Public Service

Flashback to November 2001: EMS Review after 9/11

By Mark Forror | September 11, 2017

This article was originally published in the November 2001 issue of R&WI and has been edited to comply with current grammar and style guidelines. Check out our special June 2017 50th anniversary edition of the magazine, in which we celebrate the past 50 years — and look ahead to the next 50 — of rotorcraft innovations.

A U.S. Park Police 412 crew readies burn victims for transport outside the Pentagon on 9/11. Photo by Sgt. Carmen Burgess courtesy of Reuters/Getty Images. This photo appeared in the November 2001 issue of R&WI.

A U.S. Park Police 412 crew readies burn victims for transport outside the Pentagon on 9/11. Photo by Sgt. Carmen Burgess courtesy of Reuters/Getty Images. This photo appeared in the November 2001 issue of R&WI.

The Pentagon: A case study

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No one knows the significance of EMS better than Sgt. Pilot Ron Galey, a U.S. Park Police helicopter pilot whose Bell 412, callsign “Eagle 1,” was the first medevac helicopter on the scene at the Pentagon on 9/11.

“I was on the crash phone for National Airport the day of the Pentagon attack,” he recalled. “National Airport’s tower called and said, ‘We have a 757 down somewhere in the vicinity of the 14th Street bridge.’ We were watching coverage of the World Trade Center attack on TV, and when the call came down, we looked at each other, and we just knew it as not an accident.”

Within four minutes, Eagle 1 arrived on scene. Eagle 2, the unit’s other 412, was two minutes behind them. What Galey found on the Pentagon’s quiet, park-like grounds was something akin to a war zone. A hijacked Boeing 757 had dipped its wing into the ground and cartwheeled into the west side of the Pentagon, cutting a six-story notch out of the nation’s joint military headquarters.

“I saw a lot of fire, a few people running away from the Pentagon who were on fire, and thick, black smoke,” he said. “We were told that a 757 hit the Pentagon, but we saw absolutely nothing that looked like an aircraft. There was nothing left.”

The first few minutes were spent bringing order to chaos. National Tower told Galey the smoke was so thick they were closing the airport and turning over command and control to Eagle 1. By the time Eagle 2 arrived carrying two Defense Dept. paramedics, the unit commander and the assistant commander, Eagle 1 was already downlinking information to other aircraft in the area.

Soon the sky was full of rotorcraft, including a variety of military models, and those from local TV affiliate Fox 5 and the Fairfax County Police.

The Eagle 2 co-pilot, Sgt. Pilot Ken Burchell, said that at first the Pentagon didn’t appear to be extensively damaged.

“We arrived there before the floors began to collapse, and the damage didn’t look that bad. It almost looked as though their attack had been unsuccessful,” he said. Minutes later, the floors crumbled into a charred heap.

The Arlington County Fire Dept. reported 20 possible casualties. Galey asked the Maryland State Police to send a helicopter, but it was unable to respond because the military already had clamped a no-fly zone over the area. Calls went out to AirCare at INOVA Fairfax Hospital in Virginia and MedSTAR at Washington Hospital Center. Each dispatched a medevac helicopter to the scene.

At Galey’s request, a DC Metro Police helicopter, callsign Condor, arrived ahead of the EMS ships to take over the command-and-control function. That allowed the park Police and EMS aircraft to assume a medevac role.

Pete Russett, the Air Methods pilot flying AirCare 1 for Fairfax Hospital, is also executive officer of Marine Light Attack Helicopter Squadron 775, Detachment A, in the Marine Reserves. Even his time in the Corps and EMS service did not prepare him for what he saw.

“The destruction and fire in front of me seemed surreal,” he said. “I have seen many accidents and victims, but the idea that terrorists had done this to our Pentagon was unbelievable.”

Twenty casualties soon became 11, then only three. Eagle 2 already had taken two of the victims, and MedSTAR’s EC-135 took the third. The victims were transported to Washington Hospital Center’s burn unit.

Burchell said that, given a final death toll of 189 people, the Park Police were prepared to transport many more casualties. “Both of our 412s have mass casualty kits that allow us to take four patients. Our aircraft happened to have those kits already on board,” he said.

Reports that another unauthorized radar contact was heading toward them added another dimension to the chaos.

“Even as we launched, we were advised that there was the possibility of another in bound aircraft,” Burchell said. “That certainly adds to the pressure of getting people out of there.”

At one point, Galey said, they received a report that the unauthorized aircraft was only four miles away. “We looked up, and at about 15,000 feet I saw the glint of an airplane,” he said. “I thought, oh sh--, but it turned out to be a military aircraft — thank God.”

