MAMA: Mountain Area Medical Airlift

MAMA

Mountain Area Medical Airlift

The Importance of Patient Transport Fleets To meet the growing needs of our community, Mission Health remains ahead of the latest developments in countless specialties, perfecting cutting-edge healthcare models and tools. Our fundamental goal prevails: to improve the patient experience, increase efficiency, and sustain growth.

Thus, Mission Health strives to provide superior medical and behavioral health care, to invest in innovative programs such as Virtual Care, and to construct new facilities, while enhancing existing member hospitals. Our staff, administration and supporters are instrumental in our ongoing growth and positioning as the region’s best health care provider.

Although easily overlooked, patient transport is essential to day-to-day operations, and, typically, is the first experience of the patient on their road to recovery. With scores of dedicated medical and technical professionals, speed and safety are key to the success of patient transport. Mission Health’s patient transport modes consist of ground transportation, such as ambulances and other emergency service vehicles, and the well-known Mountain Air Medical Airlift, or MAMA, helicopter fleet. Both fleets are equipped to transport victims of accidents, those experiencing health catastrophes (such as heart attack or stroke), infants in distress, and patients in need of relocation.

This work requires that our professionals deliver vital, immediate and superior quality medical care, whether on the road or in the sky. Our ICUs (Intensive Care Units) with wheels and wings carry out patient transport missions at an astounding success rate, all while tackling ambulance shortage challenges and inclement weather. As the state’s 18 westernmost counties grow—and with a population set to reach 895K by 2019—Misson’s patient transport demands are expected to increase.

Ground and air transport are critical links in the chain of survival. Reaching patients and delivering them to the hospital are pivotal in determining patient care and successful medical outcomes.

The dilemma for hospital transportation vehicles and operators is that once treatment begins at the hospital, the “bricks and mortar” setting takes center stage, leaving the transport team to race to the next emergency in breathtaking time.

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The History of MAMA MAMA, previously known as Mission Air Medical Ambulance, recently celebrated 30 years of lifesaving flights and secure patient delivery to our medical facilities. The first MAMA helicopter, MAMA 1, began service on September 29, 1986; MAMA 2 took to the air in October 2004 from Franklin’s Angel Medical Center. Years later, MAMA merged with St. Joseph’s and Memorial Mission Hospital, and became known as the Mountain Air Medical Airlift.

MAMA Fast Facts • The MAMA fleet completes roughly 1,200 billable flights annually.

• MAMA allows for increased speeds and time savings.

For example, a trip from Angel Medical Center to Mission Hospital takes 90 minutes by car, but only 25 via MAMA. • MAMA serves not only Western North Carolina, but parts of Eastern Tennessee, upstate South Carolina, and northeast Georgia.

• Our superior fleet is staffed by accomplished Mission Health leaders, including 12 flight paramedics, 12 flight nurses (all with over five years working within the Emergency Department or Intensive Care Unit), eight pilots, and three mechanics.

• MAMA payments are calculated based on pickup fees and loaded miles.

• 80 percent of MAMA expenses are fixed; 20 percent are dependent on flight volume.

• MAMA is restricted by unsafe weather conditions, and thus, unable to perform 40-45 percent of flight requests.

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Greater coverage.

More lives saved.

The typical MAMA trip measures its success in minutes – the fewer the better – it takes for MAMA staff to pick up a patient, safely move them into an aircraft, become airborne, before returning to the hospital. Every flight trip is personalized to patient need. When it comes to quickly and efficiently treating patients, each clinician must also perform a delicate balancing act: tend to patients while simultaneously tending to concerned family members on-site or those awaiting information on their loved ones following pick-up. Our compassion is displayed day in and day out by our in-flight and ground ICU teams, and all healthcare professionals. It takes a diverse and dedicated staff to help MAMA take flight, one that includes flight nurses, paramedics, pilots, aircraft mechanics, the Medical Director, the Air Medical Services Supervisor, and communication specialists.

Air Medical – MAMA, possesses a unique knowledge of the MAMA program and the constraints of the current fleet. He and his staff are acutely aware that when a patient is served by the MAMA team, it is likely one of the most stressful experiences of their lives.

“Most of our staff members, including myself, have been doing this work between 15 and 30 years, and we are always aware that this is likely the worst day of the patient’s life; in our work, no patient or case is routine,” he shares.

John Grindstaff, Supervisor When community members across Western North Carolina look to the sky and see the familiar green and white MAMA aircraft, they equate safety and healing with Mission Health, as they know superior emergency professionals are racing off to save lives.

MAMA flight nurse Cecil Greck proudly considers his service to MAMA to be the pinnacle of his career.

“Our team makes me proud,” he affirms, “and I know the services we provide to the community make a difference to families throughout the region. It’s really a classic win-win.”

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It’s important to understand that the climate and topography of mountainous Western North Carolina present unique challenges to successful flights. The warm, sub-tropical climate of Asheville and the surrounding region causes significant amounts of fog in the summer months, and snow and ice in the winter months. Low light conditions are another obstacle in safe patient transport.

These challenges present risks that must be constantly monitored and can shift mid-flight, causing assignments to be aborted.

Exposure to severe elements – rain, snow, ice, wind, and sun – cause wear and tear to the fleet much more swiftly than if the aircraft were protected by a hangar. Currently, hangars are an industry standard and MAMA has done without one since its inception. Because the helicopters sit outside, oftentimes their blades freeze. While the weather may be clear for flight, unfreezing the blades requires maintenance that can delay flights for hours, or shut down this lifesaving service completely. Other common reasons for MAMA flight denial are aircraft already in-use or undergoing necessary maintenance when a call is received. The ability to both preserve the fleet and provide increase aircraft availability would be successfully addressed with the purchase of a hangar.

