In emergency situations, rapid transport to specialized medical facilities is often the difference between life and death. Transport Helicopters, specifically designed for medical evacuation, play a crucial role in this time-sensitive process. Organizations like Life Star, operating in Connecticut, exemplify the critical function of these airborne ambulances in delivering advanced medical care swiftly and efficiently.
Life Star’s critical care air medical transport service, established in 1985, stands as the sole critical care helicopter service in Connecticut. Utilizing two American Eurocopter BK-117 twin-engine transport helicopters, they provide 24/7 coverage. Strategically based at Hartford Hospital in Hartford and The William W. Backus Hospital in Norwich, their reach extends to a 150-mile radius, servicing all tertiary care centers within this area. Annually, approximately 1,500 patients benefit from this service, with over 20,000 patients transported to date, highlighting the immense impact of transport helicopters on healthcare accessibility.
LIFE STAR critical care air medical transport service began operation in 1985.
Image: The Life Star medical transport helicopter service, a vital component of Connecticut’s emergency medical services, commenced operations in 1985, utilizing specialized transport helicopters.
The Commission on Accreditation of Medical Transport Systems (CAMTS) recently reaccredited Life Star, underscoring their commitment to superior patient care and safety in air medical transport. This voluntary accreditation, valid for three years, signifies a rigorous evaluation encompassing education, safety protocols, patient care standards, quality assurance, and meticulous aircraft maintenance. This recognition emphasizes the high operational standards necessary for effective transport helicopter services.
Each Life Star transport helicopter maintains identical crew and capabilities, capable of accommodating two patients. Aboard every mission is a highly specialized crew: a flight nurse, a flight respiratory therapist (RT), a pilot, a mechanic, and a communication specialist. This consistent crew composition ensures a high level of expertise is available on every flight, regardless of the patient’s condition.
Life Star’s commitment to including both a flight nurse and flight RT on every flight distinguishes it within the air medical transport landscape. Unlike services that might deploy specialty teams based on patient type, Life Star’s team possesses a diverse and advanced skill set. This allows them to confidently manage the complex medical needs of all critically ill and injured patients they transport via transport helicopters. Life Star flight nurses are not only Registered Nurses but also Connecticut-licensed paramedics. Furthermore, they hold specialty certifications such as CEN, CCRN, or CFRN and bring a minimum of three years of critical care experience to their role.
Flight respiratory therapists are Registered Respiratory Therapists (RRTs) and certified as EMT-Basics, with EMT-Paramedic certification preferred, alongside at least three years of critical care experience. All medical crew members maintain certifications in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Neonatal Resuscitation Program (NRP), demonstrating a comprehensive foundation in emergency medical procedures relevant to transport helicopter operations.
Image: A Life Star medical transport helicopter offloading a patient to a ground ambulance, demonstrating the seamless transfer of care in emergency medical transport operations.
New medical crew members undergo a demanding pre-employment screening followed by a comprehensive six-month competency-based orientation and training program. This rigorous program includes clinical rotations with didactic instruction from attending physicians, preceptorship during flight transport shifts, competency evaluations, and thorough orientation to safety, equipment, patient populations, and standards of practice specific to transport helicopters.
The didactic component of the medical crew orientation is customized to address identified areas of individual weakness. Candidates with extensive experience in specialized areas such as neonatology, pediatrics, trauma, cardiology, and obstetrics may undergo oral board examinations to validate their expertise. Flight observation shifts are integrated early in the didactic period to provide practical context. Recognizing the critical skill of airway management in emergency medical scenarios often encountered in transport helicopter missions, all candidates participate in operating room rotations for endotracheal tube placement training.
A minimum of ten successful intubations are required each week during the OR experience. By the end of orientation, 55 intubations are expected, with up to 25 potentially performed in a simulation center. The remaining intubations are conducted in the OR, emergency department, or in the field, providing diverse and real-world experience. Ten successful intubations must be achieved before a candidate is permitted to perform intubations on board the transport helicopter during orientation, emphasizing patient safety above all else. This intubation requirement is adaptable based on individual needs and prior experience.
Beyond medical lectures, the training encompasses aircraft safety, continuous quality improvement processes, basic survival skills, water survival techniques, and air medical resource management, all crucial for safe and effective transport helicopter operations.
Air medical resource management training, a yearly requirement for all Life Star personnel, focuses on enhancing safety culture through team building and effective communication. Candidates also hone critical surgical skills in an animal surgical skills laboratory, practicing procedures like needle cricothyrotomy, transtracheal jet ventilation, surgical cricothyrotomy, needle thoracostomy, chest-tube placement followed by open thoracostomy, pericardiocentesis, and escharostomies. Training on Life Star-specific equipment is integrated throughout the didactic and preceptor training phases, ensuring familiarity with the tools used in transport helicopters.
