LifeNet of New YorkLanding Zone Presentation

“BECAUSE MINUTES MAKE A DIFFERENCE”

Administration

• Program Director – Dean Dow• Medical Manager – John Fisher• Medical Base Supervisors

– Jon Gryniuk – Shannon Martin– Mike Paulson– Craig Castioni

• Medical Directors– Deb Funk MD, David Stuhlmiller MD

• Administrative Assistant – Desiree James

Pilots

• All pilots hold a commercial certificate with instrument rating

• Have at least 2000 hours of PIC time

• Completed specialized training in EMS flight operations

Medical Staff

• Available 24 hours a day, 7 days/week, 365 days/year

• Medically dedicated• Staffed by a

Paramedic/RN team with equal training and responsibility

• Provide advance medical procedures– advanced airway

management– hemodynamic support– advanced

pharmacology– ability to act

autonomously guided by “standards of practice”

Life Net 7-1 , AlbanyEC-135

• American Eurocopter• Twin Pratt and Whitney 650 shp

engines• Rear load for ONE patient• 187 gallons Jet A• Range of 300 on full load of fuel• Cruise speed of 168 mph

Dimensions and Weight

• Total running length – 40 ft• Main rotor diameter – 34 ft• Main rotor height – 11 ft on level

ground• Tail rotor height – 2.2 ft• Maximum gross weight – 6250 lbs.• Can carry up to 350 lb. patient

Life Net 7-2, GlenBO105

• American Eurocopter• Twin 250hp Allison Engines• Rear load for ONE patient• 150 gallons of jet A fuel on underside of

AC (similar properties to Kerosene)• Range of 300 miles on a full load of fuel• Cruising speed of 130-140 mph

Dimensions and Weight

• Total running length – 39 feet• Main rotor diameter – 32 feet• Main rotor height – 10 feet (level

ground)• Tail rotor height – 7 feet (level

ground)• Maximum gross weight – 5500 lbs.• Can carry up to 350 lbs. patient.

Air 1 / Air 2 , Kobelt & ValhallaBK117

• American Eurocopter• Twin Lycoming 650 hp gas turbines• Rear load for ONE or TWO patients• 187 gallons of jet A fuel on underside of

AC (similar properties to Kerosene)• Range of 300 miles on a full load of fuel• Cruising speed of 144-150 mph

Dimensions and Weight

• Total running length - 43 feet• Main rotor diameter - 36 feet• Main rotor height -10 feet (on level

ground)• Tail rotor height - 6 feet (on level ground)• Maximum gross weight - 7055 lb• This aircraft has carried patients with

combined weight of > 500 lbs.

Scene Responses

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

Equipment & Skills• ECG Monitoring• Biphasic Defibrillator• ETCO2 monitoring• Ventilator• IV pumps• IV warmer• Transvenous Pacer• EZ IO• Jet Insufflator• Needle & Surgical

Cricothyroidotomy• Escharotomy• RSI Intubation• Neonatal Resuscitation Equipment• Over 70 medications

Why Utilize Air Transport ?

• To “bring the Emergency Room to the patient”

• To provide the patient with early, needed and advanced medical care

• To transport the patient to the “closest appropriate facility” therefore decreasing time to Definitive Care

GOLDEN HOUR

Transport Criteria: Physiologic

• GCS < 13• Head injured with altered

mental status• Confused/combative• Unconscious/

unresponsive• Heart rate > 120• Blood pressure < 90/p• Pelvic fractures• Limb paralysis

• Burn patients—greater than >10% BSA 2nd and 3rd and >5% 3rd in any population

– These patients will be transported directly to a burn facility @ Westchester, Worcester, Syracuse University Hospital and/or Boston Children's…

