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Fighting the good fight

By Guy R Maher

story & photos by Guy R. Maher | August 27, 2014

Published on: August 27, 2014
Estimated reading time 15 minutes, 51 seconds.

A 25-year-old Tampa, Fla., hospital HEMS program builds on its solid foundation and guiding principles with a new operator and four brand new Bell 407GXs.
Spend much time with John Scott, program director for Tampa General Hospital’s (TGH’s) Aeromed helicopter emergency medical services (HEMS) program, and you’ll soon learn that he speaks his mind and doesn’t mince words. He also has a clearly defined opinion of the challenges facing HEMS programs in the United States, and is attempting to arm his program with the necessary tools to survive in a changing environment. During Vertical’s visit to Tampa earlier this year, Scott said he had seen a great deal of industry change since he joined Aeromed in 1991 — and not all of it positive.
“The HEMS industry has turned into a business to solely make money,” he said. “There is an overabundance of aircraft being operated by programs with poorly established criteria, poorly established training programs, and poorly established follow-up, utilization, and review. All of this affects the patient, and the crews.”
This issue is a huge concern to TGH, which is still operating off of the same mission statement it had 25 years ago (and the reason it started the program in the first place) — to facilitate safe and rapid transport and make a difference.
That foundation was established in March 1989, when Aeromed took flight as a single-helicopter, hospital-based program at TGH in downtown Tampa, Fla. It utilized an MBB BK-117, which was operated by what was then U.S. Jet. (U.S. Jet was subsequently bought out by C.J. Systems, which was then itself bought out by Air Methods Corp.)
The program made a major change in August 2013, when it switched providers to Metro Aviation, which has a current HEMS portfolio of 33 programs, 86 bases, and 124 aircraft. The move coincided with a refreshed focus from TGH, with three key directives identified: remembering its foundation, polish- ing its product, and being vigilant to its fiscal responsibilities. “Metro brought old fashioned values to the table,” said Scott. “A key factor for me is Metro’s stand on community-based helicopter bases — they don’t do them.”
Metro’s president, Mike Stanberry, confirmed Metro’s stance. “I don’t have a program where I live off of the transport revenue,” he said. “We see that as a conflict of interest. You simply can’t work both HEMS models — traditional and community-based — and not have a conflict.”
A New Fleet
During the Air Methods operating period, the program’s fleet had grown by a couple more BK-117s, then had partially transitioned to EC135s. But the switch in operator also saw a switch in aircraft, with four new Bell 407GXs replacing the four Air Methods’ owned EC135s in TGH’s fleet. (TGH also retained the original BK-117 in its fleet.)
One of the key contract points for TGH was a desire to switch to single engine aircraft — without giving up the performance of the twins. The program decided the 407 was the best fit and Metro would have to supply them.
It was an unusual move for Metro, which is known for operating and performing completions on Airbus Helicopters aircraft. “Had it been one or two 407s, we probably would have turned down the RFP [request for proposal],” said Stanberry. “But the request for four of them opened the door to go to the 407… [Bell Helicopter CEO] John Garrison bent over backwards to support us.”
TGH’s bases in Bartow, Sebring, and Port Charlotte each
have one of the new 407s, with the fourth used as a dedicated spare — fully equipped and ready to be placed into service at a moment’s notice. The original BK-117 is the primary ship at the TGH hospital base.
Scott said that single engine helicopters such as the 407GX can be much more cost effective than twins, yet equally capable for their missions — allowing the program to be vigilant to its fiscal responsibilities. “The type of aircraft isn’t having much of an influence on flight volume,” he said. “Volumes are more influenced by what programs are doing to stay in the game. [And] I can operate a 407 for way less than a BK-117.”
But it’s much more than just operating efficiencies that matter to THG. “We are doing about 1,800 flights per year with ‘good’ outcomes,” said Scott. “And by good, I’m referring to utilization review; if I have patients that are walking out of the Emergency Department the same day as the transport, I’m not running a responsible program.”
Finding the Right Partner
An important aspect in any HEMS operation is the relation- ship between the operator and the program. For TGH, Metro demonstrated it was in it for the long haul. “It was clear that Metro had a similar mission and vision to Aeromed — geared more towards patient outcomes, while operating efficiently and maintaining quality service,” said Scott.
Downtime from the end date of the Air Methods contract to the start of service for Metro and the 407s was a big concern for TGH. To mitigate this, Metro engaged early with TGH on all phases of the switch. TGH and the Aeromed team members were directly involved in the entire aircraft completion process, and considered everything from interior design, paint, and schematics, right down to the logos.
“The challenge was to find homes for everything in the cabin,” said Aeromed flight nurse Donny Richardson. “Metro never said ‘no’ to anything we asked for to make the final configuration what we wanted.”
But the smooth transition in operation required more than just having the aircraft completed in time; the pilots and crews also needed time to get trained and comfortable in the new helicopters before going “live.” This was especially critical for the crews, who needed to adjust to the mindset of operating in a single-engine helicopter.
“Initially, there was concern from the pilots and crews . . . about the safety of going to singles,” said Ted Edgar, the program’s lead pilot. “But we mitigated the concern by just allow- ing the industry to speak for itself; the problem with the HEMS accident record is not with engines, it’s with human factors and CFIT [controlled flight into terrain]. Plus, we’ve gained a lot of added safety features with the 407GX. We have TAWS [terrain awareness warning system], a Heli-SAS autopilot, and excel- lent performance.”
