Cutting emissions – going greener
Robin Gauldie speaks to air ambulance businesses and asks what can be done to reduce the carbon footprint of the industry
More than 10 years ago, a study of ambulance operations in Australia showed that air ambulance operations emitted 200 times more CO₂ than ground ambulance transportation. Since then, ambulance operators have cut emissions from surface transport (for instance, by investing in electric or hybrid vehicles). Medical aviation, though, is only beginning to commit to reducing emissions.
Climate change activists often focus on aviation and are especially hostile to private jet users. Air ambulance operators, although they often use the same aircraft types, face less criticism than private jet companies and their passengers, said Tom Hienckes, Business Development Manager at Luxembourg-based European Air Ambulance.
He noted, though, that the air ambulance industry relies heavily on the private jet sector. “We use the same aircraft, the same maintenance providers, ground handling agents, and even dedicated airports such as Paris-Le Bourget, London’s Biggin Hill, or Farnborough,” Hienckes said.
Many of the personnel in the air ambulance industry, including pilots, mechanics, engineers, and dispatchers, come from the private jet industry, he pointed out. “The entire medical repatriation and assistance industry has a vested interest in the positive evolution of the private jet industry,” he added.
Aircraft manufacturers have made progress. Fuel efficiency has improved by 40–50% over the last three decades
Aircraft manufacturers have made progress. Fuel efficiency has improved by 40–50% over the last three decades, according to manufacturers such as Pratt & Whitney, Safran Helicopter Engines, and Rolls-Royce. Helicopters account for less than 1% of the aviation industry’s CO₂ emissions, according to Airbus, with fuel accounting for 95% of emissions throughout a helicopter’s working life.
The company claims that the latest helicopter engines offer three times more power and a 50% reduction in CO₂ emissions compared with rotorcraft of 50 years ago. Thanks to Safran’s Arrano engines, Airbus’s next-generation H160 burns 15% less fuel than its immediate forerunners, the manufacturer claims.
Meanwhile, all main Leonardo civil helicopters are now certified for operations using a 50/50 blend of sustainable aviation fuel (SAF) and Jet A-1. In 2023, in-service AW139 helicopters carried out flights with blended fuel in Japan, Malaysia, and the United Arab Emirates, while in November, at Leonardo’s facility in Cascina Costa di Samarate, Italy, an AW139 completed the first flight of the type using 100% SAF. It was also the first flight for a Pratt & Whitney PT6 engine using 100% SAF.
The test showed an “outstanding response” to the new fuel, with no significant differences compared with the use of Jet A-1 fuel, according to Leonardo Helicopters’ Managing Director, Gian Piero Cutillo.
“This technology allows more sustainable operations keeping the same level of high performance, significantly contributing to lower CO₂ emissions,” he said. “We’re committed to joining forces with aviation partners and suppliers, authorities, energy leaders and rotorcraft service providers to incentivise the use of SAF to sustain carbon footprint reduction,” Cutillo added.
Helicopter emergency medical services (HEMS) flights, though, are still big carbon emitters. During a typical 50-minute mission, an H135 P2 or AW169 rotorcraft using Jet A-1 fuel will emit around 0.72 tons of CO₂, according to the authors of ‘Green HEMS: how to make it happen’, a report published in 2023
Blue sky thinking?
Proposed ‘clean’ fuels such as ‘green’ hydrogen – the truly zero-carbon version – and ‘blue hydrogen’, produced from natural gas, are in the pipeline. Electrically powered and hybrid gas turbine-electric fixed-wing aircraft, helicopters and drones show long-term promise for the HEMS and medevac sectors, as well as for commercial aviation. By most estimates, though, hydrogen-fuelled or electric-engined aircraft will not be built at scale for at least a decade. Electrically powered aircraft use new materials and technologies and need to be designed from scratch. Battery technology – the key to operational endurance – is lagging, and charging facilities for batteries are not yet widely available. Major challenges for operators hoping to make the shift to hydrogen-engined aircraft include the absence of widespread hydrogen refuelling facilities and infrastructure for transporting hydrogen.
A quicker fix?
Unlike hydrogen and electricity, SAF offers a quick and not-too-dirty answer to mitigating climate impact in the medium term. Fuel makers claim SAF can be used without major modification to existing engines and will be vital to the mitigation of climate impact well into the 2030s. Second-generation sustainable biofuels, offering an 80% reduction in CO₂ emissions, are already here.
