Trauma — a word that triggers all manner of thoughts in our heads, none of them good. If we were to look at definitions of the word trauma, the most common would be, “a serious injury or shock to the body, as from violence or an accident.”
Survival after trauma has increased in recent years with improvements in emergency medical services coupled with the rapid transportation of trauma patients to centers capable of providing the most advanced care.
According to the American Trauma Society, trauma is the number one cause of death in the United States for persons under the age of 44. The American Trauma Society defines trauma as an acute personal wound or injury requiring immediate care. Between 140,000 and 160,000 trauma-related deaths occur nationwide every year. For each death, at least two permanent disabilities occur.
The total annual cost of accidental death and disability in the United States is estimated to exceed $110 billion. Despite the staggering cost, trauma remains “the neglected disease.” Medical treatment of trauma within the first hour, often referred to as the “golden hour,” can prevent 20–30 percent of potential deaths and reduce hospitalization times dramatically. Helicopter air ambulance programs are a key resource in delivering trauma victims to trauma centers within the golden hour.”
EagleMed is a critical care air medical transport company based in Wichita, Kan., responsible for serving communities in 14 states, mostly in the Midwest region and including destinations in Alaska, Wyoming, Kentucky and South Carolina.
The company operates a mixed fleet of fixed wing and helicopter aircraft from more than 30 bases within its service area. Last year it provided services to more than 5,000 patients, with about two-thirds of them being flown by helicopter.
EagleMed’s helicopter operations typically extend to about 150 miles, while its fleet of fixed-wing aircraft handles flights beyond helicopter capabilities. All EagleMed aircraft are completely configured and medically equipped for mission critical transports that transform the aircraft into a “flying intensive care unit (ICU).”
Company medical personnel are specialty trained and have a variety of advanced clinical certifications. The on-site education and quality departments assure that all clinical staff maintain the highest level of ongoing education and competencies. EagleMed medical crews consist of one RN and one paramedic with advanced clinical certifications.
EagleMed is privately owned and has been in operation since 1977. The company conducted its first dedicated air medical transport patient flight in 1981. Since 2009, it has been a subsidiary of Air Medical Group Holdings.
Accredited by the Commission on Accreditation of Medical Transport Services (CAMTS), EagleMed dedicates all facets of the company towards providing the highest quality patient care in the safest environment possible. It is one of the oldest and most experienced air medical transport service providers in the Midwest.
EagleMed’s senior leadership has a combined total of 150 years of aviation safety experience. The company’s employees received the 2013 chairman’s award and the 2010 president’s award for leadership and safety from the Association of Air Medical Services, the 2011 safety award from the Helicopter Association International, was recognized by CAMTS in 2012 for a best practice in just culture, and received the National EMS Pilots Association 2012 pilot of the year award.
The following interview is with Andy Faletto,
EagleMed’s director of operations, and Jon Wilson, the company’s director of maintenance.
Helicopter Maintenance – Hello, Andy and Jon. What are the types of helicopters that you are currently operating?
Faletto – We have an all-Airbus fleet, including 13 AS350 AStars and an AS355 Twinstar that we use primarily as a backup.
Helicopter Maintenance – Where are the aircraft based?
Faletto – We operate 14 helicopters at various bases, with one each assigned to 13 bases, and a backup. Our operation is headquartered in Wichita, where we perform most of our heavy maintenance. We have two major field locations, in McAlester and Hugo, Oklahoma, which also serve as maintenance bases for services that can’t be performed in the field.
Helicopter Maintenance – How many pilots and EMS personnel are in your employ?
Faletto – We have more than 400 employees, including pilots, maintenance personnel and medical staff. That includes 120 pilots, who are split between fixed wing and helicopter assignments.
Helicopter Maintenance – How many helicopter flight hours did you total last year?
Faletto – Our helicopters logged approximately 7,000 flight hours last year, with each aircraft averaging about 600 hours a year, or about 50 hours per month.
Helicopter Maintenance – Do you do your own maintenance or is it outsourced?
Wilson – We do the majority of our maintenance in-house, up to the 12-year inspections. There are two primary reasons for that. One is the reduction in cost we achieve by doing it ourselves. Second, it gives us better quality control. By doing it ourselves, I can control quality and I can keep it at a very high standard, which is something that if I go out of house I can’t really guarantee. By doing it in house, we can actually ensure that we get the kind of quality that we’re looking for.
Faletto – And I’d add one more item to that, and that is we can do it on our schedule. So, if we only have two days to get a job done, we can marshal our labor to make sure we get it done in that two-day period. If we farm it out, they may not be able to do it in our timeframe.
Wilson – When we do use outside shops it’s usually for major inspections, completions or major avionics work.
Helicopter Maintenance – How much inventory does it take to support your own maintenance?
Faletto – We’ve got about 10,000 line items on the shelf in Wichita, about half for fixed wing and half for the helicopters. That represents close to $1 million worth of spares just for the helicopters. We also keep some basic inventory in the field, like oils, filters and lubricants. We have excellent support from the factory and we’re close to Grand Prairie, so we don’t keep a spare engine on the shelf. We do have one main rotor blade and two tail rotor blades as spares.
Helicopter Maintenance – How many people are in your maintenance department?
Wilson – We have eight mechanics that work in the hangar at Wichita. They’re not exclusive to the helicopters. They work on both the helicopter and the fixed-wing aircrafts. We have helicopter mechanics based in the field, one at each of our helicopter operating bases. All of our mechanics have A&P licenses.
Helicopter Maintenance – How many maintenance shifts do you operate?
