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The aeromedical programs of Ohio
Program
Profile
The Life Flight 365N Dauphin 2 at St. Vincent Hospital in Toledo flies about 900 patients annually. True to the heritage blazed by the Wright Brothers, the state of Ohio is still an aviation leader. Only this time it is in the field of hospital-based helicopter operations. Ohio has more aeromedical helicopters flying than any state with the exception of California, providing its citizens with border-to-border coverage. It approaches the Swiss and West Germans in response time, with few residents being more than 25 minutes from the nearest service.
History The city of Columbus hosted the first aeromedical helicopter program to start in that state in 1973. The program, dubbed "Doctor 'Copter," used a National Guard 'Huey' and was available only on weekends. The service ceased operation after transporting 164 patients in two years amid questions of liability for damages if the helicopter should crash enroute to a hospital. During the four years to follow, the EMS helicopter was gaining in popularity in the United States - - but the concept was that of a 24-hour service sponsored by and based at hospitals. More than a dozen programs had started across the nation by mid-1979. 12 HOSPITALAVIATION, AUGUST 1984
Later that year, St. Vincent Hospital of Toledo became the first Ohio hospital to sponsor a 24-hour aeromedical helicopter service with an Alouette III. It was the 22nd such program in the United States, but the first one to fly more than 500 patients during its first year save Denver and Houston. Today the service utilizes the largest helicopter to be found at a hospital in the United States, an Aerospatiale 365N Dauphin 2. It was another three years before the next aeromedical helicopter program established roots in Ohio soil, and then there were two starting at the same time - - in the fall of 1982. Cleveland Metropolitan General Hospital in Cleveland, and Grant Hospital in Columbus became the sponsors of new services. The Cleveland program started with an Aerospatiale AStar, and now has two of the craft - - and has transport agreements with more than 40 hospitals. Columbus was first to host a twin-engine helicopter in the state (third in the nation) and flies an MBB BO-105CBS. The fourth program began a year later in Dayton - - at Miami Valley Hospital - - flying an AStar, followed in early 1984 by Lorain Community Hospital in Lorain. The latter program
utilizes a Bell LongRanger II and is reportedly the only hospital in the nation with an IFR (instrument flight rules) capable helipad (final approval for the IFR approach has not been received, however). And scheduled to start this October with a BO-105CBS is the University of Cincinnati Hospital in Cincinnati. The variety of aircraft flying medical missions in the state is exceeded only by the number of operators who fly them. Clinton Aviation of Houston flies in Toledo, Cimarron Helicopters from Oklahoma City flies in Cleveland, Omniflight Helicopters of Wisconsin flies for Columbus and soon Cincinnati, Omni Helicopters of Cleveland flies in Lorain and Rocky Mountain Helicopters of Utah flies for Dayton.
Transport statistics Ohio ranks 35th in geographical size in the country, but ranks sixth in terms of population with nearly 11 million residents. In 1983, with four programs operational (the latter starting in September of that year), more than 1,400 patients were transported by helicopter. The programs of Ohio fly 50 % of all transports back to the sponsor
Program Profile...
O n e of t w o Astars for C l e v e l a n d M e t r o p o l i t a n G e n e r a l H o s p i t a l is c a p t u r e d over t h e C l e v e l a n d S k y l i n e .
hospital - - a figuare below the national average of 63 % but typical for metropolitan areas. About 13% of all flights are scene calls, and 38% of all missions are flown at night. In addition, the average 1-way flight for Ohio programs is 44 miles, reflecting an average response time of approximately 25 minutes from the sponsor hospital to the patient in need. The T o l e d o TriaI
In 1979, Certificate of Need was alive and well, and posed a substantial obstacle for St. Vincent Hospital• The hospital negotiated a one-year program with the regional health authority, on the condition that an independent panel of physicians would review all patient transports during that year. Certificate of Need approval would be based on the success of the one year trial period and on the report of the physician panel• During the first 12 months, St. Vincent's Life Flight Alouette III flew more than 500 patients. Of that number, 326 patients were reviewed by the physician panel, which concluded, "The interventions of Life Flight made a difference in a patient's status and/or life 33.2% (17.3% + 15.9%) of the t i m e . . . We found that physician, other personnel, and equipment made the critical difference, even though an average of one-half hour's time was saved on the 14 HOSPITAL AVIATION, AUGUST 1984
final leg of the journey." (Life Flight Medical Evaluation Subcommittee Report, August 15, 1979 through August 14, 1980, Toledo, Ohio). The study referred to a reduction in patient morbidity of 17.3% and a reduction in patient mortality of 15.9% as a direct result of the Life Flight service. St. Vincent Hospital received full CoN approval at the end of the trial and has transported nearly 4,000 patients during its five years of operation. "The number of flights increased steadily over the years, but the number of flights missed while on other flights also increased," stated Pat Yancy, RN, long-time program director and chief flight nurse for Life Flight. "At the same time, similar programs developed in three cities within the 130 mile service area. Though 1983 s a w . . , a record 829 flights, the need to enhance our marketing image was recognized." "Alternatives were scrutinized, Ms. Yancy continued. "The idea of a second aircraft, considered since 1980, was ruled out as too costly because of duplication of staff, supplies and other resources for sporadic (May through September) utilization. Fixed wing flights had been added in 1980, but did not reduce the number of requests within the area served by the helicopter. Many of the new technology aircraft sacrificed size for speed. The Alouette 316 being used was quite a workhorse • . . but slower than our competition,
