Helicopter Emergency Medical Services (HEMS)
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. Trauma is defined 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 dramatically reduce hospitalization times. Helicopter air ambulance programs are a key resource in delivering trauma victims to trauma centers within the “Golden Hour.”
Frequently, patients accepted by a hospital for routine care develop complications requiring immediate transport to another hospital for specialized treatment. Patient time outside the hospital environment and the level of patient care required are important transport considerations. Ground ambulance services are not normally staffed to provide the level of patient care required by many critically ill patients. In remote areas, ground transport can be time consuming, and commitments to county emergency services often limit its availability.
In this section we are going to look at three of the top HEMS operators in the United States —
Air Methods Corporation headquartered in Englewood, CO, Bedford, MA-based Boston Med Flight and California Shock Trauma Air Rescue (CALSTAR) headquartered in Sacramento, CA.
Air Methods Corporation is the nation’s largest provider of air medical emergency transport services and systems. The nearly 31-year-old company is dedicated exclusively to air medical transport, focusing on the quality of care to patients and safety in aviation operations.
Annually, company personnel transports more than 98,000 patients who require intensive medical care either from the scene of an accident or general care hospitals to highly-skilled trauma centers or tertiary care centers. Air Methods operates a fleet of more than 400 helicopters and fixed-wing aircraft at nearly 300 bases in 44 states, and is headquartered in Englewood, Colo.
The following interview took place with Director of Maintenance Chris Meinhardt, Regional Repair Station Director
Greg Gerrells and Vice President of Aircraft Support Services Archie Gray.
HeliMx: How long has Air Methods been in operation?
Chris: We started operations in 1980.
HeliMx: How many helicopters do you operate and what type are they?
Chris: We currently operate about 400 helicopters under FAR Part 135. We have 14 different models and 26 variants of those 13 models. With the Omni acquisition we added approximately 90 more helicopters and 10 fixed-wing aircraft to our operation.
HeliMx: What are the major models of your fleet?
Chris: Eurocopters would be the major supplier of the fleet with AStars, Eurocopter 135s and some BK 117s. We also operate a sizable fleet of Bell 407s.
500 Mechanics + 400 Helicopters + 5 Repair Stations + 300 Field Locations
HeliMx: How many different bases do you operate from throughout the United States?
Chris: At the present time, we operate from a little more than 300 field locations and we also operate five FAR 145 repair stations.
HeliMx: What special EMS equipment do you carry onboard the helicopters?
Chris: We carry all kinds of things from defibrillitators, balloon pumps and neo-natal transport equipment to mini-meds. Just about anything you’d find on an ambulance, you’ll find on our helicopter. We even have special neo-natal transport teams.
HeliMx: How many people are in your maintenance department by job description? I mean A&P mechanics, avionic techs, QA personnel, supervisors, etc.?
Chris: 460 field A&P mechanics with an additional 50 A&Ps, 20 avionics technicians and 20 inspectors at the repair stations. The Omni acquisition will bring in an additional 150 employees to the field maintenance operation.
HeliMx: How many directors, managers and supervisors do you have to run this size operation?
Chris: We have eight regional maintenance directors, 18 area maintenance managers, and approximately 60 lead mechanics.
HeliMx: How many QA personnel do you have?
Greg: We have designated QA personnel in our Part 145 repair stations.
HeliMx: Do you have anyone on the line who is QA?
Greg: Not by title. We have a different QA process designated in the Part 135 operation. Within the Part 145 repair stations we have a Director of QA, a chief inspector and each of the repair stations has a lead QA person with inspectors working directly for them. We have approximately 20 people directly involved in the QA process at our Part 145 repair stations.
HeliMx:Do you have dedicated avionics techs, or are they just lumped in with the A&Ps?
