Estimated reading time 19 minutes, 8 seconds.
For close to 50 years, Memorial Hermann Life Flight has provided critical care air medical transportation services for the greater Houston and Southeast Texas region.
Established to address the need for rapid response and specialized airborne emergency medical transport, Life Flight is the only non-profit hospital-based air ambulance program in the area, flying over 4,000 missions annually.
In the early 1970s, Dr. James “Red” Duke, a trauma surgeon and professor at the University of Texas Health Science Center at Houston, recognized the importance of providing immediate care to critically injured patients.
With the support of Hermann Hospital (as it was then known), Duke and his colleagues created Life Flight, a dedicated air medical service that launched in 1976, becoming one of the first civilian air ambulance services in the U.S.
Life Flight started with a single helicopter based at Hermann Hospital. The aircraft was equipped with advanced medical equipment and staffed by highly skilled flight nurses and paramedics.
To accommodate the growing demand for air medical services in the Houston area, Life Flight has since expanded its operations by acquiring additional helicopters and creating strategically positioned bases throughout the region.
In 1997, Hermann Hospital merged with the Memorial Healthcare System, forming the Memorial Hermann Health System. Today, Life Flight has become an integral part of this integrated healthcare system, providing everything from critical care trauma flights to interfacility transfers between hospitals, as well as numerous other types of specialty care medical flights.
Life Flight operates a fleet of highly equipped Airbus EC145 instrument flight rules (IFR)-capable helicopters from the John Dunn Heliport, which covers 150 miles (240 kilometers) around the hospital. Within this area are five additional remote bases that provide swifter response to outlying areas.
Outside of the normal 150-mi (240-km) radius, Life Flight also provides requested support on a case-by-case basis as approved by the director of flight operations. The company also owns fixed-wing aircraft to provide patient transportation to any location around the world.
Beyond the Level 1 trauma center downtown, Memorial Hermann also has numerous acute care hospitals spread throughout the Houston area, all of which have a helipad and IFR approach to receive patients.
Life Flight selected the EC145s for its power and payload, making it capable of transporting patients, as well as the medical team and medical equipment. Each helicopter flies with a critical care flight nurse, flight paramedic, and if required, specialized physician from the hospital.
Along with being IFR-capable, Life Flight’s single-pilot twin-engine EC145s are equipped with night vision goggles (NVGs), advanced avionics, and navigation systems, including NEXRAD satellite weather radar, GPS, and collision avoidance systems to ensure safe and efficient flight operations.
Specifically designed for air medical operations, the EC145s carry advanced and specialized medical equipment, such as cardiac monitors, portable handheld ultrasounds, ventilators, defibrillators, extracorporeal membrane oxygenation (ECMO) machines, intra-aortic balloon pumps, specialized refrigerators for blood products, and other essential tools.
Because of the aircraft’s IFR capability, Life Fight can still serve the community when weather may restrict visual flight rules (VFR) operations. This emphasizes the need to hire pilots with extensive flying experience.
Life Flight requires pilots have a minimum of 3,000 hours as pilot-in-command, as well as experience flying day and night missions and IFR operations.
“Within the helicopter industry, there are not a lot of pilots with heavy IFR experience,” said Tom Ames, lead check airman and lead flight instructor for Life Flight. “Most of the jobs out there only require pilots to fly VFR, and the ones that are IFR qualified tend to stay [where they are].”
This makes it difficult to find IFR pilots with hours of flight experience and who are interested in relocating to Houston.
“That being said, we have been fortunate over the years through networking and word of mouth to have been able to hire very qualified pilots,” Ames said.
While Life flight doesn’t have a formal pilot training school, it has developed its own in-house training standards for flying the EC145 for air ambulance operations.
“Any new pilot hired by Life Fight will start with academics and daytime flying,” Ames said. This is followed by IFR day flying and then IFR night flying.
During the two-month program, new pilots will rotate between instructors to expose them to different techniques. They’re also expected to show proficiency in specific tasks before moving to the next phase of training.