and it still offered us more patient care space than the new technology ships had." The service eventually selected an Aerospatiale 365N Dauphin 2 helicopter which began service in early 1984. It is capable of transporting up to three patients and three attendants. The aviation portion of the service is supported by Clinton Aviation of Houston, Texas. "Clinton offered us an affordable way to obtain the Dauphin 2 . . . which has allowed us to complete more flights in less time and expand our EMS scene response," explained Ms. Yancy• Clinton also leases five TwinStars to Hermann Hospital in Houston, but operations there are conducted by Hermann's own flight department. Three pilots and one mechanic are provided by Clinton to keep the Toledo program flying. The hospital provides each medical flight with a flight nurse and senior emergency medicine resident physician. "The medical crew of nurse and physician can expedite scene time because the roomy cabin allows for complete patient assessment and needed stabilization," observed Ms. Yancy. "The new ship has many promotional marketing aspects, too. Local EMS Chiefs have been visiting and flying with us, [allowing them] to learn about the emergency air medical service, the capabilities of the new aircraft, the flight crew, as well as the support staff who remain at St. Vincent and the specialized services offered by the Medical Center." St. Vincent draws from a complement of 6 full-time and 2 part-time flight nurses on 8-hour shifts. The hospital also maintains a full-time dispatch center for Life Flight, staffed by paramedics and EMT's working part-time in addition to their full-time EMS jobs. The Eagle has l a n d e d
About 80 miles to the east along Lake Erie's southern shore is Eagle Flight based at Lorain Community Hospital in Lorain. The newest program in the state, Eagle Flight leases a Bell LongRanger II on floats from Omni Helicopters of Cleveland. Lorain is a suberb of Cleveland• The dot on the map belies its p o p u l a t i o n - over 75,000 in a county of more than 270,000 people. In spite of its proximity to the aeromedical
Program Profile... programs in Toledo and Cleveland, Eagle Flight transported 90 patients during the first six months of service. The program specializes in scene calls, and has averaged 63% of its flights to accident scenes. That percentage the past couple of months has been even higher. The hospital has the distinction of operating the first and only known hospital helipad in the nation designed for IFR operations. Built in 1981, the helipad features a 40-foot diameter operating helipad marked b y sequential strobe lights (heretofore found only at the end of major airport runways) and floodlights. In addition, a PLASI (pulse-light approach slope indicator manufactured by DeVore Aviation of Albuquerque, NM) marks the glideslope for the approach. Additional aids include a heliport beacon and a lighted windsock. A 12-foot wide taxiway, complete with standard blue taxiway lights, leads to a spacious (three helicopter plus) helicopter parking ramp that comes within 90 feet of the hospital's
emergency department. Built nearly three years prior to the start of the hospital-based Eagle Flight program, the helipad is a frequent host to Coast Guard and Army Reserve medical helicopters. Unfortunately, as no precedence exists, the approval for actual IFR approaches has been delayed. Eagle Flight is staffed by a nurse and paramedic medical team and has a close working relationship with a dive rescue team. The relationship is close, as members of the dive team are associated with the hospital and include paramedics and even one physician. When the dive team is called out, as it has been about five times since it went into operation one month ago, a paramedic diver replaces the flight nurse on the helicopter. Additional special equipment is also loaded aboard for the mission. A number of calls for Eagle Flight are for water-related accidents, due to the program's proximity to Lake Erie. In addition, several flights are made to islands on the lake - - not so much for
critical patients but for basic emergencies as such patients have no way to be transported safely to the mainland. Cleveland Has Two
Metro Life Flight, sponsored by Cleveland Metropolitan General Hospital, a 680 bed tertiary medical center in Cleveland, was begun in September 1982. It was the second hospital-based aeromedical helicopter service to begin in the state of Ohio. Metro Life Flight does not view the proximity of the Lorain program as a major threat (and vice-versa) because of the difference in scope. The Lorain program is primarily directed toward scene responses, while the Cleveland service records 95 % interfacility transports. Slightly ahead of its second anniversary this summer, the service added a second helicopter - becoming the only hospital program in the state to offer two aeromedical helicopters. Part of the reason for the
HOSPITAL AVIATION, AUGUST 1984
15
Program Profile... expansion is the rapid growth of the service. About 200 patients were transported by the Metro Life Flight helicopter during its first year of service, but the second year saw a 100% increase to more than 400 patients. Utilization levels continue to soar, apparently, as program spokesman Oscar E. Carter III reports that the program is currently "averaging close to three transports per day." One of the most successful aspects of the Metro Life Flight service has been the demonstrated support and extensive participation in the program by the Northeast Ohio hospital community. "The program is truly promoted and marketed as a regional service," states Mr. Carter. "We encourage other participating hospitals to promote Life Flight as a part of their service. This allows them to promote their specialty services and use the helicopter as a transport resource." Evidence of the regional concept is present in the fact that two-thirds of all patients transported are flown to other participating medical centers. The addition of the second helicopter is also a result of this program sharing concept, with agreements with 40 other hospitals. "The additional helicopter will enable the system to significantly increase the number of transport requests that can be accepted while one helicopter is involved with another mission," states the July 1984 newsletter for Metro Life Flight. "Since the program's inception in 1982, 12 percent of the transport requests were made when the helicopter was on a run. A subsequent delay to the response resulted." The participation agreement provides standard transport agreement clauses, but emphasizes that the referring physician, upon acceptance from a receiving physician or hospital, determines patien t destination. It also provides that.the receiving hospital pay to the sponsor hospital the transport fee. Receiving hospitals have a voice in setting the fee, but the final determination is made by Cleveland Metro. When the program first started, it had participating agreements with about 15 other institutions. "The program wouldn't have gotten off the ground without their support,'" reminds Mr. Carter. Today, the total
Grant H o s p i t a l in C o l u m b u s w a s t h e first O h i o h o s p i t a l t o o p t for a t w i n e n g i n e h e l i c o p t e r - an MBB B O - 1 0 5 C B S .
