UAB Synopsis, Vol. 24, No. 26, July 11, 2005

Emergency transport service replaces original JET with faster, longer-range aircraft

The aircraft call numbers — N10UH — are the same, but UAB Critical Care Transport's (CCT) newest addition, a 2000 twin-engine Cessna Citation Bravo outfitted as a fully operational intensive care unit, is faster, larger, and more fuel efficient than the 29-year-old Cessna Citation 500 it replaced. "The new jet also has greater range, modern avionics, and a medically configured interior specifically designed for CCT," Chief Transport Nurse Laura Lee Demmons, RN, MBA, says.

The total cost of the jet, which had logged only 750 flight hours at the time of purchase, was $4.1 million. The new jet landed in Birmingham on May 14, and following several weeks of training and final preparations, the aircraft safely completed its first official trip on June 2. At 6:40 that evening, the Bravo took off in the rain for Selma, Alabama. The patient was a 58-year-old man in respiratory failure.

Prior to transport, the medical team that included Michael Burch, MD, Michael Lovelace, RN, and Troy Biles, RRT, adjusted the patient's ventilator settings, administered a breathing treatment and additional medications, and inserted arterial and central lines. Pilots Ron Saladin and Roger Kimbrough then took the Bravo up for the 20-minute flight back to Birmingham. The patient arrived in improved condition and was directly admitted to the medical intensive care unit.

With a top speed of 480 miles per hour (100 miles per hour faster than the Cessna Citation 500) and a cruising range of 1,700 miles without refueling, the Bravo saves time and money, allowing CCT to complete patient transports with greater speed and efficiency. "The Bravo's greater range expands our service area, while its relatively compact size allows us to continue to land at smaller runways, so we can still reach hospitals in rural and underserved areas," Demmons says.

"UAB Health System and University Hospital are pleased to make this investment on behalf of its patients who come from referring physicians and hospitals. It enables us to continue to provide state-of-the-art care en route to our state-of-the-art facilities," UAB Health System Associate Vice President and CCT administrator Robert Cofield, DrPH, says.

CCT regularly flies patients from Alabama, Mississippi, Florida, and Georgia to and from UAB, and neonatal transports to The Children's Hospital in Boston, Massachusetts, also are routine. "The Bravo now allows us to make the flight to Boston without refueling and shaves more than 2 hours off total transport time," Demmons says.

The Bravo's dedicated medical interior, designed by Chief Transport Therapist Diane Kahler, RRT, and CCT's medical team, can support up to two stretchers or isolettes — the old jet had room for only one patient. The Bravo is 28 inches longer than the retired jet, and designers used the extra space to create zoned work areas for the three-person medical team, usually a physician, registered nurse, and respiratory therapist, putting medical gas and electrical outlets and supplies and medical equipment in easy reach of the appropriate staff member.

Removable seating lets the crew place large medical equipment, such as the 180-pound intra-aortic balloon pump, in the front of the aircraft, instead of the rear of the jet, which speeds loading and unloading. The aircraft has an enhanced interior lighting system that includes lights in the drawers and cabinets, Kahler says.

"During the design process, our team members thought about all the features they ever wished the old jet had and worked with one of the key pilots, Terry Barnett, to find a way to add them to the Bravo," says Kahler, who has flown on more than 500 transports. Barnett added his own features to the Bravo to decrease downtime and increase the number of hours the jet is available for patient transport.

Transforming the new jet to meet CCT's specifications took more than 5 months and, in addition to the interior redesign, included a custom paint job and a 36-inch wide cargo door — believed to be the first ever installed on a Bravo. The result is a cutting-edge air ambulance that provides an optimal environment for patients and medical teams, Demmons says.

LifeGuard Transportation Services, based in Pensacola, Florida, provides the Bravo's licensed pilots and drivers for CCT's four ground units, which operate within an 150-mile radius of Birmingham.

22 Years of Transports

In 1983, CCT broke new ground in emergency transport medicine, becoming the first civilian service to use liquid oxygen in a fixed-wing aircraft and operating the first jet dedicated solely to hospital-to-hospital transfers. Before its retirement on June 1, the Cessna Citation 500 transported more than 26,000 critically ill patients and held records for the most flight hours and cycles — takeoffs and landings — in the world.

"With more than 21,000 cycles and 16,000 flight hours, the old jet was both a workhorse and a wise investment," Demmons says. "But the 500 was beginning to show signs of age, and like an old car that requires constant upkeep to keep it in good condition, operating costs were threatening to outstrip the aircraft's value."

A new Federal Aviation Administrations-mandated avionics upgrade that went into effect last January would have required a costly upgrade to the 500, Demmons says, noting that maintenance expenses were also mounting, with parts for the older jet becoming more expensive and scarce. "We wanted an aircraft that would take CCT and our patients through the next 2 decades," says Demmons, who joined CCT in 1983 as a part-time nurse.

CCT, headed by Medical Director Marlon Priest, MD, is one of the few physician-led transport services in the nation — interested residents in the Departments of Surgery, Internal Medicine, Emergency Medicine, and Anesthesiology undergo training and credentialing to serve aboard the aircraft, Demmons says, noting that CCT has been nationally accredited by the Commission on Accreditation of Medical Transport Systems since 1999 and is 1 of 107 accredited programs in the nation and the state's only hospital-based accredited service. "The new airborne ICU emphasizes UAB's commitment to making the outstanding care our faculty and staff provide accessible to every Alabamian," Dr. Priest says. "This is but one expression of our appreciation for all their support of our work for so many years. Thanks!"

CCT, which is available around the clock every day of the year, fields three air transport teams — adult, neonatal, and intra-aortic balloon pump. Demmons projects that in fiscal year 2005, CCT will complete about 650 air transports and more than 1,100 ground transports.