LifeNet of New York Landing Zone Presentation

1. LifeNet of New YorkLanding Zone Presentation

2. “BECAUSE MINUTES MAKE A DIFFERENCE”

3. Administration • Program Director – Dean Dow • Medical Manager – John Fisher • Medical Base Supervisors • Jon Gryniuk • Shannon Martin • Mike Paulson • Craig Castioni • Medical Directors • Deb Funk MD, David Stuhlmiller MD • Administrative Assistant – Desiree James

4. Pilots • All pilots hold a commercial certificate with instrument rating • Have at least 2000 hours of PIC time • Completed specialized training in EMS flight operations

5. Available 24 hours a day, 7 days/week, 365 days/year Medically dedicated Staffed by a Paramedic/RN team with equal training and responsibility Provide advance medical procedures advanced airway management hemodynamic support advanced pharmacology ability to act autonomously guided by “standards of practice” Medical Staff

6. Life Net 7-1 , AlbanyEC-135 • American Eurocopter • Twin Pratt and Whitney 650 shp engines • Rear load for ONE patient • 187 gallons Jet A • Range of 300 on full load of fuel • Cruise speed of 168 mph

7. Dimensions and Weight • Total running length – 40 ft • Main rotor diameter – 34 ft • Main rotor height – 11 ft on level ground • Tail rotor height – 2.2 ft • Maximum gross weight – 6250 lbs. • Can carry up to 350 lb. patient

9. Life Net 7-2, GlenBO105 • American Eurocopter • Twin 250hp Allison Engines • Rear load for ONE patient • 150 gallons of jet A fuel on underside of AC (similar properties to Kerosene) • Range of 300 miles on a full load of fuel • Cruising speed of 130-140 mph

10. Dimensions and Weight • Total running length – 39 feet • Main rotor diameter – 32 feet • Main rotor height – 10 feet (level ground) • Tail rotor height – 7 feet (level ground) • Maximum gross weight – 5500 lbs. • Can carry up to 350 lbs. patient.

12. Air 1 / Air 2 , Kobelt & ValhallaBK117 • American Eurocopter • Twin Lycoming 650 hp gas turbines • Rear load for ONE or TWO patients • 187 gallons of jet A fuel on underside of AC (similar properties to Kerosene) • Range of 300 miles on a full load of fuel • Cruising speed of 144-150 mph

13. Dimensions and Weight • Total running length - 43 feet • Main rotor diameter - 36 feet • Main rotor height -10 feet (on level ground) • Tail rotor height - 6 feet (on level ground) • Maximum gross weight - 7055 lb • This aircraft has carried patients with combined weight of > 500 lbs.

15. Scene Responses • LifeNet NY can and has responded within a 100 mile radius of the respective bases

16. Equipment & Skills • ECG Monitoring • Biphasic Defibrillator • ETCO2 monitoring • Ventilator • IV pumps • IV warmer • Transvenous Pacer • EZ IO • Jet Insufflator • Needle & Surgical Cricothyroidotomy • Escharotomy • RSI Intubation • Neonatal Resuscitation Equipment • Over 70 medications

17. Why Utilize Air Transport ? • To “bring the Emergency Room to the patient” • To provide the patient with early, needed and advanced medical care • To transport the patient to the “closest appropriate facility” therefore decreasing time to Definitive Care

18. GOLDEN HOUR

19. GCS < 13 Head injured with altered mental status Confused/combative Unconscious/unresponsive Heart rate > 120 Blood pressure < 90/p Pelvic fractures Limb paralysis Burn patients—greater than >10% BSA 2nd and 3rd and >5% 3rd in any population These patients will be transported directly to a burn facility @ Westchester, Worcester, Syracuse University Hospital and/or Boston Children's… Transport Criteria: Physiologic

20. Chest trauma with respiratory distress Respiratory rate > 29 Severe shortness of breath Difficulty speaking CO poisoning Amputations proximal to the hand or foot, not to include single digits Penetrating trauma Gunshots Stabbings Impailments Transport Criteria: Physiologic

21. Transport Criteria: Operational In Conjunction with Physiologic • Need for ALS otherwise unavailable • Extrication > 10 minutes • Fall of 20 feet or more • Patient ejected from a vehicle • Vehicle rollover with patient entrapped • High speed crash with significant intrusion • Motorcycle/Auto v. Pedestrian

22. Transport Criteria: Operational • Surviving patient of a MVC with a death • Age of < 5 or > 55 years old • Significant associated medical conditions • Pregnancy • ***These patients should be transported to a regional Trauma Center (Albany Medical Center, Bassett Health Care (Cooperstown), Robert Packer, St. Elizabeth’s, University Hospital, Wilson Memorial)***

23. Patients without vital signs: there is usually no survival from traumatic death Hypothermic patients being the exception No patient is too critical to transport A surviving patient will be transported before one in arrest LifeNet of New York can provide assistance to local providers and transport by ground Special Circumstances

24. Law enforcement Firefighters Industrial safety officers First responders Paramedics EMTs First Responders RNs/MDs/Pas Many of the regional counties are on automatic stand-by for “delta” calls: Rensselaer, Saratoga, Columbia, Washington, and Schenectady Who can request?

