The altimeter climbed through 1,000 feet as the aircraft began a controlled turn to the left. The back of the aircraft, which once held an executive interior, has been replaced with a myriad of medical devices and purpose kept seats. Passengers now include medical professionals and a patient on a gurney connected to tubes and breathing apparatus.
This is a standard scene in a “flying intensive care unit,” found in the aft section of hundreds of Beechcraft King Airs throughout the world.
LifeSave Transport solely operates King Airs for its fixed-wing operations and is one of the largest independently held air medical services in the nation. The company is owned and operated by two Kansas physicians who have designed a complete medical transport system to serve communities, hospitals and patients.
History and Operations
The company was launched in 2001 by 6,000-plus-hour pilot Martin Sellberg, M.D., FACEP (Fellow of the American College of Emergency Physicians). Being a fourth-generation rural Kansan and emergency physician, he understood the need for efficient medical transport from smaller communities in the state to larger ones with a more robust medical infrastructure.
Dr. Sellberg partnered with Dr. Richard Watson, another experienced physician and entrepreneur, to build a complete emergency transport system operating as a medical company first that is focused on patient care and safety with a state-of-the-art communications system, patient-centered billing division and maintenance facility.
Today, LifeSave operates 13 King Airs (several C90s, a C90-1, several C90Bs and a B200), as well as Bell 206 and 407 helicopters. It has bases in 15 locations in Kansas, Nebraska, Texas and Hawaii. The company also operates ambulances for patient transfers from the fixed-wing aircraft to the hospital.
The transmission of information is of the utmost importance in emergency medicine as it is in aviation, and LifeSave prides itself on informed and decisive exchanges. To this end, all the company’s actions derive from its communication center. Here, inbound calls originate from either medical professionals at the hospital or in the field. The skilled team gathers information related to a patient’s need for transport and helps guide the journey from point of origin, to LifeSave pickup, and all the way to drop-off at the tertiary care facility.
Through their experience in the communication center guiding hospitals and other facilities, Dr. Sellberg saw the need to further ideate what type of transport is appropriate in certain scenarios. Making the decision between calling a ground, rotor or fixed-wing asset for a heart attack patient who is 120 miles away but in stable condition can be a tough decision even for the most experienced providers. Drs. Sellberg and Watson developed a proprietary software as a guidance tool for these complex situations.
The Mission Control™ software assists the sending facility in choosing the appropriate transport method. This can be a life or death decision as well as the difference between a financially successful or unsuccessful mission. Once the method of transport is identified, the sending and receiving facilities are then directly linked to the LifeSave team to improve care throughout the transport process.
The company’s overall operations derive from the founders’ vision and backgrounds. Dr. Sellberg said they view LifeSave as “a healthcare-focused company with aviation assets,” that is “designed to provide critical care solutions when a patient needs it the most.”
Why King Airs?
The low-margin world of emergency air transport make the King Air an ideal platform. The family of turboprop’s durability, relatively low operating costs, and availability of parts are a natural fit for many medical transport operators.
All things considered – weight capacity, speed, endurance, operational ease – the King Air is an almost perfect candidate for the rigors and unique mission profile of emergency air medical transport.
Two important aspects of the aircraft are its range and endurance profiles, which tie in directly to the company’s operations in the Midwest and Hawaii, which may seem as a “random” location to some, Dr. Sellberg notes. “Hawaii is surprising in how similar it is to the Midwest, in terms of the distribution of specialty medical resources and the distances between them, so it was a natural expansion for us.” For instance, Hilo (PHTO) to trauma care in Honolulu (PHNL) is within four nautical miles of the same trip from Liberal (KLBL) in the western part of the state to Wichita (KAAO), a major medical hub for Kansas.
To better understand LifeSave’s operations, I rode along on a training flight with the crew on a Saturday evening in early August.
Arriving at Colonel James Jabara Airport (KAAO) in Wichita, I was greeted by the sight of a stoutly King Air with a Staff of Hermes painted on the tail. Excited to learn more about the operation of a flight, I attended the evening’s shift briefing, in which information pertinent to the night’s possible flights, as well as details for the pilots and medical staff to be mindful of, were discussed.
David Marten, ATP-rated and former military test pilot, was the night’s on-duty pilot and in charge of the briefing. It was a standard affair, discussing the weather in the Wichita base’s immediate service area and a rundown for me on aircraft operations, as well as other important details.
Having learned some already on why King Airs are well-equipped birds for the mission, I asked Marten how he felt about the aircraft.
“The King Air’s rugged dependability makes it a perfect fit for the medevac mission,” he said. “We don’t need the fastest, most luxurious airplane, rather we need a utilitarian aircraft offering simplicity of operation, renowned mechanical reliability and a high dispatch rate. The airplane must be ready to go when needed. There is no time to fuss with complicated systems requiring careful handling by pilots and mechanics. The King Air is the perfect load-and-go airplane offering the rugged dependability of your grandpa’s pickup truck. It simply works. Whether the airplane’s sitting out in subfreezing temperatures or baking on the ramp, I’m continuously impressed with its ability to dispatch nearly every time. When lives are on the line, I have full confidence the King Air is ready to fly.”
Unsurprisingly, medevac flying is an all-weather affair and thus pilots must be suited for such. Marten notes that “we routinely must be ready to fly into rural airports with a 4,000-foot runway and no precision approach.” Coupled with the required innate ability of “having to make difficult decisions quickly and on one’s feet, almost autonomously” leaves a special breed of pilot behind the yoke.
