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Helicopter Safety for Field Operations A different approach Russell Wise 770-366-0282 www.airmethods.com rwise@airmethods.com

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The History of Helicopters

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Arriel Cutaway of a Turbomeca Arriel TypeTurboshaft National originFrance ManufacturerTurbomeca First run1974 Major applications Agusta A109 HH-65C Dolphin Sikorsky S-76 The Turbomeca Arriel is a highly-successful series of French turboshaft engines that first ran in 1974. 1 Weighing 109 kg (240 lb), the Arriel 1 has a power output of 520 kW (700 hp). As of 2007, nearly 7,000 examples had been produced.Turbomecaturboshaft1974 1 Data from: 2 2

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Helicopter applications

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Mount Everest

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HEMS

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Physics of Flight with Anti Torque Tail Rotor

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Physics of Flight without Tail Rotor

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Air Methods Who we are:

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Founded in 1980 Roy Morgan First hospital program St. Marys, Grand Junction, Colorado. Financial NASDAQ Ticker: AIRM Employees 4,000+ Headquarters - Englewood, Colorado.

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Fortifying Our Market Presence 1997 - Mercy Air Service 2000 - ARCH 2002 - Rocky Mountain Holdings 2007 - CJ Systems 2009 Omni Flight North Georgia and Atlanta (Rescue Air 1, Life-Net, and Emory Flight) 2011 Omni Flight Nation wide

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History Began operations in June 1998 as Phoenix AirCare LLC with one helicopter strategically located in Griffin. Have steadily progressed to locations in Griffin, Gainesville, Newnan, Kennesaw, Conyers Jasper, Augusta and Ft. Benning, Springfield and Vidalia. Backed by a strong commitment from the largest Aero- medical provider in the world, AirMethods Inc.

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Air Methods who we are: Only air medical service provider with a national presence under two service delivery models HBS CBS Offer all key core competencies in-house: Aviation operations Aviation completions Aviation innovations Billing and collections Dispatch and communications Field maintenance Medical staffing and training

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Hospital-Based Flight Programs

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Community-Based Flight Programs

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Combined Flight Services

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Core Values

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Our Mission: Air Methods is uniquely positioned to serve as a partner of choice to our customers and our employees by providing safe, professional and quality services, while delivering measurable benefits to our investors.

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Guidelines for Aeromedical Transport American College Of Surgeons Committee on Trauma

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HEMS First Mission, Trauma The Golden Hour concept provides that patients seen by a trauma surgeon in a trauma center within that first hour of injury have higher survivability and a better quality of life.

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Where we transport patients to Certified Stroke Centers? Cardiac Centers? Interventional Cardiac Centers? Pediatric Specialty Centers Burn Centers?

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Scene Call EMS / Fire Determines The Landing Zone Cardiac Trauma Stroke Medical Emergency Adult and Pediatric

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ADVANTAGES Speed (Time is human tissue) Death and disability can be avoided if the right care can be provided quickly enough. Access Minimize the time out of hospital, point to point capable, avoid traffic delays. Higher level care The additional skills and equipment of a tertiary hospital; more advanced drugs, RN and Paramedic critical care capabilities.

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Crew Capabilities Maintain a critical care environment throughout transport. Provide medications and equipment not commonly carried on ground units. Vaso-active medications Analgesics Sedatives/Paralytics (RSI) Advanced Procedures and Equipment

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Medical Equipment Propaq EKG BP Pulse Oximetry ETCO2 Monitoring of two invasive lines ICP Arterial Lines Swan/Ganz Cardiac Monitor/Defibrillator LTV 1200 Transport Vent with adult / pediatric capabilities C Pap Bi Pap IVAC Med-system III med pumps. (six line capable) R.S.I. & Surgical Airway capable. PYNG and EZ I.O. device

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Weather and Visibility

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Visibility At 1000 feet on a clear day you can see approximately 200 square miles

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Federal Aviation Regulations Part 91 Part 135 TFR Class B Air Space

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Request Crew is not given patient type info prior to go decision. P.I.C. and the crew will either accept or decline the flight based on scene location and weather on the initial call, we would never want anyone to push the envelope on weather knowing a child is in need of our help. Once the flight is accepted then further information follows, such as age, weight or other variables of condition.

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Activating The System When requesting air transport the following info should be given to the Comm Center: Name of calling party, agency, and call back number. Location of incident. County, City, Street and Cross-Street and GPS coordinates as available. This is not mandatory information to start the process. Multiple aircraft inbound to the scene Ground contact and frequency Patient information Age (Adult or Pediatric) Approximate weight

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Flight Com and the 911 Center Same type system Specialized Team Approach Aviation Understanding (They are not dispatchers..only the Pilot In Charge (P.I.C.) can dispatch a flight F.A.A. Rules Com Specs handle the call and route to the closest station as you would say or Aircraft Base

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Weather Restrictions Go Flight / Air Alert based on 1.Weather minimums at our base 2.Weather minimums at your scene 3.Weather minimums at the receiving hospital 4.Weather minimums between each point Call us ASAP so the pilot on duty can assure that all areas in the flight path are safe to fly!

