Tuesday, February 28, 2012

Temporary Improvement -
Permanent Inconvenience

The Allegheny Station of the new light rail North Shore Connector, with Rivers Casino in the background.
When the new rail line opens March 25, the Port Authority's 14 Ohio Valley bus line will end service here instead of continuing into Downtown.        (Pittsburgh Post-Gazette)

By now, most of us who live in the Ohio River Valley of Allegheny and Beaver Counties (and follow the news) are aware of the threatened end to Port Authority bus service to our area by September of this year. The long-time public transit provider, citing continued shortfalls in funding and a lack of commitment by the state to establish a sustainable funding plan for the future, announced their intent to eliminate the 14 Ohio Valley and 21 Coraopolis routes, along with many others.

This is just the start of what looks to be an interesting year for transportation in our area. "Interesting" as in the old Chinese curse, "May you live in interesting times". As local media and government officials have already begun to touch upon this week, the effects of the imminent closure of the Ambridge-Aliquippa Bridge at the end of this week are likely to be compounded by repaving work on the very stretch of Route 65 that will see increased traffic loads as a result of the closure.

While recent local focus on Port Authority service has been on the threatened cessation of the 14 Ohio Valley route, a planned change of service to coincide with the opening of the new North Shore Connector stands to impact commuters in different ways - not all of them good.

As the Post-Gazette reported in January, when the new light rail line opens on March 25, the 14 Ohio Valley will end service at the line's Allegheny Station, near Heinz Field. Commuters will then have to transfer to the light rail to continue their commute into Downtown, or in my case, points east.

As I've written before, I don't always take public transit. But when I do, I have my route nicely planned. A one-block walk from home to catch the 14 Ohio Valley, which currently ends its route at the East Busway station near Grant and Liberty. From there, East Busway route P1 or P2 will whisk me to the Homewood station, and it's about a 2-block walk to the 9-1-1 center from there.

After March 25, I would have to transfer to the light rail at Allegheny Station, disembark at Wood Street or Steel Plaza, and then walk to the East Busway station or to the US Steel Tower to catch the P1 or P2 to Homewood.

Perhaps this "adjustment" is meant to soften the blow of the 14's apparent demise if the Corbett administration doesn't man up and decide to do something by September. However, other factors may be contributing to this lack of attractiveness. Consider the criticism leveled at the entire North Shore Connector project since its inception.

One recent new development has been the enlistment of financial support from several stakeholders on the North Shore - the Stadium AuthorityAlco Parking Corporation, Rivers Casino, and the Steelers - to provide enough funding to make the entire new connector part of the existing free fare zone that allows riders to travel the subway under the Golden Triangle without cost.

While that's pretty cool for the occasional weekend excursion or date night, what is the practical impact for the Sewickley area commuter? It seems to me as if the powers that be are making the use of public transit so difficult or impossible that they are hoping commuters just opt to drive into town and park on the North Shore, so that some of these forward-thinking enterprises can recoup some of their investment in the form of parking fees and other spending. That is, if you have a car, or can drive at all. 

An "improvement" such as this only serves to make things more cumbersome in the long run.

On average, using public transit would take me about three times longer than driving, with minimal cost savings at current gas prices since I don't have to pay to park. In my case, it seems as if Port Authority is deliberately trying to get me to rule out public transit as a viable option for commuting.

There are, however, other potential options available to commuters in this area. One is the bus service currently operated by the Beaver County Transit Authority. It's not as easy as it would seem at first blush, however.

According to Kristin Sheleheda, BCTA's Manager of Planning and Technology, the authority is making no plans to increase service in the wake of the impending Port Authority cutbacks. She also stressed that while BCTA makes stops in Allegheny County, all riders must board and/or depart from a location in Beaver County. For many Sewickley commuters, this would mean a "back track" to the Ambridge Park and Ride lot on 11th Street (jointly operated with Port Authority) to board BCTA Route 1 there.

Ms. Sheleheda also stated that current ridership on this route, as well as available parking spaces in Ambridge, doesn't make for a lot of space for additional commuters from Allegheny County. One must also consider the potential impact of the closure of the Port Authority Park and Ride in Moon Township, also slated to occur in September.

