Program Profile

HealthNet Aeromedical Services West Virginia Regional EMS System

By Rick Davis

HealthNet is a unique shared service, utilizing three helicopters in three cities to provide prehospital critical care medical coverage ofthe entire state of West Virginia. Photography by Dave Rogers, Flight Paramedic

HealthNet Aeromedical Services is a state-wide EMS helicopter system utilizing three operational bases and three helicopters in the state of West Virginia. It was the first shared program developed by HealthNet Inc. and its member hospitals.

Members consist of West Virginia University Hospital (Morgantown, WV) as the northern base, and the Charleston Area Medical Center, (Charleston, WV) as the southern base. The two began operation in June 1986. In July 1987, Cabell Huntington Hospital (Huntington, WV) contracted with HealthNet to become the western base, providing a home for the third HealthNet aircraft.

With all three bases under the same management umbrella, HealthNet Aeromedical Services appears to be the only statewide hospital-based emergency aeromedical helicopter system in the United States.

Background West Virginia is a very rural and

mountainous state. Although it has the nation's lowest individual crime rate it also claims the nation's highest per capita motor vehicle accident fatality rate. (The roads are crooked but the people aren't).

Pulmonary and cardiovascular disease are quite prevalent in the state, and ground transportation from rural communities to tertiary care centers can be dangerous and time consuming. Aeromedical transportation is often the only alternative.

The experience of the West Virginia State Police MEDEVAC project, a daytime only public sector ALS service established in 1982 prompted hospital officials at Charleston Area Medical Center (CAMC) and West Virginia University Hospital (WVUH) to investigate the feasibility of providing 24-hour hospital-based aeromedical coverage utilizing more

conventional nurse/paramedic crews and critical care level equipment and capabilities. Both hospitals were involved in the process of developing the HealthNet Inc. organization at the time and decided to develop their aeromedical programs as a joint effort under the auspices of the new organization.

In late 1985, CAMC Associate Administrator Judith Keagy and Andrew Lasser, Vice President of WVUH were assigned the task of doing a comprehensive review of existing flight programs to determine what constituted the current state-of-the-art. As a result of this collaborative review, a request for proposal (RFP) was prepared. Ultimately a contract for aviation services was signed on behalf of HealthNet Inc. with Rocky Mountain Helicopters (RMH) for two aircraft, six pilots and two mechanics. One aircraft would be based at each hospital with the individual hospitals providing the

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Program Profile

medical crews and control, dispatch and communications centers, landing and maintenance facilities and pilots' quarters. Initially, the B Model A-Star was selected for its reliability and lifting capability in its weight category. Patty Heilman, RN was recruited from Allegheny Life Flight for the Northern Base Chief Flight Nurse position, while I was recruited from San Diego Life Flight to serve as Program Coordinator and Chief Flight Nurse for the Southern Base.

A joint management task force drafted agreements concerning systems policy issues such as program philosophy and image, financial matters, dispatch and communications guidelines, safety requirements, marketing program and crew education and training. This level of cooperation was unprecedented in the history of the two hospitals and has proven extremely successful not only in

establishing the aeromedical system, but also in meeting the needs of the communities and referring hospitals in the region. The program has also furthered the objectives of enhancing each sponsoring institution's status as a major referral center as well as preventing the potential loss of patients and health care dollars to out of state facilities.

The First Year The first day of operations was

June 15, 1986. HealthNet was scheduled to go into service at 7:00 am. The state police program had ceased operations the previous day. At 5:00 am, the Charleston base reported fog. The first flight request came five minutes later, a three year old with meningitis. Charleston could not respond because of the local visibility. The next request came two hours later for an industrial accident, a man pinned

under 400 pounds of steel. HealthNet I (northern base) responded, as HealthNet II (southern base) was still grounded by fog. And so it was to be, large volumes of flight requests from day one, and significant numbers of missed flights due to weather.

We knew the weather would be a problem, but we had underestimated the number of requests. The system received over 200 flight requests each month and typically HealthNet was able to respond to approximately seventy-five percent. Weather is the primary cause of missed flights with "on another flight" running a close second. We quickly saw the need for additional pilots and an additional helicopter and base.

Huntington is the state's third major population center and Cabell Huntington Hospital (CHH) is its primary tertiary care center. CHH entered into negotiations with

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Program Profile

HealthNet and became the official base for HealthNet III in July 1987 (western base). At the same time, the northern and southern bases received new BK-117s and one of the original B Model A-Stars was reassigned to Huntington.

Like the first two base hospitals, CHH maintains primary responsibility for hiring and paying medical crew, purchasing equipment and providing space for the flight and maintenance crew. Unlike WVUH and CAMC though, Cabell Huntington Hospital is not a HealthNet member hospital, they simply contract with HealthNet Inc. to have an aeromedical base at their facility. This arrangement has worked well.

By contracting with HealthNet, CHH was able to obtain aeromedical services for their institution much more cost effectively than they otherwise could have. HealthNet was able to place an aircraft there by exercising an option for a "dedicated spare aircraft" as a provision of the existing contract with Rocky Mountain Helicopters.

Because Huntington is only 40 miles from Charleston and for safety and resource control reasons, all flight requests for both HealthNet II and III are received and processed by the Charleston base communications center (Charleston MEDBASE). The addition of this third base has increased the number of flight requests HealthNet is able to respond to and reduced the number of flight requests missed due to "on another flight."

Approximately 20% of our flights are directly to an accident scene or nearby LZ. Approximately 40% of our total responses are cardiac related, 40% trauma related and 10-15% are neonate transports. A total of 1,432 patient missions were completed in the first twelve months.

