Thursday, April 30, 2015

Physician Staffed HEMS for Trauma...

Dr. Bill Hinckley (Retrievalist, Flight Doctor, Medical Director at UC Health Air Care and Mobile Care - past president AMPA) notes on LinkedIn that the results of a study on the benefits of having a physician aboard a medical helicopter are being published in the journal "Injury."

The study indicates that having a physician on board resulted in an additional 5.33 lives saved per 100 flights to pick up severely injured patients. This is a significant number.

While flying with Geisinger Life Flight in 1999 and 2000, I routinely carried a resident in addition to the normal crew of flight nurse and flight paramedic. I thought then and think now that this practice was good for the resident, good for the patient, and good for HEMS/HAAO - as these doctors got to see first-hand how helicopters influence healthcare.

What are your thoughts?

Leave us a comment...

Dr. Bill writes,

Thanks for posting this, Dan. 

First, we need to clarify slightly exactly what this particular study was comparing. The control group was ground ambulance transport with paramedics. The experimental group was bringing a physician-paramedic HEMS team to the scene, by helicopter when possible but sometimes by ground in unflyable weather, and then transporting the patient accompanied by the HEMS team to the trauma center, usually by ground. This is a common model in Europe, but definitely quite different than the "typical" US model of nurse-paramedic HEMS teams that essentially never transport patients by ground. (Obviously, many exceptions to this "typical" model exist in the US, including here in Cincinnati.) So we can't necessarily extrapolate too much from this Dutch study to our situation in the US. It is convincing, however, that the concept of bringing critical care to the patient as opposed to just bringing the patient to critical care is a concept that can save lives.

However, looking more broadly at all of the HEMS outcomes literature in trauma that's been published since 1980, in my opinion the question of whether or not HEMS saves lives in trauma has been repeatedly asked and answered to the point that we know it to be true with as much certainty as we know anything in the realm of EMS (both here in the US and abroad). How much of the mortality benefit comes from time savings vs bringing additional clinical capability to the patient prehospitally remains up for discussion, though I certainly believe the latter to be the more important of the two. We also know that of the 12 studies that have specifically compared HEMS-without-a-doctor to HEMS-with-a-doctor in trauma pts, 10 of the 12 studies showed mortality improvement with the doctor on board. I suspect these benefits extend far outside the realm of trauma to other time-dependent critical illnesses, though very little outcomes research has examined that question to date. 

With that said, HEMS overutilization and HEMS safety remain as very significant issues here in the US, on which our community must continue to work diligently to improve to the level of our European and Australian colleagues. We have a long way to go.

Dan, thanks for doing what you do!

Wednesday, April 29, 2015

Connecting the Dots of Situational Awareness... Or Not.

Leading up to most aviation mishaps, some person has a clue, an inkling, a "sense" that something is wrong.

When I spend time with teams discussing AMRM and accidents, I always point out that in a helicopter any new noise, or sound, or vibration is not good and must be investigated.  


The cause of the change must be determined. We have to think through what the change might mean in the future.

Now if I could just listen to myself.

Here is a story with a happy ending, told in reverse...

The crew lived and went home safely.

The helicopter's pilot landed in a pasture. He did a great job.,,,

In flight, there was an obvious failure of a mechanical component. With vibration, fumes, and sounds. The pilot was unsure of what was wrong, and an emergency situation developed and was declared.

End of story? Not quite. Let's go back further.

I flew this helicopter several times in the days and weeks before this incident. During the first flight,  weeks prior, I noticed that the air conditioner blower seemed to run a bit rough on high speed. It just didn't feel right.

This was a level-1 situational awareness event. That is as far as my SA went though, no level 2 or 3.

Level 1: Simple sensory perception.

Level 2: Realization that the sensory input is relevant to what is happening now.

Level 3: MOST IMPORTANTLY... projecting forward... predicting what will happen in the future based upon the events unfolding now. This takes conscious thought and effort.

