How SAR operators are carrying out hoist missions during the Covid-19 pandemic

Avatar for Dayna FedyBy Dayna Fedy | April 23, 2020

Estimated reading time 9 minutes, 31 seconds.

Helicopter search-and-rescue (SAR) operations, particularly hoist extractions, have been ongoing throughout the current pandemic; while hoisting infectious patients is not a new occurrence, the virus that causes Covid-19 presents new risks and challenges to crews.

Vertical spoke with Dustin Skarra, operations manager at Priority 1 Air Rescue, in a live interview on the @verticalmag Instagram to learn about how the service is responding to suspected coronavirus cases in the Gulf of Mexico.

Shown is an actual case of Priority 1 crews hoisting a possible Covid patient — taken from the rescue swimmer’s GoPro camera. The hoist operator brings the rescue swimmer back into the cabin, while the flight paramedic treats the patient. Priority 1 Air Rescue Photo

For the last 10 years, Priority 1 Air Rescue has been providing medevac and search-and-rescue services to the oil-and-gas industry, specifically in the Gulf of Mexico. While Priority 1 crews try to land the helicopter for a rescue mission when possible, hoist extraction is sometimes inevitable. Skarra said in the current Covid-19 crisis, which has brought on new risks for SAR crews, the company is working with its medical director to ensure it is deploying the current CDC guidelines.

“If we’re transporting a patient — and this would go for patients that maybe have other disease processes [such as] measles, influenza B, or meningitis, which are also either droplet or airborne — we minimize droplet production,” said Skarra. “We put a mask on our patient, and currently we’re able to use N95s, and that almost completely eliminates any droplet production in the cabin.”

Along with the crew, the patient is provided with other personal protective equipment (PPE) such as gloves and goggles. “If they don’t have difficulty breathing, we limit our interventions . . . [and] we limit talking because we are in a closed environment — even though we are flying on an AW139, which is a pretty good-sized aircraft,” he added.

Mitigating risks during hoist operations is a bit trickier. Skarra said the flight crew is typically aware if a mission requires hoisting when they receive the call. They are also made aware, by a medic on an oil rig or vessel, if the patient is symptomatic or asymptomatic prior to launch.

The hoist mission is carried out normally in regard to the insertion of the rear crew, which consists of a paramedic, a rescue swimmer EMT, and a hoist operator who is also an EMT. Deploying PPE overtop regular equipment such as a flight suit or lifting harness presents challenges, said Skarra. Instead, the crew deploy their PPE once they are hoisted down to the working environment, and prior to making contact with the patient.

Priority 1 Air Rescue is also using a single extraction method for hoist operations to further mitigate risks.

“We’re only extracting one person at a time,” said Skarra. “So, we will first extract our paramedic and get him into the cabin. Once we get our paramedic into the cabin, he’ll make sure that he has the appropriate PPE on. The next person that we will pick up will be the patient, and currently we use a device called the AVED [Ambulatory Victim Extrication Device] if they’re ambulatory.

“When the patient is being extracted, along with your standard safety gear (helmet, goggles), they’ll also have gloves on, and they’ll also have an N95 mask on because you’re going to have very close contact with the [hoist operator] when they’re bringing them in.

“[Then] the paramedic will take over . . . they can buckle the patient in, and our hoist operator EMT can go back to extracting our rescue swimmer and the medical gear.”

Priorty 1 Air Rescue and Era Helicopters have produced a search-and-rescue program in partnership, which utilizes Era’s AW139 helicopters. Dan Megna Photo

If the patient is non-ambulatory, Priority 1 uses its PEP Bag “that can actually encapsulate and close the patient off,” added Skarra. “And so that offers some protection for droplet production.”

For Priority 1, the Covid-19 crisis has not caused a slowdown in SAR and medevac operations. Skarra said the company has recently seen an uptick in medevac patient transports in the Gulf of Mexico, refencing a 14-day period where approximately 22 patient transports were completed.

The same goes for many other SAR operators in offshore environments, where hoist operations are performed frequently. According to Francois Lassale, chief operating officer at HeliOffshore, many of the company’s members that are involved in SAR are reporting that they’re performing hoist operations on a “daily basis.”

HeliOffshore’s main goal is to bring the global helicopter industry together to collaborate on enhancing safety. During the current crisis, the company is encouraging its members to collaborate on how to best manage the pandemic, while supporting the essential offshore industry, in the safest possible way.

“These crews in search-and-rescue are used to dealing with these situations,” said Lassale. “That’s what they are designed to do and that’s what they’ve trained for. But the collaboration is really, really important right now because we’re all sharing the same moral imperative, which is to preserve safe flight.”

He added: “What we’re doing is we’re getting all the stakeholder groups together; so it’s not just working with the SAR group, it’s also working with the helicopter operators who transport people on and offshore, the oil companies who are customers of theirs, the regulators . . . and the manufacturers. We bring them all together.”

The company has achieved this collaboration through its own portal, where these various groups are able to share procedures, risk analyses, hoist practices, clinical guidelines, etc.

Lassale said some of its members are using contained EpiShuttle units, manufactured by EpiGuard, to hoist and transport Covid-19 patients. The shuttles eliminate the spread of droplets and prevent the aircraft from becoming contaminated. Since not every operator has these units, many are using the recommended PPE such as N95 masks.

When wearing a mask, “there are complications with speaking out of the [aircraft] window in the downwash and out of the door — the noise on the microphone and the feedback,” said Lassale. “So [some operators] are looking at using more rigid solutions where there’s a built-in microphone. There’s a lot of really good stuff that’s being shared on our platform.”

Pictured is HeliOffshore member Cougar Helicopters during a hoist mission with an S-92. HeliOffshore has 50 operator members, though not all of them do search-and-rescue. Many of HeliOffshore’s SAR members have been performing hoist missions on a “daily basis” through the Covid-19 pandemic. Cougar Helicopters Photo

One other challenge with the downwash during hoist operations, Lassale said, is that it creates more air circulation through the cabin while the door is open, and increases the potential for contamination. But since contamination is an overall risk when transporting infectious patients, the aircraft decontamination process is key. Each of the major aircraft OEMs have produced cleaning guidelines for the different airframe types, outlining what particular materials and chemicals can be used that won’t negatively affect the aircraft and its components, Lassale said.

“And what we’ve done is we’ve collected all that information in our singular portal where [the operators] can go and extract that information,” he said. “We did that right at the beginning of all of this. . . . Some of the things that may change a little bit is the downtime of the aircraft in between cycles of flights because there’s drying that needs to take place.

“But the decontamination [of aircraft] is the same for search-and-rescue as it is for any other operation.”

The Covid situation is continually evolving, and so are the practices and procedures of SAR operators who aim to conduct operations as safely as possible while still being efficient.

“The way [the SAR crews] fly and operate is different to the majority of the other operators who fly passengers to-and-from,” said Lassale. “They have a different set of risk levels, and they train tirelessly towards providing a good search-and-rescue platform. And again, it’s the goal of keeping everybody safe.

“So for them, this is business as usual. It’s a pandemic, yes. It’s not the first pandemic we’ve had . . . but the SAR crews are very familiar with this and having to do this.”

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