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Wake Forest revamps after two copter crashes
The air ambulance program at Wake Forest University Baptist Medical Center in Winston-Salem, NC, goes beyond the minimum requirements in an effort to make its medical helicopters as safe as they can be.
The institution flies its medical choppers under the guidelines recommended in 1988 by the National Safety Transportation Board (NTSB), which the Federal Aviation Administration (FAA) still has not adopted as requirements for all programs. Wake Forest has good reason to take helicopter safety seriously: The program began in 1986 and soon experienced two fatal crashes. Those accidents prompted the hospital to put safety first.
Those crashes occurred when the aircraft were not as advanced, and terrain avoidance systems would have helped in both cases, says James Bryant, RN, MSN, director of emergency and transport services at Wake Forest. The hospital now flies an EC-135 Eurocopter, which is smaller and more fuel-efficient than its predecessor, and it comes equipped with terrain avoidance, autopilot, satellite tracking, and a digital cockpit as opposed to older dial-type gauges.
The crew consists of one pilot, a nurse, and a paramedic. It typically carries one patient but can take two if needed. The hospital just recently acquired night vision goggles, and the crew was to begin training with them in January.
Wake Forest contracts with Air Methods, a company based in Englewood, CO, that provides the aircraft, pilots, mechanics, and logistical support. Wake Forest provides the medical crew, billing, dispatching, and flight monitoring for the missions. Flight operations are monitored from Air Methods' Colorado base, aiding the Wake Forest crew with weather reports and decision making about each mission. Wake Forest has a strict policy that says any crew member can veto a mission for safety reasons.
"If any flight member believes the flight is not a go, and that includes everything down to just a gut feeling, then we do not go on the flight," Bryant says. "Anyone can decline a flight. It could be a bad feeling about the weather or it can be that they're not feeling well, they haven't had a good day, and they don't think they can fulfill their obligation to safety."
Wake Forest never second-guesses or challenges pilots or mechanics about safety. If a mechanic says the aircraft can't fly today, that's the end of the discussion. But at the same time, Bryant says, the crew is held to extremely high standards for compliance with safety regulations. A paramedic recently was grounded for a period of time because he left a trash bag near the helicopter a safety risk because the bag could be sucked into the engine. The pilot found the bag and had the paramedic temporarily grounded, a strong message that safety infractions will not be tolerated.
The Wake Forest program works proactively to minimize many risks by designating safe landing areas in many communities, studying the approach and hazards in advance. Even with a single aircraft, Wake Forest flies about 600 missions per year, averaging two per day.
Bryant is in the process of working out an arrangement with his counterparts at other hospitals in the community, so they can share satellite tracking data for their helicopter programs, in effect creating an air traffic control system for area medical helicopters. He already has worked out an agreement with one nearby hospital and hopes to include many more. Such an arrangement could help avoid crashes, such as the June 29, 2008, incident in which seven people died when two helicopters crashed into each other near Flagstaff (AZ) Medical Center. The two helicopters, from different air ambulance services, were both trying to deliver patients to the hospital.
Wake Forest requires that its medical choppers fly under the FAA's "Part 135" rules, referring to a part of the FAA regulations governing the minimum weather allowances for safe flight, rather than the "Part 91" rules. The FAA allows medical choppers to fly under "Part 91," which means flying in worse weather, but Wake Forest insists on meeting the higher safety standards. The pilots also are instrument-rated for flying in bad weather.
"On the same day that they had a crash in Wisconsin recently, we had really bad weather with a lot of clouds rolling in as our pilot was already out on a mission, and so he made the decision to cancel the mission and land at a local airport. We picked our crew up at the airport and brought them back by ground," Bryant recalls. "Instead of trying to navigate that bad weather, he made the right decision to use instruments for a safe landing and wait for a pickup. That's the decision making we want from our crew."
Despite the best efforts to ensure safety, Wake Forest knows from experience that a medevac flight can end in tragedy. So, the hospital provides an extra $1 million in life insurance coverage for each member of the crew, beyond any insurance and other benefits they may receive from their employers.
"It gives the crew a little bit of security to know that if something were to happen, their families won't be left in need," Bryant says. "We don't want to think about crashes all the time, but we have to remember that it can happen."
For more information on the Wake Forest air ambulance program, contact:
James Bryant, RN, MSN, Director of Emergency and Transport Services, Emergency Department, Wake Forest University Baptist Medical Center, Winston-Salem, NC. Telephone: (800) 446-2255.