Rega to the Rescue

A medical emergency is traumatizing no matter where the person is at the time. But especially so when you are in a foreign country and have little knowledge of the healthcare system or your treatment options.

A young friend of mine – I’ll call him Johan - was in the Caucasus Mountains area in the country of Georgia, which borders Russia and Türkiye on the eastern edge of the Black Sea. An environmental engineer by profession, he was working with a non-governmental agency in a cooperative project on behalf of the Swiss government, using geospatial information systems (GIS) to analyze protected-area ecosystems and sustainability.

He started to develop back pain. Which got worse. So he headed for a fitness center to work out and lift some weights. With no coach, “probably completely the wrong way,” he says in retrospect.

As the pain worsened further, he tried a masseuse and a chiropractor. By now he was having difficulty sleeping, even sitting.

In Georgia, painkillers are generally not available, except for mild ibuprofen.

The pain became 24/7, he says, sleeping at best an hour a night, so he went to a hospital, which did an MRI (magnetic resonance imaging) scan.

The Georgian doctor told him he had a herniated disc – and wanted to operate on his spine - immediately! “You could lose the use of your leg.”

“I started to panic,” Johan recalls. Strange country. Shock diagnosis. Possible serious consequences. “No, thanks, you’re not going to open up my back.”

He remembered at that point that he had a card in his wallet for Rega. He called the international number on the card.

After emailing copies of the MRI scan and the doctor’s diagnosis, Rega responded that they would pick him up in Tbilisi. “Now, after 12 years,” Johan admits, “I still get tears of gratefulness.”

A local friend arranged for an ambulance to the airport, so he could keep his back horizontal, where Johan was met by “a huge private jet” (a Challenger 604) “and five people, just for me” – pilot, co-pilot, doctor, nurse, and an assistant. His Georgian friend joked, “You must be a very important person in the Swiss government!”

The aircraft interior was essentially an airborne emergency room, and the nurse gave the patient a strong painkiller, after which he fell asleep for the duration of the 2000-mile direct flight.

When he awoke, he was in the Hôpitaux Universitaires de Genève (HUG), where the Swiss doctors advised against an operation, but rather proper rehab. Today my friend is as active as he was before the injury – skiing and other sports and keeping up with two active young sons.

The ‘kicker,’ Johan says, is that when he got out of the hospital he received a letter – “Thank you for flying with us” - signed by the Rega pilot and co-pilot.

REGA, THE SWISS AIR-AMBULANCE

The cost to Johan was a 30 CHF (about US $33) annual membership fee to Swiss Air-Rescue Rega a not-for-profit air-ambulance membership service in Switzerland to which more than 3.6 million ‘patrons’ belong. (Full disclosure, my wife and I are members.) The patron fee is now 40 CHF annually for adults, free for children under 18.

Membership is restricted to legal residents of Switzerland, population about 9 million, so clearly Rega is a popular choice.

Under certain circumstances, Rega will repatriate you from anywhere in the world so you can return to Switzerland for medical treatment, which rates among the best healthcare in the world. The first option, when you call, is to determine if you can be adequately cared for in a nearby hospital. The next choice would be transport home on a commercial aircraft, perhaps accompanied by a Rega doctor and nurse. But if you’re flat on your back like Johan, as a last resort, they’ll dispatch a jet and appropriate medical team.

The shorthand name ‘Rega’ is from the translation ‘Rescue Guard – Air’ from the German Rettungsflugwacht. The organization was launched in 1952 by medical doctor Rudolf Bucher.

Based at Zurich airport, Rega conducts more than 20,000 rescue missions a year.

The vast majority, as one might expect, about three-quarters, are helicopter missions – staged from 14 bases strategically located around the ski-crazy Alpine nation: including Bern, Lausanne, Geneva, Samedan (Saint Moritz) and a rotary training base in Grenchen (Canton Solothurn).

“We are now renewing our fleet of rescue helicopters,” said spokesperson David Suchet. Rega started taking delivery in December 2024 of the first of 21 Airbus H145 D3 5-blade helicopters, which by 2026 will completely replace their mixed fleet of H145 D2 (4 blades), H145 D3 HB-ZOO and AW109SPs.

