Air medical services embrace pre-owned helicopter refurbishments

By: Lisa Gordon | Retrieved from Vertical Magazine

The General Aviation Manufacturers Association has released its latest aircraft shipments report for the second quarter of 2025, indicating that new helicopter deliveries decreased by 1.9 percent compared to the same period last year.

That dip might be partially attributable to post-pandemic supply chain issues and long delivery lead times, factors that have prompted many operators to consider quality pre-owned helicopters as an alternative to new.

In the helicopter emergency medical services (HEMS) sector, operators are expanding their fleets to meet growing demand for air medical services. Purchasing a used helicopter allows them to pay less while putting the aircraft into service more quickly — but in many cases, those pre-owned machines require upgrades before they can fly HEMS missions.

Metro Aviation, based in Shreveport, Louisiana, has seen rising demand for tip-to-tail HEMS helicopter refurbishments. In the cabin, operators are asking for lighter materials, improved communication, easier patient and attendant access, and modular designs that allow flexible medical configurations.

Up front, glass cockpits with the latest navigation and communication technologies are in demand, along with terrain and traffic awareness systems, autopilot, night vision capability, and modern LED lighting packages.

Amy McMullen, director of aircraft configuration at Metro Aviation, said the goal is to make a used helicopter look brand new. The 43-year-old company — which also operates more than 160 aircraft in the air medical sector — specializes in cutting-edge refurbishments and holds more than 30 supplemental type certificates (STCs) for a wide variety of helicopter makes and models. In the HEMS sphere, Metro’s most commonly refurbished aircraft are the Airbus H135 and H145, as well as the Bell 407.

“You never know how an aircraft will show up here and what it might need,” McMullen told Vertical Valor. “We provide everything they could ask for: HEMS interiors, exterior modifications, maintenance checks, avionics panel refurbishments, exterior paint.”

She agreed that the high cost of new helicopters and the long wait times for deliveries are fueling demand for quality used aircraft that can be retrofitted for medical missions.

“Hospitals can’t afford new aircraft, and we see demand increasing for HEMS services,” McMullen continued. “At some point, they will come to an impasse where they will need good used aircraft. We see this demand staying strong for the foreseeable future.”

About 60 percent of Metro Aviation’s current business comes from aircraft refurbishments. Typically, an aircraft arrives at Metro’s facility before the client’s first visit, when an initial design review determines what equipment is required.

“We can take them back to show them other aircraft,” she said. “Do they want a cabinet? Where do they want the plugs, oxygen, suction? What color seats do they want? It’s about what they want to mount, according to their base and their mission. We may move a few things around, like an oxygen outlet in a different spot. It’s kind of exciting to get one of these aircraft in here and watch it leave looking brand new and going to work.”

Shawn Bruton, Metro Aviation’s part 145 director of maintenance, noted that while cockpit panel STCs call for very specific instrumentation layouts, radios and EMS cabin equipment are more open to customization. He said it takes about 115 working days to complete a used helicopter HEMS refurbishment.

In addition to helping customers identify what equipment they need, Metro Aviation also points out what they don’t.

“Recently, a helicopter arrived here with a lot of equipment on it that it didn’t need,” Bruton said. “We identified what could be removed and what could be left intact. Then we did the EMS refurbishment. So we helped them save weight by getting rid of structural elements that didn’t need to be there. We help them to be successful.”

He agreed that operators are increasingly seeking out good used aircraft. For example, Metro Aviation has refurbished helicopters from the mid-2000s with only about 500 hours in a VIP configuration — prime candidates for HEMS missions, Bruton noted.

At the same time, he acknowledged that parts availability and a sluggish supply chain remain challenges. “Tariffs are killing us. We’re being charged up to 30 times more for parts we’ve purchased for years. It’s been a nightmare for our accounting department.”

Still, Metro Aviation prides itself on doing the job right.

“We remove a lot of old wiring and equipment,” Bruton concluded. “We don’t just paint over the top or add more wiring — we replace it properly. I recently asked one of our customers on the operations side, and they said they have nothing to change in the Metro HEMS interior.”

Data, diagnosis and digital tech

In Tennessee, Wysong Enterprises has a long history of successful HEMS completions on pre-owned helicopters — primarily the Bell 407 and Airbus AS350/H125, but also the EC130, EC135, and BK117 models. Beyond the rising interest in upgrading used helicopters, Wysong vice president Jonathan Davis has noticed several other trends in the HEMS space.

“From an operational standpoint, we are seeing providers focusing on aircraft data,” he said. “A variety of systems are gaining traction, whether it be the Skytrac integrations into capturing and communicating flight data, or a robust option like the HUMS [health and usage monitoring system] offered by GPMS.”

He added that while there is certainly a safety element to this trend, operators also believe that interpreting and utilizing aircraft data can help keep helicopters operational and mission-ready.

In the cabin, Davis pointed to an increased emphasis on inflight care. “You are seeing different portable equipment to diagnose and potentially treat patients, especially in areas where the expectation of transit time might be significant.

“The big thing that stands out is more and more of the medical equipment is going to USB power,” he added. “Maybe three to four years ago, you might install one USB in the cabin and one in the cockpit. Now, you might have four to six being installed in the cabin.”

In the cockpit, digital displays that enhance visibility and safety — such as dual installs of traffic-reporting ADS-B, stand-alone active traffic systems, cockpit cameras, and enhanced autopilot systems — are increasingly in demand.

