The NSW Government is creating a new Health Retrieval ... · Aeromedical Transport system Structure of ConOps –Health System Context –Operating Environment –Current Helicopter

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The NSW Government is creating a new

Health Retrieval Network to deliver high

quality clinical care faster and safer than

ever before.

8 November 2013

NSW Health Retrieval Network: Helicopter Tender

Industry Briefing

Presented by Paul Davies

Deputy Director Commercial and Procurement

Business & Asset Services

NSW Ministry of Health

Introduction and Process

Faster, safer, more transparent

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Agenda for today’s industry session

Available throughout the afternoon

- Procurement team member available for Q&A

- Probity advisors present

- All Q&As will be recorded and shared on the dataroom

Auditorium – Room 6a Break Out Room – Room 5c

9am Registrations Open

Networking/Consortia Forming

9:30am Introduction and Process Paul Davies

9:45am Probity Warwick Smith

10am Service Specifications Ron Manning

11am Coffee & Tea

11:30am Commercial criteria and Contracting

environment/conditions Luke Houghton

1pm Lunch

2pm SouthCare David Foot

2:30pm NETS Dr Andrew Berry

3pm Risk & Safety Kimberly Turner

3:30pm Q&A and Close Networking/Consortia Forming

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Reform Plan for Aeromedical (Rotary Wing) Retrieval Services in

NSW following a Strategic Review of the Ambulance Service

Two-part Review:

– operational effectiveness, financing and organisational structure and

governance of NSW Ambulance

– review of Aeromedical (Rotary Wing) Retrieval Services

The Reform Plan for Aeromedical (Rotary Wing) Retrieval Services in NSW is available on the

NSW Health website:

http://www.health.nsw.gov.au/about/nswhealth/Publications/helicopter-reform-plan.pdf

Note that this procurement process forms part of the overall reform process being undertaken

as part of the Reform Plan for NSW Ambulance. This document is available on the NSW

Health website

http://www.health.nsw.gov.au/about/nswhealth/Documents/asnsw-reform-plan.pdf












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The Rotary Wing Aeromedical Emergency Retrieval Services are

set to undergo a reform and procurement process

Features of the new networked service include:

Patients to have faster care with reduced retrieval times

Having staff on base means take-off to 15 to 30 minutes quicker

More retrieval doctors (11.5 FTE)

More retrieval paramedics (18 FTE)

Regional health strengthened – retrieval to new and upgraded facilities

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Northern and Southern NSW Super Regions

“The Procurement Process will encourage collaboration, sharing and possible joint

venturing or consortia approaches by not for profit and commercial operators to promote diversity and the retention of a mixed NGO

and commercial NSW fleet.”

Reform Plan for Aeromedical (Rotary Wing) Retrieval Services released in July 2013

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The process and the project will be managed by Ministry of Health

with support from NSW Ambulance

Ministry of

Health

Contracting

Entity

NSW

Ambulance

The contract will be entered into by the Health

Administration Corporation (HAC) and managed by

NSW Ambulance and Deloitte.

This process is being managed by the Ministry of

Health and supported by NSW Ambulance

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Deloitte has been appointed as advisors to assist the Ministry of

Health and NSW Ambulance in the procurement process

Role of Deloitte

• Assisting Ministry of Health and NSW Ambulance to reach a decision on the procurement process

• Defining the procurement strategy

• Developing the funding model

• Drafting RFT and contract documentation

• Assisting with the evaluation

Role of Ministry of Health and NSW Ambulance

• Informing the bidders of requirements

• Negotiating contracted outcome

• Ongoing project management

• Ensuring fairness and transparency is maintained throughout the process

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Project schedule

Milestone When

Industry briefing and workshops November 2013

RFT Release

- Potential Respondents will be asked to confirm intention to tender

December 2013

Respondent’s briefing and base inspection TBD

Interactive tendering workshops Late January 2014

RFT closes End of March 2014

Contracts signed December 2014

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After the release of the tender documents, further liaison with

bidders will take place

Questions and

answers

during the

RFT process

• The question and answer (Q&A) process will be managed through an online

dataroom

• Q&As submitted by bidders will be public (unless confidentiality is requested). No

details of bidders will be published

• The format will be similar to below:

Users can submit

questions to the data

room

Previous

questions

and answers

submitted

can also be

viewed

Users can nominate any

documents within the Bidder

Information folder that are

associated with the question

Documents can be downloaded by bidders from the dataroom. Security measures may be

applied to these documents.

Presented by Warwick Smith

ProcureGroup

Probity


Probity

Ministry of Health probity objective

Role of the Probity adviser – Procure Group

ICAC probity fundamentals

Our involvement

Resolution of probity issues

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RFT period

Interactions between interested parties

Expected and encouraged

Confidentiality management

No collusive practices

Communication with Government

Consistent access to information and personnel

Contact officer – Paul Davies (via

[email protected] email address

until RFT opens)

Do not contact other persons within NSW Government.

