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.

Air Medical Safety 'In Action'

Wednesday afternoon I took Leslie some lunch at work, and then took Gianna and her friend Jaime to the Robinson Mall. Afterward, I turned on the scanner and made my way toward Steubenville Pike and Route 30. My plan was to take Rt. 30 to Clinton, then head back home from there.

While in the area, I heard North Fayette VFD being dispatched to establish a landing zone at their station on Steubenville Pike. Having not monitored an accident or other incident occurring, I was intrigued by this development, and headed over, arriving just after the STAT MedEvac helicopter did.

Upon arriving, I overheard an officer of the Fire Dept. explain to others that the aircraft was landing there to transfer a patient from the nearby Kindred Hospital, a Long Term Acute Care facility. Northwest EMS was staged at the landing zone to take the crew to the hospital and bring them back to the aircraft with the patient.

While I was taking pictures, I noticed the crew paying what seemed to me an inordinate amount of attention to the sliding aircraft door. It appeared that when a crew member opened the door, it would not close or slide properly. Eventually, all 3 of the aircraft crew became involved in evaluating the problem with the door. It was obvious as to why; if the door could not be restored to normal operating condition, it was an issue that could potentially ground the aircraft.

After a few minutes, the medical crew left with Northwest EMS for the hospital. The pilot, who normally remains with the aircraft, got on his phone. It looked to me like that "Hello, AAA?" posture that people can be seen assuming while they're sitting inside their disabled vehicle on the side of the road. Instead, the call was likely to the STAT MedEvac communications center to get a mechanic involved.

About 30 minutes later, the Northwest ambulance that was initially at the LZ drove past the fire station, and I overheard on the scanner that the ambulance was on its way to UPMC Mercy, with the aircraft medical crew and patient aboard. Additional scanner traffic, and a conversation with the fire official at the scene, confirmed that the aircraft was indeed grounded by the malfunctioning door, and that a mechanic was on the way to address the issue.

Voice mail messages left for STAT MedEvac media relations staff were not returned.

This kind of occurrence may seem trivial, but it's fortunate that this did not occur at an emergency scene flight. Even if it had, despite the heightened emotions and sense of urgency common to those kinds of calls, the decision making would likely not have changed.

That's a good thing. This was absolutely the right thing to do, in any circumstance.

Over the past several years, in response to numerous accidents and incidents involving EMS helicopters, many air medical operators, with the support of trade organizations and the FAA, have moved to alter their operational practices, and even the culture within the organization, through the implementation of Safety Management Systems. These efforts involve a combination of regulatory and organizational changes designed to accomplish the following:

• Define how the organization is set up to manage risk.
• Identify workplace risk and implement suitable controls.
• Implement effective communications across all levels of the organization.
• Implement a process to identify and correct non-conformities.
• Implement a continual improvement process.
  

STAT MedEvac touts their commitment to SMS and safety practices on their website. As one who has worked in and followed the industry over the years, the accomplishments of STAT MedEvac with regard to the above bullet points appears to be fairly impressive, as it should when you are operating 17 helicopters across the region.

As the ambulance drove by on the way to Mercy, without lights or sirens, I wondered about the utilization of air transport in this instance. What were the patient's needs? Rapid transport? Specialized care not otherwise available? These are questions that have and will continue to be asked, especially as the debate over health care costs continues to heat up. That's for another post.

In the meantime, as an educated and experienced observer I was impressed with the level of professionalism, organization, and decorum on the part of the Fire and EMS agencies involved in the response. It's indicative of a general improvement in these areas that I've noticed since moving back.

Have a pleasant, blessed, and safe Easter weekend.

Prurient Pat-Downs, Soccer Supremacy

I knew that the TSA controversy would not be complete until SNL got to weigh in on it.

Enjoy:

This fall it's probably fair to say that the best professional Football being played in Denver isn't being played at Invesco.

The Colorado Rapids will be playing this evening in the MLS Cup championship in Toronto against FC Dallas. Soccer is a great game, and the Rapids have really ramped things up in the playoffs.

Best of luck to the Rapids tonight.

Have a great Sunday.

Backscatter Blues - The Sequel

One of the two main security screening areas at Denver International Airport.

There appear to be two Advanced Imaging Technology (AIT) scanners in place.

This configuration is the same at the other security checkpoint in the terminal.

Leslie and I spent a few (too few) very pleasant days together this week, and I flew out of the Pittsburgh airport Thursday evening. There are two AIT scanning units in place at PIT's only security checkpoint, and I again did not have to make the scan-or-grope choice.

