Helicopter Air Ambulance Operations Impact on Communities and

Helicopter Air Ambulance Operations Impact on Communities and Airports

Introduction Pennsylvania Air medical services are positioned throughout the state to serve sponsoring healthcare organizations. There are several services located in neighboring states that also serve PA residents. There is a broad mixture of traditional and non traditional programs as well as “for profit” and Not for profit services. I will discuss some of the differences as well as the impact that these services have on communities and airports.

Geisinger Coverage Map

Goals and Objectives Gain an improved understanding of Air Ambulance coverage in Pennsylvania. Discuss market factors that drive expansion of Air Ambulance placement. Improve understanding of financial aspects of Air Ambulance work. Recognize Hazards to providing service.

1926, the United States Army Air Corps used a converted airplane to transport patients from Nicaragua to an Army hospital in Panama, 150 miles away. History of Medical Transport The routine medical evacuation mission of helicopters, however, evolved unintentionally during the Korean conflict in the 1950’s. An estimated 22, 000 troops were evacuated by air. The Viet Nam conflict brought further sophistication to the same general concept: fast and smooth air evacuation of the critically injured to field surgery for stabilization. Field emergency care and rapid evacuation for over 800, 000 troops reduced the war-long mortality even further.

• 1966 National Academy of Science white paper Accidental Death and Disability: The Neglected Disease of Modern Society. This led to the development of the EMS system in the US. • 1970: The Maryland State Police aviation program in March, 1970, became “the first civilian agency to transport a critically injured trauma patient by helicopter. ” • Today there are over 900 Air Medical Aircraft and tens of Thousands of specialty Ground Ambulances transporting the some of sickest patients. Some are still sponsored and operated by Hospital systems but most are independent “for Profit” corporations.

• J. Walter Schaefer founded the first air ambulance service in the U. S, in 1947, in Los Angeles. The Schaefer Air Service, operated as part of Schaefer Ambulance Service. Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. • Founded by St. Anthony Hospital in 1972 with a single Alouette III helicopter, Flight For Life® was the first hospital-based air ambulance program in the United States • Since then the Air Ambulance Industry has grown considerable. A period of explosive growth took place in the 1990’s when Rock Mountain Helicopters successfully challenged states that regulated helicopter placement on the basis of the Airline deregulation act of 1978.

History of Air Ambulances in Pennsylvania • • First service was Angel Flight in Pittsburgh Center Followed by Allegheny Life Flight, Geisinger Life Flight, and Lehigh Valley Medevac all in the early 1980’s Today the state is served by forty aircraft based in Pennsylvania and many others based outside. • • • STAT Medevac 13 bases (Non Profit) Many bases outside of PA Geisinger Life Flight 6 bases (Non Profit) Allegheny Life Flight 5 bases (Non Profit) Penn. Star Flight 2 bases (Non profit) Has one base outside PA Penn State Life Lion 2 bases (Non Profit) Rocky Mountain Holdings dba (For Profit) Operates in just about every state in the country • • • Lehigh Valley Med. Evac 4 bases Jeffstat 2 bases Guthrie Air 1 base Temple Medflight 1 base Conemaugh Med. Star 1 base Commonwealth One 1 base Several aircraft bases have ceased operations or changed ownership over the past five years as health systems merge and streamline healthcare cost.

The Jeanie is out of the Bottle The Airline Deregulation Act of 1978 • Up in the Air: Inadequate Regulation for Emergency Air Ambulance Transportation Consumer reports: March; 2017 • Air Ambulance Services Stun Patients With Bills NBC News March 2017 “"We're going to need an act of Congress to say air ambulances don't fall under the aviation deregulation act. "

Traditional vs. Community Based Services Traditional air medical services are hospital based, hospital operated and not for profit. • Provide charitable work • Contracts with Insurance companies • Higher degree of medical oversight • Historically has operated better quality equipment. Community Based Non Traditional services • May or may not have relationships with local hospitals • Owned and operated by for profit corporations (Aviation Vendors) • Historically have few if any contracts with third party insurance companies • Historically have utilized the most inexpensive equipment on the market (Medical and aircraft)

Regulations • Aviation • • FAR Part 135 FAR Part 91 • Medical Oversight • Department of HHS • • Centers for Medicare and Medicaid services • • Emergency preparedness and disaster relief Regulates reimbursement fee structure for not only Medicare but also third party insurers. State Department of Health regulations • • States dictate medical scope of practice and issue licenses same as any other ambulance. States are powerless to regulate billing, placement, operation, and management of Air ambulance due to federal regulations.