Some HEMS operators are already experimenting. In 2021 ADAC Luftrettung first flew an Airbus H145 powered by a blend of biofuel and conventional Jet A-1 fuel made by French company TotalEnergies. Since then, ADAC has initiated research projects in cooperation with Airbus, Safran and Pratt & Whitney at its bases at Cologne Bonn and Aachen airports, according to CEO Frédéric Bruder. ADAC’s goal is to log 1,000 flight hours using SAF in each project, Bruder said.
Another German operator, DRF Luftrettung, has also been looking at the viability of SAF. “In cooperation with the engine manufacturer Safran Helicopter Engines and Airbus Helicopters, we have tested SAF on the Airbus H135 helicopter at our HEMS base in Magdeburg,” said DRF spokesperson Eva Baumann. “With the pilot project, DRF Luftrettung aimed at reducing CO2 emissions and making a contribution to greater sustainability in aviation. The test phase in Magdeburg ended successfully – the use of the SAF had no negative influence on the technology of the H135.”
By most estimates, though, hydrogen-fuelled or electric-engined aircraft will not be built at scale for at least a decade
Price and availability
Operators and engine makers say the biggest obstacles to adoption of sustainable fuels are price and availability. “The limited availability of SAF compared to conventional jet fuel makes it difficult to consistently access SAF, even in Europe,” said Hienckes. “The infrastructure for producing, storing, and distributing SAF is still developing, and SAF still faces regulatory hurdles and certification processes.
This adds complexity and uncertainty in adopting SAF, which is still more expensive than conventional jet fuel due to limited production and higher production costs, and the cost of SAF is still a significant barrier for operators and clients.
“Addressing these obstacles will require collaboration among governments, industry stakeholders, and researchers. Without strong policy support, including subsidies, tax incentives, or mandates for SAF blending, air ambulance operators may be less inclined to switch to SAF,” he added.
SAF costs around 2.5 times as much as conventional aviation fuel, and making it available at every major airport – let alone at smaller facilities often used by medevac operators – is not yet viable, according to fuel manufacturers.
This is another disincentive for smaller, cost-conscious air medical operators, said Baumann. “Because we are a non-profit organisation, the high costs of SAF compared to conventional fuel and the not yet widespread availability in Germany [mean] further use is currently out of the question,” she said.
Volker Lemke, Managing Director of FAI rent-a-jet, agreed: “We are constantly reviewing how we can reduce our carbon emissions and the environmental impact of our business, and that includes the use of SAF. We are in particular looking at how we can use more SAF in the future; however, we see two challenges here. SAF is significantly more expensive than fossil jet fuel. This extra cost would have to be passed on to our customers, which is difficult in the highly competitive ambulance market. Those who uplift large volumes of SAF at an early point in their journey could indeed be at a competitive disadvantage as a result.
Some of our larger customers, such as travel insurance groups, are prepared to pay the higher price to help reduce their carbon footprint, [but] this does not apply to all customer sectors.”
The bigger challenge, Lemke said, is availability. “Typically, the destinations where we pick up and drop off patients are often smaller airports, frequently in regions where SAF is not available nor likely to be in the near future. Until there is more availability, we have no alternative but to use standard jet fuel.”
Air ambulance flights are currently excluded from emissions trading as a way of offsetting their carbon footprint, Lemke added: “As far as we know, there are no plans to change this. However, we believe that offsetting should be done as part of a broader approach alongside other actions to reduce emissions, such as efficient operations, the use of SAF, and improved aircraft technology.”
Could making engines even more efficient be part of the solution (even if only in the short term) – especially if, as makers claim, SAF can be ‘dropped in’ as it becomes more widely available? Less so for air ambulance operators than for commercial airlines, where the savings potential is estimated to be around 25%, said Lemke. “For business jets used in air ambulance services, the savings are likely to remain (optimistically) below 10%. For older air ambulance models, these upgrades are often not available at all or are extremely expensive.”
On the ground
It’s easy to focus on the role of fuel-thirsty engines, as operators concede, and major cuts in emissions may have to wait for innovative technologies that are still some way from becoming universally available and affordable.
In the short to medium term, helicopters especially will continue to be thirsty beasts. Until that changes, some EMS operators are finding it easier to reduce their carbon footprint on the ground.
In the UK, Essex & Herts Air Ambulance Trust (EHAAT) has cut its absolute emissions by more than 20% since 2021, according to Cliff Gale, EHAAT’s Special Projects Adviser.
