Vanderbilt LifeFlight Ride-Along Safety Briefing

1. Vanderbilt LifeFlight Ride-Along Safety Briefing

2. Welcome to Vanderbilt LifeFlight Thank you for applying to the Vanderbilt LifeFlight Ride-Along program. We are excited to have your participation. The LifeFlight Ride-Along Program is designed to allow direct visualization of patient care in the field, as well as, provide exposure to appropriate flight criteria, and safe helicopter operations.

3. This presentation will offer an overview of the Vanderbilt LifeFlight Program, as well as preview essential safety information for candidates participating in the Ride-Along program. After completing this presentation, please complete the attached questionnaire and present it to the flight crew on duty the day of your Ride-Along.

4. VANDERBILT LIFEFLIGHTOVERVIEW Vanderbilt LifeFlight is the critical care air medical transport service for Vanderbilt University Medical Center (VUMC). VUMC is the 6th largest level I trauma center in the nation, with a service area of approximately 65,000 square miles. Vanderbilt Life Flight completes over 2900 patient transports a year.

5. VANDERBILT LIFEFLIGHTOVERVIEW In supporting Vanderbilt University Medical Center, Vanderbilt LifeFlight utilizes five helicopters, a KA-200 fixed wing aircraft, and a Lear jet. Our aircraft are strategically placed in Nashville, Lebanon, Tullahoma, Clarksville, and Mount Pleasant. This placement allows rapid access to definitive care for all of middle Tennessee, southern Kentucky, and northern Alabama.

6. Types of Vanderbilt Aircraft

7. Vanderbilt LifeFlight Base Locations and Service Area

8. Vanderbilt LifeFlight Overview As illustrated on the previous slide, LifeFlight helicopters serve the area within the 130 mile radius around Nashville. The addition of our fixed wing aircraft allows us to now conduct international patient transports. Vanderbilt LifeFlight has completed patient transports to locations as far away as Cairo, Egypt and Mexico City, Mexico.

9. Vanderbilt LifeFlight Overview Vanderbilt LifeFlight mission goals: • Safety • Provide the highest quality patient care • Community Education/Outreach

10. The LifeFlight Commitment to Safety The number one focus of Vanderbilt LifeFlight is safety. Our safety highlights include: • Over 25,000 accident free patient transports completed since the program’s inception in 1984. • Vanderbilt LifeFlight operates solely in dual engine aircraft • Our pilots average over 5,000 hours of flight experience • The first CAMTS (Commission of Air Medical Transport Services) accredited air medical transport provider based in Tennessee

11. The LifeFlight Commitment to Safety Safety Highlights continued: • LifeFlight can safely respond to transport requests under poor weather conditions. Global positioning systems (GPS) allow direct routing during poor weather situations which will minimize flight delays. LifeFlight is the only air medical transport service in Middle TN utilizing this technology. • LifeFlight components/medical equipment installations meet or exceed FAA requirements.

12. Quality Patient Care LifeFlight medical crew members receive competency based training in all areas of care including: • Adult and Pediatric Emergencies • Cardiac Emergencies • Neurological Emergencies • Trauma and Burn Emergencies • Respiratory Emergencies • Obstetrical Emergencies

13. Clinical Competence LifeFlight crewmembers are trained to perform life-saving skills that would normally only be available in an emergency department. These skills include: • Chest tube insertion • Femoral venous access • Pericardiocentesis Vanderbilt LifeFlight also carries two units of blood on every helicopter. This allows initiation of blood transfusions in flight. Blood transfusion is another treatment that is normally unavailable in the pre-hospital setting.

14. Clinical Competence Additionally, Vanderbilt LifeFlight medical crew members receive extensive training in difficult airway management. Advanced airway skills include: RSI intubation, needle cricothyroidotomy, and surgical cricothyroidotomy

15. Clinical Competence Many continuing education and continuous quality improvement activities are mandatory for medical crew members. Some of these activities include: • Monthly chart review meetings with attending emergency, trauma, anesthesia, and pediatric physicians • Bi-annual skills labs • Documentation of skills competencies

16. Community Outreach Community outreach and education is another primary mission of Vanderbilt LifeFlight. We routinely fly in for various local community events such as safety fairs, conferences, or other educational events.