Another possibility is the involvement of the private sector in providing transportation. Ohio Township-based  Lenzner Coach Lines stepped in to provide bus service to and from the outer North Hills and Cranberry, after Port Authority service cuts last year. While it's unknown if demand, cost and/or market viability would permit Lenzner to establish a profitable route to replace the 14, Lisa Finigan, Lenzner's Charter Manager, told me that they are "watching".

Perhaps a better question would be how all of this translates into an improved system of moving people around the city and the region, and what this all means to our attractiveness as a destination for prospective employers as well as visitors. I think about this a lot whenever I travel through the North Hills, the North Boroughs, or my old neighborhood in Aliquippa. In my mind's eye I can still see where the streetcars used to run.

You can ask some of the same questions of PennDOT when looking at some of the remnants of the past that they still lean on heavily to support the transportation needs of the future. Consider that the Ambridge-Aliquippa Bridge, opened in 1927, carries about 12,000 cars a day, while the Sewickley Bridge, originally built in 1911 and replaced in 1981, carries around 19,000 cars.

It would seem that the Ambridge Bridge is due for replacement, or at least a plan to do it, but no one seems to be talking about that at all. Jim Struzzi of PennDOT District 11 told me that there are indeed no plans to replace the now 85-year-old span.

Considering that Ambridge is enjoying a revitalization of sorts through the reclamation and redevelopment of older industrial sites, and Aliquippa may be in the running to do the same, the importance of a reliable river crossing here seems hard to understate. 

It took years of politicking and economic uncertainty to replace the first Sewickley Bridge; what will it take to help assure that when Aliquippa and Ambridge are ready to grow in earnest, a strong and reliable bridge will be in place to facilitate it?

I haven't been back here long enough to understand all the nuances of transportation funding in Pennsylvania, but according to several sources one of the main reasons behind all of this trouble is the refusal of the federal government to allow the state to make I-80 a toll road. This was a key part of Act 44 of 2007which also established a funding partnership between the Turnpike Commission and PennDOT.

The federal refusal to allow the tolling of I-80 is what appears to be pinching both PennDOT and the Port Authority now. This sounds to me like building the casino and buying all of the slot machines before the gambling law is passed. Why rely so keenly on something that doesn't exist yet, and is risky to boot?

This analogy probably has something to do with the fact that the bulk of this post is being written in Las Vegas. I don't gamble, however, and neither should those we as citizens entrust with being stewards of critical infrastructure and services.

Governor Corbett has recommendations in hand from a commission that he appointed, but seems content to not act upon them thus far. How do we as a society and a state plan on improving anything when that is the example being set by our leadership?

Have a good week ahead.

Postscript, 2/29/12 12:43 PMPort Authority is holding a required public hearing on their proposed service changes today at the David L. Lawrence Convention Center. Testimony is expected to continue through 8:00 PM tonight. Check the P-G or Trib websites for more information. 
Also, Port Authority has an online public comment form available. It can be accessed by clicking here.

Wednesday, February 15, 2012

Construction Creates Chopper Confusion, Communication Challenges

The greater Sewickley area, with the Hospital and its most recent medical helicopter landing zones indicated. (Bing Maps)

On a quiet Sunday afternoon last October, I was doing some household chores when the unmistakable hum of rotors overhead shook the house. I knew the sound – a light twin-engine helicopter, most frequently used locally for EMS purposes. Not having heard the fire department across the street responding anywhere, I turned on the scanner and jumped in the car.

What was happening should be a fairly routine occurrence for any community that has a hospital such as Heritage Valley Sewickley. Interfacility transfers from smaller hospitals to larger facilities with specialized capabilities make up the lion’s share of the air medical transport business in this region. A helicopter had been summoned to transport a patient from the Sewickley hospital to a specialty facility in Pittsburgh.

This is a more complicated process than in most communities; Sewickley is one of only two full-service hospitals in Allegheny County that is not served by a licensed heliport (the other is UPMC McKeesport). Typically, the use of this type of Landing Zone (LZ) requires a Police, Fire, and EMS response - scene safety and security issues need to be addressed, and an ambulance is needed to transport the helicopter crew to the hospital, and bring them and the patient back to the aircraft. 

The radio traffic revealed a lot. The helicopter was circling Quaker Valley High School’s stadium, but was telling its dispatcher that all they saw was an athletic event. They could not make radio contact with anyone on the ground. The helicopter’s dispatch directed them to the field at the Sewickley Valley YMCA, across Blackburn Road from the hospital. Upon my arrival there, families were playing soccer together, but nothing indicated that the field was to be used for emergency purposes.

