Thursday, October 1, 2009
Methodology: Understanding Number One
Air Methods bills itself as the "World’s Largest Air Ambulance Operator" for a very good reason: It is.
The numbers tell the tale. Air Methods flew 105,971 missions in 2008, serving 42 U.S. states from 249 hospital and community bases. This translates to 138,219 total flight hours for the company’s fleet of 300-plus rotary and fixed-wing aircraft. This fleet is primarily comprised of Bell and Eurocopter helicopters. Flying and backing them are 3,150 employees nationwide, from pilots and medical personnel to maintenance technicians, flight controllers and office staff.
"The biggest challenge of my job is managing employees in 250-plus locations," says Air Methods CEO Aaron Todd. Rotor & Wing found out how Air Methods does this safely and effectively.
Roy Morgan founded Air Methods. He was a pilot in Colorado. In the 1970s, Morgan flew an unplanned air medical service (AMS) mission in a conventional helicopter. The patients were a gravely injured woman and her grandchild, waiting for a winter storm evacuation from a highway patrol cruiser. "Here are your patients," the officer said, and Morgan asked, "Where’s the nurse?" The officer replied, "There is no nurse." The experience convinced Morgan that properly equipped and staffed AMS helicopters were a must. This is why he founded Air Methods in 1980, starting with a program in Grand Junction, Colo.
"Since then, we have grown through expansion and acquisition," says Todd. Under the second category, Air Methods acquired Mercy Air in 1997; ARCH in 2000; Rocky Mountain Holdings in 2002; and CJ Systems in 2007.
Since those early days, Air Methods has focused on air medical transport, and nothing else. To do so effectively, the company is organized into three divisions — Hospital-Based Services (HBS), Community-Based Services (CBS) and the Products division.
The HBS division is where Air Methods started out. In this model, the hospital leases the aircraft, hires EMS personnel and communications staff, and runs its AMS program. All Air Methods does is provide pilots and maintenance, including backup aircraft.
Air Methods’ HBS program is very attractive to clients such as Iowa Health-Des Moines. Its Life Flight AMS program is currently using an Air Methods’ Eurocopter AS350B2 that will soon be upgraded to an EC145.
"The HBS arrangement works very well for us," says Life Flight program manager Evelyn Jackson. "Air Methods handles all of the program details, including Part 135 compliance, allowing us to focus on medical care. It would cost us more in time and money to run the helicopter program ourselves, and Air Methods has more resources than us in terms of personnel, maintenance and spare aircraft."
The CBS division is entirely different. Under the CBS model, Air Methods provides a hospital/medical service with a complete AMS package — aircraft, pilot, mechanic and EMS staff, as well as program management. "The point of CBS is that our clients get a fully-capable AMS program; including critical-care medical staff who know how to treat burn, cardiac, pediatric, respiratory and trauma cases," Todd tells Rotor & Wing. "We handle all of the details, including meeting requirements for FAA Part 135 air carrier certification." Air Methods has CBS clients in 18 states.
The Products division designs, builds and certifies air medical interiors for helicopters. It’s a capability that allows the company to ensure standardization across its AMS platforms, in addition to creating an extra revenue stream. Interiors aren’t limited to small aircraft: the company converted an L1011 into a flying hospital for Operation Blessing. Air Methods also provides multi-purpose interiors for the U.S. military’s UH-60Q Black Hawk helicopters and Stryker medical evacuation vehicles.
Large AMS Management
Air Methods’ headquarters is in Englewood, Colo., but its 249 bases are scattered across 42 states. Add its LifeCom communications/transfer center in Omaha, Neb. — which handles flight booking, coordination, tracking and logistical support for Air Methods operations — and the company’s Operational Control Center in Englewood, and there’s a lot to manage. So how does Air Methods do it?
"We start with national standards for flight operations, medical care, and maintenance," explains Craig Yale, vice president of corporate business development. "We then transmit these standards to our regional operations, each of which have their own offices and infrastructure. Our regional operations are key to balancing the need for consistency and the reality of the fact that, when you’ve seen one AMS base, you have only seen one. They are all different."
"The concept is to go regional and local where you need to, and stay national where it makes sense," Todd adds. "This is why we have regional operations, and networks to help them support the local bases within their territory. But we keep billing centralized here in Englewood, because it just makes sense to handle it in one place. The same is true for LifeCom and our Operational Control Center. We wanted to have a 30,000-ft view of these aspects of our business to ensure maximum safety for everyone."