Interactive workshops

Data room opens post issue of RFT

mailto:[email protected]

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Today

Questions

End of presentations unless specifically requested

Some questions may be taken on notice

Reliance

Purpose of today is to provide information

Information that is to be relied upon must be confirmed in

writing

Request for Proposal document can be relied upon

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Contact details

Warwick Smith

Director : Procure Group

Phone: 0416 107 378

Email: [email protected]

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Questions – until 10am

Prepared by Dr Ron Manning

Executive Director, Health Emergency and Aeromedical Services

NSW Ambulance

Service specifications


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Objectives

High quality service that ensures equitable access to critical care across NSW

Operational availability and flexibility is our key priority – if the aircraft is not available,

treatment is delayed and which has a direct impact on the patient outcome

Safe operations: a strong and visible approach to risk and safety management

Just culture with open reporting and joint investigation of any and all incidents

Culture of collaboration and partnership at every level - from the people on the base

through to the Chief Executives

Long term relationship, consistent change management processes during the life of the

contract

Consistent service delivery

Aviation providers who understand and support our responsibilities as an emergency

medical service provider for NSW

Culture of excellence: clinical excellence and aviation excellence

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Development Process

Aeromedical Reform plan

Consultation with clinicians and contractors

Concept of Operations

Service Specifications

– Range

– Payload

– Performance


ConOps describes the NSW Medical Retrieval and

Aeromedical Transport system

Structure of ConOps

– Health System Context

– Operating Environment

– Current Helicopter Network

– Mission types and task profiles

– Operational Profiles by Base

Performance or Outcome based capability definition

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Medical Retrieval System

– Integrated system of road ambulances, helicopters, fixed

wing aircraft and clinical teams

– Choice of vehicle is based on clinical urgency

– Patient destination is driven by the Critical Care

Networks and Major Trauma Referral Networks

– State-wide clinical coordination, support & advice for

critically ill patients

– State-wide tasking service for aeromedical and medical

retrieval resources

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Task Profiles describe task types and overlay (or risk)

conditions

Base profiles describe the operational model, health

system relationships and context, and the tasking profile for

each base

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Range

Aircraft need sufficient range to ensure that:

– Area serviced by each base can be covered (usual

tasking profiles are described in the ConOps)

– Coverage of regional and remote NSW is optimised

– Capability for a trauma service flight from base, to scene,

to Sydney, Canberra, Newcastle, or Brisbane

– Weather and the absence of navigation alternates is not

limiting service and coverage

– Approximately 350nm round trip

Payload

Standard crew

• Adult pre-hospital or retrieval: 1 x pilot, 1 x

Aircrewman, 1 x Doctor, 1 x Paramedic

(400kg)

• + 1 x rescue crewman or + 1 x doctor or + 1 x

paramedic (+100 kg); OR

• NETS: 2 x pilot, 3 x medical crew (500 kg)

Removable medical and rescue equipment = 240kg

• includes rescue stretcher, survival equipment,

patient stretcher and turntable, supplemental

“Simula” seating, water rescue equipment, fuel

pump and hose, cargo net, books and charts

Medical equipment = 79.26kg

• Includes bridge, monitoring/ventilation

equipment, packs, Lifepak 15

Patient combinations include:

• One stretcher patient

• Two stretcher patients

• NETS transport unit(s) (160 kg)

• Stretcher patient, ECMO technician, ECMO

machine (15kg)

• Stretcher patient, Intra-Aortic Balloon Pump

(50kg)

• Megalift stretcher and bariatric patient (up to

180kg)

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Performance Class

Certified for Category A elevated HLS, ground level confined area HLS and clear

area/reject area procedures, and when the payload allows

Category A procedures to be applied and Performance Class 1 if available at the relevant

HLS

If PC1 is not possible, Performance Class 2 is to be applied if suitable forced landing

areas are available

Minimum performance requirement is the application of Performance Class 2 with

exposure

Our objective is that when operating to and from high density hospital facilities where a

forced landing or “exposure” would have an unacceptable community and infrastructure

impact, aircraft are operating to Category A/Performance Class 1 as often as possible

CASA Notice of Proposed Rule Making

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Capability

Twin engine

Two pilot IFR equipped, single pilot IFR (SPIFR) certified with a four axis autopilot

preferably with enhanced hover and SAR modes

Night Vision operations

Hoist capability (fixed hoists at winch bases)

Cabin storage for lightweight medical and rescue equipment

Offshore capability

Cabin able to accommodate 2 stretcher patients and 3 medical crew plus equipment, 4

seated crew when stretchers not in use

Cabin structure able to accommodate Megalift stretcher, NETS cots, IABP

Attachment points for stretchers, NETS cots, IABP, ECMO and MegaLift stretcher

Medical oxygen, medical air, nitric oxide and suction systems

Electrical outlets, oxygen/medical air outlets, IV hooks positioned near stretcher patients

and within easy seated access of medical attendants

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Interoperability

One Air Operators Certificate per region, one operations manual

Standardised fleet, two types of helicopters for the State

– Identical configuration (EMS fit-out compatible with NETS and adult retrievals)

