology problems … and there’s intensive care transfers we take out to Wellington, Christchurch, Auckland and sometimes Hamilton. So we’re quite busy. We do about a thousand transfers a year – between a thousand and twelve hundred – now that’s not helicopter, that’s overall aviation ones. With each transport, a decision is made: ‘Is the helicopter warranted? Should it go by fixed-wing?’ Often because of the cost, a helicopter’s not warranted, but if we feel that the speed is balanced by the gain for the patient, then we use the helicopter if it’s going to give us a positive advantage. And it’s door-to-door. At times that does make a difference.

We’ve had to extend our staff resource to meet the demand, so the concept of a flight nurse came out. And this bunch of smiling people are at the last helicopter open day, putting small children in stretchers and carrying them round, and showing people how to do intraosseous insertions – I’ve no idea why, but people like using our equipment to drill holes in bones and hook them up to drips, and … handy what you can do.

We use anaesthetic technicians as well as … the rest are nurses apart from this ugly fellow here who’s one of my colleagues called Ross Freebairn who is the current Medical Director, and would get into the nursing photograph [chuckle] – but that’s another story.

A cardiology patient in 1982, I think … ’83. We asked him if he liked flying – no, it must be later … must be ’92 ‘cause it’s the Squirrel – we asked him if he liked flying and he said, “I was a pilot in Bomber Command during the war. I’d be delighted.” And we could hardly stop him talking – he had chest pain from his coronary problems – he was going down for the equivalent of stenting, and he enjoyed it totally and completely. He was a good patient. And you can see from the daylight, we were off at first light to fly down there.

Working inside the helicopter, the Squirrel, is cramped. I’ve taken the photograph; that’s Brent, one of the pilots. Those are the controls; there’s my monitors. If the patient reaches over, he can get his hand on the controls. So, we’re pretty selective about who goes in there. The syringe pump’s running; there’s a defib [defibrillator] behind. And this blanket is covering over the patient. I’ve got a nurse sitting beside me, or a technician. So we always travel with two people, and there’s often a helicopter crewman as well – it’s quite cosy. My view by turning immediately to the right is Brent, and then we get the scenery outside, and we get some nice views from time to time. That’s Wairoa, coming into land … little ‘H’ for helipad. That block’s gone, so this photograph must have been taken some time ago. That’s Wairoa on a somewhat wetter day. You can see that … this is more recent, but you can see how the block’s gone.

And one of the worries is that when you drive through Dannevirke, there’s this huge building there … oh, go over to Napier there’s a huge building. We’ve really contracted our medical services. When I first came back here they used to do major surgery in Wairoa, pretty successfully. Now that’s not even a functioning operating theatre, so we’ve got to have a fast-track service to get up there and get people back and get operating on [them].

The CAA … Civil Aviation [Authority] … have pressured us to get bigger and better machinery, but that increases the expenses of running it. To land on the rooftop in Wellington … we were going to be banned from doing that with the Squirrel, because it hasn’t got a twin engine in case the engine fails as you’re coming into land. And you can understand their point of view – if they get a hot helicopter with a ton of kerosene on it hitting the side of the hospital, there’s going to be a hell of a lot of paperwork! [Chuckles] But the practical reality of it is, the turbine engine in the helicopter is incredibly reliable, and there’s … don’t think there’s a recorded failure of one coming into land on a rooftop. But there’s peculiar things they have to do when they leave the rooftop. They come down onto it very ordinary, but they actually have to back off it in case the engine stops, and they can then glide … helicopters do glide, but very steeply, and they can glide back onto the top of the roof.

The safety of twin engines though, does … it is nicer. I must admit, the newer helicopter does have quite a lot more power than the Squirrel. There’s also more room to work in, so I really like the bigger helicopter, but there’s this problem – you know, do we really need it? Well, they say we have to have it. I’m not a businessman – thank goodness we’ve got businessmen making these decisions, so that I don’t have to worry about that.

That’s the new one. It looks like a big, fat hen. And its call sign then was Hotel-Echo-November, or HEN. It’s now Hotel-Indigo … Burger King, isn’t it? Indigo-Bravo-Kilo, that’s right. And it’s been repainted a little bit. And it’s nice – it’s just a bit bigger, it’s got a different configuration. We’re very lucky to have it. We’ve got a stretcher to put people on it.