Faletto – In Wichita, we operate just a single shift but we have some mechanics that come in early; they start at 6 a.m. The majority of the mechanics start at 8 a.m., and then I have a couple of A&Ps that don’t come in until about 10 a.m. So essentially, that gives me coverage from about 6 a.m. to about 8 p.m. Then at 8 p.m., I have a maintenance controller that comes in and is on duty for 12 hours, until 8 a.m. the next morning.
Helicopter Maintenance – What is a maintenance controller?
Faletto – The maintenance controller is the person that receives information from the pilot any time there’s a discrepancy with an aircraft. Regardless of where the aircraft is located, if the pilot has a problem, he calls the maintenance control desk. The maintenance controller coordinates getting a mechanic to the aircraft, helps to get any parts that might be needed, and lets the communication center know the status of the aircraft. We have two maintenance controllers who are both A&P mechanics with lots of real world experience, so they can comprehend what the pilot is telling them is wrong.
Wilson – Our field mechanics are on call 24/7 with time off to compensate them for unusual situations. I keep the mechanics rotated on time-off schedules with mandatory rest periods. That way they can cover their own base and a neighboring base as well in case we need them.
Helicopter Maintenance – How many inspectors do you keep on staff?
Wilson – All of our mechanics are inspectors. They all play a dual role of both being an inspector and being a mechanic. But we actually have one overall chief inspector. So whenever they’re working, either as an A&P performing regular duties or functioning as an inspector, they’re still actually doing that under the auspices of the chief inspector.
Faletto – It always takes two people. In the absence of a mechanic, we use a pilot for that second set of eyes. In our company we classify that as a compulsory maintenance check, when a mechanic and a pilot or a mechanic and a mechanic look at a completed job and pronounce the aircraft fit to return to service.
Helicopter Maintenance – What kind of training do your maintenance personnel receive?
Wilson – EagleMed puts a high premium on training. All of our helicopter maintenance personnel attend factory training at Airbus for the airframe and at Turbomeca on the engine, which are both located in Grand Prairie, TX. They go back for recurrent training every other year.
Faletto – In addition to the factory-specific training on the airframe and the engines, we have night vision goggle training, and a process we call learning management system which gives them courses in a wide range of subjects ranging from crew resource management and HAZMAT to basic accounting and risk management, and other skills they need to develop professionally.
Wilson – We probably average about 80 hours of training annually for each of our maintenance personnel.
Helicopter Maintenance – In a typical 30-day period, how many and what type of helicopter inspections do you normally perform?
Wilson – We maintain all of our aircraft in accordance with the manufacturer’s approved maintenance program. The inspections are dictated by flight hours, which are averaging about 50 per month per aircraft. We will typically perform a 100-hour inspection on each aircraft every two months. With 14 helicopters, that works out to a little more than one each week, and the same for our fixed-wing fleet.
Helicopter Maintenance – Of all the maintenance tasks that you perform, which have you found to be the most labor intensive and time consuming?
Wilson – The number one issue we have is with air conditioning, in terms of unscheduled maintenance events, which is labor intensive and time consuming because you can’t plan for it. AC seems to be the least reliable system on the aircraft, but it’s critical for us because it gets really hot in Kansas and Oklahoma and those things have to be working if we’re going to take great care of our patients.
Helicopter Maintenance – Who performs pre-flight and post-flight inspections on the aircraft?
Wilson – The pilots perform the pre-flights. Maintenance personnel typically do the post-flight inspections, usually based on at least some input from the pilots.
Helicopter Maintenance – Who has the responsibility for assigning aircraft to flight operations?
Faletto – Ultimately that’s my responsibility, but on a day-to-day basis, the communication center assigns aircraft based on patient needs, trip requirements and crew and aircraft availability.
Helicopter Maintenance – Who assigns the maintenance tasks to be done each day?
Wilson – I do.
Helicopter Maintenance – Have you started any initiatives regarding the push towards a safety management system (SMS)?
Faletto – Yes, and in fact, we have a very mature SMS in place today. We initially inaugurated our SMS system about two years ago. Today we are using Baldwin Safety and Compliance of South Carolina as an added resource to reinforce our efforts. We are working on the requirements to advance to Level 3 on the FAA’s voluntary SMS scale and our goal is to get to Level 4 by next year.
Helicopter Maintenance – Last but not least, if you were looking to hire a new mechanic, what skill sets would you be most interested in?
Wilson – Let me start by saying we have very low turnover in our maintenance department. We’ve only turned over three maintenance personnel since 2009. We are growing, however, so we do periodically have a requirement to hire new mechanics. And I can tell you the biggest thing we look for is flexibility. We need someone who is willing to go anywhere at any time, and can fix anything while they’re holding a flashlight in their teeth while being bitten by mosquitoes.
Faletto – That’s because the helicopter never breaks at home. It always breaks in the air and the pilot lands it on a country road somewhere. And the maintenance controller gives the mechanic the coordinates, and the mechanic’s job is to load up whatever tools he’ll need, find the helicopter and fix it on site. The mechanic we’re looking for is the one with the flexibility to provide outstanding results under the very trying conditions I’ve just described.
Andy Faletto flew Bell UH1 Hueys in Vietnam and has subsequently logged more than 7,500 rotorwing flight hours, primarily in civilian air medical operations.
Jon Wilson has more than 30 years of aviation maintenance experience. He initially worked on business aircraft, and then spent 26 years with a Part 121 carrier maintaining transport category aircraft. He joined EagleMed in 2009.