Community Impact • Benefits • • • Improved access to advanced healthcare resources in rural areas. Resource for providing medical training to local volunteer ambulance companies. Provides local revenue through use of local services • Hinderances • Noise complaints!

• Benefits • • Impact on Airports Usually long term tenants Commercial operator- all aircraft movements equate to additional federal funding • AVP Tower a good example Medical and Disaster expertise on site at your airport • Assist with planning, drills, training, and actual emergencies Purchase other services • • Hangar rental Aviation Fuel • Hinderances • • Potential for damage to facilities and other aircraft Helicopters do not always follow published airport traffic flow Increased Potential for fuel spills Noise complaints

Hazards to Operations Reduced visibility Long-distance in unfamiliar place Crew fatigue Exceeding helicopter’s performance Landing or takeoff in hazardous LZs

Safety • • • Standardized Procedures Ongoing safety and operational training Robust Safety Management System Crew Coordination Aircraft equipment • • • NVG equipped Dual GPS Three axis autopilot TCAS/TIS TAWS Satellite and active weather radar Flight data recording ADSB in and out coming in 2020 Instrument Rating • Instrument approaches to Hospitals

• Equipment cost • • New medium twin engine aircraft with safety enhancements- 10 -14 Million Specialized team salaries and benefits Dedicated operations center Direct aircraft operating cost (DOC) • • • Economics It is never what the salesman tell you! Our aircraft 1200 -1500/hour Maintenance Training Instrument currency/Training Fuel $$$ Burn on average 80 gal/hour Medical equipment/Training Insurance Average cost of local transport $$$

Geisinger Life Flight • The Geisinger Life Flight program first started operation in July 1981 with a single helicopter. Celebrating 37 years of service this year! One of the first three transport programs in the state. • Today there are nine helicopters All twin engine SPIFR rated • Geisinger operates its own FAA part 135 commercial certificate • • Dedicated director of operations, director of maintenance, chief pilot, Director of safety, training manager, aviation QA inspector and much more All vehicles are PA DOH EMS licensed • • • All Patient Transport vehicles and services are CAMTS Accredited 110 Medical Providers (EMT, Paramedics, RN, and Physicians) 28 Pilots 12 aviation mechanics 10 NAACS certified dispatchers/Communications technicians

Team members must be highly trained and highly motivated. Conclusions Team members must be able to rapidly adapt to changing situations, patient conditions, and transport conditions. Pre-planning is essential.

Questions?

Blakeman, T. C. , MSc RRT, & Branson, R. D. , MSc RRT FAARC. (2013). Interand Intra-hospital Transport of the Critically Ill. Respiratory Care, 58(6), 1008 -1021. References Comeau, O. Y. , RN, MS, CNS, CCRN, Armendariz. Batiste, J. , RN, MSN, CCRN, & Woodby, S. A. , RN, BSN, CCRN. (2015). Safety First! Using a Checklist for Intrafacility Transport of Adult Intensive Care Patients. Critical CARE NURSE, 35(5), 16 -24. Tipping, R. D. , MB, BS, FRCA, Mac. Dermott, S. M. , DO, Davis, C. , & Carter, T. E. , MD. (2015). Air Transport Of The Critical Care Patient. In Combat Anesthesia: The First 24 Hours (pp. 391 -399). Houston, TX: Office of the Surgeon General Borden Institute Fort Sam Houston.

Contact Information Redmond Lines RN, BSN, CCRN, CFRN, CMTE, PHRN Clinical Operations Manager Geisinger Life Flight Office: 570 -451 -1068 Life Flight Program Information 570 -271 -6217