Ask Us Anything About… Penn State Life Lion Critical Care Transport

Description – The video begins inside the helicopter (Life Lion) hanger where two individuals are standing next to a blue helicopter that say™s Penn State Health Milton S. Hershey Medical Center. The two individuals are looking at the camera. Standing from left to right is Joe Depatto, Flight Nurse, Penn State Life Lion Critical Care Transport and Scott Gilbert.

Scott Gilbert – Of course here at the Hershey campus and we’re going to show you this helicopter in some detail and we’re also going to talk about the people who staff this helicopter and who care for patients all across the region and beyond. So, let’s see a good place to start would be Joe. I mentioned that you are a flight paramedic, tell me about the people who staff this helicopter, three main positions on board I understand?

Joe Depatto – Yes, sir, so we have a pilot in charge, we have a flight nurse and a flight paramedic. We staff the helicopter 24 hours a day, 365 days a year.

Scott Gilbert – So, what do you do when you’re not flying and you’re here at the hangar?

Joe Depatto – So, we have additional responsibilities, we have a lot of continuing education that we have to maintain, we have hospital requirements, education requirements that we have to meet as well. So, if we’re not manning the helicopter, not eating breakfast, not eating lunch, we’re studying and getting our continuing education done.

Scott Gilbert – Now there are two main types of calls what we call scene response calls and also transports. Can you talk about kind of which is more common and what those make up?

Joe Depatto – Sure, so about 60% of our flights are inter-hospital flights so that means we’re picking up a patient from one hospital and taking them to another. Life Lion about 5% of those inter-hospital flights are actually taking patients to other hospitals so we don’t necessarily just bring patients back to Hershey Medical Center we’ll take them to Lehigh Valley, we’ll take them to York Hospital, we’ll take them to whatever tertiary care facility the referring institution is requesting. Then we have our scene flights that is making up about 40% of our flight volume to date. We’re finding that our scene volume is becoming a little bit less and our inter-hospital volume is picking up a little bit more. But most of the scene volume is traumatic related, it could be a fall, it could be a vehicle accident or it could be a medically related incident which somebody has a heart attack, a stroke and they need to get to tertiary or definitive care within a short amount of time period. And the best way to do that is in a straight line, avoiding any type of traffic using helicopter.

Scott Gilbert – So, I know it’s Life Lion before I even look up it’s because of that trademark sound that it makes. Why do we hear that high-pitched whistling sound, what is it about this helicopter and that sound that sets it apart from other aircraft?

Joe Depatto – So, what I want to do is I want to direct you towards the rear of the aircraft that is what we call the fenestron and what happens is that when that tail rotor spins at over 4,500 rpm’s it’s pulling air through that fenestron or that enclosed space and it’s creating that whistling sound and that whining sound that you’re going to hear that is so distinctive with the Dauphin helicopter.

Scott Gilbert – And that’s what’s we have here a Dauphin helicopter?

Joe Depatto – Yes, sir so this is a Dauphin AS365 Airbus for American Eurocopter Helicopter.

Scott Gilbert – Can we take a look inside?

Joe Depatto – Absolutely.

Scott Gilbert – Maybe starting with the spot where you take care of patients here in the back of the aircraft.

Joe Depatto – So, this is the interior of our aircraft. As you can see, it’s a pretty enclosed environment where you have to be kind of contortionist at times to be able to provide room for the number of people that we can carry in the back of the aircraft, not comfortable but pretty roomy when necessary. And back here, we carry all of the necessary equipment, if we need to bring additional equipment we can do that. We’ll secure it to the back wall or place it in different parts of the aircraft. So, here we have an artificial ventilator that helps breathe for the patients. We carry the tubing for the ventilator. In a compartment down here we carry our transport IV pumps, which we carry multiple IV pumps with us. On the litter here, we have a red blanket that we use to help thermoregulate the patient during cold weather. Now that we’re starting the transition out of the wintertime we’re still going to carry this with us just because it helps isolate the patient and keeps any contaminated fluids inside that area. We have a first response bag which is located right here that we take in on all scene and inter-hospital calls with us. Inside there, we have our advanced airway equipment, we have advanced cardiac medications in there, we have a bunch of other tools of the trade that we use to help stabilize patients. Next to us over here is another bag that we use to bring with us. In here we have additional equipment which specifically for Life Lion. We actually talk about bringing pointy care to the bedside, Point-of-Care is a specific type of blood testing device that Life Lion specifically carries that allows us to be able to look at different blood work and allows us to adjust the treatment that is already being done for the patient accordingly after we get these testing results. So, this is a pretty sophisticated piece of equipment that we bring along with us to the bedside. So, then inside here we have a bunch of different accouterments and attachments that helps us for inter-hospital calls specifically.