When I got back to Denver around midnight, I got the above look at a checkpoint with no one there. Two of the AIT units are in place at this checkpoint, along with two at the second terminal checkpoint. There are obviously numerous magnetometers in place that continue to screen passengers, and that only a percentage of the traveling public, if not a minority, are subject to the advanced screening at present. I obviously don't know what the ratio of advanced units to the old-style magnetometers is at major airports across the country, and I doubt that TSA would volunteer this information.

Based solely on my experience at two airports this week, and given the short time frame before the Thanksgiving travel rush, I don't believe that TSA will be able to, or even wants to, put their draconian screening agenda in place before next week. This could be in response to the public outcry, or perhaps to try to deflate protests such as National Opt Out Day.

It's quite possible that additional advanced scanners could be deployed before the Christmas holidays; more reason for those who oppose their use and/or the more aggressive pat-downs to maintain due diligence. So far, it appears that there is plenty of hue and cry despite polls that say otherwise. But like anything that catches the attention of a fickle 24-hour news cycle, staying power without provocative storytelling or visuals can be a hard thing to come by.

I have personally struggled with the concept and execution of this program, especially when I read internationally recognized security experts panning the TSA's efforts. However, I am equally concerned with surreptitious activities that could be much more damaging to the fabric of the American way of life than backscatter X-Rays or a screener getting a little too familiar with your private parts.

While the egregious nature of these gropings in the name of security theater seem to be easily monitored, documented, and reported, increased profiling, data mining, and threat assessment activities are not. Many of the media articles regarding the TSA controversy reference the airport security procedures utilized by El Al, the Israeli national airline, which include interviewing every passenger. The airline suggests that passengers arrive three hours before departure.

Several commenters have favored this type of interpersonal screening over a technology-based effort that seemingly has to change with every new way that someone tries to blow up a plane. On the other side of the equation, civil and religious liberties groups have concerns about profiling associated with this method of screening.

The recent debacle in Pennsylvania involving a private, US/Israeli-owned concern identifying lawful association and protest activity as "threats" further underscores the need for close regulation and monitoring of any activity of this type.

So it appears that we have a choice with how to deal with security while flying; endure scanning or search procedures that are intrusive and infringe on cultural and religious expectations for privacy and modesty, or allow unrestricted information gathering and possible profiling which can be used to gather and store information on the lawful activities of private citizens, whether or not it involves traveling by air.

Without assurances that constitutional protections are in place for the latter, I would prefer an occasional particle beam or grope than the unfettered expansion of a surveillance society.

I will have loved ones flying over the holidays; Evan will travel to see his aunt and uncle in Oklahoma over Thanksgiving, and Leslie and Gianna will be here for Christmas. I want to make sure they are protected by a system that is responsive, effective, and fair.

Enjoy your Thanksgiving week, wherever your travels may take you.

Backscatter Blues

Transportation Security Administration

I got dem backscatter blues,

it's not just "take off your shoes",

but now they blast me with electrons

to see me in the nude,

Oh yeah, I got dem backscatter blues..

Leetsdale, PA - I drove from Grand Junction to DIA yesterday morning to take advantage of some very nice week-before-holiday-craziness airfares, and spend a few days with Leslie. The passes on I-70 were a bit interesting with the snow, but it took only an hour longer than usual to get to Denver.

Once I got to DIA I started looking for signs of discontent with the new Advanced Imaging Technology body scanners that TSA says are in Denver and a number of similarly-sized airports. These have been causing quite the ruckus among some travelers, travel industry lobbying groups, airline employees, and civil rights activists.

The scanners (they look like the one pictured above) were in use at one of the two large security checkpoints inside the Jeppesen Terminal that I got to look at. There was a fairly long but well-moving line of people, and I didn't notice much wanding or patting down. Some travelers were going through the old magnetometers, but a good portion were getting their altogether analyzed by a couple of someones in a nearby office.

I'm sorry, but having engaged in Dispatcher humor over the years I know a job is a job and human nature is human nature. I can't help but imagine comments like "Hey, Charlie, get a load of these!" floating around occasionally.

Because I was flying out of the A Concourse, I chose to use the smaller checkpoint located just before the bridge that connects the main terminal to the gates and airport offices at this concourse. I did not have to make the fateful "porno-scan or pat-down" choice that many travelers have had trouble with of late. There were two AIT machines in place, but neither of them was being used. I whisked through one of the four magnetometers in use, and was at the gate with time to spare.

The TSA personnel that check IDs and boarding passes were going out of their way to say "hello", and ask "how are you doing today?". To an semi-educated non-expert like myself, this felt like one of the most innovative and non-invasive screening processes that the TSA could employ on a regular basis. Most Americans will respond positively to pleasantries, especially in the regulation-regimented mundane environment that is the flying experience today. Anyone who doesn't would probably stick out.

Is being unsociable probable cause for more intensive scrutiny? I personally doubt it, but with TSA trying to re-write the rulebook for civility and civil liberties in the age of "security theater", just about anything is possible. This is why due diligence and common sense need to be the order of the day, not more ridiculous rules that frustrate the flying public even more than flying does already.

