West Virginia is the only U.S. state located entirely within Appalachia, an eastern U.S. region encompassing the Appalachian Mountains and surrounding counties.
A predominantly rural state, with 80% of its mountainous terrain covered by forest, West Virginia’s transportation infrastructure is challenged by both topography and funding.
Those factors, combined with widespread rates of chronic disease and an aging population, can make access to healthcare difficult for its nearly 1.8 million residents, as well as those living in rural sections of surrounding states. The challenge is only growing as rural hospital closures continue across the region.
That population, however, has a savior. West Virginia is a tight-knit community whose residents share a deep commitment to one another. Forty years ago this July, that ethos brought together three competing hospitals to form a not-for-profit critical care transport system serving the entire state.
Their collaboration, foresight, and dedication led to the creation of HealthNet Aeromedical Services, the state’s only nonprofit helicopter operation combined with a ground ambulance emergency medical service (EMS). This summer, HealthNet celebrates 40 years of service to West Virginia and the surrounding region.
Born from tragedy
HealthNet Aeromedical Services was founded in 1986 as a not-for-profit medical transportation organization after the West Virginia State Police ended both its helicopter program and interfacility helicopter transport service.
“The superintendent of the state police called the CEOs of the three largest hospitals in the state and basically said ‘We’re drawing down our helicopter program,’” said HealthNet president and CEO Clinton Burley. “That put the hospitals into action.”
The three hospitals — now part of Marshall Health Network, Vandalia Health, and West Virginia University (WVU) Medicine — recognized the benefits of pooling resources to provide a service that could cover all of West Virginia.
HealthNet partnered with Rocky Mountain Helicopters (later acquired by Air Methods in 2002) to provide two Aérospatiale AS350B helicopters and turnkey aviation services.
The helicopters were stationed at two of the hospitals: one in Morgantown, near the state’s northern border, and one in Charleston, the state’s most populous city. A third AS350B arrived at the hospital in Huntington near the western border one year later.
A growth mindset
Throughout HealthNet’s first two decades, the hospitals grew into healthcare systems as they consolidated smaller facilities. HealthNet also expanded, adding additional bases.
In 1987, it leased two MBB/Kawasaki BK117s, introducing twin-engine service that allowed for greater capacity and longer transport distances with the larger helicopters. Over the following years, HealthNet continued to invest in additional bases, larger aircraft, and enhanced onboard capabilities.
Most recently, despite economic downturns in the state, HealthNet ordered four new Airbus H135 helicopters in 2023, each carrying an $8.5-million price tag. The aircraft are owned by HealthNet and operated by Air Methods. Additionally, HealthNet signed a lease for a fifth new H135.
“We are dedicated to providing the best and safest service possible, which includes new aircraft that offer a higher level of situational awareness and clinical capability,” Burley said. “When we took delivery of the final H135 in February, 50% of our fleet was officially less than eight months old. That’s pretty remarkable.”
Today, HealthNet operates eight bases with 10 aircraft — two Eurocopter EC145s, five H135s, and three EC135s — all rated for single-pilot instrument flight rules (IFR). This is in addition to its 46 ground ambulances.
The operation is anchored by EC145s at its northernmost and southernmost bases, with six H135s distributed among the remaining bases and two spare aircraft to ensure maximum availability. Air Methods provides pilots, aircraft management, and maintenance, while HealthNet covers all other expenses.
Creating their own path
HealthNet’s founders were intentional in the design of the program. Operations and procedures used elsewhere in the country were by no means a one-size-fits-all solution for West Virginia. This meant investment would need to go well beyond aircraft and ground transport services.
One of those non-negotiables was the organization’s communications service.
“As a cost-cutting move, many programs have contracted with national communications centers or large centers that handle multiple programs,” Burley said. “It was vital we had people answering the calls and dispatching the aircraft and ambulances who had very localized knowledge and clinical experience.”
Burley said a dispatcher hundreds of miles away might not recognize the rural route numbers, road names, or landmarks commonly used by callers in West Virginia. That local familiarity, he noted, can make a meaningful difference when every minute counts.
Today, HealthNet operates three localized communications centers staffed by emergency medical technicians (EMTs) and paramedics with experience serving the areas they cover.
The centers, located at the main hospital campuses in Huntington, Charleston, and Morgantown, receive calls from 911 operators and hospitals seeking medical transport, then identify and dispatch the closest helicopters and ambulances.
