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In 1984, the Apple Macintosh computer was launched,Ronald Reagan was president, the cost of a postage stampwas 20¢, the price of a regular gallon of gas was $1.21,

and the price of jet fuel averaged around 84¢ a gallon.It was also an important year for residents of Middle

Tennessee; it was the year Vanderbilt began its air ambulanceprogram. On July 5, 1984, Vanderbilt University Medical Center(VUMC) initiated its “LifeFlight” operations with a Bell 206LongRanger helicopter owned and operated by Kenn Air forVanderbilt. The first patient transport was made the next daywith pilot Bill Hamblin and flight nurses Allison Bolin andKathy Ogle. Hamblin stayed with the program until he retiredin 2009.

That first flight was a culmination of years of planning andcareful orchestration that built a solid network of emergencyservices throughout Middle Tennessee. LifeFlight is the bridgethat ties the region's emergency services network to the worldclass physicians, nurses, and staff at Vanderbilt, and becauseof that strong network and stringent medical training and

oversight of its medical flight crews, Vanderbilt care is takendirectly to the patient.

Vanderbilt was among the first academic medical centersto add air medical transportation for critically ill patients. In1983, John Sawyers, MD, professor and chairman of theDepartment of Surgery, and Joseph Ross, MD, professor ofmedicine and associate vice chancellor for health affairs,made the decision to add a patient transport helicopter tothe services of Vanderbilt University Hospital. The movewas part of a larger strategy by the medical center to buildand brand top-level trauma surgery and emergency medi-cine programs.

In 1984, LifeFlight’s first medical director, John A. MorrisJr, MD, now associate chief of staff of the Vanderbilt HealthSystem, chief medical officer of the Vanderbilt HealthAffiliated Network, and professor of surgery and adjunct pro-fessor of biomedical informatics, joined the faculty, startinghis tenure several weeks ahead of time in order to coincidewith the arrival of the medical center’s first helicopter.

Vanderbilt LifeFlight Celebrates 30 Years of Service

Jerry Jones, MPA, EMT-IV

Morris and Ross focused on patient care with the helicopterand not just the idea of rapid transport. “We wanted to usespecially trained nurses with an expanded skill set who cantake Vanderbilt’s services into rural communities rather thanmerely transport patients to the hospital,” said Morris, whoserved as LifeFlight’s medical director from 1984-2010.During the 26 years he served at the helm, the program grewinto one of the safest and most advanced in the nation withthe care it provides.

“We did things 20 years ago that were the right thing forthe individual patient,” he says, “but were horrific in terms ofthe risks we took—though we didn’t know we were takingthem at the time. We once landed an aircraft on GarlandAvenue [the street in front of Vanderbilt University Hospital]so we could treat a guy with a stab wound to the heart, andwe got that guy to live. Imagine landing a helicopter in themiddle of Garland Avenue to do this. But we knew from theflight nurse’s report that the patient wouldn’t make it the 500yards from the football field [LifeFlight’s landing zone duringits early days] to the ER [emergency room]. There are thosekinds of heroic but horrendous stories.”

Morris set the bar high to be a part of the medical crew.With the vision of taking Vanderbilt to the patient, he knewthe medical training for nurses had to be some of the toughestin the country. The typical flight nurse has academic medicalcenter or tertiary care hospital experience as well as an emer-gency medical services (EMS) background. Nurses must bedually licensed as a registered nurse and an emergency med-ical technician (EMT) or paramedic; have a minimum of 3 yearsof emergency department/critical care experience (ideally at alevel 1 trauma center); pediatric experience greater than640 hours; Tennessee or National Registry EMT or EMT para-medic; basic cardiac life support, advanced cardiac life sup-port (ACLS), pediatric advanced life support (PALS), andneonatal resuscitation program (NRP) certifications; and oneof the following: certified emergency nurse (CEN), criticalcare registered nurse, and/or certified flight registered nurse(CFRN) certifications; either a trauma nursing core course ora transport nurse advanced trauma course; and a strong pref-erence for previous flight experience.

Paramedics were added to the flight crew mix in 2005. Allflight paramedics must be critical care paramedic licensed,have national flight paramedic certification, have 3 years ofexperience as a paramedic in an emergency setting, pediatricexperience, and certifications including basic life support(BLS), ACLS, PALS, pre-hospital trauma life support or basictrauma life support, and NRP.