The scanning of pilots was evidence that not a lot of foresight was going into the processes that TSA uses. As the pilots' unions and several aviation experts have pointed out, why would a pilot need to be scanned for a box cutter when he is eventually going to be placed at the controls of the most deadly terrorist weapon in recent history - a fully-fueled jet airliner?

For me, it appears that the TSA is treating the average, law-abiding citizen like the proverbial frog in the pot of water on the stove. How high will "Big Sis" (TSA Secretary Janet Napolitano) turn up the heat, and will citizens jump out in dismay, or sit there and be poached?

Have a great evening.

Of ER's and Airlines

I began Tuesday by looking for some local media coverage of the 'Gasland' screening the previous evening that I couldn't attend.

Finding none (grrrr), I did locate several items that resonated with me and are likely of some significance to all of us:

I've traveled on airplanes a lot over the last several years. A lot of that flying has been on jetBlue, because of convenient flight times, destinations, reasonable fares, and amenities that make the flight go by faster. No bag fees and free satellite TV are big pluses.

I've never encountered a situation like the one that resulted in the flight attendant becoming fed up, which has dominated the Internet chatter since Tuesday and perhaps become its own example of what one online commenter called "narcissistic, impatient, and self-centered".

A lot of people have a large measure of sympathy for Steven Slater; knowing the nature of the airline business, a meltdown such as his might be understandable given the awesome responsibilities, business pressures, and working conditions conducted in the face of an unsympathetic and at times hostile customer base. One could say the same about public safety personnel, especially police officers.

Nevertheless, jetBlue, its customers, and the FAA had expectations of Mr. Slater when he put on that uniform and stepped onto that aircraft in Pittsburgh. Based on other news reports, he may have been on his last nerve even before his initial run-in with the (inexplicably) still-nameless passenger over carry-on luggage.

In the end, Mr. Slater failed to meet those expectations in a most egregious manner. Regardless of how the details are spun or how much sympathy people may have for him, there will be consequences for his failure. To borrow from the sometimes nebulous parlance of today's Human Resources profession, I wish him the best in his future endeavors.

In defense of the remainder of his profession, I believe that a large measure of what a business gets from its customers rests very much on how the employees feel about working there. With the airlines, I'm always intrigued at the different ways that they operate, and how that affects the overall flying experience. Based on all of that, I can say that jetBlue is pretty cool, but that Southwest still has them all beat.


Another profession that is on the front lines of our collective community safety net is the nursing profession, especially those that staff our nation's emergency rooms. I've known numerous ER nurses over my working life, and they are truly a breed apart in terms of their level of commitment, expertise, and general approach to life and living.

ER nurses see the best and worst of what comprises our society; these metrics do not follow the lines of social or economic status. In an AP story from Tuesday, assaults on ER nurses are on the increase, and mental health and substance abuse programs are being cut at a time when economic pressures stand to result in increased drug and alcohol abuse, violence, and as a consequence, ER visits.

Many ER nurses are fed up, and are pursuing criminal charges against those patients that assault, grope, or spit on them in the course of trying to assess their injuries or render care. Nursing groups such as the Emergency Nurses Association are lobbying state legislatures for tougher laws, including making assaulting a health care professional a felony.

The AP story quoted a representative from the International Association for Healthcare Security and Safety about the need for hospitals to re-think their approaches to safety and security in the ER environment. As someone with a lot of experience working in hospitals, I understand the need to devote considerable time and energy to develop policies and practices that optimize the mission and goals of health care organizations.

However, I think that hospitals need to use these opportunities to partner with experts outside of the industry to develop community-based plans for responding to and handling issues in the ER and hospital environment. Hospital security personnel, the majority of whom are not sworn law enforcement officers, should have core competencies in managing critical incidents that dovetail with incident management practices already being used by their local public safety agencies.

Like I've said before, I haven't had any personal experience with uncivil behavior on an airplane, but I've seen enough bad behavior in ER's to last me just fine. Either way, we as citizens and human beings have some responsibilities in these areas, so I'll conclude with my ideas on this:

• BEHAVE. If you encounter behavior that is an affront to your sensibilities, attempt to deal with the situation calmly, avoid physical confrontation or personal attacks, and try to remember details; names, dates and times, locations, what was said, etc.

• DOCUMENT what happened, whether it be a police report, letter to management or government agency, or just a personal narrative for later action. Include the details. Be articulate, forthright, and unemotional. Insist on a reply and follow-up action.

With that, enjoy your fellow human beings the rest of this week and the weekend ahead. Some ideas for healthy camaraderie that you might find me at this weekend include the Friday night Glade Park Fire Dept. Movies Under the Stars (still the best family entertainment around), and KAFM's RadioDaze event Saturday at the Kannah Creek Brewery.

