From a density altitude perspective, what Miami lacks in elevation, it makes up for in heat and humidity. While shooting photography and video last month at Miami-Dade Fire Rescue, Air Rescue Bureau (Air Rescue), it was in the mid 90s and the humidity was so thick in the air that my videographer from arid Arizona looked at me and exclaimed, “I think I’m melting!”
Combining the challenges of this operational environment, the ops tempo, and the variety of missions that Air Rescue may be asked to perform, both human and machine are constantly tested at this county government helicopter rescue operation.
Established in 1836, the sprawling and diverse Miami-Dade County in south Florida is the state’s third largest county at 2,431 square miles, and it is surrounded by natural wonders. On its west is one of the largest and most unforgiving wetland ecosystems in the world, the 2,410-square-mile Everglades National Park. On the southern border is the pristine island chain of the Florida Keys. And to the east are the clear blue waters of Biscayne Bay and the Atlantic Ocean.
Because the county features more than 80 miles of beautiful coastline, it’s a veritable playground to virtually every water sport known to man. Its 2.7 million residents and 16 million annual tourists hail from every ethnic background and every walk of life imaginable. When you toss those millions of culturally diverse citizens together, all driving and playing in one geographic locale, tragedy is bound to rear its ugly head. No wonder this county’s fire and rescue agency is among the 10 largest in the country with nearly 2,500 employees. And when a mishap occurs to the degree that a helicopter must be called for help, Air Rescue is the last line of defense and stands ready for that call.
The Air Rescue program began in 1985, so it’s had 35 years to hone its skill sets while striving to add value to both the emergency system and county residents. In the unit’s humble beginnings it had only one helicopter, a Bell 412. In 2000, a second helicopter was added to accommodate the ever-increasing call volume. Fast forward to today, and Air Rescue operates four Bell 412s with two bases, one located in the north end of the county and the other located in the south.
“The Bell 412 has been a reliable helicopter, and its large cabin space combined with the hoist makes it an excellent platform for the agency’s operational profile,” said Air Rescue Capt. Jeff Suarez, who’s in charge of the unit. He went on to elaborate that it takes approximately 68 personnel to keep the two-base, four-helicopter operation flying 24/7/365. This includes 18 pilots, 45 flight medics and five helicopter mechanics.
Each duty helicopter is crewed by four personnel including an Aircraft Commander (pilot in command), a co-pilot and two flight medics. The minimum requirements to be an Aircraft Commander are 1,500 helicopter flight hours and a Certified Flight Instructor rating. A co-pilot is required to have 1,000 hours of flight time.
Four aircraft at two bases meet the needs for maintenance and a high level of readiness. The best-case scenario is for Air Rescue to have one duty aircraft at the north base and another duty aircraft at the south base. The third aircraft would be a spare in case one of the duty ships has an unscheduled maintenance issue, while the fourth aircraft slot would be for the aircraft that is in a scheduled phase of maintenance or inspection.
From an operational and regulatory standpoint, Air Rescue operates under FAR Part 91 and that puts it firmly in a relatively small and shrinking pool of operators. Most civil helicopter operators that are transporting sick or injured patients do so under FAR Part 135 that limits pilot duty times to 14 hours. But like its West Coast brothers at Los Angeles County Fire (which also operates Bell 412s), Air Rescue is a fire-rescue organization that works on a firefighter schedule with shifts of 24 hours on duty and 48 hours off. Because it does not bill patients or fly for hire, the organization can remain under the umbrella of Part 91.
Busy In the Air
As the county population has grown, so has the unit and its mission capabilities. On any given day or night, crews can find themselves landing in the street to pick up a traumatic injury patient, flying offshore performing search and rescue operations, or dropping water from a Bambi Bucket on a wildland-urban interface fire.
Alongside its beautiful parks and beaches, unfortunately the county also features traditional big-city elements such as crime and population congestion that produce plenty of sick or traumatically injured patients who need helicopter transport. The unit receives approximately 1,700 flight requests per year and approximately 80 percent are patient transports.