That’s another one of our inner-city technicians, Ross Imlay, taking down … recording some of the data here – patient’s blood pressure; a ventilator; intubated patient travelling out of Wairoa. And it’s pretty relaxed, I have time to take photographs. See – so I can be sitting, and we’re not worried about these patients that we’ve stabilised before we fly. We’ve got time to do things. And coincidentally we’re just flying over the cemetery out of Wairoa … [laughter] on a wet and rainy day.

We do get some lovely views, that’s Napier and Hawke’s Bay. You carry a camera because you see things that you’re privileged to see, really.

Wellington … Government House is somewhere down there; the Basin Reserve; Tararuas; Hutt Valley, up there. That’s on finals into Wellington Hospital; another pilot with one of the back-up helicopters that were used – it’s another Squirrel, the small one.

One of our hospital security guards going down for his coronary artery stenting, safely on the Wellington rooftop. And then he said, “would you take a photograph so I’ve got a record of it?” “But of course.” And then he’s there keeping an eye on it.

Sometimes we fly really high. [Laughter] Look into the future and see this as an ambulance? No, I don’t think so. But isn’t it a fantastic photograph? I cadged this out of the Dominion, I couldn’t resist it.

There’s Wellington; we’re a little bit up here; there’s the Sounds; Nelson’s here; Hurunui River; and Christchurch. Now sometimes we fly right down this coastline to go to Burwood with spinal injuries … fly to Christchurch. These guys are about two hundred kilometres up. We don’t often get that high. [Chuckles]

There’s a lot of complex reasons as to why our system works as well as it does. It does work very well and it’s not very expensive.

We’ve got sponsors; we get good business advice; we’ve got people who know how to run a business; we’ve got Mike Toogood, who steers it all in the right direction; we’ve got the Trustees, who know what they’re doing. It’s a lean, mean business machine, and there’s a demand for the services from the Bay because we’re isolated. And we feel, within the hospital, that if we want to take you to one of the bigger centres where we can get a better result – that’s what we’ll do, and we’ll do it as soon as we can. This makes it all possible. The only real reservation we have is with major burns, where I think we’re going to lobby to get the next burn unit for New Zealand in Brisbane, because that’s where the best burns are. So we might be going across the Tasman. But we get about ten major burns a year, so again, you run into the cost-benefit problem of how to best manage them.

From my perspective as a consumer for my patients of Hawke’s Bay, to the Trust I’d say “thank you for making all of this possible”, ‘cause it really is a wonderful facility.

Skyline contributes enormously to it, and Graeme Lowe and the Lowe Corp Rescue Centre at the back of the hospital, which is interestingly where the helicopter took off with Russell Worth the neurosurgeon and Peter Button flying it, some twenty-odd … twenty-five years ago … so they’ve built this Centre on that.

So there we are – thank you.

[Applause]

Any questions for Forbes?

Q: Is the new helicopter going to stay black in colour?

A: It would cost forty thousand dollars to change it – we’ll do it tomorrow if you pay us. [Laughter] The objective is to get the principal sponsor’s logo onto it, but it is forty grand. It’s like changing the colour in your car – you sort of wonder whether it’s really worth it. I don’t know – it’s a business question. It flies perfectly well whether it’s black or white [chuckles] or whatever. It’s lovely to fly, you know … it’s a great machine. It’s really nice. Don’t know.

Q: That was really interesting – thank you, Forbes. My question is, do you get the same turbulence in a helicopter that you can get in a fixed-wing?

A: No, that’s another delight with them. The blades flex, and the body stays quite still. If you think of the guys who are hunting deer, they couldn’t have shot deer out of a fixed-wing aircraft in the areas they were flying in. The planes move around too much. And you notice it more at night with the strobe lights going. You can actually see the blades then, ‘cause they get stopped with the strobe flashing. You can see the blades bending and flexing. And sometimes in photographs you can see when they’re really making them work – you can see the blades flex in a particular position. The blades are incredibly strong – they can actually chop down trees about that size without any damage. This is why they’re so dangerous if you get near them, they’ll chop you up quite happily. They’re very, very strong, but they’re also very flexible and they absorb a lot of the impact. I know flying … we flew over the Ruahines one time to go to Palmerston, and ran into something very, very unpleasant when we’re about five thousand feet above the hills. We’d gone higher to get out of wind, but it still got us. We weren’t quite turned over, but it was a most unpleasant experience – in a fixed-wing one, but I’ve been in worse weather than that in the helicopter – you can feel the noise and the moving. In fact our most turbulent flight in the helicopter was coming out of Dusky Sound about two months ago with a guy called Hannibal Hayes … hundred to a hundred and twenty mile an hour wind gusting through a saddle – it was the only one we could get through. It was a Squirrel so I knew its capabilities, and going through it I could hear everything bending as it was going through it, and you could feel the machine tensed. But the actual movement that came through to us as passengers … the others didn’t know what was going on, and I was sitting with both fingers crossed thinking ‘I’m not enjoying this at all’. They really soak up all the turbulence. They’re much more comfortable to travel in than a plane.

