No state in the union can match Utah for its remarkable geographic diversity. In the west, the Great Basin encompasses nearly half of the state. It’s sparsely inhabited with vast arid deserts, expansive salt flats and rolling sand dunes.
To the east, high desert landscapes and magnificent red sandstone formations are home to iconic outdoor adventure destinations like Moab, the Colorado River and Utah’s “Mighty Five” national parks. Bisecting the state are the Wasatch Mountains. Their peaks tower to over 11,000 feet, providing year-round recreation and what’s touted as “the greatest snow on earth.”
Of Utah’s three million inhabitants, most are concentrated throughout a swelling urban metropolis emanating from the state capital, Salt Lake City (SLC). In recent decades, Utah has experienced tremendous growth, earning a reputation as one of the best states for business. In fact, in 2016, Utah owned the distinction of being the fastest-growing state in the country. As a result, there has been considerable residential and commercial development along a 120-mile Interstate corridor extending north and south from SLC.
Beyond the growing metropolis, large ranches and small rural communities dot the landscape, separated by large swathes of public lands, extending for hundreds of miles in every direction.
The geography of the state presents tremendous challenges to those responsible for medical care throughout the region, and in particular, for those living and recreating far beyond the urban emergency medical services (EMS) catchment areas.
A tradition of service
Since first opening its doors in 1965, University of Utah Health Care (UUHC) has been a leader in innovating solutions for these challenges and advancing medical services, not only for residents of Utah, but for neighboring states as well.
One such solution was launched in June 1978, when UUHC embarked on what was, at the time, a relatively new business model: utilizing aircraft to facilitate patient transport. The AirMed program was established initially in partnership with Key Airlines — a small regional commuter and charter company based in Idaho — becoming only the seventh such program in the country.
In 1985, Englewood, Colorado-based Air Methods assumed operation of the fleet. Over the next three decades, the partnership thrived, with the operator and UUHC together developing infrastructure for improving service and expanding coverage.
From its inception, AirMed was brand loyal to Bell Helicopters. Over the years, the program operated light single-engine Bell 206s, and more recently 407s, for most day-to-day missions. Bell medium twins — a Bell 222 and later a 430 — were acquired for missions requiring heavier loading or longer distances. As the program grew, it also brought aboard a pair of Pilatus PC-12/45 fixed-wing aircraft for long hauls and instrument flight rules (IFR) missions.
In 2011, AirMed began evaluating aircraft to replace its aging Bell 430. After careful consideration of a handful of twin-engine aircraft, including the Bell 429, the longstanding loyalty to Bell ended. Instead, the program chose the Eurocopter (now Airbus Helicopters) EC145 as the aircraft most capable of meeting its requirements for cabin size, performance and capabilities.
“The EC145 has been a great aircraft,” said Jason Brown, who joined AirMed in 2000 as a pilot with Air Methods and was instrumental in the evaluation and acquisition of the EC145. “Some people talk about it being a little slow, and it is a slower aircraft. But in the distances we travel it doesn’t make any difference. A majority of our flights, with that particular aircraft, are an hour or less. But it lifts our heavier loads and does really well in the high-and-hot environment, which was of critical importance to our mission.”
In the fall of 2016, after nearly 30 years under Air Methods’ umbrella, the aircraft operations torch was passed. Metro Aviation, based in Shreveport, Louisiana, successfully bid UUHC’s request for proposal and was awarded the AirMed contract. Nearly the entire crew of pilots and maintenance personnel chose to stay with the AirMed program and joined the ranks of Metro Aviation.
Brown, who assumed the role of aviation site manager for Metro, said, “From the aviation side, I think the transition went very smooth and very quick. Metro was very proactive to make that transition happen in a short period of time and the previous vendor was also very supportive and helpful.”
The transition to Metro brought more than a just a new operator name. It also ushered in a new standard of state-of-the-art technology that streamlined flight planning and improved aircraft monitoring and communications.
AirMed pilots were introduced to the Electronic Flight Bag (EFB), an iPad-based system integrating Complete Flight and ForeFlight software for flight planning/management, en route data/weather and flight documentation.
AirMed was especially enthusiastic about the Outerlink IRIS system aboard Metro’s aircraft. This provides an advanced level of safety with voice, video and flight data monitoring and recording of all cockpit indications and operating parameters. It also provides real-time flight tracking and satellite based push-to-talk capabilities for direct voice and data communications with Metro’s operational control center. Brown said, “With IRIS, Metro has gone well beyond the newly implemented [14 Code of Federal Regulations 135.607] requirements for helicopter air ambulance flight data monitoring.”
“The transition to Metro Aviation has exceeded our expectations,” said AirMed program manager Frankie Hurst. “Metro’s commitment to safe operations and installing the IRIS program on all of our aircraft will enable our program to focus on safety through quality improvement initiatives. The flight data monitoring system and program that Metro has in place to process the data is leading the air medical industry. During this time of more operators and more aircraft in every area, we cannot accept less than being as safe as possible with the most current equipment.”