Take care.

Spring 'Break' Travelogue

One week ago Friday I left the freezing rain and wind in Denver for the wind-driven snow of Omaha for a job interview. I was dutiful in arriving at DIA an hour and 45 minutes ahead of my departure time, only to be met by a mass of humanity comprised of two of the larger groups of travelers that still appear to be active even in this economy; spring break and collegiate athletes.

This wasn't the college-age spring breakers headed to Florida or Mexico; these were families with several groups of teens and tweens in tow, who seemed hell-bent on packing their entire wardrobes along with them. This made for an interesting combination with the men's and women's track and field teams from the Air Force Academy.

To make a long line short, myself and my luggage barely made it to the plane in time.

I spent a good portion of the day trying to familiarize myself with Omaha and its surroundings, should anything come of my interview, which seemed to go well. That evening I flew to Pittsburgh to spend some time with Leslie and check on my mother, who fell a couple of weeks ago and sustained a shoulder injury.

Leslie's daughter Michaela was looking well at the beginning of the week; she was talkative and somewhat more energetic than she had been in past visits. We enjoyed some springtime activities to go with the sunny, 60-plus degree weather, playing miniature golf and eating ice cream.

By mid-week, however, both the weather and her disposition had changed. Recurrent bouts of nausea and vomiting had us in the ER at Children's Hospital twice, primarily for IV fluids and anti-vomiting drugs to try to keep Michaela from becoming dehydrated. Near the end of the week, she started receiving these fluids and meds at home.

Michaela is due for a follow-up visit at Children's in Philadelphia, which will hopefully show that the MIBG radiation she had earlier this year is beating back the neuroblastoma that she has fought for over 4 years now. Your prayers and kind thoughts are welcome as always.

I was also at a local hospital with my mother, so that she could have an MRI scan of her injured shoulder. The concern here is identifying a need for surgical intervention, and if none is required how much rest and healing is needed before starting any rehabilitation. Either way, the goal is to preserve as much function of the joint as possible.

My Hometown.

Mom's convalescence was further complicated by some type of flu-like illness toward the end of last week. I made a couple of grocery runs for her, and when I left on Saturday she was starting to feel slightly better. I'm hoping that the trend continues for both her and Michaela, and as I make my way back again soon I'll hopefully be able to see some smiles again firsthand.

*****

I extended my visit by a couple of days, and the clamor of Spring Break reared its ugly head again when trying to plan a return trip. In this context I really can't say enough about Southwest Airlines. Their method of operations, efficiency, and level of customer service really stood out on this trip, and they deserve some props for the way that they conduct themselves in an industry that is largely perceived as an essential but nonetheless unpleasant experience.

At a minimum, you can change flights and use the same funds you initially paid without penalty. They charge no baggage fees in the majority of circumstances. If you book far enough ahead of time, their fares are hard to beat. One of their customer service reps spent a good 45 minutes on the phone with me trying to connect the dots from Pittsburgh to Denver without extensive layovers. She was patient, efficient, and knew her stuff.

Southwest's gate operations are as efficient as they can possibly make them. They turn an aircraft around and move people better than just about anyone. They do this with a pleasant disposition and even a sense of humor. An example is below, from a few trips ago:

(Upon touchdown) "And believe it or not, that was his first try..Ladies and gentlemen, we at Southwest Airlines would like to be the first to welcome you to Pittsburgh. Please remain seated, with your seat belts fastened, until Captain America brings us to a screeching halt at the gate."

People seem to get this about Southwest, because nearly every seat was full on every flight this time around. Nice job, folks.

Say what you want about the airline industry. Michael Moore made a few good points about that in his latest film. Yeah, I'm trying to find work in this business, and it's not easy. $10 and hour to dispatch planes in Memphis? How about I just flip burgers in GJ or Denver or Pittsburgh for 9?

And yes, it can be an unpleasant to be intruded upon by our security infrastructure and then stuffed into a 500 MPH sardine can. There are ways to deal with this (see Up In The Air - for more than just this reason), and it helps when simple human decency trumps the unpleasantness of the situation.

In fact, just about everyone I interacted with seemed to be quiet, pleasant, patient, and mindful of others, despite some of the circumstances they were encountering.

Well, not quite everyone...

Have a good week ahead.

Addendum, 3/29/10, 4:40 PM: Today's Denver Post featured a story on the Aircraft Dispatcher training program at Jeppesen that I attended last year. It's a great program, and appears to be available without costs for residents of several metro Denver counties. Reading this will give you an idea about the situation many older workers find themselves in.