25. Agency or comm. Center calling Call back # State and county Lat/long or nearest roadway and cross street Ground frequency with or without PL The AC can program high/low and ultra high frequencies Scene information Description of landing area Hazards and their position to the LZ How To Request1 800 525-6663

26. Delorme Street Atlas

27. STAND BY • Automatic stand by/ launch currently instituted in Rensselaer, Columbia, Saratoga, Schenectady, and Washington counties for all “delta-level trauma” • Readies AC and FC for mission • Second call is needed to launch or cancel • No charge if cancelled enroute • Automatic launch for areas > 30 nautical miles

28. Early Call • Lets YOU know if: • the AC is out on another call • unable to fly due to weather • is on a maintenance delay or out of service • may be a short delay only and still able to be utilized • an available AC will be found or we may be able to intercept

29. Weather--Pilot’s Final Decision • Minimum standards for ceiling and visibility • day versus night • Weather based on satellite readings, current conditions, and forecasts • Pilot knows only destination when making decisions

30. Enroute Information Scene (LZ) information only FC will obtain patient report when safely landed.

31. Landing Zone Officer • One person assigned, landing the AC safely the only responsibility • AC will try to contact LZ officer ~ 5-10 minutes out • LZO may need to be on apparatus radio; portable may not transmit • Focus all attention on managing communications, approach/departure, and landing site area

32. Landing Zone Officer • Directs the AC into the scene. May be required to use directions, “out your right door and/or clock method--nose of AC is 1200, tail of AC 0600. • Locating the scene in daylight is more difficult, even with overhead lighting. • AC/pilot may circle LZ numerous times before landing.

33. Slide of LZ officer, in turnout

34. Proximity to the accident, utmost importance 80’X70’ Level surface Clear of obstructions Secured by LZ officer Approach and departure path clear of obstructions Choosing the Landing Zone

35. DAY Flares (caution) Cones Rescue vehicles Overhead lighting on rescue vehicles both for day or night NIGHT Flares (caution) Chemical light sticks Battery powered flash lights (secured to ground) Headlights from two vehicles pointed at LZ to form an X Marking the Landing Zone

36. Secure loose debris (car doors, trunk lids, stretchers, linens, baseball hats etc.) Protect yourselves! Wear turnout gear, goggles, protective eye shields LZ walk through Secure nearby activity Moving traffic Rescue activity Apparatus and ambulance doors closed Keep all spectators > 200 feet from LZ. Only those assigned to protect the AC allowed < 100feet Preparing Touchdown Area

38. SAFETY FIRST AND FOR ALL: • Fire Department • Pre-hospital providers • Police Department • Life Net of New York • All involved in the safe transfer of a critically ill or injured patient

39. Take Off and Landing “Most Critical Time of Flight” AC will not land w/o first attempting to make contact with LZ command

40. Arrival / Landing Information • Obstructions: wires, power lines, light poles, smoke stacks, antennas, etc. • Report all obstructions to the pilot as the AC is over the landing zone, never assume pilot has seen all obstructions. • Winds: wind direction and intensity helps the pilot better plan the landing. Helicopter lands and takes off with nose into the wind.

41. Arrival / Landing Information • Condition of the touchdown surface: be specific, ie: slope, surface (mud, packed snow, dust). • Security: assure crowd is secure and all traffic is stopped for landing and take-off. • LZ officer will be notified of “final approach”. If any unsafe or potentially unsafe situation arises, contact pilot to make aware. Use short simple commands: “STOP! WIRES!”, etc.

42. Hazards WIRES, POLES, CHURCH STEEPLES, LIGHT POLES, UNLIT TOWERS (Cell), STREET SIGNS, PLOW STAKES, etc...

43. High Hazards Do not assume the AC cannot land in the presence of wires near the roadway.

44. Landing / Lift-off Safety During night operations, NEVER allow white lights to shine into the cockpit. Night vision will be compromised

45. Final Approach • As the AC is on “final approach” the pilot or FC may ask the LZ officer to have all white lights, shining toward the LZ, extinguished before touchdown. • The AC can produce > 70 mile per hour winds with short final. Protect yourselves.

46. Always approach the AC from the nose. Never approach the AC unless directed by the FC or pilot. If asked to get equipment by FC in AC, never approach w/o the getting pilot’s attention. Keep all personnel and others at least 50 feet away from the AC when running. May post a safety officer 50 feet behind the tail rotor NEVER APPROACH OR GO NEAR THE TAIL ROTOR OF THE AC. Ground Operations

48. Let the FC come to you FC does NOT require assistance off-loading equipment Keep apparatus and EMS vehicle doors and windows closed. Leave patient in ambulance Nothing carried above the waist level. No smoking within 50 feet of the AC No sheets, blankets, baseball hats near AC Firefighters should have turnout gear and helmets with shields down. Ground Operations

49. Keep All vehicles > 50 feet from AC • Cartoon of pic of EMS vehicle damage by rotor blades.

50. Patient Preparation • Flight Team will perform: • patient assessment • required interventions • transfer patient to FC stretcher • load into AC