Deutsche Rettungsflugwacht e.V.–German Air Rescue (DRF), headquartered in Stuttgart, Germany, has been specializing in airborne emergency care and medical aid for more than 30 years. Founded by the Björn Steiger Foundation in 1972, DRF has become one of the leading air rescue services in Europe, providing both primary (emergency) and secondary (patient transport) rescue service from 32 bases of operations throughout the continent.

What separates DRF from most other air ambulance businesses is that it functions as a nonprofit organization. What’s more, its considerable size allows a unique organizational standard not commonly found in most companies. Currently, DRF’s fleet consists of three Learjet 35s and one Beech King Air B200, as well as 54 helicopters, all of which are based at 32 air rescue centers in Germany, Austria and Italy. (The fixed-wing aircraft are all based at the Baden Airpark.) The operation employs 180 pilots (22 of them fixed-wing pilots), as well as 80 aircraft technicians, three full-time physicians and 32 paramedics, and has contracts with hundreds of doctors and paramedics.

Coordinating DRF’s vast operations is a specialized central alert center staffed by 13 full-time dispatchers who are medically trained and qualified as paramedics or as EMS flight crewmembers. Frank Spirgatis, director of DRF, said having so many highly qualified dispatchers is essential for handling the volume of air ambulance flights DRF does each year. In fact, DRF carried out 17,637 air rescue operations last year, of which 776 were repatriation flights into 99 different countries. (DRF has logged more than 300,000 operations since 1973.)

A considerable amount of DRF’s work involves repatriating individual citizens from overseas destinations, as well as doing large-scale evacuations in the wake of humanitarian disasters. In particular, the organization was actively involved in relief efforts following last year’s tsunami in Southeast Asia and even positioned a medical crew on-site to coordinate evacuations.

DRF does not currently fly into war zones, such as Iraq and Afghanistan, for security reasons. Patients from those countries are generally evacuated by military aircraft to a safer location, such as Kuwait or Uzbekistan, where they are transferred to a DRF ambulance aircraft.

Security, however, is not the biggest issue facing air ambulance operators, said Spirgatis. “The greatest challenge is convincing responsible organizations, such as insurance companies, of the difference between ‘high-quality’ and ‘low-budget’ providers.” DRF spares no expense to highlight the gulf between the two. For example, each of the organization’s fixed-wing aircraft is dedicated to air ambulance operations in a single-patient configuration with one physician and one paramedic or flight nurse on board all flights. (Many operators of patient transfer flights often provide just one flight nurse.)

In addition, DRF maintains its own medical training organization, and last year it started aircraft simulator training for physicians and paramedics to improve professional skills in a realistic environment. DRF medical staff are now required to do recurrent simulator training sessions–complete with video-based debriefings–one week each year.

Keeping Medical Skills Sharp

Such an intensive commitment goes well beyond the norm for most air ambulance companies, but Spirgatis said this kind of training is necessary to ensure medical crews can deliver the highest medical standard for intensive-care patients in a limited environment. It is worth noting, however, that, unlike most other air ambulance operators providing patient transfer for stabilized non-emergency patients, DRF’s fixed-wing operations have an exceptionally high share of critically ill patients, with approximately 65 percent of patients classified as NACA 4 (possibly life-threatening) or worse and more than 20 percent on ventilation.

As with all air rescue operations, time is of the essence for DRF. Spirgatis said, “Due to the very short reaction time–15 minutes for quoting, two hours for activation–a high organizational standard is mandatory. This includes, but is not limited to, cooperation among all parts of the company, particularly flight ops and crews. Often, flights into remote areas in places such as Africa and Central Asia have to be performed on short notice. This requires experience and personal skills, such as self-management and the ability to lead the crew. While on schedule, pilots need to be ready at any time.”

Spirgatis also noted the psychological challenges of the job, saying, “As a nature of this business, pilots very often do not know where they will spend the next day.”