number of participating hospitals is 40. Metro Life Flight's two helicopters, AStar 350B models from Aerospatiale, are crewed by six pilots and provided by Cimarron Helicopters of Oklahoma City. Each patient transport is attended by a critical care nurse and a staff level physician from either the Department of Emergency Medicine or Internal Medicine. Trauma and Life Flight
In central Ohio is Grant Hospital, sponsor of its Life Flight helicopter program begun in the autum of 1982. The program was first in the state to move up to a twin-engine helicopter, an MBB BO-105CBS. (Twin-engine helicopters are found at 40% of all programs across the nation). Like virtually all new hospital-based helicopter services, Grant Hospital availed itself of the resources of existing aeromedical services. "At numerous times throughout our implementation, Norfolk (the Nightingale program at Medical Center Hospitals in Norfolk, Virginia) hosted myself, our chief flight nurse, our marketing director, medical director and various members of our trauma committee," recalls Tom Baxter, program director for Grant Hospital Life Flight. Mr. Baxter requested and received the resources of other programs in Tulsa, Oklahoma and Evansville, Indiana in the training of flight nurses. Each new
flight nurse was sent to one of the programs for five days of "on-the-job" training with the host medical teams, including participation in actual missions. The beginning of Grant's aeromedical service coincided with completion of a building addition to the hospital. The new addition included a new ICU and CCU, an expanded and consolidated laboratory, a new trauma center, expanded surgical area and a double-in-size radiology department which included newly acquired digital angiography and linear accelerator. The helicopter is staffed with the pilot and a nurse/paramedic medical team. Paramedics, like those of most aeromedical programs, work about one 12-hour shift per week in addition to full time EMS employment with local agencies. Nurses are also scheduled for 12-hour shifts. Dispatch functions were assigned to an existing 24-hour hospital security dispatch center. The addition of a logging recorder, a TV monitor for the parking garage helipad, and two remote units for the rooftop VHF transceiver (one is located in the emergency department), plus an orientation for dispatchers was all that was needed to provide 24-hour communications for Life Flight. The program's aircraft, three pilots, and a mechanic are provided by Omniflight Helicopters, Inc. of Janesville, Wisconsin. Omniflight is HOSPITAL AVIATION, AUGUST 1984
17
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Program Profile...
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It's waterproof, windproof and breathable, with 3-ply Gore-Tex laminated to 83/17 poly/cotton poplin for wear resistance. The liner is a brushed nylon tricot for a soft, warm feel. This weather-shedding model includes a three-piece billed hood, two sno-proof cargo parckets with handwarmer ~ockets behind them, and two additional ~ockets at the chest. Drawstring waist with cordlock. Double slider zipper with zipper flap secured by snaps. Throat protector, gusset cuffs with velcro closure. Availalbe in navy blue, tan and steel blue. Sizes XS, S, M, L, XL GTS List $158.00, our price $133.00 (Quantity )rices available).
