Air ambulance outfit offers emergency services
HOT SPRINGS – At about 11 a.m. Wednesday morning, Andrew Busse and Tyler Fees, helicopter pilots with Black Hills Life Flight, the air ambulance group that will celebrate its first year of existence in Hot Springs on July 1, cranked up their blue and white Bell 407 helicopter and went airborne.
While Busse called in the appropriate course towards Custer Regional Hospital, the Life Flight hangar and landing pad behind the new Hot Springs Ambulance Service building on Cascade Road, grew smaller and smaller; and Seven Sisters Mountain got closer, until the helicopter was above the mountain, then moving north, toward Custer.
It was Fees’s first day on the job, and he was getting some required flying time, as well as some firsthand reconnoitering of the places he would be flying to, hazards he might face – like the communication towers on Battle Mountain, some not lit; also the two communications towers and the wind sock near Custer Regional.
Fees is a Hot Springs native. He graduated from Hot Springs High School in 2002, he said, then served a hitch in the Navy. But he wanted out of the military and desired to learn how to fly, so he went to a community college, then a commercial pilot’s school – before being lucky enough to land the job with Black Hills Life Flight in Hot Springs. He had to compete with many other pilots vying for the job, he said, and he was glad to get it.
Busse, a veteran of the South Dakota National Guard, has been flying for Air Methods, the parent company of Black Hills Life Flight, for several years, including assignments in Wasilla, Alaska and in New Mexico.
Altogether, Air Methods employs four pilots, four nurses and four paramedics to operate the air ambulance, which Busse described as a “flying emergency room,” 24 hours a day, seven days a week.
The basic service Life Flight does can be broken down into two categories, Busse said:
• Inter-facility transport – where a patient who needs specialized care is flown from say Fall River Hospital to a large facility, with specialized treatment facilities, like Rapid City; Scottsbluff, Neb.; Casper, Wyo.; or Fort Collins, Colo.
• On-scene call – The helicopter responds to a emergency directly -- an auto accident, an injured hiker stranded in the Black Hills National Forest, a horseback rider injured on the Buffalo Gap National Grassland, etc. – and transports the person to care.
On each call, Busse said, there are four people in the helicopter: the patient, a pilot, a paramedic and one or two registered nurses (one nurse if a paramedic is along, potentially two nurses without the paramedic –only one paramedic per flight, due to state regulations regarding the level of training and expertise involved).
John Schroder, of Rapid City, is an Air Methods RN, two years into his job, a position he is very happy with, thanks to the good crew dynamics he’s witnessed. He works two 24-hours shifts weekly, and describes his role with the emergency team as “90 percent preparation for something to happen,” before responding.
Schroder also described the emergency equipment in the plane as basically a “flying emergency room,” with heart and breathing monitors, a good supply of oxygen, all of the necessary emergency room treatment tools, communications tools with both the receiving medical facility and the sender, etc.
The helicopter also features a gurney that swivels around inside the helicopter, so a paramedic or nurse can work on them while flying.
Training is rigorous and constantly updated, Schroder said.
Air Methods maintains its commission on Accreditation of Medical Transport Systems (CAMTS), which includes a voluntary audit every three years to establish that the company meets and exceeds industry- standards addressing the quality of patient care, education of medical personnel and medical equipment, and operational and safety concerns.
Since the helicopter is kept in a constant state of readiness to respond to an emergency, medicines and devices that must be at a constant temperature are temperature-controlled using a portable air conditioner for the helicopter in summer, a warmer during winter.
Busse said the average flight is about 25 minutes long, although flights to Ft. Collins, Colo. or to Greeley, Colo.’s Burn Center run about 1:20. And all crew members are under strict rules from
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Pilots fly by visual reconnoitering, Busse said, using night vision goggles for flights after dark.
Any crew member can refuse a call, if they believe the crew’s safety is in jeopardy – “three to fly, one to die” was how this was described – but this is no easy decision because the focus of the team is helping people.
For example, if there is sleet or dense fog, the crew will not fly because they cannot see landmarks in fog, and could become too heavy to remain airborne in sleet.
Busse described an enormous pre-flight checklist that is checked and double-checked prior to each flight with Fees, and Schroder talked about how each item in the medical kits are accounted for and restocked following each flight. Redundancy is at the heart of the crew’s preparations.
Schroder hangs a stuffed toy penguin in the helicopter while he is restocking medicines and devices to let everyone know this is taking place – the source of some joking with the crew.
Busse and Seth Mendel, another pilot who was coming off his night shift, looked at the area’s weather from several different resources, considering wind speed, humidity, cloud ceiling and a slew of other factors, then submitted a risk analysis by computer link to Air Methods.
Cyrus Bowman, of Hot Springs, a retired Marine, takes care of the helicopter’s mechanical items, and team members described him as especially thorough, making sure everything is in proper flying order.
Flights are monitored and cleared through the company’s Operational Control Center, manned around the clock with a pilot supervisor; also, AirCom, a national emergency communications center in Omaha, Neb., that fields calls, provides flight coordination, follows flights and offers logistical support.
When a call for help or transport comes in, it is via company cell phone, and prior to flying everything is double-checked, a process that takes about two minutes after the initial check done by the pilot and medical members of the team.
None of this comes without a cost, and many are the tales of extreme costs associated with air ambulance service.
Busse said that Air Methods is pushing a $30 – $40 per household annual membership to the service in the community, assuming that Air Methods can get 5,000 or more regional people to participate in this. Without a membership, the cost of the air ambulance could run anywhere from $12,000 on up for a trip, depending on how far the helicopter must travel.
However, Busse said that Air Methods uses no-balance billing, tapping insurance coverage first, and does not refuse to transport non-members or those who cannot pay if they really need the service, so the $59,000 per flight cost to operate the helicopter – this includes the cost of the helicopter, medical devices, drugs, training, equipment, upkeep, rental fees to stay at the ambulance building, salaries, etc. – ends up getting spread out over everyone the service deals with, from those who don’t pay to those who are members.
He also said anyone who balked at the cost should ask themselves how much the life of a loved one or their own life is worth.
Busse said Englewood, Colo.-based Air Methods is looking at getting regional coverage for the Black Hills and Nebraska Panhandle. There is currently a crew in Rapid City.
Air Methods was founded in 1980, by Roy Morgan after a personal experience convinced him that properly-equipped and staffed air medical service helicopters were a must. With one helicopter and a single hospital contract in Colorado, Morgan pledged his commitment to safety and outstanding patient care.