What Canada can learn from established air-medical services—and where advanced aviation could add value next
Several months ago, our daughter suffered a serious injury while skiing in the Austrian Alps. She was airlifted off the mountain by helicopter to a local hospital before undergoing surgery to repair a torn ACL at University Hospital Erlangen in Germany, where she lives. Coincidentally, it was the same specialist hospital where she had undergone ENT surgery a year or two earlier and, more recently, gave birth to our first grandchild.
During those hospital stays and our visits to Erlangen, I found myself intrigued by the regular arrival and departure of Airbus H145 helicopters from the hospital’s rooftop heliport. The flights were frequent, remarkably quiet and seamlessly integrated into the daily operation of a major university medical centre.
As someone who has spent more than three decades working in aviation, it prompted an obvious question:
If Helicopter Emergency Medical Services can be integrated so effectively into healthcare delivery in Germany, why do we not see more of this in Canada—or, closer to home, in the Montréal region?
But that question leads to a more interesting one.
As aviation technology evolves, where else could aviation—whether crewed or uncrewed—improve Transport Medicine and ultimately contribute to better patient outcomes?
HEMS is part of a much bigger picture
Transport Medicine is a specialized branch of emergency and critical care medicine focused on the safe movement, stabilization and continuous medical treatment of patients during transit via ground, rotor-wing or fixed-wing ambulances.
HEMS is therefore not simply an aviation service. The helicopter provides the mobility, but its purpose is medical: getting critically ill or injured patients to appropriate care quickly while maintaining the level of clinical support they require during transport.
University Hospital Erlangen provides a useful illustration.
Its 24-hour rooftop heliport provides direct internal access to emergency, surgical and critical-care services. Patients arriving by helicopter can be transferred rapidly from the aircraft to the receiving clinical team, eliminating a secondary ground transfer.
The helicopter itself is only one part of the equation. Its value comes from what the overall system enables: faster access to appropriate care and, where time is clinically significant, the opportunity for better patient outcomes.
That is the principle worth examining in Canada.
Where does aviation add value?
Canada already has highly capable air-medical services. ORNGE, STARS, Airmedic and provincial providers use helicopters and fixed-wing aircraft to connect patients with healthcare across some of the world’s most challenging geography.
The question is not whether aviation belongs in Canadian Transport Medicine. It clearly does.
The more useful question is whether there are additional situations in which aviation could add sufficient clinical or operational value to justify its use.
Canada and Germany are very different. Population density, geography, healthcare organization, infrastructure and funding make direct comparisons inappropriate. A model that works in Bavaria cannot simply be transplanted to Quebec or elsewhere in Canada.
But the underlying principle travels well.
Aviation becomes particularly valuable when time, distance, geography or access create a barrier between a patient and the care that patient needs.
That is readily apparent in remote and northern Canada, where aircraft may be the only practical means of reaching specialized medical services.
The question deserves consideration in metropolitan and regional healthcare systems as well.
Are there patient transfers in Greater Montréal, for example, where road congestion, distance between facilities or access to highly specialized services creates clinically significant delay? Could aviation improve selected inter-hospital critical-care transfers? Are there regional communities from which faster access to Montréal’s specialist centres could improve outcomes?
These are questions to investigate rather than conclusions to assume.
And they should begin with the medical requirement—not with a preferred aircraft.
Must we always move the patient?
This leads to a broader opportunity.
Traditional Transport Medicine understandably focuses on moving patients. But the healthcare problem is fundamentally one of bringing the patient and the required medical capability together.
Sometimes the patient must move. Major trauma, complex surgery and intensive specialist intervention may require transport to a tertiary medical centre.
But in other circumstances, could we move what the patient needs instead?
Healthcare systems already depend upon the time-sensitive movement of:
- blood and blood products;
- organs for transplantation;
- diagnostic and laboratory specimens;
- pharmaceuticals and medical supplies;
- specialized equipment; and
- medical personnel.
The clinical value of these movements varies considerably, as do payload, distance and urgency.
This is where developments in uncrewed aviation become particularly interesting.