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Departing the rooftop helipad at Miami Valley Hospital in Dayton is the Care FLight helicopter enroute to a rural hospital for patient transport. prove itself nationwide, Miami Valley the second largest operator of again became interested - - to the aeromedical programs, and operates point of obtaining a feasibility study. more twin-engine helicopters for But a series of delays, reviews and hospitals than any other operator. other priority projects postponed the implementation of the project until Dayton Enlarges EMS Capabilities last year. Miami Valley Hospital, a 772-bed Care Flight was begun in designated trauma center, had been September 1983. The program has interested in hosting an aeromedical adopted some atypical staffing program as early as 1977. Initial patterns for flight nurses and justification for a helicopter was based dispatchers to fit budgetary on the desire of smaller rural constraints, and yet they appear to communities to enlarge their EMS work quite well. capabilities. To do so would have The Astar helicopter, leased to the required additional people and hospital by Rocky Mountain vehicles, which were not Helicopters, is medically staffed by cost-effective due to the low two flight nurses for each flight, who frequency of transports from each work a variable 8 or 12 hour shift. In area. In addition, such a frequency addition to the chief flight nurse, six full-time flight nurses staff the would not maintain skills necessary for highly-trained personnel. program, along with six part-time The helicopter, by virtue of its flight nurses. The part-time nurses speed, could provide the same work 16 hours a week for Care Flight resource but cover a much larger area and 24 hours per week in other critical due to its speed. The helicopter idea care areas of the hospital. was supported by the concept of Dispatch is part of hospital security. improving quality of care, and Care Flight missions take priority, alleviating the staffing problems faced however. Dispatch functions with in the rural communities. two full-time dispatchers who fill the The aeromedical helicopter concept Monday-Friday 8-5 shift and was viewed rather skeptically at the Sunday-Thursday eveing shift. The time, however, as only a handful of balance of shift hours are filled by programs were then operating, and part-time personnel. While the job little was known about them. A description requires EMT's, most common conception was that the dispatchers have a paramedic whole idea was a passing fad, one certificatiion. which wouldn't work in the long run. During a Care Flight mission, the In 1980, after the hospital-based dispatcher can concentrate on helicopter concept had begun to aeromedical operations by putting
Program Profile... security calls on a call-forwarding system to another area of the hospital. Alternatively, a security officer is called in to handle the routine traffic. The system works quite well, according to program personnel. C i n c i n n a t i G e t s a "'Go'"
The University of Cincinnati Hospital is the sixth and latest medical center to adopt a helicopter in the state of Ohio. Slated to begin in October, the service will utilize an MBB BO-105CBS operated by Omniflight Helicopters. Staffed by a nurse and emergency medicine resident (the University had one of the first EM resident programs in the nation), the program will serve portions of southern Ohio, northern Kentucky and southeastern Indiana. Not unlike Dayton, aeromedical helicopters have been in the minds of many in the Cincinnati area. University Hospital first became serious about the concept in 1982, when a feasibility study was commissioned in October of that year. That same month, in reply to a request by University Hospital, the state
Department of Health ruled that the air ambulance programs no longer needed a certificate of need review. "The establishment of an air ambulance service is not considered a new health s e r v i c e . . , it is considered an extension of existing emergency service provided by the hospital," replied the department. As the hospital made preparations to begin the project, the state declared a financial crisis and put a hold on the issuing of any monies for new projects. The helicopter project and its helipad at the state-sponsored university fell to the axe. Late in 1983, as the financial crisis eased, the hospital again laid plans to begin its aeromedical service. This time, the state revised the Certificate of Need procedure, and rescinded all pending applications, including previous awards of non-reviewability. University Hospital again went through the paperwork process and eventually gained another determination of non-reviewability. While hospital personnel were busy in the trenches at the front, a local non-hospital air ambulance service
appeared at the rear, announcing its intention to fly an aeromedical helicopter. But the service lasted only a few weeks, allowing the hospital to proceed with its internal approval process. For the next several months, previous research was updated, meetings were held, and committee presentations and reviews were scheduled. Finally, the last approval was obtained, and the University went out for bid to prospective vendors. Applications were mailed to 26 vendors. Eighteen of them appeared at a mandatory bidder's conference. Eight of them submitted bids. Four of those bids were disqualified as they did not meet specifications. And through a detailed selection process, the successful operator and aircraft model were determined. As this issue goes to press, flight nurses are being trained, the aircraft is being configured, the helipad is being constructed, and a myriad of other implementation duties are being attended to in preparation for the sixth aeromedical helicopter program in the state of Ohio.
Clinton Aviation can help your EMS program take flight. Whatever your EMS needs, the sky is the limit with Clinton Aviation. Clinton offers you a full range of EMS services--consulting, aircraft sales and leasing, operations management and complete turnkey programs. For your immediate needs, our current inventory of rotary aircraft includes: • Five 355F TwinStars • Two 365N Dauphin 2s • One 360C Dauphin • One 350D A-Star For more information about our full EMS aviation services, contact Clinton Aviation, P.O. Box 60429, Houston, Texas 77205, 713/443-2000.
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HOSPITALAVIATION, AUGUST1984 19
Profile
The Life Flight 365N Dauphin 2 at St. Vincent Hospital in Toledo flies about 900 patients annually. True to the heritage blazed by the Wright Brothers, the state of Ohio is still an aviation leader. Only this time it is in the field of hospital-based helicopter operations. Ohio has more aeromedical helicopters flying than any state with the exception of California, providing its citizens with border-to-border coverage. It approaches the Swiss and West Germans in response time, with few residents being more than 25 minutes from the nearest service.