"Quiet" Time in the Civil Wars

One month ago, I left Denver after successfully completing Aircraft Dispatcher training. The trip five Mondays ago to San Jose was interesting and enlightening; more about that below. I then flew the redeye from San Jose to JFK and then a morning flight into Pittsburgh, for about five days with Leslie and the girls, and perhaps a chance to decompress for the first time in a good while. The visit was all of that, and a bit more.

I arrived back in Grand Junction in the wee hours of Nov. 4, and got about 3 hours of sleep before beginning the better part of three days of recording about 160 middle schoolers for the Words program. Post-production begins in earnest this week, with no real end in sight, as we will be recording another large group of kids in December. Despite some at times tenuous logistical and other challenges, this is a lot of fun, and has helped to keep stressful times in their place.

Since returning from Pittsburgh, I've been decidedly more reflective about things as they are, and about how they may turn in certain ways in the foreseeable future. I use this term almost laughingly; if, six years ago, I could have foreseen what was going to happen to my family and career, I would not have believed it.

In any case, the written word has been hard to come by of late, and I chalk this up to something that I can't put my finger on, save that I've been more peaceful and quiet than I can remember in a long time. For the most part, it's been a good thing. I hope that I can hold on to that feeling while I try to bring this electronic journal up to speed, along with managing the process of getting a new job in a tough economy.

**********

The Air Medical Transport Conference in San Jose was kind of what I expected; many of these trade conferences are somewhat formulaic in their organization and presentation, and the venues are typically some cavernous convention facility that all look painfully similar, save for the unique metropolitan canvas that has been painted around each one.

The differences with this conference, aside from all of the nice helicopters in the exhibit hall, seemed to center around unspoken differences, discomforts, and uncertainties coming from those who ply their trade in the air medical industry, or who supply hard goods and/or services to it.

Some of the presentations that I attended were straightforward and very informative. An overview of proposed and pending FAA regulation of air medical services operating under Part 135 of the FAA's rules seemed to be fairly well-received by the numerous attendees present.
Some of the recent NTSB recommendations were discussed at greater length than others, but I came away from the session with what I had traveled in part to hear; that there will be a greater emphasis placed on operational control by the FAA with HEMS operators who have more than 10 aircraft operating. This means the potential for a greater number of people trained as I am to be working as part of the industry.

A presentation on dealing with "difficult" employees was interesting, but in retrospect was somewhat off the mark in my mind. The presenter had plenty of anecdotal information about different situations involving what he perceived as difficult employees, and some of the things he recounted were truly egregious. I thought he needed to more discerning between an employee who causes a specific and significant problem, and an employee who is truly difficult to manage, for whatever reason. Having at times been labeled this myself, I think it has more to do with personal mismanagement of job-related knowledge, pre-conceived notions and/or agendas, combined with just the right amount of attitude.





By far the most interesting session was conducted by Dr. Ira Blumen of the University of Chicago, on HEMS accidents. Dr. Blumen subtitled his presentation "The Good, The Bad, and the Ugly" to relate his session to the famous 60's spaghetti western of the same name.

Part of his stated reasoning for this was that the three main characters of the film (played by Clint Eastwood, Lee Van Cleef, and Eli Wallach) were Civil War veterans. He related this to his view of what he called a "civil war" among those engaged in the provision of air medical services. He cited the various business models, both for profit and non-profit, hospital-based and stand-alone, along with numerous organizations of physicians, pilots, nurses, paramedics, and others, some with agendas that may conflict with those of others.

Dr. Blumen and his colleagues have conducted exhaustive data collection and research into accidents involving air medical services. The NTSB and FAA have referenced his research as part of their investigation into the inordinate number of HEMS accidents during 2008. One interesting trend that is being seen is an increase in the use of single-engine aircraft, presumably due to reduced operating costs.

Another impressive part of the conference was the emphasis on safety being promulgated from many different corners. One such effort is the Vision Zero initiative, sponsored by several trade organizations along with AAMS.

I saw a lot of familiar faces, from my days in Pittsburgh and elsewhere. I saw equal measures of people who have been in the business a long time and seemed to be growing weary, and young, healthy, idealistic hard workers who had reached the top of their game and were ready to get busy.

I left San Jose with the impression that the industry was in the midst of systemic change, and while uncomfortable it is inevitable and somewhat necessary if this expensive and critical resource is to remain credible and accessible to those who need it most.

************

The underlying theme of systemic change is also making its way known in my personal life as well. While I was in Pittsburgh at the beginning of the month, I proposed to Leslie. She said yes.

Leslie is a strong, intelligent, independent, driven Christian woman that I've known for a long time. Those of you who have been here for a while know that she has two daughters. Gianna will turn 17 at the end of the month.

Michaela, who just turned 8, has been fighting cancer for almost 4 years now. There are new developments in her treatment course that are beginning to take shape. I'll have more about those later.

