If someone is in a serious accident or experiencing a life-threatening emergency in West Virginia, there’s a strong chance responding emergency medical technicians (EMTs) will call a HealthNet Aeromedical Services helicopter for patient transport.
“What the EMTs don’t do is call for a helicopter and say, ‘Make sure there’s a well-trained crew onboard to handle this emergency,’” said HealthNet vice president and chief operating officer Nick Cooper. “They expect the best of the best to step out of the helicopter ready for anything and immediately provide life-saving care. We make sure every one of our clinicians is trained to meet that [expectation].”
Due to the rugged, rural nature of West Virginia — and the distance much of the state lies from Level I and Level II trauma centers — HealthNet’s Airbus H135 and H145 helicopters are, in essence, fully equipped flying emergency rooms. The certified flight paramedics and certified flight registered nurses onboard are, in many ways, trained even more extensively than their emergency room counterparts, enabling them to deliver a wide range of critical care.
HealthNet Flight Academy
To ensure the level of training and skill required to bring an emergency room to a patient more than an hour’s flight from a trauma or specialty hospital, HealthNet requires job applicants to have at least three years of high-volume emergency room, adult critical care, and/or 911 provider experience, along with a long list of state, national, and specialty certifications.
“We place some very high expectations on our clinicians, and we realized that in order to do that well, we have to provide a structured orientation process that helps them meet those expectations and become familiar with our operation,” Cooper said.
The result is HealthNet’s internal flight academy — a rigorous, mandatory 10-week training program designed to prepare every new clinician hire for whatever they may encounter in the field.
The academy was developed around two primary training goals. The first is to ensure new hires are current and familiar with the most common emergencies HealthNet encounters, as well as its policies and procedures for responding to those events medically. The second is to train new team members to perform their jobs on a helicopter.
“Everyone always has some skills they’re very strong in and some where they need support to get up to expectation,” Cooper explained. “This program allows us to work with them individually, identify where they need additional support, and provide it. Also, we have a very specific mentality here and the academy allows us to determine, regardless of a candidate’s experience, if they’re going to fit into our system, work well with our medical director, and be complementary to how we operate.”
Almost every new clinician at HealthNet is hired on a part-time basis, typically maintaining a full-time job in an emergency room or on an ambulance while picking up shifts on the helicopter as they build seniority. The academy is designed to accommodate that schedule. New team members converge weekly at HealthNet’s headquarters in Charleston, West Virginia, for one eight-hour training session. Each week focuses in depth on a different topic, with time split between classroom instruction and hands-on training in one of HealthNet’s simulation rooms.
As Cooper explained, “[On] a typical training day, we’ll be in the classroom for a few hours going over the topic of the day — for instance, respiratory emergencies. We won’t cover every [condition] in the book, but we do discuss the vast majority of respiratory emergencies we’re typically faced with in the field. We talk about our guidelines, and our medical director talks about what’s expected in certain situations.
“Once we’ve covered the material, we break them into groups and rotate through the sim rooms and simulate the respiratory emergencies,” he added. “We try to get them uncomfortable, throw things at them out of left field to see how they respond when adversity hits, and help them build on their skills.”
HealthNet’s simulation rooms replicate an adult emergency room, pediatric emergency room, emergency obstetrics, and emergency neonatal care. Each space is equipped like its real-world counterpart, complete with equipment, gurneys, training mannequins, and even brightly painted walls in the pediatric room.
“These rooms are designed to look like the ER [environments] they represent, helping put clinicians in the mindset for working with patients,” explained HealthNet president and CEO Clinton Burley. “By training in a tactile environment, people are more effectively prepared for the environment they’re going to experience.”
The academy also includes a helicopter simulator. HealthNet acquired a BK117 helicopter fuselage, painted it in HealthNet livery, installed a fully functional medical interior, and added elements to simulate flight, including speakers that emit engine noise, radio calls, and pilot communications, as well as computer screens mounted in the windows to display what clinicians would see during flight.
Located in the training center’s garage, where the floor is painted white with a red “H” and ceiling lights hang in an “X” over the aircraft like rotor blades, the helicopter simulator is the crown jewel of the flight academy. It allows clinicians to practice everything associated with working around and onboard the aircraft, from safe movement near the helicopter and proper door operation to assisting the pilot, loading and unloading patients, and providing care in flight. In-flight emergencies are also simulated using cabin-based smoke generators.
The simulated “hangar” also includes areas for clinicians to practice restocking supplies, as well as a refrigerator where they can simulate retrieving blood, plasma, and temperature-sensitive medications to load into portable coolers for flight.
“In training, we hit the big-ticket items — respiratory, cardiac, and trauma — early on, then hit on them continuously through the rest of the program as we cover other topics, bringing clinicians into the helicopter simulator to put it all together,” Cooper said.
Flight training
In addition to eight hours of classroom and simulator training each week, academy students must also work either a 12- or 24-hour shift weekly, as their schedules allow. During these shifts, they are paired with an onboard clinician who serves as their field training officer (FTO). When not flying on calls to assist, new hires train with their FTOs on medical protocols and HealthNet procedures.
“We have a checklist for our FTOs of 53 categories that they mark throughout the trainee’s orientation,” Cooper said. “Each category has three stages as they build from proficiency to mastery. The categories you didn’t experience on a flight, you’ll discuss with your FTO and demonstrate mastery to be signed off. The FTO is the final step. When they’ve determined you’ve mastered all the categories, they’ll sign you off and you are no longer a third provider. You are assigned your own shifts.”
Certified to the hilt
Orientation is only one step in ensuring the best of the best step off the helicopter when called, Cooper said.
HealthNet’s flight paramedics and nurses must maintain an extensive portfolio of advanced clinical, trauma, pediatric, neonatal, and emergency-response credentials, along with ongoing state and federal training requirements. While some certifications may be completed after hire, clinicians are required to achieve and sustain their specialty flight credentials within two years.Each clinician on HealthNet’s helicopters trains for hundreds of hours each year to stay current.
“The training at HealthNet only begins with the flight academy,” Cooper said. “Our education teams help our clinicians maintain all these certifications through classroom, computer-based training, and hands-on practice throughout their careers here.”