An OVERVIEW OF AIR MEDICAL SERVICES 航空医疗服务概览 （上） Denise Uhlin

DENISE UHLIN CUSTOMER SOLUTIONS MANAGER – BELL 客户方案经理-贝尔 © 2018 Bell Helicopter Textron Inc. EMERGENCY MEDICAL SERVICES / AVIATION急救医疗服务/航空 40+ Years Experience 40多年经验 PRE-HOSPITAL / HOSPITAL EMERGENCY MEDICAL SERVICES院前急救/医院急救医疗服务 Nationally Registered Paramedic / Ground & Air Medical Services 国家注册护理人员/地面及航空医疗服务 Program Director/Chief Flight Nurse (UNC HOSPITALS, CHAPEL HILL) 项目总监/首席飞行护士（北卡罗来纳大学医院，教堂山） Regional Safety Director (AIR METHODS CORP） 区域安全总监（Air Methods公司） AVIATION 航空 Director Air Medical Services (PHI AEROMEDICL SERVICES) 航空医疗服务总监（ PHI AEROMEDICL SERVICES 公司） Western Hemisphere Director Quality & Safety (BRISTOW GROUP) 西半球质量兼安全总监（Bristow集团） BELL – Customer Solutions Manager / EMS 贝尔-客户方案经理/医疗应急救援 Hired to support China in developing world class air medical services for it’s citizens 协助支持中国开展先进的航空医疗服务，造福人民 © 2016 Bell Helicopter Textron Inc.

INDUSTRY TERMINOLOGY 行业术语 Bell Confidential and Non Proprietary Common: HEMS (Helicopter Emergency Medical Service) HEMS（直升机医疗急救服务） HAA (Helicopter Air Ambulance) HAA (直升机空中救护车) General: AMS (Air Medical Services) AMS (航空医疗服务) System designed to meet China’s unique needs 研究符合中国特色的体系 Reflects expanded service models 反映可延伸的服务模式

PRESENTATION OBJECTIVES 演讲目的 Bell Confidential and Non Proprietary WHY providing air medical services is important 航空医疗服务为何如此重要？ Decreased mortality 降低死亡率 Increased clinical outcomes 增加临床成果 HOW to provide air medical services 如何提供航空医疗服务 Funding models 资金模式 Operating structures 营运架构

AIR MEDICAL SOLUTIONS FOR CHINA 中国的航空医疗解决方案 Bell Confidential and Non Proprietary Bell will support China in developing Air Medical Services that are safe, efficient & economically sustainable, while providing a high level of care to the greatest number of citizens 贝尔将协助中国开展安全、有效、经济的可持续发展航空医疗服务， 并为最大数量的公民提供高水平关怀服务 Options are ENDLESS – commercial 135 operations funded by insurance - one of many options 数不清的可选方案– 由保险基金支持的135家商业运营商 – 多选一 Develop unique, air medical service by leveraging best practices, & expanding or redefining traditional systems 利用借鉴最佳实践方案发展独特的航空医疗服务，扩展并再定义传统方案。 The system should allow for a mixture of operations & equipment which provide the most coverage & care 该体系应允许混合经营及设备，以达到最大的覆盖面及服务 Greater Access = Improved Patient Survival and Functionality 更好的渠道 = 更多的病患被救助+更完善的功能

IMPROVING ACCESS TO HEALTHCARE 改善医疗服务的渠道 Bell Confidential and Non Proprietary Improving the people’s wellbeing and access to healthcare is critical to becoming a modern, developed society. President Xi emphasized this as a continued area of focus for China during the 19th CPC National Congress. 要成为一个现代化的发达社会载体，改善人民的幸福指数和享受医疗服务的渠道是非常关键的。习主席在中 共19届全国代表大会上也强调对此需要持续关注。 Building an effective Helicopter Emergency Medical Service (HEMS) system across China is necessary to preserve life and improve wellbeing for the greater good of all people. 在全中国建立有效的直升机医疗急救服务（HEMS）体系，对于挽救生命，改善全民健康是非常有必要的。 2016 > 260,000 traffic deaths in China - Many could be prevented with AMS Network 2016年，在中国，超过26万人死于交通事故；如有航空医疗服务（AMS）网络，很多死亡可以避免。

BRIEF HISTORY 历史回顾 Bell Confidential and Non Proprietary

THE US EXPERIENCE 美国经验 Bell Confidential and Non Proprietary Helicopters first used for medical evac by military in the 1950s – 1970s 在20世纪50年到20世纪70年代，直升机开始被军方用于医疗 Government programs led to dual-purpose use of military & public safety helicopters (Maryland State Police, MAST) 政府项目引导直升机同时为军方及公共安全事业服务 (马里兰 州警察局，MAST） Mid 1980s expansion to commercial ops with growth explosion thru 1990s to present day 20世纪80年代中期，延伸至商业运营行业；并从20世纪90年 代至今呈现爆发式增长态势 Organized, coordinated efforts in the US date back nearly 50 years 在美国，这样有序和谐的发展可追溯到近50年前

THE US EXPERIENCE 美国经验 © 2018 Bell Helicopter Textron Inc. Over last 50 years, every imaginable model & structure used for Air Medical Services in the US 在美国，过去的50多年里，每一个可想象的模式 和架构都被用于航空医疗服务。 What proves successful for one region, state, or even country, may not work for another 具体问题具体分析，因地制宜。 © 2016 Bell Helicopter Textron Inc.