When I sensed the roughness in the AC fan, I wasn't even aware of the sensation. I was in the middle of starting a helicopter with a critical patient on board. We needed to go. I placed the blower switch on low speed, it ran smooth and blew cool. I placed the switch on medium speed, smooth and cooler. I placed the switch on high speed and felt the roughness and heard a change in the sound - a low rumbling or roaring sound. It didn't feel right.

Without conscious thought  I switched back to medium speed and it smoothed out. Solved...(?)

I continued on with my patient transport, indeed with several of them. With no conscious thought of why, I operated the AC at medium, or low. This is almost the same as discovering a rough ride at high speed due to a rotor system out of track or balance - slowing until the ride smooths out, and leaving it at that.

As it turns out, I am not the only pilot who operated this aircraft and sensed this roughness - and avoided the high speed setting. In my mind, that makes this a human-factors issue.

In one of the opening moments of his series "Cosmos," Dr. Neil Degrasse Tyson mentions how humankind has risen to prominence on earth because of pattern-recognition. So here is a chance to learn from a pattern: It's all too easy to sense something wrong, make the problem go away (for now) and forget about it. But mechanical problems seldom correct themselves. A subtle hint may be our only warning of a pending failure - and we might not like circumstances when the failure happens.

I  failed to deduce what might happen in the future based upon what I "knew" to be true now. My fan didn't feel right on the highest speed. 

 In most aviation mishaps, some person has a clue, an inkling, a "sense" that something is wrong. But they don't think it through. Perhaps they are too focused on starting the aircraft or talking on the radio or to the crew. Or maybe they are trying to get home before running out of crew-day.

And as happened at the Mayo Clinic's flight program years ago, a "slight ticking sound" turns into something like this...

I am very glad that my failure get to the third level of situational awareness didn't end in tragedy. When operating an aircraft, we must use all senses to detect any change, or problem. And then we have to do something about it...

Friday, April 24, 2015

What Happens When A New Trauma Center Opens In Your Back Yard

For trauma centers, it’s a zero sum game. The number of trauma patients in a given geographic location is fixed. (Actually, it goes up slowly over time as the population increases). So if a new center opens, those patients are redistributed. The new center gets more patients because they are now “designated.” And the existing centers get fewer because there are not as many patients left.

Click here to read more at Dr. McGonigal's blog. (linked with permission)

For helicopter air ambulances, the effect can be dramatic. A local hospital achieving level-two status means many of the patients that would have previously been flown are now driven into town. Flight volumes can be cut in half. A close working relationship with a hospital has always been key to success for any HAA program - in this case it is even more so. The facility that used to refer patients out can now receive many of them. But the referral areas shift and new relationships (or better ones) with EMS agencies must be developed. 

Sidebar: Some thoughts on gaming the system...

More so than ever before, flight teams must seek to be an integral component of every agency they serve. The temptation to cross over the line of what is ethical, legal, and moral must be resisted however. Paying a fee for calls which circumvents the practice of using the closest appropriate aircraft is a dirty secret which cannot be concealed forever - and the anti-fraud arms of the government are long and strong. People talk.

Saturday, April 18, 2015

Turning to avoid or exit weather...

From an accident report.

After a short discussion the pilot then stated he was going to divert, and he began a left turn to return to Tulsa, Oklahoma. Soon after beginning the left turn the helicopter impacted trees and terrain at a surface elevation of about 850 feet msl...

He put  the aircraft into a standard-rate turn to the right, still climbing, and as things settled down he leaned over to change the frequency on the radio. This required him to put his head down for a few seconds. It took him two tries to roll in the frequency - why was everything so hard to do? He pressed the flip-button to move the frequency into the active-field and looked up to the instruments.

"HOLY SHI...!" As his head came up in the turn, he accelerated the fluid in the three semi-circular canals in his inner ear in different directions. He had an overpowering sense that the aircraft was rolling, pitching, and yawing - all at once. He tried to look at his instruments but his eyeballs were jerking laterally in his head. He had a sudden urge to throw up....

