Sikorsky S76s save kids at Arkansas Children’s Hospital

Dedicated HEMS operation uses integrated SMS and FAA-approved FOQA program to provide safe patient transport to advanced care facility.

By Stuart Lau
ATP/FE/CFII. Boeing 747, 747-400, 757/767, CRJ and Saab 340

(L–R) Arkansas Children’s Hospital maintenance team and pilots at LIT maintenance facility.

Helicopter EMS (HEMS) operations in the US are complex. From organizational structure to insurance reimbursement rates, it’s a difficult business. Operationally, HEMS is even more challenging, from dynamic weather conditions to the pressures of performing in the “golden hour”—the most critical time in patient care.

As a result, safety sometimes suffers. It’s no wonder that Congress, NTSB, FAA, GAO, media and public alike scrutinize this segment of the helicopter industry heavily. One operator, Arkansas Children’s Hospital (ACH), has mitigated these risks by employing several layers of defense.

By design, Angel One Transport—the flight operations unit of ACH—has become the prototypical example of a hospital-based HEMS program. Angel One manages hazards by exceeding regulatory requirements and employing industry best practices—such as a Web-based safety management system (SMS), FAA-approved flight operational quality assurance (FOQA) programs, computer-based flight manifest and risk assessment tools—to enhance an already effective safety culture.

Based in Little Rock AR, Angel One Transport’s 2 Sikorsky S76C+ helicopters connect the state to a world-class advanced pediatric care facility. Aviation facilities include 2 rooftop helipads at AR62 (Arkansas Children’s Hospital, Little Rock AR) and a maintenance and operations center at LIT (Little Rock AR).

Last year, more than 1200 patients—mostly children—were flown on ACH aircraft. Also last year, 20% of flights were flown in IFR conditions—AR62 has a published helicopter GPS instrument approach procedure. Typical missions are 100–130 nm, split evenly between day and night operations.

Dir of Aviation Operations B J Raysor says, “Angel One allows ACH to project the equipment, training, people and technology that make the hospital great. This same level of care and safety is then maintained throughout the trans­port back to ACH for continued treatment and eventual recovery.”

Raysor joined Angel One in 1993 and has transitioned the organization from a vendor-based service to an inhouse or hospital-based program. In 2003, ACH obtained Part 135 air carrier certification. Raysor points out that he serves as leader, visionary and facilitator, but credits his staff for successful execution of the department’s flight plan.

“ACH’s success has been achieved due to a dedicated team of aviation professionals enthusiastically committed to making Angel One better and safer every day,” says Raysor. Angel One Transport is deeply integrated into all disciplines and management levels at the hospital, and these relationships center on safety and patient care.

According to Raysor, “From the top down it is a safety-driven organization—the aviation unit receives unwavering support from senior management and hospital board members.” ACH is ranked as one of the top 25 pediatric care facilities in the US. Employing more than 4200 people, ACH is the only dedicated pediatric health care and burn facility in the state.

For 3 years straight, ACH has been ranked in the Fortune 100 best companies to work in the US. Angel One has achieved an HAI platinum safety rating and was Assn of Air Medical Services (AAMS) program of the year in 2005.


Angel One Transport acquired both its air-medical-equipped Sikorsky S76C+ helicopters in 2002.

In 1978, Angel One Transport began operations as Arkansas Neonatal Transport Service (ANTS) with 1 ground-based ambulance. To expand the service and area of operation, a Bell 206 was added in 1986. An MBB BO105 joined the fleet later and, in 1992, a PHI-supplied Sikorsky S76A increased Angel One’s capability in speed and range.

A newer S76A was added in 1999. The S76As brought dual-pilot IFR capability—but in 2002 the current fleet of S76C+s was purchased, allowing the program to transition from dual to single-pilot IFR operations. ACH is very satisfied with the Turbo­meca 2S1-powered S76C+.

It considers speed, range, payload, IFR capability and reliability strong points. Each aircraft flies 850–1000 hrs a year—equivalent to the utilization of 2.5–3.0 aircraft in similar operations. The Turbomeca engines are reported to provide excellent power-to-weight ratios with beneficial fuel economies.

Raysor says, “Reliability and support for these engines has been very strong—the original 4 engines are installed on the airframes, each with more than 7000 hrs of flight time. “Overall product support from Sikorsky (Helicopter Support Inc) and Turbomeca has been strong,” he continues.

“Both support vendors understand our mission [and] the challenges we face and have worked diligently to overcome any problems.” Raysor describes Sikorsky and Turbomeca as important partners in ACH’s success. To supplement the helicopters, ACH uses a contracted Hawker Beechcraft King Air 200 equipped with a LifePort air ambulance interior and a cargo door.

All fixed-wing contractors are required to meet the strict criteria of the hospital’s preferred fixed-wing provider program. This quality assurance process validates a set of standard performance and safety requirements by both internal and third-party audits and satisfies the flight department’s Commission on Accreditation of Medical Transport Systems (CAMTS) accreditation.

Beyond the minimums

Flight Nurse Scott Rundle prepares neonatal care equipment for a flight.

In recent years, the safety of HEMS operations has attracted much negative attention. Following the Feb 2009 NTSB public hearings on the subject, the safety board added improving HEMS safety to its 2009–10 “most wanted list.”

Specifically, there were recommendations to conduct all flights with medical personnel on board in accordance with stricter Part 135 regulations, develop and implement flight risk evaluation programs, require formalized dispatch and flight-following procedures including up-to-date weather information, and install terrain awareness and warning systems (TAWS) on aircraft.

Even before the hearings, ACH satisfied or exceeded all of NTSB’s safety recommendations. Since 2003, ACH has operated as an air carrier under Part 135 regulations. Prior to each flight, Angel One pilots use a computerized flight manifest that includes a risk assessment tool—at any time, regardless of ranking, an Angel One pilot can refuse any flight.

All ACH flight dispatchers are trained to evaluate weather using a computer-aided dispatch system, and each aircraft is equipped with Sky Connect satellite tracking devices for flight following. Each Angel One helicopter is equipped with Honeywell HTAWS/ EGPWS, single-pilot IFR (SPIFR) auto­pilots, XM Weather systems, FDC engine inlet filters and Appareo GAU 2000 flight data systems.


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