One of the first decisions I was asked to make when I got to St. Luke’s was whether we should continue to operate Air St. Luke’s. I gave it a lot of thought and in the end, I concluded that the community would be disadvantaged if we were to stop.
I realized that our helicopters provide many added safety features over others. Our helicopters are dual engine rather than single engine, which is more costly, but much safer. Our pilots are equipped with the latest in advanced flight navigation technology, making navigation in the dark and over mountainous terrain much safer. And the training and experience of our pilots and crew are unparalleled.
We are the only Idaho-based air ambulance. South and south-central Idaho are our home and community, and we go to a lot of extra effort to work with emergency services throughout our region on training and preparedness.
I have asked my blog editor, Roya Camp, to tell the Air St. Luke's story. Her report follows.
Air St. Luke’s recently was accredited for the fourth time, and while that’s cause for celebration, it’s the myriad services our transport division provides that are the really exciting news.
The certification, by the Commission on Accreditation of Medical Transport Systems, was something that the Air St. Luke’s team sought out as a voluntary effort to improve its own high standards, according to program Director Mike McGrane.
The team started preparing for the inspection more than a year ago, reviewing standards and identifying opportunities to improve in areas such as safety, risk management, and integrated risk assessment and monitoring.
Team members weren’t surprised to find that quite often, they’d already adopted best practices, in advance of more recent standards.
“We did it because we want to be great,” he said. “It’s a collection of standards that we aspire to.
“We’re progressive, so we’d adopted things they’d changed,” McGrane said.
One of the approaches Air St. Luke’s has taken is a best practice straight out of the military playbook.
TeamSTEPPS, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety, is a system developed by the Department of Defense and the Agency for Healthcare Research and Quality.
The method, based on 25 years of research related to teamwork, team training, and culture change, is used to integrate teamwork into practice to improve the quality, safety, and efficiency of health care.
The TeamSTEPPS emphasis on a flow of communication and cross-checks with colleagues, adopted by civil aviation and within military hospitals, has been a good fit with the Air St. Luke’s team and its work, McGrane said.
“For us, it’s a safety thing, watching out for one another,” he said. “That’s team safety and patient safety for us.
“The culture we’ve engendered in our program makes this possible,” McGrane said. “We want to be the best. We want to improve on things we do.”
The Air St. Luke’s team has been aiming for the top since before 2002, when the helicopter service and dedicated flight team were established in the Treasure Valley, joining a fixed-wing plane. Since that time, the team has established a second base and helicopter at Magic Valley.
The service is staffed by St. Luke’s employees, primarily from intensive and emergency care backgrounds. St. Luke’s contracts for pilots, mechanics, and the equipment.
Positions with the Air St. Luke’s team are coveted. It’s very competitive to get on with the team, and turnover is low.
One of the things that sets the team apart from other air transport groups is its level of training. Air St. Luke’s requires team members to train in, among other things, high-altitude physiology, and to rotate through the intensive care unit and operating room.
The training, and the requirement, highlight Air St. Luke’s unusual position in connection with St. Luke’s Health System. Many air transport services are unable to make such intensive ongoing training programs available because they serve multiple health systems.
Air St. Luke’s team members train in high-altitude physiology and rotate through intensive care and the operating room.
Because Air St. Luke’s and the St. Luke’s Health System are integrated, air transport is more an extension of care than it is strictly a system of moving patients, and the accreditation team noted the strong outreach component in its findings.
For Air St. Luke’s managers, the rural nature of the region has dictated an emphasis on survival training as well. Remote vehicle and hunting accidents and extreme weather and topography are factors that air transport services may not be as well-equipped to address.
“Our people have conducted searches,” McGrane notes. “In one case, we built a fire for the family.”
And while it’s more expensive for St. Luke’s to operate its own air service, McGrane said, the structure is more efficient in the long run, when it comes to outcomes and long-term costs.
Most importantly, there’s the patient experience.
Patients are served by equipment that is unusual for an air transport unit, including a self-contained ICU for a baby that can move between vehicles and an intra-aortic balloon pump that can provide artificial circulation for shock transport when needed, and by the constant communication and tight, trusted relationships with emergency providers and physicians and between sites.
They also benefit from multiple, less obvious features offered by Air St. Luke’s.
“We’re providing services that we can’t bill for, like returning babies to their communities,” McGrane said. “A for-profit (air transport) company’s not going to do those things.”
Memberships help pay for Air St. Luke’s services, including simulation training for EMTs, nurses, and physicians in Challis, Emmett, Riggins, and other outlying areas. For the past five years, the Air St. Luke’s team has organized simulations and worked with community providers on patient scenarios.
By bringing monthly continuing education to smaller communities and replicating scenarios, the clinicians hope to minimize the need to transport rural residents out of their homes and support networks.
More than 1,200 people were trained last year alone.
“If we can improve care in the community, we can eliminate problems upfront,” McGrane said.
The Air St. Luke’s team expects to get a formal letter announcing the reaccreditation next month, but improvements and innovations haven’t taken a summer break. Plans are progressing for construction of hangars in Magic Valley and Meridian to protect the helicopters during freezing winter weather and the heat of summer to ensure quicker response time. And Air St. Luke’s recently acquired two new ambulances.
Next up: an application for mobile devices that will connect emergency first responders throughout the region with the Air St. Luke’s communications center. By alerting Air St. Luke’s to responders’ location, and keeping responders apprised of aircraft availability, response time will be reduced. That’s Air St. Luke’s, out ahead again!
For more information about Air St. Luke’s membership and how to support Air St. Luke’s, see http://www.stlukesonline.org/specialties_and_services/ASL/membership.php
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.