I have no other words right now other than I know what I feel when I am with Leslie. It is a mixture of calm, peace, and confidence in the face of life challenges for both of us.

As many are much more aware than I am, there are many obstacles to bringing two lives together. Family issues are unfortunately a big part of this. I'm hopeful that the gratitude we all have for being in homes, with ample food and good people both around us and thinking of us from afar, will nurture understanding as this joining of lives and hearts moves toward becoming a reality.

Leslie recommended a good movie that I found in the Redbox and watched yesterday. Not Easily Broken is an excellent story about how life can be good and joyful, even when it's challenging from more than a few fronts, expected and otherwise. If you're interested further, grab it up.

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I was out getting a turkey and other things for Thursday's meal today, and one other thing I did was to take up Ralph D'Andrea's suggestion from a few days ago, and drop off a 21 lb. turkey at the Salvation Army offices on 4th Street. It will be used to feed the many in our community who are in need of a good meal on Thanksgiving Day.

Good night.

Back..to the Future?

San Jose - When I first started into public safety communications, I wanted to learn and see as much as I could. Being in my 20's and on a budget, I went to my first two trade conventions largely on my own dime. I took the Greyhound to Milwaukee in 1986 and drove myself and a colleague to Baltimore in '87, staying in less expensive hotels on the fringes of the downtown, and taking public transit to the convention areas.

After finishing Aircraft Dispatcher school, I found an opportunity to do kind of the same thing, while getting the latest information on an industry that has long been of interest to me, and made up a good portion of the best part of my career.

The Air Medical Transport Conference, here through this evening, is the annual gathering of the Association of Air Medical Services. Back in the 80's, the organization was known as ASHBEAMS (American Society of Hospital-Based Emergency Air Medical Services), and changed their name to AAMS in the early 90's. It's certainly more reflective of the international scope of the profession, as well as the varied ways that these services are delivered around the world.

I wanted to see how the industry has changed, how it compares to other segments of EMS that I've been more familiar with from recent work experience, and what challenges exist from a financial, regulatory, and operational perspective. This is of particular interest, given some significant changes in business models, service delivery modalities, and the attention of government to the manner that the industry operates in the wake of one of the worst years for accidents and fatalities in recent memory.

I had a pretty good time here; it was about par with most conference trips I've taken since that loss leader tour over 20 years ago. I'll have much more about what I saw and found out over the next few days.

In the meantime, I'm glad that I'm not flying back to Denver tonight. I would likely not be getting there. It looks like when I do return early next week, the snow flying tonight will be melting like crazy, as temperatures are forecast to be in the 60's.

Have a good rest of the week.

An End to a Beginning

Last Friday I completed the Aircraft Dispatcher course at Jeppesen Academy. I decided to stay and take a two-day International Flight Planning course on Monday and Tuesday. Some of my classmates (pictured at right) stayed as well. They are from, among other places, Luxembourg, Australia, and Singapore. Other classmates have returned home to places like Missouri, Ohio, Montana, Germany, and Nigeria.

Due to scheduling issues, my FAA oral and practical exam was moved from last weekend to yesterday. Despite having to slug my way through the manual flight plan from hell, things went very well, and I now have my FAA Aircraft Dispatcher license. I drove back to Grand Junction last night.

There's lots to get caught up with, and I'm going to have a very busy few days before getting on the road again next week. School was an interesting and fairly intense experience, considering the body of knowledge and the need to be able to combine all of the study areas into the ability to exercise what is known as Operational Control in some segments of the aviation industry.

There are some segments of the industry in which I have an ongoing interest and considerable experience, and I'm going to try to pursue those avenues as much as possible. The location of those opportunities will probably play a big role in where I go, but for now I'm interested in getting into an aviation-related business somewhere close.

It's the beginning of another interesting road. The journey is what makes it worthwhile.

Have a great evening.

A Little Break in the Burgh

Greenwood Village / Centennial, CO - Took the Sunday night redeye last week from DIA to JFK, then a connection that got me to Pittsburgh by mid-morning on Monday. Now I'm back in Denver, getting ready to start school tomorrow and plot some potentially serious changes. More about that later.

Over the last week, I did not touch a computer or watch any live television. I did read a few newspapers and went through my e-mail on my cell phone. Other than that, I was largely removed from the "virtual" outside world, spending a lot of quality time with Leslie and her girls.

Pittsburgh has been an interesting place for the last few months. The upcoming G-20 Summit and its planning process have been the focal point of local government and emergency services since June. Part of this includes preparing for extensive and well-coordinated protest movement that plans to descend upon the city as well.

The visit was definitely something I needed, and not only because I miss her very much. My immersion in technology and information is at times not healthy, and being with her brings that point to bear in a very significant way.

