When the NSW Ambulance Service calls through line 6 to the operations room at the Broadmeadow base, the pilot or crewman who answers the phone does not know what to expect.

"It could be a hospital transfer, could be a motor vehicle accident, could be a horse rider, could be a yacht sinking, could be an airplane crashed, a hang glider, someone off a cliff," said chief pilot Mike de Winton.

The team of a pilot, air crewman (who assists the pilot with communication and navigation) and a rescue crewman (who assists with equipment and "down the wire" operations) push the helicopter out of the operational hangar.

"The pilot's consideration at this time is, is this job within the scope of the team he's flying with? Is it within his scope and his capabilities?" de Winton explained.

"He has to consider the fuel capabilities of the aircraft, can we get there and get back in, can we get there and get to whatever hospital they want to go to?"

The Westpac Rescue Helicopter Service was established 37 years ago by the Newcastle Surf Life Saving Association as a surf rescue and coastal observation operation.

Cliff Marsh, now chairman of the service, was a coalminer and branch president when he sent lifesaver Evan Walton to New Zealand, where a similar service had been set up.

"As long as I live I'll never forget Evan Walton talking to my investigation team when he came back - the enthusiasm just bubbled over," Marsh said.

The service began during the summer months of 1975, with surf clubs from Hawks Nest to the Central Coast able to call the service during daylight in the summer to pluck swimmers out of the ocean.

There are now four canary yellow and red helicopters that operate 24 hours a day, seven days a week from bases at Broadmeadow and Tamworth.

They have become an instantly recognisable touchstone of life in the Hunter, often seen or heard on their way to one of the 1400 door-to-door emergency medical and search and rescue missions they complete each year.

"Sometimes I take a deep breath and I'm amazed at the growth," Marsh said.

FOR the first time in its history, the service will have to bid against other operators for the NSW Ambulance Service contract to continue to provide an emergency medical helicopter to the area.

General manager Richard Jones said the state government's new contract would require operators to meet higher standards in terms of aircraft and response time and would be valued at $15 million to $20 million a year, which required the Minister for Health to open it to tender.

"It's obviously a significant decision," he said. "We'd like to think that because of our record, it stands on its own and we'll be given an equal shake of it as anyone else.

"We're not uncomfortable with it, we'd prefer it to be closed - of course we would - but we certainly understand state government rules on the size of the contract and that it needs to be open."

Newcastle MP Tim Owen said that while there was a state government push for a consistent service across the state, the Westpac Rescue Helicopter Service remained the best operator for its region.

"They have a great reputation, they've been there for a very long time, they provide within the bounds of what they have, in terms of capability, a great service," Owen said.

"It's home-grown, well thought of, well structured, a well-run organisation."

Jones said the rescue helicopter's five-year contract, due to expire at the end of the year, was likely to be extended by six months to give the government time to process applications. The request for tender is expected before the end of the year.

It is understood commercial operators including Canadian Holding Company Helicopters, Australian Helicopters and Bristow will be among those bidding for the seven-year contract with three one-year options.

Jones said he understood the state government would base its decision 60 per cent on the way the operator runs its business and 40 per cent on the price for which the service could be provided.

The Westpac Rescue Helicopter Service receives 45 per cent of its annual $14 million budget from the state government, which pays the service a standing charge and a flying charge.

The remaining 55 per cent is raised through corporate sponsors (12 per cent) and community fund-raising, including payroll deduction, particularly from the mining sector; cash housie; gala balls; golf days and by the 38 authorised volunteer support groups spread across the region that together collect about $500,000 each year.

Jones said it was this element of "community ownership" that drove the service's decision to install neonatal cribs in each of its four helicopters and go into debt to buy another helicopter last year, so it could operate at 95 per cent availability (well above the 80 per cent the NSW Ambulance Service stipulated in the contract).

It has also allowed the service - with the permission of the NSW Ambulance Service - to attend from its Newcastle base 50 search and rescue missions in the year to June, along with its 437 primary missions from an accident site to a hospital and 467 secondary missions or inter-hospital transfers.

Jones said there were questions around whether a commercial operator would continue to complete missions outside the emergency medical realm.

"They'll have a contract with the NSW Health Department that will say you will do primary missions and secondary missions and that's it," he said.

"They don't do work for police, like we do for fires - go and pick up two fishermen stuck at high tide - [and if they do] they'll do that but for the top rate.

"They won't take the police and look for an old man that's just walked away from somewhere."

Jones is comfortable with the 60 per cent weight given to the way the service operates its business.

"We have the local knowledge, we have a proven track record, we have the infrastructure, we have the aircraft, we have the systems," he said.

"For the past five years we've been building those systems and we believe they're some of the best in Australia."

He is referring to the work overseen by the safety, environment and quality manager the service hired in 2008, former crewman Rob Jenkins.

Alongside former chief pilot, and now check and training captain Peter Cook, Jenkins was involved in the introduction of night goggles for pilots, which chief pilot de Winton said was the single greatest safety enhancement to emergency medical field services.

"Before, we were flying out to places and we were going in blind, but we weren't seeing anything until the last 300 or 400 feet," de Winton said. "The goggles turn night-time into a green daytime."

Also under the microscope for comparison against other operators is the service's lean organisation of its engineering and maintenance.

Chief engineer David Oswald and his team of six Broadmeadow-based engineers take a proactive and preventative approach to maintaining the service's four aircraft, with half of their time spent doing hands-on work and the other half planning scheduled maintenance.

