When Size Matters: Offshore Helicopter EMS Operations

It is licensed in the state of Louisiana as an air ambulance, but this is not your typical air ambulance—not in its size or the scope of its mission. Its fuselage is 56 feet long with a rotor diameter of 56 feet. Its maximum weight is 26,000 lbs. The cabin is 20 feet long, six feet wide and six feet high. It has a maximum speed of 190 mph. Its mission is to provide medical and rescue services to the offshore oil industry in the Gulf of Mexico.

Vital Statistics

The helicopter is a Sikorsky S-92, and it’s crewed by five people: a pilot, copilot, flight medic and two rescue specialists. It is based in Galliano, LA, and operated by CHI Aviation. The operation is run on a subscription basis for oil companies with platforms in the Gulf of Mexico. CHI also has an AgustaWestland AW139 helicopter it uses for the same mission on an ad hoc basis for customers without subscription contracts for the S-92. They also get rescue assignments from the U.S. Coast Guard. Both ships are crewed 24/7.

The contract covers personnel on oil platforms, the ships that supply the platforms and the helicopters that transport the workers to and from the platforms. Containing one of the world’s largest oil fields, the Gulf of Mexico has about 5,000 oil-related structures, supported by dozens of supply ships and a fleet of over 400 helicopters. In 2014 these helicopters made 740,000 flights over the gulf and transported two million passengers.

“We use the S-92 because of its range, speed and payload capabilities,” explains David Jacob, CHI’s director of offshore operations and a longtime paramedic. “Some of the platforms are 200 miles or more offshore. We can carry a huge amount of rescue gear. Our rescue specialists are certified in vertical rope, confined-space and hazardous-atmosphere rescue. We can also rescue all of the passengers of the largest helicopters used for offshore transport if one ditches in the gulf.”

The S-92 is one of the newest helicopter designs. It has an all-glass electronic display instrument panel that incorporates the latest flight control, navigation, communication and engine systems. The helicopter can perform rescue missions day or night and in bad weather. It has a color weather radar that can also detect the oil platforms. It has dual GPS systems for navigation.

It also has forward-looking infrared (FLIR) and low-light television cameras in a gyrostabilized turret under the nose. The helicopter can be used as an airborne command post for an incident on an oil platform. Its crew can record and transmit imagery, and an oil company representative can be on board and talk with his personnel via the satellite phone in the cabin. They can also use it to see hot spots on an oil platform in case of a fire.

Another feature is a sophisticated autopilot system customized for search and rescue missions. It can automatically come to a 50-foot hover at any location specified by the pilot. Search patterns can be programmed and flown by the autopilot coupled to the GPS system to maximize search coverage. It is also equipped with dual rescue hoists in case one fails.

The facilities at Galliano are high-tech. The hangar is climate-controlled, which is especially important in the summer, with its high temperatures and humidity. The base has its own power supply, and the hangar is rated for a Category 3 hurricane.

Staffing and Training

“Acadian Ambulance provides the paramedics for our operation,” Jacob says. “They also provide all the medical equipment, protocols, 24-hour online medical control, and dispatching and flight-following services. We can use Acadian’s aircraft to back us up, and we may handle a local call for them with our AW139. Acadian ground operations span from Mississippi to Texas, so if we need additional equipment or personnel for an MCI, we can get them from Acadian ground ambulances.”

“The flight medics do not go through the rope and confined-space rescue training,” says flight paramedic Anthony Cramer, Jr., who is also an RN. “We do go through hoist training. In water rescues, the rescue swimmer would deploy and bring the patient into the helicopter, where the flight medic would then begin treatment. If the patient is on land, a vessel or an oil platform, the flight medic would be hoisted down to the victim, as well as a rescue specialist. There are always two people going down to the patient.

“The flight medics have a good working relationship with the rescue specialists. We pretty much live together when we’re on duty. The rescue specialists have a varied amount of medical training. The minimum is EMR, but many are EMTs and paramedics. They can work on the patient under the direction of the flight medic. Since we work so much together, they can anticipate the flight medics’ needs. It is just like a crew in the back of an ambulance.

“The flight medics work under the same protocols as the Acadian Air Med flight crews, which are pretty extensive. We can do RSI, CPAP and 12-lead ECG, and we carry a ventilator. We can initiate a lot of treatment before arrival at the hospital because of our long transport times. They have a protocol for what they call chemical extrication. They use it in case they have a patient who is trapped by machinery or has a difficult extrication from where they fell. They use etomidate as a hypnotic sedative. The patient isn’t aware and has no memory of the event afterward.

“Our calls run the gamut from trauma to medical,” explains Cramer. “There is a lot of heavy machinery and moving heavy equipment on oil platforms. We have all the medical-type calls found in any community. One of our biggest complaints is chest pain. We do 12-leads and can send them to the hospital while we’re en route. We also carry beta blockers and IV nitrates for STEMI patients. Once the hospital has the 12-lead, the ED doctor and cardiologist decide whether to bypass the ER and send the patient directly to the cath lab when we land. We have done that several times with very good results. If we need to talk with medical control for orders or to contact the receiving facility, we have a satellite phone as part of the communications suite on the helicopter.