A thought for your consideration...

We should be extremely careful during a turn to avoid weather (clouds, heavy rain) or to exit it. Especially at night. Most IIMC procedures call for a turn only to avoid known obstacles, for good reason. Transitioning to instrument flight is harder than we remember if it has been a while. Climbing or flying straight ahead lets us get our cross-check going and lets things (and us) settle down. 

What we absolutely DO NOT want to do during a turn is let our attention be divided or distracted, and under no circumstances should we put our head down to change a radio frequency or change GPS settings or destination (as in direct-to back to base). Doing this - putting our head down in a turn - causes trouble when we rotate it back up to the head-up position.

 We accelerate the fluid in our 3 semi-circular canals in different directions and this causes disorientation (the coriolis illusion) and - in severe instances - nystagmus.  When we hear of pilots losing control of aircraft after entering clouds or other weather, or flying them into the earth, this is what we think of. He or she was trying to do too many things too quickly when all that is required is to fly the aircraft...

If your aircraft has an autopilot, and it has a go-around button (perhaps on the collective) that rolls you wings level and puts you into a climb-speed  attitude after it is pressed, and all you have to do is pull collective for climb...

Life is good.

Friday, April 17, 2015

Eaglemed Prelim...

NTSB Identification: CEN15FA171
Use this for your next shift briefing. Ask your team mates what each of them could have or would have done as these events unfolded to prevent this from happening...

Nonscheduled 14 CFR Part 135: Air Taxi & Commuter
Accident occurred Thursday, March 12, 2015 in Eufaula, OK
Aircraft: EUROCOPTER AS 350 B2, registration: N919EM
Injuries: 1 Fatal, 2 Serious.
This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.
On March 12, 2015, about 2315 central daylight time, a Eurocopter AS 350 B2 helicopter, N919EM, operating as "Eagle Med 35", was destroyed after impacting trees and terrain during maneuvering flight near Eufaula, Oklahoma. The pilot was fatally injured and the two medical crewmembers sustained serious injuries. The helicopter was registered to and operated by Eagle Med, LLC; Wichita, Kansas. Dark night visual meteorological conditions (VMC) prevailed at the time of the accident and a company visual flight rules flight plan had been filed for the 14 Code of Federal Regulations Part 135 helicopter emergency medical service positioning flight. The helicopter departed from St. Francis Hospital Heliport (4OK3); Tulsa, Oklahoma, about 2248, and was destined for McAlester Regional Airport (MLC), McAlester, Oklahoma.

During the previous northbound flight to transport a patient to the 4OK3 heliport, the pilot mentioned to the medical crew that he noticed that the clouds above their cruise altitude were lower than he expected. The pilot descended slightly and the helicopter landed at 4OK3 without incident. While on the ground the pilot checked weather again and after conferring with the medical crew they decided to begin the planned return flight from 4OK3 to MLC. The helicopter was southbound at a cruise altitude of about 1,500 feet msl when the medical crew reported the helicopter had twice briefly entered and exited instrument meteorological conditions. After a short discussion the pilot then stated he was going to divert, and he began a left turn to return to Tulsa, Oklahoma. Soon after beginning the left turn the helicopter impacted trees and terrain at a surface elevation of about 850 feet msl. The impact resulted in the separation of the tail boom and portions of the fuselage and the main wreckage came to rest on its right side. The helicopter's fuel tank remained intact, there was no fuel leak, and there was no postimpact fire.

After impact the surviving medical crewmembers extracted themselves from the wreckage and immediately made a cell phone call to report their situation and location. Several agencies then used the position report from the crew, data from the on-board GPS position reporting system, and signals from the 406 MHz emergency locator transmitter to locate the wreckage. Emergency responders hiked in the dark night conditions through the remote rugged terrain and arrived several hours later.