Chris: Yes to both of those scenarios. We have a few individuals at the field level whose forte or expertise is avionics, but they’re also A&P mechanics. We have some very good spark chasers as A&P line mechanics, but as they run across issues and need more guidance they will call the avionics shop in Denver or Pittsburgh or West Miflin, Penn., for additional expertise. Repair stations have an avionics department. There’s the manager and a lead in each respective repair station.
There are two classifications of avionics techs: the installers, the guys actually working on the floor installing the equipment, and those doing bench-level maintenance. We can perform bench-level maintenance at each of the repair stations in Pittsburg and Denver. They have a radio shop with technicians doing repairs to radios and other avionics equipment that comes in from the field.
24/7 365 Days a Year
HeliMx: How many maintenance shifts do you operate?
Chris: In the field we’re 24/7. An A&P mechanic assigned to an aircraft or a base ensures that his aircraft is maintained that morning, everything is good to go for that day and then he is allowed to depart. But he is on call 24/7 for that shift.
HeliMx: It sounds like you do not have, for lack of a better term, a day shift and a night shift.
Chris: We have one person on call 24/7. There’s always somebody on call. Now, there may be a shared aspect depending on the size and complexity of a program that maybe they rotate on call, but there’s always someone on call 24/7 for an aircraft. The repair stations run one shift.
HeliMx: How many flight hours are you running per year?
Chris: On a yearly basis, we fly around 125,000 flight hours with close to 100,000 patient transports. Some programs in the summer fly 110 flights per aircraft per month!
HeliMx: In a typical 30-day period, how many and what type of inspections do you perform?
Chris: It just depends where we are in the maintenance cycle. Each program runs as an individual business, with both hospital-based customers and community-based customers. They are all customers on the maintenance side of the house. In some cases they have their own spares and availabilities, and they may own their spares so they run their own business within that program. Maybe a program utilizes two aircraft and maybe another program uses 12 aircraft. Each program is its own business and they manage their maintenance requirements within that program. At any given time of the day or night, we have between 20 and 25 aircraft in the air. I know we’ve peaked higher than that on weekends.
HeliMx: Do you have any maintenance tasks that are outsourced to an MRO or back to the OEM, and why?
Chris: While we typically want to control our maintenance process by having our repair stations perform our depot-level requirements, sometimes due to regional concerns it is more effective to have an aircraft repaired by a local MRO facility. There are also certain processes that only the OEM is approved to accomplish, so those will naturally be repaired through the OEM.
What’s The Procedure for Doing a Maintenance Task?
HeliMx: From start to finish, what’s the procedure for doing a maintenance repair or inspection? It has to start with something and it has to end and be signed off, so what are the steps in the process?
Chris: Good question! Let’s say an aircraft out in the field is scheduled for a 50-hour inspection. The mechanic is going to see that inspection on the maintenance schedule. He reviews that particular inspection process and makes sure he has all the parts on-hand prior to starting the inspection. Filters, oils and o-rings need to be replaced at the 50-hour inspection. He’ll then notify his local mechanics and management that the next day at a particular date and time which aircraft will be out of service for three hours due to scheduled maintenance.
The morning of the actual inspection, the mechanic shows up; the pilot knows he’s coming in at that time for scheduled maintenance and they go into our maintenance system, take the aircraft out of service for scheduled maintenance at 0500 and return to service at 0800. The mechanic performs the 50-hour inspection on the aircraft for those three hours, then completes all log book entries in accordance with both company policies, procedures and FARs. If any ground runs are required, he will have previously discussed this with the pilot. There’s also a “second set of eyes” rules in place. We also have an item inspection policy, depending on the level of maintenance being performed. Once that has all been complied with and they do any ground runs necessary, perhaps an operational flight is required. Then they go back into our maintenance system and put the aircraft back in service and inform our communications group as well. They notify our communications group by phone in most cases.
Labor Intensive & Time Consuming
HeliMx: Of all the maintenance tasks you perform, which have you found to be the most labor intensive and time consuming? There’s always what I call gas and go, normal and routine tasks. For whatever the reasons are, the tasks I am talking about just take that much more time and labor to accomplish.
