When the U.S. confirmed its first case of the novel coronavirus on Jan. 21, 2020, helicopter emergency medical service (HEMS) operators around the country quickly ramped up safety procedures to protect pilots and crews while continuing services.
Most HEMS providers already have procedures in place for transporting infectious patients, but the difference between those transports and COVID-19 transports are the frequency of occurrence, according to Ben Clayton, chief safety officer at Life Flight Network.
“You might fly for years and have one measles patient where you have to do this procedure, [and] now we’re all doing a lot more of them; so the procedures that we’re following are the same, it’s just that we’re doing it much more frequently than we historically would have,” explained Clayton, who was one of three panelists speaking in a Covid-19 webinar on pilot safety hosted by the Association of Air Medical Services (AAMS) on April 28.
Life Flight Network, which operates a fleet of 45 aircraft, focused on three main steps to prepare for the virus outbreak and ensure pilot safety. The first was having adequate personal protective equipment (PPE), including N95 masks, gloves, gowns and eye protection; next was implementing refresher training for pilots on how to properly wear PPE; and third was tracking patients for Covid and ensuring crew member safety and awareness in the case of virus exposure.
“Pilots don’t necessarily focus on PPE generally . . . so that’s something that we wanted to do refresher training on,” said Clayton. “Initially pilots would say, ‘My glasses fog up when I wear my N95.’ Well that’s obviously an issue with how they have their N95 on, or maybe it’s not fit quite correctly. So that’s something that we wanted to look at.”
When pilots know how to properly don an N95 mask, it eliminates risks of mask failure, especially with flight helmet use.
Life Flight Network also worked quickly to build a dashboard that allowed the company to track PPE levels at all the bases. A second dashboard tracks patients and the crew members involved in each patient transport, as well as what PPE they used on the transport. “That way, if [a crew member] is exposed we can quickly notify them,” said Clayton.
Also on the pilot safety webinar panel was Rick Ruff, director of operations at Boston MedFlight. To date, MedFlight has done more than 320 Covid transports — 95 percent used the company’s critical care ground vehicles, and five percent were done by helicopter, said Ruff.
In addition to using tracking methods to remain aware of pilot and crew exposure to the virus, Ruff said MedFlight had to “tighten up” its N95 fit testing and PPE training and policies for pilots when the outbreak began. When it comes to reviewing donning and doffing procedures for PPE with pilots, “our best resources are our medical crews,” said Ruff.
The company also developed “Covid checklists” that are available to pilots in the aircraft as a refresher for each transport.
MedFlight operates four Airbus H145 aircraft and an EC145 as a backup. Ruff said initially, the company would only transport Covid patients if the flight could be completed without the use of the environmental control unit (ECU) in the aircraft. “Fortunately, our director of maintenance worked with the FAA and Airbus to create a method to use HEPA [high-efficiency particulate air] filtration on our H145 and EC145 ECU systems to protect the pilots and crew from the recirculating air in that ECU system,” he added.
MedFlight is also restricting patient-pilot contact during loading procedures, and has restricted its pilots from accessing medical care facilities during transports. “In the past, [pilots] would typically go in to assist the crews with bags and stretcher [decontamination] and do their flight planning. We now restrict them from going into any of the hospitals,” said Ruff.
Casey LeBrun from Metro Aviation, Inc., said Metro has taken a similar approach with its pilots in terms of restricting their access to hospitals and separating them from the patients. After med crews have been in contact with an infected patient, they are considered “contaminated,” and will then separate themselves from the pilots as well, said LeBrun.
“By that I mean [the med crews will] fly in the back of the aircraft until they get back to base and everything is decontaminated,” he added. “The med crew [decontaminates] the rear of the aircraft, and the pilot takes care of the front. . . . They change their clothes, if needed, and we’re ready to fly again.”
When coronavirus initially spread to the U.S., Metro halted all Covid patient hauling “until we knew more about it,” said LeBrun. “Once [Metro] met with their panel and met with the customers and decided that it was safe to do [Covid transports], and [once] the pilots had been trained and fit tested on the use of proper PPE, then we started slowly working our way into following the CDC guidelines and allowing [the] transfer of Covid patients.”
Metro, as well as MedFlight and Life Flight, is using barriers in some of its aircraft that were initially installed as part of a night vision goggle (NVG) supplemental type certificate to block light, but also work to block air circulation from the cabin to the cockpit. In Metro’s Bell 407, Airbus EC130 and AS350 aircraft where there is no barrier and pilots are more exposed to patients, LeBrun said the pilots are required to wear gowns in addition to other appropriate PPE.
LeBrun said since Covid-19 began to spread in the U.S., the overall flight volume with Metro has decreased. This means pilot fatigue has not been a major concern.
Life Flight Network’s Clayton agreed, saying, “Fatigue hasn’t been a huge issue. We’ve been focusing on trying to keep stress levels down more than the fatigue.”
MedFlight’s Ruff said the company has ramped up its tracking to make sure “one specific crew is not getting hit more than other crews,” and has also ramped up its ground vehicles, which transport the majority of Covid-19 patients.