The same logic applies to LifeCom’s One Call transfer center. Trying to coordinate patient transfers on a local hospital-by-hospital basis is a recipe for chaos — there are just too many variables that can get in the way of rational, safe scheduling. "One Call streamlines the process," says Yale. "Each of the facilities we work for has dedicated coordinators available to us, who know the specific hospital protocols and procedures they have to work within."
Safety is a long-standing issue for AMS operators. It’s an issue that Air Methods takes very seriously, as proven in part by the company having its own director of safety, Ed Stockhausen. He reports directly to the COO.
"It is quite common for airlines to have safety directors, but not Part 135 companies," Stockhausen says. "Four years ago we decided it was time to create the position, to aid in the deployment of our SMS process."
Short for safety management system, SMS is a voluntary FAA-recommended process. Essentially, companies such as Air Methods take it upon themselves to police all aspects of operational safety, rather than waiting for FAA inspectors to identify problems during their inspections. Under its SMS program, Air Methods is encouraging self-reporting of potential safety issues by staff (through FAA’s Aviation Safety Action Program) and having trained safety observers ride with pilots during flights to monitor their performance (Line Oriented Safety Audit), as well as introducing in-flight data collection for later analysis (Flight Operations Quality Assurance).
Air Methods has a number of other safety-enhancing programs in place. For instance, the SilentWhistle program allows employees, customers and vendors to file anonymous reports about their safety concerns. SilentWhistle is a backup to the company’s accident incident damage malfunction operations reports (AIDMORs), which are designed to bring problems to management’s attention. Air Methods also has an executive safety council chaired by Todd that provides direction to the company’s Corporate Safety department. In addition, monthly meetings of the root cause analysis (RCA) dig into problems to find primary causes and fix them.
RCA helps explain why Air Methods helicopters are well-equipped with flight safety gear. "We looked at the root causes of helicopter EMS accidents and found that inadequate awareness of terrain and weather conditions were major contributing factors," says Todd. "This is why our new helicopters come equipped with — and our older models are being retrofitted with — full suites of flight safety equipment." These suites include night vision goggles (NVGs), helicopter terrain awareness and warning systems (HTAWS), XM satellite weather systems, satellite-based location tracking of company aircraft, and wire strike prevention technology.
This said, the company has a way to go in deploying these capabilities fleet-wide. By the end of this year, Air Methods expects to have 42 percent of its fleet equipped with NVGs, and 28 percent to have HTAWS and XM satellite weather. Around 85 percent will have satellite tracking, and 71 percent will have wire strike prevention technology.
Even with the best safety equipment, accidents can still happen. When they do, "we dispatch trained crews to the scene to help with the investigation — we want to know what happened to keep it from happening again — and to aid the victims," says Stockhausen. "We also get spare aircraft into place fast, to help our clients resume their AMS program as quickly as possible." Air Methods operates a fleet of 30 spare helicopters. They are distributed across the country, for fast deployment when needed.
Finally, to support its pilots while aloft, Air Methods monitors all of their aircraft nationally at its Operational Control Center. The OCC is manned 24/7 with a pilot supervisor on all shifts. Its mission to keep Air Methods pilots informed about hazardous weather, monitor their flight plans and locations in real-time (using satellite-based GPS tracking), and to provide real-time assistance when problems arise.
"The OCC’s Site Watch software takes flight plans fed to us by our clients computer-aided dispatch systems, and compares them to known hazardous weather," says Stockhausen. "It creates a 30-nautical-mile ‘bubble’ around the aircraft, warning it within this distance if dangerous weather is in its path. The OCC has the ability to talk to some of our pilots using satellite phones. Finally, the OCC’s flight management system provides the company with ongoing position reports about all of our in-flight aircraft."
Training and Flight Skills
Safety is a big part of Air Methods’ crew training. This is why the company has devised AMS-specific courses for its pilots, so that they know what they are likely to come up against on the job.
"Air ambulance training includes learning how to work with medical crew, what to expect from certain kinds of illnesses and injuries," says Todd. "This training comes with its own ground school and flight training, and pilots must pass two written exams to qualify to work with us."
That’s not all: new Air Methods pilots must pass basic indoctrination training — including inadvertent IMC recovery training — and base orientation courses. Once on staff, pilots will take perform recurrent ground school training and air medical resource management training annually, plus flight training semi-annually.
Of course, only experienced pilots need apply to Air Methods. For the company to even consider a candidate, they must have 2,000 hours VFR experience (1,000 hours turbine); 2,500 hours IFR (1,000 hours turbine) and 200 hours logged in night flying. Pilots need to be instrument certified and qualified, with 100 hours or more instrument experience preferred. Air Methods favors pilots who have ATP certificates, air medical transportation experience and excellent interpersonal skills. For those pilots applying to work in high-altitude areas, mountain flying experience is required.
