Salt LaKe City, Utah

LDS Hospital Life Flight

The p r e s e n t helipad for LDS Life Flight is o n a hill behind P r i m a r y Children's Hospital. The p a d i s complete with u n d e r g r o u n d refueling, pilot's quarters, a n d work/storage area. A helipad is being built atop the new LD$ Hospital, scheduled for completion late this year.

Life's Flights Alouet te 319 departs a snow c o v e r e d pasture n e a r the site of a truck/train accident 15 m i l e s north of Salt Lake City.

Photo by Bob Waller, Davis County Sheriff's Office

"Neither rocks, nor snow, nor dark o f night

Shall keep me from m y appointed f l ight."

Such a twist of the familiar postman's motto nearly describes one of the early hospital-based helicopter programs. In Salt Lake City, LDS Hospital became the seventh hospital to sponsor aeromedical transport in the na- tion. The program flies a variety of missions. Over half of all calls are to the scene of accidents - ski resorts, primitive mountain areas, oil and gas drill rig sites, and of course, highway motor vehicle ac- cidents. And about one-third are flown at night.

Begun in March 1978, Life Flight came into existence the same month as a competing program at the University of Utah Hospital (see Hospital Aviation, February 1982). Since then, they have flown over 2,500 patients and ac- cumulated an estimated 300,000 miles on their Alouette III.

LDS HOSPITAL

UFE

Their Alouette is a model 319, one of only three in the United States. It has a longer range than its brother the 316, which is com- mon on more than a dozen aeromedical programs around the nation. The longer range is necessary for Life Flight's average round trip of 120 miles, and is made possible by a more fuel- efficient engine.

The program is unique in ways other than its high percentage of scene flights. It transports a high percentage of trauma patients, was the first program in the nation to fly with a nurse-paramedic medical team, and recovers actual mission cost from transports to other hospitals.

Scene flights are a product of the distinct seasons in Utah. Promoted as having "the greatest snow on earth," Utah has 11 ski resorts located within 40 air miles of LDS Hospital. Life Flight

8 HOSPITAL AVIATION, JANUARY 1983

averages 30 to 40 flights into ski resorts each ski season to retrieve patients with head, neck or internal injuries. While the Aiouette often sets down at the base of the ski area, it often is directed to one of the pre-designated landing sites up on the hill. One ski area has 9 such sites, which prevent the ski patrol from taking severely injured skiers on long toboggan rides to the base of the mountain. Such pre- planning is important when it is realized that the vertical rise at many ski areas is in excess of 3,000 feet above the parking lot. The Alouette proves its worth as a workhorse, as resulting elevations are upwards of 9,000 feet above sea level.

Other winter scene flights are for injured snow mobilers and cross- country skiers. In the summer, the scenery changes color but many locations remain the same. Only this time, flights are for injured

"JerrF James, a long-time pilot with LD$ Life Flight, reported that he has been o n flights landing as high as 11,300 feet to rescue in- jured hikers."

hikers, mountain climbers, and hunters, as well as motor vehicle accident victims.

Jerry James, a long-time pilot with LDS Life Flight reported that he has been on flights landing as high as 11,300 feet to rescue injured hikers. A popular area for such flights is the High Uinta's Primitive Area, with peaks reaching well over 13,000 feet. The area ranges 50 to 80 miles east of Salt Lake, and is the site of many summer recreational retreats for Utah residents and visitors.

LDS Life Flight finds that about 76% of all patients transported fall into the trauma category. This is due in part to the level of scene flights, and to the fact that Air Med, the competing transport program, has specialized in neonatal, high-risk maternal, and burn patients. For this reason, the program has done well with its nurse-paramedic medical team staffing.

LDS Hospital provides five full- time flight nurses for the program

working 12 hour shifts. Eleven paramedics, who have regular jobs with either the Salt Lake County Fire Department or the Davis County Sheriff's Department, fill in the second position from their "off-duty" time. Many are trained in mountain rescue, and by virtue of their primary job, are very familiar with the territories many scene flights take them.

Training is an important part of LDS Life Flight. The occasion for the interview for this story was the Third Annual Air Transport

Seminar held in January and sponsored by the aeromedical program. The seminar was attended by nurses, paramedics, and physicians primarily from Utah, Wyoming and Colorado, but had representatives from as far east as Kentucky. Medical Management and Procedures were featured, including burns, cardiac care, resuscitation, head trauma, shock, intubation, saphenous cutdown, and hypothermia. (Those attending the hypothermia lecture took good notes, as the 1984

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senunar will feature winter surviv~al, complete with sleeping in snow caves).

Cost is a major topic of concern today among aeromedical programs. Again, LDS Life Flight differs from the norm in its cost recovery procedures. About 500 of all transports return to LDS Hospital, where the patient is billed directly for the transport charge. The vast majority of the remaining patients are taken to one of about seven hospitals (two of which are 40 miles distant) where a transport agreement exists. The agreement provides that the receiving hospital will pay actual round trip "rotor time" (flight hours) which includes both monthly and hourly costs billed by the operator, plus a professional fee for the medical team. The payment is made to the sponsor hospital, and is computed on the

IIIII IIIII

" O v e r ha l f o f a l l cal ls are to the scene of accidents.. ." I

previous month's average cost per flight hour, and a fixed hourly rate for the medical team. As a result, Life Flight experiences a higher degree of cost recovery for transport missions when compared to the national program average. It is one of only a handful of hospitals that has adopted such a charge theory, and in the opinion of the author, is entirely equitable to all concerned. It enables other hospitals to share in the program without a tremendous cost, and the sponsor hospital to recover part of its investment.

An interesting parallel is that the competing program, University of Utah Air Med, has a similar charge structure, except it is based on miles instead of hours. In fact, both programs participate in each other's charge agreements, and are even frequently called to back the other up for mission flights. Each program occasionally will even refer patients to the other if they feel the other is better suited to handle the task.

Competitive problems do exist, however, but do not appear to be of a destructive nature. By virtue of each program transporting more than 600 patients per year, it appears there is enough transport

10 HOSPITAL AVIATION, JANUARY 1983

business for two helicopter programs in Salt Lake City. It must be remembered that the city serves a vast geography, with the closest major city being Denver 500 miles across the Rocky Mountains to the east.

Program Director for Life Flight is Mary Lloyd, R.N. Mary also functions as Chief Flight Nurse, and~ handles the business and nursing affairs for Life Flight. Assistant Program Director is Thad Moore. Thad is responsible

~arketing, PR flights, outreach ~ion, program dispatch, and aramedic schedule. Both Thad

Mary Lloyd, R . N . , Life Flight Director, and Thad Moore, Assistant Director, participated in endotracheal intubation instruction at one of the many workshop stations during the seminar.

Dr. Thomas developed a complete trauma equipmen t transport pack for the LDS Life Flight program. The pack has numerous special ly-designed c o m p a r t m e n t s for spec i f ic equipment and drugs, and was constructed by his wife.

and Mary are active participants on the flight schedule. Medical Director is Frank Thomas, M.D. He recently replaced Terry Clemmer, M.D., who is now director of the Trauma Center for LDS Hospital.

Chief Pilot is Harry Wadley. Harry is an 11-year veteran with Rocky Mountain Helicopters, operator for the program. Mechanic is Joe Bordelon, who keeps the Alouette flying about 900 hours per year on its missions of mercy. []

Frank Thomas, M.D., is Medical Director for Life Flight, and conducted a n L V. venous cutdown lab during the r e c e n t Air Transport Seminar in Salt Lake City.

HOSPITAL AVIATION, JANUARY 1983 11