History The city of Columbus hosted the first aeromedical helicopter program to start in that state in 1973. The program, dubbed "Doctor 'Copter," used a National Guard 'Huey' and was available only on weekends. The service ceased operation after transporting 164 patients in two years amid questions of liability for damages if the helicopter should crash enroute to a hospital. During the four years to follow, the EMS helicopter was gaining in popularity in the United States - - but the concept was that of a 24-hour service sponsored by and based at hospitals. More than a dozen programs had started across the nation by mid-1979. 12 HOSPITALAVIATION, AUGUST 1984
Later that year, St. Vincent Hospital of Toledo became the first Ohio hospital to sponsor a 24-hour aeromedical helicopter service with an Alouette III. It was the 22nd such program in the United States, but the first one to fly more than 500 patients during its first year save Denver and Houston. Today the service utilizes the largest helicopter to be found at a hospital in the United States, an Aerospatiale 365N Dauphin 2. It was another three years before the next aeromedical helicopter program established roots in Ohio soil, and then there were two starting at the same time - - in the fall of 1982. Cleveland Metropolitan General Hospital in Cleveland, and Grant Hospital in Columbus became the sponsors of new services. The Cleveland program started with an Aerospatiale AStar, and now has two of the craft - - and has transport agreements with more than 40 hospitals. Columbus was first to host a twin-engine helicopter in the state (third in the nation) and flies an MBB BO-105CBS. The fourth program began a year later in Dayton - - at Miami Valley Hospital - - flying an AStar, followed in early 1984 by Lorain Community Hospital in Lorain. The latter program
utilizes a Bell LongRanger II and is reportedly the only hospital in the nation with an IFR (instrument flight rules) capable helipad (final approval for the IFR approach has not been received, however). And scheduled to start this October with a BO-105CBS is the University of Cincinnati Hospital in Cincinnati. The variety of aircraft flying medical missions in the state is exceeded only by the number of operators who fly them. Clinton Aviation of Houston flies in Toledo, Cimarron Helicopters from Oklahoma City flies in Cleveland, Omniflight Helicopters of Wisconsin flies for Columbus and soon Cincinnati, Omni Helicopters of Cleveland flies in Lorain and Rocky Mountain Helicopters of Utah flies for Dayton.
Transport statistics Ohio ranks 35th in geographical size in the country, but ranks sixth in terms of population with nearly 11 million residents. In 1983, with four programs operational (the latter starting in September of that year), more than 1,400 patients were transported by helicopter. The programs of Ohio fly 50 % of all transports back to the sponsor
Program Profile...
O n e of t w o Astars for C l e v e l a n d M e t r o p o l i t a n G e n e r a l H o s p i t a l is c a p t u r e d over t h e C l e v e l a n d S k y l i n e .
hospital - - a figuare below the national average of 63 % but typical for metropolitan areas. About 13% of all flights are scene calls, and 38% of all missions are flown at night. In addition, the average 1-way flight for Ohio programs is 44 miles, reflecting an average response time of approximately 25 minutes from the sponsor hospital to the patient in need. The T o l e d o TriaI
In 1979, Certificate of Need was alive and well, and posed a substantial obstacle for St. Vincent Hospital• The hospital negotiated a one-year program with the regional health authority, on the condition that an independent panel of physicians would review all patient transports during that year. Certificate of Need approval would be based on the success of the one year trial period and on the report of the physician panel• During the first 12 months, St. Vincent's Life Flight Alouette III flew more than 500 patients. Of that number, 326 patients were reviewed by the physician panel, which concluded, "The interventions of Life Flight made a difference in a patient's status and/or life 33.2% (17.3% + 15.9%) of the t i m e . . . We found that physician, other personnel, and equipment made the critical difference, even though an average of one-half hour's time was saved on the 14 HOSPITAL AVIATION, AUGUST 1984
final leg of the journey." (Life Flight Medical Evaluation Subcommittee Report, August 15, 1979 through August 14, 1980, Toledo, Ohio). The study referred to a reduction in patient morbidity of 17.3% and a reduction in patient mortality of 15.9% as a direct result of the Life Flight service. St. Vincent Hospital received full CoN approval at the end of the trial and has transported nearly 4,000 patients during its five years of operation. "The number of flights increased steadily over the years, but the number of flights missed while on other flights also increased," stated Pat Yancy, RN, long-time program director and chief flight nurse for Life Flight. "At the same time, similar programs developed in three cities within the 130 mile service area. Though 1983 s a w . . , a record 829 flights, the need to enhance our marketing image was recognized." "Alternatives were scrutinized, Ms. Yancy continued. "The idea of a second aircraft, considered since 1980, was ruled out as too costly because of duplication of staff, supplies and other resources for sporadic (May through September) utilization. Fixed wing flights had been added in 1980, but did not reduce the number of requests within the area served by the helicopter. Many of the new technology aircraft sacrificed size for speed. The Alouette 316 being used was quite a workhorse • . . but slower than our competition,
