Vanderbilt LifeFlight Celebrates 30 Years of Service Jerry Jones, MPA, EMT-IV
n 1984, the Apple Macintosh computer was launched, Ronald Reagan was president, the cost of a postage stamp was 20¢, the price of a regular gallon of gas was $1.21, and the price of jet fuel averaged around 84¢ a gallon. It was also an important year for residents of Middle Tennessee; it was the year Vanderbilt began its air ambulance program. On July 5, 1984, Vanderbilt University Medical Center (VUMC) initiated its “LifeFlight” operations with a Bell 206 LongRanger helicopter owned and operated by Kenn Air for Vanderbilt. The first patient transport was made the next day with pilot Bill Hamblin and flight nurses Allison Bolin and Kathy Ogle. Hamblin stayed with the program until he retired in 2009. That first flight was a culmination of years of planning and careful orchestration that built a solid network of emergency services throughout Middle Tennessee. LifeFlight is the bridge that ties the region's emergency services network to the world class physicians, nurses, and staff at Vanderbilt, and because of that strong network and stringent medical training and
I
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oversight of its medical flight crews, Vanderbilt care is taken directly to the patient. Vanderbilt was among the first academic medical centers to add air medical transportation for critically ill patients. In 1983, John Sawyers, MD, professor and chairman of the Department of Surgery, and Joseph Ross, MD, professor of medicine and associate vice chancellor for health affairs, made the decision to add a patient transport helicopter to the services of Vanderbilt University Hospital. The move was part of a larger strategy by the medical center to build and brand top-level trauma surgery and emergency medicine programs. In 1984, LifeFlight’s first medical director, John A. Morris Jr, MD, now associate chief of staff of the Vanderbilt Health System, chief medical officer of the Vanderbilt Health Affiliated Network, and professor of surgery and adjunct professor of biomedical informatics, joined the faculty, starting his tenure several weeks ahead of time in order to coincide with the arrival of the medical center’s first helicopter. Air Medical Journal 33:4
Morris and Ross focused on patient care with the helicopter and not just the idea of rapid transport. “We wanted to use specially trained nurses with an expanded skill set who can take Vanderbilt’s services into rural communities rather than merely transport patients to the hospital,” said Morris, who served as LifeFlight’s medical director from 1984-2010. During the 26 years he served at the helm, the program grew into one of the safest and most advanced in the nation with the care it provides. “We did things 20 years ago that were the right thing for the individual patient,” he says, “but were horrific in terms of the risks we took—though we didn’t know we were taking them at the time. We once landed an aircraft on Garland Avenue [the street in front of Vanderbilt University Hospital] so we could treat a guy with a stab wound to the heart, and we got that guy to live. Imagine landing a helicopter in the middle of Garland Avenue to do this. But we knew from the flight nurse’s report that the patient wouldn’t make it the 500 yards from the football field [LifeFlight’s landing zone during its early days] to the ER [emergency room]. There are those kinds of heroic but horrendous stories.” Morris set the bar high to be a part of the medical crew. With the vision of taking Vanderbilt to the patient, he knew the medical training for nurses had to be some of the toughest in the country. The typical flight nurse has academic medical center or tertiary care hospital experience as well as an emergency medical services (EMS) background. Nurses must be dually licensed as a registered nurse and an emergency medical technician (EMT) or paramedic; have a minimum of 3 years of emergency department/critical care experience (ideally at a level 1 trauma center); pediatric experience greater than 640 hours; Tennessee or National Registry EMT or EMT paramedic; basic cardiac life support, advanced cardiac life support (ACLS), pediatric advanced life support (PALS), and neonatal resuscitation program (NRP) certifications; and one of the following: certified emergency nurse (CEN), critical care registered nurse, and/or certified flight registered nurse (CFRN) certifications; either a trauma nursing core course or a transport nurse advanced trauma course; and a strong preference for previous flight experience. Paramedics were added to the flight crew mix in 2005. All flight paramedics must be critical care paramedic licensed, have national flight paramedic certification, have 3 years of experience as a paramedic in an emergency setting, pediatric experience, and certifications including basic life support (BLS), ACLS, PALS, pre-hospital trauma life support or basic trauma life support, and NRP. Additionally, all medical crewmembers must complete annual clinical rotations in the medical center that incorporate the latest research with bedside practice as well as opportunities to practice invasive skills with a variety of formats. Each must also attend or review all monthly case conferences that cover a variety of topics and case studies. All clinical staff members are trained to perform advanced procedures including rapid sequence induction with oral July-August 2014