Training of pilots is conducted on a full-flight simulator operated by Lufthansa Aviation Training - LAT in Opkifon, Switzerland, which was produced by Reiser Simulation and Training, Berg, Germany. Installed in 2023, the FFS features ‘roll-on/ roll-off’ interchangeable cockpits for the H125, H145 D2, AW169 – and in July 2024 was certified by the European Union Aviation Safety Agency (EASA) for the new H145 D3 model.

Of note, also last July, Rega was granted authorization by the Swiss Federal Office of Civil Aviation (FOCA - Office fédéral de l'aviation civile) to use new Required Navigation Performance Authorization Required – RNP-AR) instrument flight procedures to Interlaken hospital. Suchet: “Rega has a vision to cope with bad weather conditions. Around 600 patients per year are unable to benefit from air rescue because of bad weather conditions, and Rega is working to change this situation. Thanks to low-flight networks, but also thanks to other technologies. And we work with very experienced pilots.” Rega is the first helicopter operator in the world certified for the RNP-AR procedure.

EUROPE’s 1st CHALLENGER 650 FFS

The new jewel in the Rega crown is a full-flight simulator for the Bombardier Challenger 650 business jet. The FFS was produced by AXIS Flight Simulation of Leibring, near Graz in the south of Austria.

Rega ordered three specially designed Challenger 650 aircraft in 2015 to replace its Challenger 604s, which it had operated since 2002. They took delivery of the new fleet in 2018.

The Challenger 650 offers “a unique size with the range versus size versus space inside the cabin. It's nearly unmatched. That's why you see also now many other medical planes using Challenger,” Raphael Jenni told us on a visit to LAT near Zurich airport. He is a Commander and Nominated Person Crew Training Jet for Rega.

The 650 features a cabin height of 6 ft 0 in (1.8m), width of 7 ft 11 in (2.4m), and length of 25 ft 7 in (7.1m), and can handle up to four patient lie-down stretchers. The jet has a range of 6,500 km.

High-thrust engines allow for a shorter take-off distance, and the high-wing design offers a smooth ride for medical patients and crew. A Bombardier Vision flight deck with head-up display (HUD) and enhanced vision system (EVS) reduces pilot workload.

However, the training regimen, until recently, included an onerous twice-a-year travel for each of Rega’s 28 pilots to North America. Simulators for the Challenger 650 are located at CAE facilities in Montréal, Canada and Dallas, USA, as well as at FlightSafety International’s Columbus, Ohio learning center. In addition to the transatlantic flight and accommodation costs twice a year, Rega crews in training were far away from their base and less available for emergency missions.

Rega contemplated installing their own simulator in Zurich and calculated that the reduction in training travel costs over a period of time would be roughly equal to the price of purchasing an FFS (about 13 million CHF, 14.37M US).

One problem: CAE owned the flight aerodynamics data rights needed to produce a 650 sim that met EASA regulatory specifications. “Since the Bombardier Aircraft Training Center was sold to CAE the intellectual property rights uniquely for that flight package were at CAE,” notes Jenni. Neither CAE nor FSI was interested in building a 650 device for Switzerland, and CAE’s offer price for the data package was “not manageable” within Rega’s budget.

Helping support the CL650 FFS purchase was Lufthansa, which built a new 11,000-square-meter training facility at the Zurich airport about five years ago.

The solution evolved to AXIS, which has the capability to develop its own aero models for the 650. They also offered a roll-on/ roll-off design which could accommodate additional aircraft models using the same core FFS motion and visual systems.

AXIS Flight Simulation was started 20 years ago by Martin Rossmann (now retired), and has focused largely on ATR prop-driven regional aircraft. Ignoring the traditional start-small philosophy of manufacturing, they launched immediately into full-motion Level D simulators. In 2017, Christian Theuermann arrived as chief financial and commercial officer (now sharing Executive Management with ExecuJet founder Niall Olver), and AXIS increased capacity to 2-3 simulators per year with more than 100 employees.

In 2023, they established Aeroset to conduct their own flight testing and data collection. The flight test campaign for the CL650 included aircraft procurement, parameter specification, test point generation, and data post-processing with flight test campaigns performed in Europe in 2022 and 2023.