and it still offered us more patient care space than the new technology ships had." The service eventually selected an Aerospatiale 365N Dauphin 2 helicopter which began service in early 1984. It is capable of transporting up to three patients and three attendants. The aviation portion of the service is supported by Clinton Aviation of Houston, Texas. "Clinton offered us an affordable way to obtain the Dauphin 2 . . . which has allowed us to complete more flights in less time and expand our EMS scene response," explained Ms. Yancy• Clinton also leases five TwinStars to Hermann Hospital in Houston, but operations there are conducted by Hermann's own flight department. Three pilots and one mechanic are provided by Clinton to keep the Toledo program flying. The hospital provides each medical flight with a flight nurse and senior emergency medicine resident physician. "The medical crew of nurse and physician can expedite scene time because the roomy cabin allows for complete patient assessment and needed stabilization," observed Ms. Yancy. "The new ship has many promotional marketing aspects, too. Local EMS Chiefs have been visiting and flying with us, [allowing them] to learn about the emergency air medical service, the capabilities of the new aircraft, the flight crew, as well as the support staff who remain at St. Vincent and the specialized services offered by the Medical Center." St. Vincent draws from a complement of 6 full-time and 2 part-time flight nurses on 8-hour shifts. The hospital also maintains a full-time dispatch center for Life Flight, staffed by paramedics and EMT's working part-time in addition to their full-time EMS jobs. The Eagle has l a n d e d
About 80 miles to the east along Lake Erie's southern shore is Eagle Flight based at Lorain Community Hospital in Lorain. The newest program in the state, Eagle Flight leases a Bell LongRanger II on floats from Omni Helicopters of Cleveland. Lorain is a suberb of Cleveland• The dot on the map belies its p o p u l a t i o n - over 75,000 in a county of more than 270,000 people. In spite of its proximity to the aeromedical
Program Profile... programs in Toledo and Cleveland, Eagle Flight transported 90 patients during the first six months of service. The program specializes in scene calls, and has averaged 63% of its flights to accident scenes. That percentage the past couple of months has been even higher. The hospital has the distinction of operating the first and only known hospital helipad in the nation designed for IFR operations. Built in 1981, the helipad features a 40-foot diameter operating helipad marked b y sequential strobe lights (heretofore found only at the end of major airport runways) and floodlights. In addition, a PLASI (pulse-light approach slope indicator manufactured by DeVore Aviation of Albuquerque, NM) marks the glideslope for the approach. Additional aids include a heliport beacon and a lighted windsock. A 12-foot wide taxiway, complete with standard blue taxiway lights, leads to a spacious (three helicopter plus) helicopter parking ramp that comes within 90 feet of the hospital's
emergency department. Built nearly three years prior to the start of the hospital-based Eagle Flight program, the helipad is a frequent host to Coast Guard and Army Reserve medical helicopters. Unfortunately, as no precedence exists, the approval for actual IFR approaches has been delayed. Eagle Flight is staffed by a nurse and paramedic medical team and has a close working relationship with a dive rescue team. The relationship is close, as members of the dive team are associated with the hospital and include paramedics and even one physician. When the dive team is called out, as it has been about five times since it went into operation one month ago, a paramedic diver replaces the flight nurse on the helicopter. Additional special equipment is also loaded aboard for the mission. A number of calls for Eagle Flight are for water-related accidents, due to the program's proximity to Lake Erie. In addition, several flights are made to islands on the lake - - not so much for
critical patients but for basic emergencies as such patients have no way to be transported safely to the mainland. Cleveland Has Two
Metro Life Flight, sponsored by Cleveland Metropolitan General Hospital, a 680 bed tertiary medical center in Cleveland, was begun in September 1982. It was the second hospital-based aeromedical helicopter service to begin in the state of Ohio. Metro Life Flight does not view the proximity of the Lorain program as a major threat (and vice-versa) because of the difference in scope. The Lorain program is primarily directed toward scene responses, while the Cleveland service records 95 % interfacility transports. Slightly ahead of its second anniversary this summer, the service added a second helicopter - becoming the only hospital program in the state to offer two aeromedical helicopters. Part of the reason for the
HOSPITAL AVIATION, AUGUST 1984
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Program Profile... expansion is the rapid growth of the service. About 200 patients were transported by the Metro Life Flight helicopter during its first year of service, but the second year saw a 100% increase to more than 400 patients. Utilization levels continue to soar, apparently, as program spokesman Oscar E. Carter III reports that the program is currently "averaging close to three transports per day." One of the most successful aspects of the Metro Life Flight service has been the demonstrated support and extensive participation in the program by the Northeast Ohio hospital community. "The program is truly promoted and marketed as a regional service," states Mr. Carter. "We encourage other participating hospitals to promote Life Flight as a part of their service. This allows them to promote their specialty services and use the helicopter as a transport resource." Evidence of the regional concept is present in the fact that two-thirds of all patients transported are flown to other participating medical centers. The addition of the second helicopter is also a result of this program sharing concept, with agreements with 40 other hospitals. "The additional helicopter will enable the system to significantly increase the number of transport requests that can be accepted while one helicopter is involved with another mission," states the July 1984 newsletter for Metro Life Flight. "Since the program's inception in 1982, 12 percent of the transport requests were made when the helicopter was on a run. A subsequent delay to the response resulted." The participation agreement provides standard transport agreement clauses, but emphasizes that the referring physician, upon acceptance from a receiving physician or hospital, determines patien t destination. It also provides that.the receiving hospital pay to the sponsor hospital the transport fee. Receiving hospitals have a voice in setting the fee, but the final determination is made by Cleveland Metro. When the program first started, it had participating agreements with about 15 other institutions. "The program wouldn't have gotten off the ground without their support,'" reminds Mr. Carter. Today, the total
Grant H o s p i t a l in C o l u m b u s w a s t h e first O h i o h o s p i t a l t o o p t for a t w i n e n g i n e h e l i c o p t e r - an MBB B O - 1 0 5 C B S .