intubation, nasal intubation, needle and surgical cricothyrotomy, needle chest decompression, chest tube placement, central line placement, and pericardiocentesis. Packed red blood cells are carried on all flights and given as needed. Because the department is part of an academic medical center, LifeFlight crewmembers have some exceptional opportunities for medical training that many other flight programs may not have access to; 2 of those, the use of a cadaver laboratory and a high-fidelity simulation laboratory, allow crewmembers to be exposed to some very complex medical scenarios. The cadaver laboratory is used on a regular basis to learn and maintain invasive procedures and skill sets. Another unique program is the ability to have an emergency medicine resident fly as part of the regular medical crew. Each year, 1 physician is selected from the emergency medicine resident program and trained to operate on shift as a regular crewmember. The experience exposes the emergency medicine resident physician to flight medicine and operations and allows LifeFlight’s registered nurses and paramedics to learn the latest in emergency medicine. Physician involvement remains one of the keys to maintaining clinical performance. Jeremy Brywczynski, MD, assistant professor of emergency medicine, became the medical director in November 2010. He implemented an oral review board for all medical crewmembers. On an ongoing basis, he meets with each crewmember and gives scenarios about how that patient would be cared for; this gives him the opportunity to get to know all crewmembers, their skill level, and what areas the department may need to focus on for future education. Brywczynski also attends chart reviews to answer questions and bring out teaching points during the monthly case conferences. He is assisted by his colleague, Jared McKinney, MD, assistant professor of emergency medicine, who serves as medical director over the ground and event medicine divisions. Today, LifeFlight has made more than 40,000 flights and has more than 130 employees, 5 bases, 1 airplane, 4 ground ambulances, and several divisions that form a cohesive integrated transport service. Rotor-wing air carrier transportation is provided by AirMethods, and fixed-wing air carrier transportation is provided by SevenBar.
LifeFlight’s Working Parts More than 130 Vanderbilt employees keep LifeFlight running smoothly. Add to that the approximately 34 pilots and 17 mechanics who work for LifeFlight’s vendors, AirMethods and SevenBar, and you have some 180 personnel who serve as VUMC’s most visible brand—walking, flying, and rolling billboards. LifeFlight staff work in 7 different divisions and serve as Vanderbilt ambassadors in every community within the medical center’s 65,000–square mile catchment area.
Emergency Communications The front door to VUMC and the Monroe Carell Jr Children’s Hospital at Vanderbilt, the emergency communications division has 18 employees manning more than $1 147
million worth of highly sophisticated communications equipment. This team of licensed EMTs and paramedics dispatch and follow 5 helicopter bases; an airplane; and neonatal pediatric critical care ground, ground EMS, and LifeFlight Event Medicine ambulances. Additionally, this office serves as the Regional Communications Center (Region 5) for Tennessee, dispatches any stat emergency calls throughout the medical center campus, monitors weather conditions, and tracks more than 6,000 takeoffs and landings at the Vanderbilt helipads.
Helicopter (Rotor Wing) Sixty-one employees make up the rotor wing division (excluding the AirMethods pilots and mechanics); 47 of those are flight nurses, and 9 are flight paramedics. LifeFlight operates a fleet of 6 Airbus helicopters: 3 EC145s, 2 EC135s, and 1 EC130 from bases located in Lebanon (LF 1), Tullahoma (LF 2), Clarksville (LF 3), Mt Pleasant (LF 4), and Smyrna (LF 5), TN, covering all of Middle Tennessee, Southern Kentucky, and Northern Alabama. The sixth helicopter is used as a backup. Each base has a chief flight nurse who manages the base and its employees. The program flew with just 1 helicopter from 1984 to 1987. From 1987 to 2012, an additional 4 aircraft were added. Each base also has a “critical care response” car for the medical crews to meet local EMS teams and assist transport by ground ambulance on missions that cannot be completed by air because of weather conditions. The cars are former Vanderbilt University police department patrol vehicles. The vehicles do not respond to emergencies with lights and siren, nor do they respond directly to scene calls. The LifeFlight medical crew will have all of the medical equipment and supplies that are normally available on the helicopter, including lifesaving blood. In 1998, LifeFlight began working with its vendor AirMethods to implement a single pilot instrument flight rules (IFR) capability. Since then, it has built an advanced network of low-structure IFR approaches to enhance safety and availability during decreased visibility. In 2009, night vision goggles were added on all helicopters.