CURRENT STATUS 目前状况 © 2018 Bell Helicopter Textron Inc. US > 1200 civil & government helicopters serving 320 million 美国超过1200架民用及政府直升机服务3亿2千万人口 1 helicopter / 267,000 people 平均一架直升机服务26万7千人 China <100 AMS helicopters to serve 1.4 billion people 中国 不到100架 AMS直升机服务14亿人口 With US ratio - 5,243 helicopters to cover population 如果按照美国现状比例，应该有5243架直升机 AMS in China should involve a combination of: 中国的AMS应该涵盖： Government operations 政府运营 Part 91 Operations 91部运营 Part 135 Operations 135部运营 © 2016 Bell Helicopter Textron Inc.

CHINA – US COMPARISON 中美情况对比 Bell Confidential and Non Proprietary Geographic sq. km. ‘footprint’ of China vs US. 地理分析 中美“足迹”对比 Variations comparing additional demographics: 人口统计方面不同的对比 Physician density 医生密度 Hospital bed density医院床位密度 Tremendous Air Medical Services Growth potential for China

CHINA – US COMPARISON 中美情况对比 © 2018 Bell Helicopter Textron Inc. China 中国 United States 美国 Population 人口 1,373,541,278 (2016) 323,995,528 (2016) Area 国土面积 9,596,960 sq. km平方千米 9,833,517 sq. km平方千米 Physicians density 医生密度 1.49 physicians医生 / 1,000 population人 (2011) 2.55 physicians医生/ 1,000 population人 (2013) Hospital bed density 医院床位密度 3.8 beds 张床/ 1,000 population 人(2011) 2.9 beds张床 / 1,000 population 人(2011) Consider a model that gets patient to the doctor / higher level of care 思考一种可以让病患有医生资源或更高水平的医疗服务的模式 © 2016 Bell Helicopter Textron Inc.

FLEXIBILITY IN AIR MEDICAL SERVICES OPTIONS 更灵活的航空医疗服务模式 Bell Confidential and Non Proprietary More than one way to operate SAFELY under US regulations:在美国法规下，安全运营可遵循不止一种法规 Part 91 91部 Part 135 135部 Focus on Capability & Availability容量及实用性 Maximize use of single engine, single pilot operations to provide greatest coverage economically 最大化使用单发单驾驶操作，来更经济地实现最大的覆盖量 91% Bell AMS sales to North America are single engine 贝尔AMS销售到北美的91%都是单发直升机 Bell committed to helping China develop their air medical and emergency service solutions 贝尔承诺将帮助中国发展其航空医疗急救服务行业

Bell Confidential and Non Proprietary 航空医疗服务 有什么益处？ 为什么重要？

WE ALL REALIZE .…..我们认识到…… Bell Confidential and Non Proprietary Air Medical Services SAVE LIVES! 空中救援服务可以拯救生命！ Benefits extend beyond the trauma scene flight 空中救援服务带来的优势远远不止灾难现场的救援 Any condition to benefit from advanced care &/or rapid transport 满足包括高级医疗救护以及快速转运之内的所有情况需求 Benefits accomplished thru 3 inter-related functions: 这些优势得益于以下的三个核心功能 rapid expert care to victim, which in turn . .专业人员快速抵达现场 decreases mortality, and . . 有效降低死亡率 improves outcomes. .更好的救援结果 Improved outcomes are a major factor in effectiveness of medical care 更好的救援结果是高效医疗救援最主要的因素

PATIENT OUTCOMES 病患的结果 Bell Confidential and Non Proprietary Secondary Outcome Variables 病患的次要可变因素 Physiologic–decrease morbidity & mortality (manage breathing, stop bleeding) 物理因素-减轻症状并减小死亡率（控制呼吸， 有效止血） Logistic-decrease time parameters (time to surgery, procedures) 逻辑因素-较少时间影响（送医时间以及程序） Decreased ICU & hospital stays 减少重症监护室以及住院的时间 Primary Outcome Variables 病患主要的可变因素 Survival 存活率 Functional 功能性 Both equally important, for example: Undesirable for patient to survive but to remain in vegetative state 生存和保持机体的功能两者同样重要， 因为病患活下来，但是却进入植物人 状态并不是一个理想的结果 or AMS addresses by: 1) Getting to patient quickly 2) Providing advanced level of care

RESEARCH SUPPORTING AMS EFFECTIVENESS 研究数据支持了航空医疗服务的有效性 © 2018 Bell Helicopter Textron Inc. Samplais - Transport to a Level 1 facility decreases the odds of death by 38% Samplais-运输至1级医疗设施使病患死亡的概率减小了38% UK Study – Increased survival in patients with low probability of survival due to combination of HAA & care at the hospital UK Study– 生存几率很低的重症病人的存活率因为医疗救护直升机（HAA）和医院的紧急救护得到了提高 Nardi - HAA crew stabilization & advanced care at the scene & enroute is associated with a threefold decrease in mortality compared to ground transport Nardi-相比地面救护，医疗救护直升机（HAA）机组的稳定化和专业化配合先进的灾难现场以及航程中的救护使病人 的死亡率降低了三倍 Baxt & Moody - 300 patient outcomes examined using injury severity scores to predict mortality, only difference ground vs air HAA had 52% decrease in predicted mortality Baxt&Moody-通过对300例病伤情严重程度以及患治疗结果的分析，预测接受医疗救护直升机（HAA）服务的病人死 亡率将比地面救护的病人低52% Air Medical Services decrease mortality and improve clinical outcomes 空中医疗服务降低死亡率并提升临床医疗效果