“We do have certain formal standards, but this job is experience-based so each pilot will find out what works for them by working with different people throughout their training,” Ames said. “You can’t duplicate a single flight in air ambulance. Every flight is different, so we try to expose them to as much as we can over the two-month period.”
This includes various patient scenarios, weather conditions, and day and night operations. Pilots also receive full-motion EC145 flight simulator training in Shreveport, Louisiana.
“What we do here is some of the highest level of aviation flying. Patients’ lives are at stake,” Ames said. “Our training isn’t easy, but it is necessary. I am proud to say that because of our high standards, almost all the pilots we hire end up making it all the way through the program.”
Flight nurses and paramedics
Tony Herrera, a flight nurse and clinical coordinator, facilitates the training and onboarding of new medical crew members.
“We are constantly updating the guidelines that we all work from,” Herrera said. “That requires a lot of coordination with different hospital physicians to ensure that what we are doing for our patients in the air is based on evidence-based practice being done in the medical community.”
Life Flight conducts monthly flight review meetings to discuss the outcomes of specific case studies and identify lessons learned. Because Life Flight treats all types of patients — from premature infants to geriatric patients — and every type of medical condition, it’s important for the flight medical crew to work with specialty teams across the hospital system.
“We have to be familiar with all the specialists and their teams. That’s part of the process of just keeping our staff up to date,” Herrera said. This includes staying up to date with current federal medical guidelines. “Our job is to provide the patient with ICU level care the minute we make contact in the field, and we must make sure that what we are doing in the air is the same as what they’re going to do in the ICU.”
For flight paramedic CJ Saunders and flight nurse Kristi King, this concept is understood well. Both work out of East Base at the Baytown Airport, roughly 35 mi (56 km) from the Memorial Hermann Medical Center downtown.
All flight nurses and flight paramedics at Life Fight are required to be dual certified with both credentials. Potential applicants that make it past the screening process at Life Flight are invited to a didactic interview where they undergo scenario-based drills, a written exam and a panel interview.
“Finally, if you are hired, there’s an orientation process,” King said, which can last about three months depending on previous experience.
In addition to acquiring flight credentials, the medical crew is also required to obtain specialty medical training certifications as well.
“Most of those we’ve already acquired being in some kind of firefighting/paramedic job apart from the certified flight paramedic certification,” Saunders said.
Once the crew get in the air, King said it’s hard to tell the difference between the flight nurse and flight paramedic.
“Because we are affiliated with a hospital system, we are trained to the same incredibly high standards,” King said. “In fact, many times we are doing more treatments based on our approved guidelines than most nurse practitioners or paramedics are doing in a hospital, which is a testament to the level of training we receive while with the company.”
East Base typically sees an average of 75 to 85 flights a month, ranging across a spectrum of call types.
“We do fly a lot of stroke and cardiac patients because our location is more rural,” King said. “And we fly farther out east into even more rural areas that may not have the types of medical facilities to treat a stroke patient or critical heart attack.”
Saunders added trauma calls like vehicle accidents to the list of call types the East Base sees often, making a helicopter a vital tool in rural areas compared to ground ambulances.
“Our flight time is usually in the minutes,” Saunders said. “Plus, having the only Level 1 trauma center with a helipad in Houston, our response time to getting a critical patient to the hospital is very fast.”
Tactical mission support
Life Flight also has a team of special operations nurses and paramedics, providing tactical medical support to local Houston Police SWAT teams, several Federal Special Response Teams, Customs and Border Patrol, Texas Marine and Air Divisions and other law enforcement organizations.
This support is called Operational Medicine and consists of members who are selected and trained in tactical medical support, as well as cross trained to go on boats with federal response teams that do interdictions on the water. Operational Medicine teams also cover natural disaster response.
“Team members are selected based on experience and demonstrated clinical skills from their time working within the company,” said George Tarver, senior flight paramedic and operational medicine team leader. “A lot of the team members have backgrounds in military medicine and heavy tactical medical experience.”