Preceptorship commences after these initial training stages. If a medical crew candidate doesn’t demonstrate sufficient knowledge or skills, they receive targeted additional training. Preceptorship duration varies based on flight volume and preceptor feedback. Flight types (scene, interhospital) and diagnosis categories are carefully monitored to ensure each candidate demonstrates competence across all facets of air medical transport before being released from preceptorship. Post-flight debriefs, completed after every mission, assess clinical performance and communication skills, providing continuous feedback throughout the training process for transport helicopter crew members.
Independent flight clearance requires three key achievements: passing examinations for each section of Life Star’s standards of care, successfully completing patient care scenarios using a human patient simulator (HPS), and passing oral board examinations in neonatology, high-risk obstetrics, cardiology, Intra-Aortic Balloon Pump (IABP) validation, pediatrics, and trauma.
Life Star utilizes a high-fidelity human patient simulator with real-time case moderation to enhance clinical skills during initial orientation, continuing education, and for high-risk, low-frequency (HRLF) cases. HRLF cases include high-risk obstetrics, toxicology, neonatal, and difficult airway scenarios. These simulations are vital for preparing crew for the diverse challenges encountered in transport helicopter medical emergencies.
HPS sessions are led by experienced senior flight nurses and flight respiratory therapists, alongside the director of the Hartford Hospital simulation center. The Laerdal SimMan and Simfant simulators offer comprehensive physiological monitoring, replicating real patient conditions. Staff practice a range of procedures on the simulators, including airway management, surgical airway procedures, gastric intubation, and central venous access, all essential skills for transport helicopter medical teams.
Each simulated case includes pre-recorded radio communication mimicking dispatch and en-route patient updates, and a complete mock patient record. Staff conduct bedside reports, patient assessments, provide on-site and en-route care, and deliver radio and bedside reports to the receiving center, mirroring the entire patient transport process within the transport helicopter setting. Scenario-driven HPS sessions are recorded and utilize objective evaluation tools for clinical performance and team interaction. Initial training scenarios cover a wide array of clinical topics, including ACLS, PALS, NRP, cardiogenic shock, toxic ingestions, and various medical and trauma emergencies relevant to transport helicopter transports.
During their first year of independent practice, new crew members are paired with a more experienced medical crew member (with over six months of experience). Performance reviews are obtained from crew partners during this period. Before being cleared to fly with any crew member, discipline-specific leadership observes them during at least one flight shift. Each new crew member is assigned a mentor, a senior crew member, to guide them through the logistical aspects of transport medicine, ensuring a well-rounded onboarding experience for transport helicopter medical professionals.
Image: The Life Star helipad, a critical infrastructure element for transport helicopter operations and rapid patient transfer to and from medical facilities.
Ongoing education is integral to the Life Star flight team. Bi-weekly continuous quality improvement (CQI) meetings review flights and cases, and cover other essential topics. CQI is a continuous cycle of evaluation, data analysis, interpretation, and system modification aimed at enhancing patient care, a core principle for any transport helicopter service striving for excellence.
Annual skills day validates competency in using all onboard medical equipment and in specialized procedures like IABP, ventriculostomy, ventilator management, central venous access, and intraosseous placement, crucial skills for managing complex patients within transport helicopters.
Alongside annual skills day, medical crew members participate in animal surgical laboratories to maintain proficiency in surgical skills. Clinical staff rotate through the HPS program twice annually for recurrent training. Scenarios cover toxicology, high-risk obstetrics, and neonatal emergencies, ensuring preparedness for a spectrum of critical conditions encountered in transport helicopter medical transport.
Mandatory annual training for all Life Star disciplines includes altitude physiology, stress management, survival training, and Safety Day. These requirements validate competency in cockpit emergency procedures, fire suppression systems, hazardous material awareness, emergency engine shutdown, and emergency location transmitter procedures, all vital for ensuring safety in transport helicopter aviation. Emergency egress training further enhances safety, teaching crew members how to react to aircraft-ditching emergencies, particularly relevant for transport helicopter operations that may occur over water bodies.
Life Star’s comprehensive training program is meticulously designed to build upon a medical flight crew’s continuing education, enhancing their abilities and experience, ultimately ensuring the highest standards of care are delivered via transport helicopters to patients in critical need.
RT
Dawn Filippa, RRT, EMT-P, is a flight respiratory therapist with Life Star. For more information, contact [email protected].