IF-AND-THEN = Go Helicopter
The need for a helicopter is basically determined by medical protocol. In a traumatic injury case, the goal is to get the patient to the local trauma center within the “golden hour.” A traumatic injury may include (but is not limited to) a shooting, stabbing, burns, auto accident with rollover or patient ejection, high fall, or drowning.
IF a patient is deemed a trauma case (based on criteria above), AND the patient cannot be driven to the nearest trauma center via ambulance or rescue truck in 20 minutes or less, THEN a helicopter is called to transport the patient.
Miami’s population density creates an incredible amount of road congestion that makes a trip to the nearest trauma center via ambulance a slow trip. The golden hour standard combined with terrible traffic are the main drivers behind most trauma calls that are transported via helicopter.
The unit flies somewhere between 1,700 and 2,000 hours annually, and approximately one-third of those hours are training flights. With such a diverse mission profile, a healthy amount of quality training is critical to maintaining high levels of proficiency among the pilots and flight medics. Every mission scenario that crews face has a SOP (standard operating procedure) that must be followed, with communications being one the most important components to maintaining high levels of safety.
The Scene Call
The most common calls the unit may face include traumatic injuries caused by accidents or complex medical conditions that require transport from a scene to a specific specialty hospital. Most often this means that the helicopter crews are landing at sites such as streets, parks or shopping centers. These LZs (landing zones) often are unprepared and full of hazards such as traffic, people, power lines and debris.
Unprepared LZs require an incredible amount of communications and teamwork to safely get in and out. Crews never just arrive and land. Every scene on solid ground will require additional ground assets such as fire engines or rescue trucks to locate and establish a safe and secure place to land the helicopter.
The ground assets perform a ground recon of the LZ and communicate, via radio, all hazards in and around the LZ. The ground and air will remain in constant communications from landing to patient loading to departure from the scene.
The Coastal Challenge
Miami-Dade County is a world-class coastal destination that attracts boaters, anglers, scuba divers, kite boarders and swimmers. And it is home to one of the nation’s busiest ports, the Port of Miami. This “Cruise Capital of the World” draws more than four million cruise ship passengers annually.
All this water-based activity creates a unique and challenging situation for Air Rescue. A patient on a vessel or floating in the water adds a whole new level of complexity to the rescue operation, yet the golden hour rule and transport protocols still apply.
Enter the Hoist
One of the more complex and higher risk operations that Air Rescue performs is hoisting patients from environments that are not reachable by vehicle. The two environments that most often require the use of the hoist are over water or the Everglades swamp.
In the coastal environment, patients may be hoisted directly out of the water or off a vessel such as a Metro-Dade fire boat, Coast Guard cutter, or large ship. Each type of vessel poses a different challenge and may require a different procedure. For example, a spinally compromised patient on a fireboat may require the use of a Stokes basket, while a patient clinging to a capsized boat in high seas may require a rescue swimmer and a rescue strop.
Rotorcraft Pro had the opportunity to participate in a training exercise in which a simulated patient was hoisted from one of the county’s fireboats. It’s not uncommon for a fireboat to be first to reach an injured person, so the crews from both units (helicopter and boat) regularly train together.
Prior to launch, the crew will be communicating with dispatch or personnel on scene (if there are any) to determine what equipment will be needed. The three most common pieces of rescue equipment that may be used are a Stokes basket, rescue strop, or rescue basket. Each one can accommodate different types of injuries and scenarios.
Enroute to the scene, crews will communicate with on-scene boats or personnel to confirm the exact location of the scene, patient status, sea state, wind speed/direction, and any other elements that may impact the operation. Once over the scene, the helicopter will orbit and evaluate the situation and develop a plan that includes direction of approach, hoisting height, what equipment to use, and whether or not to send crew down on the hoist.
“The greatest concern during a hoist operation is getting the cable tangled in a boat or land-based obstruction,” said pilot Kalynn Hargis, who happens to be the first female to achieve that position in the history of Air Rescue. This scenario becomes exponentially more hazardous if an entanglement occurs on a boat pitching and rolling on high seas. To avoid injuring people or damaging the helicopter, the emergency procedure for this worst-case scenario requires the crew to cut or “punch out” the cable.