A typical Operational Medicine call will see two crew members head to the scene in one of the company’s Chevy Suburban vehicles.
“Everything that we carry on the aircraft that’s related to trauma, we carry in our Life Flight Suburban as well,” Tarver said. “Once we arrive, we are given details of the operation and then our team will set up to provide care in what we call the ‘warm zone.’”
When an officer goes down, they are brought to the warm zone — an area that’s a safe distance from the active incident — to receive care from the Operational Medicine crew. A Life Flight helicopter is also on standby to transport the officer to the trauma center.
“This is one of the few civilian programs in the country that offers this type of
operational tactical medicine outside of dedicated law enforcement or fire
departments,” Tarver said.
Saving dogs that save lives
For many years, tactical medics have been treating dogs in the military. But before Life Flight, there hadn’t been a program that did the same in the civilian sector.
Typically, when a law enforcement dog is injured in the field, they would be transported to a veterinarian in the back of a police vehicle — many would die before making it there.
Noticing this trend, Duke had wanted to create a program to help injured K-9 dogs have a better chance of survival. After Duke passed away in 2015, Life Flight honored his wishes and began the process of creating such a program.
In 2020, Life Flight launched K-9 Casualty Care Course, the first non-government air ambulance service in the nation to provide training, treatment and transportation for injured K-9 dogs through established protocols.
The program’s education course is offered to K-9 handlers, or law enforcement, fire and emergency medical services (EMS) agencies that have an existing K-9 program or are interested in starting one. K-9 handlers undergo specific in-the-field emergency care training for their K-9s, including wound packing, poison control, CPR and tourniquet use. Each handler receives a K-9 specific individualized first aid kit (IFAK) to help them carry out those procedures.
“We built the program off of military K-9 protocols and applied it into the civilian law enforcement, fire, and EMS sectors,” Tarver said. “Then we mirrored the K-9 air transport program after what we have been doing for humans for almost 50 years.”
He said the program was developed in two phases, starting with the education component for K-9 handlers followed by the air transport component.
He said surprisingly, critical care for humans and dogs is similar, and the company has been able to make the program accessible for people of all skill and knowledge levels. Life Flight offered its first hands-on class in 2017 to a law enforcement agency in Houston before officially launching the air transport program in 2020.
Today, all Life Flight crew members are trained in K-9 medicine, undergoing K-9 clinicals before they’re able to treat and transport K-9s in the aircraft.
“Since 2020, we have transported two K-9s locally and taught over 1,300 people the K-9 Casualty Care Course, which to my knowledge has led to five known K-9 lives saved across the country,” Tarver said. “Our founder wanted us to take care of dogs the same way we take care of people. These animals serve our communities, so it’s the moral thing to do for our K-9 officers.”
Other specialty programs
Life Flight has also created numerous other specialty programs that are taught in-house to EMS agencies, advanced practice providers, nurse practitioners, doctors, and physician assistants. Once such program is the Cadaver Lab, which is used to help train and practice high-risk skills.
“People from all over the world come to take these labs because we’re able to use donated cadavers to teach high-risk skills and demonstrate techniques on injuries that are rarely seen outside of combat scenarios,” said Joel Benavidid, flight paramedic and clinical educator. “A course like this has never been done anywhere else. It has been very successful to the point where we probably have done well over a thousand labs.”
The program is offered to agencies outside of the organization, as Benavidid said the goal of the teaching labs is “to make everyone better at saving lives, which ultimately is everyone’s reason for being in the field.”
Life Flight continues to play a vital role in the Houston and Southeast Texas region, providing a crucial link in the EMS chain. By providing rapid response via helicopter and expert inflight medical care for critically ill or injured patients, Life Flight ensures patients receive the fastest and best possible treatment, which leads to countless lives being saved.
“Everybody is extremely passionate about their jobs, about continuing education, all toward the goal of improving patient outcomes and saving lives,” Tarver said. “Where it started was with Duke’s passion. All of us share that passion, and honor his legacy today through the work we do at Life Flight.”