A meteorological reporting station was located at Okmulgee Regional Airport (OKM) in Okmulgee, Oklahoma, about 20 miles north-northwest of the accident location at an elevation of approximately 720 feet. An automated weather report from OKM at 2315 indicated wind from 020 degrees at 3 knots, visibility of 10 statute miles or greater, ceiling broken at 2,400 feet above ground level (agl), broken cloud layer base at 3,000 feet agl, temperature of 12 degrees C and a dew point temperature of 11 degrees C, and an altimeter setting of 30.13 inches of Mercury. Prior to this report, the lowest cloud layer had been reported as being at or above 5,000 feet agl since 2015, except for 2255, when the lowest cloud layer was reported as being scattered at 1,100 feet agl.

A meteorological reporting station was located at McAlester Regional Airport (MLC) in McAlester, Oklahoma,about 28 miles south of the accident location at an elevation of 770 feet. Beginning at 2153 and continuing through the accident time, MLC automated reporting indicated the lowest cloud bases were between 900 and 2,100 feet agl. A previous report at MLC at 2053 showed overcast clouds with bases at 9,000 feet agl.

GodSpeed Abe Bronn...

Haverfield Aircraft 

I met Abe Bronn when he showed up to fly the air medical helicopter my company operates near Charleston, South Carolina. As I was the duty pilot that day, I conducted his local area orientation and we got to know each other.

He was a veteran, a Night Stalker (Little bird guy), a golf-lover, and an all-around good guy. He got along well with his crews and flew very well. We were lucky to have him with us.

Later, when I worked another base and it came time for the  daily radio checks with aircraft all over the state, Abe would check-in with a hearty "GOOD MORNING AIR-COM! LifeNet 7 has you LOUD and CLEAR.... This always made me smile. The last time I saw Abe, he and his wife were at a party in Charleston. It was a lot of fun for my wife and I to get to know them.

Abe left us and took a job with Haverfield performing utility work. I just learned that he was killed while crashing into a river in Alabama.

Please keep Abraham Bronn's family in your thoughts and prayers.

God Speed friend...

Read more by clicking here...

Thursday, April 9, 2015

Making The Case For Tiered Reimbursement....

Recently, I spent two days in Concord North Carolina, with team members from MedCenter Air. If you are not familiar with this flight program, take it from me; it's a squared-away organization. The hospital supports a first-class program, with great equipment and highly qualified and continuously trained staff. When Clinicians leave MedCenter Air, it's to become PAs, CRNAs, NPs, or to run programs like Duke Lifeflight. The look and feel is one of excellence.

Consider this,

MedCenter Air, Boston MedFlight, LifeLion and Geisinger LifeFlight in Pennsylvania, Mayo-One and Memorial Hermann Life Flight all spend more money to be the best in HEMS, but they get the same pay for flying patients as does a company transporting people in the cheapest, least capable aircraft available.

So, the question is, why doesn't the government drive the industry toward a better future by using a payment-differential scheme for Helicopter Air Ambulance flights? They have done this for years to entice health-care providers to offer services in rural areas. After all the crashes, why doesn't someone suggest we do something differently.  Do profits trump lives? Is the government being paid off?

A good discussion of CMS payments being used to influence what healthcare is available where is at...

For reasons both moral and ethical, society continues to move towards health-care that is more safe, capable, and effective. This includes HEMS/HAA, which is a force-multiplier for the health-care industry but which is provided at differing levels of capability and safety.

If we were to take away the 900 or so helicopters that are used on to move patients from less capable rural health-care services to tertiary-care hospitals in major population centers and to respond to accident scenes,  the inadequacies of our national system would become immediately apparent. With all it's problems, HEMS props up a faltering national health care system. As it is, HEMS/HAA operates largely "under-the-radar," even in the face of NTSB reports that highlight the fact that all HEMS/HAA companies are NOT equal.

