AA OPERATIONS CENTER Liberty is planning deployment of 44 Air Ambulances thru a network of more than 22 FTC Centers scheduled for completion in SA by 2017. Each FTC will be required to maintain a minimum of 2 Air Ambulances in flight ready mode for dispatch throughout 12 over lapping operational zones. Up to 90 percent of the 22 FTC training and leasing aircraft including Air Ambulances may be dispatched into SAR mission services for National Disasters and National Emergencies, when requested. The overall program is controlled and directed from the AA Operations Center at the company's SA corporate headquarters.
AA Operational Center Air Ambulance Operational Center Teams consist of: MD Medical Directors CS Communication Specialist VCP Virtual Co-Pilot
Goals of the AA Operational Control Center The goal of the AA Operational Control Center is to provide pilots with the information they need when they need it; when they are on a flight and the weather suddenly starts deteriorating or they have been asked to alter their route. Liberty ‘s AA Team also employs a staff of Registered Flight Nurses with previous flight, critical care and management experience within its AA Operations Center to serve as MedLink, a clinical resource available to medical flight crews 24 hours a day, 7 days a week. Flight crews can speak directly with the MedLink RFNs through the Liberty AA team Operations Center. From protocol clarification, policy and procedure reference or equipment problem solving, the MedLink RFN provides immediate information to the crews.
Goals Cont These RFNs have the ability to readily contact the company's Medical Directors, transferring physicians or the receiving facilities while the crew is in-flight to discuss current situations and immediately pass information from the physicians to the crews. RFNs are trained to sort patients needs by the five-level triage system developed by the military. This helps establish each patients Emergency Severity Index prior to transport. I n addition to crew resource utilization, MedLink offers assistance to transferring hospitals in locating a receiving hospital for patients in need of a higher level of care. Through a significant investment in its highly-skilled personnel and a capital investment of over $xxxxx million in collaboration with technology leaders such as Avaya and Cisco, By 2017, SA fleet of 44 Air Ambulances fleet will provide a future successful model to expand throughout the continent of Africa providing a centralized approach that facilitates tight operational control and rapid response, ultimately resulting in safe, reliable aviation operations and timely, high-quality patient care.
RE-MAN COMPLETION CENTER Liberty Air Ambulance is planning a 60,000-square-foot Re-Man Completion Center, scheduled for completion in 2015. This site will employ more than 60 aviation professionals proficient in mechanics, avionics, composite and sheet metal fabrication, aircraft painting, with a deep technical expertise developed through servicing the Liberty Air Ambulance helicopters. At the end of 2500 flight hours, each aircraft undergoes a rigorous FAA/CAA-approved refurbishment process, whereby the aircraft is largely remanufactured, including a complete overhaul or replacement of all rotational parts; time limited parts components, structures and avionics upgrades. The end result is an essentially new aircraft in the Company's standardized configuration, with either an Allison Rolls-Royce C30 engine or Liberty new high efficiency Series 2 or Series 3 gas turbine engine and Liberty Evac's proprietary litter system.
CLINICAL CARE Liberty AA Team will employs over 100+ registered nurses and 100+ paramedics who serve on its medical flight crews, with one nurse and one paramedic serving on each mission with 100+ PIC. The Company's registered nurses average 12 years of critical care experience, with a minimum requirement of 3 years experience. The paramedics average 13 years of active pre-hospital experience, with a minimum requirement of 3 years ES (emergency services) or ambulatory experience.
