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EMS Helicopters: Dispatchers Facing the Challenge
Author: David Dowling
Copyright: Copyright 9-1-1 Magazine, Feature Content
By David Dowling
I once had a boss that strongly urged me not to “spend a lot of time and energy on trying to figure out this helicopter mess. We all know helicopter transportation is just a fad and will soon be forgotten.” He was so wrong.
Picture this – late 1970’s, San Bernardino County, California. The largest county in the continental United States. A vast, 20,105 square mile display of dirt and rocks, high elevation mountains and low valleys, cities and farmland, major transportation routes and off road recreation opportunities, all affected by an increasing population steadily migrating eastward from Los Angeles. There were 32 public agencies providing FIRE/EMS services operating through ten dispatch centers. There were also ten private ambulance companies operating their own dispatch centers. In the next ten years, by 1989, there would be 24 EMS helicopters also available to respond to emergencies.
The majority of these responders were utilizing different frequencies with no centralized co-ordination. EMS helicopter companies such as Lifeflight based in Chino and Long Beach, MedAir based in Santa Ana, UCLA Medstar, Flight for Life in Las Vegas, Guardian Air in Kingman Arizona and Medical Air Transport(MAT) in Riverside were all advertising their services to the public. Public Safety providers were also beginning their own EMS helicopter programs. San Bernardino County Sheriff, California Highway Patrol, Arizona Department of Public Safety, El Toro Marine Corps Search & Rescue, and Fort Irwin Army “Dust Off” Med-Evac Black Hawks were all increasing their visibility to the public in pre-hospital care transportation. Mercy Air, which would ultimately become the backbone of our current EMS helicopter system, was also becoming an important participant in this evolving system.
In these early days, the Federal Aviation Administration provided the only regulatory oversight for these helicopters. There were no common air to ground radio frequencies identified and no standards for determining the need for medical air transportation, much less a method to acquire and dispatch a specific transportation or “rescue” resource. There were no standards for assigning plain language radio call signs. Several attempts were made to develop a first generation, satellite based, tracking system to assist the dispatchers, but funding was not available at the time. Dispatching was wide open. (See side bar, below)
In 1988, under the auspices of California Code of Regulations, Title 22, the Inland Counties Emergency Medical Agency (ICEMA) created an EMS Aircraft Ordinance. Included in this ordinance was direction to establish the San Bernardino County Communications Center (CommCenter) as the countywide co-ordination center for all EMS helicopter operations. Initially one of the four on duty dispatchers would receive a request from the field and initiate a search, by telephone, from all appropriate air providers as to who was available to respond and who had the shortest Estimated Time of Arrival (ETA) to the scene. In many instances, ETAs were provided that did not account for aircraft liftoff time, thereby adding several minutes to the flight time and ETAs not being met. That process could take up to 12 minutes and considering that these helicopters could travel at 120 MPH, it was obvious that time was being wasted using this procedure. The proliferation of EMS helicopters to handle calls in San Bernardino County was now adversely affecting the dispatchers’ ability to manage their normal call load. Allocation of staff time was causing delays in the dispatchers’ routine job of initial attack dispatching of ground resources. The dispatchers desire to effectively utilize these resources would cause management to develop a way to objectively decide which helicopter was to be dispatched to any particular call. The obvious answer was to use our existing Computer Aided Dispatch (CAD), modifying the fire software to accept and recommend helicopters.
In August, 2003 the current EMS helicopter dispatch process was put into place using the existing CAD system. By 2003, there were consistently over a thousand helicopter requests per year. Sixteen geographical zones, known as Helicopter Demand Zones (HDZ) were established covering the entire county. These zones were entered into the Geo File with recommendations based on the aircraft with the shortest ETA to the incident’s LAT/LON. Each zone has multiple aircraft bases to draw from with dispatchers allowed to make changes only if they are firmly aware that another copter is closer.
There are currently at least 20 EMS helicopters available and entered into the CAD data base for use within this County, with bases listed as follows: Mercy Air (Rancho Cucamonga, Anaheim, Victorville, Hesperia, Mojave, Banning, Pahrump NV, Henderson NV and Boulder City NV.), SBSD (Rialto), CHP (Victorville), and Care Flight (Bullhead City and Parker, AZ.) Additional EMS helicopters are available on a “call when needed” basis from Los Angeles County FD, Los Angeles County Sheriff, National Training Center/Fort Irwin, Native Air/Havasu City and CHP/Thermal. County dispatchers react to the CAD recommendation and closely co-ordinate the response directly with the helicopter, if necessary. Mercy Air aircraft and crews are controlled by Life Comm dispatchers in Omaha, Nebraska but are also now equipped with 900MHZ pagers, SAT Phones and County 800MHZ trunked radios as well as all applicable VHF channels. A common air to ground co-ordination channel has been established (156.075). County dispatchers continue to closely co-ordinate and integrate other available EMS aircraft from Military facilities such as Twentynine Palms Marine Training Center and occasionally firefighting aircraft engaged in Search and Rescue missions.
The use of helicopters in the pre-hospital care system is here to stay. Their value and flexibility are being demonstrated daily. The next time you are driving through the vastness that is San Bernardino County, on to Las Vegas or points further east and see or “hear” the unmistakable sound of the rotors of Mercy Air, San Bernardino County Sheriff “40King Air Rescue” or CHP “H80” flying south toward Loma Linda University Medical Center, or Arrowhead Regional Medical Center, you will now have a better understanding of “what it took to get that aircraft there in the first place” and the dispatchers that Faced The Challenge.
“Injured Hiker….. Request Air Rescue”
In the early days, a hiker had been injured in a fall near the community of Mt. Baldy. Located high in the San Gabriel Mountains, this beautiful but rugged area was popular with back country hikers and regularly experienced incidents of this nature. The first call was received at the Mt. Baldy Volunteer Fire Department station and was quickly referred to San Bernardino County Sheriff’s Department and the US Forest Service/Angeles National Forest. Almost immediately, the SBSD sent a patrol copter into the area for a first-hand look. Shortly thereafter, the Forest Service requested the Los Angeles County Sheriff Air Rescue helicopter respond to the incident from its base in Long Beach. By this time the SBSD patrol copter had requested, through its own dispatch center, that SBSD Air Rescue be dispatched to the incident. This second helicopter was equipped with a winch for a possible extraction of the injured hiker. Because the LASD copter was out of position, the LA Sheriff requested that LA County Fire Department send their closer Air Squad to the incident. En route to the area, the SBSD Air Rescue requested that Mercy Air be dispatched to a designated landing zone near the incident in case the victim needed ALS transport to a trauma center. By this time there were at least 4 copters responding to this incident, all on different frequencies, working this incident, which was located in a narrow and inaccessible canyon area. The LA County FD and SBSD Air Rescue arrived in the area at about the same time only to find a US Forest Service firefighting helicopter on scene providing basic EMT level care to the victim.
While rather an extreme example, this actual event and others similar to it were occurring at various locations throughout our County. With safety being of prime concern, incidents like these prompted our County to establish the procedures that are in use today.
About The Author…
David Dowling retired last year after a 40 year career as the first Center Manager of what is now known as the San Bernardino County CONFIRE JPA Communications Center. His first article for 9-1-1 Magazine appeared in April 2004 and covered mutual aid operations on the Grand Prix/Old Fires of 2003.
Related story: RIP David Dowling April 18 2014