“Most pilots are a little bit of adrenaline junkies,” he noted. “We have a first responder mentality and it’s important to be able to focus on flying, even with a panic going on in the back. You have to be able to compartmentalize.”
I learned that the company’s pilots average about 400-500 hours a year and, for example, the Wichita-based aviators fly into about 200 airports in Kansas and Nebraska, so every flying day is different from the one before.
Soon after the briefing was completed, it was time for my orientation flight before the night’s real mission calls came in. I was able to take the right seat on our short hop to Medicine Lodge Airport (K51), about one-and-a-half hours if driven.
This airport was chosen because it is a regular pickup location for the crew, including a trauma the night before. The airport is also almost a perfect locational representation for why medical evacuation flight companies exist. The town of 2,000 is the most populous in its west-central Kansas county but lacks advanced specialty medical care. LifeSave bridges the gap for residents, providing access to services such as trauma-related injuries. Operators like LifeSave help bridge the gap for residents in these more rural communities, allowing them to have better access to specialized medical care.
N813JB, a 1980 C90, was the airborne ambulance of the evening and was preflighted prior to my arrival. The aircraft’s interior, like all of the company’s King Air aircraft, was modified in-house.
Marten fired up the right-side engine, followed by the left. Comms with Wichita were succinct, and our flight details were confirmed. Being that LifeSave’s hangar is at the far end of the airport, taxi to the hold-short line was quick, and we were cleared across moments later. This “quick start; quick flight” mission profile is important, as it can dictate a patient’s ultimate outcome, which Marten communicates as “speed is life.” The company’s goal is always to be able to take off within 10 or 15 minutes of receiving a transport request.
Being that our flight was a dry-run-only mission and that no patient was on the receiving end, the crew didn’t have the nerves that I would expect them to have if a car crash or heart attack victim would be riding back with us. That being said, all aspects of the trip were handled as realistically as they could.
While the aircraft continued climbing to 8,000 feet, the medical crew ran through some scenarios and communication points in the back. At this point, they would have begun arranging all needed medical supplies, in anticipation of what would be needed for the patient.
Our trip averaged about a 230-knot cruise speed and before touchdown we crossed the field at pattern altitude, to verify that no wildlife or farm implements were making the runway home. The C90 showed one of the reasons it is a staple in medical transport flying, as Marten put the props in reverse after the tires kissed pavement. In only about 1,000 feet, we were slowed and jaunting to parking at the north end of runway 16/34.
To better understand the flight from a patient’s point of view, I opted to ride back in the cabin with Megan Campbell, flight nurse, and Ismael Maravilla, paramedic. Their medical knowledge and experience are a natural complement to one another, which allows them to handle many types of medical emergencies and maladies. For those situations that require a little more attention, the two can phone the company’s 24-hour medical control or the receiving hospital’s doctors from a satellite phone.
To get the full feel of what a patient experiences, I became one. With my simulated broken leg from a car clipping me while on my bike, I was situated onto the sit-up medical cot facing the rear of the aircraft and buckled in. At that point, Campbell and Maravilla would have taken medical intervention had my condition been legitimate.
Perhaps surprising to many, about eight out of every 10 patients may be critically ill but are clinically not experiencing rapid changes in their condition during transport to a specialist (often orthopedic or cardiac-related). For the other remaining two, the medical crew’s jobs become more complex.
Many times, when the crew arrives on the scene, they may be the most experienced in emergency trauma care and actively assist the other practitioners on actions in anticipation of transfer. For instance, the night prior to our flight, the crew was in Medicine Lodge to bring a trauma patient to Wichita for acute care. The ground team awaited LifeSave’s arrival for trauma center care, so they were on-ground for more than an hour stabilizing the patient and preparing them for transport.
Even with the time spent on the ground, flying to Wichita was still a net time gain in the end. According to LifeSave, trips over 100 miles (of what would have been driven) almost always are better taken in the air. From that decision point, weather conditions and total distance dictate whether rotors or propellers prevail.
The return flight is only as eventful as the patient’s condition and fortunately my flight was as uneventful as it could be. After 23 minutes, we were back on the ground at Jabara and pulled up next to one of the company’s ground units where I got to experience the patient transfer process. At this stage (and onboarding), one of the King Air’s few weaknesses became apparent. The relatively small 28-inch cabin door can occasionally be an obstacle for the team to navigate, as the cot is a tight fit. After passing the threshold, I was put down the “slide” onto a cart and on my way to the company’s ground unit.
In some scenarios, such as transferring a critical patient in Denver where traffic slows an ambulance’s route, I was informed that the patient would be transferred from the fixed-wing asset to a rotor wing. From there, the patient is airlifted directly to the care facility’s helipad. More often though, they are whizzed away in the ambulance.
No matter which way the company transports someone to tertiary care, the pilots, paramedics and nurses are happy to know that they are making a difference on likely the worst day of someone’s life.
Grant Boyd soloed at 17 in a 1977 Cessna 150M. In the seven years since, the private pilot has been involved in aviation through a variety of avenues: from marketing to customer service. He has written more than 85 articles for a number of aviation magazines and loves learning about aircraft/pilots with unique missions. Grant can be reached at firstname.lastname@example.org.