Transport Criteria: Physiologic

• Chest trauma with respiratory distress

• Respiratory rate > 29

• Severe shortness of breath

• Difficulty speaking• CO poisoning

• Amputations proximal to the hand or foot, not to include single digits

• Penetrating trauma– Gunshots– Stabbings – Impailments

Transport Criteria: Operational In Conjunction with Physiologic

• Need for ALS otherwise unavailableNeed for ALS otherwise unavailable• Extrication > 10 minutesExtrication > 10 minutes• Fall of 20 feet or moreFall of 20 feet or more• Patient ejected from a vehiclePatient ejected from a vehicle• Vehicle rollover with patient Vehicle rollover with patient

entrappedentrapped• High speed crash with significant High speed crash with significant

intrusionintrusion• Motorcycle/Auto v. PedestrianMotorcycle/Auto v. Pedestrian

Transport Criteria: Operational

• Surviving patient of a MVC with a death• Age of < 5 or > 55 years old• Significant associated medical conditions• Pregnancy• ***These patients should be transported

to a regional Trauma Center (Albany Medical Center, Bassett Health Care (Cooperstown), Robert Packer, St. Elizabeth’s, University Hospital, Wilson Memorial)***

Special Circumstances

• Patients without vital signs:– there is usually no

survival from traumatic death

– Hypothermic patients being the exception

• No patient is too critical to transport

• A surviving patient will be transported before one in arrest

• LifeNet of New York can provide assistance to local providers and transport by ground

Who can request?

• Law enforcement• Firefighters• Industrial safety

officers• First responders• Paramedics• EMTs• First Responders

• RNs/MDs/Pas• Many of the

regional counties are on automatic stand-by for “delta” calls:

• Rensselaer, Saratoga, Columbia, Washington, and Schenectady

How To Request1 800 525-6663

• Agency or comm. Agency or comm. Center callingCenter calling

• Call back #Call back #• State and countyState and county• Lat/long or Lat/long or

nearest roadway nearest roadway and cross streetand cross street

• Ground frequency Ground frequency with or without PLwith or without PL

• The AC can The AC can program high/low program high/low and ultra high and ultra high frequenciesfrequencies

• Scene informationScene information• Description of Description of

landing arealanding area• Hazards and their Hazards and their

position to the LZposition to the LZ

Delorme Street Atlas

STAND BY

• Automatic stand by/ launch currently instituted in Rensselaer, Columbia, Saratoga, Schenectady, and Washington counties for all “delta-level trauma”

• Readies AC and FC for mission• Second call is needed to launch or

cancel• No charge if cancelled enroute• Automatic launch for areas > 30 nautical

miles

Early Call

• Lets YOU know if:– the AC is out on another call– unable to fly due to weather– is on a maintenance delay or out of

service– may be a short delay only and still able

to be utilized– an available AC will be found or we may

be able to intercept

Weather--Pilot’s Final Decision

• Minimum standards for ceiling and visibility– day versus night

• Weather based on satellite readings, current conditions, and forecasts

• Pilot knows only destination when making decisions

Enroute Information

Scene (LZ) information onlyFC will obtain patient report

when safely landed.

Landing Zone Officer

• One person assigned, landing the AC safely the only responsibility

• AC will try to contact LZ officer ~ 5-10 minutes out

• LZO may need to be on apparatus radio; portable may not transmit

• Focus all attention on managing communications, approach/departure, and landing site area

Landing Zone Officer

• Directs the AC into the scene. May be required to use directions, “out your right door and/or clock method--nose of AC is 1200, tail of AC 0600.

• Locating the scene in daylight is more difficult, even with overhead lighting.

• AC/pilot may circle LZ numerous times before landing.

Slide of LZ officer, in turnout

Choosing the Landing Zone

Choosing the Landing Zone

• Proximity to the Proximity to the accident, utmost accident, utmost importanceimportance

• 80’X70’80’X70’• Level surfaceLevel surface• Clear of Clear of

obstructionsobstructions• Secured by LZ Secured by LZ

officerofficer

• Approach and Approach and departure path departure path clear of clear of obstructionsobstructions

Marking the Landing Zone

• DAY– Flares (caution)– Cones– Rescue vehicles– Overhead lighting

on rescue vehicles both for day or night

• NIGHT– Flares (caution)– Chemical light sticks– Battery powered

flash lights (secured to ground)

– Headlights from two vehicles pointed at LZ to form an X

Preparing Touchdown Area

• Secure loose debris (car doors, trunk lids, stretchers, linens, baseball hats etc.)