number of participating hospitals is 40. Metro Life Flight's two helicopters, AStar 350B models from Aerospatiale, are crewed by six pilots and provided by Cimarron Helicopters of Oklahoma City. Each patient transport is attended by a critical care nurse and a staff level physician from either the Department of Emergency Medicine or Internal Medicine. Trauma and Life Flight
In central Ohio is Grant Hospital, sponsor of its Life Flight helicopter program begun in the autum of 1982. The program was first in the state to move up to a twin-engine helicopter, an MBB BO-105CBS. (Twin-engine helicopters are found at 40% of all programs across the nation). Like virtually all new hospital-based helicopter services, Grant Hospital availed itself of the resources of existing aeromedical services. "At numerous times throughout our implementation, Norfolk (the Nightingale program at Medical Center Hospitals in Norfolk, Virginia) hosted myself, our chief flight nurse, our marketing director, medical director and various members of our trauma committee," recalls Tom Baxter, program director for Grant Hospital Life Flight. Mr. Baxter requested and received the resources of other programs in Tulsa, Oklahoma and Evansville, Indiana in the training of flight nurses. Each new
flight nurse was sent to one of the programs for five days of "on-the-job" training with the host medical teams, including participation in actual missions. The beginning of Grant's aeromedical service coincided with completion of a building addition to the hospital. The new addition included a new ICU and CCU, an expanded and consolidated laboratory, a new trauma center, expanded surgical area and a double-in-size radiology department which included newly acquired digital angiography and linear accelerator. The helicopter is staffed with the pilot and a nurse/paramedic medical team. Paramedics, like those of most aeromedical programs, work about one 12-hour shift per week in addition to full time EMS employment with local agencies. Nurses are also scheduled for 12-hour shifts. Dispatch functions were assigned to an existing 24-hour hospital security dispatch center. The addition of a logging recorder, a TV monitor for the parking garage helipad, and two remote units for the rooftop VHF transceiver (one is located in the emergency department), plus an orientation for dispatchers was all that was needed to provide 24-hour communications for Life Flight. The program's aircraft, three pilots, and a mechanic are provided by Omniflight Helicopters, Inc. of Janesville, Wisconsin. Omniflight is HOSPITAL AVIATION, AUGUST 1984
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WE HAVE GORE-TEX o PARKAS!
Program Profile...
Insulated Gore-Tex Parka
The cape shoulder parka combines high style with low temperature and heavy weather capabilities. Sontique * fill ]rovides warmth, yet is slim and supple for outdoor activity. Two-ply Gore-Tex is laminated to tough poly/cotton poplin for a waterproof, windproof, breathable shell. Fully lined with nylon taffeta. The billed hood stows in the snap-down collar. Two full-bellowed sno-proof cargo lockets, insulated handwarmer pockets and an inside cargo pocket with elasticized top. Drawstring waist with cordlock. Zipper flap has full center velcro seal. Gusset cuffs with velcro closure. Available in royal blue, mahogany (dark red), and gray. Sizes S,M,L,XL. GTP List $206.00, our price $172.00 (Quantity prices available).
Gore-Tex Shell
It's waterproof, windproof and breathable, with 3-ply Gore-Tex laminated to 83/17 poly/cotton poplin for wear resistance. The liner is a brushed nylon tricot for a soft, warm feel. This weather-shedding model includes a three-piece billed hood, two sno-proof cargo parckets with handwarmer ~ockets behind them, and two additional ~ockets at the chest. Drawstring waist with cordlock. Double slider zipper with zipper flap secured by snaps. Throat protector, gusset cuffs with velcro closure. Availalbe in navy blue, tan and steel blue. Sizes XS, S, M, L, XL GTS List $158.00, our price $133.00 (Quantity )rices available).