– Able to accept a winch (but hoists only installed on nominated aircraft)

– Stretchers and NETS interoperable with road and fixed wing aircraft

Goals

– Pilots, aircrewman are able to move seamlessly between aircraft in a region

– Clinical crew and equipment are able to move seamlessly between aircraft in the fleet

– Maintenance, training and back up arrangements managed across the network

– Improved safety

– Improved availability and efficiency

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Availability

Aircraft support the Critical Care Referral Network and the Trauma Plan

97% availability

– Northern Region: aircraft at Newcastle, Lismore and Tamworth

– Southern Region: aircraft at NETS (Westmead), Canberra, Orange, Wollongong and

Sydney (x2)

When tasked, an aircraft with the right equipment and the right crew is available to

immediately respond (eg if IFR is required and the aircraft is non IFR, the aircraft is not

available)

Robust system of training, back up aircraft and maintenance management to support

availability

Response times – time from tasking to as quickly and as safety as possible (KPIs)

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Fit Out

EMS and rescue equipped

Capable of undertaking the tasks described in the Concept of Operations

Interoperable across bases, users and tasks

Developed with the users to incorporate current equipment specifications

NVG operations capable

Air conditioned

Safety features

Template aircraft concept

Final approval of fit out and any equipment by NSW Ambulance, ACT Ambulance and

NETS

Detailed requirements in the tender document

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EMS Requirements

Enough area for two stretcher patients and seated medical crew

Medical crew have easy visual and physical access to the patient, monitor, ventilator,

infusion pumps, gauges etc from a seated position

Medical crew able to access the head of a patient with sufficient space to be able to

manage a patient’s airway

Stretchers, bridges, mega-lift stretcher

Integrated oxygen, medical air, power and suction with outlets accessible throughout the

cabin to support medical treatment, medical crew able to see gauges and operate

medical services and equipment while seated

Clean configuration with storage in shelves and cupboards (able to be opened and closed

with one hand)

Lights, power outlets, rails, hooks, switches to be recessed to reduce risk of head strike

or finger catch

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Aircraft

2007 or later, < 4000 hours

Newcastle 1100, Bankstown 1600, others 350 to 850 hours.

Aircraft must be capable of:

– Slope landings up to 10 degree

– Landing in snow

– Extreme weather

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Optional Extras

Snow Kit for SouthCare/Canberra helicopter.

– cost

– operational limitations

– additional maintenance requirements

– time for installation and removal

De-icing

– cost

– operational limitations

– additional maintenance requirements

– time for installation and removal

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Training

Training must not be at the expense of operational availability

Same training, same standard across an operating region

Contractor provides:

– Helicopter operational and safety training for doctors, paramedics and nurses (including HUET)

– Crew Resource Management Training: must include clinical and aviation crew

– Orientation flights for pilots and crewman

– Training to maintain currencies for pilots and crewman, and clinical staff

Tender documents to provide:

– Number of doctors and paramedics at each base (noting rotation of registrars)

– Training requirements and expectations around currencies

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Training

Opportunity for innovation

Training concept and training management plan should include:

– Number of trainers, qualifications of trainers

– Training schedule and currencies

– Where the training will take place (is there a training base within the region?

– How training will be conducted

– Syllabus and skill sheets

– Static training devices

– Training requires dedicated aircraft for periods between 1 to 8 hours (usually 4 hours)

– Estimate of training hours: 550 hours for ongoing currencies per annum

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Maintenance

Class A Maintenance in accordance with the requirements of the OEM

Subject to inspections and audit during the contract

Robust system of back ups, supported by spare parts and maintenance planning

Maintenance:

• Must support and not compromise operational availability

• Must be planned and actively managed

• Should take place in periods of low activity (weeknights)

• Not be scheduled for periods of high activity (weekends and public holidays)

• Unplanned maintenance and aircraft unavailability must be immediately notified to the AOC

• Light maintenance facilities on base

• Heavy maintenance – contractor preference

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Tasking

Exclusive use by NSW Ambulance, all tasking by AOC

AOC provides a statewide tasking service

AOC will task for AMSA, search and rescue and requests for aircraft from Police or any

other agency

Aircraft will be tasked on a network basis within a region, and across the State

No exclusivity over a region: where required aircraft will be tasked into the other region to

provide coverage

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Air Crew

Current model for adult pre-hospital and inter-hospital retrievals is pilot and air crewman

with a doctor and a paramedic

Paramedic trained in the rescue crewman role at Sydney and Canberra – winch and

water rescue trained

Two pilots currently used for aircraft at the NETS base

Other options:

