AUAA… Episode 13 Life Lion – Penn State Health Milton S. Hershey Medical Center

Of course here at the Hershey campus and we’re going to show you this helicopter in some detail we’re also going to talk about the people who staff this helicopter who care for patients all across the region and beyond. So let’s see a good place to start would be Joe. I mentioned that you are a flight paramedic tell me about the people who staff this helicopter. Three main positions on board I understand? Yes, sir, so we have a pilot in charge we have a flight nurse and a flight paramedic. We staff the helicopter 24 hours a day 365 days a year. So what are you doing you’re not flying and you’re here at the hangar? So, we have additional responsibilities, we have a lot of continuing education that we have to maintain, we have hospital requirements, education requirements that we have to meet as well. So if we’re not manning the helicopter, not eating breakfast, not eating lunch, we’re studying and getting our continuing education done. Now there are two main types of calls or we call scene response calls and also transports. Can you talk about kind of which is more common and what those makeup? Sure, so about sixty percent of our flights are inner hospital flights so that means we’re picking up a patient from one hospital and taken to another. Life Lion about five percent of those inter-hospital flights are actually taking patients to other hospitals so we don’t necessarily just bring patients back to Hershey Medical Center. We’ll take them to Lehigh Valley, will take them to York Hospital, will take them to whatever tertiary care facility the referring institution is requesting. Then, we have our scene flights, that is making up about forty percent of our flight volume to date. We’re finding that our scene volume is becoming a little bit less and our inner Hospital belongings become picking up a little bit more but most of the scene volume is traumatic related, it could be a fall, could be a vehicle accident or we could be a medically related incident which somebody has a heart attack a stroke and they need to get to tertiary or definitive care within a short amount of time period and the best way to do that is there’s a straight line avoiding any type of traffic using a helicopter. So I know it’s Life Lion before I even look up it’s because of that trademark sound that it makes why do we hear that high-pitched whistling sound, what is it about this helicopter and that sound that sets it apart from from other aircraft. So, what I want to do is, I want to direct you towards the rear of the aircraft that is what we call the fenestron. And what happens is that, when that tail rotor spins at over 4,500 rpm, it’s pulling air through that fenestron or that enclosed space and it’s creating that whistling sound and that whining sound that you’re going to hear that is so distinctive with the Dolphin Helicopter. And that’s what’s what we have here at Dauphin yes sir so this is a dolphin AS 365 Airbus for American Eurocopter Helicopter. Can we take a look inside especially maybe starting with a spot where we where you take care of patients here in the back of the aircraft. So this is the interior of our aircraft as you can see it’s a pretty enclosed environment we have to be kind of contortionist at times to be able to provide room for the number of people that we can carry in the back of the aircraft not comfortable but pretty roomy when necessary. And back here, we carry all of our all of the necessary equipment if we need to bring additional equipment we can do that. We’ll secure it to the back wall or place it in different parts of the aircraft. So, here we have a artificial ventilator that helps breathe for the patients. We carry the tubing for that for the ventilator and a compartment down here we carry our transport IV pumps which we carry multiple IV pumps with us. On the litter here, we have a red blanket that we use to help thermoregulate the patient during cold weather now that we’re starting to transition out of the winter time we’re still going to carry this with us just because it helps isolate the patient and keep any contaminated fluids inside that area. We have a first response bag which is located right here that we take in on all scene and inter-hospital calls with us. Inside there, we have our advanced airway equipment we have advanced cardiac medications in there, we have a bunch of other tools of the trade that we use to help stabilize patients. Next to us over here is another bag that we use to bring with us. In here we have additional equipment which specifically for Life Lion we actually talked about bringing pointy care to the bedside plenty care is a specific type of blood testing device that lifeline specifically carries that allows us to be able to look at different different blood work and allows us to adjust the treatment that is already being done for the patient accordingly after we get these tests and results. So, this is a pretty sophisticated piece of equipment that we bring along with us to the bedside so then inside here we have a bunch of different accouterments and attachments that helps us for inter hospital calls specifically. Of course your caring for some of the most critical patients and that involves some rather advanced procedures that we wouldn’t even think of happening in an ambulance let alone in a helicopter. Talk about some of the the most advanced procedures that you can perform inside the aircraft. So, some of the advanced procedures that we can do as pre-hospital providers, both health professional nurses, and paramedics is you know, surgical airways or chest needle decompressions which if somebody’s involved in traumatic accident they have a broken rib or collapse lung we can place a needle into their chest to help reduce any pressure or attention that’s inside that chest cavity. We can also you know do a surgical airway if we need to to