“As primarily a helicopter operator, there is no getting away from the fact that we are a carbon-hungry operation, especially when it comes to fuel,” he said. “However, we are doing everything we can to help mitigate our environmental impact, reduce our carbon footprint and carry out measures for carbon offsetting, such as planting trees. We are also monitoring closely future innovations, such as the development of sustainable aircraft fuel.”
On the ground, EHAAT made environmental considerations a priority when building its state-of-the-art air base at North Weald, in Essex, installing solar power panels and all-electric climate control. EHAAT has also installed photovoltaic power panels at its Earls Colne air base, also in Essex, and has moved to plug-in hybrid-powered vehicles for its rapid response ground fleet.
Empty legs are often not that well utilised in the market, so there is room for improvement for many operators
In Canada, Blackcomb Helicopters, which operates a range of missions for government and private-sector clients in British Columbia, aims to cut its overall emissions through a range of options on the ground, such as increased use of electric vehicles, and intends to offset all of its CO₂ output in collaboration with the Nature Conservancy of Canada’s Darkwoods forest conservation project. European Air Ambulance, too, is making changes on the ground as part of a four-year plan initiated last year. “Offsetting emissions is a critical component of our environmental, social and governance (ESG) strategy,” said Hienckes. “In addition to offsetting emissions, we are implementing a range of other measures, such as installing solar panels on our hangars to harness renewable energy and reduce our reliance on traditional power sources. Transitioning our car fleet to electric vehicles is another significant step towards reducing our carbon emissions and promoting sustainable transportation practices.”
Flying fewer empty legs makes environmental sense
“In our fixed-wing department, we try to avoid empty leg flights, optimising the planned and flown routes and using the modular principle regarding our medical equipment to minimise the necessity of returning to home base,” said Baumann.
“However, regarding our fixed-wing department, we are somehow limited in our strategic activities by the size of our organisation, with a comparatively small fleet.”
For operators, longer missions may involve unexpected detours – for example, to avoid overflying conflict zones – and efficient routing can be an issue that affects CO₂ emissions as well as fuel costs.
“At FAI, we see efficient routing as an important element in helping to reduce our carbon footprint,” said Lemke. “While we cannot solve geopolitical problems, we believe that every operator should consider the best alternatives and critically analyse new options in the event of new conflicts and the associated detours.
“At FAI, we calculate alternative and efficient solutions on a daily basis, a process that was absolutely essential during the pandemic, for example. Even more important is selecting the most efficient combination of flights, which we believe offers the greatest potential for reducing emissions.”
Hienckes said the geopolitical situation has a significant impact on operations: “Changes occur daily, some on a very short notice,” he commented. “However, the efficient routing of international air ambulance flights is also influenced by numerous other factors, such as air traffic control regulations, weather conditions, fuel prices, airspace congestion, security assessments, and aircraft performance restrictions.” European Air Ambulance’s solution is to use advanced flight-planning software that considers factors including geopolitical conditions, weather forecasts, and aircraft performance, to optimise routing in real time. “Additionally, we invest significant effort in training our dispatchers and keeping them up to date with the latest technologies,” Hienckes said.
The entire medical repatriation and assistance industry has a vested interest in the positive evolution of the private jet industry
Often, as Lemke pointed out, air ambulance flights are carried out as single turnarounds, flying from their home base to pick up the patient, transporting them
to their final destination and then returning to base. “This typically results in active transport legs of only perhaps one third, with smaller combinations of flights at perhaps 40%,” he said. “At FAI we achieve an average combination rate of 2.8 to 3.2 flights, and therefore live legs of around 55–60%. Flying fewer empty legs simply makes a lot more environmental sense.”
“Empty legs are often not that well utilised in the market, so there is room for improvement for many operators,” Lemke added. “This does not require a broker, but rather comes from the operator, who puts together the optimum combination of flights.”
Here, too, smart tech is becoming an important tool, Hienckes said. “By using advanced algorithms and predictive analytics, operators can better match supply
with demand, reducing the need for empty leg flights.”
We don’t yet live in an ideal world where sustainable biofuels, green hydrogen, and battery-powered aircraft and the infrastructure to support them are cheaply and widely available. That will happen, and perhaps sooner than we think. In the meantime, air ambulance operators are finding strategies – on the ground as well as in the air – that they can adopt here and now.