Given no winch at Orange and Tamworth – opportunity for two pilots

Two pilots and specialist Crewman for water rescues (Newcastle & Lismore model)

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Bases

Operated by the contractor as the contractor’s facility

Must support the operating model for that base in the concept of operations

Sufficient size to keep aircraft at the base under cover

Under cover parking and access for road retrieval vehicles

Rest areas (includes day rest and sleeping quarters) for air and medical crew

Sufficient space for maintenance and spare parts (stored in appropriate conditions)

Sufficient storage for medical and rescue equipment

Reject area of 400m

Joint operations and planning room for clinical and aviation crew

Culture of mutual respect, joint purpose and collaboration between the crews

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Pilots, Aircrewmen and Engineers

Through out the contract duration pilots, air crewman and LAME must meet minimum

experience and qualification requirements

To be approved by NSW Ambulance

Management team to be approved by NSW Ambulance

Rostering

– Rosters of pilots and aircrewman should align with the rosters for medical crew, where

possible.

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Safety and IRSMS

Sound and video recording to be installed

SMS and IRSMS required which align with NSW Ambulance systems

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Reporting

Daily and monthly operational reporting requirements

Regular reporting on maintenance and training

KPI regime

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Livery

High vis markings

Open for negotiation

Must acknowledge role of NSW Government and NSW Ambulance

SouthCare livery to be retained

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Questions – until 11am

Tea & Coffee will be served in Bay 4 North

Turn right outside room,

follow to end then turn left and

head down the stairs

Tea & Coffee

Presented by Luke Houghton

Deloitte

Commercial criteria and

Contracting environment/conditions


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Northern and Southern NSW Super Regions

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Government is seeking a contact with a single entity for

each of the regions

Ministry of

Health

Contractor

(Corporate/ NGO)

Sub-Contractor

(Corporate/ NGO)

Funding

For all aspects of

operation and ownership

Sub-Contractor

(Corporate/ NGO)

Sub-Contractor

(Corporate/ NGO)

Contract payments for:

• Operating costs

• Maintenance

• Capital costs

• Financing costs

The recommended contracting structure adopted for the project, subject to value for money considerations, is a single

contract between Government and a contractor (e.g. a corporate entity or an NGO, backed by a provider of finance) for each

region, supported by sub-contracts between the corporate party (or NGO) and (other) NGOs or commercial parties.

Government has a preference for continued NGO involvement and associated community participation.

It would be expected that the primary

contractor would be responsible for the

provision of:

• Aircraft

• Air Operators Certificate;

• Undertaking tasked missions

• Training of aviation and clinical crew

(for aviation aspects)

• Procedures/ Manuals

• Insurances

• Maintenance

• Pilots, crewman and engineering staff

and

• Bases.

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Analysis of Financial Risk during RFT

Evaluation

The RFT Evaluation Plan will require detailed analysis and assessment of the financial viability of the bidding

entities. Such assessment will cover the following aspects:

Review of historical financial data (income statement, balance sheet and cash flow) for each bidding entity

including:

– Assets, Liabilities (e.g. debt and bond facilities); Guarantees outstanding; Gearing; Banking covenants;

Earnings; Profitability; and Credit rating

Discussion on recent or planned changes in corporate structure, ownership and acquisitions or divestments that

are known;

Capacity to meet contractual requirements including: (subject to further review and advice by no later than

RFT issue)

– Parent company guarantee, Proof of initial capital for equity subscription; and Bank Guarantee (Security

bond).

Review of the bidding entity’s financial model for financial viability of the bidding entity's offer including sensitivity

testing around key cost drivers.

Analysis of consortium structure and history and overview of Consortium members (if applicable);

All bidding entities (including NGOs) will be subject to being assessed against these criteria (amongst others

including technical, contractual and value for money requirements) with preferred tenderers being ranked in order

of their assessed levels of financial risk.

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Other evaluation criteria seek to address the Respondent’s

experience, internal operations, compliance with the service

specification and commercial conditions, and its financial offer

Risk and safety management

Understanding of the task

Operational capability and experience

Maintenance capability and experience

Management and organisational structure

Approach to efficient operations

Approach to staff management and improvement

Approach to Community Support

Approach to transition of operations at contract commencement

Financial offer

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Government has defined key contractual parameters which it is

seeking to fulfil through award of the tenders

Payment terms – payment mechanism, treatment of fundraising, KPIs,

abatements and cure regime, contract variations, SIRF

Aircraft requirements – specifications, livery

Operational constraints – exclusive/other use of aircraft, CASA

requirements, maintenance, reporting, training

Contractual conditions – term, rollover, transition provisions, handover

provisions, insurance

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These are defined in more detail…

Parameter Description

Abatements An abatement regime will be developed in conjunction with the Key Performance Indicator (KPI) regime as part of the RFT documentation

Aircraft specification

Respondents are required to provide aircraft that meet the service specification. The Reform Plan states that the fleet will be standardised to two aircraft types.