Most people don't understand the differences that mean some helicopters can only fly on nice clear days while others can fly through moderately adverse weather like rain showers and clouds. While some can transport two patients, others are restricted to one and have to sacrifice fuel-range if that single patient is heavy. Some helicopters can transport patients supported by heavy, bulky equipment like an Intra-Aortic-Balloon-Pump, while others force crew members to squeeze in next to each other and make any real patient care in-flight difficult if not impossible. Ironically, no matter how limited a programs capability, they all get to call themselves the same thing, and can request the same reimbursement. Hence, the "race to the bottom."

Indeed, under current reimbursement schemes, there is a moral hazard in that the financial incentive is for a helicopter ambulance company to operate the smallest, cheapest, least-capable equipment that will get a patient airborne, no matter what provisions for safety are left off. The airlines overwhelmingly fly with multiple engines (in case one quits) but in HEMS single-engine helicopters are the predominant choice - because turbines are both expensive and reliable. To the insurance company, a helicopter is a helicopter. In reality, there are significant differences between variants. 

Helicopter engines are extremely reliable, but on occasion, they fail. If it's night or you are over hazardous terrain when your single engine fails, you are going to get hurt - or worse. That's why having two engines is a good idea.

LAKE CITY, AR  – The Air-Evac rescue team in Lake City walked away unharmed after a hard landing late Wednesday night.
According to Air-Evac, the rescue helicopter was on final approach to their base when they suffered an engine malfunction. 
The pilot was able to set the helicopter down close to the helipad in what they called a hard landing. 
No one was injured in the landing, but the helicopter did receive minor damage.
The crew does have a spare helicopter on the scene so no services will be disrupted.
Air-Evac says the incident is being looked into, and the damaged helicopter will be sent off for repairs.

If that engine had failed over a dense forest, or over frigid water, those people would most likely be dead.

Last year, two different helicopter companies had single-engine helicopters crash on the same day after suffering loss of power from their one available engine. Because turbines DO fail, airliners have at least two engines available for safety and redundancy. We take it for granted that multiple engines are part of the picture on a big jet, but not on a helicopter, because many people don't understand how helicopters work, or what their limitations are.

The other benefit of having two motors in HEMS is that we can then legally (and rationally) fly in the clouds - with an autopilot and pilot training. There is a proposal in the works for reforms to allow single-engine helicopters to fly under instrument flight rules (IFR), or in the clouds. This would help create pilots who are better trained for inadvertent cloud encounters (inadvertent instrument meteorological conditions or IIMC), and would doubtlessly reduce the instances of pilots pushing down on the collective and descending after flying into fog or cloud or heavy rain. 

With single engine IFR, we still have the problem of one motor. If we are in the clouds and that one motor quits, we can't glide very far - maybe a half mile per thousand feet up - and we might not like the landing area underneath us. Single-engine IFR is an added capability for a program that is predominantly restricted to visual flight conditions- because it offers a legal and sensible way to recover from a hazardous situation. But for real confidence in the clouds, two motors are better than one.

Today, the passengers, who are also patients, are not able to ask questions about the aircraft they are being shoved into. There is no "truth in transport" requirement to tell patients or family members the risks and options available. But that is coming.

To move HEMS towards more safe and capable operations the time has come for tiered-reimbursement. If the government started with Medicare and Medicaid, private insurers would follow suit. If company A provides twin-engine reliability and is able to fly in the clouds, they should be able to claim more reimbursement. They offer more bang and should get more buck.

Changing reimbursements must be reasonable and thought out. There are two mechanisms for doing this, grandfathering or sun-setting.

Grandfathering would mean that anyone operating an aircraft as of a certain "start-date" would be exempt from any changes to reimbursement (decrements or deductions) that might be effective after that date, for as long as that aircraft is operated by that company. While this might reduce the resale value of a helicopter, it would allow the operator to continue under the current paradigm until the cost of putting the aircraft into service has been recouped. 