New Air Methods mechanics go through a three-day program to examine their skills and instill knowledge of the company’s expectations and procedures. Regular training courses in areas such as autopilot maintenance and field-level engine maintenance are held for mechanics as well, on an ongoing basis. Minimum standards include an FAA A&P license and advanced electrical troubleshooting skills. Candidates with two years’ experience in relevant areas will get preference at hiring time.
As Microsoft can attest, it isn’t always fun being the biggest company in your industry. Yet despite its size, Air Methods is receiving good reviews from its customers.
Stacy Brewers is one of these customers. She is director of flight services and chief clinical officer at Life Link III. Based in Minneapolis, Life Link III is a consortium of eight health organizations in the region. Air Methods flies Bell 407 and 222 helicopters for Life Link III under a CBS contract.
"Air Methods has proven to be a very good partner over the many years we’ve worked with them," says Brewers. "They’ve always provided good support and helped us make changes when we’ve needed to make them. Air Methods being the largest AMS operator also helps. They have the resources to provide spare aircraft, get parts fast and get our regular aircraft back to service quickly."
"Air Methods handles everything for us," explains Brian Simpson, program manager of AirMed. In operation with the University of Utah’s University Health Care in Salt Lake City, AirMed operates one Bell 430, two Bell 407s, Bell 206L-3 and two Pilatus PC-12 turboprop airplanes.
"We’ve been with them for 15 – 20 years. The hospital believes Air Methods is just better-equipped than we are to manage and maintain our fleet, get pilots, manage government procedures and obtain spares when we need them. And if I ever have problems, I can pick up the phone and talk to Aaron Todd."
Life Flight’s Evelyn Jackson notes that her company has "seen a lot of improvement in Air Methods’ customer service over the past three years." She serves as a member of the company’s customer service advisory board. "Despite their size, they have become a very responsive company. That’s great, because we like being able to count on them to handle our fleet for us."
Air Methods is rapidly approaching its 30th anniversary. In this time, it has grown from one pilot’s response to the challenge of helicopter EMS into the world’s largest AMS operator.
So what’s next? More of the same, says Todd; all with a continuing emphasis on improving flight and operational safety.
"We have a high duty and responsibility to lead the way on AMS safety," he tells Rotor & Wing. "Besides what it provides to our own clients and staff, this duty is why we have implemented so many safety initiatives, and why we are shriving to equip our helicopters with night vision goggles, TAWS, and satellite communications/tracking. For those who point to the human factor in AMS accidents, we are responding through crew training and better flight management through our OCC. Air Methods is serious about safety."
The bottom line is that as 29 years have shown, Air Methods has the drive, skill and resolve to succeed in the AMS industry. But all this success has not changed the company’s fundamental mission since Roy Morgan founded it. Then and now, Air Methods is dedicated to providing proper air medical transport to patients, with care beginning even before they enter the aircraft. Given the 100,000-plus flight hours Air Methods logged last year alone, thousands of lives have been saved by this AMS operator; at the very least.
Maintenance Services for Hire
In addition to its AMS flight services and products division, Air Methods is an FAA-approved airframe and limited engine repair station. It has a full-service maintenance and overhaul facility staffed by licensed, factory-trained personnel. Air Methods’ maintenance facility can handle periodic inspections, routine maintenance, major airframe repairs, refurbishments, dynamic component overhauls and non-destructive inspections.
Air Methods is an authorized service center for the following Bell helicopters. For field maintenance, it can service the 206, 206A/B, 212, 222, 230, 407, 412 and 430 models. Air Methods is authorized to perform component overhauls on the 206A/B, 206L, 212, 222, 230, 407 and 412.
The company is also an authorized service center for Eurocopter. It is authorized to do maintenance and repairs on the AS350, AS355, BK117, BO105, EC130 and EC135. Details on its avionics installation and repair services can be found at the company’s website.
Finally, Air Methods occasionally sells used aircraft from its fleet. At press time, the following aircraft were available: an Agusta 109E (registration N109UP), Bell 206-L3 (N200LL), Bell 430 (N430Q), and Eurocopter BK117 A3 (N986LE).
Air Methods Facts
Air Methods monitors all of their aircraft nationally at its Operational Control Center. The OCC is manned 24/7 with a pilot supervisor on all shifts and provides real-time assistance when needed.