help breathe for the patient which has becoming less and less common because we have other tools and other devices that allow us to help be able to manage those patients breathing for us. You’re watching ask us anything about Life Lion from Penn State Health. I’m Scott Gilbert along with Joe DePato. He is a flight paramedic here. He’s been with Life Lion for 12 years so that’s why he knows his stuff so well here and we do welcome your questions for Joe about Life Lion just feel free to add them to the comment section below this Facebook post and we do have a question here about when will a new helicopter be put in service. So, some people have seen on our Facebook page we put some teaser photos out. We are actually in the process of securing a new helicopter, it’s going to be as part of the dolphin family for Airbus. It’s an ec155 and we’re hoping to have that in service, flying patients in the region probably around July one. Now there are three helicopters in the fleet can you tell us a bit about where they’re stationed and the maintenance schedule and how there’s always one that’s kind of under review. Right? Yeah, so, right now we have two aircraft in service 24 hours a day 7 days a week 365 days a year. One is located here at Hershey Medical Center, the other one is located at Carlisle airport we also have a third aircraft which serves as a backup for reserve aircraft that will get rotated into a main aircraft position whether it in Hershey our Carlisle depending on the needs of the aircraft. So every 10, 25, 50, 100, 200, hours and up to 600 hours these aircraft are inspected and parts are changed as needed depending on time of use or calendar time and once we reach 600 hours of use then that aircraft has to be completely torn down, torn apart, inspected and have parts replaced as necessary. So it’s crucial that we have a third helicopter that can be put in service in Carlisle or Hershey to back up any of those other aircraft that are there to be able to allow us to maintain the service that we provide 24 hours a day 365 days a year from both bases without missing a beat. So all of our aircrafts are all instrument rated, two of them are M3 aircraft which allows a different electronic system in the aircraft which gives aircraft a little bit more power. We have one that’s an N2 it’s just a little bit less power but it still performs in the same function as an N3. So we’re very fortunate that all three of aircraft are pretty similar so that we can continue to maintain our operations without without skipping a beat. Sounds good, i’ll let you get out of the aircraft here give you a little more breathing room and as i do so remind you that we welcome your questions whether you’re watching this video live or if you’re watching it on playback. If you’re watching on playback after the fact we can certainly get those questions to Joe and the rest of the crew here a Life Lion and get a good answer for you. I know that one question we hear sometimes is about what determines when it comes to a scene response. Who makes the call and how is it made as to whether or not the patient can be transported by ambulance versus by helicopter. So it’s a very good question, what happens is that we rely on our local 911 providers to be able to make the determination if a patient needs to be flown to a hospital and the critical nature of that patient needs tertiary or specialty care. So, if there’s a 911 activation for a local EMS provider and it sounds like this patient’s condition is time sensitive, they’ll arrive on scene they’ll assess the patient and make a determination based upon what they’re seeing on the scene with the patient’s condition and then contact Medical Command, speak with Medical Command and between the two of them they’ll make the determination if an air medical resources necessary. A lot of it varies depending on location. So we don’t want to have somebody from Harrisburg City call a helicopter because somebody has a heart attack or stroke they have appropriate resources that are right next to them in that city that can manage those patients very well. It’s for the patients who are in Juniata county, Perry County that are in upper Daulphin County who have a greater than hour transport ground time that need to get to definitive care quickly to manage those patients. So we’re thinking about those stroke patients because we know that stroke right now is time-is-brain. And same with heart attacks, time is muscle. Time is heart muscle so anytime we can compress those time frames it increases the chance of patient survival from those unfortunate incidents. You mentioned a lot of people even though it may not look like it a lot of people can fit back here. One question we just had online is how many patients can be transported at a time. That’s the question from Ann. So with our aircraft we’re very fortunate that we can transport to patients with minimal configuration time. With the helicopter that’s across the way being serviced and the other one that’s in Carlisle right now, we have a secondary litter base that’s in the aircraft so it has minimal reconfiguration time we can if we’re told by the on-scene providers that we need, they want to know if we can transport a second patient we can immediately pull out the seat the seat that we have in place there stow it in our cargo area pull out the secondary litter and have it ready to go within within minutes. This one just requires a little bit of reconfiguration what you’re going to see here is you’re going to see these seat cushions come off you’re going to see flaps open up you’re going to see this bench lay down and then we’re going to get a stretcher from the back of the aircraft that will play be placed here, excuse me, for the patients be secured appropriately. So with these aircraft, with the power that we have, we are not limited by weight specificly to lift off the ground. So some of our barriers that we have are