Landing Zone Operations

1. Landing Zone Operations

2. Course Purpose The purpose of this presentation is to provide you with information to properly, safely and efficiently select a site for a remote landing zone, perform reconnaissance of that site, properly identify and secure the site and communicate with the flight team to provide for a safe landing and takeoff. This presentation is NOT intended to replace formal classroom training by qualified personnel. It should simply be used as a guide to orient new personnel or refresh existing personnel on Landing Zone Safety. Local protocols should always be followed. If you have any questions please contact our program at: (856) 325-4880 Please utilize this information to educate personnel in your department.

3. About The Aircraft: Sikorsky S-76B Aircraft is piloted by 2 State Police pilots Crewed by 2 medical personnel Can hold 2 patients (conditions permitting)

4. What area does Southstar cover? SouthSTAR’s primary coverage area is from Interstate 195 south to Cape May point. Should NorthSTAR, our sister ship, require that we assist in the northern area of the state we will respond there as well.

5. The most critical part of our entire mission are the landing and take-offs we perform at remote landing zones. There comes a point in which we rely HEAVILY on the ground team ( YOU) to properly select, establish and secure our landing zones for the safety and benefit of all involved. This is a duty not to be taken lightly or handled complacently. The dedication and professionalism of the ground team leads us to be one of the SAFEST air medical programs in THE NATION. YOUare the first link in conducting a safe medevac operation by establishing a SAFE landing zone.

6. PATIENT CRITERIA Step 1: Physiology Adult Trauma Triage Guidelines • Glasgow Coma Scale +/- 12 • or AVPU = P or U • Systolic BP <90 • Pulse 60/min or >130/min • Respiration ,<10min or >29/min YES To Trauma Center with ALS (if Available) Source: http://www.state.nj.us/health/ems/guideline.shtml

7. Adult Trauma Triage Guidelines Step 2: Anatomy • Penetrating Injuries • Gunshot Wounds • Stab Wounds to Head, Neck, Torso, Extremities (above the elbow and knee) • Flail Chest • Fractures - More Than One • Fracture InvolvingHumerus and/or Femur • Paralysis or Evidence of a Spinal Cord Injury • Amputation Above Wrist or Ankle • Burns When Combined with Other Major Injuries • High Voltage Electrical Injury • Pelvic Fractures YES To Trauma Center with ALS (if Available) Source: http://www.state.nj.us/health/ems/guideline.shtml

8. Adult Trauma Triage Guidelines Step 3: MECHANISM OF INJURY(Required Consult with Medical Command, when Available) • Ejection from Motor Vehicle • Extrication > 20 min with an injury • Falls > 20 feet • Unrestrained Passenger in Vehicle Roll Over • Pedestrian, Motorcyclist or PedalcyclistThrown or Run Over YES To Trauma Center with ALS (if Available) Source: http://www.state.nj.us/health/ems/guideline.shtml

9. Fly or Drive ? Fly or Drive? When Making an Informed Decision Consider the Following: • Ground travel time to the nearest trauma center(e.g., distance, traffic congestion) • The helicopter's estimated time of arrival (ETA), the transfer time, and flight time to the trauma center • Whether multiple patients are involved Source: http://www.state.nj.us/health/ems/fly_drive.shtml

10. Fly or Drive ? Fly or Drive? Guidelines • Ground transport should be used for an un-entrapped patient who is within 20 minutes ground travel time from a trauma center. • Entrapped patients are an exception to the 20-minute rule, if the helicopter can reach the scene while the patient is being rescued or extricated. • The helicopter should generally be called to a scene which is more than 30 minutes by ground from a trauma center. Source: http://www.state.nj.us/health/ems/fly_drive.shtml

11. Fly or Drive ? Fly or Drive? • Helicopter use when ground travel time is between 20 and 30 minutes is a “Gray area” • You need to consider factors such as the helicopter's estimated time of arrival, in-flight time, extrication time, etc. 30 Min. 20 Min. H Source: http://www.state.nj.us/health/ems/fly_drive.shtml