Nov 2001 AMTC EMS review

This photo originally appeared in the November 2001 issue of R&WI. Photo courtesy of Sikorsky

EMS/AMTC Review: Compassion under fire

As America recovers from the shock of the extraordinary events of 9/11, the carnage of that day brings into sharp focus the importance of the country’s helicopter-based medevac services.

The air medical community itself has been hard hit by the fallout of the terrorist acts. During the week following the attacks, the FAA shut down all general aviation flights, leaving traditionally underfunded EMS providers strapped for cash.

Dawn Mancuso, executive director of the Association of Air Medical Services (AAMS) in Alexandria, Virginia — an organization representing EMS operators and crewmembers — said:

Many of our members have faced severe cash flow problems. The losses for that one week alone were $1 to 2 million [per operator]. In addition, some insurance companies have notified their customers that the war riders on their policies have been canceled. Our risk pool is the same as the airlines, so we’re facing liability insurance premium increases as well.”

Military call-ups also have left a few AAMS members shorthanded, while others report problems getting takeoff clearances. “Some of our members have reported waiting as long as 45 minutes for clearances,” she said.

AAMS members foresaw the terrorist threat early and focused on the logistics of handling large numbers of injured, but many were not prepared for the collateral damage to their businesses.

“There has always been ongoing training and discussion on what to do with mass casualties. What the programs didn’t expect is the aftermath of the management problems related to insurance issues and lost revenues,” Mancuso said.

In the long run, however, the attacks will force hospitals and insurance companies to re-evaluate the importance of EMS in facing a looming terrorist threat. That re-evaluation is likely to work in the rotorcraft industry’s favor.

Less than two weeks after the attacks, the 2001 Air Medical Transport Conference (AMTC) began as scheduled: Sept. 24 to 26 at the Orange County Convention Center in Orlando, Florida. Six associations, including AAMS, sponsored the conference.

The 9/11 attacks failed to derail AMTC, as they did many tradeshows. However, the growing sophisticating of terrorist cells means that all government agencies and private associations are rethinking the logistics of caring for mass casualties in the context of a well-coordinated attack.

An unsigned statement posted on the AAMS website soon after the attacks noted that it was “premature” to cancel the conference and vowed that the show would go on. The statement also praised those who canceled their attendance after being called to active duty, and offered refunds to any attendee who sent AMS written notice of cancellation.

Despite the events of 9/11, attendance was strong. About 1,500 visitors went to the show, with five or six exhibitors and about 300 attendees backing out. Those who visited the conference found a total of 112 educational seminars, a majority of them focusing on helicopter themes from years past: insurance coverage for helicopter services; creating effective safety programs; avoiding accidents; human factors for flight crews; and certification standards for medical personnel, to name just a few.

AAMS is now in the process of learning the lessons of 9/11, according to Mancuso. In that vein, AMTC quickly lined up two unscheduled sessions on the World Trade Center attacks.

Matt Caudill, a fireman-paramedic with the Plain Township Fire Department, New Albany, Ohio, presented, “Urban SAR Response to Terrorist Acts.” As a rescue specialist for Ohio Task Force 1, the state’s search and rescue contribution to the Federal Emergency Management Agency (FEMA), Caudill reviewed his unit’s participation in relief efforts at the World Trade Center in New York.

Diane Fojt, president of MECA, an air medical training company based in Tampa, Florida, conducted a “Review of World Trade Center Critical Incident Stress Management.” The session focused on coping mechanisms for medical personnel responding to the World Trade Center tragedy.

In addition to these seminars, three sessions scheduled before Sept. 11 proved chillingly prescient.

Perhaps most on-target was Michael Cox’s “Chemical and Bacteriological Terrorist Attacks: The Coming Threat.” An emergency medical technician-paramedic and registered nurse, Cox flies with Florida Flit 1 in Orlando.

His presentation began with a historical overview of the use of blood, nerve and blistering agents, as well as bacteriological agents such as anthrax, to infect urban populations He also discussed the availability of materials that could be used to construct a chemical or bacteriological weapon and presented several scenarios illustrating how a chemical attack by terrorists would affect pre-hospital, transport and in-hospital management of victims.

The discussion took on a new sense of urgency hen, just one day before Cox made his presentation, news reports revealed that some of the terrorists had approached aerial application operations with detailed questions about the payload capacity of crop dusting aircraft.