Airplane (Fixed Wing) Five employees are assigned to the fixed wing division (excluding SevenBar pilots and mechanics). Two of those are flight nurses and 3 are flight paramedics. LifeFlight 10 (airplane) opened in Nashville in 2004. The fixed wing aircraft is another component of Vanderbilt’s comprehensive transport program. Each year, VUMC’s fixed wing program transports patients to destinations across North America.
Ground Transport Staffed by a dedicated team of 13 EMT-IVs, paramedics and critical care paramedics, the ground transport division does BLS and advanced life support discharges from VUMC as well as critical care transfers. 148
Event Medicine The event medicine division has 1 full-time employee and more than 25 part-time EMTs and paramedics. Functioning as a highly visible arm of LifeFlight, the team provides emergency medical care and transportation to more than 600 community events, including the Nashville Predators, the Nashville Sounds, and all Vanderbilt athletics.
Discharge Transport The discharge transport division consists of 2 full-time employees and handles the logistics and coordination of all Air Medical Journal 33:4
patients discharged by ambulance from VUMC. It also dispatches and coordinates LifeFlight’s ground transport.
12% of all scene flight patients received blood while inflight
Education, Outreach, and Marketing
121 ST-segment elevation myocardial infarction patients transported by helicopter 142 stroke patients transported by helicopter
The education, outreach, and marketing division consists of 3 full-time employees, 1 part-time employee, and 2 student workers and is responsible for all external education efforts; marketing; digital media; business development; EMS equipment cleaning and delivery back to its home agency; coordination of the mobile command and communications bus; and coordination of the student group, Vanderbilt Emergency Medical Society, and interaction with EMS and hospital customers. More than 12 courses are offered to 911, EMS, and hospital providers through this division as well as a large annual EMS conference. More than 3,000 people were provided with EMS education in 2013 from Vanderbilt LifeFlight.
Leadership LifeFlight operates as a department within the nonprofit VUMC. It operates under the emergency services umbrella, which reports to the chief nursing officer of VUMC. Jeanne Yeatman, MBA, RN, EMT, who served as LifeFlight’s program director from 2002 to 2012, oversees all emergency services as its administrative director. Lis Henly, RN, EMT, serves as LifeFlight’s program director along with Kevin Nooner, MSN, RN, CEN, CFRN, EMT-P, who serves as its operation director.
LifeFlight by the numbers (2013) 5 helicopters staffed 24/7 1 backup helicopter 1 airplane 4 ground ambulances Takeoffs and landings at Vanderbilt helipads: 6,751 Average speed of a LifeFlight helicopter: 138 mph Average response time for helicopter (flight time): 24.1 minutes 2,770 hours flown by helicopter (365,563 miles)
Community events worked by event medicine: 534 5 community-located bases: Lebanon, TN (LifeFlight 1) Tullahoma, TN (LifeFlight 2) Clarksville, TN (LifeFlight 3) Mt Pleasant, TN (LifeFlight 4) Smyrna, TN (LifeFlight 5) Airplane (LifeFlight 10) is located at the Nashville International Airport Emergency communications division (flight communication) 26,279 trauma pages sent 14,067 ambulance radio reports taken Jerry Jones, MPA, EMT-IV, is the public affairs manager for Vanderbilt LifeFlight in Nashville, TN. He is a seasoned EMS professional serving as the former chief of Bedford County EMS. He has been with Vanderbilt University Medical Center for 13.5 years. 1067-9991X/$36.00 Copyright 2014 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.03.003
798 hours flown by airplane (35,348 miles) Total loaded miles by ground ambulance: 1,627 Transports: Helicopter: 2,409 Airplane: 265 Ground EMS (discharge transport ambulance): 1,470 Event medicine (ground ambulance): 81 Total transports: 4,225 60% interfacility flights 40% scene flights 83% of patients are adults 17% of patients are pediatric 4.5% of all patients received blood while inflight
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n 1984, the Apple Macintosh computer was launched, Ronald Reagan was president, the cost of a postage stamp was 20¢, the price of a regular gallon of gas was $1.21, and the price of jet fuel averaged around 84¢ a gallon. It was also an important year for residents of Middle Tennessee; it was the year Vanderbilt began its air ambulance program. On July 5, 1984, Vanderbilt University Medical Center (VUMC) initiated its “LifeFlight” operations with a Bell 206 LongRanger helicopter owned and operated by Kenn Air for Vanderbilt. The first patient transport was made the next day with pilot Bill Hamblin and flight nurses Allison Bolin and Kathy Ogle. Hamblin stayed with the program until he retired in 2009. That first flight was a culmination of years of planning and careful orchestration that built a solid network of emergency services throughout Middle Tennessee. LifeFlight is the bridge that ties the region's emergency services network to the world class physicians, nurses, and staff at Vanderbilt, and because of that strong network and stringent medical training and