the girth of a patient so as long as a patient meets a certain girth size, we are not limited as much by the weight we don’t have to offload equipment we’re just immediately going into reconfiguration mode and getting the patient set up getting the aircraft set up to have two patients put in. Good question Ann and thank you for that and thank you for watching as we continue here with ask us anything about Life Lion. We’re learning all about Penn State Life Lion critical care transport which involves this helicopter right here and a couple other parts of the operation we’ll talk about shortly but Joe, I’m wondering if you can show us the cockpit the part where the pilot sits. Yeah, absolutely. So we’re just kind of pan forward here we’re going to go up to where the pilot sits, where the good kind of rubber meets the road here. So we’re going to briefly show you the interior of the the cockpit at this point in time going to show you all the buttons that are in the cockpit we’re going to you can see the different gauges that are there the different screens that are there, all things that the pilot has to rely on to be able to operate this aircraft smoothly and safely. There’s a comment from Lucy saying something very nice about how Life Lion is an amazing asset to our families and it’s such a talking about life-saving heroics I know you hear a lot of that but i bet that never gets old, does it? No it doesn’t, we really appreciate it. I mean, we like to be humble in hearing that stuff . We are here to serve a purpose, we’re here to serve the community here, to serve the patients and do what we can to help them in their time of need. So not only we bring in world-class care to the bedside with Hershey Medical Center trained staff we’re also bringing humility along with us and so what we want to do is see those patients get stabilized and on the road to recovery and hopefully be able to see them come back here for a visit and you know we get to interact with them and hear about their stories, hear their life stories, hear about how we made a difference in their lives. That’s great. As we talked about the cockpit and this aircraft is a hole that has the ability to fly in some conditions but other aircraft may not and that’s a lot because of the instrumentation things like IFR and GPS can you talk a little more about what those thing are and how they contribute to that? Sure, so IFR which is called instrument flight rules. That is at a point when we fly into the clouds only looking at the instruments. We are not flying visually or using visual references by the ground. Excuse me. So what we’re doing is we’re looking at our altimeter, we’re looking at how our speeds we’re looking at the direction of which we’re traveling by the vectors that are being given to us by air traffic control so it’s a whole completely different form of flying and our pilots trained to do that and have been trained from the previous experience to fly by instrument and not by visual rules. So every six months our pilots go through vigorous training to learn, to get certified in their ability to be able to fly by these instruments. So it’s kind of a little bit of a complicated process in the fact that, if we have low visibility weather and we have it’s outside the ranges of what the FAA says that we can fly visually so if the minimums are too low to fly visually we’ll go on a call by call weather check then if a request comes in from a referring to hospital or a scene the pilots will check the weather then they’ll determine yeah I could do this but if I have to fly by instruments I have to go to a specific location because I can only get into that location using GPS waypoints that our way points that are established in the sky by another company and they certify it to be safe for us to use to get down to an appropriate level to be able to then visually see the ground then land the helicopter appropriately. If we’re not able to go to that location that we’re not going to be able to make that work. So it’s ultimately up to the pilot then whether or not the fly. Yes, Yes sir, so the pilot makes the ultimate decisions. You know, that’s what they get paid the money to do and pay the money to make decisions to fly to fly the helicopter in both good and bad weather conditions. Good. We have a question from Ron, he’s wondering how big is the service area the life line serves i know i’ve seen some photos from Life Lion on hospitals. Oh well over state lines. So our service areas not really it’s only limited by the distance of which we can fly. At certain times we have to think about is it better and more efficient to fly the patient by rotor wing or is it better to go by fixed wing. So once we get out about a little over an hour and 15 hour-and-a-half flight distance time, then we got to look at rotor wing so in our 15 minutes an hour and a half that’ll get us up to Boston that’ll get us down into the Carolinas that’ll get us over into Virginia beyond Pittsburgh out until Ohio. So we’ve reached all those destinations just last year alone we went to 80 different locations between Pennsylvania, New York, Maryland, Virginia, West Virginia, Ohio. So we’re touching a lot of different places. Now, when we’re talking about scenes were restricted to the closest helicopter and that is determined by the local 911 communication center the local 911 communications center will establish the areas of which all helicopters will respond to. So in certain areas we it may take us 10 to 15 minutes to get to a scene call other areas we could be one to two minutes away, depending on which aircraft is requested. Bryce is asking a bit about transports versus emergency calls we talked about this a little bit earlier we touched on briefly the fact that the number of transport calls or i should say the proportion is going up as compared to seen responses. Yeah. So Bryce, that’s a good question we get that question asked a lot. We