From a technology standpoint, Davis also pointed to growing interest in systems that enable secure transmission of patient data between aircraft and hospitals.

In the HEMS sector, Wysong averages eight to 10 new completions or used refurbishments per year. In addition to installing kits from a variety of vendors, the company offers its own full EMS interior kit for the Bell 407, as well as a range of interior and exterior light kits, EMS accessories, mission pouches, and more. Davis is confident the market will continue to expand.

“There is still a continued need for air transport for a variety of reasons, and I think that growth rate will likely result in a continued strong demand for both new and upgraded aircraft to support that need,” he reflected. “I do think the [Robinson] R88 and [Airbus] H140 platforms have the potential to be disruptive in the space. With these airframes coming to market, it will be an interesting opportunity for product providers and flight crews to potentially reevaluate or build from the ground up to meet the current needs of HEMS operators.”

Cost, weight and technology

Englewood, Colorado-based United Rotorcraft is the products division of Air Methods, another prominent provider of HEMS.

Jeanette Eaton, United Rotorcraft’s vice president of strategy and business development, said the company designs, integrates, and installs medical equipment, avionics packages, and other accessories for HEMS missions.

Customers can choose from a list of existing products and modifications, or the company can develop something new to meet specific needs. Standard medical equipment includes patient loading systems, floor overlays, equipment racks, IV hangers, cabin lighting, and more.

“Our modifications of used aircraft are utilizing the same interiors we would put in a new aircraft,” Eaton said. “Some of our key products include the Bell 407 [GX/GXi], EC130 T2, H125, Bell 429, Bell 412 EP, EC145 D2, and EC135 T2. We can support new aircraft completions, as well as used aircraft modifications.”

Eaton noted that the EMS market has slowed since the No Surprises Act took effect at the beginning of 2022.

“The market is now correcting itself,” she continued. “We’re seeing corporations such as Air Methods and others resuming the purchase of new and refurbished aircraft. The refurbished/used HEMS helicopter market is robust, driven by both long lead times for new helicopter deliveries from the OEMs, as well as the fact that HEMS operators can fulfill their missions with fully refurbished aircraft as effectively as with new aircraft, but at a lower cost. United Rotorcraft specializes in completions kits that are readily available for the OEMs, as well as Air Methods and other operators.”

Eaton noted a growing trend of helicopter operators seeking modular, versatile interiors that can be adapted to multiple missions. To meet these evolving needs, United Rotorcraft recently launched a “complete revamp” of its medical interiors.

“We’ve been talking with Air Methods and other operators, looking at it from the clinician and owner/operator points of view,” she explained. “We’re getting down to details for each product line. For example, what’s most important: storage, USBs, outlets, suction medical, weight versus payload? We’re listening to customers and the plan is to let their voice drive us.”

She said opportunities are especially strong with aircraft such as the Bell 407GXi, 429, and 412EP, as well as Airbus Helicopters’ H125, EC135, EC130, and EC145, and the Sikorsky Firehawk.

“We are constantly asked how to lighten up the interior,” Eaton said. “People want to lighten things up, go digital, reduce pilot workload, and enhance communications to base.”

Specifically, United Rotorcraft customers are looking for upgraded avionics systems that improve reliability and operational performance. Preferred equipment includes weather radar, helicopter terrain awareness and warning systems (HTAWS), and ADS-B integration.

In the cabin, operators want fully integrated patient care systems that are securely mounted, reliably powered, and designed for intuitive clinical access.

Communication, Eaton stressed, is key across all aspects of the mission: between pilots and clinical crews, clinicians and patients, and air-to-ground — including VHF, UHF, and FM radios. United Rotorcraft has also received requests for wireless headsets and satcom services to facilitate communication between the aircraft and its home base.

When customers come to United Rotorcraft, they sit down with a salesperson to review a checklist of requirements.

“It starts very simple and easy,” Eaton explained. “We review their timeline, certification needs, mission, distance travelled, and funding. Based on what platform they have, we get into specific requirements like oxygen, suction, range, floor [blood floor or dam]. Sometimes they are brand new and they don’t know what’s available, so our job is to educate.”

United Rotorcraft completes eight to 10 HEMS completions and upgrades each year, holding about 213 related STCs. Turnaround time varies depending on the scope of the project. The company also produces an additional five to 10 HEMS kits annually, which are then installed by operators at their own locations.

“Typically, it takes five to six months to install one of our EMS interior kits,” Eaton said. “But if we have one on the shelf ready to go, it can be done as quickly as two months. When we get a request to refurbish an aircraft, it’s always a really tight schedule. It’s definitely a competitive advantage to have a shorter delivery time.”

She believes HEMS refurbishments of pre-owned helicopters will remain a strong market niche for United Rotorcraft, noting that sales are currently trending upward.

“Our mission statement is about saving lives and protecting the environment, so that will always be the number one priority for us,” she concluded. “Medicine and aviation are two highly regulated industries, so we have to stay ahead of that, working with the FAA and other regulators. HEMS refurbishments remain a competitive sector, especially when it comes to cost, weight and technology. Our product line review will advance all our kits — we are looking at all the new and advanced technology to reduce weight and gain cabin area.”

From tip to tail, a complete refurbishment can transform the right pre-owned helicopter into a lifesaving tool for EMS professionals. Equipped with the latest avionics, medical interiors, and exterior enhancements, these machines can be readied in a matter of months, offering improvements in performance, safety, and efficiency for the missions that matter most.  

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