Mission Capable

Aleda White recalls little about her horrible accident that October morning just days before her 23rd birthday. She was driving a delivery van along a narrow section of Highway 70 in northern California’s ruggedly scenic Feather River Canyon. As she rounded a bend in the road, a vehicle traveling the opposite direction abruptly swerved into her lane.

 Airbus Helicopters' single-engine H130
Enloe Medical Center was the U.S. launch customer for Airbus Helicopters’ single-engine H130 in air medical configuration, thanks in large part to its improved performance, excellent visibility, and mission flexibility. Dan Megna Photo
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White successfully avoided a collision, but overcorrected and ultimately lost control. Her van plummeted over 300 feet down a rocky, nearly vertical cliff, coming to rest mid-slope above the rushing river.

The accident was not witnessed, but fortunately an off-duty search-and-rescue specialist passing by spotted the skid marks and stopped to investigate. His phone call initiated the emergency response of local fire and rescue assets, including a FlightCare Airbus Helicopters AS350 BA from nearby Enloe Medical Center (EMC) in Chico, California.

“I remember I was kind of perplexed when we first got on scene,” said Marty Marshall, the Enloe emergency medical services (EMS) program director who piloted the FlightCare helicopter that day. “We had been dispatched to a vehicle over the edge but when we arrived on scene we couldn’t figure out what we were looking at. There were boxes and packages scattered all over the cliff. We began to realize the wreckage was a UPS delivery van that had pretty much disintegrated halfway down the slope. It was hard to believe that whoever was driving that truck was still alive.”

White had remained belted into her seat; however, she was unconscious, having sustained numerous critical injuries including a broken neck, pelvis, femur, internal injuries and severe head trauma.

For EMS first responders, it was a race against the clock. Stabilizing and extracting White may have been routine compared to the daunting prospect of hauling her back up the steep canyon wall in a Stokes litter.

From the air, the FlightCare crew knew it was necessary to get their personnel into the scene to make a first-hand evaluation, but the steep terrain afforded no options for landing the helicopter. However, a large boulder protruding from the side of the cliff did provide suitable rotor clearance and skid purchase for Marshall to execute a one-skid landing, allowing for the safe deployment of flight paramedic Randy Kemp.

FlightCare's subscription membership plan
With over 9,000 members, the Enloe FlightCare’s subscription membership plan assures that members will not be billed for out-of-pocket expenses when transported by FlightCare or any of eight reciprocating air medical programs. Dan Megna Photo

Kemp and rescue personnel agreed that White was in critical condition and might not survive the rigorous ordeal of being pulled up and out of the canyon. The FlightCare crew believed they could provide a better alternative.

When White was readied to be moved, the FlightCare helicopter returned to the boulder, where Marshall skillfully executed another one-skid landing. “I moved into position and placed my left skid on the boulder,” said Marshall. “They [Kemp, EMS, and rescue personnel] lifted [White] up and into the aircraft. The flight nurse, Donna Knapp, who was still on board, secured [White] and the flight medic climbed back aboard.” A short 15-minute flight and White was delivered to the medical professionals at EMC.

Thirty Years of Service

Specialized mission capabilities like one-skid and toe-in landings, and the operational latitude to perform them, set FlightCare apart from other more traditional helicopter emergency medical services (HEMS) operators.

FlightCare has over 30 years of serving the northern Sacramento Valley and the mostly rural mountain communities throughout the Sierra Nevada foothills. To date, they’ve provided timely medical transport for nearly 19,000 critically ill or injured patients.

EMC is a 298-bed, independent non-profit hospital with a legacy spanning over 100 years, and serves a population of more than 400,000 throughout eight counties.

It’s also the only hospital in the state to own and operate its HEMS program. EMC owns and maintains the aircraft and the Federal Aviation Regulations part 135 certificate. The pilots, medical crew, and maintenance technicians are all employees of EMC.

The FlightCare program was launched in July 1985 after EMC earned the designation as California’s first Level 2 Trauma Center. EMC teamed up with a small helicopter operator who had a single HEMS contract for a hospital-based program in Idaho.

The operator committed an AS350 B and a maintenance technician for the EMC program and hired just two pilots (one being Marshall, who had been flying helicopters offshore in the Gulf of Mexico). The program was ambitious, expected to provide 7/24/365 coverage with what might be considered a skeleton crew.