12. Fly or Drive ? Fly or Drive? • While a helicopter is fast once in the air, getting to the landing zone and loading the patient can easily add 5 to 10 minutes, or more, to on-scene time. • Consider requesting a helicopter for incidents involving more than three critical patients. • Additional manpower, communication with medical control, and transport options can be obtained by using the air medical helicopter system. Things to Keep in Mind: Source: http://www.state.nj.us/health/ems/fly_drive.shtml

13. Calling for a Medical Helicopter in New Jersey • PLEASE NOTE: Calling for a specific Medical Helicopter directly by phone is Not permissible. • The State requires that allrequests for Medical Helicopter response in New Jersey MUST initiated through REMCS. • REMCS can be reached by contacting your local dispatch center or by calling: 1-800-544-4356

14. We are already ON A MISSION Reasons why SouthSTAR may not be available: Weather throughout the Complete Flight is below SouthSTAR’S minimum flight standards Maintenance Requirements

15. OUR Weather Limitations • Day: 800ft ceiling with 2 mile Visibility • Night: 1000 Foot ceiling with 3 mile visibility • Weather is checked throughout the entire flight plan. • Never hesitate to call; pilots will make the final fly decision. • Be sure to notify pilots of significant weather conditions at THE LANDING ZONE ( i.e.: ice, fog, thunderstorms ). Weather can change AND deteriorate quickly. We are relying on your input to conduct a safe operation. Most all Air Medical Crashes are WEATHER RELATED!

16. What is required for a SAFELanding Zone?

17. Questions to ask yourself: Do I have a communications officer?They should have a familiarity with all areas your team serves. Have excellent communication skills, a good sense of direction and is completely free from providing direct care to the patient (s). What are the high risk / accident areas in the area?Check out possible landing zones in advance close to these areas. Assess and make note of their associated problems and risks. Note landmarks to help locate the area. Note hazards that need to be relayed to SouthSTAR prior to their arrival.

18. Flat, hard surface is preferred 110’ X 110’ - Approx. 2 lengths of “attack line” Clear of overhead obstructions Clear approach and departure paths Note some important info: Helicopters don’t take off and land vertically. We take off and land into the wind when possible. High heat and humid conditions effect our aircraft performance. We may need more area to operate under these conditions Marked out with4 FLARES Secure the area of vehicles and pedestrians Area should be free of debris AllWHITElights off !! Emergency apparatus Other vehicles (headlights) Flashlights * Scene lights* By turning these lights on, you are in effect BLINDING the pilots No flash cameras !!! DO not look directly at the helicopter as it is landing unless you have eye protection. A SAFE LANDING ZONE CONSISTS OF:

19. Tasks before Aircraft arrival • Locate an area as described. Be prepared to have a request to change the LZ by SouthSTAR should the pilots request you to do so. • Utilize available apparatus / scene lighting PRIORto aircraft arrival to assist in identifying LZ hazards • Deploy your personnel, with hand lights, to “walk the LZ”. Have them scan overhead the LZ surrounding area as well as the LZ itself for hazards, slopes, wires, etc. • Identify access sites to be secured. • Allow no unnecessary vehicles near the LZ • Deploy personnel to secure ALL access points • Keep bystanders, family etc. well away from the actual LZ • Deploy flares as prescribed ( placed in each corner of LZ ) • Ensure that your radio is on the proper frequency for contacting SouthSTAR • Stand by and await contact from SouthSTAR for an LZ description/briefing

20. Can YOU See The Ground??? IMPORTANT !!! During night operations,DO NOTshine any form of light on the LZ or at the aircraft. You are hurting our operation, not helping us by destroying our night vision. This action can lead to an accident. Once the aircraft is on the ground and awaiting the patient, again, No lights are to be utilized to illuminate the area while transporting the patient to the helicopter .

21. A Thought on Wires… Electrical lines pose one of the greatest dangers to the helicopter crew as well as the the ground crew. Failure to notify the pilots of surrounding wires in the immediate area as well as surrounding area could result in a catastrophic accident… NOTE: WE CANNOT SEE WIRES WHEN AIRBORNE, WE ARE RELYING ON YOU TO ADVISE US OF THEIR LOCATION.

22. From a Pilots view, it is not easy to identify hazards even under day flying conditions. Night time is even more difficult. We completely Rely on your Assistance.

