MedCenter Air is an air medical provider, serving the US states of North Carolina and South Carolina, offering emergency transport services in partnership with GAMA Aviation and the Air Methods Corporation.

The program, which completed its first flight on 26 May 1986 – transporting an injured NASCAR driver from Charlotte Motor Speedway – has grown substantially since its inception, when it employed a single Bell 206 helicopter based on the front lawn of the Carolinas Medical Center.

The service opened its first rooftop helipad in 2003, and now maintains four helicopter bases – three in North Carolina (Concord, Hickory and Wadesboro), as well as one in Rock Hill, South Carolina – each the home of a Eurocopter EC135 P2+, equipped for on-the-scene and interfacility responses. All four primary helicopters are owned outright by Atrium, while a fifth EC135 is also leased as a back-up aircraft.

All bases operate on a 24-hour, all-year basis, offering a service area of up to 150 nautical miles. Crews for helicopter emergency medical services (HEMS) are provided by Air Methods under a long-term contract. The company also provides maintenance for the helicopter fleet.

The service opened its first rooftop helipad in 2003, and now maintains four helicopter bases

Time and distance

The service responds to both ‘interfacility and scene requests’, explained Michelle Hicks, Flight Nurse with Atrium Health MedCenter Air and Mobile Medicine. “Interfacility is a hospital-to-hospital transfer request, moving the patient from a lower level to a higher level of care. One example would be a heart attack patient being transferred to a hospital that has capabilities for heart catheterization.

“A scene request is a response from a 911 call. The emergency medical service (EMS) agency responding to the incident will call for a helicopter based on the patient’s needs and proximity to the nearest hospital for definitive care,” she said.

Emergency response requests are more common in rural areas where there is a greater level of access to patients on the ground, the pair explained. “In rural areas, our helicopters often land in roadways or fields for scene requests,” said Dennis Mack, Director of Operations with Atrium Health MedCenter Air/Mobile Medicine. “In the urban areas, helicopter transport requests are usually more interfacility-type transfers, due to so many small hospitals in close proximity.”

According to Mack, ‘time and distance’ are the main factors in deciding when to deploy an Atrium Health air ambulance helicopter over a ground ambulance. A rapid response in the first hour after an accident or medical emergency – commonly known as the ‘golden hour’ – is vital to give patients the highest chance of survival.

“One example would be a time-sensitive myocardial infarction, or heart attack patient, who needs immediate transport to the percutaneous coronary intervention facility,” he explained. “If the receiving facility is closer by ground, an ambulance is sent. If it is further than 20 to 30 minutes away by ground, the helicopter would be faster.”

Fixed-wing jets for long-distance flights

MedCenter Air also offers long-distance medical transport services – originally launched in 1987, using a single King-Air 200 – with a fleet of four fixed-wing aircraft. “We currently have three Pilatus PC 24s and one Cessna Citation V jet,” said Mack, who added that like with its helicopters, Atrium Health owns all four jets outright.

“Our fixed-wing aircraft are the preferred method of patient transport for anything over 150 nautical miles,” added Hicks. Flight crews are provided by GAMA Aviation.

Nearly 200 teammates and extensive equipment

While flight and maintenance crews are provided through third parties, Hicks and Mack said that MedCenter Air’s medical crews were drawn from a unified pool, regardless of mission type. “The same medical crew and configuration are trained to perform patient care in either mode,” they explained.

In total, Mack said that the MedCenter Air team comprises ‘nearly 200 teammates’ in total across both its flight and medical crews, including ‘registered nurses (RN), respiratory therapists (RT), paramedics, emergency medicine technicians (EMT), certified flight communicators and pilots’.

Crew members have extensive training, including experience in the ICU or emergency department

“Crew members have extensive training, including experience in the intensive care unit (ICU) or emergency department, and are cross credentialed with emergency medical services (EMS) certifications, along with other advanced training. The extensive capabilities and training allow the crew to make life-saving decisions while in the air,” Mack said.

He also explained that ‘Atrium Health’s MedCenter Air aircraft and ground ambulances carry the same equipment’. Onboard gear includes a Hamilton T-1 transport ventilator, IMPELLA ventricular assist devices (VAD), intra-aortic balloon pumps and video laryngoscopy devices, as well as onboard nitric oxide, heated high-flow O2 and blood supplies.

“We are currently in the process of changing protocols, from carrying two units of blood and two units of plasma, to carrying two units of whole blood,” Mack said.

Integrating services and helicopters

MedCenter Air had remained unshaken by recent changes to legislation covering air ambulance services, such as the No Surprises Act – this came into force on 1 January 2022, establishing new protections for patients from ‘surprise billing’. The Act is primarily designed for those forced to employ medical providers outside of their insurer’s network of partner companies.

Consequently, Mack explained, since the Act ‘applies to patients whose insurance companies are not in-network with the agency providing the service, and since Atrium Health is in-network with most insurance companies … we have not experienced any issues at this point’.

Regarding the future of MedCenter Air, Mack added that Atrium Health was exploring the possibility of acquiring new Airbus H-135 helicopters this year, with further news expected in the second quarter of 2023. “Although it is premature to discuss future plans, MedCenter Air is always recruiting experienced providers to our team. We continue to integrate services with our partners at Atrium Health Wake Forest Baptist, following the strategic combination in October 2020.”

This saw the Wake Forest Baptist Health system, including the Wake Forest School of Medicine, merge with Atrium Health to become a single organization, bringing over seven million people under its collective aegis. It provided MedCenter Air with access to more resources, as well as an opportunity to significantly expand its reach.