MAMA 1’s aircraft base is located in Asheville, North Carolina, while MAMA 2’s base is in Franklin, North Carolina. Unfortunately, Franklin experiences frequent inclement weather, posing additional flying risks. This impacts flight denials, which currently number at 2,974 for Asheville and 2,808 for Franklin. Bad pre-launch weather, or weather that forces a flight to abort, are the primary reasons flights are denied. Low-lying fog and visibility restrictions accounted for over 2,000 flight denials between 2010 and 2014. Currently, the Franklin base is located below the fog accumulation level, which is typically between 1,900 and 2,200 feet.

(If the Franklin base were moved, non-IFR aircraft would not be permitted to transport patients.

However, local emergency personnel could still arrange for patient transport to a location with the highest level of care above the fog line.) Mission Health is currently researching new sites for land purchase so the Franklin base would sit above the fog line.

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Enhancing the MAMA Fleet MAMA helicopters are at a point of critical need.

The fleet presently consists of two aircraft, in addition to a backup helicopter. However, the managing department recommends a new purchase and fleet retrofitting plan to ensure that all aircraft meet FAA standards, as well as updates to address the growing needs of NICU and cardiac care patients. “An increased need for more powerful aircraft and new technology will provide us important lift capability,” explains Grindstaff. Improved lift capacity is key to transporting necessary NICU and cardiac equipment, and thus, providing successful in-flight patient care.

These equipment upgrades will guarantee that the iconic MAMA fleet maintains its stellar reputation.

Furthermore, a dramatic increase in the need for MAMA’s services is expected over the next decade, and a third aircraft would amplify coverage and availability. Currently, intra-aortic balloon pump (IABP) and neonatal transport requests can warrant extended flight calls averaging four to five hours, decreasing aircraft readiness. With the projected need for cardiac services expected to increase at Mission Hospital, we anticipate similar increases in cardiac care needs on MAMA flights.

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Safety is paramount to every transport MAMA performs. The MAMA fleet is inspected daily to guarantee the highest level of safety for every flight.

And to ensure aircraft staff are prepped for potential flights, there is a tiered system of safety approvals in place. MAMA flights must be approved by the Medical Director, and every crew member may approve or deny a flight based on his/her personal comfort level. Three favorable votes get MAMA in the air, while one rejection can keep her grounded.

To ensure even greater safety, MAMA aircraft must be upgraded to possess single-pilot instrument flight rules (SPIFR) capabilities, which allows for more complicated missions. These upgrades would decrease denied or aborted flights, a key concern during inclement weather.

Time is always of the essence for MAMA. How quickly an aircraft gains altitude, correctly positions, and reaches proper speed are of paramount importance. Speed, in turn, depends on availability.

Lois Hancock, an ICU nurse for 20 years when she joined MAMA in 2003, explains that the need for optimal coverage “affects our work every day…

Speed is our reason for being. Minutes and seconds matter. If we don’t have enough power in our fleet, it will limit our response time and our access to the public.” The benchmark response time for MAMA missions is ten minutes.

Quicker access to lifesaving emergency care at Mission Hospital Improvements to our aircraft navigational tools are a critical step to addressing speed concerns. Flying on navigational instruments (or IFR capabilities) is like using a GPS system, and enables an aircraft to designate and maintain correct speeds, altitude and direction. IFR allows for increased technological support for the aircraft. Moreover, it enables the crew to focus on and treat the patient. Many of our aircraft require updates to these navigational tools, not only to better address patient needs, but to enhance speed, logistics and support.

Equipping each aircraft with enhanced medical supplies and tools is also essential to quickly transporting and delivering patients. Each air transport comes equipped with a “tool box.” Making sure that each of these boxes has the appropriate equipment for air transport, however, is critical to the success of MAMA. Each aircraft requires upgrades to obtain their own stretcher, for instance, rather than relying on the same cache of stretchers used by conventional ground transport. This would increase the critical patient pick-up and turnaround time.

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Help MAMA save more lives With the financial and capability investments described below, MAMA helicopters will continue to thrive and will exceed industry safety standards.

FINANCIAL NEEDS: •Retrofitting MAMA 1 with required FAA technology and refurnishing medical interior components over 18 years old is especially urgent ($300K). As of March, 2017, MAMA 1 will be grounded if she doesn’t receive the mandated FAA upgrades to her avionic systems.

•Funds to replace MAMA 2 with a gently-used aircraft (approximately $4.6M), along with technology to provide a state-of-the-art care environment and fly-on navigational instruments •Funds to purchase four pairs of new night vision goggles ($14K/pair): Our fleet was the first civilian EMS helicopter service in the country to use night vision goggles, however, our current gear are 19 years old.

•$2.3 Million to invest in an optimal location to relocate MAMA 2’s Franklin, NC base; an altitude of 2,300+ feet is necessary to remain above the fog line.

•$60K for an aircraft hangar (an industry standard) to protect the fleet when not in use.

One of the most compelling reasons to invest in the Patient Transport program is MAMA’s impressive safety track record as one of the best in the industry for the last three decades. Our standards of care are exceptional. We are committed to providing top-quality patient transport service across the skies of western North Carolina. To continue offering our astonishing level of patient transport service to the mountainous region of North Carolina, our air transport requires technical updates and a sustained financial investment.

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