Perhaps it was the enthusiasm and can-do attitude of the crews that made it seem the new FlightCare program was becoming a successful expansion for EMC. Unfortunately, this would prove not to be the case. Within six months, the operator’s financial difficulties became apparent and shortly thereafter the company filed for bankruptcy.

In spite of the operator’s failure to keep FlightCare financially solvent, EMC recognized the tremendous potential of HEMS. So, the hospital developed a plan to absorb the program itself, offering the pilots positions as EMC employees.

EMC crafted a deal with the previous operator to lease the AS350 B. The hospital also approached another local commercial HEMS operator and arranged to temporally operate the aircraft under that company’s part 135 certificate.

By 1989, EMC had obtained its own part 135 certificate and completed the outright purchase of the AS350 B (which was later upgraded to an AS350 BA). In June 2001, FlightCare earned the distinction of being one of the first HEMS programs in the U.S. to be certified by the Federal Aviation Administration (FAA) to operate using night vision goggle (NVG) technology.

Sadly, that same year, FlightCare experienced an unthinkable tragedy that took the life of the program’s beloved chief pilot, Ron Jones, and severely injured the two onboard members of the medical crew.

In loving memory of Ron Jones
Former Enloe chief pilot Ron Jones will forever be remembered; this solemn tribute is affixed to the H125’s rear cabin window. Dan Megna Photo

Just after dark in late September, FlightCare responded into the mountains for a single-vehicle accident. Jones chose a familiar grassy, unimproved area as the landing zone (LZ). What he didn’t realize was how the dry weather conditions and recent off-road vehicle activity had torn up the turf.

As the helicopter descended into the LZ, dirt and loose vegetation were stirred up. The aircraft quickly became engulfed in the whirling debris and Jones lost outside visual reference. He aborted his approach and attempted to climb back up, but just as the helicopter emerged from the dust it drifted into the tops of the nearby trees.

An AS350 B2 replaced the aircraft lost in the crash and proved to be a reliable workhorse for the next 10 years. By 2012, however, the B2 was approaching the original equipment manufacturer’s required 12-year inspection.

FlightCare understood the inspection downtime would mean four to eight months without the aircraft. Marshall said, “We knew we’d better make a plan. We’re going to either be down using a leased aircraft, or we’re [going to] be out of service for a long time, which will kill our momentum and our business.”

The program considered the purchase of a new aircraft — an AS350 B3e. But rumors were beginning to circulate throughout the industry about a new variant of the popular single-engine EC130.

The EC130 T2 (now the Airbus Helicopters H130) was originally targeted at the helicopter tour industry and promised more power, an improved cabin and air conditioning, and a quiet, smooth ride.

One big selling point for the T2 was the reported reduced noise signature. Marshall said, “Since we operate off the rooftop in the center of a very a noise-sensitive neighborhood, we’ve always promised our neighbors, when we had the opportunity, we would buy something that was less noisy.”

For the pilots and crews, the T2 offered many other improvements over just the acoustics. Marshall said, “We were also able to begin to start talking about the safety features like the crashworthy seats, crashworthy fuel system, patient comfort, the size of the work space, the air conditioning, the cockpit design … It’s all a tremendous improvement over what we had before.”

During the HAI Heli-Expo held in Dallas, Texas, in February 2012, American Eurocopter (now Airbus Helicopters, Inc.) announced the EMC FlightCare program had inked an order for an EC130 T2, making it a launch customer and the first to operate the model in a HEMS role.

By October, after careful consideration of completion options, EMC had chosen Colorado-based United Rotorcraft to create the HEMS interior for the new aircraft. A major consideration for FlightCare was United Rotorcraft’s ability bundle the 121 installations to into a single supplemental type certificate (STC).

The new EC130 T2/H130 entered service with FlightCare in February 2015, and quickly earned high praise. “The T2 was absolutely hands-down the right aircraft,” said Marshall. “The United Rotorcraft STC was just beautiful. The pilots loved the way everything was positioned over on the left side [of the cockpit] instead of leaving things in the original configuration. They incorporated the synthetic vision and the [Garmin] 500H, 750 and the 650, satellite phone … Everything was built in and goes through your helmet.”

H130 foreground
When the H130 (foreground) came online in 2015, the original plan called for the existing AS350 B2 to be sold. Enloe ultimately determined that to maximize the program’s capabilities, the AStar should be completely rebuilt and maintained as a backup. Dan Megna Photo

In addition to dual rear cabin sliding doors, the FlightCare H130 has a right front cabin door that has been modified to open wider to facilitate patient loading. The standard rear seating configuration has also been modified. The four forward-facing “passenger” seats were replaced by three more comfortable and robust pilot chairs. This created a gap for the patient’s head to rest between the attending medical crew. The third chair also provides seating, for example, to allow a parent to ride along with their child.