I found the collected public safety resources of Sewickley Borough assembled at the Quaker Valley Middle School, awaiting an aircraft that never came. The STAT Medevac chopper elected to land at the Valley Ambulance Authority headquarters, across the river along Route 51 just south of the Sewickley Bridge.

Construction activity at the Middle School had just begun in earnest; I heard additional radio traffic that indicated that the Middle School, which apparently was the "regular" LZ for the hospital, was not going to be available for use because of the work going on. I chalked up the confusion to this logistical uncertainty, and figured that the powers that be would have it straightened out in short order.

However, two similar situations occurred during the third week of January. On the first occasion the helicopter elected to land at Valley Ambulance again. The following day, the landing occurred at Osborne Elementary School.  I thought it necessary to look into the situation a little further. What I found presented an opportunity to learn more, and perhaps identify some issues that may need to be looked into down the road.

Aerial view of Heritage Valley Sewickley, with the YMCA and its soccer field across Blackburn Road. (Google Maps)

When I lived in the area before 1995, helicopter landings for patients at what was then Sewickley Valley Hospital were relatively infrequent. When those landings did occur, the LZ of choice was the soccer field at the Sewickley Valley YMCA, as illustrated.

During 1993 and 1994, controversy ensued about the lack of a heliport at the hospital, along with issues related to noise and safety as it impacted residents of the neighborhoods surrounding both the hospital and the YMCA. I contributed my own opinion at the time, which was that if the hospital intended to fly people out of their facility, then they should work toward building a heliport on their campus.

I wondered why the YMCA was apparently no longer being considered for landings, and found two public servants willing to shed more light on the subject. Cochran Hose Company Chief Jeff Neff stated that the YMCA field has become "tighter" for landings due to the facility's expansion encroaching upon it, and the field's location against a wooded hillside. When the "Y" added a row of parking to its lot south of the field, the decision was made to use the Middle School field along Ohio River Boulevard as the "official" landing area. Sewickley YMCA Executive Director Trish Hooper did not respond to a request for comment.

Chief Neff also stated that he had received an e-mail from "someone on the medical side" indicating that until the work at the Middle School was complete, all landing zones for patients being flown out of the hospital will be established at Valley Ambulance's headquarters. This landing area is located between Route 51 and the railroad tracks, in a largely industrial area. Sewickley Borough Manager Kevin Flannery, who has been directly involved in the planning efforts to establish an acceptable designated landing area, confirmed Chief Neff's statements. When asked about any community concerns regarding more recent arrangements, Mr. Flannery stated that his office has not received any complaints in recent years.

Landing Zone at Valley Ambulance Authority headquarters along Route 51 in Moon Township.

Acceptance by the community is but one of a two-pronged approach to the problem of where to establish an area to land what is, for many areas, a critical means of accessing emergency care. According to Frederick V. Peterson Jr., Vice President for Emergency Management at the Hospital Council of Western Pennsylvania, the state has "strict licensure criteria" that govern exactly where and how a heliport is constructed, maintained, and monitored, including assuring that the landing area is "sized to accommodate the size of the aircraft that intend to use it". Mr. Peterson added that an unlicensed LZ designated by a hospital for patient transfers may only be permitted a certain number of landings before attracting some type of regulatory attention. 

As you would expect, the government has lots to say about heliports. The FAA has published detailed guides with recommendations on heliport design, and one of the nation's foremost authorities on fire safety and emergency preparedness has just issued updated standards for the nation's heliports, most of which are owned and/or operated by hospitals.

In Pennsylvania, evaluating and licensing heliports falls under the purview of PennDOT, and its Aviation Division. Spokesperson Erin Waters characterized her agency's approach to an unlicensed hospital LZ this way:
While we evaluate heliport situations on a case-by-case basis, in general, if the hospital's stated "intent" is that the designated site will be used approximately four times a year then no licensing action would be required. The municipality may have local zoning requirements that must be met as well for this "infrequent" use. Upon owners' request, we would be willing to review sites. We work to facilitate a cooperative relationship with aviation stakeholders.
The amount of use that LZs get in the Sewickley area would appear to fit that profile. When asked about any concerns that the Quaker Valley School District had regarding the use of their property for this purpose, Dr. Joseph Marrone, Director of Administrative Services, stated in an e-mail:
Safety which has been addressed by all concerned.  The other is disruption to the teaching and learning process.  The use of the fields is very infrequent, a few times a year.
Another factor to consider is the role that Heritage Valley Sewickley plays as the closest hospital with an Emergency Department to Pittsburgh International Airport. In the event of a Mass Casualty Incident (MCI) there, or anywhere proximal to the Sewickley area, how would the lack of a licensed heliport impact the hospital's ability to receive and/or manage patients? 

