Program Supporting Documentation

Washington County Multi-Mission Helicopter Rescue Program

What are the primary goals of the program? The "WHY"

  1. The primary goal is to build a multi-mission public safety rescue helicopter program that can provide air medical transport, search and rescue operations to include hoist rescue operations for water rescue, and fire fighting capability for our rural grass fires. There is only one program like this in the state and one of just a few in the nation. However, none have collaborated to the degree we have in attempts to make this model fiscally responsible.
  2. Rural healthcare is not growing in Texas. In fact, rural healthcare and hospitals are closing across Texas at an alarming and all-time high percentage. We have started to see this effect close to home (Bellville General is on life support, Lagrange voters chose not to subsidize their local hospital, and across the state, roughly 20 rural hospitals have closed since 2013 ). Not only are these facilities closing altogether, but the ones that do not close are also closing services. Our local hospital has no cardiac services, pulmonary services, definitive trauma care, neurology, cardiothoracic and now recently we are facing a potential closure of our obstetrics facility. We currently have one of the most respected ground public safety EMS departments in the entire state and provide the highest level of care, however, the speed at which these patients arrive at definitive care is ultimately of the highest priority. This locally based aircraft will be a fully functional HEMS (helicopter EMS ) Ambulance with our rescue paramedics and flight nurses as crewmembers.
  3. Our County has been approached three (3) times since 2006 by private for-profit air medical programs trying to build a program here in Brenham. Why? Because as you can see with our ground EMS revenue our patients are in a high payer mix. Meaning most patients have multi-insurance carriers (Blue Cross and Medicare).
  4. Why not just use the local helicopters already in existence? Even though it seems like there are local providers that could provide EMS air rescue for our citizens, honestly, there is no one close enough. Even if they were they do NOT do multi-mission rescue work as we desire. They only fly sick or injured patients. If we waited until an aircraft arrives then we actually extend the patient arrival time to the hospital. These patients can not wait 35 minutes for an aircraft and then turn around and transport them back to a hospital. Which is what we are doing now, which is why we seldom use an aircraft. We can transport them by ground faster. With the addition of this program, we can get these patients to definitive care in under half the time we are now. Which translates into lives saved.
  5. Positive Economic Impact on the community. The Public / Govt program will bring a for-profit company of 10-12 employees with high paying salaries to the county. REACH will have four-rotor wing pilots, mechanics, and aviation support specialist that will be employed here in the county. This fact that Washington County will be able to provide superior critical care access to definitive care for a rural county in Texas will be a positive economic impact as well. The community is an elderly retirement community that currently has limited access to facilities in downtown Houston, Austin, etc...
  6. We are currently working to see if having a fire suppression capable aircraft would lower ISO ratings and reduce potential property owners' insurance.

Defnitions and Talking Points

HEMS: helicopter emergency medical services

AMC: air medical crewmember; this consist of flight nurses, flight paramedics, and pilots; all three make up the "crew member"

Crew Chief: The crew chief on a multi-mission public safety aircraft is ultimately responsible for the "back seat" of the aircraft. This individual will be a rescue paramedic credentialed both as the rescue specialist and the hoist operator. Ultimately responsible for assisting the pilot in indirect visibility hoist operations for both static and dynamic rescue operations. These rescue paramedics will be county employees.

Air Crew Rescue Specialist: This is the rescuer that exits the aircraft on a hoist cable that is swift water rescue trained, SAR, and helicopter rescue trained. This position will be only in use when the aircraft is in a public mission role for search and rescue operations. During normal EMS transport of patients, this crew member will be off the aircraft.

FAA135: a certificate that an aviation program is granted by the FAA (federal aviation administration) to transport sick and injured victims. It allows them to act as a HEMS operator.

FAA133: a certificate that an aviation program can be granted that allows them to perform public rescue missions. It is a very stringent, rigid, and somewhat outdated but is the current process for non-governmental agencies to perform these missions.

Public Missions: government entities can be exempt from most of the FAA133 certificate oversight and can perform the rescue, SAR, and fire suppression missions under the "public mission" programs. They must have policies and procedures in place to provide such care but do not report to the FAA.

EC145: is a helicopter made by Airbus. The EC145’s designed-in modularity and large unobstructed cabin with flat floor contribute to the helicopter’s flexibility for a full range of applications (multiple mission profiles - EMS, Fire Suppression, and Hoist Rescue), accommodating up to 8 passengers in standard configuration and 10 passengers in a higher density configuration, plus one or two pilots.

This multi-purpose rotorcraft can be tailored for emergency medical services and law enforcement duties, along with aerial work, passenger transport - including private and business aviation - and offshore operations. For multi-mission operators, the H145 can be reconfigured for different roles quickly and easily.

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"Helicopters and Helicopter Programs are insanely expensive and the taxpayers can not afford this program."