Today, AirMed operates a total of nine aircraft from seven bases in two states. The main base is UUHC, where the EC145 is located. Its primary missions are high-risk obstetric and neonatal cases.
Five Bell 407s (two first-generation and four of the newer GX models) are strategically located at satellite bases surrounding SLC: Park City, Tooele, Layton and Nephi. A sixth base is located out of state, 155 miles northwest of SLC in Rock Springs, Wyoming, with a 407 and a PC-12/45.
A sixth 407 (a spare aircraft) and the second PC-12/45 are based at Metro’s maintenance facility at SLC International Airport. The overall fleet ownership is split between Metro and UUHC.
“The 407 is really the staple of this program,” said Brown. “It does really well, even in these high, hot environments. The university starts at 5,000 feet at the pad, and Park City is 6,600 feet. I’d say we consistently are landing on scene flights at 8,000 to 9,000 MSL. Now you add temperatures into that and you’re running DAs [density altitudes] 10,000 to 11,000 feet easy. It’s a very challenging environment for the pilots, for the crews, for patient care… But the 407 does a good job.”
The helicopters operate strictly single-pilot visual flight rules (VFR) and utilize night vision goggles after dark, typically covering a 160-mile radius from the base. They average 1,700 to 2,200 medical calls annually, with 30 percent scene calls and the balance interfacility transports.
All throughout AirMed’s flying environment, conditions are highly demanding and pilots and crews must be prepared for extreme and rapidly changing conditions. Brown said, “We can take off today on a mission and land in the snow at 10,000 feet. The next mission we might be out in the desert on an ATV accident. So it’s greatly varied terrain, which makes operating here a real challenge.”
While AirMed crews do not perform “rescue” missions, they do often perform “search-and-assist” missions: transporting search-and-rescue (SAR) assets — even canines — and aiding in aerial searches. This capability is especially valuable in the steep mountains where the threat of avalanche is an ever-present danger during periods of heavy snow accumulation.
A new SAR tool recently adopted by AirMed for winter search missions is the Recco system. This is a lightweight hand-held device that uses sophisticated radar technology to locate avalanche victims. The system can quickly scan a large avalanche field and detect victims equipped with Recco reflectors.
These small, lightweight, battery-free transponders have become popular with skiers and snowboarders. They’re affixed to helmets, ski boots or clothing, and provide location signals to the detector.
AirMed medic Cory Cox noted, “The 2016/2017 ski season was the first season in 17 years Utah did not have an avalanche fatality.” In spite of the historic snows throughout the season, Cox suggested it was the quality of the snow that kept the slopes stabilized.
Committed to excellence
The AirMed program is staffed by 155 dedicated folks. One hundred and eight of them are medical personnel, dispatchers and support staff who are UUHC employees. Metro’s personnel include 34 pilots (two of whom provide on-site management) and 13 aircraft maintenance technicians. Six technicians staff Metro’s main maintenance facility, while the balance are assigned to the satellite bases.
Aircraft and crews are available 24/7 and routinely transport patients from throughout Utah as well as Colorado, Idaho, Montana and Nevada. They have the distinction of serving one of the largest geographic regions of any air medical program anywhere in the country.
UUHC has an esteemed reputation as one of the top research and teaching hospitals in the nation. Co-located with the University of Utah in a picturesque campus setting in the foothills east of SLC, UUHC is a Level 1 trauma center and home to a number of notable specialty institutes including the Intermountain Burn Unit, Moran Eye Institute and Huntsman Cancer Institute. UUHC has also expanded throughout metro SLC as a regional health care system consisting of four hospitals and 10 neighborhood health centers.
Additionally, in 2016, after seven consecutive years of Top 10 rankings in a prestigious national Quality and Accountability Study, UUHC earned the number-one ranking for quality, safety and accountability.
In recent years, as UUHC expanded into the suburbs and rural communities, AirMed also expanded its operations. In the past five years, the program has added two new bases and started to provide advanced neonatal transport capabilities. It also expects to add hand-held ultrasound to each aircraft.
While recent changes in healthcare have affected the AirMed program, Hurst believes the overall impact has been quite positive: “The increased emphasis on quality has given us the opportunity to evaluate and adopt practices that contribute to better outcomes for our patients.”
With an abundance of natural, unspoiled grandeur, active outdoor lifestyle and alluring business climate, Utah’s future growth will continue to embrace innovation and technology to improve all aspects of public services.
For the region’s emergency medical services, it’s clear UUHC and AirMed will be striving to set the standard for medical care throughout the Intermountain region. Hurst said, “The care that we provide, the safety of our team and the communities we serve, are the top priorities for AirMed.”