Scott Gilbert – Of course, you’re caring for some of the most critical patients and that involves some rather advanced procedures that we wouldn’t even think of happening in an ambulance let alone in a helicopter. Talk about some of the most advanced procedures that you can perform inside the aircraft.

Joe Depatto – So, some of the advanced procedures that we can do as pre-hospital providers, both health professional nurses and paramedics is, you know, surgical airways or chest needle decompressions which if somebody’s involved in a traumatic accident they have a broken rib or a collapsed lung we can place a needle into their chest to help reduce any pressure or tension that’s inside that chest cavity. We can also, you know, do a surgical airway if we need to, to help breathe for the patient which is becoming less and less common because we have other tools and other devices that allow us to help be able to manage those patients’ breathing for us.

Scott Gilbert – If you’re watching ask us anything about Life Lion. From Penn State Health, I’m Scott Gilbert along with Joe DePato, he is a flight paramedic here. He’s been with Life Lion for 1years so that’s why he knows his stuff so well here and we do welcome your questions for Joe about Life Lion. Just feel free to add them to the comment section below this Facebook post. And we do have a question here about when will a new helicopter be put in service.

Joe Depatto – So, some people have seen on our Facebook page we put some teaser photos out, we are actually in the process of securing a new helicopter, it’s going to be — it’s part of the Dauphin family for Airbus, it’s an EC155 and we’re hoping to have that in service flying patients in the region probably around July 1.

Scott Gilbert – And there are three helicopters in the fleet can you tell us a bit about where they’re stationed and the maintenance schedule and how there’s always one that’s kind of under review right?

Joe Depatto – Yeah, so right now we have two aircraft in service 24 hours a day, 7 days a week, 365 days a year. One is located here at Hershey Medical Center, the other one is located at Carlisle airport. We also have a third aircraft which serves as a backup or reserve aircraft that will get rotated into a main aircraft position whether at Hershey or Carlisle depending on the needs of the aircraft. So, every 10, 25, 50, 100, 200 hours and up to 600 hours these aircraft are inspected and parts are changed as needed depending on time of use or calendar time. And once we reach 600 hours of use then that aircraft has to be completely torn down, torn apart, inspected and have parts replaced as necessary. So, it’s crucial that we have a third helicopter that can be put in service in Carlisle or Hershey to back up any of those other aircraft that are there, to allow us to maintain the service that we provide 24 hours a day, 365 days a year from both bases without missing a beat. So, all of our aircraft are all instrument rated, two of them are M3 aircraft which allows a different electronic system in the aircraft which gives the aircraft a little bit more power. We have one that’s an Nit’s just — has a little bit less power, but it still performs in the same function as an N3. So, we’re very fortunate that all three of our aircraft are pretty similar so that we can continue to maintain our operations without skipping a beat.

Scott Gilbert – Sounds good. I’ll let you get out of the aircraft here and give you a little more breathing room and as I do so I’ll remind you that we welcome your questions whether you’re watching this video live or if you’re watching it on playback. If you’re watching on playback after the fact we can certainly get those questions to Joe and the rest of the crew here at Life Lion and get a good answer for you. I know that one question we hear sometimes is about what determines when it comes to a scene response who makes the call and how is it made as to whether or not the patient can be transported by ambulance versus by helicopter.