From air ambulance to an aviation toolbox
Helicopters and fixed-wing air ambulances are sophisticated assets designed to transport patients and medical teams safely while providing appropriate care in transit. They will remain indispensable where those capabilities are required.
But not every time-critical healthcare movement requires an aircraft carrying pilots, medical personnel and a patient.
Advanced drone operations could potentially complement existing Transport Medicine systems by moving smaller, high-value medical payloads quickly and directly between healthcare facilities or communities.
A laboratory specimen that reaches a diagnostic facility sooner may enable earlier treatment. Rapid delivery of blood products could support an emergency department or remote clinical team. Moving a time-critical pharmaceutical or medical device by air could sometimes be more efficient than moving a vehicle—and its driver—through congested roads.
This suggests that aviation should increasingly be viewed as a toolbox rather than a particular type of aircraft:
Ground transport → fixed-wing air ambulance → helicopter → uncrewed aircraft → emerging advanced air mobility
Different tools serve different missions.
A drone cannot replace a HEMS helicopter carrying an unstable trauma patient and critical-care team. Conversely, deploying a crewed helicopter to transport a small medical payload may be unnecessary where an uncrewed aircraft can perform the mission safely, reliably and more efficiently.
The value lies in matching the capability to the healthcare requirement.
Advanced Air Mobility: start with the need
The same principle should guide emerging Advanced Air Mobility.
Electric vertical take-off and landing aircraft may eventually provide additional options for medical logistics, movement of healthcare personnel and selected inter-facility patient transport. Their usefulness will depend on certification, operating rules, infrastructure, weather capability, range, payload, reliability and economics.
But healthcare should resist the temptation to begin with the technology and then search for applications.
A successful drone demonstration is not, by itself, a healthcare innovation. Nor will introducing an eVTOL automatically improve Transport Medicine.
The appropriate starting point is the problem:
What needs to move? How urgently? Over what distance? Under what clinical conditions? What level of care is required during transit? And which mode provides the best combination of outcome, safety, reliability and cost?
Only then should the aircraft enter the discussion.
This also provides a more meaningful basis for aviation demonstrations. Rather than proving simply that a drone or new aircraft can fly between two locations, demonstrations should test whether the service improves a measurable healthcare outcome or system requirement.
A layered approach to Transport Medicine
As healthcare becomes more specialized and regionalized, the ability to connect patients and medical resources efficiently becomes increasingly important.
Canada’s geography makes that challenge particularly acute—but also creates an opportunity to think more broadly about how aviation is used.
A regional Transport Medicine strategy could map where time and access most affect care and then determine the appropriate combination of ground and aviation capabilities.
That could include:
- identifying patient and medical-logistics flows where time materially affects clinical outcomes or healthcare delivery;
- measuring current transport times, transfers and constraints;
- determining whether moving the patient or moving the required medical capability provides the better solution;
- matching each requirement to the most appropriate ground, fixed-wing, helicopter or uncrewed option;
- evaluating the complete clinical and economic benefit rather than transport cost alone; and
- testing promising new approaches through carefully designed regional demonstrations.
Such an assessment might conclude that the existing solution is already optimal.
Elsewhere it might support greater use of HEMS, improved hospital access, a different fixed-wing connection or a new inter-facility arrangement.
And increasingly, some missions may present credible opportunities for advanced drone operations and, eventually, other forms of AAM.
Looking beyond the helicopter
My interest in this subject began by watching helicopters arrive and depart from University Hospital Erlangen.
The initial question was simple: why not in Canada?
The answer is unlikely to be that Canada should simply replicate the German model. Our healthcare systems, geography and operating environments are too different for that.
But Germany’s experience demonstrates what aviation can contribute when it is integrated purposefully into Transport Medicine.
The more important question is therefore not whether Canada needs more helicopters—or more drones.
It is whether we are systematically identifying where aviation can help patients receive the care they need sooner, more reliably or more effectively.
Sometimes that will mean moving the patient.
Increasingly, it may also mean moving what the patient needs.
The future opportunity is to use the full range of aviation capabilities—crewed and uncrewed—where they can demonstrably contribute to better healthcare and better patient outcomes.
Continue the Conversation
Leadership, complexity, and navigating change are ongoing conversations rather than fixed conclusions.
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