Helicopters every time – you know, I’m a rotor-head, I’ve said that. [Chuckles]

Q: Where people that just wouldn’t fly in a helicopter normally, do you get sort of patients saying … they’re freaked out as soon as they ..?

A: Yes. Oh, even just for planes as well, you get people who are frightened of flying. It’s a real problem. But we’re fortunate – we do have a lot of sedatives available to make it possible. [Laughter] If you’re really sick … you know, if you are sick-sick … you’re often unconscious with a tube down your throat, and you don’t know anything about what’s going on, so it’s not a problem. But there are people, particularly with coronary artery disease, who are wide awake and anxious. And the anxiety does not help at all, whereas somebody like that the Bomber Command pilot – he relaxed when he got in there. It’s a matter of … it’s a mind game, and working your way through it and getting your head around the fact that it’s actually more dangerous to drive to Napier for a cup of coffee, or to go shopping, than it is to fly in any of the planes.

The most dangerous helicopter flights are the rescue ones, ‘cause you’re working your away from the aviation safety net of instrument-rated flying. Helicopters are usually visual, so they’re a little bit more dangerous. They’re closer to the ground and have the capacity to fly into it. Our ICU transport’s always pad-to-pad, so they’re in the rather more safe group. It’s the guys who do the rescue stuff, like flying into that plane that had crashed in the Ruahines – there’s a more of a chance there of meeting something utterly unexpected. But the people who volunteer to do that have evaluated the risks, and they’re not the ones that get frightened of flying. And if it’s too much of a problem, we do sedate people so that they can …

Another contra-indication of flying is insanity … if you’re mad and think that you can fly the plane, and you want to pull on the controls … we’re quite likely to sedate you then as well, one way or another. [Chuckles]

But you know, for some people it’s terrifying to go on them, and I can relate to that. You’ve got to trust the people that you’re with. And when you walk onto a plane, you don’t who they are; you don’t know if they’re sober; you don’t know what they’ve been doing last night; and then if … hearing some of those hanky pankies they get up to at night with flight stewardesses … it’s coming out …

Q: A few weeks ago I flew down to Wellington and back – I got really sore eardrums. Does that happen on a helicopter?

A: If … it’s probably related to the height, and it’s related to the air not diffusing out of your lungs, ‘cause … if staff have a cold, we don’t let them fly.

Questioner: I had a bit of a cold.

Forbes: Your eustachian tubes block up a bit and your inner ear doesn’t … it’s got air in it which expands as you get higher, and it’s painful. It really hurts. But the helicopter being low, doesn’t usually get that as a problem, because it doesn’t get high enough to get the … as you go higher the pressure drops, and with the helicopter being low, you don’t get that as a problem. Although, the helicopter can go up to about ten thousand feet, and your cabin in a pressurised aircraft is usually pressurised to about eight thousand feet. So there is a bit of a pressure differential.

But if you’ve got blocked ear tubes, then it will … you’ll get a problem.

Q: So if you’ve got to make an urgent flight – say to Wellington, do you sort of have to communicate with sort of flight control towers that you’re coming, so that … don’t bungle planes ..?

A: So is that for me, making an urgent flight?

Questioner: Yeah.