Joe Depatto – So, it’s a very good question. What happens is that we rely on our local 911 providers to be able to make the determination if a patient needs to be flown to a hospital and the critical nature of that patient needs tertiary or specialty care. So, if there’s a 911 activation for a local EMS provider and it sounds like this patient’s condition is time sensitive, they’ll arrive on scene, they’ll assess the patient and make a determination based upon what they’re seeing on the scene with the patient’s condition and then contact medical command, speak with medical command and between the two of them they’ll make the determination if an air medical resource is necessary. A lot of it varies depending on location. So, we don’t want to have somebody from Harrisburg City call a helicopter because somebody has a heart attack or stroke, they have appropriate resources that are right next to them in that city that can manage those patients very well. It’s for the patients who are in Juniata county, Perry County, that are in upper Dauphin County who have a greater than hour transport ground time that need to get to definitive care quickly to manage those patients. So, we’re thinking about those stroke patients because we know that stroke right now is brain, time is brain and the same with heart attacks, time is muscle, time is heart muscle. So, anytime we can compress those timeframes it increases the chance of patient survival from those unfortunate incidents.

Scott Gilbert – You mentioned a lot of people even though it may not look like it, a lot of people can fit back here. One question we just had online is how many patients can be transported at a time, that’s a question from Ann.

Joe Depatto – So, with our aircraft we’re very fortunate that we can transport two patients with minimal configuration time. With the helicopter that’s across the way being serviced and the other one that’s in Carlisle right now, we have a secondary litter base that’s in the aircraft so it has minimal reconfiguration time. We can, if we’re told by the on-scene providers that we need, they want to know if we can transport a second patient we can immediately pull out the seat that we have in place there, stow it in our cargo area, pull out the secondary litter and have it ready to go within minutes. This one just requires a little bit of reconfiguration, what you’re going to see here is you’re going to see these seat cushions come off, you’re going to see flaps open up, you’re going to see this bench lay down, and then we’re going to get a stretcher from the back of the aircraft that will be placed here, excuse me, for the patients to be secured on appropriately. So, with these aircraft, with the power that we have we are not limited by weight specifically to lift off the ground. So, some of our barriers that we have are the girth of a patient, so as long as a patient meets a certain girth size we are not limited as much by the weight and we don’t have to offload equipment, we’re just immediately going into reconfiguration mode and getting the patient set up, getting the aircraft set up to have two patients put in.

Scott Gilbert – Good question Ann and thank you for that and thank you for watching as we continue here with ask us anything about Life Lion. We’re learning all about Penn State Life Lion critical care transport which involves this helicopter right here and a couple other parts of the operation we’ll talk about shortly. But Joe, I’m wondering if you can show us the cockpit, the part where the pilot sits.

Joe Depatto – Yeah, absolutely. So, we’re just going kind of pan forward here, we’re going to go up to where the pilot sits, where the kind of rubber meets the road here. So, we’re going to briefly show you the interior of the cockpit at this point in time. Going to show you all the buttons that are in the cockpit, you can see the different gauges that are there, the different screens that are there, all things that the pilot has to rely on to be able to operate this aircraft smoothly and safely.

Scott Gilbert – There’s a comment from Lucy saying something very nice about how Life Lion is an amazing asset to our families and it’s such a — talking about life-saving heroics. I know you hear a lot of that, but I bet that never gets old, does it?

Joe Depatto – No it doesn’t, we really appreciate it. I mean, we like to be humble in hearing that stuff. We are here to serve a purpose, we’re here to serve the community, here to serve the patients and do what we can to help them in their time of need. So not only are we bringing world-class care to the bedside with Hershey Medical Center trained staff we’re also bringing humility along with us. And so, what we want to do is see those patients get stabilized and on the road to recovery and hopefully be able to see them come back here for a visit and, you know, we get to interact with them and hear their stories, hear their life stories, hear about how we made a difference in their lives.

Scott Gilbert – That’s great. As we talk about the cockpit and this aircraft as a whole, it has the ability to fly in some conditions that some other aircraft may not and that’s a lot because of the instrumentation, things like IFR and GPS. Can you talk a little more about what those things are and how they contribute to that?