• Protect yourselves! Wear turnout gear, goggles, protective eye shields

• LZ walk through

• Secure nearby activity– Moving traffic– Rescue activity– Apparatus and

ambulance doors closed

– Keep all spectators > 200 feet from LZ. Only those assigned to protect the AC allowed < 100feet

SAFETY FIRST AND FOR ALL:

• Fire Department• Pre-hospital providers• Police Department• Life Net of New York• All involved in the safe transfer of

a critically ill or injured patient

Take Off and Landing

“Most Critical Time of Flight”AC will not land w/o first attempting

to make contact with LZ command

Arrival / Landing Information

• Obstructions: wires, power lines, light poles, smoke stacks, antennas, etc.

• Report all obstructions to the pilot as the AC is over the landing zone, never assume pilot has seen all obstructions.

• Winds: wind direction and intensity helps the pilot better plan the landing. Helicopter lands and takes off with nose into the wind.

Arrival / Landing Information

– Condition of the touchdown surface: be specific, ie: slope, surface (mud, packed snow, dust).

– Security: assure crowd is secure and all traffic is stopped for landing and take-off.

– LZ officer will be notified of “final approach”. If any unsafe or potentially unsafe situation arises, contact pilot to make aware. Use short simple commands: “STOP! WIRES!”, etc.

Hazards

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

High HazardsHigh Hazards

Do not assume the AC cannot land Do not assume the AC cannot land in the presence of wires near the in the presence of wires near the

roadway.roadway.

Landing / Lift-off Safety

During night operations, NEVER allow white lights to shine into the cockpit. Night vision will be compromised

Final Approach

• As the AC is on “final approach” the pilot or FC may ask the LZ officer to have all white lights, shining toward the LZ, extinguished before touchdown.

• The AC can produce > 70 mile per hour winds with short final. Protect yourselves.

Ground Operations

– Always approach the AC from the nose.

– Never approach the AC unless directed by the FC or pilot.

– If asked to get equipment by FC in AC, never approach w/o the getting pilot’s attention.

– Keep all personnel and others at least 50 feet away from the AC when running.

– May post a safety officer 50 feet behind the tail rotor

– NEVER APPROACH OR GO NEAR THE TAIL ROTOR OF THE AC.

Ground Operations

– Let the FC come to you

– FC does NOT require assistance off-loading equipment

– Keep apparatus and EMS vehicle doors and windows closed.

– Leave patient in ambulance

– Nothing carried above the waist level.

– No smoking within 50 feet of the AC

– No sheets, blankets, baseball hats near AC

– Firefighters should have turnout gear and helmets with shields down.

Keep All vehicles > 50 feet from AC

• Cartoon of pic of EMS vehicle damage by rotor blades.

Patient Preparation

• Flight Team will perform:

– patient assessment

– required interventions

– transfer patient to FC stretcher

– load into AC

Patient Loading

• Only FOUR people to carry patient/stretcher into the AC

• One person on each corner

• Follow the directions of the FC

• Load patient into AC feet first

Patient Loading

• Approach AC toward nose and watch pilot and FC for directions

• Stay close to body of AC

• After patient is loaded, FC and/or pilot will secure stretcher and equipment

After Loading Patient

Depart AC off the nose when directed by FC or Pilot

Departure InformationLimit Communications to Hazards

Only

– Assure AC and tail rotor is clear of any obstructions

– Maintain visual contact with the AC until clear of LZ

– Maintain radio communications with the pilot until the AC is safely in forward flight

– Immediately report any safety concerns to the pilot, again using short, simple commands

Hazmat Situation

– Preparation and consideration for everyone’s safety

– Give AC and FC advance warning, if possible– Land AC at least 1/2 mile from hazardous

scene– FC do not carry protective suits or breathing

apparatus for protection. Early warning is recommended

– Patients will be completely decontaminated prior to being placed in the AC

75 x 7575 x 751/2 mile

HazmatWind direction

MCI Situation

• Consider utilizing LifeNet of New York as part of your MCI plan

• FC will be available to the transport officer• Patients are able to be dispersed with

available AC not overwhelming one facility• If multiple patients are involved in a

situation, multiple AC can be activated using the LifeComm dispatch center.

• Have separate LZ areas for each AC called to incident. Each LZ does not require separate FD

Equipment Return

Be sure all equipment is well marked. LifeNet will make every effort to return all

equipment by ground or mail.

Post flight contact

• Any concerns should be addressed as soon as possible

• Please complete and return our customer survey to allow us to continue to improve our service

• (518) 262-8800

QUESTIONS ?