Asset ownership All assets are to be owned/provided by the Respondents.

Basis for Payment Similar to the current contract structure, the payments will be based on standing charges, hourly flying charges and the performance framework

CASA Requirements

Respondents are required to meet CASA regulations, including proposed changes to the category in which ambulance functions are provided. The service specification will, in line with current requirements, set standards for aeromedical providers which align closely with those required for the proposed Air Transport category.

Contract Area Two distinct contract regions – North and South. It is Government’s intention to secure two different Contractors for the two regions subject to value for money considerations.

Contract Term 10 Years. An option to extend the term by 5 years at the absolute discretion of the Ministry of Health for Contractors who have met certain performance hurdles may be included in the contract.

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Cure Regime A graduated cure regime and step in rights will developed as part of the RFT documentation

Exclusive Use Aircraft are provided for the exclusive use and tasking by NSW Ambulance.

Fundraising Government has a preference for continued NGO involvement, community participation and associated fundraising to support the delivery of the services.

Handover provisions

Provisions for transfer to a successor Contractor for all assets that are critical to the provision of the services (e.g. aircraft, bases) at end of the contract term at pre-determined values will be included in the contract .

Insurances Respondents will be required to provide the applicable insurances.

KPIs A KPI regime will be developed as part of the RFT process and may include abatement, a service improvement fund and a graduated cure regime.


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Livery The Contractor is responsible for painting the Aircraft in the scheme approved by NSW Ambulance including the logos and signage prior to commencement of Contract.

All insignia, other than the Aircraft registration, will be subject to approval by NSW Ambulance. The Contractor must ensure that the signage and logos do not contravene any aviation or other law or constitute a safety hazard.

Consideration will be given to local customisation to preserve regional identity.

Maintenance Maintenance costs will be borne by the Contractor.

No Net Gain or Net Loss Threshold

A no net gain or net loss provision will be developed to provide a basis to assess the financial impact of a contract variation or change event and determine the adjustments to payments required. The no net gain or net loss provision will include a threshold set at an appropriate level (in terms of the net present value of the financial impact over the remaining term of the contract) below which no payment adjustments will be made.

Reporting Reporting will be a key KPI for Contractors and will be linked to a financial performance measure.


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SouthCare A subcontract with SouthCare in the South Region will be a mandatory requirement for a complying response. As SouthCare is a Government to Government relationship it will be treated differently to other existing service providers. SouthCare will provide a “term sheet” to be included in the RFT outlining the costs and services they will be providing to the Contractor which will not be negotiable.

Training Facilities Training facilities will be developed as part of the requirements

Training Procedures

The Respondents will need to develop a training management plan for aviation staff as well as for medical staff. The objective of the training management plan will be to ensure that pilots and crewman not only maintain a high level of currency and competence, but that team based training includes medical staff, particularly crew resource management and scenario training.

Transition in The Respondents will develop a transition plan as part of the RFT response and develop a transition plan designed to minimise the risk of service disruption.

Transition out Transition out provisions at the end of the contract term will be detailed in the contractual documentation for the RFT.


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Respondents are required to provide base solutions

Base Ownership Comments on accessibility and alternatives

Sydney Bankstown Airport Corporation

A new base will need to be developed by the Respondents for Sydney. Respondents considering

Bankstown Airport as a location for a base development should direct inquiries to Bankstown Airport

management. Respondents are also invited to propose alternative suitable solutions for another

Sydney base location.

Wollongong Shellharbour City Council

The base at Illawarra Regional Airport is leased to the current contractor.

Orange Orange City Council

The land and facilities are owned by Orange City Council and are leased to the current contractor.

Westmead (NETS)

Western Sydney LHD

The base is located with NETS at Westmead Hospital. The hangar is co-located with an elevated helicopter landing site (HLS).

ACT ACT Government The base is leased to the current contractor. Respondents should direct inquiries to the ACT Directorate of Justice & Community Safety.

Newcastle Newcastle City Council

The base is located at Broadmeadow on land owned by Newcastle City Council which is leased to the

current contractor. All structures on the site are owned by the contractor, Hunter Region SLSA

Helicopter Rescue Service.

Tamworth Tamworth City Council

The base is located at Tamworth Airport and is owned by Tamworth Regional Council and leased to the current contractor. Assets are owned by Hunter Westpac Helicopter Service.

Lismore Lismore City Council

The current base is located at Brunswick Street, Lismore and is owned by the current contractor,

Northern Region SLSA Helicopter Rescue Service. .