Edgar also applauded the way the pilots were transitioned into the 407s. “There was plenty of time allotted — as much time we wanted to get comfortable,” he said. “[Metro] didn’t shortcut the training.”
Indeed, one of the major aspects in helping both the pilots and crew become comfortable with the 407 transition was the fact that all 17 Aeromed pilots were sent to Bell for the full 407 initial course. “Metro made it happen,” said Scott. “And TGH supported it by footing the bill. Not only that, there was no gap in our operations because of the transfer. It was real smooth and the credit goes to Metro.”
Safety as Paramount Concern 
In speaking to Scott, it’s clear that even while switching from twin-engine to single-engine operation, safety isn’t an area on which he is prepared to compromise. “Safety is a living part of this program,” he said. “It won’t be diluted.”
A year in to the aircraft’s operation with Aeromed, the crews have moved past their initial concerns, and have become both operationally and emotionally comfortable with the new heli- copters. “The pilots were great in preparing us for the operational differences,” said Richardson. “I like how [the 407] flies — it’s really smooth. The visibility is great through those big windows. And we’ve handled some exceptionally tall patients with great access thanks to the sliding sled.”
Aeromed flight paramedic Chuck Nelson said the change of aircraft required learning to do things differently before loading patients for the flight. “We had to stop and think on those first couple of scene calls until we got used to the tail rotor,” he said. “Now it’s automatic — no one under the tail, no one aft of the doors.”
The program, as with the huge majority of Florida HEMS programs, has always operated visual flight rules — and this makes sense for most operating in Florida. “The weather is usually nice here,” said Edgar. “But when it’s bad, it’s really bad — not just half-bad. The thunderstorms are easy to fly around.”
However, Edgar added that a pilot’s personal minimums always prevail, and no-one is pressured to fly in unsafe or uncomfortable conditions. For night operations, Aeromed is using NVIS-9 night vision goggles.
The pilots also pointed out how much the 407’s Garmin G1000 panel and autopilot aid in situational awareness and aircraft control. “We get it all on the G1000: obstacles, terrain, plus
all the publications, including fully updated flight charts,” said Edgar. “And one other thing about Florida — at just 2,000 feet you can avoid everything in the state.”
Another major consideration to flying in Florida is the presence of water. Besides the fact that Tampa is a coastal city, Florida is well known for its plethora of lakes — many of them huge — along with many swamps.
This presented an unexpected cost, as Aeromed didn’t real- ize in the beginning how often it transitions water. “Now that we’re operating single-engine, we either have to have pop-out floats, or be positioned close enough to land for an autorotation,” said Edgar. “Having pop-out floats will allow us to revert back to multi-engine standards for flying over water.” At press time, two of the three base-dedicated helicopters had been fitted with floats.
Charting Through the Unknown
TGH Aeromed has clearly found a good fit in both opera- tor and aircraft, which bodes well for future operations in an increasingly competitive market.
The pilots rave about the performance of the 407GX in the program’s hot and humid environment and report consistent cruise speeds of 136 knots burning 48 gallons per hour. “We usually sit in service with enough fuel to fly one and a half hours, not including our required reserve of 30 minutes — that’s two hours total.” said Edgar. “With a crew weight of 630 pounds, that leaves us with a 530-pound payload. We have carried a 400 pound patient already in the 407. [But] having a 500-pound payload is important because it would allow us to carry another passenger such as a family member or prison guard if needed.”
Regarding dispatch reliability of the 407, Stanberry stated: “The 407’s are doing quite well. . . . Going to the 407 has been a terrific change for Metro.”
The 407’s are equipped for TGH’s present and future needs, also meeting the new proposed Federal Aviation Administration (FAA) regulations for HEMS operations. However, the future for TGH’s BK-117, which doesn’t meet the new proposed FAA regulations, is undefined. The BK-117 is well suited for some special needs such as neonate, and other specialty team flights — but even that may change.
“Medical equipment size is getting small enough now that the 407 is showing signs that it may be best,” said Scott. “Our NICU [neonatal intensive care unit] will have an isolette for the 407, and our Sebring 407 is doing balloon pump flights with a smaller unit. The future of the BK will be based on the cost to refurbish and upgrade it — and we have a three-year deadline for that decision.”
And regarding Metro Aviation, the response is equally positive. “Metro trusts [Edgar] to represent them,” said Scott. “He’s my single point contact — and they’ve shown a great sense of ownership in the program relationship. It’s pride in the program, not Metro against Aeromed. And this has contributed to the team’s high morale.”
However, when discussing the state of the HEMS industry itself, Scott wasn’t quite as positive. “This industry is going through some significant change,” he said. “Little of it is good. We have lost that ‘quality of service’ model to ‘quantity of service,’ and competition is killing patient outcome. Patients are transported then discharged with this big bill for which they scream, ‘I didn’t ask for this!’ ”
Stanberry said he thought the industry in general should be concerned about its billing expense. “We need to be beyond reproach,” he said. “The patient should be the one who benefits — existing programs need to work together to utilize these expensive assets for the benefit of their communities.”
That’s certainly the approach that TGH Aeromed is seeking
to continue in Tampa — and the result is pride in the program from the hospital itself and from the community it serves. “The number one priority in any operational climate is safety,” said Scott. “Then you have to be successful. All I can try to do is protect my program and hope to get through what happens next.”

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