Chris: With all the different makes and models of aircraft we operate, the most intensive maintenance tasks in terms of labor and time are the 600-hour inspections on up. It’s the longer interval inspections that require us to look deeper into the aircraft. The 12-year inspection on the Astar is a huge one. The 6,000-hour inspection on the BKs is also a huge one, and even the 800-hour inspection on the EC-135 takes a bit of time and manpower. It primarily depends on how much disassembly is required and how much you physically have to inspect the aircraft.
Inspection intervals repeat themselves. It’s not the 600- or 800-hour inspection that takes so long — it’s all the discrepancies you find in the inspection; cracked bulkheads, corrosion and wiring issues. Additionally, you may have the installation of new radio equipment, a new medical mount, and those types of things, and then the corrective action on top of that.
Those are the things that eat the calendar up. The physical inspection in a lot of cases you could knock out in a week. It’s everything you find during that week. When we refurbish an Astar, we tell planning that it’s going to take us a month to do the inspections, but it’s going to take us three or four months to do the corrective actions on the discrepancies that we find, along with any new installations we’re going to do at that time.
HeliMx: Do you have any lessons learned or tips you would like to share with our readers on a particular task? Something that you do, staying within the rules and guidelines of the FARs and ICAs, but you found that by using a particular tool or doing it a particular way saves time?
Chris: Ensuring that you have a very good and robust preventative maintenance program. Corrosion is always a big factor with a helicopter, especially with the aluminum and magnesium gear boxes. Any preventative maintenance you can do with different corrosion inhibitors is a big plus. Not having to change the gear box because of corrosion saves time, labor and money, and keeps the aircraft in service. That’s probably one of the biggest things you can do. Another is desalting the engines and a robust FOD program. Make sure that everyone’s exercising control of their hand tools. If you leave a flashlight someplace, it can cause thousands of dollars in damage.
HeliMx: Who has the responsibility for assigning aircraft to flight ops?
Chris: Our business units today, according to the way our structure is set up, help organize and move aircraft around based upon business needs, maintenance needs and pilot training. It’s really a group effort when it comes to an area. You have a maintenance area, a flight operations area and a business area. The three of them work together to ensure fully operational bases are up in service and have spare aircraft available as needed. It’s a group effort between the three areas.
HeliMx: Who says an aircraft is now flightworthy and can now go back into service?
Chris: The A&P mechanic — he’s the one in charge of that aircraft. Once the maintenance action is completed, he will put the aircraft back into service with the communications center. The communications center knows what aircraft is in service at that base, so they can build it back into the aircraft rotation.
HeliMx:What’s your largest area where you have the most aircraft?
Chris: On average 14-15 aircraft per area, but within that area there could be several different programs.
HeliMx: Who assigns maintenance tasks each day?
Chris: The lead mechanics have that responsibility. They forecast a couple of weeks out and even further out depending on the larger items, but they work with their base mechanics on a daily basis to take aircraft in and out of service for scheduled maintenance. Unscheduled maintenance just happens when it happens. You have to have that lead mechanic looking over the four or five bases because Base A may not know that Base B wants to go out of service at the same time, and you really don’t want to have two bases neighboring each other out of service, so you try to alternate as much as you can throughout the week. You also want to keep your business unit involved because they’re also scheduling medical crews as to when they are coming in, and if they know they’re going to be out of service for the first four hours that day, why bring a medical crew in?
HeliMx: For all intents and purposes, you’re operating like an airline. You have the same problems from a scheduling standpoint with mechanics and medical crews similar to what airlines have with flight attendants and pilots.
Chris: Some people say an airline, however we’re a Part 135 on demand carrier.
HeliMx: You’ve got a lot of the same issues.
Chris: Yes, and we just happen to be larger than most airlines. We’re the sixth-largest operating certificate with the FAA.
HeliMx: Are you doing anything with night vision?