1. In some instances existing bases may be available to Respondents

2. Contractors should consider negotiation with existing occupiers in the fist instance

except for Bankstown

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Questions – until 1pm

Available from the following locations:

. Bites Café in Bay 8

. FunkyChino in National Innovation Centre

. Café Del Santos in Biomedical Building

. Sette in Media City

Lunch

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Afternoon Session 2 - 4pm

Presentations from:

2.00pm SouthCare

2.30pm NETS

3.00pm Risk & Safety

Followed by

3.30pm Open Q&A Session, further networking


Presented by David Foot ASM

Chief Officer ACT Ambulance Service

Secretary / Director ACT & South East NSW Aero-medical Service

SouthCare Rescue

Helicopter


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SouthCare

Operating Company /Fund Structure

Contractual Arrangements

Operational Profile

– Missions

– Search and Rescue Arrangements

– Medical and Paramedical Staffing

– Symonston Helicopter Base

– Community Profile

– Tender Contact details

Questions

62

Operating Company / Fund Structure

The ACT and South East NSW Aero-medical Service Ltd (the

Operating Company) is a joint venture between the ACT and

NSW Governments. (One share each).

The Operating Company was established / incorporated under

the Corporations Act in 1998. The function of the Operating

Company is to oversee all contractual arrangements as they

apply to provision of aeromedical services on behalf of the two

Governments.

The SouthCare Fund Pty Ltd (the Fund), is established under

their own Constitution to manage all sponsor and community

relationships, fundraising activities and to offset the direct

costs to the two Shareholders.

63

Contractual Arrangements

The Operating Company will have two key Agreements

established for the ongoing provision of the service:

– A tri-party agreement between the ACT Government,

NSW Government and the Operating Company detailing

the funding and operational arrangements;

– An agreement /contract between the Operating Company

and the successful Contractor consistent with the NSW

Health Aviation Package Contract but with specific

arrangements for the service based in Canberra.

64

Contractual Arrangements (cont)

65

Contractual Arrangements (cont)

The Agreement between the Operating Company and the

Contractor will require amongst other things:

– all invoicing related to SouthCare operations to be

invoiced to the Operating Company

– mission / flight / performance information forwarded to

the Operating Company after each mission

– the use of the Hume Helicopter Base under a specified

leasing arrangement

– the use of ACT Health Directorate Medical Staff and ACT

Ambulance Service Intensive Care Paramedics

Operational Profile

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Missions

In 2012-13 SouthCare undertook 498 missions, totalling

821 flying hours:

– Primary 171

– Secondary 308

– SAR 19

34% 62% 4% 0%

Mission Profile

Primary

Secondary

SAR

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Tasking Arrangements

The NSW Ambulance Service Air Operations Centre

(AOC), is the sole tasking authority for missions occurring

in New South Wales.

The ACT Emergency Services Agency Communications

Centre is the sole tasking authority for missions occurring

in the Australian Capital Territory.

Tasking requests received from external bodies i.e. Police

are referred to the responsible jurisdiction.

These arrangements will remain.

69

Search and Rescue

The Operating Company has contractual arrangements for

Australian Search and Rescue (AMSA) taskings via the Air

Operations Centre (AOC)

The helicopter may be requested to perform SAR activities

by relevant lead agencies e.g. Australian Federal Police,

NSW Police

These arrangements will remain

70

Staffing

Medical and paramedical staff are sourced from the Capital

Region Retrieval Service (CRRS - TCH), and the ACT

Ambulance Service

CRRS manage college accreditation, Clinical Governance

and Review.

The Chief Officer – ACT Ambulance Service holds

responsibility for the day to day operational and

administrative arrangements that apply to the service

These arrangements will remain

71

Symonston Helicopter Base

Purpose built facilities are located in Symonston ACT.

The successful tenderer will be required to enter into a

leasing arrangement with the ACT Emergency Services

Agency at a stated rate. The rate and lease conditions will

be the same for all prospective tenders.

A security guarantee will required by the successful

tenderer in relation to the base facility.

These arrangements will remain.

72

Helicopter Base (snapshot of facilities)

– Rest area – 3 recline areas (medical /paramedical staff)

and 2 recline areas (aviation crew);

– Engineering area / workshop

– Base Manager Office / Briefing Room

– Medical office space x 2 (one enclosed office for tele-

medicine)

– Separate kitchenette meals area

– On-site fuel farm

– Heated hanger slab

– Conference Room

– EPA compliant.

73

Community Profile

To support fund raising activities

– The Fund will advise livery requirements

– Public relations missions will need to be undertaken

Tender Contact Details

All enquires must be directed to:

[email protected]

Please do not contact SouthCare directly


75

Questions – until 2:30pm

Presented by Andrew Berry

State Director, NETS - NSW

Neonatal & Paediatric requirements of RW


Newborn & pædiatric Emergency Transport Service

Responsibility: NSW & ACT

Age-group: Newborn to Adolescent (< 16 yrs)

Setting: Hospital to Hospital (inter-facility)

Emergency Referrals; too sick for regular ambulance

Process options: – Consultation (local care)

– Transport

– Retrieval ± Regional resuscitation

State-wide clinical coordination

NETS – NSW

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Statewide service of NSW Health

Managed by Sydney Children’s Hospitals Speciality Network

Main Base and Heliport at Westmead (Western Sydney LHD)

Satellite services

– ACT Clinicians: ACT Health

– Hunter Clinicians: HNE LHD

– Sydney and Regional road ambulances managed by NETS

Gazetted ambulance service

NETS – NSW

79

3400

3600

3800

4000

4200

4400

4600

4800

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

0

500

1000

1500

2000

2500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

When is NETS called?