HOSPITAL AVIATION MARKETING 53 West 1800 South Orem, Utah 84058 801-226-3060 (For Information, Circle 47 on Inquiry Card)
18 HOSPtTALAVIATION, AUGUST 1984
Departing the rooftop helipad at Miami Valley Hospital in Dayton is the Care FLight helicopter enroute to a rural hospital for patient transport. prove itself nationwide, Miami Valley the second largest operator of again became interested - - to the aeromedical programs, and operates point of obtaining a feasibility study. more twin-engine helicopters for But a series of delays, reviews and hospitals than any other operator. other priority projects postponed the implementation of the project until Dayton Enlarges EMS Capabilities last year. Miami Valley Hospital, a 772-bed Care Flight was begun in designated trauma center, had been September 1983. The program has interested in hosting an aeromedical adopted some atypical staffing program as early as 1977. Initial patterns for flight nurses and justification for a helicopter was based dispatchers to fit budgetary on the desire of smaller rural constraints, and yet they appear to communities to enlarge their EMS work quite well. capabilities. To do so would have The Astar helicopter, leased to the required additional people and hospital by Rocky Mountain vehicles, which were not Helicopters, is medically staffed by cost-effective due to the low two flight nurses for each flight, who frequency of transports from each work a variable 8 or 12 hour shift. In area. In addition, such a frequency addition to the chief flight nurse, six full-time flight nurses staff the would not maintain skills necessary for highly-trained personnel. program, along with six part-time The helicopter, by virtue of its flight nurses. The part-time nurses speed, could provide the same work 16 hours a week for Care Flight resource but cover a much larger area and 24 hours per week in other critical due to its speed. The helicopter idea care areas of the hospital. was supported by the concept of Dispatch is part of hospital security. improving quality of care, and Care Flight missions take priority, alleviating the staffing problems faced however. Dispatch functions with in the rural communities. two full-time dispatchers who fill the The aeromedical helicopter concept Monday-Friday 8-5 shift and was viewed rather skeptically at the Sunday-Thursday eveing shift. The time, however, as only a handful of balance of shift hours are filled by programs were then operating, and part-time personnel. While the job little was known about them. A description requires EMT's, most common conception was that the dispatchers have a paramedic whole idea was a passing fad, one certificatiion. which wouldn't work in the long run. During a Care Flight mission, the In 1980, after the hospital-based dispatcher can concentrate on helicopter concept had begun to aeromedical operations by putting
Program Profile... security calls on a call-forwarding system to another area of the hospital. Alternatively, a security officer is called in to handle the routine traffic. The system works quite well, according to program personnel. C i n c i n n a t i G e t s a "'Go'"
The University of Cincinnati Hospital is the sixth and latest medical center to adopt a helicopter in the state of Ohio. Slated to begin in October, the service will utilize an MBB BO-105CBS operated by Omniflight Helicopters. Staffed by a nurse and emergency medicine resident (the University had one of the first EM resident programs in the nation), the program will serve portions of southern Ohio, northern Kentucky and southeastern Indiana. Not unlike Dayton, aeromedical helicopters have been in the minds of many in the Cincinnati area. University Hospital first became serious about the concept in 1982, when a feasibility study was commissioned in October of that year. That same month, in reply to a request by University Hospital, the state
Department of Health ruled that the air ambulance programs no longer needed a certificate of need review. "The establishment of an air ambulance service is not considered a new health s e r v i c e . . , it is considered an extension of existing emergency service provided by the hospital," replied the department. As the hospital made preparations to begin the project, the state declared a financial crisis and put a hold on the issuing of any monies for new projects. The helicopter project and its helipad at the state-sponsored university fell to the axe. Late in 1983, as the financial crisis eased, the hospital again laid plans to begin its aeromedical service. This time, the state revised the Certificate of Need procedure, and rescinded all pending applications, including previous awards of non-reviewability. University Hospital again went through the paperwork process and eventually gained another determination of non-reviewability. While hospital personnel were busy in the trenches at the front, a local non-hospital air ambulance service
appeared at the rear, announcing its intention to fly an aeromedical helicopter. But the service lasted only a few weeks, allowing the hospital to proceed with its internal approval process. For the next several months, previous research was updated, meetings were held, and committee presentations and reviews were scheduled. Finally, the last approval was obtained, and the University went out for bid to prospective vendors. Applications were mailed to 26 vendors. Eighteen of them appeared at a mandatory bidder's conference. Eight of them submitted bids. Four of those bids were disqualified as they did not meet specifications. And through a detailed selection process, the successful operator and aircraft model were determined. As this issue goes to press, flight nurses are being trained, the aircraft is being configured, the helipad is being constructed, and a myriad of other implementation duties are being attended to in preparation for the sixth aeromedical helicopter program in the state of Ohio.
Clinton Aviation can help your EMS program take flight. Whatever your EMS needs, the sky is the limit with Clinton Aviation. Clinton offers you a full range of EMS services--consulting, aircraft sales and leasing, operations management and complete turnkey programs. For your immediate needs, our current inventory of rotary aircraft includes: • Five 355F TwinStars • Two 365N Dauphin 2s • One 360C Dauphin • One 350D A-Star For more information about our full EMS aviation services, contact Clinton Aviation, P.O. Box 60429, Houston, Texas 77205, 713/443-2000.
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