Joe Depatto – Sure, so IFR which is called instrument flight rules that is at a point when we fly into the clouds only looking at the instruments. We are not flying visually or using visual references by the ground. Excuse me. So, what we’re doing is we’re looking at our altimeter, we’re looking at how our speeds, we’re looking at the direction of which we’re traveling by the vectors that are being given to us by air traffic control. So, it’s a whole completely different form of flying and our pilots train to do that and have been trained from their previous experience to fly by instrument and not by visual rules. So, every six months our pilots go through vigorous training to learn, to get certified in their ability to be able to fly by these instruments. So, it’s kind of a little bit of a complicated process in the fact that if we have low visibility weather and we have — it’s outside the ranges of what the FAA says that we can fly visually. So, if the minimums are too low to fly visually we’ll go on a call by call weather check. Then if a request comes in from a referring hospital or a scene the pilots will check the weather then they’ll determine yeah, I could do this. But if I have to fly by instruments I have to go to a specific location because I can only get into that location using GPS waypoints that are waypoints that are established in the sky by another company and they certify it to be safe for us to use to get down to an appropriate level, to be able to then visually see the ground then land the helicopter appropriately. If we’re not able to go to that location then we’re not going to be able to make that work.

Scott Gilbert – So, it ultimately is up to the pilot then whether or not to fly?

Joe Depatto – Yes, yes sir, so the pilot makes the ultimate decision, you know, that’s what they get paid the money to do and paid the money to make decisions to fly the helicopter in both good and bad weather conditions.

Scott Gilbert – Sounds good.

Scott Gilbert – We have a question from Ron, he’s wondering how big is the service area that Life Lion serves. I know I’ve seen some photos of Life Lion on hospitals well over state lines.

Joe Depatto – So, our service area is not really, it’s only limited by the distance of which we can fly. At certain times, we have to think about is it better and more efficient to fly the patient by rotor wing or is it better to go by fixed wing. So, once we get out about a little over an hour and 15, an hour-and-a-half flight distance time, then we got to look at rotor wing. So, an hour and 15 minutes to an hour-and-a-half that’ll get us up to Boston, that’ll get us down into the Carolinas, that’ll get us over into Virginia, beyond Pittsburgh out into Ohio. So, we’ve reached all those destinations, just last year alone we went to 80 different locations between Pennsylvania, New York, Maryland, Virginia, West Virginia, Ohio. So, we’re touching a lot of different places. Now, when we’re talking about scenes we’re restricted to the closest helicopter and that is determined by the local 911 communication center. The local 911 communication center will establish the areas of which all helicopters will respond to. So, in certain areas it may take us 10 to 15 minutes to get to a scene call, other areas we could be 1 to minutes away, depending on which aircraft is requested.

Scott Gilbert – Bryce is asking a bit about transports versus emergency calls. We talked about this a little bit earlier, we touched on briefly the fact that the number of transport calls or I should say the proportion is going up as compared to scene responses.

Joe Depatto – Yeah, so Bryce, that’s a good question and we get that question asked a lot. We typically do about 1,200 flights a year and about 60% of those are inter-hospital, the other 40% are scene calls. So, you know, it varies from year to year, but we’ve been pretty, we average about the 1,200-flight volume a year, so that stays pretty consistent.

Scott Gilbert – It’s about three or four a day?

Joe Depatto – Yeah, exactly.

Scott Gilbert – Between the two helicopters?

Joe Depatto – Yes, yep.

Scott Gilbert – You’re watching Ask Us Anything About Life Lion, from Penn State Health I’m Scott Gilbert along with Joe DePato, a flight paramedic here and we welcome your questions. Some great questions and comments so far so please do keep those coming. Part of Life Lion critical care transport that we don’t see out here in this particular garage is the ground unit. Can you tell us a little bit about that and obviously, we have a whole fleet of Life Lion EMS vehicles, but also a specialized ground unit that critical care transport staffs can you talk about that?

Joe Depatto – Yeah, so Life Lion division as it is breaks down into two different sections. So, we have the Life Lion 911 or Life Lion EMS then we have Life Lion critical care. Life Lion critical care consists of the helicopter and the critical care ground unit. The critical care ground unit is a ground transport truck that has all the capabilities of an aircraft and the same crew complement. So, you have a nurse, a paramedic, and an EMT who drives for us and also assists us with patient care. On those transports, we bring the same type of equipment and the same personnel for whatever is requested. But sometimes we can’t fly so we’ll send our critical care ground team. And sometimes with some locations it may be just as quick to send a ground ambulance versus sending the aircraft for some of the local hospitals. I’m sorry, excuse me. So, we have that service available. Then the Life Lion EMS, Life Lion EMS we have I believe 13 or 14 different 911 service trucks that are on the road on a daily basis between our Berks County units, our Lebanon County and Dauphin County units. They’re there serving the community in a 911 capacity and they’re also doing nonemergency transports as well. And they do several thousand calls a year. They’re a huge asset to the medical center and the Life Lion division. So, it makes, you know, we’re very unique in the fact that Life Lion itself having the 911 EMS component, the critical care ground component and the helicopter service it’s a very unique system where you don’t really see a system like this throughout the United States.

