--by John Croft, FAA Office of Communications
Minutes count — especially when it involves getting a critically ill patient to the proper hospital, particularly in dense urban areas.
“Time is of the essence,” says Dr. Christopher Wuerker, executive director for Medical Shock-Trauma Acute Resuscitation (MedSTAR) Transport at MedStar Washington Hospital Center. “Minutes count and that’s where helicopters come into play.”
Wuerker oversees a helicopter transport program that hospital operator, MedStar Health, primarily uses to transfer patients between Maryland, Virginia, and Washington D.C. hospitals. As in other major metropolitan areas, gridlock is a common feature of surface transport in D.C. The advanced navigation and surveillance capabilities deployed by the FAA are a key part of the helicopter success equation.
I recently flew on two different MedSTAR flights to see how the program benefits from industry-leading risk management processes and advanced technologies like Automatic Dependent Surveillance-Broadcast (ADS-B) and Performance Based Navigation in its operations.
MedSTAR supplies flight paramedics and flight nurses but contracts the flight operations to Shreveport, Louisiana-based Metro Aviation. MedSTAR has four Eurocopter EC135s based in three locations for the 24/7/365 operations. Three helicopters, each with a crew of three — pilot, medic, and nurse — are on call every day; one helicopter is a hot backup. The crews and the helicopters are equipped for instrument flight rules flights as well as night vision goggle operations.
On March 18, 2019, I accompanied a crew out of Tipton Airport in Fort Meade, Maryland for a demonstration flight in VFR conditions to MedStar Washington Hospital Center to simulate helipad operations and patient loading and unloading into the hospital’s Level I trauma center.
A MedSTAR flight typically begins with a hospital physician’s “flight request” call to MedStar’s communications center in Lanham, Maryland. The call center links the requesting doctor with an “accepting physician” at one of MedStar Health’s nine acute care hospitals. If the doctors agree that the patient should be flown, a request is sent to the iPad of a Metro Aviation pilot. The pilot completes a risk assessment using the iPad, which also serves as the electronic flight bag. The risk assessment includes questions on weather, route, pilot’s readiness, and the crew’s fitness for the flight. The completed assessment goes to Metro’s operational control center in Shreveport, Louisiana where communications specialists review and evaluate the score. Once they approve the flight, Shreveport sends a dispatch number to the pilot, and the flight launches. It’s typically less than ten minutes from first notification to skids-up.
During the demo flight, pilot Steve Schubert demonstrated how he uses ADS-B Out and In to boost situational awareness in the cockpit, but also to give air traffic control and Homeland Security agencies more precise surveillance data inside the highly secure airspace near the White House and the Capitol. MedSTAR has been operating with ADS-B for more than a decade, starting with the FAA’s Safeflight 21 program in 2006. “We get an audio callout when [the traffic] is close,” says Schubert. “Air traffic controllers do a tremendous job pointing out traffic, but sometimes there are too many aircraft and having the information on a display is extremely helpful.”
To have ILS-like capability is really a game changer.
At the hospital center, the crew demonstrated the transportation of a patient to the Level I trauma center. A typical round trip for the Tipton Airport team is 0.2 flight hours to the outlying hospital; 0.2 hours to MedStar Washington or MedStar Georgetown, and 0.2 hours back to Tipton.
On a later second flight, we flew with a Metro pilot from a MedSTAR base at the St. Mary’s County Regional Airport in southern Maryland to learn how Metro benefits from the Wide Area Augmentation System (WAAS) approach capability in two of its four helicopters.
Jeremy Fryer, an ex-Army AH-64 Apache pilot, explained that by having WAAS and helicopter approaches with localizer performance with vertical guidance (LPV) minimums, crews have more assurance that they can safely reach the hospital in lower visibility conditions. “With WAAS giving us an extra 200 feet compared to a GPS approach, there’s a significant increase in the flights where we can get into the hospital,” says Fryer.
Minimums are a key consideration for MedSTAR dispatchers and pilots deciding whether to move a patient by helicopter or ground transport. “To have ILS-like capability is really a game changer,” says Fryer. “It removes a significant portion of the workload and allows me to better monitor what’s going on, and to think further ahead.”
Wuerker says modern helicopters with advanced avionics and the medical technology and human expertise they carry on board have created a paradigm shift on the traditional concept of “the Golden Hour,” a reference to the benefits of getting a trauma victim to the hospital in the first hour after an accident or medical crisis.
“With advanced technologies, we can intervene more quickly on acute strokes and heart attacks in the pre-hospital environment,” says Wuerker. “We now deal in Golden Minutes.”
John Croft is a flight instructor and a speechwriter/editor in the FAA Office of Communications. Croft uses ADS-B in the Piper Archer he co-owns with two other pilots, and he regularly flies a small team of FAA communicators to talk to pilots and other stakeholders about FAA safety technologies.
