EMS helicopters prove essential during storms

 - October 1, 2008, 5:23 AM

Helicopters again played a critical role in providing safe evacuations and critical rescues before and after twin hurricanes that pounded the U.S. Gulf Coast between September 1 and September 13. But unlike when Hurricane Katrina laid waste to New Orleans and parts of coastal Mississippi and Alabama in 2005, this time authorities were ready, with detailed plans in place for Gustav and Ike. However, the back-to-back storms did severely stress area helicopter resources.

While military helicopters again took the lead in post-storm rescues, civil EMS helicopters handled medical evacuations and repatriations, and that task was well coordinated across agencies from various levels of government, according to those familiar with the situation. Three main structures governed EMS helicopter response to the storms: local hospital and ambulance plans, state evacuation and disaster response plans, and the federal hospital assistance plan. As part of the last plan, the Federal Emergency Management Agency (FEMA) activated the Federal Ambulance Contract. Englewood, Colo.-based Air Methods is currently the EMS helicopter provider under that contract. Other regional helicopter EMS companies responded under local, regional and state plans.

“The difference from Katrina? Night and day,” said Chris Eastlee of the Association of Air Medical Services (AAMS). “There was so much more planning and so many more existing agreements that helped alleviate the kind of dysfunction we saw after Katrina,” he said.

Before Gustav, EMS helicopters–many of them positioned to cope with surging and compressed demand–evacuated more than 150 critically ill patients in the storm’s path. Two days before Ike slammed into Galveston, 26 EMS helicopters, some using a makeshift base on a football field, evacuated more than 200 patients in two days. “These are very sick people–trauma and heart patients; they’re intubated and on multiple [intravenous] drips. So time is of the essence with a big storm breathing down our necks.” 

Air-Evac contributed four helicopters to the Galveston scrum from bases including Carrizo Springs, San Marcos, LaGrange and West Texas, flying patients in Ike’s path to hospitals as far away as Austin before shutting down on September 11 due to deteriorating weather conditions that included 40-knot gusts.

Mike Eastlee, Air-Evac Lifetime regional director of based operations for Texas, said the state did a good job pre-positioning resources to support rotor operations before and after the hurricanes. “They made sure all the little airports had fuel and pre-positioned ambulances and buses and water along the route,” he said.

But the individual helicopter companies also brought preparedness plans to the table. “It’s a challenging environment, and not just the weather,” Eastlee said. “Crews are flying half a day sometimes to get to the hurricane area and when they get there the place is closing down. There’s no place to eat and fuel can be an issue.”

Air-Evac starts planning days before an evacuation is called, putting crews on standby, stocking the helicopters with provisions and arranging for crew housing at the destination. Crews are put on standby. Each helicopter gets two crews, and no crew works more than a 12-hour shift. Helicopters are preloaded with narcotics, medical supplies and fuel. Crew housing is arranged at or near the temporary forward bases, generally small airports near the edge of the impact area. If necessary, fuel is trucked in. Parts and mechanics are sent on in advance. Any maintenance scheduled for the deployment days is anticipated and, when possible, performed ahead of time. “We have smart people who block all the holes in the maze of logistics,” said Eastlee. “It’s a lot like going into battle.”

Communications on, and tracking of, Air-Evac’s helicopters is also easier post-Katrina, as the aircraft are equipped with SkyTrac GPS tracking and the crews have BlackBerrys for text-messaging. “It’s a different world today from what it was just a few years ago,” Eastlee said.

Overall medical air asset coordination during the storms in South Texas was handled through the Alamo Regional Command Center in San Antonio. By September 10, more than 170 people were working at the communications center there. Shawn Salter, chief flight nurse and director of clinical operations for San Antonio AirLife, served as day shift air operations director. The Command Center coordinated EMS helicopter and fixed-wing assets and lined up available hospital beds and medical shelters for medical evacuees, including special-needs patients. Between 2:30 a.m. and 6:30 a.m. on September 11, five Texas Air National Guard C-130s evacuated 134 special-needs patients from the greater Houston area. More than 350 ground ambulances were set aside for special-needs medical patients.  

Of the 26 civilian EMS helicopters involved in Ike’s pre-storm evacuation, 15 came from Air Methods under contract with FEMA; the other 11 were the four from Air-Evac,  two from Halo Flight (Corpus Christi), two from San Antonio AirLife, one from Southeast Texas Air Rescue & Medical Transportation Co., one from Dallas CareFlight, and one from Cook Children’s Hospital in Fort Worth. In the hours after Ike hit, the Command Center readied three strike teams to fly into the areas hit; each team was composed of five helicopters.

Salter agrees that the region was much better prepared for Gustav and Ike than it was for hurricanes Katrina and Rita three years ago but still sees room for improvement. “We had a robust infrastructure then, but the magnitude of the events forced us to refine our plans going forward. The coordination of air-medical assets is much better than in the past; however, there are still areas of improvement that have been identified.”