From the picturesque San Juan Islands off the northwest coast of mainland Washington state, across the Cascade Mountains into Montana and Idaho, and up into Southeast Alaska, Airlift Northwest has been providing emergency medical services (EMS) to some of the most remote communities in the Pacific Northwest for more than 30 years.
The organization was founded in 1982 by Dr. Michael Copass and a consortium of hospitals in the Seattle area, including the University of Washington Medical Center, Seattle Children’s and Harborview Medical Center, to bring high-quality air medical transportation to an underserved area in Southeast Alaska. The catalyst was a house fire in rural Alaska, in which three children were caught. Transport south to the burn center at Harborview could not be arranged quickly enough, and, tragically, none of the children survived. Dr. Copass vowed that no one else would suffer the same fate due to lack of access to medical services.
Airlift Northwest has since expanded its service with a mixed fixed-wing and rotary-wing fleet. The helicopters primarily serve western Washington, while the fixed wing aircraft serve Washington, Alaska, Montana and Idaho. The organization’s headquarters, maintenance facility and a rotary-wing/fixed-wing base are centrally located at King County International Airport (also known as Boeing Field) in Seattle.
For those who live on the islands off the coast of the Pacific Northwest, the ability to travel by Airlift Northwest’s helicopters — as opposed to ground transport via ferry — means they can reach definitive treatment on the mainland within minutes rather than hours.
Similarly, the small communities in the eastern Washington mountain range often require transfer to a hospital or trauma center with additional resources. The vast majority of transports are brought to Harborview’s Level 1 trauma center, the University of Washington Medical Center or Seattle Children’s Hospital.
Interfacility flights represent about 70 percent of the organization’s missions, with the remainder consisting of scene calls. In the summer, this changes to nearer a 50/50 ratio, due to the increased number of tourists and the amount of outdoor activity in the state.
Chris Martin, Airlift Northwest’s executive director, told Vertical that the organization’s scene calls can vary from automobile and truck accidents, to responding to head injuries caused by hiking, climbing or mountain biking accidents; and from industrial trauma to heart attacks. During the winter months, the helicopter bases respond to scene calls at ski resorts involving skiers and snowboarders, as well as automobile and industrial accidents. The comparative speed of air transfer versus land transfer for those offshore only increases during the winter months.
Evolving Platforms
Airlift Northwest began helicopter operations in 1985 with Agusta A109 Mk. IIs. “The A109 Mk. II fit our needs at the time as they were very fast, smooth, and the cabin size worked well for our nurses,” said chief flight nurse Brenda Nelson. “The pilots liked the Mk. II because it was a good IFR [instrument flight rules] platform and had good performance.”
But, in 2005, after 20 years of service, the aircraft were aging and needed to be replaced. Airlift Northwest decided to stay with the AgustaWestland platform and transitioned to the new AW109E Power, operating a fleet of four. The Power provided more powerful engines, better avionics, and the same cabin layout. The AW109E performed well, but, in 2009, Airlift Northwest contracted with Air Methods to do a fleet replacement. It considered the Airbus Helicopters EC145 and EC135 T2, and while both were good candidates, it chose the latter for its lower operating costs. Today, Airlift Northwest’s rotary-wing fleet includes four EC135 T2s and a single AW109E. Air Methods provides the pilots and maintenance for both aircraft types.
The EC135 T2s are equipped with terrain awareness and warning systems, satellite flight tracking and weather updates, and traffic collision avoidance systems. The medical interiors of the EC135 T2s and the AW109E include a Lifepak 15 monitor/defibrillator, Drager Ventilator, Spectrum pump, Minimed multi channel pump, GlideScope video laryngoscopy system, i-STAT diagnostic machine, and an AirBORNE isolette for neonatal flights.
The flight crews also use ANVIS-9 night vision goggles to help increase safety. “They simply provide a larger picture of the environment, increase the crew’s situational awareness, and lower everyone’s fatigue factor,” said chief flight nurse Brenda Nelson.
Airlift Northwest’s helicopters operate from four bases, all within the state of Washington. In the north, about 23 miles from the Canadian border, an EC135 T2 is based at a hospital in Bellingham. This generally responds to the Mt. Baker ski area, and Whatcom, San Juan and Skagit counties — with the largest proportion of its flights coming from the San Juan Islands.