I
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oversight of its medical flight crews, Vanderbilt care is taken directly to the patient. Vanderbilt was among the first academic medical centers to add air medical transportation for critically ill patients. In 1983, John Sawyers, MD, professor and chairman of the Department of Surgery, and Joseph Ross, MD, professor of medicine and associate vice chancellor for health affairs, made the decision to add a patient transport helicopter to the services of Vanderbilt University Hospital. The move was part of a larger strategy by the medical center to build and brand top-level trauma surgery and emergency medicine programs. In 1984, LifeFlight’s first medical director, John A. Morris Jr, MD, now associate chief of staff of the Vanderbilt Health System, chief medical officer of the Vanderbilt Health Affiliated Network, and professor of surgery and adjunct professor of biomedical informatics, joined the faculty, starting his tenure several weeks ahead of time in order to coincide with the arrival of the medical center’s first helicopter. Air Medical Journal 33:4
Morris and Ross focused on patient care with the helicopter and not just the idea of rapid transport. “We wanted to use specially trained nurses with an expanded skill set who can take Vanderbilt’s services into rural communities rather than merely transport patients to the hospital,” said Morris, who served as LifeFlight’s medical director from 1984-2010. During the 26 years he served at the helm, the program grew into one of the safest and most advanced in the nation with the care it provides. “We did things 20 years ago that were the right thing for the individual patient,” he says, “but were horrific in terms of the risks we took—though we didn’t know we were taking them at the time. We once landed an aircraft on Garland Avenue [the street in front of Vanderbilt University Hospital] so we could treat a guy with a stab wound to the heart, and we got that guy to live. Imagine landing a helicopter in the middle of Garland Avenue to do this. But we knew from the flight nurse’s report that the patient wouldn’t make it the 500 yards from the football field [LifeFlight’s landing zone during its early days] to the ER [emergency room]. There are those kinds of heroic but horrendous stories.” Morris set the bar high to be a part of the medical crew. With the vision of taking Vanderbilt to the patient, he knew the medical training for nurses had to be some of the toughest in the country. The typical flight nurse has academic medical center or tertiary care hospital experience as well as an emergency medical services (EMS) background. Nurses must be dually licensed as a registered nurse and an emergency medical technician (EMT) or paramedic; have a minimum of 3 years of emergency department/critical care experience (ideally at a level 1 trauma center); pediatric experience greater than 640 hours; Tennessee or National Registry EMT or EMT paramedic; basic cardiac life support, advanced cardiac life support (ACLS), pediatric advanced life support (PALS), and neonatal resuscitation program (NRP) certifications; and one of the following: certified emergency nurse (CEN), critical care registered nurse, and/or certified flight registered nurse (CFRN) certifications; either a trauma nursing core course or a transport nurse advanced trauma course; and a strong preference for previous flight experience. Paramedics were added to the flight crew mix in 2005. All flight paramedics must be critical care paramedic licensed, have national flight paramedic certification, have 3 years of experience as a paramedic in an emergency setting, pediatric experience, and certifications including basic life support (BLS), ACLS, PALS, pre-hospital trauma life support or basic trauma life support, and NRP. Additionally, all medical crewmembers must complete annual clinical rotations in the medical center that incorporate the latest research with bedside practice as well as opportunities to practice invasive skills with a variety of formats. Each must also attend or review all monthly case conferences that cover a variety of topics and case studies. All clinical staff members are trained to perform advanced procedures including rapid sequence induction with oral July-August 2014