Transport solution • What is the most appropriate vehicle

to transport the patient, team and

equipment?

o Road

o Rotary Wing (small or large?)

o Fixed Wing

• Where is the nearest clinical team /

vehicle to the patient?

• Is it busy? Is there sustained demand

for more?

Clinical solution • What are the appropriate clinical

resources?

o Retrieval Doctor?

o Critical Care Nurse?

o Paramedic

o Nurse practitioner

o Consultant?

o Midwife?

o Proceduralist; surgeon,

obstetrician?

o Specialist; IABP technician,

perfusionist?

• Where are these clinical resources

located?

• Is there sufficient sustained demand to

locate these clinical resources closer to the

patient?

Patient’s needs • What is the patient’s clinical need?

– Inter-hospital (80% of patients)

o What level of care do they need?

o Do they require a specialist

medical team? How many

clinicians and what skills?

o What equipment is required?

o How large does the transport

vehicle need to be to

accommodate all of the above?

– Pre-hospital (20% of patients)

o Do they require a medical team?

o How time-critical is medical

intervention?

• What is their transport need?

– Where are they?

– Where do they need to go?

– Does the patient have any special

transport needs? Eg requires sea-

level transfer, iNO, etc? The clinical solution should drive the transport solution; not the other way around

Patient

Outcome

Objective

Start with the patient, not the porter

Right patient, Right problem, Right solution

• Telemedicine o See

o View

o Know

80

81

Patient transport options

Treat and stay; with one or more consultations

Transport with local ambulance/referring staff

Regional retrieval team

Tertiary retrieval team

– NETS Sydney (newborns & pædiatric)

– NETS ACT (newborns)

– NETS Hunter (newborns)

– Cross border services (Vic/SA/Qld)

82

Coordinate transfer / retrieval

18%

Maternal transfer 7%

Consultation 11%

Other 2%

Back transfer 6%

Helo 13%

Road 35%

FW 8%

Retrieval

Outcome of calls to NETS

83

NETS retrieval teams

2-3 person (Dr + Nurse + Trainer/Additional skills)

Life support system

– Neonatal – 167kg

– Paediatric – Bridge 38kg + Stretcher

Parent

Clinical shifts

– Length (≤) 12 hours

– Staggered starts 07, 09:30, 12, 14, 20, 23

84

Helicopter missions/activity

Flight times Outbound Inbound

54 mins (11 – 3:13) 60 mins (4 – 3:10)

Annual hours 1,094

Launch time 30 mins (on-site) 90 mins (off-site)

Referring

Hospitals

85

3 pICUs

10 nICUs

Melbourne

Canberra

4

1

Newcastle 1

Sydney

Brisbane 2

2 2

3

1

8 2

10 nICUs

3 pICUs

Tertiary Destinations

86

Manual handling

87

Stabilisation and Packaging: 1 – 3 hours

88

89

Components of the process of retrieval

Mo

bil

isat

ion

Cal

l

Ou

tbo

und

Inb

ound

Sta

bil

isat

ion

⅓ clinical care

⅓ travelling

⅓ other … H

ando

ver

R

econst

uti

on

90

Operational characteristics

Most patients not transported ‘back to base’

Triangular journey profile

– Outbound (Leg 1)

– Inbound (Leg 2)

– Repositioning (Leg 3)

De-coupling of teams from vehicle

Legs 1, 2 and 3 may be by same; or a mixture of types

Fatigue management

91

Selection of vehicles

Patient

– Acuity (how sick)

– Time-criticality (how urgent)

– Team-delivered care

– Destination-delivered care

Distance

– Point-to-point / Flying time

– Functional

92

50 km

1 hour

Road

93

100 - 500km

Helicopter

94

100 - 500km

Helicopter

95

0 – 300 km

Road growth

96

300 – 1000 km

Fixed wing

97

Road – 3 Bases

98

Road & RW – 3 Bases

99

All ‘NETS’ options

100

Challenges

Medical equipment

– Airworthiness

– Inter-operability across all vehicles (inter-hospital)