1. Yes, the air medical and air rescue world is incredibly expensive to operate. This is the exact reason we are entering a joint private/public venture. The first of its kind in the nation. This will allow us the best opportunity to keep cost low and services high. The truth is...the way we have established this program requires no money and no additional dollars from taxpayers. The currently selected vendor will be reimbursing the county for all salaries, program direction, administrative oversight, and housing (crew quarters). There is zero "required" cost to the taxpayer. However, should this program had been in existence in the 2016 May flood at least 4 of the 5 fatalities would have been rescued.

"There have to be some hidden expenses your not considering?"

EMS Director Deramus has performed cost analysis, revenue recovery opportunities, and concept design for multiple years. We have been vetting this particular project for nearly two years. Undoubtedly with a project of this magnitude, we may have overlooked some details however, we believe we have established one of the most experienced teams in the nation to build this project. Even down to adding additional personnel in the dispatch center for things, such as aviation communication specialist positions, have been considered and are again reimbursed by the aviation vendor as to not incur the cost to the taxpayers.

"How does this effect the current ground EMS in regards to revenue and resources?"

Great question. One of the most significant benefits of the program is the fact that we currently do over 900 IFT's (transfers) per year. This currently causes a significant squeeze on our staffing and ability to keep a proper amount of staffed ambulances in the county to ensure adequate responses. The air rescue program will alleviate the need for additional staffing for probably 3 years. A saving to the county of over $750,000 during these three years. It will reduce some of our mileage, wear and tear and resource allocation applied to inter-facility transfers which is also an operational cost savings. It also serves as a back up to our ground resources if we are overwhelmed with 911 responses.

"I can't believe we are going to have private air medical company taking care of our citizens, visitors, and patients."

Your statement is the exact reason we have not allowed a private air medical vendor to come into our county thus far and we do not intend to start this now. Our goal was to seek out an aviation vendor with the highest standards in regards to pilot training, maintenance of aircraft, etc... and that would allow us to do what we do well patient care. Actually, this is a true partnership. The private vendor is going to focus on the aviation side of the business such as pilot training, aircraft, aircraft maintenance, etc... and we are going to do what we do best and focus on the clinical and fiscal operations side of the business. So it will still be our county flight paramedics managed by our current EMS Director and our local medical director overseeing the care on these air ambulances. No different than our ground units.

"Why don't we just use one that is already here like PHI?"

PHI (petroleum helicopters) actually approached us about basing an aircraft here several years back. Keep in mind none of these air medical providers currently perform multi-mission programs. They only provide air medical transport known as (HEMS) or helicopter EMS. They are currently unable to perform fire suppression missions and search and rescue operations as defined in our goals above.

Several things need to be understood here. First, our goal is NOT just to build another air medical program. If that was the case we would have invited one of the MANY existing providers that have approached us about this over the last decade and MANY have approached us. In fact, the existing PHI ship setting on the pad of CHI St. Josephs Hospital approached us prior to moving from Coulter Field to CHI and desired to have that base here. You must understand that without a true collaborative public-private partnership these bases open, close and move nearly daily in our state and are 100% based on the number of patients they transport for sustainability. Just this month multiple air medical-only bases have closed near San Antonio and surrounding rural areas of Texas. Which we believe will be much more fiscally efficient than our government owned and operated counterparts.

Their approach and pitch have always surrounded a priority that did not align with our primary goals of patient care to the highest level and fiscal responsibility. What we are building is a public multi-mission helicopter rescue program that will not only provide air medical transport for our sickest of sick patients but also support search and rescue missions including hoist rescue operations during flooding and fire suppression support for the many grass fires we see in Texas. The hoist operations alone would have saved the lives of four fatalities during our May 2016 floods. This program will be only the second program in the state that provides EMS critical care and rescue services and one of the few in the country. It is the first of its kind that has placed a private vendor into public rescue status using a government relationship that we have modeled.

"What about the exorboritant bills I hear about regarding air medical transport?"

It is no hidden secret that air medical billing practices and healthcare in general cause extremely high bills to be sent to the patients. Rumors of bills reaching an excess of $40,000 are not just a rumor. We are not only sensitive to this but it is also one of the reasons we have been reluctant to support a private for-profit air medical provider setting up shop here. However, this was discussed with the president of the air medical vendor. We have reached an agreement to sign the entire county residents up to what is known as a "subscription plan" It allows zero balance billing to occur. Meaning much the same as we do for our ground operations. We will be able to bill insurance carriers full bills and any additional amounts left unpaid would be written off by the billing company. The county resident patients will not incur these exorbitant bills.

"Will this helicopter rescue program help our neighbors?"

Absolutely. We believe this will truly serve as a regional program that can support helicopter that will support these counties with fire suppression needs and search and rescue needs including hoist rescue operations. Our intent is to utilize our existing emergency management, public safety, and local political relationships to create a program that is mutually beneficial for the rural counties surrounding us. It will certainly be made available to them and will be up to them should they take advantage of this opportunity for their citizens.