AXIS has also delivered a CL350 Level D FFS for Aviation Academy Austria, another first for the EU mainland. And they are developing a Beechcraft King Air C90GTx sim for the National Institute for Aerospace Research (INCAS) research facility in Strejnicu, Romania. INCAS’ work contributes to EU policymaking under the FlightPath 2050 vision and Horizon Europe programme. The King Air FFS features an XT6 visual system from RSi and a VanHalteren motion system. Other types AXIS has delivered include Fokker 70/100, Cessna Citation XLS and XLS and Citation CJ1+ sims.

A SIM OF THEIR OWN

Rega’s Jenni says, “With our own instructors, our own simulator, we can tailor our training to the pilots and the operation. We are now able to really train our pilots more into competency-based training and assessment (CBTA). And we are able to train our pilots as well more on specific airports.

“We are now doing our training with all Rega instructors and examiners. Before we shared instructors and examiners. Now we have all Rega-based. And through that, we can be even closer to our philosophy.”

“It is difficult if you have foreign instructors and examiners for your crew,” he explains, “because of the sheer distance you have to Canada and the cultural difference. We always standardize them, but it's difficult to get it together.

“Combined with the difficulty we had during Covid basically gave us the reasoning to evaluate the possibility to have our own simulator. With AXIS we had a unique partner which allowed us to do this in a cost which is manageable and compared to the costs we had before.”

Jenni continues: “We profit for our pilots, for our training and for our operation. Also to test certain procedures, new procedures from our ops team. We can do much more than before and increase our flight safety.

“With our own simulator they can sign up for a free individual training, whatever they would like to experience. So there are many small elements which allow us to increase flight safety directly through this unique setting, which we have here with the geographical location.

“We also track the data similar to EBT (evidence-based training). But we balance the effort for the statistical part because with 28 pilots we don't have enough data to really go full EBT. We are aware of that. We can't go fully statistical. We are still trying to analyze this competency-based data and include it in the recurrent training.

“Through the partnership with Lufthansa Aviation Training, we have the same visual system as they use in Munich or Frankfurt (Rockwell Collins EP-8100, but upgrading as the first EP-8200 customer, according to LAT). We were able to take over quite a lot of their detailed airports, and together with what we invested now for our own simulator, we come to 87 detailed modeled airports, which is a huge number compared to other business jet simulators.

“There is also a separate additional model for the EVS. It is limited, but it's about training the procedure. To have a few airports to train the procedure, that's sufficient.”

MISSION PARAMETERS and TEAM PREP

The missions are as varied as you might expect for retrieving people who are injured or fall ill.

Jenni calls it “a cascade of possibilities. Maybe you are in an emergency response center in whatever country. We have a database of doctors, a database of all major hospitals. And they also know about quality levels of hospitals, so the doctor may recommend you go to another clinic if you are able to go by yourself. Or maybe organise for you a transfer to another clinic.

“A second possibility would be that you would be arranged to go back on a line flight, maybe with a nurse from Rega, maybe with a nurse and a doctor. And if the condition is even worse than that, the last resort which you would employ then is the jet, which we would then send to get you back home.”

The minimum crew complement is two pilots, a doctor and a nurse. “If we have two patients which require additional surveillance or additional work, we can have 3 or 4 pilots, depending on the length of the mission,” Jenni explains. “With three pilots, we obviously can have a much longer duty period; for example, a mission today leaving to Phuket, Thailand – for this mission there will be three pilots.

“If you have to do a landing because we pick up another patient or need more ground time, it could be that we need a fourth pilot, and with four pilots we can manage to go to New Zealand.”

Because of the on-call nature of the rescue/ medical missions, pilots are always on standby: “We have a reporting time of 1 or 2 hours on call.”

“In most cases,” Jenni says, “I would get an SMS the day before for a mission for the next day. That's the normal case when it's well planned, if it's not immediately necessary to fly. If it's an emergency, if it's more urgent, I would get a phone call and they'd tell me, you're going there, check in two hours, and that's your crew. And then I would go to the Rega center at Zurich Airport, and we first have a 30-minute pilot's briefing. From dispatch, we get all the flying documentation, and the pilots do the whole briefing on the flight. Then we join together with Mission Control and the medical team for a briefing of the whole mission. And then we go to the aircraft and prepare the aircraft for departure. The medical team prepares all the medical equipment to take with them. Depending on whatever is required for this specific patient or the specific patients. And then we go.