One of the most important aspects to consistent and safe hoist ops is discipline. Crews must have the discipline to follow the procedures that keep them focused on two critical components: communications and checklists. Crews must resist the tendency to become complacent since hoisting operations, especially over waterborne vessels, are extremely unforgiving.
Another set of unique geographic features requires Air Rescue to fight fire from the air. For example, the entire western edge of Miami-Dade County is where modern civilization interfaces with the Everglades National Park. Most of the rugged Everglades can be accessed only by foot, canoe, kayak, airboat or helicopter.
It just so happens that Florida is the lightning capital of the U.S., too. According to the National Lightning Detection Network, lightning strikes more than a million times per year in the Sunshine State, with more per square mile than any other state. Although wildland fires in the area can be started by man-made sources, many are caused by lightning.
Because most wildland fires in south Florida are inaccessible by land-based fire trucks, especially in the Everglades, most calls of this nature are managed by the Florida Division of Forestry. Even though Forestry has highly capable and specialized equipment, the agency regularly calls upon Air Rescue to help create firebreaks and extinguish fires at the urban interface.
Depending on which aircraft are in service, crews have a couple options for firefighting tools. They may use a Bambi Bucket slung under the helicopter on a short line, or they can utilize a Simplex foam-tank system.
Most operations will deploy the Bambi Bucket since it offers greater operational flexibility. Surprisingly, the crews are able to transition from one type of operation to another at respectable speeds. In the short period of time we spent with Air Rescue on flying ops, we were able to transition from multiple Stokes-hoist evolutions to a patient scene call to a Bambi Bucket firefighting operation in rapid succession, with only quick breaks in between for briefing, refueling and reconfiguring the helicopter.
The tasks required between each operation were shared equally among the four-person helicopter crew. In the transition into firefighting operations, for example, crew members almost simultaneously calculate fuel loads, remove medical gear and patient litters, and install the Bambi Bucket in about 15 minutes.
Upon arriving on scene, the crew will locate a water source that is nearest to the fire, then find a suitable landing area to set down and finish reconfiguring the helicopter. After landing, the flight medics will exit the aircraft and lay the bucket and short cable on the ground, connect the cable to the belly hook of the helicopter, and perform one last test of the release mechanisms that are controlled from the cockpit.
Typically, in order to keep the aircraft as light as possible, one flight medic will be left on the ground when the aircraft lifts off to go fight fire. The flight medic who remains on the helicopter will then lay crosswise on the floor of the helicopter and look out the side door to act as a spotter for the pilot in command. That medic’s job is to help the pilot spot obstacles, judge heights above dip sources, and time water drops.
Keeping Your Head in the Game
As a former firefighter and helicopter air ambulance pilot myself, I have experienced the highs and lows that this type of work can bring. The work is both physically and psychologically demanding.
“Some of the challenges I have seen people face in the unit is constantly dealing with death,” Suarez said. “It takes a psychological toll on your mind and body to be running multiple, high-intensity calls after midnight, shift after shift.” But crew members often can counteract that negative with a positive final outcome.
“It can be very satisfying when you save someone’s life, and the loop is closed when you meet that person six months later and they thank you personally,” Suarez noted.
Lt. Enrique Gonzalez, an 18-year fire and rescue veteran with 10 years as a flight medic, said his favorite type of call is what he calls an “inert survivor.”
“We get to fly out to a person who is not injured or sick, but just stuck,” Gonzalez explained. “Nobody’s hurt. It could be a person lost in the Everglades or floating in the ocean with their overturned boat. This is a guaranteed happy ending call, and I get to be the one who lends them a helping hand!”
The concept of a “helping hand” is probably an apropos description of the Air Rescue unit itself. This taxpayer funded, government operated program provides a lot of value to the county with its diverse skillsets. On a daily basis, much like a helping hand, Air Rescue crews descend from above and touch people in an effort to protect the lives and property of millions of residents and visitors in Miami-Dade County.
CHECK OUT THE VIDEO