Chris: Absolutely. By the end of August, with the exception of the aircraft scheduled to be removed from the operational fleet in the short term, all of our aircraft will be configured for night vision and by year end, all of the pilots will be trained accordingly.
HeliMx: If you were looking to hire a new mechanic, what skill set would you be most interested in?
Archie: It’s getting harder and harder to find qualified A&Ps that are helicopter specific. If they have three years turbine helicopter experience, we’d definitely take a hard look at them. We would like to see more people who can actually shoot a rivet. You know, use the A in the A&P. It’s amazing with mechanics today — even five or 10 years ago they would have had a hard time repairing a radio rack crack, even with explicit instructions from an OEM or DER. Anyone with an avionics background, sheet metal skills and turbine helicopter experience we are very interested in. Those are the three big things we’re always looking for.
Safety Management System
HeliMx: Has Air Methods started any initiatives regarding the push towards a safety management system?
Chris: Absolutely. We recently have exited Level 2 and we’re now on Level 3, looking forward to exiting that Level. I think that we are the leader in the helicopter industry for SMS. We’re the only helicopter operator in the industry that has exited Level 2.
HeliMx: Have you run into any resistance in the field in the sense there are a bunch of myths and erroneous information surrounding SMS?
Chris: No. One thing that we are always monitoring is what it’s going to cost to implement something like SMS. We always want to manage our costs and I don’t know that we’ve completely identified what the total costs for levels 1, 2 and 3 will be. Level 1 is just building all your manuals, building all your systems. Level 2 is the reactionary mode and we’ve done that by risk assessment, things being sent by different reporting devices. Now in Level 3 we’re going to have to demonstrate our ability to be proactive, to mitigate risk from Level 2.
Our FAA FSDO is with us once a month for what we call a super Wednesday, a day we hold nothing but safety meetings. It’s about seven to eight hours for the meetings. We work with the FAA constantly, demonstrating to our FSDO where we are because we need their buy in before we can go any further with SMS. Once we’re comfortable, have a project completed and we’re mitigating risk proactively, then we can set up a date and time with the FAA in Washington, D.C., and the SMS troops can come out here for a couple of days to review our project with our department heads so we can demonstrate how we’re being proactive. That’s in the near future.
Meinhardt began his 26 year aviation career in 1984 in the United States Marine Corps. Before leaving the Marines, he completed his FAA requirements and earned his A&P license. He also has his IA. Meinhardt has held a variety of positions within the helicopter industry: sheet metal fabricator, engine overhaul technician, external load mechanic and crewman, EMS line mechanic, chief helicopter mechanic, Part 145 chief inspector and Part 135 director of maintenance. Meinhardt also serves on the HAI Finance and Leasing Committee, Co-Chair for the Bell Helicopter 429 Customer Maintenance Advisory Panel, Maintenance Representative for the International Helicopter Safety Team (IHST) and is a participant on the Rotorcraft Maintenance Policy Industry Group (RMPIG).
Gerrells has more than 25 years of helicopter maintenance and aviation experience and has been with Air Methods since 1989. He has served in a variety of positions including line mechanic, lead mechanic, field maintenance supervisor, field maintenance manager, maintenance resource and planning director and director of maintenance. Prior to joining Air Methods, Gerrells was with Rocky Mountain Helicopters. He is a certified A&P mechanic and has a bachelor’s degree in business management.
Gray’s primary responsibilities include oversight of Part 135 and 145 maintenance, material management, quality assurance, maintenance planning and fleet management. Gray has more than 35 years experience in the aviation field. After completing his education at Pensacola Jr. College and Mid Continent School of Aeronautical Science, he started his career in aviation working for PHI in Lafayette, La. From 1974 to 2002, his work with PHI included the positions of maintenance technician, maintenance manager, fleet manager, director of material management, as well as the director of corporate aviation for fixed-wing aircraft. He has been vice president of aviation support for Air Methods since 2002.