Oswald said scheduled maintenance was required every 50 hours of flying, for example, so each of the two Newcastle-based aircraft operated for 25 hours before being rotated with the other machine and serviced after its second 25 hours in the air.

Even though there is only one crew available to work at any one time, in extreme emergencies the service will launch its second aircraft and call in

stand-by crew.

A SPOKESMAN for the Minister for Health declined to comment on the imminent contract, saying only that "a decision on the procurement strategy and process for future services" would be decided after the government finalised its response to a long-waited review of rescue helicopter services in NSW.

"The NSW government initiated a review into the state's aeromedical services to ensure that patient needs are being met and that taxpayers are getting value for money when it comes to these contracted services," a spokesman for the Minister said.

"The review is assessing current aeromedical retrieval services and models of care, as well as recommending an implementation plan and procurement strategy, to ensure patients are receiving the best possible care.

"The review is under way, with the final report due in the coming months.

"The review has included extensive consultation with clinicians, paramedics, local health districts, local councils, helicopter operators and other stakeholders."

JONES said the helicopter was only one link in a medical chain that included doctors, nurses, paramedics, ambulance officers and ward staff, as well as those first on the scene.

But he was adamant the results, expected this month, must include the allocation of a doctor and paramedic stationed permanently at the Broadmeadow base, as a 2004 review recommended should be the case by 2010.

"It can't not be, it's absolutely ludicrous it can be anything else," he said.

"Its the gold standard. We don't have it and every other service does."

MP Owen agreed and said he had spoken to the Ambulance Service on behalf of the rescue helicopter and also visited the NSW Minister for Health, Jillian Skinner, almost daily, pleading the service's case.

Currently, whenever it is allocated a mission, the service waits for two road-based intensive-care paramedics from Hamilton to meet at the base.

But this arrangement doesn't always work. Sometimes the paramedics have not been in the helicopter for some time or can't get to the base in time, including a recent case when a man was ejected from a car on the highway at North Arm Cove.

The helicopter was ready but the paramedics were attending to a cardiac arrest in Raymond Terrace.

"The medical retrieval unit in Sydney said 'Put the machine [helicopter] away, we're sending a machine up.'

"Six minutes it would have taken us to be there - it's absolutely ridiculous and it has to change."

In other circumstances, the NSW Ambulance Service decide a doctor and paramedic are needed at the site.

Jones referred to an accident between a utility and truck on the F3 Freeway, near Cooranbong in late August.

The Sydney helicopter landed in a field at Morisset about 9.35am and the utility driver, a man believed to be in his 30s, was transported by ambulance to the helicopter and arrived at John Hunter Hospital about 10.12am.

The Hunter helicopter was at the Broadmeadow base, about 10 minutes away, and an intensive-care paramedic team was available.

"We've been agitating for more than five years," he said.

"We've been missing out on so many jobs. You'll see the Sydney machine flying over and think, where are they going?

"And the ambulance will say a doctor was needed for the patient. How do you argue with that?"

To Jones, the delay to wait for a Sydney crew with a doctor and a paramedic to travel to the Hunter Region could in some cases put lives at risk.

The Herald recently reported on the case of father-of-two Mark Mannile, who was found unconscious and hanging by a shattered ankle halfway down Heaton Lookout in the Watagan Mountains in June 2008.

The Hunter Westpac Rescue Helicopter Service spent three hours in windy conditions winching him up from the ledge and transported him to John Hunter Hospital where he was treated for a fractured skull, a broken back, a broken neck, shattered cheekbone, punctured lung, broken ankles and a break to every single rib.

"There was no doctor on the night I was rescued. If I had to wait, I wouldn't have made it," Mannile said.

TIM Owen said the service shouldn't have to wait until the review results were published for a doctor and paramedic to be allocated to the base.

"If there is an accident in a week, or two weeks or three weeks' time, before the review is finalised - any loss of life or any serious injury where the most expedient system can't get to them - we have to have that capability in our region."

The absence of an on-site doctor and paramedic could also lead to wastage of the crew's time and fuel.

The service is required to take a doctor and paramedic on inter-hospital transfers or secondary missions, which make up about 50 per cent of their workload.

Chief pilot de Winton said the crew might take two paramedics with them to a car accident at Nabiac and fly the patient to Taree Hospital.

But if the patient needed to be taken from Taree Hospital to John Hunter Hospital, the helicopter would need to fly back to Newcastle to pick up a doctor and nurse and drop off the paramedics.

"It's very easy to get emotional about responses, but it's all about patient care, getting patients to the correct hospital for the correct treatment as quickly as possible with the right team to do it," de Winton said

The administration building - built in 2008 to replace the building demolished after the June 2007 storms - was designed to accommodate a doctor and paramedic on site.

JONES is hopeful the service will be able to continue its role serving the region.

"I'm extremely confident because it's the future of our people," he said.

"We have 55 full-time staff now between here and Tamworth, so I'm extremely confident, while not being overly confident, because I know the job we do stacks up.

"We've benchmarked ourselves against our opposition and we reckon we beat them in pretty much every area.

"Where they can't beat us is that community support, so the community discount we can potentially offer the government - they haven't got that at all."

And if the service for some reason is not awarded the contract?

"We operate under a trust and we cease to exist, quite simply. Any money we have in the can gets distributed to like-minded charities in the region.

"So that's the stark reality, but we don't ever contemplate that.

"If we weren't doing the job, if we weren't delivering for the customer, which is the NSW Ambulance Service, I'd be worried. But we deliver far more than is required in the contract."