Medical Crew Training Includes: All medical crewmembers must be certified in: Basic Life Support Advanced Cardiac Life Support Pediatric Advanced Life Support Pre-Hospital Trauma Life Support (PHTLS) or International Trauma Life Support (ITLS)
Additional certifications include: Neonatal Resuscitation Provider Critical Care Emergency Medical Technician - Paramedic (preferred) Ongoing competency standards are achieved through: Skills Lab Training Simulated Patient Care Experiences Helicopter Safety and Landing Zone Instruction Quarterly and Annual Competency Training
6 Month Clinical Internship Program Flight nurses and flight paramedics selected to work for Liberty AA team are enrolled in a six-month Clinical Internship Program. The Clinical Internship offers didactic training, unique hands-on skills training, simulated patient care experiences, flight training and safety training. Advanced critical care topics include: Cardiac Emergency Management Hemodynamic Monitoring Flight Physiology Drug Assisted Intubation Traumatic Brain Injury Management
Advanced skill level labs include: Advanced Airway Management including Surgical Cricothyrotomylso Radiological and 12-lead EKG Interpretation Ventilator Management A Advanced Airway Management including Surgical Cricothyrotomylso included: Simulated Patient Care Experience with Experienced Liberty AA Team Crewmembers Night Vision Training Scenarios Landing Zone and Helicopter Safety Class Air Medical Resource Management
Additional Patient Care Services Training include: The Liberty AA Team Training Center, under the auspices of Patient Care Services, is responsible for the oversight of internal and external training programs. These programs include, but are not limited to: American Heart Association (AHA) courses National Association of Emergency Medical Technicians (NAEMT) courses Educational programs in which Continuing Education Units (CEUs) and Contact Hours are awarded.
Future Accreditations Planned: By 2014, Liberty AA Team will earn additional accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS) and American Heart Association Training Center. EMS, Inc., is also an approved provider of the Continuing Education Coordinating Board of Emergency Medical Services (CECBEMS) for Continuing Education Units (CEUs) in the categories of First Responder, Basic and Advanced Provider.
METI Emergency Care Simulators Liberty AA Team uses METI Emergency Care Simulators as part of its initial training process and recurrent training. The Emergency Care Simulator is a life-size computerized mannequin utilized for clinical skill set training from basic airway management to high level advanced procedures, such as chest tube insertion and central line placement. The simulator provides the ability to approach training from a scenario-based situation through the aspects of critical thinking and hands-on critical patient care. Liberty AA Team employs 15 such Emergency Care Simulators throughout its service area, representing an investment of more than $xxx,000, to conduct competency training for its medical staff in the field to continue to ensure its personnel are well-trained and providing top-quality patient care.
AA Operational Center Chart 44 Air Ambulances Flight Teams Consist of: PIC Pilot in Command RFN Registered Flight Nurses FP Flight Paramedics
Support Team Air Ambulance Support Team at Operational Center consist of: MD Medical Directors CS Communication Specialist VCP Virtual Co-Pilot
PIC Certifications: Liberty Air Ambulance program trains instrument-rated pilots who are skilled aviators to become proficient air medical pilots by completion of transition training under Liberty’s proprietary training course or Liberty 2 year AA PIC AA Internships. The classes deliver both operational and procedural instruction, as well as aircraft and mission- specific training in the Liberty Air Ambulance helicopters. Each Liberty AA pilot meets stringent FAA/CAA standards and has more than 1,000 rotary hours or has recently completed 2 year AA PIC internship with 200 hours in type, plus completed both IFR and Commercial ratings.
Pilot Certification Cont Pilots must also achieve standards established in Liberty Air Ambulance proprietary FAA/CAA-approved training program. As part of their continuous improvement program, all pilots are required to complete recurrent training, which includes a Part 135/NVG check-ride, on an annual basis. Mission-specific training includes flying at night and landing on unimproved rural terrain, such as pastures and fields. Base assignment requires rigorous local flight orientation training to become an authority on local terrain, hospitals and landmarks.
Cinergy Benefits Liberty AA team realizes many benefits from its use of one Family of aircraft, including: efficiencies in basic thru advanced training programs, cockpit and instrument layout, maintenance and inventory management, internships for all levels of Liberty’s Air Ambulance Program. All these contribute to sustaining a high average aircraft availability; insuring safe operations and a streamlined cost structure that ensures financial viability.