“We do all the emergency and safety training together... the ground emergency training for flight attendants. We do have equation training, smoke training, fire drills, ditching –all the emergency training we do together with the medical team.

“We have multiple different floor plans. We can take an ICU (intensive care unit) out and put a cargo plate in, or we can take a seat out and put an installation in for the ECMO (Extracorporeal membrane oxygenation) transport.”

A patient isolation unit –invented during the time of the Ebola disease outbreak - allows Rega to isolate highly infectious patients from the rest of the cabin crew. A new version has a filter for both sides. “Before we had only to protect the people outside the bag from the person inside the bag. And now we protect both sides. So if you have someone with immune illness, then he is not endangered by us being close to him,” Jenni notes. “The main driver of this patient isolation unit was our chief doctor of Rega, Roland Albrecht.”

“The larger changes of the cabin are done by our maintenance team,” Jenni adds. The in-house engineering team is certified by EASA.

“Our CG of the aircraft compared to the business jet is more aft, but it's still obviously within limits; it's more aft because the business jet has the galley in front, and the galley weight is so much in front that our crew rest doesn't have the same weight.

“If you go empty – for example, we bring a catastrophe team for disaster assistance - sometimes we would bring them on site. The first batch of people with dogs and so on. And then we would go with all the equipment, but we would fly back empty. And on the flight back our CG moves even further aft. So we would have to put some sandbags in front.

“All our pilots have to be capable to fly anywhere. So all the pilots have the same qualifications.”

There is strong loyalty to the Rega brand among the pilot cadre. It is not uncommon, notes Jenni, for their pilots to have careers of 25-30 years with the company. “They need more than 2,000 hours of training to join Rega. So they are very experienced and they usually come from commercial helicopter companies or from the army.” The first Swiss woman to hold a jet license and the first female flight instructor, Ursula Bühler Hedinger, flew for Rega for a quarter century.

NEED SOME CL650 FFS TIME IN EUROPE?

Although the Challenger 650 fleet numbers are small in Europe, the Middle East and Africa compared to North America, Lufthansa Aviation Training is marketing the excess simulator capacity of the Rega device – in effect, competing with CAE and FSI.

Because of the roll-on/ roll-off design, a second business jet cockpit is planned as well (though the aircraft type is not yet decided).

“The idea is to expand that further into the business aviation sector, maybe on the same type. But it could also be other aircraft types and other simulators that we want to place,” says Stefan Kaufmann, LAT Deputy Head of Pilot Training

“During Covid times, we discovered that the business aviation sector was giving us a lot of return, whereas the airlines were more or less grounded. But the business aviation sector was booming. So we want to tap into this market more. However, Lufthansa is still a passenger airline and that remains the focus. The group’s requirements have to be satisfied first, but whatever we can do outside the group we're very interested to push ahead.”

In November 2024, LAT became the first EASA-certified Approved Training Organization (ATO).

“We’re partnering with the German ATO to form the ATO in Europe, governed by EASA,” Kaufman explains. “And that project is a top priority. The training syllabus for this type (Challenger 650) will be the first one that we will apply under the new EASA ATO. We already have one that is certified by the Swiss authority.”

“We don't really know yet how EASA will process those applications and how fast they are,” he adds. “They might delegate it to local authorities. They might do some part themselves. They announced just recently that they want to reorganize, because I don't think it will remain the only ATO that wants to get approved as an EASA ATO.”

“Of course for us, one big benefit is that we can employ instructors under one organization, whereas at the moment we have them listed in different ATOs. So just from an HR point of view, it will be much easier to manage the instructor group and to facilitate the exchange between the different training locations.”

THE AUTHOR

Rick Adams, FRAeS, is a 40-year veteran of aviation training communications. He leads the annual Pilot Training Conference at Halldale’s World Aviation Training Summit (WATS) and writes regularly for CAT. Adams recently authored the 1st book on Artificial Intelligence in Aviation Training: The Robot in the Simulator.