Further south, another EC135 T2 is based at Arlington, about 50 miles north of Seattle. This base frequently serves the Olympic peninsula, a large landmass with three hospitals that often need to transfer patients to a higher level of care. A third base is located at King County International Airport, and is home to the organization’s AW109E. This tends to undertake shorter flights to the surrounding areas and to the islands of Bainbridge, Vashon and Bremerton, which rely primarily on ferry services. The most southerly base is in Olympia, which uses an EC135 T2 to cover the southern part of the state. The bases at Arlington, Seattle, and Olympia are located at airports and have instrument approaches (two have instrument landing system approaches). “Our base layout gives us the ability to cover the entire length of western Washington, including the coast,” said Martin.
The bases generally cover a radius of 150 miles (240 kilometers), but this can be extended by refueling at local airports. Each base has its own mechanic to take care of inspections and minor problems, but, for larger inspections and repairs, the helicopters are brought down to the main Seattle maintenance facility.
On the fixed-wing side, the company has a Learjet 31 based out of Seattle that operates throughout the region.
It flies specialized teams, including intra-aortic balloon pump teams, neonatal specialists, and in the near future, will be adding extracorporeal membrane oxygenation teams in close cooperation with Seattle Children’s Hospital.
Airlift Northwest also keeps another Learjet 31, together with an Aero Commander 690A, in Juneau, Alaska. Because of its speed, the Learjet 31 flies to either Anchorage or Seattle depending on patient requirements. Another Aero Commander is based in Yakima, and primarily serves central and eastern Washington. The Aero Commander in eastern Washington is set to be replaced by a Pilatus PC-12 in the new year.
Selecting the Right Crew
Airlift Northwest pilot Neal Jacobs told Vertical that the challenge presented by the Pacific Northwest weather was one of the reasons the entire fleet was compose of twin-engine instrument flight rules aircraft. “This is not a job for novice pilots,” he said. “I don’t say that to brag…. Quite the opposite. Flying here in the Pacific Northwest can be humbling.”
Because of this, the majority of the organization’s pilots have military flying backgrounds, or have completed complex aircraft progressions in the civilian world.
Jacobs said the summer weather in the region provided clear skies and moderate temperatures, but that a trip over the Cascade Mountains could bring clear air turbulence and near-desert like temperatures. He said the rainy season typically begins in late September and continues into April or May. The winter months are dominated by the Aleutian (sub-polar) influence of southeast Alaska, which sets up a stagnant, wet winter environment influenced by the maritime moisture of the Puget Sound. Seattle rarely sees freezing temperatures at the surface. However, freezing fog is not uncommon, as well as significant frost when the temperature drops below freezing. “In my experience, it’s one of the most interesting, challenging and humbling places to fly in the United States,” said Jacobs.
Pediatric flights represent about 25 percent of the organization’s total, and due to the volume of interfacility flights it completes, Airlift Northwest’s medical configuration is a pediatric/adult nurse team. This configuration has been the same since the organization’s inception in 1982.
“Our nurses generally have five to 10 years of critical care experience when they start with us,” Nelson told Vertical. “[They] can be pediatric or neonatal nurses for the pediatric nurse positions; or have cardiac, trauma, burn, and/or medical ICU experience for the adult nurse position. This allows them to give expert care to the children and adults needing our assistance.”
Nelson said Airlift Northwest works hard to train nurses to think independently and enhance their assessment skills. Nurse training begins with two and a half weeks of didactic education, which includes lecture and simulation. This is followed by three months with an assigned preceptor, and this training is customized to the nurse’s needs. They also get 16 to 24 hours of clinical time in the operating room with attending physicians and another 16 to 24 hours of clinical time in specialty areas. Each year, Airlift Northwest provides three competency days for its nurses to go over new procedures, equipment, or policies — and they are encouraged to go to medical conferences.
“With 80 nurses, it takes an effort to make sure all are trained to the highest standard, but most are so highly motivated that they take this training and continuing education in stride,” said Nelson.
Airlift Northwest executive director Chris Martin told Vertical the organization is proud to be serving the residents of the Pacific Northwest and Alaska, and, as it approaches its 35th anniversary, is looking to further enhance safety with the commissioning of a dozen non-14 Code of Federal Regulations part 97 approaches that serve its most frequently visited hospitals. The organization is also working on an enhanced low level route structure that will utilize the intersections and reporting points of those approaches in cooperation with the current Federal Aviation Administration route structure to create a low level route for flying during instrument environment when the freezing level is low.
“Over the years, we have transported patients from all walks of life, many with complicated medical conditions, surgical complications and life threatening traumatic injuries,” said Martin. “There is a great satisfaction knowing Airlift Northwest and its crews continue to be a critical part of these patients surviving their injuries.”