Each center includes large wall monitors displaying live images from hospital and base helipads, as well as computer monitors tracking all assets, giving dispatchers full situational awareness to help ensure a rapid response.
HealthNet also developed its own flight academy specifically to train clinicians. The 10-week program for newly hired flight registered nurses and paramedics dives deep into critical care and mobile critical care, aircraft familiarization, submerged aircraft egress, survival training, and basic aviation knowledge that allows clinicians to support their pilots in flight and emergencies.
The course is divided equally between classroom instruction at the training center and aircraft ride-along training. The training center includes classrooms and simulated environments, with several rooms configured to replicate emergency, neonatal, and pediatric care settings. It also features a full aircraft simulator built from an actual BK117 fuselage and outfitted with a HEMS interior.
A flying ER
Due in large part to the vast remoteness of the region HealthNet serves and the distances to trauma centers, its helicopters are among the most extensively equipped in the industry.
“We’re basically a mobile ER,” said Dave Cutright, certified flight paramedic at HealthNet Base 2 in Millwood. “A lot of the critical access hospitals are limited in what they have, and that’s why we carry all we do.”
Cutright said each aircraft carries blood products, along with a comprehensive medication kit containing 31 drugs, including pain medications, blood pressure medications, antibiotics, and temperature-sensitive pharmaceuticals. Blood, plasma, and medications that require refrigeration are stored in refrigerators at each base and transported on every flight in a cooler.
Key onboard equipment includes a portable cardiac monitor with 12-lead EKG, pulse oximetry, invasive and non-invasive blood pressure monitoring, temperature monitoring, and end-tidal CO2 capabilities.
Crews also carry advanced and emergency airway kits for intubation, surgical cricothyrotomy and thoracostomy kits, infusion pumps, a Butterfly portable ultrasound device, video laryngoscopes, portable and installed oxygen systems, and comprehensive emergency and trauma kits stocked with dressings, blood pressure cuffs, and other essential supplies.
As well, the aircraft can support ECMO and neonatal transport equipment. In the event of a flight emergency, each aircraft also carries a survival kit.
In addition to the pilot, HealthNet flights typically include a certified flight paramedic and a certified flight registered nurse. When weight and balance permit, crews can also carry a specialist, trainee, or patient family member onboard.
Clinicians work 24-hour shifts, while pilots work 12-hour shifts, rotating between day and night schedules with a break in between.
Onboard clinicians are required to hold a state mobile critical care certification prior to hire and attend HealthNet’s 10-week flight academy.
As HealthNet is accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS), crew members must also obtain their flight paramedic flight registered nurse certification within two years of hire.
Additional required certifications include neonatal resuscitation program, trauma nursing core course, advanced cardiac life support, basic life support, and pediatric advanced life support.
With a full-time medical director on staff, HealthNet continuously evaluates and updates its equipment and procedures while providing the training required to perform advanced interventions. For instance, clinicians are trained to perform finger thoracotomies for chest decompression, a life-saving procedure used to relieve chest tension in patients with severe chest trauma.
In addition to the intensive initial training program, HealthNet clinicians complete extensive continuing education and hands-on training each year. Requirements include quarterly continuing education to maintain state and national certifications and company standards, monthly in-base procedural reviews, annual survival training, and more.
“To stay proficient, we’re almost always either researching, studying, or training,” said Matt Chapman, certified flight registered nurse at Base 5 in Beckley. “I couldn’t begin to tell you how many hours a year. Easily hundreds.”
Lifesaving care
All the training and equipment investments HealthNet makes pay off in the field. The bases experience a steady stream of scene and interfacility transports, with those farthest from larger hospitals handling a higher proportion of interfacility transfers. The helicopters respond throughout West Virginia and into rural areas of neighboring Pennsylvania, Ohio, Kentucky, Virginia, Maryland, and Tennessee.
Because West Virginia is a major destination for outdoor recreation, common scene calls across the state include vehicle, hunting, boating, ATV, skiing, climbing, hiking, and other recreational accidents, depending on the season and location. Vehicle and ATV accidents top the list.
“Tens of thousands come for our ATV trails and we have a lot of ATV accidents with head injuries and crushing injuries from roll overs.” Chapman said. “West Virginia also has one of the higher percentiles of not only diabetes and obesity but also smoking and recreational drug use. We transport a lot of heart attack, stroke, and diabetes emergencies as well as drug overdoses and other medical issues that can get very complicated.”
