Sonja J. Carlson

Best Practices

By Sonja J. Carlson

Paramedic Scott Anderson worked the first North Memorial Air Care (Minnesota) shift inside a Jet Ranger helicopter without wheels, moved outside the hangar atop a flatbed wagon pulled by a tractor-trailer. The space inside was cramped, to say the least, with the nurse and Anderson sitting side-by-side next to the patient in transport.

“We had to do as much as we could at the hospital before leaving and primarily managed the patient’s airway en route,” Anderson said.

There was no Global Positioning System (GPS), and dispatch estimated the helicopter’s location between point A and point B on the flight plan. The pilot would use time and distance estimates. Dispatch pulled out maps directing pilots to fly, for example, five miles northeast of a particular town or provide intersection of roadways.

“Our onboard medical crew would get out the atlas and try to pinpoint the scene,” said Steven Brinkman, a pilot with North Memorial Air Care for 30 years.

Anderson said pilots learned to navigate and find the destination “on the fly,” before the advent of GPS.

“I’ll never forget a Memorial Day flight where we were landing in Des Moines (Iowa) and didn’t know where the hospital was,” he said. “Dispatch had to use landmarks to direct us to the hospital.”

Once arriving at the hospital, before heliports were more the norm, staff on ground identified an open area for the helicopter to land.

Anderson, who has been with the company since 1985, said the process involved innovative, on-the-spur-of-the-moment thinking.

“I remember a flight where the best place to land was a ballfield, and we were told that we shouldn’t have any trouble finding it because it was so well lit,” Anderson said. “They had all the ballfield lights on and the local ambulance at the ready. It felt like we were on display.”

These days, hospital safe-landing zones are predefined. With the advent of GPS, pilots are armed with a satellite system that can determine the user’s position and display it on the unit’s electronic map. They can enter the GPS coordinates into the navigation unit, and autopilot will fly the crew directly to the scene.

GPS does not diminish the importance of dispatch. Atmospheric interference, satellite positioning, and tuning inaccuracies can interfere with accuracy. Flights absent of predefined safe-landing zones must take into account obstacles like trees, towers, and wires. The dispatcher must coordinate a temporary landing zone to include latitude/longitude coordinates, a ground contact, and special radio frequency, and, at the same time, (if applicable) Pre-Arrival Instructions (PAIs) for the patient.

A statewide radio communications systems introduced 14 years ago enhances ground-to-air contact. Pilots and dispatchers can talk back and forth regardless of location or altitude, either from systems built in the aircraft or by using handheld radios.

“There were many times we did not have communications,” Brinkman said. “Because, prior to that, we could talk only if we were in the air at a certain minimum altitude.”

Instead of carrying minimal supplies to ease the patient’s pain, at best, EMS helicopters are equipped with medications, ventilators, cardiac monitors, CPR equipment, surgical devices, and blood/fluid resuscitation products vital to keeping the patient alive en route prior to arriving at the hospital.

The care required starts with information gathered at dispatch.

“Our customers can be 911 callers, ground resources [police, fire, EMS], or other hospital personnel,” said Jan Althoff, EMD/Quality Assurance at North Memorial Air Care. “Triaging and providing Pre-Arrival Instructions can differ slightly depending on the customer.”

The helicopter EMS industry has expanded rapidly, particularly over the past 15 years, and with popularity and prevalence comes scrutiny and regulation.

The Federal Aviation Administration (FAA) published a final rule affecting all helicopter providers—not solely air medical helicopters. The portion of the regulation applying to helicopter air ambulance requires helicopter instrument rating for all air ambulance pilots, preflight planning to identify and document the highest obstacles along their planned routes, and a risk analysis considering all aspects of the route and weather.

The tractor-trailer is no more, and ballparks are left to the hometown team. GPS saved dispatch from location estimation.

During the 30 years since its founding, North Memorial Air Care has evolved from a single aircraft and two pilots to nine Agusta 109 helicopters—reaching speeds of up to 180 mph—flown from six bases in Minnesota and Wisconsin. More than 100 pilots, paramedics, and flight nurses provide response throughout Minnesota and areas of Wisconsin, Iowa, and the Dakotas. They respond to more than 4,500 service requests each year.

North Memorial Air Care Communications Center is accredited by the Commission on Accreditation of Medical Transportation Systems and by the Commission on Accreditation of Ambulance Services.

1985 Air Care team:

The original North Memorial Air Care team in 1985 that has grown to a team of more than 100 pilots, paramedics, and flight nurses today, serving Minnesota and western Wisconsin with nine aircraft and six bases.

1985 helicopter:

North Memorial Air Care launched in 1985 with a single helicopter that often had to land in fields due to the lack of heliports.

1985 team aircraft:

The team that started North Memorial Air Care in 1985 and helped it grow into one of the longest-running air ambulance services in the upper Midwest.

1985 team helicopter:

With no ground crew back in 1985, the North Memorial Air Care medical team would tow the helicopter out of the hangar themselves.

Current team Agusta:

Today, North Memorial Air Care has transported nearly 50,000 patients and flown more than 80,000 hours safely.

2015 dispatch:

North Memorial Air Care Emergency Medical Dispatcher Steve Carlson monitors flights from its six bases to more than 150 communities across Minnesota and western Wisconsin.

2015 Agusta:

The latest addition to North Memorial Air Care’s fleet of nine Agusta 109 twin-engine helicopters.