Hackensack University Medical Center’s Air Ambulance Service connects access-challenged patients with world-class care
In April 2016, Hackensack University Medical Center’s emergency medical transportation helicopter, AirMed One, was fully accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS). Considered the most prestigious certification a medical air transport program can achieve, CAMTS accreditation required the AirMed One program to pass a rigorous review of all their services. This included site inspections, document reviews, interviews with AirMed One staff and examinations. Full accreditation is an impressive feat for any medical transport program—but it’s even more extraordinary when that program is so young.
At the time of accreditation, AirMed One was entering its fourth year of operation. This year, it’s celebrating six years and more than 1,500 missions providing patients in communities throughout New Jersey and southern New York with mission-critical access to timely care at Hackensack University Medical Center and any of the other 15 hospitals within the Hackensack Meridian Health network.
A Critical Mission
In northern New Jersey, where Hackensack is based, AirMed One serves two primary purposes. “When you’re talking about the rural areas we serve, obviously there’s a great distance between facilities,” says Mark Sparta, FACHE, COO and EVP of population health clinical operations.
But New Jersey is also the most densely populated state in the country. Even with lights and sirens, emergency medical services (EMS) vehicles cannot easily navigate the roads at most times of the day, especially at peak drive times.
“The mission of medical air transport is vital to getting patients in a variety of settings to the complex care they need in a much timelier fashion,” Sparta says.
In addition to providing rapid scene response for trauma, stroke and cardiac events, AirMed One specializes in inter-facility transports between hospitals and expands the footprint of Hackensack University Medical Center’s capabilities and access.
Since the program launched, inter-facility transfers have increased by 50 percent. In 2014, the door-to-door-to-balloon time for STEMI (ST-elevation myocardial infarction) averaged 265 minutes, with no cases under the 120-minute threshold set forth by the American Heart Association. Two years later, after activating new protocols that dispatch AirMed One as soon as the transfer call comes in, the average time dropped to 138 minutes, with 22 percent of cases at less than 120 minutes.
Behind these achievements is a multidisciplinary crew of dedicated administrators and highly skilled pilots, flight nurses, paramedics, mechanics and communications specialists who work tirelessly to ensure AirMed One is always ready to respond.
“There have been times where we’ve gone two days without a flight,” says Joseph Solda, chief flight nurse. “Then there are days when we’re flying eight hours straight. Every day is a challenge, but each day has a routine, too.”
Twice a day, at shift change, the crew meets for an extensive briefing, covering the day’s weather and other factors that could impact operations. Pilots have 12-hour shifts, while the medical crew is on duty for 24 hours at a time. With the exception of the pilots, who are employed by Englewood, Colorado-based Air Methods Corporation, all of the crew are employees of Hackensack University Medical Center.
The helicopter is kept at Greenwood Lake Airport, approximately 30 miles away from Hackensack University Medical Center. The off-site location gives AirMed One more range for emergencies (it can fly about 250 miles), while close proximity to the hangar (about a 30-second walk) ensures the crew can mobilize quickly.
Extending the Hospital’s Reach
Equipped with a full range of technology and advanced medical equipment, AirMed One is configured to mirror the most sophisticated intensive care units.
“Hackensack University Medical Center is the quaternary care center for our region, and our medical air team is trained to that level,” says Michelle Kobayashi, administrative director of EMS and emergency community operations. “We’re able to take that quaternary level of care and start it at the point of patient contact.”
The air medical crew monitors and controls the operational use of the intra-aortic balloon pumps and other ventricular assists devices for patient care during the entire patient care transport. In 2014, thanks to the generosity of a hospital board member, AirMed One was the first air medical unit in New Jersey to be equipped with the LUCAS chest compression system, which performs high-quality, uninterrupted chest compressions when a patient goes into cardiac arrest.
The crew is currently assessing whether—and how—to offer mobile extracorporeal membrane oxygenation (ECMO) therapy on the helicopter.
“We are constantly evaluating new advances and how we can continue to integrate cutting-edge technology into the services we offer in flight,” Sparta says.
AirMed One’s clinical crew meets regularly with hospital clinicians and representatives, and it sits on key service line committees, such as cardiology, heart attack, trauma and sepsis.
“We’re an extension of the hospital out in the field,” Kobayashi says. “That makes collaboration with other hospital departments so important. By working together, we’re able to better anticipate what our patients will need and be prepared to initiate the care we know our hospital physicians will be delivering upon transfer.”
The crew also attends bimonthly STEMI review meetings with a cardiology STEMI work group examining each transfer brought in by Air Med One.
“We dissect each one all the way down to when the phone call started from the sending institution,” Solda says. “We even look at arrival time at the sending hospital and how quickly they called our transfer center. And when we do something exceptionally well, we try to figure out how to replicate it.”
One of the recommendations that came out of a STEMI transfer review was to “autolaunch” AirMed One the moment the transfer call comes in.
“When a physician from one of our sending facilities calls in and says ‘STEMI’ we automatically start sending resources his way,” Solda says. “We don’t wait for the conversation to finish. We start the movement of the aircraft while they’re still talking. We know we’re going to treat that STEMI patient, and we want them under our care in our institution as soon as possible.”
Coordination and Consistency
Autolaunching AirMed One and subsequently caring for patients in flight requires a tremendous amount of coordination.
“It’s a true team in the helicopter,” says Christopher Gallagher, lead pilot. “Each crew member has specific jobs and knows what the other crew members are doing at all times. That doesn’t happen accidentally, but with lots of practice and regular training.”
There’s also a consistency to how things are done, and the crew follows scripts to make sure no step is overlooked. “Every time I fly with the team, I hear them say the exact same thing the last time I flew with them,” Kobayashi says. “That contributes to the way a team can work so effectively on such highly critical cases.”
Committed to Safety
Protocols and scripts are just the beginning of AirMed One’s commitment to safety. The crew’s motto is “Patients First, Safety Always,” which was Solda’s long-held personal philosophy before he even began working on AirMed One.
When the aircraft flies at night, all crew members wear night-vision goggles (NVGs). “Once you get into the more rural areas, where there are fewer ground lights and occasionally no visible stars or moon, everything is black without the NVGs,” Gallagher says. “And we’re not going from well-lit airport to well-lit airport: We’re often landing in fields and parking lots. With the whole crew wearing NVGs, everyone can help identify obstacles and hazards in and around the landing zone to ensure a safe landing every time.”
The helicopter has two engines and is capable of operating safely on one in the event of an engine failure. Additionally, the fenestron, or enclosed tail rotor design, allows the crew and emergency personnel to operate more safely while loading and unloading patients through the rear doors with the engines running.
“From the inception of the program, when it was just an idea, our administrators agreed that safety had to be first,” Solda adds. “The hospital has made these investments to ensure that we always operate in the safest way possible.”
Looking ahead, Sparta says Hackensack Meridian Health is evaluating the need for a second helicopter based in a different location.
While the new plan will be expensive, “not everything we do in healthcare can be a direct profit-and-loss analysis,” Sparta says. “We have to do more of a programmatic review of our responsibility as a healthcare provider and what’s available in order to improve outcomes for the communities we serve. The reality is: AirMed One’s importance in serving our communities has been demonstrated time and time again.”