H130's dual sliding doors
The H130’s dual sliding doors allow Enloe’s medical crew members, like chief flight nurse Jenny Humphries, the ability to clear the tail when landing off field. Dan Megna Photo

As for the medical crews’ perspective of the H130, FlightCare senior flight nurse Neal Cline said, “We love that aircraft. It’s quiet. It’s roomy. It has an incredible air conditioner. It has incredible visibility. Most everything is easy to get to. Even though now it seems my partner is so far away as opposed to being on your lap in the AStar. But there’s so much room!” When pressed for a criticism of the H130’s medical configuration, Cline smiled and said, “Well, I suppose it could use a better trash can.”

electronic stethoscope
The FlightCare H130’s intercom system includes a jack for an electronic stethoscope, allowing nurses and paramedics to listen to blood pressure, lung sounds, or heart tones while in flight. Dan Megna Photo

Once the H130 came online, the B2 was overhauled and placed back into service. Now, for the first time, FlightCare has a backup aircraft. During the first six months of H130 service, when it was unavailable due to inspections or maintenance, the B2 covered 56 revenue flights that otherwise would have been lost.

A High-Performing Team

Because EMC is an independent nonprofit hospital and FlightCare is an integrated department of the hospital, they have a unique approach to how flight crews are selected and managed.

All medical personnel are chosen from among tenured EMC professionals: nurses from the emergency department and paramedics from the ground ambulance program.

Those hoping to one day make the jump to FlightCare understand that every day is a job interview, and making the grade takes much more than fantastic medical skills. Potential candidates are scrutinized — in most cases for years throughout their day-to-day hospital duties — for their professionalism, interpersonal skills, and decision-making ability, as well as their clinical skills.

The medical personnel and pilot candidates who are selected to undergo interviews are in for a rigorous and intimidating process. They face a lengthy roundtable interview with all members of the FlightCare crew, in which each has an opportunity to question and pass judgment on all candidates.

“Because of the unique nature of what we do, it lends itself well to having the high-performing and integrated team that we have,” said Jenny Humphries, FlightCare chief flight nurse. “We only have 17 or 18 of us, which allows us to raise the bar for our expectations, skill sets, our communications, how we deal with one another. I think that results in a really highly functioning team. We can teach someone the technical skills to do our jobs, but we really look for the human qualities a crewman brings to the team.”

FlightCare nurses have added requirements to maintain and improve their clinical proficiency. “When we’re not flying, our nurses work in the hospital’s emergency department, which provides a clinical expertise that’s really second-to-none,” said Humphries.

Paramedics are also required to perform clinical rotations in departments throughout the hospital, or pick up shifts on EMC ground ambulances.

Today’s FlightCare team comprises five pilots, five paramedics, and seven flight nurses. They operate around the clock, averaging three missions a day, flying 750 to 800 patients annually. The aircraft are maintained by a full-time director of maintenance, Dan Dawson, and supported by two part-time, per-diem mechanics.

A portion of Flightcare team
A portion of the Enloe FlightCare team: Jenny Humphries, Roger Srouji, Marty Martshall, Sean Abrams, Eliza Anderson, Jennie Grant (FlightCare program assistant), Neil Cline, and Jim Cuneo. Dan Megna Photo

EMC FlightCare, being hospital owned and operated under its own part 135 certificate, is the last of its kind in the state of California. Nationally, these types of models are becoming increasingly rare.

But operating this way does afford the flight crews the freedom to operate with a degree of autonomy, with the latitude to expand their operating profile to meet a unique mission situation. And in the case of Aleda White, this may very well have made the difference in her survival.

After three weeks of care at EMC, White was transferred to another hospital near her parents’ home in Nebraska. There, she underwent three months of care and rehabilitation followed by four months of daily outpatient physical and occupational therapy.

Thankfully, White made a complete recovery and today is enjoying a fulfilling life with her husband and three daughters, just miles from the scene of her accident.

“Without FlightCare, many of the positive outcomes wouldn’t even be possible,” said White. “When time is the factor between life and death, they give people a chance. This FlightCare crew will always be my heroes. They gave me a starting point for my second chance. I honestly believe I wouldn’t have had one if not for them.”

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