According to Knox T. Walk, EMS Manager for Allegheny County Emergency Services, the impact would be negligible. "No hospital destinations (specific to the severity of a patient's injuries) are written into the Airport MCI plan", Mr. Walk stated. This is designed to prevent any particular hospital or group of hospitals, i.e. trauma centers, from being inundated with victims it could not handle. Given the hospital's proximity to Pittsburgh and its trauma centers and other specialty facilities, Mr. Walk added that he thought it "doubtful" that helicopters would be used to transport patients from Sewickley Hospital in an MCI scenario.

Considering that it takes me about 20 minutes, absent rush hour traffic, to get into downtown Pittsburgh from Leetsdale, one can see very quickly the validity of Mr. Walk's assertions. In addition, our area is served by one of the county's largest and most competently run EMS agencies. The availability of rapid ground transport, combined with the direct traffic routes and drive time at emergency speeds, literally makes a helicopter trip from Sewickley into Pittsburgh more time-consuming in comparison.

With these factors in mind, why are any patients flown from our area hospital? This is where incident-specific circumstances and patient care issues begin to muddy the clearer waters we seem to have explored thus far.

It's been reported that some of these most recent helicopter trips involved the transport of pediatric patients or premature infants. The specialty centers that receive and treat these types of patients often send their own personnel and equipment with the helicopter to effect the patient transfer. These "specialty teams" help to assure that the patient receives specialized care at the earliest opportunity, and helps the referring hospital meet its obligations under federal law to effect the transfer with "qualified personnel and transportation equipment", which the referring hospital may not have or be able to spare.

In some cases, the hospital receiving the patient is the one that makes decisions on the mode of transport. This appears to be the case with one of the recent landings; according to Mr. Flannery, the staff at Heritage Valley Sewickley were not aware that a helicopter was being sent. In the early 90's, a medical helicopter with a Children's Hospital transport team responded for a child in distress at the Edgeworth Commons outpatient surgery center, landing in the parking lot with little or no prior notification to local Police, Fire, or EMS. Incidents such as this helped to create the emphasis on a coordinated, multi-disciplinary response to help assure proper coordination and protection of patients, responders, and community assets.

So where was the ball dropped here? As it is so often in many, if not most jurisdictions across the country, problems arise when essential communication pathways are under-utilized or ignored. Something as simple as the lack of a common radio frequency for contact between ground responders and the aircraft continues to hamper air medical responses, and diminishes their effectiveness when time to definitive care is a factor.

A change in the availability of an infrequently-used landing area - recognizing that change, identifying an alternate contingency, and communicating it to all stakeholders in advance of a pressing need - these are all things that I have encountered in my years in EMS, air medical, and public safety communications.

I would have preferred to obtain a greater perspective from what would appear by all aspects to be the key local stakeholder, but attempts to secure a statement from, or an interview with, a representative of Heritage Valley Sewickley were unsuccessful. J. Daniel Murphy, Vice President for Institutional Advancement, stated in an e-mail that he tried to obtain a statement for a week after my initial call, but didn't have any luck.

Mr. Murphy referred me to Mr. Flannery at Sewickley Borough, who seems to be the official most responsible for assuring that some form of communication took place across multiple jurisdictions, institutions, and disciplines. Multiple messages left for representatives of the region's air medical service providers,  STAT Medevac and Life Flight, also went unanswered.

It seems that we as citizens, and especially as health care consumers, are faced with an escalating risk-versus-benefit equation when it comes to managing the type of health care services we seek out, receive, and are able to reasonably afford. As these concerns continue into this presidential election year and beyond, it's my hope that we can have some assurance that the community's public safety net - and that includes hospitals and helicopters - will all be on the same page about what is needed, how to get it here safely, and how to make sure the community's risk profile is not impacted negatively by a lack of coordination or communication.

Be safe out there.