23. Possible LZ Sites ??? SCENE

24. Possible LZ Sites ??? NOTE the Location of wires... LZ LZ LZ SCENE LZ LZ LZ

25. Communicating With the Pilots How to Provide a Landing Zone Briefing

26. What is a Sterile Cockpit ? • Once the Aircraft begins it’s final approach to the landing zone. ALL RADIO TRANSMISSIONS MUST CEASE. • This includes all conversations within the aircraft and ALL radio communications with the landing zone team unless absolutelyURGENT. • ANYradio transmission to SouthSTAR while on final approach to the LZ alerts the pilots to the possible need for evasive actions and the possibility to abort the approach to land. • Any urgent problems threatening the safety of the Aircraft landing are signaled by: “ABORT, ABORT, ABORT” (On The Appropriate Radio Frequency Being Utilized)

27. Communications • Usually done on South Jersey Net frequency • Each radio channel used possesses its own unique problems. Please know your radio frequency ahead of time. • Note: We limit radio transmissions when starting our approach into the landing zone. ONLY necessary communications should be made regarding potential hazards. NO patient updates etc. We ask that you employ radio discipline so that we may maintain aSterile Cockpit Environment • Approximately 2 to 3 minutes out SouthSTAR will ask for a landing zone briefing via the radio frequency utilized by your department.

28. Communications (Continued) • Provide information on the landing zone such as: • Location • In reference to the scene as well as area landmarks. • Simply stating “You have been here before” is unacceptable. • Describe area to be landing in: • Grass Field • Parking Lot • Roadway 3. Surface type: • Asphalt • Grass or • Dirt Please advise the pilots if the surface is wet, dusty, or covered in snow 4. The approximate size of the landing zone: • 110’ x 110” MINIMUM 5.HAZARDS !!! • Wires • Towers • Light standards • Trees, etc. Make note of their location North, South, East and West of the LZ. Relay this very important information to SouthSTAR Advise how the LZ is marked out: “ Your LZ is marked out by 4 FLARES”

29. Radio Communication Example SouthSTAR:“ ABC LZ from SouthSTAR, we are approximately 2 minutes out, can you provide us with a description of the LZ?” Landing Zone:“SouthSTAR your landing zone is set up to the west of the accident scene. You will be landing in a plowed cornfield in excess of 100 x 100. Your obstructions are, telephone poles with wires approx. 50 feet high to the north along the roadway. You have a tree line to the east and a fence line to the south. There are no overhead wires or obstructions. You do have an unlit cell phone tower to the west outside the LZ area. The LZ is marked out with 4 flares. The area is secure awaiting your arrival, patient is on location at this time.” SouthSTAR:“SouthSTAR received, please advise when you have a visual on us”. NOTE: Please do not reply “ You have been here before” when asked to describe the LZ. This may not be the case for the pilot (s) on duty that given day.

30. SOMETIMES WE MAY NEED HELP FINDING THE ACTUAL LANDING ZONE… Should you hear us or see us and there has been no radio communication established, reach out for us on the radio frequency being utilized. PLEASE NOTE: • Our dispatch coordinates only place us within an approximate 1 mile radius on the scene when correct. • We look for emergency lights, flares and the actual scene when we are close. • An aid to our navigation would be you advising us that we are in your sight. EXAMPLE “SouthSTAR we have a visual on you at this time, we’re off to your 2 o’clock position” (make note that when using the clock method the pilot is facing 12 o’clock).

31. Approach and Landing • Once over the LZ we will perform a “High Recon” (circling overhead) to identify the LZ and check its suitability. • We will then perform a “Low Recon” to identify any unreported problems or obstructions and determine the safest approach path. • Once deemed suitable and safe we will begin our final approach. This initiates the“STERILE COCKPIT”procedure.

32. Instances that May Require an ABORT TO LAND: A person or vehicle entering the landing zone area rendering it unsafe. SouthSTAR heading towards wires or obstacles known to the ground crew. DO NOT ASSUME WE SEE WHAT YOU SEE !!! Mechanical Issues . **** ANY INSTANCE THAT YOU AS THE GROUND CREW DEEMS AS UNSAFE !!! YOU HAVE THE AUTHORITY TO ABORT OUR LANDING.