Additionally, all medical crewmembers must completeannual clinical rotations in the medical center that incorpo-rate the latest research with bedside practice as well as oppor-tunities to practice invasive skills with a variety of formats.Each must also attend or review all monthly case conferencesthat cover a variety of topics and case studies.

All clinical staff members are trained to perform advancedprocedures including rapid sequence induction with oral

intubation, nasal intubation, needle and surgical cricothyro-tomy, needle chest decompression, chest tube placement,central line placement, and pericardiocentesis. Packed redblood cells are carried on all flights and given as needed.

Because the department is part of an academic medical cen-ter, LifeFlight crewmembers have some exceptional opportu-nities for medical training that many other flight programsmay not have access to; 2 of those, the use of a cadaver labo-ratory and a high-fidelity simulation laboratory, allowcrewmembers to be exposed to some very complex medicalscenarios. The cadaver laboratory is used on a regular basis tolearn and maintain invasive procedures and skill sets.

Another unique program is the ability to have an emer-gency medicine resident fly as part of the regular medicalcrew. Each year, 1 physician is selected from the emergencymedicine resident program and trained to operate on shift asa regular crewmember. The experience exposes the emer-gency medicine resident physician to flight medicine andoperations and allows LifeFlight’s registered nurses and para-medics to learn the latest in emergency medicine.

Physician involvement remains one of the keys to maintain-ing clinical performance. Jeremy Brywczynski, MD, assistantprofessor of emergency medicine, became the medical directorin November 2010. He implemented an oral review board forall medical crewmembers. On an ongoing basis, he meets witheach crewmember and gives scenarios about how that patientwould be cared for; this gives him the opportunity to get toknow all crewmembers, their skill level, and what areas thedepartment may need to focus on for future education.Brywczynski also attends chart reviews to answer questionsand bring out teaching points during the monthly case confer-ences. He is assisted by his colleague, Jared McKinney, MD,assistant professor of emergency medicine, who serves as med-ical director over the ground and event medicine divisions.

Today, LifeFlight has made more than 40,000 flights andhas more than 130 employees, 5 bases, 1 airplane, 4 groundambulances, and several divisions that form a cohesive inte-grated transport service. Rotor-wing air carrier transportationis provided by AirMethods, and fixed-wing air carrier trans-portation is provided by SevenBar.

LifeFlight’s Working PartsMore than 130 Vanderbilt employees keep LifeFlight run-

ning smoothly. Add to that the approximately 34 pilots and17 mechanics who work for LifeFlight’s vendors, AirMethodsand SevenBar, and you have some 180 personnel who serveas VUMC’s most visible brand—walking, flying, and rollingbillboards. LifeFlight staff work in 7 different divisions andserve as Vanderbilt ambassadors in every community withinthe medical center’s 65,000–square mile catchment area.

Emergency Communications

The front door to VUMC and the Monroe Carell JrChildren’s Hospital at Vanderbilt, the emergency communi-cations division has 18 employees manning more than $1

147July-August 2014

million worth of highly sophisticated communicationsequipment. This team of licensed EMTs and paramedicsdispatch and follow 5 helicopter bases; an airplane; andneonatal pediatric critical care ground, ground EMS, andLifeFlight Event Medicine ambulances. Additionally, thisoffice serves as the Regional Communications Center(Region 5) for Tennessee, dispatches any stat emergencycalls throughout the medical center campus, monitorsweather conditions, and tracks more than 6,000 takeoffsand landings at the Vanderbilt helipads.

Helicopter (Rotor Wing)

Sixty-one employees make up the rotor wing division(excluding the AirMethods pilots and mechanics); 47 of thoseare flight nurses, and 9 are flight paramedics.

LifeFlight operates a fleet of 6 Airbus helicopters: 3 EC145s,2 EC135s, and 1 EC130 from bases located in Lebanon (LF 1),Tullahoma (LF 2), Clarksville (LF 3), Mt Pleasant (LF 4), andSmyrna (LF 5), TN, covering all of Middle Tennessee,Southern Kentucky, and Northern Alabama. The sixth heli-copter is used as a backup. Each base has a chief flight nursewho manages the base and its employees. The program flewwith just 1 helicopter from 1984 to 1987. From 1987 to 2012,an additional 4 aircraft were added.

Each base also has a “critical care response” car for themedical crews to meet local EMS teams and assist transportby ground ambulance on missions that cannot be completedby air because of weather conditions. The cars are formerVanderbilt University police department patrol vehicles. Thevehicles do not respond to emergencies with lights and siren,nor do they respond directly to scene calls. The LifeFlightmedical crew will have all of the medical equipment andsupplies that are normally available on the helicopter,including lifesaving blood.

