You started your career with the United States Air Force (USAF) as a flight medic. What inspired you to pursue a career in this sector?
I didn’t perform very well in my freshman year of college; however, I knew that I needed some structure and discipline in my life to be successful. I had no previous ambition to work in the medical field, but my recruiter vectored me there after seeing my Armed Services Vocational Aptitude Battery (ASVAB) score. Once I started training, I took to it like a duck to water.
Your career with the USAF spanned a variety of roles, culminating as the Commander of 433rd Aeromedical Evacuation Squadron, the largest air medical evacuation squadron in the USAF. What were the greatest challenges you faced in this position, being responsible for over 200 personnel during wartime and disaster responses?
The biggest adjustment for me was having the final say on personnel issues. Leaders must ensure that they are providing the training and equipment for personnel to perform at their highest level during stressful situations such as wartime or supporting a natural disaster. Having to facilitate someone’s departure from service is never taken lightly, but it makes the squadron stronger and enhances mission capability.
You’ve also managed to achieve success in a variety of civilian roles. How has your experience in the military and as a registered flight nurse helped you in these positions?
I was very fortunate to have a career in aviation in both sectors of my life. Becoming a flight medic instructor prior to becoming a civilian flight nurse set a great foundation of understanding flight physiology and its effects on patients. Additionally, in the military we instituted operational risk management (ORM), safety management system (SMS), flight operational quality assurance (FOQA), and Aviation Safety Action Program (ASAP) reporting before we did in helicopter emergency medical services (HEMS) – which enhanced my civilian career.
As the Helicopter Air Ambulance Segment Manager for Bell, what does your role look like from day to day?
My primary role is to be an advocate for the HEMS operator that is in a Bell aircraft or that is considering a Bell purchase. I have flown the mission and understand the challenges. I was President of the Texas Association of Air Medical Services (AAMS) for six years and I am experienced in knowing what hospital-based, community-based and specialty flight teams are concerned about. I have been spending a lot of time educating the Bell team on the No Surprises Act as well as other legislative activities that will affect this industry. In emerging markets, I provide presentations on HEMS safety of operations.
What is the main thing that people need to know about the platforms, service and support that they can expect when thinking about Bell helicopters as an emergency transport vehicle?
Bell’s Customer Service and Product Support Teams work around the globe to ensure that our customers achieve the success that they are aiming for: mission ‘up time’ and cost containment. Due to reimbursement challenges in the industry, many are not in the market for new HEMS helicopters, and we must support them in their current aircraft so they can provide the service to their community with limited out-of-service time.
What innovations and advances can we expect to see from Bell helicopters to improve or enhance the air medical provision for their customers?
Bell is continuously looking at ways to improve the platforms that we produce, and new advancements, such as the ‘fly-by-wire’ technology of the 525 that has the probability to eventually transcend the entire commercial product line. Additionally, the upcoming US Army Future Long-Range Assault Aircraft (FLRAA) V-280 technologies may also find their way to the commercial aircraft within the next 10–15 years.
You’ve mentioned Bell’s Customer Service and Product Support Teams. What added value does Bell place on aftermarket support and on your relationships with original equipment manufacturers (OEMs)?
The aftermarket vendors that have supplemental type certificates (STCs) for Bell’s HEMS interiors have always availed themselves to the customer as well as working closely with our commercial sales team and configuration managers. This team approach enhances the customer experience to ensure that the aircraft are built to their desired specifications to meet their mission.
My interaction with established HEMS programs is limited, while those new to the industry allow me to collaborate with the customer and the vendors to ensure that they ask the right questions and have a full understanding of their configuration needs based on local policies and medical oversight.
You’ve mentioned your work with Bell also affords you the responsibility of being an educator, helping new organizations that enter the air medical field. What does this involve?
One of the subjects that I have an opportunity to teach is on HEMS safety. Discussing the importance of crew resource management (CRM), ORM and a robust SMS program within an organization is paramount to meeting mission objectives. When I first started flying in the 1990s, the medical crew were seen as ‘self-loading baggage’ by pilots; however, now they are seen as valuable crewmembers that contribute to safe operations.
In emerging markets, I like to also present the history of US HEMS operations and discuss how we have evolved from an industry with high accident rates to the 2008 Congressional hearings that led to the safer operations that we have today.
You stated that you are educating your colleagues on the No Surprises Act (NSA), an important change to the medical legal landscape in the USA. What implications does this have on air medical transport and what can Bell do to support its customers in this area?
Bell is highly aware on the current challenges facing the industry today. The NSA has had some unintended consequences to the HEMS industry by delaying arbitrated payment amounts for out-of-network transports from insurance carriers. The NSA states that these payments must be made within 30 days of the arbitration agreement, but there is no oversight to ensure that this is occurring. Some providers have shared with me that they still haven’t been paid for flights accomplished in early 2022.
Bases have been closed and, if this disruption in cash flow continues, there will be a loss of valuable transport resources to the rural areas of our country that has already seen the closing of 200 hospitals since 1995.
The mission profiles of HEMS are swinging more heavily towards inter-hospital transport, meaning that the patients are often high acuity with complex needs resulting in the necessity for bulky and heavy equipment to safely transport them. How does Bell work with OEMs and operators to ensure that the aircraft are able to maintain performance under the demands of the extra payload?
This is a challenge for both the program itself and the OEM. Due to the delayed reimbursement issues of the NSA addressed above, it is not an opportune time to entertain aircraft replacement, so the programs have to be vigilant on the weight of medical equipment they carry as well as any additional staff (such as with extracorporeal membrane oxygenation (ECMO)) on their current platforms.
At Bell, we are always looking for innovative ways to improve the performance of our aircraft (electrically distributed anti-torque (EDAT) and recent sustainable aviation fuel (SAF) flights) and there is a finite performance level for every class of aircraft. If moving up to a larger aircraft is not financially viable, the program will have to look at ways to manage weight to make sure they are able to accomplish the majority of their mission requests.
The philosophy in Europe is a bit different than here in the USA – a number of programs do not fly with all of the equipment they can carry if the data does not warrant it. I spoke to a program manager that shared that they fly their ECMO team out to an outlying facility and then the team and patient return by ground since, once the patient is cannulated, they are deemed more stable. I believe that since the market in the USA is so competitive no program wants to be without something they may only use a few times a year.
Remote and rural hospital closures are an issue facing the global medical community, especially in the USA. What is Bell doing to alleviate the pressures of having longer and more frequent flights to compensate for fewer centers providing medical care?
This is a challenge for all of us. When you have fewer aircraft resources in a region, then you will have to complete longer legs to accomplish these missions – which then send your aircraft to milestone maintenance events at a faster pace per year. This can be an unbudgeted expense that has to be managed. The Bell 429 is the first helicopter to have a maintenance program designed under MSG-3. The maintenance steering group was able to guide the direction of the design to make the aircraft more maintenance friendly, cost effective and efficient to operate. This may not be a panacea, but it should be able to allow those operating Bell 429s to contain their maintenance costs.