Saving lives in Big Sky country

Eurocopter AS350B3 AStar and pair of King Air F90s fly patients to western Montana's trauma center in Missoula.

Pilot Bob Bartlett and Paramedic Tony Pope take off from MT23 (St Patrick Hospital Heliport, Missoula MT). The concrete "M" on the west face of Mount Sentinel in the background signifies the University of Montana.

Minimum weather for dispatch in the helicopter Life Flight program for a cross-country flight is 1000-ft ceiling and 3-mile visibility for day missions and 1000-ft ceiling and 5-mile visibility for night/NVG missions.

Monthly safety meetings are held for all medical flight personnel, mechanics and dispatchers. The dispatchers call in and actually visit in person several times a year. The medical director attends the meetings as well.

Participants discuss operational issues for planning purposes—eg, upcoming maintenance and scheduling—then move on to safety issues from actual incidents from their own program or issues experienced by other flight programs.

The flightcrews discuss these incidents and how they would have handled (or prevented) a similar situation or incident. Involving everyone in the monthly safety meetings gets "buy-in" from all facets of the Life Flight Team and develops an effective safety culture.

Bowman feels that safety has been improving throughout the EMS industry in the past 5 years and that the old paradigm of "getting the mission done at all costs" is slowly going away. Until Aug 2012, another flight program served the Missoula area with Life Flight.

Bensen says that they worked with their pilots and medical director to resolve safety issues and to share no-go launch decisions so as to ensure the EMS service or hospitals in the area did not "helicopter shop" to push pilots into a launch decision after being denied by the other flight program.

Helicopter shopping has occurred in this industry in the past and will inevitably end in disaster if allowed to continue. This program has an excellent risk mitigation process, allowing pilots to perform preflight planning and make decisions without the added pressure of patient information prior to launch.

Aircraft in use

Eurocopter's AS350B3 was chosen to meet the needs of high altitude and mountainous terrain. This helicopter is well known in law enforcement and EMS circles as a performer with versatility and safety and competitive maintenance costs.

It excels in high and hot conditions and has broken several altitude records—including landing on top of Everest in 2005, which puts Montana's highest point, Granite Peak (12,807 ft) well within its reach.

In the front office, the helicopter is equipped with a Garmin GNS430 and EHSI flight display. Tied into the GNS430 is an H-TAWS display system by Sandel. The TAWS provides an accurate display of terrain in the vicinity of the helicopter to provide pilots with critical altitude and terrain information to fly safely in all areas. To aid with situational awareness and increase safe flight ops, a wire environment warning system was also installed.

The high-altitude capability of the AS350B3 is put to the test with rescue operations such as this one, when Life Flight landed and picked up a patient near the Como Peaks (c 9500 ft) in the Bitterroot Mountains southwest of Hamilton MT.

The cockpit is NVG compatible and the flightcrews use Gentex SPH5 helmets with ITT ANVIS-9 NVGs. Bowman says that Life Flight was the 10th EMS flight program certified to use NVGs in the nation and emphasizes the world of difference they make.

The 2 Beech King Air F90s are always on call for longer patient transfer flights, with the cockpit a mix of new and older technology.

The 1981 aircraft have not been upgraded much but do have the Garmin 430 and Sandel TAWS display installed. A Lifeport stretcher and loading system is installed in the F90s for patient loading and care. Other than that, says Fielding, they are "standard early King Airs—really good aircraft, strong and reliable."

Training and CAMTS accreditation

In keeping with the program's strong desire to maintain a safe operating environment, Metro Aviation requires regular training for its pilots in addition to the safety meetings and training of St Patrick Hospital.

Bowman notes that all helicopter pilots attend annual simulator training with FlightSafety Intl in Dallas TX and have to pass an annual check ride while there. Every 6 months they must pass a VFR and NVG evaluation as part of Part 135 certificate requirements.

Dispatch services for Life Flight are provided under contract by Northwest MedStar, Spokane WA. Here, incoming calls are received and flightcrews are dispatched from the regional call center.

Each quarter, all pilots undertake instrument flight training even though the helicopter is not IFR certified, just in case the crew goes inadvertent IMC.

All pilots are NVG trained and certified under NVGs. They conduct annual NVG training and checking internally. Two of the 4 Life Flight helicopter pilots have previous military NVG experience. Fixed-wing pilots also attend annual simulator training but with Flight­Safety Intl in Long Beach CA. They also take required FAR 135 training and evaluations.

Safety is not just a flightcrew issue. St Patrick regularly works with and trains rural paid and volunteer EMS providers and fire-and-rescue organizations about landing zone and helicopter safety. The program recently participated in avalanche training, as well as other medical training, discussions of patient care from a clinical perspective and helicopter EMS procedures.

To further ensure that it operates to the highest standards, the St Patrick flight program is accredited through the Commission on Accreditation of Medical Transport Systems (CAMTS)—an organization dedicated to improving the quality of patient care and safety of the environment for all modes of medical transportation.

Areas required to meet CAMTS standards include safety, education, aircraft utilization, medical direction and clinical care. Life Flight has held the accreditation for over 10 years and remains the only CAMTS accredited organization in western Montana.

Into the future

Looking ahead, Bensen says she hopes that St Patrick Life Flight is the primary choice of any flight services in the region and hopes always to meet its patients' needs.

She states, "I would like to see newer aircraft that meet future patient needs and having the partnership with Metro Aviation will help us meet that goal." Life Flight is now partnering with Community Medical Center in Missoula, the hospital that lost its flight program in Aug 2012, and hopes to add the capability to transport neonatal patients in helicopters—a capability it has in the King Airs but not in the AStar.

Western Montana is a challenging environment, and the team at St Patrick Life Flight works tirelessly to provide a highly professional and time-critical response team whenever time is of the essence in the "golden hour."

Jay Chandler has written for Pro Pilot magazine since 1995 and has flown for the FAA, military and Part 91 and 135 operators.



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