With few neonatal specialty services available in rural hospitals, HealthNet transports many newborns and NICU teams. The crews also respond to industrial and mining accidents, providing care for patients suffering from chemical burns, crush injuries, limb mutilations, electrical burns, and other severe trauma.
“We once had a four-aircraft scene flight where there was a team of guys removing an old oil tank from around an old well they were plugging, and evidently, they didn’t check for fumes before cutting the pipes.” Cutright said. “It exploded and we had four extremely burned patients. We flew them all to the burn unit in Pittsburgh.”
A dedicated safety focus
For all of its 120,000-plus patients, HealthNet has not had a single accident. Burley attributes HealthNet’s 40 years of accident-free service to the organization’s tireless dedication to safety.
Each week, HealthNet holds a safety meeting attended by leaders and staff from all bases and divisions. During each meeting, one base presents on a safety topic, after which the other bases and stakeholders, including Air Methods representatives, discuss potential safety concerns. The meeting is one component of the company’s extensive internal safety program.
“With our size and volume, we did not want to strictly rely on our aviation operator’s safety structure,” Burley said. “We wanted to maintain our own safety management system internally and have that flow to Air Methods. It is important for us to have safety eyes in the bases and all operations daily.”
That commitment is evident throughout the organization’s safety culture. All employees are encouraged to speak up if there is even a hint of a safety concern.
In the field, pilots, paramedics, flight nurses, communicators, and mechanics strictly follow the company’s “four to go, one to say no” policy. The policy can apply to anything from flight safety concerns to fatigue.
“If one of us is just super tired after a long day of calls, the company can give us up to four hours of rest,” said Dee Dee Isom, certified flight paramedic at Base 3 in Huntington. “They’ll take the aircraft offline with no hassle. They want us to be safe.”
Due to the remoteness and challenging terrain throughout the region, HealthNet uses a network of helipads developed in partnership with the state when it is not possible to land directly at a scene. The helipads are equipped with lighting and windsocks and are located along interstate highways.
“We have some areas that are so remote and rugged, it’s just not safe to land at a scene,” Burley said. “By pre-positioning these helipads in strategic locations, the ambulance can get to the patient and bring them safely to the helicopter pretty quickly.”
With its single-pilot IFR fleet, HealthNet operates six GPS IFR approaches into its helipads, with additional approaches in development. The organization is also working with the Federal Aviation Administration (FAA) to develop low-level IFR routes across the state and install remote weather cameras, Burley said.
What’s more, HealthNet was the first operator east of the Mississippi River to receive FAA approval to use night vision goggles (NVGs) all the way to the ground. With NVG-compatible lighting throughout both the flight deck and cabin, the entire flight crew can participate in outside visual situational awareness during approaches and departures.
“Some of the places we fly to, it is so dark, especially if there is no moon,” said Perry Ward, HealthNet pilot at Base 3 in Huntington. “You just have to have NVG. Even with your searchlight, you’re not seeing everything because you’re putting the light in one place. With NVG, we can watch out for the wires and see the terrain all around us. It’s much safer.”
HealthNet’s newly acquired aircraft add another level of safety through a four-axis autopilot, Airbus’ Helionix glass cockpit system, and more powerful Pratt & Whitney PW206B3 engines.
The new aircraft also feature additional side and tail LED lighting to better illuminate work areas for clinicians, as well as cameras that provide pilots with enhanced visibility of crew activity around the aircraft during loading and unloading operations.
“We are very proud of the fact we’ve flown more than 120,000 patients and never had an accident,” Burley said. “Our board has complete buy-in on helping us continuously increase safety.”
That said, HealthNet does have one National Transportation Safety Board (NTSB) investigation on its record. During one flight, a sliding door detached from the aircraft and landed in a dense forest. The aircraft landed safely, and there were no injuries. The NTSB determined the door had not been properly secured.
New procedures were developed, and every member of every flight team received additional training. At the conclusion of the investigation, Burley requested the door back from the NTSB as a reminder.
“I bring this with me when I meet flight team members on the first hour of their first day, telling them the story of the one moment of inattention that led to this door exiting the aircraft,” he said. “We are not immune just because we have this wonderful history of safety. There is no room for complacency, and I use this to remind them safety is everyone’s responsibility at all times.”