17. TNCC ENPC NRP BTLS AMLS Advanced Skills Lab Pediatric BTLS Community EducationVanderbilt LifeFlight offers multiple educational opportunities for health care providers within our service area. Some of the classes provided include:

18. Community Education EMS Night Out (ENO) is an additional educational opportunity provided by Vanderbilt LifeFlight. ENO attendees may earn CEU’s by participating in two 45 minute lectures on various topics. The lectures are separated by a dinner break, where food is provided. ENO is open to everyone and admission is free.

19. Please visit our website for more information about Vanderbilt LifeFlight. www.vulifeflight.com

20. Passenger Safety Briefing Let us again welcome you to Vanderbilt LifeFlight. We are pleased to have your participation in the Ride-Along program. The goal is for every Ride-Along participant to have a positive and exciting educational experience. Our first, and most important, priority in creating a positive experience is ensuring your personal safety. The following portion of this presentation will focus on aviation and scene safety.

21. Passenger Safety Briefing A Vanderbilt LifeFlight crew will typically consist of a pilot and two flight nurses. Please strictly adhere to any instructions from crew members, as all direction will be given with your best interest in mind. The pilot will be the ultimate authority at all times.

22. Approaching the Aircraft Please do not approach a running aircraft unless accompanied by a LifeFlight crew member. These diagrams indicate the proper areas from which the aircraft may be approached. As a Ride-Along participant, you will not typically enter the “Caution Area”. You should NEVER enter the “Danger Area”.

23. Approaching the Aircraft The main rotor system may flex, or bend down, when the aircraft engines are running at less than full idle. In some helicopters, this can greatly reduce the height clearance when approaching an aircraft. Never travel underneath the main rotor system unless the aircraft is at full idle, or completely shut down.

24. Approaching the Aircraft Patients are loaded using the rear clam shell doors. Since this requires emergency personnel to enter the CAUTION area, you will see the pilot station himself between the tail rotor and the rear doors. His job is to prevent someone from inadvertently backing into the tail rotor. This is what we refer to as performing “tail watch”, and is well illustrated in the photo on the right.

25. Approaching the Aircraft Participating as a ride-along may provide some exciting circumstances. However, regardless of the emotional gravity of any situation, please maintain your situational awareness, and be mindful of the rotor systems at all times. One small mistake can have catastrophic consequences.

26. Types of LifeFlight Helicopters You will be flying in one of two types of helicopters, either the EC-145 or the BK-117. While these aircraft are very similar, there are subtle differences between the two. This presentation will also preview some of the important differences you will need to be familiar with.

27. EC-145 The exterior doors of the EC-145 are shown, closed and secured, in the upper photo. Note the handles are in the vertical (locked) position. Twist the handles, as shown below, to unlock and open the doors

28. EC-145 The interior door handles of the EC-145 are pictured to the right. The upper photo shows the handle in the vertical (locked) position. To open the door, simply lift the handle up, as illustrated in the lower picture.

29. EC-145 In an emergency situation, the windows on the rear compartment doors may be removed. The red tabs highlighted in the photos are located on both the interior, and exterior portions of the doors. Remove and pull a red tab to disrupt the window seal. This will allow for easy separation and removal of the window

30. EC-145 In the EC-145, fire extinguishers are located in both the forward and rear compartments. The rear extinguisher is located next to the rear clamshell doors (pictured above). The forward extinguisher is located between the two seats (pictured below).

31. EC-145 This picture illustrates proper operation of the EC-145 seatbelts. Seatbelts must be worn at all times.

32. EC-145 To ensure optimal seatbelt performance, the belt should be snuggly seated low across the pelvis. The top picture shows a properly donned seatbelt. While the lower picture has the seatbelt situated too high, and too loose.

