HI Uplift: Blueberry Aviation HEMS report signals slow ahead
The AW109 Trekker could play an increasing role in HEMS missions. (Photocredit: Blueberry Aviation).
Slow ahead is the prediction for growth in the Helicopter Emergency Medical Services market, according to the latest report from rotary and fixed-wing sales specialist Blueberry Aviation. Produced in co-operation with Pteron Valuations, the report sets out a comprehensive picture of global demand driven by replacement activity and coloured by regional hots spots.
Moderate annual growth of about 2.1% per annum is predicted for most HEMS markets. Blueberry Aviation’s executive vice president Aubrey Point sums up the sector like this: “The HEMS market keeps growing but at a rather slow pace. The fleet is modern, and growth is mainly driven by replacement rather than adding new capacity. Emerging markets struggle to develop HEMS services due to issues of funding structures and regulations.”
The 2025 HEMS Market Report identifies 2,482 units in the global emergency medical services market (EMS) and 350 units on onshore rescue (excluding Russia), according to research in December 2024 by Pteron Valuations.
While the HEMS fleet has shown constant growth since the early 2000s, the size and quality of this growth has mostly been gradual. Although there was a sharp increase of 5% per year between 2003 and 2005, the average growth rate has slowed to 2.1% a year over the past 10 years. Overall, the fleet has grown by more than 70% since 2004.
For Point, the recipe for current growth lies in “economic strength or high gross domestic product per capita, the strength placed on the value of human life and strong health insurance systems,” Other drivers include government funding and regulations and geography with long distances needing air ambulances, he tells us.
‘Mainly a replacement market’
Last year 77 new helicopters and 44 pre-owned aircraft were deployed in HEMS markets. Retired aircraft totalled 52, giving net annual growth for the HEMS fleet of 69 aircraft or 2.5% in 2024. “Looking at those figures, the HEMS market is mainly a replacement market, even if new aircraft are added every year,” according to the report.
“Those replacement strategies mostly take place in well-developed countries where medical and operational requirements are brought to higher standards and where operators can afford to bring their helicopter assets to higher technological levels.”
Likely candidates for replacement include old models such as BO105, AS365, B212 and MD900/902. For new aircraft, this is the H145 D3 that has benefited from most of the new acquisition decisions in the 3t-3.8t category. As a form of confirmation, nearly half of the recent civil H145 deliveries went to EMS, by far the best seller in that market. Overall, Airbus products account for 60% of the HEMS fleet worldwide.
At the higher end of the product range in the medium category, the AW139 takes a dominant position among those of the EMS and onshore rescue helicopters that can ensure heavier and longer-range missions, reveals the report. An average of more than 10 new aircraft are geared every year towards EMS and/or onshore rescue missions.
Last year, another 18 AW139 aircraft, previously deployed for broader public services missions or leased in other mission segments were specifically reconfigured for EMS and/or onshore rescue missions.
Biggest category
Dissecting the global HEMS fleet, single-engine helicopters (1.5t to 2.9t) account for 830 assets or 29% of the fleet. Light twins, light mediums and mediums account for the remaining 71%. Of those, by far the biggest category is light twins (2.6t-4t) representing 1,530 airframes, followed by mediums (5t-7t) at 310 units. Light mediums (4-4.9t) account for 99 helicopters.
EC135/H135 and EC145/H145 are clearly the most favoured EMS helicopters worldwide for both primary and secondary missions, says Point. Plus, there is a trend towards slightly heavier light-twin helicopters capable of embarking more medical personnel and equipment on board is materialising in most developed jurisdictions.
He sums up the choice of HEMS assets like this: “The AW109 Trekker could play an increasing role while providing good performances at a very competitive budget.
“The Airbus H140 and H145 should maintain a strong dominance in the light-twin HEMS segment in the years to come while the AW139 on the Leonardo side should lead onshore rescue markets worldwide.”
North America
Turning to geography, as expected, North America operates by far the biggest HEMS fleet at about 1,426 units followed by Europe at 833 units – with both regions accounting for 80% of the world’s fleet. The number of HEMS aircraft in Eastern Asia is estimated at 194 units and in Africa/Middle East at 156 units. Australasia accounts for 114 units with 62 units in Latin America.
The report notes the market in several European countries – notably Germany, Switzerland and Austria – has reached saturation. So where should we look for growth? “Moderate growth will come from Asia-Pacific such as China, Korea, Japan, Australia and developing Asian countries which are committed to introducing the latest technologies in their fleets,” says Point.
“Growth is, of course, driven by rising GDP per capita, expanding healthcare systems and new demand in large countries where ground ambulances do not comply with decent medical requirements. But the development will not be as fast as some people could expect.”
Despite the steady progress of advanced air mobility aircraft, such as eVTOLS, it will be some time before these assets make a significant contribution to the EMS sector. “Although eVTOLs could provide greener, cheaper, quieter solutions, the current technology and regulations do not allow any reliable implementation in the near future,” says Point.
Read Blueberry Aviation’s 2025 HEMS Market Report here.
Meanwhile, if you are visiting European Rotors on Tuesday, November 18th, why not make a date to attend the Helicopter Investor Finance Forum focusing on the HEMS market at 15:15 CET? Helicopter Investor will be taking the temperature of the sector with a panel of industry insiders. More information is available here.