Scott Gilbert – I mean one of the risks of doing this live interview is the possibility that really at any minute we could hear tones and the aircraft will have to head on out of here and take off. So, Diane asked a good question that is about how quickly can the helicopter deploy. And I guess it all begins with this tractor pulling the aircraft out of the garage and getting the staff. And what does that involve?

Joe Depatto – So Diane, it’s a good question. So, what it does is once the tones are activated it sets in motion a lot of moving parts. It takes a whole complement of people to get the aircraft out in a timely fashion. So, everybody kind of assumes a role and a responsibility. One person will open up the door, another person will get on the tractor, and the other person will disconnect the electrical cord, secure up the aircraft. At the same time, everybody’s doing a walk around the aircraft, doing a pre-flight check to make sure that all doors are secured, everything’s locked, everything’s in place and making sure that the aircraft’s ready for flight. So, we like to have a response time from a stat response time for a scene call in six minutes or less. Inter-hospitals we require them to be off the ground anywhere between 10 and 12 minutes because we like to gather a little bit of information before we go on our inter-hospital call because we want to make sure that we’re going to bring the necessary equipment whether it’s a balloon pump or we’re going to need the Isolette, which we have an Isolette over on the other side of the hangar we can go take a look at. So, people can see when we talk about Isolette and we’re transporting those kids that are less than 10 pounds what are the specific type of devices that we use to carry those small kids from the referring hospital to the destination hospital.

Scott Gilbert – Yeah, let’s go take a look at that in just a moment here. First though one question about while you’re in the air how fast can the aircraft fly?

Joe Depatto – So, the aircraft will fly at about 150 knots depending on the wind, the prevailing winds at the time which come from the west to east. If we’re getting a little bit of a push there we can reach ground speeds up to about 200 miles an hour. But when we’re flying at about 150 knots we’re typically doing about 170 to 180-mile an hour ground speed.

Scott Gilbert – So, let’s go take a look at that Isolette if we could.

Joe Depatto – Yeah, absolutely.

Scott Gilbert – So, we’ll follow you.

Joe Depatto – So, make sure you guys watch the tow bar.

Scott Gilbert – Yeah. So, a lot of different litters it looks like over here, we see them all lined up. And I imagine you grab whichever one or ones you need for the particular call.

Joe Depatto – Based on the requirement based upon its setup, so this one, this Isolette specifically is set up for the aircraft. The reason being is it has a specific sled body to it which allows it to fit into the aircraft. So, with the Isolettes we have a specific monitoring device that is used for adults, pediatrics and neonates. We set it up specifically for neonates that allows us to do noninvasive cardiac monitoring, blood pressure monitoring, pulse oximetry and temperature monitoring. And then inside. So, we can kind of give you a little bit of a perspective on the inside and how small the environment is in the inside, including the small little stethoscope that is needed to be able to listen to their heart and lungs. But on the inside, this has its own internal temperature regulating device so we can warm the interior of that up to meet their specific body requirements and needs. And then at the same time, we can isolate them from the outside environment so we can keep them warm and then we can keep them secluded as well. We have specific restraining devices for the babies inside and then also we have a ventilator on here which allows us to breathe for them if need be. We have our IV transport pumps which our NICU specific. And this whole contraption itself, you know, just really it brings everything together for us to be able to go pick up those small kids.

Scott Gilbert – And I imagine you have a number of those calls given the level four, highest level NICU that we have at Penn State Health Children’s Hospital that’s probably a somewhat regular call for you?

Joe Depatto – So yeah, I would say probably about 5% of our total flight volume, transport volume in a year involves the neonates. We do see peaks and valleys with them depending on the time of year and month, so some months we’ll be really busy with them, other months we won’t be.