FIXED-WING OPERATIONS Liberty AA team offers airplane medical transport services at all international airport locations in SA. The fixed-wing service serves as an adjunct to the helicopter service by providing a faster means of transportation for long transports, IFR (instrument flight rules) capabilities for flights in inclement weather the helicopter is not able to accept, and as an additional asset when the helicopter is committed on another flight. Liberty AA team has contracted with xxxMed, a Part 135 operator, to operate the aircraft and provide pilots for the services, while Liberty AA team provides the medical crew. This AA team partner has several long distance aircraft including a King Air E90 and Citation used for long distance services.
Mission Providing service to the medically underserved areas of SA, often in rural areas that other ambulance companies may not adequately service; Responding rapidly through a contiguous footprint of mutually- supporting bases in collaboration with numerous hospitals, physicians, emergency 911 centers and EMS agencies; Taking an active role in the advancement of health care services in the communities it services, through local interest and public relationships in each community it serves; Providing superior patient care and aviation operations associated with substantial financial resources, a professionally managed, common infrastructure and standardized, centrally controlled operations.
Mission Driven Culture Serving Those Most in Need Liberty AA team is committed to providing increased access to emergency trauma care to rural SA. In a life- or limb-threatening medical emergency, a successful patient recovery often depends on the amount of time it takes to deliver that patient to the emergency room. 50 million South Africans live in both metropolitan and rural areas, approximately 90% of Liberty AA's patient transports are expected to originate from rural areas. Agriculture: 9% Industry including mining: 26% Services including transportation of products: 65%
Critical Facts: Access to Definitive Health Care for Rural South Africans Liberty AA team believes that those who choose a rural way of life should have the same benefits when it comes to emergency care as those who choose to live in a metropolitan community. Workers that are more than an hour away from a Level 1 or 2 trauma center Rural trauma victims are twice as likely to die from an accident or medical condition versus an urban victim due to failure to arrive at a hospital within the "Golden Hour". (2) Numerous changes in the nation's delivery of health care have made the trauma and tertiary care centers a vital hub for outlying hospitals. The result is an increasing need to transport a greater number of patient’s longer distances for complex, time-dependent care, such as primary cardiac intervention, strokes and complex surgery. (3)
Flight Team Nurses Credentials: Prior to active flight status, all medical personnel must have the following current certifications and must maintain them in a current status. Flight Team Nurses Minimum 3 years current critical care experience State RFN license (Must have license for states served) BLS (Basic Life Support for Health Care Providers ACLS (American Heart Association Advanced Cardiac Life Support) PALS (American Heart Association Pediatric Advanced Life Support) PHTLS (National Association of Emergency Medical Technicians Pre- Hospital Trauma Life support OR ITLS (International Trauma Life Support) All nurses are required to hold an advanced certification (CFRN, CEN, and CCRN) within 2 years of hire.
Flight Team Paramedics Requirements: Minimum 3 years current experience as a paramedic on an ALS unit State Paramedic License (Must have License for states served) BLS (Basic Life Support for Health Care Providers ACLS (American Heart Association Advanced Cardiac Life Support) PALS (American Heart Association Pediatric Advanced Life Support) PHTLS (National Association of Emergency Medical Technicians Pre-Hospital Trauma Life support OR ITLS (International Trauma Life Support)
Flight Team PIC Requirements: Our pilots flying the Liberty 2500 or Liberty 4000 must meet the following requirements: FAA/CAA Requirements Minimum, commercial rotorcraft-helicopter rating Helicopter Instrument rating Class II flight physical Additional Liberty AA Team Requirements: 1000 hours total flight time 750 hours helicopter time 750 hours helicopter pilot command time (PIC) 100 hours un-aided night flying 250 hours turbine