“Acadian Air Med has a QA/QI process, and we are part of that as well. Our charts get reviewed like any other Air Med chart. We can also use the Air Med quality improvement coordinator for advice and opinions on patient care issues that occur. Our flight medics are all very experienced, and most have come from the Air Med side of Acadian. We work seven-on, seven-off, and many work shifts for Air Med to get more volume and keep their skills fresh.

“An MCI is a real possibility on oil platforms. Do people just need to be moved off a platform because it is on fire or in danger of sinking? Or was there an event that created a large number of casualties? If there is a medic stationed on the platform, he or she will have done the initial triage by the time the helicopter arrives. If not, we can begin to do the triage and packaging for transport. We might move victims to another close platform with medics on it and transport the more serious patients to shore. We can also use our AW139, and Air Med might be able to send some of their helicopters offshore to platforms. We can also pick up some Acadian Air Med crews and their gear on the way out to a known MCI.”

Due to the size and weight of the S-92, the crew may have to land at an airport near the hospital and have a ground ambulance transport the patient and flight medic from there. They’ll go to the most appropriate facility for the patient’s condition—STEMI center, stroke center, trauma center, burn center, etc. The dispatch center, which is Acadian’s, finds the closest, most appropriate destination so the crew doesn’t have to “shop” for a receiving facility.

“Almost 100% of our pilots and rescue specialists have military search and rescue experience,” says Jacob. “We have U.S. Air Force pararescuemen and rescue pilots, U.S. Coast Guard rescue swimmers and pilots, and U.S. Navy pilots and rescue swimmers. There is a large amount of trust among the crews because of that. We know we will revert to our military training when things get challenging. The crews rely on their crew resource management training, which they all had in the military. We all know how to communicate effectively in stressful situations.”

A Hazardous Environment

Oil platforms are built like ships, with compartments, vertical ladders and complex machinery. Dangerous chemicals and gases like methane and hydrogen sulfide are common, so the rescue specialists can extricate people from hazardous atmospheres with low oxygen using air tanks. They can also do vertical rope rescue for victims of falls or others who cannot use the ladders inside the platforms.

Hoist missions in the water and bayous have their own set of unique hazards. “In addition to looking for the normal hazards for a helicopter hoist operation, we are also looking for natural hazards such as sharks and alligators,” says Mike Fout, a rescue specialist instructor and former U.S. Navy rescue swimmer. “We also look for debris or contaminants in the water. In addition, we have to think about the sea state and water temperature. For contaminants, we will minimize our time in the water and use a direct-deployment rescue method where we’re never unhooked from the hoist cable. We also have dry suits we put on to minimize skin exposure.”

Many of the rescue specialists had this training in the military, but all of them are current with the necessary civilian certifications for these skills. They have to recertify every two years on all of them. They also adhere to international standardized training and hold internationally recognized certifications for their rescue skills. All the paramedics are nationally registered and certified by the states of Louisiana and Texas.

“When we’re first hired, we get qualified in one position on the team, and then we get dual-qualified with time as both hoist operators and rescue swimmers,” Fout says. “The goal is to have all rescue specialists dual-qualified.

“In addition to maintaining currency with the different helicopter deployment methods, day and night, we also have confined-space and vertical rope rescue training to stay current with. We do a lot of training. We try not to be idle. We will pull out our confined-space and rope rescue gear a couple times a week and train. Our hangar is about three stories high inside, and we can practice vertical rope rescue techniques in there.

“A new person gets qualified on the aircraft first and then is sent to different rescue schools. We work with Roco Rescue, which specializes in industrial rescue training, for high-angle rope and confined-space rescue training. Medical training is done by Acadian Ambulance.”

There is an instructor cadre that includes hoist operators and rescue swimmers who meet regularly to discuss new gear and new procedures they might want to adopt. If a new piece of equipment looks promising, they will get it and test it both in a static environment in the hangar and then with the aircraft.

The instructor cadre also meets to decide on future training needs, updates that might be needed in the process, and any improvements to the operation they might be able to make. They also look at how other civilian and military rescue units do things to see if they might want to add to or adjust their program.

“We are fortunate enough to have a large cross-section of military rescue experience,” says Fout. “Each brings their own experiences we can look at to see if something would be a good fit here.”

Conclusion

CHI’s S-92 helicopter is a combination rescue truck and critical care transport ambulance. It can handle rescue and medical incidents on ships, oil platforms and in the bayous and open water of the Gulf of Mexico. All of the people interviewed by EMS World said there is no better air ambulance and rescue helicopter anywhere in the world.

Barry D. Smith is an instructor in the Education Department at the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.