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Commitment to Safety Investments in Safety Technologies Night Vision Goggles (NVG) Helicopter Terrain Avoidance Systems (HTAWS) Garmin GPS XM Satellite Weather Satellite Tracking Reinvestment of revenues into safety

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Pilots Our pilots average more than 20 years of flying experience. All Pilots working on the Air Methods Georgia team have the following: A minimum of 3000 helicopter flight hours. Commercial instrument rating. A minimum of 500 hours night flying. 1000 hours of turbine time.

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Alert Status Alert / Standby Request awaiting confirmation Crew prepares for potential flight Air Stand Bys (Over 20 miles/10 minutes) or as requested by calling agency

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Adult, Pediatric Male, Female If known, current condition Radio communication Ground contact inbound Flight Crew Radio Information Landing Zone Information / Hazards Pt. update if possible Any Other Pertinent Changes

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Estimated Time En-route Lift off time = 5 minutes day, and 7 minutes at night Distance from Helicopter Location to Incident Scene = X miles X miles divided by 2 = Flight Time in minutes Lift time + Flight time = ETE Ex. (24 miles) (24 / 2) + 7 = 19 min Weather can affect Lift Off Times

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GPS - Global Positioning System Computer aided Flight Following systems is revolutionary for Air Medical organizations. Dispatch can maintain contact with the flight crew at all times, even on the ground. This reduces errors inherent in voice-based radio communications and enhances safety.

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Nurses A minimum of 3 years of Emergency Department and/or critical care experience ACLS PLS, PALS, or ENPC BTLS, PHTLS, or TNCC Former EMS experience, Instructor certifications, and teaching experience is preferred.

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Paramedics A minimum of 3 years of EMS experience in a high volume EMS service. ACLS PLS or PALS BTLS or PHTLS Instructor certifications and teaching experience is preferred.

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Mechanics Minimum 10 years experience as a certified air-frame and power plant mechanic. All mechanics have extensive experience in maintenance of various rotor-wing aircraft. Qualified in Euro-copter AS 350 and BK 117 Factory Training.

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Communication Specialists NENA APCO NFPA NAACS (National Association of Air Medical Communication Specialists)

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ROTOR GEAR Type: AS 350 B2 A-STAR Speed: 120+ Knots (140+ MPH) Cruise Distance: 300 miles Capability: One patient Weight of patient dependant to location of LZ and fuel load.

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BK 117 Cruise - 135 Knots or 155 MPH Range 300 Miles Capable of 2 patients or 1 500 pound patient

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The Challenge is in getting the Right Patient, to the Right Place, at the Right Time. We can help!

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Communications Center NAACS (National Association of Air Medical Communication Specialists) Computer Automated Flight Following Radio Communications Delorme Mapping System GPS

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A little different than a typical 911 Center Com Specs call you back to update E.T.E.s and advise of potential destination. Com Specs obtain acceptance for our patients on ALL scene flights at a Level I or II Trauma Center, Cardiac/Stroke Center, Pediatric Center, etc. Relay of patient report to receiving facility. Assist in monitoring weather prior/during and after flight. Flight following and position reports

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Flight Tracking

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When you consider using a helicopter, ask yourself. Do I have a good landing zone, a designated landing zone coordinator and safety officer? Do you have adequate crowd control police or fire? Do we have good communications with the helicopter crew?

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Helicopter Shopping Why we do it and what is the cost

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Marking the Landing Zone Good communications! Emergency lights are helpful (day and night). Strobes and/or dimmed headlights at night. Consider parking Emergency vehicle under any nearby obstructions.

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Choosing a Landing Zone (LZ) Try to select an LZ that is adjacent to the scene to avoid the need for ground transport that could prolong a patients pre-hospital time. (However, when necessary, a remote LZ is 100% appropriate.) Select a landing zone that will allow for an angled approach from at least two directions. This approach and departure path should be clear of towers, poles, wires, trees, signs, and other obstructions

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Hazards in or near the LZ Wires Electrical horizontal Wires Guy wires vertical Unlit Towers Dust Smoke Chemical Exposure Crowd Control

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Landing Zone Select a LZ that is as level and firm as possible. Parking lots, roads, sport fields, and other locations are most desirable, free of debris The size of the landing zone during the day must be at least 60 square. The size of the landing zone during the night should be 100 X 100. Keep pedestrians and vehicles away from the landing zone. The pilot has the final say on the selection of the LZ. And the pilot may divert.

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LZ Minimums

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Dark or decreasing light operations LZ 100 ft x 100 ft

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Night Vision Preservation Night vision is affected by white light never point lights at the aircraft. Studies show a 2-3 hour exposure during the day can increase the initial phase of dark adaptation by 10 minutes.

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The Landing Zone Officer Designate a landing officer ( Ground Contact ) to communicate with the helicopter crew as soon as the helicopter makes initial contact. Notify the emergency dispatch center of the frequency you intend to communicate. Provide the helicopter crew with a description of: The landing zone. Include the size of the landing zone, how it is marked, a list of any nearby obstructions. Any other air traffic in the area. Patient report is actually a disruption to aircraft on approach. Notify the helicopter crew when you have them in sight. (Arms straight up overhead, with back to wind.) Immediately notify the crew if any last minute hazards are detected or if an unsafe condition develops. (Crossed arms back and forth overhead to alert an abort) Please use plain language instead of 10 codes. Affirmative or Negative is the preferred response to a yes or no question.