intubation, nasal intubation, needle and surgical cricothyrotomy, needle chest decompression, chest tube placement, central line placement, and pericardiocentesis. Packed red blood cells are carried on all flights and given as needed. Because the department is part of an academic medical center, LifeFlight crewmembers have some exceptional opportunities for medical training that many other flight programs may not have access to; 2 of those, the use of a cadaver laboratory and a high-fidelity simulation laboratory, allow crewmembers to be exposed to some very complex medical scenarios. The cadaver laboratory is used on a regular basis to learn and maintain invasive procedures and skill sets. Another unique program is the ability to have an emergency medicine resident fly as part of the regular medical crew. Each year, 1 physician is selected from the emergency medicine resident program and trained to operate on shift as a regular crewmember. The experience exposes the emergency medicine resident physician to flight medicine and operations and allows LifeFlight’s registered nurses and paramedics to learn the latest in emergency medicine. Physician involvement remains one of the keys to maintaining clinical performance. Jeremy Brywczynski, MD, assistant professor of emergency medicine, became the medical director in November 2010. He implemented an oral review board for all medical crewmembers. On an ongoing basis, he meets with each crewmember and gives scenarios about how that patient would be cared for; this gives him the opportunity to get to know all crewmembers, their skill level, and what areas the department may need to focus on for future education. Brywczynski also attends chart reviews to answer questions and bring out teaching points during the monthly case conferences. He is assisted by his colleague, Jared McKinney, MD, assistant professor of emergency medicine, who serves as medical director over the ground and event medicine divisions. Today, LifeFlight has made more than 40,000 flights and has more than 130 employees, 5 bases, 1 airplane, 4 ground ambulances, and several divisions that form a cohesive integrated transport service. Rotor-wing air carrier transportation is provided by AirMethods, and fixed-wing air carrier transportation is provided by SevenBar.
LifeFlight’s Working Parts More than 130 Vanderbilt employees keep LifeFlight running smoothly. Add to that the approximately 34 pilots and 17 mechanics who work for LifeFlight’s vendors, AirMethods and SevenBar, and you have some 180 personnel who serve as VUMC’s most visible brand—walking, flying, and rolling billboards. LifeFlight staff work in 7 different divisions and serve as Vanderbilt ambassadors in every community within the medical center’s 65,000–square mile catchment area.
Emergency Communications The front door to VUMC and the Monroe Carell Jr Children’s Hospital at Vanderbilt, the emergency communications division has 18 employees manning more than $1 147
million worth of highly sophisticated communications equipment. This team of licensed EMTs and paramedics dispatch and follow 5 helicopter bases; an airplane; and neonatal pediatric critical care ground, ground EMS, and LifeFlight Event Medicine ambulances. Additionally, this office serves as the Regional Communications Center (Region 5) for Tennessee, dispatches any stat emergency calls throughout the medical center campus, monitors weather conditions, and tracks more than 6,000 takeoffs and landings at the Vanderbilt helipads.
Helicopter (Rotor Wing) Sixty-one employees make up the rotor wing division (excluding the AirMethods pilots and mechanics); 47 of those are flight nurses, and 9 are flight paramedics. LifeFlight operates a fleet of 6 Airbus helicopters: 3 EC145s, 2 EC135s, and 1 EC130 from bases located in Lebanon (LF 1), Tullahoma (LF 2), Clarksville (LF 3), Mt Pleasant (LF 4), and Smyrna (LF 5), TN, covering all of Middle Tennessee, Southern Kentucky, and Northern Alabama. The sixth helicopter is used as a backup. Each base has a chief flight nurse who manages the base and its employees. The program flew with just 1 helicopter from 1984 to 1987. From 1987 to 2012, an additional 4 aircraft were added. Each base also has a “critical care response” car for the medical crews to meet local EMS teams and assist transport by ground ambulance on missions that cannot be completed by air because of weather conditions. The cars are former Vanderbilt University police department patrol vehicles. The vehicles do not respond to emergencies with lights and siren, nor do they respond directly to scene calls. The LifeFlight medical crew will have all of the medical equipment and supplies that are normally available on the helicopter, including lifesaving blood. In 1998, LifeFlight began working with its vendor AirMethods to implement a single pilot instrument flight rules (IFR) capability. Since then, it has built an advanced network of low-structure IFR approaches to enhance safety and availability during decreased visibility. In 2009, night vision goggles were added on all helicopters.