IFR Infrastructure

– Low-level IFR routes

– Point in Space approaches

Operational challenges/limitations

– Endurance/Range

– Ground transport

– Freezing level VS LSALT

– Fog

101

Questions – until 3pm

Presented by Kimberley Turner

Chief Executive Officer

Aerosafe Risk Management

Risk & Safety Requirements

IRSMS Briefing


103

Overview of Presentation

• Requirements for Safety and Risk Management

• Linkage with CONOPS, Requirements & Specifications

• NSW Ambulance IRSMS Framework

• Activating the NSW Ambulance IRSMS

• Operational Risk Management

• SMS Framework

• Ongoing Utilisation of the IRSMS

• Commitment to NSW Ambulance Safety & Just Culture

• Enhancement of Project Resource Model

104

Future Direction

Changing requirements for next decade

Increased aviation capability

Leverage advancements in technology and safety

Greater level of integration medical and aviation

Greater expectation toward the management of risk

Ability to adapt to change

Overview of Requirements

Aeromedical System

Overview of Future Direction


Requirements

• Integrated Risk & Safety Management

• Aviation Capability Requirements

• Sustainment

• Medical Integration

• Training

• Facilities

105


IRSMS Integration

107


Provides foundational structure for scope of operation

Part 3: Task Profiles

Foundation to the IRSMS is the scope of operations

undertaken including

– Medical

– Aviation

– Facilities

Risk criteria is threaded throughout CONOPS

IRSMS Framework and Program Purpose

‘Implement a System-Wide

Integrated Risk & Safety Management System (IRSMS)

to gain operational and organisational assurance that Aeromedical

activities are undertaken within an acceptable level of risk’.

108

IRSMS Project Outcomes

109

NSW Ambulance IRSMS Framework

110

Current Status of the NSW Ambulance IRSMS

• STEP 1: Executive IRSMS Program Briefing

• STEP 2: Operational Risk Management

• STEP 3: Integration with Ambulance’s IRSMS Framework (SMS philosophy, process, practices)

• STEP 4: Establishing State-Wide ‘ BAU Practices’ for risk & safety management at the strategic and operational levels

• STEP 5: Embed into CONOPS, contractual requirements and ongoing partnering and integration of activities, operations and oversight

111

NSW Ambulance Operational Risk

Management Package

• ORM Package defines the scope of operations through a set of specific task profiles

• Aligned with the task allocation process (AOC) to enable network wide monitoring of the overarching Aeromedical operational profile

• Trend and monitor variations from the “normal”

• Informs business, contract, strategic and resource planning to address systemic safety & risk

112

Focus Area 1: Operational Risk Management

• What is ORM?

• Why is ORM a focus area?

• Importance of integration of SMS practices

when utilising a composite staff & crewing

model

113

NSW Ambulance Operational Risk

Management Package

• Aeromedical Tier 2 Application Map provides the definition of the scope of operational activities for:

• Rotary Wing Activities

• Fixed Wing Activities

• Aviation Maintenance Activities

• Operations Management Activities

114

Focus Area 2: Safety Management Systems

• Individual safety programs (SMS) working with one common framework

• Provision of consistency of practice across the Aeromedical network - regardless of Contractor’s business model

• Ability to link safety and risk data across the network

• Role of the AOC in operational safety monitoring

• Defined framework owned by NSW Ambulance and used by all Contractors in the Aeromedical network

115

Focus Area 3: Ongoing Use of IRSMS

• Embed practices in normal ‘day to day’ activities

• Training and up-skilling, skills transfer

• Strategic practices for use by CEOs, Contract Managers, and the NSW Ambulance Executive

• Operational practices for use by all staff, crew members and contractors

116

117

Aviation Safety Network

• What is the ASN?

• Who is the ASN?

• What is the scope of support?

• How does it work?

• Appointment of ASN Reps

118

The Role of an ASN Representative

• Develop ORPs

• Introduce, update and

monitor the usage of the

ORP package

• Coach, mentor and up-skill

key personnel in risk and

safety management

• Coordinate the release of

safety promotion and

communication activities

• Oversee the safety reporting

activities at the base

• Conduct localised training with

staff and crew at the bases

• Measure safety performance

• Prepare safety and risk reports

and plans

• Facilitate the change

management process in

accordance with the ASN plan

• Participate in ASN activities as

the base rep

119

Your Role in IRSMS Implementation

• Executive representatives

• Communications to staff and crew

• Active involvement and participation

• Oversight of the integration of practices

• Aeromedical network oversight activities

120

121

1. Define the governance, risk management and safety

management systems currently in place within your

organisation

2. Outline how your systems will integrate and align with the

NSW Ambulance IRSMS

3. Define your organisational cultural and provide evidence

of your underpinning philosophy, processes and practices

in risk & SMS

4. Demonstrate how your organisation adopts a risk based

approach to change

Tender Response

Q&A

Further questions

Clarification questions leading up to issue of tender documentation

– All questions should be addressed to Paul Davies via

[email protected] until the tender is issued

– All questions through online data room from that point onward

Any requests to keep answers to questions confidential will be

subject to consideration of the potential benefit to all tenders

We are available to take further meetings with interested parties

leading up to RFT issue

Any comments from attendees on the material presented today

should also be submitted to this email address.

123



For further information:

www.health.nsw.gov.au

[email protected]

Thank you!

124