Forbes: Yeah, there’s multiple radios within the helicopters – they’re on several channels: ambulance, police, and aviation. And there’s also a GPS system for flight-tracking so that people know where we are all the time. But you have to follow the standard aviation rules. Now, we can ask for flight priority when we’re going into any of the hospitals. Often the control tower will say ”what is your priority rating?” Or “what’s your medical priority?” And if we say we have none, they may direct us to go somewhere else while other flights come in. But you’re in contact with them all the time. It is quite tightly controlled. And you’re dealing with professionals – they’re doing it all day, every day. They know what they’re doing. If we are using medical priority, then the commercial flights go round again. But the airlines get a bit hissy about that, because people … if they have to do a go-around they may miss a connecting flight, and we don’t get the flak, they do, so we try and avoid that. But generally, particularly with the helicopter to Wellington, we’re beside the airport activity, rather than a part of it. But if it’s the planes going in, it’s part of the airport activity. You’re not allowed to fly in there after eleven o’clock I think, isn’t it? We don’t have night flights, which I’m not too unhappy about. Flying at night’s a bit more dangerous, and the rescue flights at night are even more dangerous again. But if we have to, we’ll break the aviation rules. There is legislation available that allows us to say we’re going to break all the rules because we have to get to a particular point. And then there’s a mountain of paperwork afterwards as you justify what you’ve done.

Q: Why are helicopters more expensive to fly than fixed-wing planes?

A: It’s a good question. They run on kerosene, not petrol, so it’s not particularly inflammable – which is, I find, very reassuring, ‘cause most of the bulk of the thing is fuel – they’re very thirsty. They’re expensive to run because they’re under a lot of pressure. We replaced the tail rotor on the Squirrel – it was ten thousand dollars for a crack in the tail rotor. Makes having a car really quite a pleasure, when you look at the bills that Mike gets for the helicopter.

Helicopters are under a lot of tension. They’ve got the fan at the top – they’re powerful machines. That fan is trying to spin the body around that way, but you want to fly in a straight line, so you’ve got another fan at the back pushing against that. It’s an unstable system.

With the planes … see, the Tomahawk that crashed … if you let go of the controls on that, it’ll wriggle a bit and settle down into a stable flight pattern. It’s quite relaxed and not very stressful. You let go of the controls in the helicopter and it falls over immediately … in about three seconds.

The B-K, the black one, has got … it’s a different construction of rotor head and it tends to stabilise itself. It’s a rather more stable machine if you let go of the controls. But nobody in their right mind … it’s like letting go of the car steering wheel and saying, “oh, where am I going?” No, you see, you don’t do it. But it means that you’re flying a machine that’s under constant tension all the time, and it wears out more quickly.

And, as I said, those wings … the top rotor … they’ll chop through that thickness of wood quite happily. It’s not good for them, we don’t recommend doing it. But that gives you an idea of the complexity. It’s multiple layers of aluminium and carbon fibre and fiberglass, all in a particular aerofoil. Everything about the wretched things is expensive. Then you go and put a radio in them, and they cost $10,000 to work properly. So it’s just never-ending – they’re expensive beasts, but I think part of it is that they’re under so much pressure all the time that they wear out quickly. And we know how quickly they wear out, and unlike our cars where we wait until it breaks down, they get selective … what’s the word? There is a word. They get prophylactic maintenance done on them. You know the hours that each part will last, and you replace it before it breaks down. So … you get an engine replacement … two years ago, wasn’t it? The Squirrel had an engine? Quarter of a million dollars. Quarter of a million. Would you put a new engine in your car? The new engine’s to make sure it doesn’t go wrong. You know, sitting in the thing, I’m very happy that we’ve got that attitude. I rather like that. It is a safety issue. And it’s all been done – there’s no rocket science in this – they know how long the components will last. They replace them before they break, but that comes in as part of the cost.

There is a phenomenon called deferred maintenance, where you don’t carry on with the maintenance of your machine, and sooner or later while you’re doing a tight turn crop-dusting or spraying, something breaks and you became a ball of flame. Bruce Harvey told me, “crash, burn, die”. And because you’ve got that if something goes wrong it’s a good idea to forget about deferred maintenance and do the maintenance. You don’t want to have breakdowns in the thing. And more so for the helicopter, ‘cause you’re close to the ground all the time. You haven’t got time to work out where you’re going to go. You’ve got seconds if something breaks, so helicopter pilots are very special people.

Hope I’ve covered the history side of it. It’s quite nice the way it’s grown and developed and where we’ve got to. Thank you very much. Thank you for letting me share one of my passions with you.

Thank you very much, Forbes.

[Applause]

It was most informative, and I’m sure we all learned lots.