33. EC-145 Passenger Briefing Card

34. EC-145 Passenger Briefing Card

35. BK-117 The front and rear compartment door handles of the BK-117 are pictured in the opposite photo. The handles are in the closed and secure position. To unlock and open these doors, twist the handles in the directions indicated by the arrows.

36. BK-117 The interior door handles for the BK-117 are pictured below. The forward compartment handle is on the left, and the rear compartment handle is on the right. Turn the handles as the arrows indicate to open the doors.

37. BK-117 On the BK-117, the doors may be jettisoned after an emergency landing. The door jettison triggers are pictured below. Pull the jettison trigger to detach a door.

38. BK-117 Fire extinguishers are located in both the front and rear compartments on the BK-117. In the front compartment, the extinguisher is located between the seats. The rear compartment extinguisher is mounted on the wall between the bench seat and the door.

39. BK-117 Pictured on the right is a BK-117 seatbelt. These belts act in a fashion similar to the EC-145 seatbelts, and operate as illustrated. Again, seatbelts must be worn at all times during aircraft operation. FASTEN UNFASTEN

41. Aircraft Door Operations LifeFlight crew members will typically handle the operation of the aircraft doors. Only in the event of an emergency aircraft evacuation would non-LifeFlight personnel be expected to open or close aircraft doors.

42. Although emergency landings/evacuations are uncommon, and highly unlikely. The FAA requires ALL passenger carrying aircraft to include emergency evacuation procedures in their passenger briefings. In the event of an emergency landing, please remember the following steps. Stay Calm Check that seatbelt and helmet straps are securely fastened After aircraft stops, exit aircraft using doors if possible. Exit via windows if unable to open doors. Be mindful that rotors have stopped turning before exiting. Crew members will rendezvous, at a safe distance away, directly off the nose of the aircraft, in the 12 o’clock position. Emergency Evacuation

43. In-Aircraft Communications On the day of your Ride-Along, you will be given a helmet similar to the one pictured here. This helmet has a microphone, and will plug into the aircraft intercom systems. This allows you to effectively communicate with the crew members.

44. In-Aircraft Communications Your helmet cord will plug into an intercom box. There is one box for each seat in the aircraft. The bottom picture shows the box, and how the helmet cord should be inserted.

45. In-Aircraft Communications The illustration below describes the controls on the intercom box. InterCom Talk Switch. The volume button may be rotated clockwise, or counter-clockwise, to appropriately adjust the intercom volume Radio Transmit Button Helmet plug -in

46. In-Aircraft Communications Depending on which aircraft you are in, the intercom talk switch operates in one of two ways. In the EC-145, slide the switch as indicated in this photo. This switch should lock in the “on” position. Then simply speak into the helmet microphone to talk. EC- 145

47. In-Aircraft Communications In the BK-117, slide and hold the intercom talk switch, as indicated in the photo, to talk on the intercom system. When you are finished talking, release the switch, and it will return to the neutral position. Do not lock the switch in the “on” position, as in the EC-145. BK-117

48. In-Aircraft Communications The radio transmit button is used to send communications outside the aircraft (i.e. patient report to the emergency department, or communications with flight comm). With the exception of an emergency situation, ride-along participants would not need to use the radio transmit button.

49. In-Aircraft Communications During takeoffs and landings, aircraft occupants will observe what is known as “sterile cockpit”. In our environment, sterile cockpit refers to the elimination of all conversation that is not directly related to aviation safety and/or the aircraft maneuver taking place.

50. Key Points For Review • Safety is always the #1 priority • Strictly adhere to any crew instructions • Maintain situational awareness at all times. • Never approach a running aircraft unless accompanied, or directed, by a crew member • Be mindful of the CAUTION and DANGER areas when around the aircraft. STAY AWAY FROM THE TAILROTOR.