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.