Management Like many programs, HealthNet

subscribes to a "participatory management" philosophy. One of the greatest strengths of hospital-based aeromedical organizations is the very high level of skill, experience,

Healthnet utilizes two BK-117 and one AStar 350B helicopters, The medical crew consists of a flight nurse/paramedic team.

II Two communications centers handle the dispatch and communications Jl needs for all three HealthNet bases. IBM PC computers handle a variety of ] weather reporting and statistical reporting functions. J

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Program Profile

and maturity of the staff: medics, mechanics, pilots, and nurses alike. Involving each team member in the decision making process provides not only for better decision making but also for the personal and professional growth of the individual.

At the Charleston base, every member of the flight team works on one or more "operational groups." One group has been established for each of the five primary operations areas: safety, education, communications center, data collection and marketing. Program goals and annual objectives are established for each group by the local management team.

The Charleston based management team consists of the Program Coordinator, the Lead Pilot, the Associate Hospital Administrator, and the Medical Director. At least one member of the management team participates on each group. To ensure consistency at the systems level, management teams from each HealthNet base meet quarterly to discuss system- wide philosophy and policy issues.

Safety/communications center It is the philosophy of HealthNet

as well as Rocky Mountain Helicopters that no patient and no mission is important enough to compromise safety in any way. Additionally, we feel that the determination of what constitutes safe conditions cannot rest with one person but must represent and interaction between the pilot and Safety Officer, the program coordinator, and hospital administration and the medical flight crew and ground providers.

A formal, joint (HealthNet and RMH) safety philosophy and program goals are written by the management group. Each base has an organized and on-going Safety Operations Group. The Group is staffed with a pilot as Safety Officer and includes the mechanic, a flight nurse, a flight paramedic, the Program Coordinator, and a representative of hospital administration. The group meets

monthly and established short and long range goals and assigns responsibility for completion.

Flight following is performed at ten to fifteen minute intervals with pilot reports. Each report consists of a latitude and longitude from the helicopter's LORAN navigation computer as well as ground speed and estimated time remaining enroute. Agreements have been entered into with other regional aeromedical providers and communications centers for flight following when an aircraft is out of range of one of the HealthNet centers, or when another service is operating in our area.

A computer file lists every hospital landing site in the region including coordinates, LORAN identifier, hazards, ground contact information, visual clues, best approach, alternate LZ and other information such as noise abatement procedures. Another computer file lists previous scene and designated LZ's by state and county. A hard copy of the file is kept in the aircraft. The entries are reviewed and updated as necessary by the pilot and crew at the completion of each flight as part of a flight review debriefing.

Significant safety issues are documented on a Safety Bulletin form and posted on a clipboard in the communications center. These

forms can be completed by any team member and are approved and countersigned by the Safety Officer. The safety group reviews these bulletins quarterly and awards a twenty-five dollar bonus to the crew member submitting the bulletin with the greatest potential impact. All personnel are required to read and initial these forms prior to beginning a flight shift. A mandatory reading file containing pertinent safety related articles and reports of recent aeromedical and aviation accidents and incidents is also maintained. We subscribe to the popular industry attitude that you must learn from other people's mistakes because you will never be able to make them all yourself.

HealthNet has established conservative weather minimums that are clearly delineated. Local daytime flights require a 500 foot ceiling and one mile visibility. Both cross country daytime flights and local night flights require 1,000/Three. Cross countl~y night flights require 2,000/Five

The communications center receives hourly weather sequence reports for 14 reporting stations in our region via telephone line to an IBM PC AT. If the ceiling or visibility are below minimums, the flight is refused and other transportation arrangements are coordinated. In addition to the hourly sequence reports, the PC system also reports terminal forecasts and generates a regional map depicting ceiling and visibility for all reporting points in the state and surrounding region.

The communications center in Charleston is also equipped with the Kavouras RADAC 1000 color weather radar system. This system is equipped with a dedicated telephone line to the local National Weather Service radar site as well as a dial-up line allowing access to any other site and including the NOAA geostationary satellite system allowing a regional view from 23,000 miles in space.

While the primary hardware for the systems is located in the communications center, an auxiliary

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Program Profile

video output is remotely transmitted to the pilots' quarters near the helipad. This sophisticated weather information is essential because it is not infrequent that the flight crew is a remote area will have communications with our centers only and be out of range from any FAA facility.

The communications center at each operations base double as regional medical command centers. All ground units in the region must contact one of these centers to receive treatment orders and hospital routing. The fact that these same centers dispatch HealthNet aircraft and are typically staffed by HealthNet Flight Paramedic/ Communications Specialists with immediate access to the on-duty medical command physician insures full and appropriate integration of the aeromedical service into the regional emergency services system.

Data Collection HealthNet has devoted hundreds

of hours to the development of a software program that will collect and generate several reports, including the biannual ASHBEAMS statistical summary. The program consists of three interactive dBASE III-plus programs which incorporate demographic, flight and clinical data on every aeromedical mission, including standbys, training flights or aborted or missed flight requests.

Each incident report is entered into the IBM PC AT located in the communications center. Entry time averages three minutes per incident. ASHBEAMS has performed a great service for our industry by providing a standard by which all aeromedical organizations can compare. It is our belief that software systems like this will enhance and speed data collection for all programs.

In addition to generating the six

month ASHBEAMS report, our program produces custom reports on demand such as individual hospital referral pattern analysis, revenue summaries, frequency of medical crew procedures performance or response and ground time summary.

Summary HealthNet Aeromedical Services

represents one of a growing number of aeromedical organizations utilizing innovative approaches to fulfilling regional emergency transportation needs. HealthNet has achieved a very high degree of inter- hospital cooperation to build a safe and effective statewide aeromedical system that is well integrated with the existing regional EMS system.

Rick Davis, RN, MBA, is the Program Coordinator and Chief Flight Nurse for HealthNet's southern base in Charleston, WV.

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