Flight Team MECHANICS FTC mechanics are responsible for the inspection and maintenance of all FTC aircraft daily inspections and on going service requirements to maintain Flight Readiness. The lead mechanic must have the following credentials: Minimum 10 years experience in helicopter maintenance or 12 month Liberty internship training in type. Current A & P Certificate Current Pass Port and Province or Valid State Drivers License
Total Airports in SA (567 in 2013) Airports with Paved Runways total: 145 over 3,047 m: 112,438 to 3,047 m: 61,524 to 2,437 m: 53,914 to 1,523 m: 66under 914 m: 9
Airports - with unpaved runwaysAirports - with unpaved runways: total: 422 2,438 to 3,047 m: 11,524 to 2,437 m: 29914 to 1,523 m: 260 under 914 m: 132 (2013)
Key Infrastructure Points Communications Centers are Bloemfontein, Cape Town, Durban, Johannesburg, Port Elizabeth, and Pretoria Mobile Cellular 50.372 million (2009) Major Ports and Terminals: Cape Town, Durban, Port Elizabeth, Richards Bay, Saldanha Bay
Land Boundaries: total: 4,862 km border countries: Botswana 1,840 km, Lesotho 909 km, Mozambique 491 km, Namibia 967 km, Swaziland 430 km, Zimbabwe 225 km Coastline 2,798 km Maritime claims: territorial sea: 12 nm contiguous zone: 24 nm exclusive economic zone: 200 nm continental shelf: 200 nm or to edge of the continental marginMaritime claims
Elevation extremes: lowest point: Atlantic Ocean 0 m highest point: Njesuthi 3,408 mElevation extremes Terrain: vast interior plateau rimmed by rugged hills and narrow coastal plainTerrain Climate: mostly semiarid; subtropical along east coast; sunny days, cool nightsClimate
Natural resources: gold, chromium, antimony, coal, iron ore, manganese, nickel, phosphates, tin, rare earth elements, uranium, gem diamonds, platinum, copper, vanadium, salt, natural gasNatural resources Land use: arable land: 12.1%permanent crops: 0.79%other: 87.11% (2005)Land use Irrigated land: 14,980 sq km (2003)Irrigated land Total renewable water resources: 50 cu km (1990)Total renewable water resources Freshwater withdrawal (domestic/industrial/agricultural): total: 12.5 cu km/yr (31%/6%/63%)per capita: 264 cu m/yr (2000)Freshwater withdrawal (domestic/industrial/agricultural)
Environment - current issues: lack of important arterial rivers or lakes requires extensive water conservation and control measures; growth in water usage outpacing supply; pollution of rivers from agricultural runoff and urban discharge; air pollution resulting in acid rain; soil erosion; desertificationEnvironment - current issues Environment - international agreements: party to: Antarctic- Environmental Protocol, Antarctic-Marine Living Resources, Antarctic Seals, Antarctic Treaty, Biodiversity, Climate Change, Climate Change-Kyoto Protocol, Desertification, Endangered Species, Hazardous Wastes, Law of the Sea, Marine Dumping, Marine Life Conservation, Ozone Layer Protection, Ship Pollution, Wetlands, Whaling signed, but not ratified: none of the selected agreementsEnvironment - international agreements GDP - composition by sector: agriculture: 2.5%industry: 31.6%services: 65.9% (2011 est.)GDP - composition by sector Labor force: 17.66 million (2011 est.) country comparison to the world: 35Labor force35 Labor force - by occupation: agriculture: 9%industry: 26%services: 65% (2007 est.)Labor force - by occupation
AA Flight Crew consist Pilot, RFN and Flight Paramedics
Each AA most essential medical equipment consist of: Cardiac Monitors Defibrillators IV pumps & solutions Infusion pumps Oxygen Oxygen supplies, regulators and gauges Pulse Oximeter Portable suction units Intubation equipment Respirator/Ventilator Oropharyneal airways Hand operated bag-valve mask resuscitators Blood pressure cuffs Drug box FAA approved stretcher
Typical Response within a Zone 911 Emergency Call initiated. In this example, management or local emergency responders report a local explosion at Flour Processing Plant. The report indicates possible multiple injuries expected, CS immediately dispatch 4 rotorcraft from two Zones to respond. CS request dispatch 2 AA from Zone 6 CS request dispatch 2 AA from Zone 5 As the1 st RFN arrives by air to the accident site, triage training allows 5 levels of necessary care. The most serious will be transported first to the appropriate hospital where ER physicians make final evaluation and establish appropriate emergency treatment for patients.