WILD BLUE YONDER
September 8, 2015
By Audrey Fraizer
LifeLink III Communication Specialist Mike Jacobson sits totally immersed at his CAD directing critical care helicopter flight crew to the nearest Trauma I center for a patient critically injured in a grain elevator blast at a feed mill in northwest Wisconsin. The weather was originally forecast to be good enough to complete the trip, but Mother Nature threw a monkey wrench into the mix as the low pressure system intensified and began moving faster than anticipated. Lowering clouds and rain threatened to block the route.
While flying in rainy, windy conditions is generally not an issue, explained LifeLink III Communication Manager Rob Vawser, lack of visibility can obscure towers and other vertical obstacles along with landmarks necessary to guide the helicopter to the scene and landing.
“The pilot can become disoriented so we stay away from fog and heavy clouds,” said Vawser, who took over the management position in January at the communication center based in Minneapolis, Minn.
At the heart of the incident is Jacobson. He will stay on the call and—if necessary—coordinate ambulance service if the flight is diverted and conditions further deteriorate. He will update the medical crew onboard regarding the situation on scene and communicate with the hospital.
“It’s straight on our shoulder every time we send people out,” Jacobson said. “We have to live with all of our decisions to the end of time.”
In the last 25 years, air medical transport has become an essential part of EMS in Minnesota due, at least in part, to the increasing popularity of the north woods with its stretches of heavy forest and isolated lakes and the distance to a tertiary hospital from a small local access hospital for patients requiring a higher level of care. Nearly 90 percent of LifeLink III’s air transport involves inter-facility transport. The other 10 percent comprises trauma emergencies such as grain elevator explosions or motor vehicle accidents resulting in critical injury; actual helicopter emergency medical service (HEMS) transport depends upon first responders on scene, who also decide the service to call (generally related to proximity) and which hospital to send the patient. Pilots decide whether to fly if the weather is bad.
An explosion at a grain elevator is not uncommon in the rural areas LifeLink III serves; however, for the purposes of this story, the specific incident was dramatized to highlight the intensity of helicopter dispatch, whether for an emergency in a remote setting or an inter-facility transfer. Jacobson has been in dispatch since 2005 (following three years in ground ambulance) and the intensity wrapped into this job is a major reason he wouldn’t trade it for anything else in or out of EMS.
“It’s the excitement,” he said. “We make decisions in a split second. Somebody needs you at that moment and you’re doing all you can possibly do to save that person’s life.”
Jacobson’s dedication earned him a ticket to Shreveport, La., for a beta test of a simulator program designed specifically for HEMS dispatchers by the Metro Aviation Helicopter Flight Training Center. The HEMS Commlab provides scenario-based, hands-on training and evaluation for air medical communication specialists. The helicopter crew and CAD/radio operators are situated within the four walls of the same building, separated by a wall. Together they practice worst-case scenarios that can happen although they do not occur at any great frequency.
“These are major incidents that require practice because if they happen, it can be tragic,” said Vawser, who helped design the lab prior to moving to Minnesota. “Some of these are incidents that don’t turn out so well and the sim lab allows you to see how you could do it better.”
According to information available from the Metro Aviation website, training includes inter-facility and scene transfers, bird strikes, neonatal transfers, multiple aircraft requests, misinformation and changing landing zones, as well as instrument flight rules (IFR) conditions and instrument meteorological conditions (IMC). Communication specialists sharpen skills for map reading, customer service, radio operations, flight planning and following, and safety-related procedures.
Jacobson spent two days at the HEMS Commlab in Shreveport participating in three practice scenarios and rotating among the CAD, radio, and control desk. Working in a strange environment with people he did not know until the class, and operating unaccustomed equipment, added to the experience, he said.
“This was as real as you can get without being in the communication center,” he said.
Vawser said the Commlab for HEMS communication specialists is a first for the industry and replaces the unannounced drills common to flight dispatch; the lab also falls in line with the type of training flight crews receive and Federal Aviation Administration (FAA) regulations highly recommend.
Today’s world of HEMS is a far cry from a generation ago when Cheryl Pasquarella, registered nurse, started with the company in 1982. Pasquarella wanted a change from the hospital setting and that’s exactly what she found as the nurse on an ambulance helicopter.
“The industry was in its infancy,” she explained. “A supervisor sat at a desk and would page us out when the call came in. We had a flight plan but it was still a daunting task to find the people.”
The air ambulance was equipped with standard hospital equipment—nothing specific to helicopter medical response—which exacerbated the situation.
“We were limited to what we had on the aircraft,” she said.
This was prior to the advent of satellite phones. There was no ground communication. People at the scene might hear the helicopter above but were unable to attract the attention of a flight crew, particularly at places obscured by Minnesota’s thick forests. HEMS was a dangerous mode of rescue, underscored by statistics of the 52 fatalities caused by EMS helicopter crashes between the years 1985 to 1989; the numbers made helicopter flight safety a priority for the National Transportation Safety Board (NTSB) in Washington, D.C.
“We knew the danger involved,” said Pasquarella, LifeLink III Director of Compliance & Quality Assurance. “But we tried not to think about it.”
As a former nurse in a hospital, she was also outside her comfort zone of control. The helicopter did not provide the benefit of good lighting, additional staff, tools and drugs, and space. It was hard to hear anything above the rotor noise.
“We had to figure out what to do with what we had,” she said.
After 15 years in the air, Pasquarella decided she no longer wanted to be standing in a cornfield in the middle of January, watching her breath turn into little clouds in the below freezing weather, while trying to stabilize a patient prior to flight. She switched to HEMS administration and currently oversees the myriad regulations that govern HEMS. She said flight control, safety, and navigation technology has made flights by EMS helicopter crews much safer, as have constant training and subsequent certifications. Studies showed that EMS helicopter safety has improved due to the development of navigational aids such as the Garmin Head-Up Display.
But it’s not only technology.
LifeLink III has also heavily invested in research, including studies into noise levels and the use of sophisticated equipment modified for flight, such as the use of ultrasound for diagnosing collapsed lungs. Medical helicopters also commonly carry more drugs than an ALS ground ambulance.
The industry, however, still has its risks and when an accident does occur, it becomes a high-profile incident that heightens the perspective of just how inherently dangerous HEMS can be. The FAA still considers (and probably always will) helicopter safety a priority, as shown in the agency’s sweeping final rule issued on Feb. 20, 2014, that applies to all helicopter operators. Briefly, the ruling requires helicopter operators, including air ambulances, to have stricter flight rules and procedures, improved communications and training, and additional on-board safety equipment. Employers are required to provide sufficient aviation-specific training to permit communication specialists to perform their intended functions and to know what their limits of authority may be.
Despite the rules, the layers of regulations, and constant scrutiny, there’s the personal side of the industry that keeps communicators at the CAD.
“I love what I do,” said Niki Fortune, LifeLink III flight Communication Specialist since 2008. “Everything starts with us, and, whatever happens, their safety is our responsibility. This is our family.”