33. Flight Team Interaction • Once safely on the ground the Aircraft will SHUT DOWN (approximately 1 minute). • The Medical Flight Team will exit the Aircraft and come to you. • Please DO NOT APPROACH THE AIRCRAFT !

34. Operating around the aircraft: • NEVERapproach The Aircraft While the Blades are Spinning. • The safest approach is 90 degrees from the side doors. • Begin approach outside of the span of the rotors. Rotors extend 24 feet from top of helicopter. • NEVERapproach the aircraft from the rear. • NEVER approach the Aircraft on your own, Signal us first and we’ll come to you. • There have been instances of the “rotor brake” disengaging and the blades spinning. If you hear the engines running and the blades are not spinning; assume that they could start spinning at any time ! STAY OUT OF THE DANGER ZONE ! • If wearing a hard hat, beware of rotor blades.

35. How do you approach the aircraft ?? Stay away from the front and rear of aircraft. Approach from the side and walk directly to the rear cabin door. Exit the area in thesame manner you approached. DANGER!!! Rear of aircraft, tail rotor danger area !! DANGER !!! Front of aircraft, main rotor danger area !!

36. SouthSTAR’S blade has the potential to go as low as 4’6” in the front of the aircraft. PLEASE STAY CLEAR OF THE FRONT !!! 4 ' 6"

37. NEVER WALK AROUND THE BACK! Tail Rotor is 6’5” from ground on a level surface

38. In case of a Fire: • Southstar has on - board fire protection Do not approach the aircraft unless escorted by a crew member. • Beware of the blades They may still be spinning !! • If Fire Is Seen (not just smoke);Signal Pilot They will escort you to the proper area of the ship to fight the fire. In the event of a fire, and the crew is unable to extinguish it, make note of the areas to fight the fire: • Engine compartment access: One under each engine on each side of aircraft provides access to that particular engine compartment. • Nose of aircraft: Electronics & Batteries Remove safety plate, fight fire. Both Sides of Aircraft

39. Our aircrafts Fuel Bladder Location May contain up to 280 gallons of jet fuel

40. If You Want To Help • Copy patient information (if time permits). • Ensure Patient is Properly Secured To Long Board. • Ensure patient is properly covered. • Transfer patient to the aircraft with flight crew. • Transfer may require 2 to 4 members. -One member at each point of the stretcher facing forward - NO BACK PEDALING ! - Take your time, use controlled urgency • Load patient with the flight crew present. • Exit the area promptly .

41. Patient Loading • Use caution approaching the aircraft. • Avoid rotor blades • Flight crew will advise whether the patient is to be loaded head or feet first. • Get stretcher close to pedestal. • All stretcher straps off. • Long board straps remain on. Color coding the straps recommended for speed and ease

42. Patient Loading (continued) • One Member at each side of head • One Member at each side of feet • One Member at each side only if needed • Watch IV lines! • Lift together • Make sure patient does not slide off of the pedestal

43. Exiting the Area • Please take your O2 bottles with you. • Walk out of rotor span using caution to avoid rotors. • Gather in place out of the immediate area but remaining in view of pilot. • We’ll secure doors and secure the patient. • Please make sure no equipment is left behind. • If you notice equipment immediately outside the aircraft after the blades start spinning – Do Not return for it. Signal the pilot and a flight crew member will retrieve it.

44. Demobilization • Extinguish flare • Debrief / Critique with members • Discuss what worked, what could have gone better and any suggestions you might have for future improvement Once the aircraft has safely departed, the LZ may be broken down.

45. Any questions regarding SouthSTAR operations please call the on-duty flight crew at: 856-325-4880 The SouthSTAR Hangar Virtua Health, Voorhees, N.J. 08043 • Additional information • Issues • Assisting with critique • Training opportunities with your organization • Community outreach programs

46. When any one Medical Helicopter launches on a mission, we are all part of a large, integrated team… IF ANY ONE PART FAILS…WE ALL FAIL You literally hold our lives in your hands during the most critical phases of a mission THANK YOU FOR KEEPING US SAFE !