This new information led the FBI and other authorities to speculate that such interest was a prelude to a terrorist plan to deliver a chemical or bacteriological agent in another wave of attacks. A 1993 report by the U.S. Congressional Office of Technology Assessment estimated that between 130,000 and 3 million deaths could follow the release of 100 kg of anthrax spores upwind of the Washington, D.C., area.

Andrew Swartzell, a registered nurse with CALSTAR in Hayward, California, reviewed the concept of the Disaster Medical Assistance Team (DMAT) as part of the National Disaster Medical System (NDMS) in his presentation, “NDMNS: Catastrophic Care for the Nation.” DMATs are groups of professional and paraprofessional medical personnel that provide emergency medical care during a disaster. In mass casualty incidents, their responsibilities include triage, providing austere medical care, and preparing patients for evacuation.

The teams are organized under the NDMS< a partnership between the Department of Heath and Human Services; the Department of Defense; the Department of Veterans Affairs; FEMA and state and local governments.

Another session applicable to the terrorist attacks was DR. Michael Humphrey’s presentation on aeromedical support during a mass casualty incident. A flight doctor for LifeFlight in Toledo, Ohio, Humphrey used as a case study an incident that occurred last year at the Lonz Winery, Put-in-Bay, Ohio, in which one person was killed and 75 were injured when a 35-foot section of a terrace collapsed.

Sikorsky Aircraft was among the airframe manufacturers represented at the conference. As a corporation based in nearby Connecticut, Sikorsky aided in the World Trade Center relief effort On Sept. 11, Sikorsky sent its S-76 chase aircraft to Teterboro Airport in New Jersey at the request of the Port Authority of New York and New Jersey.

Sikorsky also transported trauma teams via a fleet of seven Army Black Hawks flown by U.S. Navy and Sikorsky pilots. Based at the Wall Street Heliport, the helicopters were the city’s only medevac units that day, according to Sikorsky spokesman Bill Tuttle.

Despite the emergency, the company managed to make the Orlando conference The Palm Beach County, Floria, Heath Care District’s S-76C+ “Trauma Hawk” gave rides to conference visitors from the Orlando airport. On static display at the Sikorsky booth was LifeFlight-Miami’s S-76A+.

MD Helicopters Inc. of Mesa, Arizona, also was highly visible at the conference. EMS is a huge market segment for the company: 35% of all MD Explorer deliveries are to air medical operators.

To underscore the importance of that market, the company celebrated at AMTC the Explorer’s 15,000 hours in EMS service. Allegheny General Hospital in Pittsburgh flew 10,000 of those hours, while the Regional Emergency Medical Services Authority (REMSA) of Reno, Nevada, accounted for 5,000 hours.

Alleghany operates four of the light twins; REMSA’s single Explorer averages 1,500 flights and 1,000 patients per year, according to John Morrison, director of Critical Care Services for REMSA-Care Flight.

This month, REMSA-Car flight will upgrade the engines on its Explorer to Pratt & Whitney Canada’s PW207E powerplant, which increases the aircraft’s available power by nearly 11%.

“With the current engines, we have issues with the high-desert terrain and the heat, so the upgraded engines will give us much better performance in our [operating] environment,” said Herb Brady, VP of Operations for REMSA.

The helicopter’s certification for Category A single-pilot IFR (SPIFR) operations give it more flexibility to operate in visibility conditions that would ground most helicopters.

Cathy Fackovec, administrative director of Allegheny Hospital’s Department of Emergency Medicine, which includes LifeFlight, said the Explorer’s quiet NOTAR anti-torque system helps their operation meet the requirements of their noise abatement agreement with the lo al community. The lack of a tail rotor also means that, in her words, “We don’t have to worry about someone walking into the tail rotor anymore.”

The Explorer’s 172.5 cubic feet of cabin space is especially popular with the male nurse in the program. Although many of the female nurses prefer the old bench seats from LifeFlight’s earlier BK117s, that is no longer an option, Fackovec said, due to new crash attenuation standards.

Rounding out the list of major airframe manufacturers represented at the show were Agusta Aerospace, American Eurocopter and Bell Helicopter.

A total of eight helicopters and two full-scale mockups graced the show floor. Bell exhibited a 407 flying for MedTrans in Greenville, South Carolina. Agusta brought an EMS-configured A109 Power mockup and a VIP-configured A119 Koala. Rocky Mountain Helicopters, of Provo, Utah, displayed a medical interior concept in an EC-130 B4 cabin mockup to solicit comments from potential customers for Rocky’s own EMS interior design. The company signed a purchase order to 10 EC-130 B4s at the Paris Air Show in June.

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