typically do about 1200 flights a year and about sixty percent of those are in our hospital. The other forty percent are scene calls so you know it’s varies from year to year but we’ve been pretty we average about the 1200 flight volume a year so that stays pretty consistent. About three or four a day? Yeah, exactly. Between the two helicopters. Yes, yep. You’re watching ask us anything about Life Lion from Penn State Health, I’m Scott Gilbert along with Joe, DePato, a flight paramedic here and we welcome your questions. Some great questions in comments so far so please do keep those coming. Part of Life Lion critical care transport that we don’t see out here in this particular garage is the ground unit can you tell us a little bit about that and the obviously we have a whole fleet of Life Lion EMS vehicles but also a specialized ground unit that critical care transport staffs can talk about that? Yeah, so Life Lion division as it is breaks down into two different sections. So we have the Life Lion 911 or Life Lion EMS then we have Life Lion critical care. Life Lion critical care consists of the helicopter and the critical care ground unit. The critical care ground unit is a ground transport truck that has all the capabilities of the aircraft and the same crew component so you have a nurse a paramedic and an EMT who drive source and also assist us with patient care. On those transports, we bring the same type of equipment and the same personnel for whatever is requested but sometimes we can’t fly so we’ll send our critical ger ground team and sometimes with some locations that may be just as quick to send that ground ambulance versus sending the aircraft for some of the local hospitals. I’m sorry, excuse me. So we have that service available. Then the Life Lion EMS. Life Lion EMS we have, I believe 13 or 14 different 911 service trucks that are that are on the road on a daily basis between our Berks County units, our Lebanon County and Daulphin County units they’re serving the community in a 911 own capacity and they’re also doing non emergency transports as well and they do several thousand calls a year. They’re a huge asset to the medical center and the Life Lion division so it makes, we’re very unique in the fact that Life Lion itself having the 911 EMS component, the critical care ground component and the helicopter service it’s a very unique system where you don’t really see that a system like this throughout the United States. I mean one of the risks of doing this live interview is the possibility that really is any minute we could hear tones and the aircraft will have to head on out of here and take off. So Diane asked a good question that is about how quickly can the helicopter deploy and I guess it all begins with this tractor pulling the aircraft out of the garage and getting the staff and what does that involve? So Diane, it’s a good question. So what it does, once the tones are activated it sets in motion a lot of moving parts. It takes a whole complement of people to get the aircraft out in a timely fashion so everybody kind of assumes the role on a responsibility one person will open up the door another person will get on the tractor and the other person will disconnect the electrical cord secure up the aircraft at the same time everybody’s doing a walk around the aircraft doing a pre-flight check to make sure that all doors are secured everything’s locked everything’s in place and making sure that the aircraft’s ready for flight so we like to have a response time from a stat response time for a scene call in six minutes or less. Inner hospitals we require them to be out to ground anywhere between 10 and 12 minutes because we like to gather a little bit of information before we go on our inner hospital call because we want to make sure that we’re going to bring the necessary equipment whether it’s a balloon pump or we’re going to need The isolett, Which we have the isolette over on the other side of the hangar we can go take a look at so people can see when we talk about isolette and we’re transporting those kids that are less than 10 pounds what are the specific type of devices that we use to carry those small kids from from the referring Hospital to the destination Hospital. Let’s go take a look at that in just a moment here first though one question about while you’re in the air how fast can the aircraft fly? So the aircraft will fly at about 150 knots depending on the wind the prevailing winds at the time which come from the west to east if we’re getting a little bit of a push there we can reach ground speeds up to about 200 miles an hour but when we’re flying at about 150 knots were typically doing about a 170 180 ml in our ground speed. So let’s go take a look at that isolette. Yeah, absolutely so we’ll follow you so make sure you guys watch the tow bar. So a lot of different litters it looks like over here we see them all lined up and I imagine you grab whichever one or ones you need for the for the particular call. based on the requirement based upon its setup so this one, this isolette specifically set up for the aircraft reason being is it has a specific sled body to it which allows it to fit into the aircraft so with the isolates we have a specific monitoring device that is used for both adults an used for adults pediatrics and neonates. We set it up specifically for neonates that allows us to do non invasive cardiac monitoring blood pressure monitoring pulse oximetry and temperature monitoring and then, inside. So we can kind of give you a little bit of a perspective on the inside and how small the environment is in the inside including the small little stethoscope that is needed to be able to listen to their heart and lungs but on the inside, this has its own internal temperature regulating device so we can warm the interior of that up to meet their specific body requirements needs and then at the same time it we can isolate them from the