We ate Greek food, went to one of the best farm markets anywhere, and enjoyed a double feature at the drive-in. I did a couple of repair projects for Leslie, and observed some of the things she has to deal with as a parent of a cancer kid.

Leslie's daughter Michaela, who I've written about previously, is now participating in the clinical trial of a cancer medication that appears to be impacting her tumors in a positive way. She receives the medication every three weeks; this is followed by one week of IV medications and fluids to address the biggest side effect of the medication, that being vomiting and dehydration.

Friday night was the first night of this one-week cycle. I watched as Leslie mixed three different medications with saline in three different syringes, each to be delivered over a 15 or 20 minute period via an infusion pump. She then has to put a bag of fluid on a different pump that is infused over 12 hours. Michaela carries this in a backpack when she is walking around.

This protocol, which includes other IV and oral medications during the day, appears to be working well; Michaela's episodes of vomiting have been drastically reduced. She is able to go to school. She wants to be a normal second grader, and is growing tired and frustrated with her illness and its effect on her ability to be active.

One thing that I find gratifying and somewhat humbling is that Michaela likes it when I am there. In the wake of the changes that our collectives lives have seen over the last few years, it feels to me that it is time to embrace that change a bit. That's what I'm starting this week.

I'll be taking a six-week course at the Jeppesen headquarters near Centennial Airport south of Denver to obtain my FAA Flight Dispatcher license. I hope to take this training and licensure and obtain a job somewhere within the aviation sector.

I'm keeping an open mind, have committed to maintaining a positive attitude that comes with any new venture, and am clearing my calendar and email in-boxes for the next few days to get acclimated to the routine. I plan to return to Grand Junction on the weekends, but will also try to take in some of my favorite things in Denver if I have time; the Rockies, Rapids, lots of movie choices and good Mediterranean food are a few of these.

I'll also be remaining active on this blog, if only to post observations at times, but I have several collections of ideas that will be out there, if more infrequent in their posting while I'm at school and afterward.

There's plenty going on out there that is relevant to both my past and future which I am heeding the call not only to write about, but to act upon. The woman I love, and the skills that I have been given, are both big action items in this scenario. How this evolves is the adventure that well-lived lives are made of.

Have a good week ahead.

Good Weekend Writing

Aviation and baseball are two subjects that attract more than just a passing interest with me. Over this holiday weekend, as many rites of summer begin to make themselves known to us again, I thought I would call attention to two excellent pieces of journalism. One calls attention to history, while another details the potential loss of an avocation for thousands of Americans.

Gary Harmon of the Grand Junction Daily Sentinel has been reporting periodically in recent weeks on a new security directive from the Transportation Security Administration that threatens the practice of, and commerce surrounding, general aviation.

Yesterday, Mr. Harmon got most of Page One and then some to detail not only the frustration of private pilots, airport operators and trade associations, but also to illustrate the manner in which the TSA has tried to hide behind vague rhetoric and confidentiality laws to conceal details of most of the changes being made.

Pressure from trade groups and members of congress has yielded a commitment from TSA to revise certain portions of the directive, but they still won't share those revisions with the general aviation community. The Sentinel's editorial board has also weighed in, asking TSA to exercise some common sense and transparency in dealing with a community and industry that could be gradually eroded away by this directive, which is slated to go into effect on June 1.

Combined with a sidebar about a local private pilot and his vintage flying machine, accompanied by magnificent photography from Gretel Daugherty, the piece displayed some of the best talent that we have in local media. Gary looks like he's found a niche issue to sink his teeth into, and his considerable journalistic skill has been showcased because of it.
Now if only we could do something about that column...


Tomorrow is the 50th anniversary of one of the greatest individual achievements in baseball history, even if all it got the player involved was a loss in the record books.

On May 26, 1959, Harvey Haddix of the Pittsburgh Pirates pitched 12 perfect innings against the Milwaukee Braves, retiring 36 batters in a row before an error and a hit gave him a 1-0 loss in 13 innings.

In an excellent example of leveraging online content with the printed word, the Pittsburgh Post-Gazette ran a package of stories in Sunday's edition that detailed what has been called A Perfect Loss. This multimedia presentation provides links to photographs, the P-G's original coverage of the game, and other content that not only illustrates the magnitude of the feat, but the effect it had on the game and the man who did it.

For me, reading about the game lent new meaning to the term "run support". It also made me think about the evolution of the game today in comparison to its historic past. Today we have starters, middle relievers, late relievers, and closers. A complete game win is a notable feat, a no-hitter significant, a perfect game remarkable. It's doubtful that you will see anything approaching Haddix' achievement ever again.

Yet looking at the achievements of those who played the game 40 or 50 years ago (or longer), the almost romantic allure of some of those players seems to easily overshadow the over-specialization, the performance enhancements, and the over-reliance on minutiae over instinct that has impacted the game in many ways.