Sun-setting - as the FAA did with airline regulations decades ago - would leave things as they are initially, then would gradually incentivize the operation of more capable and safe aircraft, and could include other factors, such as highly trained and credentialed staff.

Reimbursement should favor more capable aircraft, pilots, and crews, able to offer more service in a more safe manner to the public.

One sunset scheme would be to leave things as they are for three years. Then separate transports into three tiers, This differentiation would apply to individual transports as with basic-life-support and advance-life-support ground-ambulance trips, based on equipment and staff. A tier-one trip would include a twin-engine instrument-flight-capable aircraft with full autopilot, night vision goggles, a specially trained and highly experienced pilot and medical crew, with the highest levels of available certification such as ATP for the pilot, CFRN or CFP for the medical staff, and CAMTS for the program. If all these conditions were met for a trip, tier-one reimbursement could be claimed.

Tier-three would equate to the least capable aircraft; one engine, limited to flying in visual-flight conditions (fair weather), perhaps even restricted to daylight conditions. The crew would meet the minimum requirements.

Tier-two would fall somewhere in the middle. 

After the sunset period, reimbursements would be paid in full for tier one, with a percentage reduction for tiers two and three, phasing over successive years to reflect the disparity in costs associated with the different types of  HEMS programs available today. The end goal is to have ALL services eventually work towards the tier-one level of service. Companies will follow the money. We have to create a rational path.

That is what our patients deserve. And that is how we will stop losing so many flight crews.

Wednesday, April 8, 2015

Program Profile : Memorial Hermann Life Flight

We have come upstairs for a tour and I look out the window of the communications center and think how nice it is for the comspecs to be able to see the pad.

We walk out onto the rooftop helipad and find three beautiful red and black Airbus EC-145s sitting on their freshly-painted spots. The view, of both the three identical aircraft and the surrounding city of Houston is breathtaking. A person could like this place.

Christopher "Todd" Grubbs, Chief Pilot (L), and Mike Mock, Program Safety Officer

Todd Grubbs, Life Flight's Chief Pilot shows me some sights around the horizon, then points at a yellow building a short distance away. "Our GPS approach is going to guide us to a spot right over there."  The GPS approach he is referring to will be an LPV (localizer performance with vertical guidance) and will look and feel just like the ILS (instrument landing system) approaches that we have been performing for decades. Only the LPV won't require ground-based localizer and glide-slope transmitters typically found next to runways - it will use a wide-area augmentation system (WAAS)- a ground-based transmitter sending continuous position-correction data to the aircraft's on-board GPS. WAAS allows for precision-approaches anywhere!

Initially, the approach guidance will be usable down to 200 feet above the surface, with possible future upgrades allowing descents even lower. Todd is a man with a mission - to derive maximum operational benefits from the technology situated on his aircraft, on the ground, and in space. His enthusiasm for the job at hand and his deep understanding of what is possible are exciting and refreshing, like the cool spring day we are enjoying.

At 8;00 AM I had joined about fifty of Todd's co-workers as he presented an informative "state of the program" address.  He covered where they are as a CFR Part 135 air carrier - 5 bases, 6 identical aircraft with one serving as a spare, all aircraft and pilots IFR capable  - and where they are headed, and what will be required to get there. A vendor has been selected to "terp" (the process of creating terminal instrument approach procedures) GPS approaches at several hospitals that Life Flight visits. Once this is done a helicopter low-level instrument-flight-rules (IFR) route structure will be defined in and around the Houston area that will allow IFR trips underneath the heavily traveled routes used by the  passenger-jet air carriers flying into and out of Houston. They will even incorporate the  tower-enroute-control described in the Airman's Information Manual allowing IFR flights without needing to talk with approach-controllers.

What does all this mean?