"There is no need for this program in such a small rural county and certainly not the expertise to manage it safely!"

The truth is most successful air medical programs are based in rural areas of the nation. The reason is in urban metropolitan areas there are major (Level I or II) trauma centers within minutes of driving distances. In rural areas, however, this can be 50-60 miles away. In our case it 45 miles to the closest Level II trauma center, PCI capable facility, and neurology, etc... Over 75 miles to the closest level I trauma center or pediatric-specific facility. Regarding the concerns of having the expertise to manage the program. We currently have the only two-time recipient of the Texas EMS Director of the Year employed with the County. He has also served for over seven years as a rotor wing (helicopter) based flight paramedic for a busy rural HEMS Program in central Texas. In addition to this, Mr. Casey Ping, has been consulting REACH to properly build this program concept, Casey was the Program Director for Travis County STAR Flight. Mr. Casey Ping has built one of the most successful multi-mission helicopter rescue programs in the nation. He has spent more than 25 years with Travis County and is retiring in July. We intend to hire a program director to work under our EMS Director to assist in managing the new helicopter rescue program. Mr. Ping has indicated he would apply for this position to assist staff personnel both building, developing and direct management of the new division. Mr. Ping is also on the board of the ICAR and the founding member of the APSCA

"Who is going to fly (actually pilot the aircraft) and who's liable or insuring this program?"

Director Deramus and Mr. Ping have vetted the REACH aviation flight department thoroughly. The Chief Pilot of Special Operations is a U.S. Marine Corp trained pilot and has served in various line pilot positions through instructional pilot positions for over 11 years with REACH (Marc Circali). REACH will have oversight of the entire aviation (flight) side of the operations and will manage the pilots, aircraft, and maintenance. Working directly with the FAA to ensure standard adherence and safety standards. REACH and Washington County will both hold insurance certificates in the unfortunate event of a liability incident.

"What about all the accessories that goes into a program like this (equipment)?"

Some people do not know this but Washington County EMS has one of the most respected special operations division in the State of Texas in regards to swift water rescue. Currently, we have two swift water rescue boats, a military version high profile water rescue vehicle, they utilize the latest state of the art night vision goggles (NVG's), etc.. and none of this equipment was purchased with tax dollars. It was all funded through donations to the department, grants, or other non-tax dollar funds. We expect to continue this process with the new program. However, our aviation vendor has also contractually agreed to the initial purchase of this equipment. Items such as night vision goggles, helmets, personal protective equipment, flight suits, rescue litters, etc... all are purchased by the aviation vendor.

"Who owns, operates, and maintains the helicopter?"

Early on during this conversation about creating a public safety helicopter program. We discussed this with our government partners and mutually decided this was not the perfect scenario. We felt there were certain efficiencies lost with a county trying to be its own aviation vendor. Meaning trying to hire trained aviation mechanics, pilots, flight department directors, etc... seemed to be an inefficient practice for one program. We have found that partnering with an existing vendor (REACH) who already has this staff naturally creates some significant cost-sharing related expenses. REACH air medical will own the FAA Part 135 that allows the aircraft to be utilized for air medical transport. REACH will supply the pilot and qualifications/training. REACH will provide mechanics and technicians. REACH purchased three EC145 aircraft. In fact, the actual aircraft currently being utilized by Travis County STAR Flight. These aircraft are already rescue hoist, fire suppression and medical airworthy rated by the FAA.

"You mention that this aircraft will be capable of fire fighting. How?"

The EC145 that will be housed here in Brenham will have a cargo hook that is capable of carrying a bamsi (self filling bucket when dumped into a water source) bucket that holds up to 150 gallons of water. Our Paramedic Crew Chief and Pilot will be qualified to perform water drops using a bamsi bucket. The benefits of fighting fire from the air can be enormous in grass or wildland fires. Specifically those we see here in Texas when at times the ground is wet and difficult to maneuver in with heavy rescue trucks. The helicopter can quickly extinguish hard to reach hot spots and assist local FD's in numerous ways. See the attached video.

"You have mentioned a private aviation vendor named REACH Air Medical, who will have organizational leadership and program management?"

The Director of EMS will have the ultimate program oversight. We, Washington County, have hired a program specialist to work under the direction and leadership of the Director of EMS who has specialized training in public multi-mission rescue operations. He will be the Air Division Chief of Operations just like Justin Knuppel is the Ground Divisional Chief. Both working under the Director of EMS. REACH will provide maintenance staff and pilots and will ultimately have organizational authority over their staff. However, the direction of the program meaning acceptance of missions, dispatch, crew competency and such will be no different than our existing EMS organization chart with the addition of the program manager.

I will add though that Director Deramus and Mr. Ping has vetted the leadership (Sean Russel -President, Marc Circali - Chief Pilot, etc...) as well as their overall company values. The collaboration and partnership seem to be a perfect match for what we have developed here in our EMS Department.

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