It was a good read and an excellent history lesson, even if it also served as a reminder that I'll be turning 50 next year.

Speaking of baseball, there's a lot of interest in Grand Junction currently, and not just because it's JUCO week. Our Mesa State Mavericks are in the NCAA Division II College World Series for the first time, and as of now are still in the winner's bracket. They play later today. A link to an interactive bracket and other information is here.

I hope that your weekend was a safe and enjoyable one. Being involved in public safety, this translates to hoping that you or your loved ones were not involved or associated with some of the injuries sustained in our area through violence, carelessness, or reckless recreation.

It's travel time later this week. Talk to you then.

In Praise of Dispatchers

Dispatch "Dis*patch"\, n.

1. The act of sending a message or messenger in haste or on important business.

2. Any sending away; dismissal; riddance.
To the utter dispatch of all their most beloved comforts. --Milton.

3. The finishing up of a business; speedy performance, as of business; prompt execution; diligence; haste.
Serious business, craving quick dispatch. --Shakespeare.

4. A message sent with speed; especially, an important official letter sent from one public officer to another; -- often used in the plural; as, a messenger has arrived with dispatches for the American minister; naval or military dispatches.

- Webster's Unabridged Dictionary

You'll have to excuse me for tooting the horn of my own profession for just one day.
I'm called to recognize those on who we as a society rely to safely and effectively coordinate critical resources, no matter what types of resources they may be.

This week marked National Public Safety Telecommunicators Week, which was established back in the early 90's to recognize the contributions of those who toil in relative obscurity and 'interesting' work environments, through political and cultural quagmires, and with uncooperative and often hostile citizens (and sometimes responders), to get the right help to where it's needed.

I've been doing this sort of thing for over 25 years. The fundamentals of the profession really haven't changed much, even though just about everything else has - right up to what they call those who do this job. As you can see from the definitions above, the emphasis of the word was on speed and haste. Now the emphasis is on the tools and skills used, with unwieldy, PC-sounding titles like "Telecommunicator" or "Communications Specialist". They sound more professional, but still don't do justice to the skill sets required.

The last time I was called a "Dispatcher" was while working at Life Flight in Pittsburgh. Around 1990 our job titles were abruptly changed to "Air Medical Communications Specialist" after the FAA objected to the use of the title "Dispatcher" in an aviation-related position without being licensed by the FAA as a "Dispatcher".

It turns out that such a position has a lot of responsibilities for flight planning, routing, and calculating such things as fuel loads and weight and balance. They also maintain contact with commercial aircraft while in the air to advise of changes in weather, or to communicate other information on behalf of the airline they're working for. Another name for this job responsibility is "Flight Superintendent".

Coordinating resources at this level is an awesome responsibility, just as dealing with a sometimes frantic general public can be, to go along with Law Enforcement, Fire, EMS, Public Works, and Human Services personnel, all whose demeanor can approach a similar level at times.

As time passes, and the priorities and challenges of this life change, I've been buoyed by the quality of the young people who have challenged themselves to get past the long screening process and lengthy training program, and continue to carry themselves in an honorable and professional manner. You know who you are.

One big difference in many parts of the United States is in how Telecommunicators are generally regarded and trained. This is something that has improved in the years that I've been in Colorado, but there are still many places in this country where those who serve as the critical link between citizens and public safety professionals are regarded as no more than clerical staff. Their agencies receive the same priorities with regard to funding. In fact, over the years some legislatures in other states have seen fit to attempt to raid 9-1-1 surcharge funds, in the same way that Colorado dallied with tapping a worker's compensation fund. Politicians and priorities, hmmm....

Grand Junction and other areas in Colorado have an excellent public safety communications system, from the Technology through the Processes all the way to the People. While that doesn't mean that there isn't room for improvement in many areas, it does mean that there are responsive, professional people on the other end of the line, ready to address just about any situation thrown at them.

The reported difficulties in finding the kind of people who can accomplish this on a consistent basis is also that much more of a validation that they are an equal part of the team that protects lives and property in Mesa County.

I've dispatched with a walkie-talkie, cell phone, and clipboard in the passenger seat of a car, in closet-sized rooms with dust bunnies the size of cats, in rental office trailers with borrowed carpets to try to improve the acoustics, in the basement of an old train station, in a large, well-equipped truck that incorporated many of my own design ideas, and in the Emergency Operations Center for a major metropolitan area.

Now I'm back in a hospital in a windowless room, but maybe there's a chance for some light on the subject. Perhaps it's time for me to take "Dispatching" to a different level. Who knows where I'll end up?

This coming week includes some tough anniversaries in our recent history as a state and a nation. More about that later. May your week ahead be a peaceful one.