Scott Gilbert – You’re watching Ask Us Anything About Life Lion from Penn State Health, we’re talking all about Penn State Life Lion Critical Care Transport and how it saves precious time while also delivering specialized treatment to patients all across South-Central Pennsylvania and beyond. We have a question from Bryce here about requirements for a ride-along, we pretty much limit our passengers to patients, right?

Joe Depatto – So, not necessarily just patients so we have a pretty active ride-along program, but unfortunately, it’s been kind of reduced in the fact that it’s very limited in the people that we allow to do the ride-alongs. So, we only allow people who are employees of Penn State Health, people who are residents of the College of Medicine, nursing students and anyone who’s a firefighter or EMT who has gone through our landing zone training course. They have to have that specific training done before they can come onto the helicopter. We want to be able to give them awareness of what we encounter when we’re flying into a scene or into a hospital so that if they’re part of a fire department or an EMS provider that they know the dangers that will exist and the things that we’re looking for as we’re going into the scene.

Scott Gilbert – And the paramedics and flight nurses are trained to obviously handle a wide range of medical situations, but there are times as you mentioned before when maybe nurses, residence physicians who don’t normally fly in the helicopter may come along right?

Joe Depatto – Yeah, so what, you know, about 90% of the flights that we do we can do with a standard nurse paramedic configuration. The other 10% of the flight we augment the nurse paramedic configuration with a specialty care provider. So, we may bring a respiratory therapist along with us who will bring nitrate that will help assist with a patient with their breathing. We may bring respiratory along to help us manage these ventilators for the NICU kids who are intubated, who we don’t see a lot of. So, we see more pediatric patients who are ventilated, we see adult patients that are ventilated, but it’s the NICU kids who require a lot of that special fine-tuning treatment that we bring respiratory along with us, they’re a great asset for us. And then at times we’ll bring a nurse practitioner or fellow along from the NICU for those really challenging NICU patients that need further assessment, further care and increased management. So, we’ll get the guidance and direction of how to manage those patients from them while they’re at bedside with us. Then also with ECMO patients in which we’re bringing a heart and lung bypass to the bedside, if we’re going to do a cannulation bedside we’ll bring a CT surgeon with us and also a perfusionist. If the patient is already cannulated bedside and we’re bringing an ECMO patient back to Hershey Medical Center we’ll just bring a perfusionist along with us. So, with that we’re adding additional support to our crews, but the nurses and the paramedics at staff line have to know everything about those adult ECMO patients. They have to know how to manage any adult medicine ICU patient, any neuro ICU patient, a NICU patient, pediatric patient, the entire spectrum of patient care our providers need to know how to manage each and every one of those patients. We have

Scott Gilbert – Some fantastic thank yous coming in like I mentioned, some thank yous coming in from Kristin, Sherry, Lucy, Linda, a lot of people very thankful for the service that Life Lion provides here in central Pennsylvania. So, Joe, I could stand here and talk with you for about three more hours on Facebook, but I’ve got to let you get back to work and I want to thank you very much for your time today and ask you is there anything else we didn’t talk about that you want to tell folks?

Joe Depatto – No, I think we covered a great deal of things, but you know we’d love to get more into the helicopter operations. Next time we’ll try to bring a pilot involved to get them to really discuss the intricacies of what we do from the aviation standpoint and really what sets our program apart from a lot of other programs in the state and in the country in the fact that, you know, we’re our own part 135 certificate program where all the operations are maintained here at Hershey Medical Center. And we have contacts directly with FAA, so any decisions that are being made are being made right here at Hershey Medical Center which we’re very fortunate about, we’re very proud of the support that the dean and the health system gives us in being able to help treat and transport the patients of Pennsylvania and beyond. So, we just want to thank everybody for tuning in to be part of it and you know glad to always showcase what we do here at Life Lion and we’re very proud of what this program has done.

Scott Gilbert – Joe DePato of Penn State Life Lion Critical Care Transport. Thanks for your time today.

Joe Depatto – Thank you very much, we appreciate you guys coming over.

Scott Gilbert – Yeah, we appreciate all the great questions and comments during this. Thank you again for watching, ask us anything about Life Lion from Penn State Health.