Airplane (Fixed Wing) Five employees are assigned to the fixed wing division (excluding SevenBar pilots and mechanics). Two of those are flight nurses and 3 are flight paramedics. LifeFlight 10 (airplane) opened in Nashville in 2004. The fixed wing aircraft is another component of Vanderbilt’s comprehensive transport program. Each year, VUMC’s fixed wing program transports patients to destinations across North America.
Ground Transport Staffed by a dedicated team of 13 EMT-IVs, paramedics and critical care paramedics, the ground transport division does BLS and advanced life support discharges from VUMC as well as critical care transfers. 148
Event Medicine The event medicine division has 1 full-time employee and more than 25 part-time EMTs and paramedics. Functioning as a highly visible arm of LifeFlight, the team provides emergency medical care and transportation to more than 600 community events, including the Nashville Predators, the Nashville Sounds, and all Vanderbilt athletics.
Discharge Transport The discharge transport division consists of 2 full-time employees and handles the logistics and coordination of all Air Medical Journal 33:4
patients discharged by ambulance from VUMC. It also dispatches and coordinates LifeFlight’s ground transport.
12% of all scene flight patients received blood while inflight
Education, Outreach, and Marketing
121 ST-segment elevation myocardial infarction patients transported by helicopter 142 stroke patients transported by helicopter
The education, outreach, and marketing division consists of 3 full-time employees, 1 part-time employee, and 2 student workers and is responsible for all external education efforts; marketing; digital media; business development; EMS equipment cleaning and delivery back to its home agency; coordination of the mobile command and communications bus; and coordination of the student group, Vanderbilt Emergency Medical Society, and interaction with EMS and hospital customers. More than 12 courses are offered to 911, EMS, and hospital providers through this division as well as a large annual EMS conference. More than 3,000 people were provided with EMS education in 2013 from Vanderbilt LifeFlight.
Leadership LifeFlight operates as a department within the nonprofit VUMC. It operates under the emergency services umbrella, which reports to the chief nursing officer of VUMC. Jeanne Yeatman, MBA, RN, EMT, who served as LifeFlight’s program director from 2002 to 2012, oversees all emergency services as its administrative director. Lis Henly, RN, EMT, serves as LifeFlight’s program director along with Kevin Nooner, MSN, RN, CEN, CFRN, EMT-P, who serves as its operation director.
LifeFlight by the numbers (2013) 5 helicopters staffed 24/7 1 backup helicopter 1 airplane 4 ground ambulances Takeoffs and landings at Vanderbilt helipads: 6,751 Average speed of a LifeFlight helicopter: 138 mph Average response time for helicopter (flight time): 24.1 minutes 2,770 hours flown by helicopter (365,563 miles)
Community events worked by event medicine: 534 5 community-located bases: Lebanon, TN (LifeFlight 1) Tullahoma, TN (LifeFlight 2) Clarksville, TN (LifeFlight 3) Mt Pleasant, TN (LifeFlight 4) Smyrna, TN (LifeFlight 5) Airplane (LifeFlight 10) is located at the Nashville International Airport Emergency communications division (flight communication) 26,279 trauma pages sent 14,067 ambulance radio reports taken Jerry Jones, MPA, EMT-IV, is the public affairs manager for Vanderbilt LifeFlight in Nashville, TN. He is a seasoned EMS professional serving as the former chief of Bedford County EMS. He has been with Vanderbilt University Medical Center for 13.5 years. 1067-9991X/$36.00 Copyright 2014 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.03.003
798 hours flown by airplane (35,348 miles) Total loaded miles by ground ambulance: 1,627 Transports: Helicopter: 2,409 Airplane: 265 Ground EMS (discharge transport ambulance): 1,470 Event medicine (ground ambulance): 81 Total transports: 4,225 60% interfacility flights 40% scene flights 83% of patients are adults 17% of patients are pediatric 4.5% of all patients received blood while inflight
July-August 2014
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