outside environment so we can keep them warm and then we can keep them secluded as well we have specific restraining devices for the babies inside and then also we have a ventilator on here which allows us to breathe for them if need be. We have our IV transport pumps which our NICU specific and this whole contraption itself you know, just really it brings everything together for us to be able to go pick up those small kids. And I imagine you have a number of those calls given a level-4 or highest level NICU that we have at Penn State Children’s Hospital that’s probably a similar regular call. So yeah, I would say probably about five percent of our total flight volume transport volume in a year involves to the neonates. We do see peaks and valleys with them depending on the time of year and a month so some months will be really busy with them other months we won’t be. You’re watching ask us anything about Life Lion from Penn State Health we’re talking all about Penn State Life Lion Critical Care Transport and how it saves precious time we’ll also delivering specialized treatment to patients all across South-Central Pennsylvania and beyond. We have a question from Bryce here about requirements for a ride-along we pretty much limit our our passengers to patients right? So not necessarily just patients so we have a pretty active ride-along program but unfortunately it’s been kind of reduced in the fact that it’s very limited in the people that we allowed to do the right along so and we only allow people who are employees of Penn State Health, people who are residents of the College of Medicine, Nursing Students and anyone who’s a firefighter EMT who has gone through our landing zone training course they have to have that specific training done before they can come onto a helicopter. We want to be able to give them awareness of what we encounter when we’re flying into a scene or into a hospital so that if they’re part of a fire department or an EMS provider that they know that the dangers that will exist and the things that we’re looking for is we’re going into the scene. The paramedics and flight nurses are trained to obviously handle a wide range of medical situations but there are times as you mentioned before when may be nurses residence physicians who don’t normally fly in the helicopter may come along? Yeah. So what you know about ninety percent of the flights that we do, we can do with the standard nurse paramedic configuration. The other ten percent of the flight we augment the nurse paramedic configuration with a specialty care provider. So we may bring a Respiratory therapist along with us who will bring nitric that will help assist with the patient with their breathing. We may bring respiratory long to help us manage these ventilators for the NICU kids who are intubated who we don’t see a lot of so we see more pediatric patients who are ventilated we see adult patients or ventilated but it’s the NICU kids who require a lot of that special fine-tuning treatment that we bring respiratory along with us be here they’re a great asset for us. And then, we all at times will bring a nurse practitioner or fellow along from the NICU for those really challenging NICU patients that need further assessment further care and increased management. So we’ll get the guidance and direction of how to manage those patients from them while their bedside with us. Then also with ECMO patients in which we’re bringing a heart and lung bypass to the bedside. If we’re going to do a cannulation bedside will bring its CT surgeon with us and also perfusionist if the patient’s already cannulated bedside and we’re bringing an ECMO patient back to Hershey Medical Center will just bring our perfusionist along with us. So with that, we’re adding additional support to our crews but the nurses and the paramedics that staff line have to know everything about those adult ECMO patient’s. They have to know how to manage any adult medicine ICU patient, any neuro ICU patient, a NICU patient, pediatric patient, the entire spectrum of patient care our providers need to know how to manage each and every one of those patients. We have some fantastic thank yous coming in, like I mentioned some thank yous coming in from Kristin sherry Lucy Linda a lot of people very thankful for for the service that Life Lion provides here in central Pennsylvania. So Joe, I could stand here and talk with you for about three more hours on facebook I’ve got to let you get back to work and I want to thank you very much for your time today and ask you is there anything else we didn’t talk about that you want to tell folks? I think we cover great deal things but you know we’d love to get more into the helicopter operations next time we’ll try to bring a pilot involved get them to really discuss the intricacies of what we do from the aviation standpoint and really what sets our program apart from a lot of other programs in the state and in the country in the fact that you know where our own part 135 certificate program where all the operations are maintained here at Hershey Medical Center and we have contacts directly with the FAA so any decisions that are being made or me being made right here at Hershey Medical Center which were very fortunate about we’re very proud of the support that the Dean and the health system gives us and being able to help treat and transport the patience of the Pennsylvania and beyond. So we just want to thank everybody for tuning in to be part of it and you know glad to always showcase what we do here at Life Lion, we’re very proud of what this program is done. Joe DePato of Penn State Life Lion, critical care Transport.Thanks for your time today. Thank you very much we appreciate you guys coming over. We appreciate all the great questions and comments during this thank you again for watching ask us anything about Life Lion from Penn State Health.

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