It means Life Flight is able to transport ill and injured persons in worse weather conditions than they could before they became an IFR air carrier - and they are able to fly when other services are stuck at their bases for low ceilings and reduced visibilities. Their capabilities are going to improve even more with the addition of precision approaches to the hospitals they serve. A great program is getting even better.

I am visiting Life Flight thanks to fellow retired NightStalker Mike Mock. Mike is Life Flight's safety manager, and I had talked to him about presenting AMRM training. He arranged for me to have a two-hour block of time in which to spread the gospel of staying alive by working for and with each other instead of in spite of and against each other. The class went well and I had a great time meeting and bonding with the team.

Life Flight was started in 1976 by a Texas-sized personality named Dr. James"Red" Duke. They were the second air medical program in the United States. As Mike explained to me at dinner that evening, Dr. Duke treated President Kennedy and saved Governor Connally on a dark day in Dallas.

Dr. Duke is getting on in years now, but he is still the Medical Director, and is loved and respected by his team. The flight team went so far as to create their radio call sign in his honor, on the radio to ATC they are "RedDuke..."

How cool is that?

You can learn more about Dr. Duke by clicking here...

The Life Flight team are TV stars! Click here for more...

I think any man who loves what he does is lucky - and I love sharing the AMRM experience with flight teams. Visiting Life Flight was an honor and a privilege. 

Thursday, April 2, 2015

Air Methods Enters Into Long-Term Agreement with Vanderbilt LifeFlight

Image courtesy JEMS

Denver, April 2, 2015 – Air Methods Corporation (NASDAQ: AIRM), the global leader in air medical transportation, announced today that it entered into a partnership with Vanderbilt University to acquire certain assets utilized in connection with the Vanderbilt LifeFlight Program, including medical equipment and three Airbus Helicopters EC-145 aircraft, as well as a 10-year agreement restructuring the program under Air Methods’ Alternative Delivery Service Model. Under the Alternative Delivery Service Model, Air Methods will provide aviation, fuel, maintenance, aircraft, dispatch, billing and EMS licensure. Vanderbilt will continue to provide all medical staffing, patient care and clinical services for Vanderbilt LifeFlight. The program will continue to operate under the Vanderbilt LifeFlight branding. Mike Allen, Air Methods’ president of domestic air medical services, stated “Air Methods and Vanderbilt LifeFlight have a strong partnership and track record of delivering high quality service to communities across Tennessee and the region. In this new service model, we will continue in our mission to give more tomorrows by providing the highest quality, around-the-clock service in partnership with Vanderbilt University and the exemplary patient care that has been their hallmark.” Vanderbilt LifeFlight currently provides hospital-based emergency air medical transport services throughout Tennessee and Southern Kentucky, with remote helicopter bases in Lebanon, Tullahoma, Clarksville, Smyrna and Mt. Pleasant, Tenn. Soon, a sixth base will open in Henry County, Tenn. LifeFlight also operates a fixed-wing aircraft (airplane) base at Nashville International Airport. “We look forward to continuing Vanderbilt LifeFlight’s commitment to excellence in patient care and patient safety with our longtime partner and industry leader,” said Stephan Russ, M.D., associate professor of Emergency Medicine at Vanderbilt University Medical Center and associate chief of staff for Vanderbilt University Hospital. “Vanderbilt LifeFlight has been delivering industry leading medical care as a community asset since 1984, and we trust that this opportunity will strengthen the access, reach and viability of the program for many more years to come.” Air Methods Corporation (www.airmethods.com) is the global leader in air medical transportation. The Air Medical Services Division is the largest provider of air medical transport services in the United States. The United Rotorcraft Division specializes in the design and manufacture of aeromedical and aerospace technology. The Tourism Division is comprised of Sundance Helicopters, Inc. and Blue Hawaiian Helicopters, which provides helicopter tours and charter flights in the Las Vegas/Grand Canyon region and Hawaii, respectively. Air Methods’ fleet of owned, leased or maintained aircraft features over 450 helicopters and fixed wing aircraft.