In 1998, LifeFlight began working with its vendorAirMethods to implement a single pilot instrument flightrules (IFR) capability. Since then, it has built an advanced net-work of low-structure IFR approaches to enhance safety andavailability during decreased visibility. In 2009, night visiongoggles were added on all helicopters.

Airplane (Fixed Wing)

Five employees are assigned to the fixed wing division(excluding SevenBar pilots and mechanics). Two of those areflight nurses and 3 are flight paramedics. LifeFlight 10 (air-plane) opened in Nashville in 2004. The fixed wing aircraft isanother component of Vanderbilt’s comprehensive transportprogram. Each year, VUMC’s fixed wing program transportspatients to destinations across North America.

Ground Transport

Staffed by a dedicated team of 13 EMT-IVs, paramedics andcritical care paramedics, the ground transport division doesBLS and advanced life support discharges from VUMC as wellas critical care transfers.

Event Medicine

The event medicine division has 1 full-time employee andmore than 25 part-time EMTs and paramedics. Functioningas a highly visible arm of LifeFlight, the team provides emer-gency medical care and transportation to more than 600 com-munity events, including the Nashville Predators, theNashville Sounds, and all Vanderbilt athletics.

Discharge Transport

The discharge transport division consists of 2 full-timeemployees and handles the logistics and coordination of all

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patients discharged by ambulance from VUMC. It also dis-patches and coordinates LifeFlight’s ground transport.

Education, Outreach, and Marketing

The education, outreach, and marketing division consists of 3full-time employees, 1 part-time employee, and 2 student work-ers and is responsible for all external education efforts; market-ing; digital media; business development; EMS equipmentcleaning and delivery back to its home agency; coordination ofthe mobile command and communications bus; and coordina-tion of the student group, Vanderbilt Emergency MedicalSociety, and interaction with EMS and hospital customers.

More than 12 courses are offered to 911, EMS, and hospitalproviders through this division as well as a large annual EMSconference. More than 3,000 people were provided with EMSeducation in 2013 from Vanderbilt LifeFlight.

Leadership

LifeFlight operates as a department within the nonprofitVUMC. It operates under the emergency services umbrella,which reports to the chief nursing officer of VUMC. JeanneYeatman, MBA, RN, EMT, who served as LifeFlight’s programdirector from 2002 to 2012, oversees all emergency servicesas its administrative director. Lis Henly, RN, EMT, serves asLifeFlight’s program director along with Kevin Nooner, MSN,RN, CEN, CFRN, EMT-P, who serves as its operation director.

LifeFlight by the numbers (2013)5 helicopters staffed 24/71 backup helicopter1 airplane4 ground ambulancesTakeoffs and landings at Vanderbilt helipads: 6,751Average speed of a LifeFlight helicopter: 138 mphAverage response time for helicopter (flight time): 24.1

minutes2,770 hours flown by helicopter (365,563 miles)

798 hours flown by airplane (35,348 miles)Total loaded miles by ground ambulance: 1,627

Transports:Helicopter: 2,409Airplane: 265Ground EMS (discharge transport ambulance): 1,470Event medicine (ground ambulance): 81 Total transports: 4,22560% interfacility flights40% scene flights83% of patients are adults17% of patients are pediatric

4.5% of all patients received blood while inflight

12% of all scene flight patients received blood while inflight

121 ST-segment elevation myocardial infarction patients transported by helicopter

142 stroke patients transported by helicopter

Community events worked by event medicine: 534

5 community-located bases:Lebanon, TN (LifeFlight 1)Tullahoma, TN (LifeFlight 2)Clarksville, TN (LifeFlight 3)Mt Pleasant, TN (LifeFlight 4)Smyrna, TN (LifeFlight 5)Airplane (LifeFlight 10) is located at the Nashville

International Airport

Emergency communications division (flight communication)26,279 trauma pages sent14,067 ambulance radio reports taken

Jerry Jones, MPA, EMT-IV, is the public affairs manager forVanderbilt LifeFlight in Nashville, TN. He is a seasoned EMS profes-sional serving as the former chief of Bedford County EMS. He hasbeen with Vanderbilt University Medical Center for 13.5 years.

1067-9991X/$36.00Copyright 2014 by Air Medical Journal Associateshttp://dx.doi.org/10.1016/j.amj.2014.03.003