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Highway Landing Zones When selecting the LZ on any Highway, select the site that has the best approach and departure route. Keep in mind Wires, Bridges, Adjacent Buildings etc. With a divided highway, use best judgment when deciding to designate LZ on same side vs. opposite direction of travel lanes. Stopping ALL traffic may be the best option when dealing with the distractions of a Air Medical Helicopter landing on your accident scene. Rubber Neckers may create a much more hazardous situation than than what you are already dealing with. (Avoiding Secondary Crashes)

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Land on the Road ?

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Never assume Land in front of the truck. Which Truck?

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THE MOST APPROPRIATE COMMUNICATION MAY BE. AIR LIFE Helicopter this is Hwy 316 Command Hwy 316 Command this is Air Life 6 Go Ahead AIR LIFE 6 I have you in sight. Be on guard for News Helicopters in the area. Were at your 3:00, and would like you to land at the North end Of the Accident scene, South of the RED Fire truck that is blocking the Roadway. Hwy 316 Command - I do have you in sight sir. I understand The North end of the accident scene south of the RED Fire Truck. Well Be on the ground in two minutes.

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Be Ready for . AIR LIFE Helicopter this is Hwy 316 Command Hwy 316 Command this is Air Life 6 Go Ahead AIR LIFE 6 I have you in sight. Were at your 3:00, and would like you to land at the North end Of the Accident scene, South of the RED Fire truck that is blocking the Roadway. Hwy 316 Command - I do have you in sight sir. I see some high tension electrical wires in my approach path. Please have Law enforcement block the South Bound traffic, and secure a Landing zone there. Ill go around. Advise when the LZ is secure.

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Ground Personnel Safety It gets dusty when a helicopter lands.

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Communicating with the Aircraft When directing the Helicopter to your location use the clock method based on the NOSE OF THE AIRCRAFT Never base the clock designation on your position 12:00 3:00 9:00 6:00

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Safe Approach Areas Approach aircraft onlyApproach aircraft only when directed to do so by the crew. Secure any loose items such as hats, stretchers and linens.Secure any loose items such as hats, stretchers and linens. Enter and leave rotor disk area as group at crew directionEnter and leave rotor disk area as group at crew direction

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If you have a helmet, secure the chin strap. No other hats should be worn, and nothing loose on your body. Cover up, head to toe. Wear full eye protection and gloves. Do not approach the helicopter until asked to do so by a crewmember. Always walk, never run, around a helicopter. If the landing zone is uneven, never approach or depart from the uphill side. Always use the downhill side where you are in the pilot's view. Do not touch anything on the helicopter unless directed to do so by a crew member. Remain clear of the tail rotor and main rotor at all times. At night. Do not flash any bright lights at the aircraft. Headlights on low beam, away from the LZ. Overall Safety

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Helicopter Loading There is nothing more that can be said about a Tail Rotor Strike other than it is a bad thing. Against wires, it can bring the aircraft down. But most of all Will it just leave a mark or will it kill you?

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Helicopter Loading Only approach the helicopter, from the front, when asked to do so by the pilot or crewmember Do not permit anyone to approach the aircraft while rotors turn without the flight crew. If possible, designate a person to Guard the tail rotor. STAY CLEAR Area Danger

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Lift-Off and Departure The LZ coordinator ( Ground Contact ) will notify the pilot when the landing zone is clear of all ground personnel. Again check for other air traffic in the area and notify the helicopter the area is clear. Maintain all protective devices against flying debris. Notify your dispatch that the helicopter has lifted off and if possible their destination. If at all possible, try to maintain a secure landing zone with all personnel and emergency equipment for a couple of minutes after the helicopter departs. If an in-flight emergency develops, this will allow the pilot to return safely to a secure landing zone.

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Lift- Off and Departure

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Fire Ground Operations We are not here to write your Departments Policy. We are here to share what we have learned and discovered, and discuss ways in which we may improve what is accepted as Best Practice. #1 Rule Do not allow your crew and equipment to become a casualty. #2 Rule If we are not in it and it is on fire protect property.

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Fire Ground Operations

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Air Methods Bases in Georgia AirLife 1 Griffin AirLife 2 Gainesville AirLife 3 Jasper AirLife 4 Newnan AirLife 5 Kennesaw AirLife 6 Conyers LifeStar 1 Springfield LifeStar 2 Vidalia LifeNet Augusta

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Business Managers for Georgia Russell Wise rwise@airmethods.com Jeff Wilson jwilson@airmethods.com Russell McDaniel rmcdaniel@airmethods.com Chad Black cblack@airmethods.com David Herrin david.herrin@airmethods.com

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is a promise Air Methods & Air Life Georgia are obligated to provide your patients and your public safety officers the safest scene and the most experienced transport environment available. We are dedicated to that purpose!

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CEU Numbers GFSTC Approval # 1749-1007-01 EMS CEU# 10-2010-CE-011

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