EXECUTIVE SUMMARY... ES-1 CHAPTER 1 HISTORY AND BACKGROUND ORIGINS OF TRAUMA CARE SYSTEMS AND EMERGENCY MEDICAL TRANSPORTATION... 1-1 CARE OF THE INJURED AND AIR MEDICAL TRANSPORT THE U.S. EXPERIENCE... 1-2 INTEGRATED TRAUMA AND HELICOPTER EMERGENCY SYSTEMS IN THE U.S.... 1-3 Trauma Centers vs. Trauma Systems... 1-4 National Priorities and Development of Trauma/HEMS Systems... 1-5 Professional Associations and Trauma/HEMS Advancements... 1-10 HELICOPTER AIR MEDICAL TRANSPORT TODAY... 1-11 SAN FRANCISCO BAY AREA AIR MEDICAL TRANSPORTATION... 1-12 CONCLUSIONS... 1-13 CHAPTER 2 PURPOSE AND NEED BASIS FOR THE STUDY... 2-1 BAY AREA AND SAN FRANCISCO TRAUMA CARE... 2-4 Bay Area Trauma Centers and Air Medical Access... 2-4 San Francisco Trauma Care System... 2-6 Evolution of Trauma Care in San Francisco and the Role of San Francisco General Hospital Trauma Center... 2-7 THE SAN FRANCISCO TRAUMA CARE SYSTEM ENVIRONMENT... 2-9 Geography and Demographics... 2-9 Trauma Care System Design... 2-10 CURRENT AIR MEDICAL ACCESS SYSTEM... 2-11 STRENGTHS AND VULNERABILITIES OF THE TRAUMA CARE SYSTEM... 2-12 Single Designated Trauma Center... 2-12 Capacity Saturation... 2-15 Environmental, Geographical and Medical Transport Constraints... 2-16 Multiple Casualty Incident Risk Natural and Geopolitical... 2-17 Pediatric Trauma... 2-17 San Francisco Off-shore Rescues and the Neighboring Region... 2-18 TRAUMA SYSTEM NEEDS RELATED TO AIR MEDICAL ACCESS... 2-19 Consistently Available Trauma Resources... 2-19 Comprehensive Pediatric Trauma Care... 2-19 Timely Access to Advanced Trauma Care and Improved Patient Transport... 2-19 PREVIOUS AIR MEDICAL ACCESS STUDIES IN SAN FRANCISCO... 2-20 Medical Use vs. Commercial Use... 2-20 The Vertiport Study... 2-20 The McKesson Report... 2-21 Findings and Conclusions... 2-22 CHAPTER 3 BENEFITS OF AIR MEDICAL ACCESS INTRODUCTION... 3-1 i
GENERAL BENEFITS OF HEMS... 3-2 Trauma Transport... 3-4 Scene Transport Studies... 3-4 Interfacility Transfer Studies... 3-6 Transfers from a Referring Hospital to Trauma Center... 3-6 Transfer from Scene Accident to Trauma Center... 3-7 Non-Trauma Transport... 3-8 PRIMARY BENEFIT: MITIGATION OF TRAUMA SYSTEM VULNERABILITIES... 3-9 The Care of Injured Children... 3-10 Standard Trauma Care Consistently... 3-10 Multiple Casualty Incidents... 3-11 Primary Benefit Summary... 3-12 SECONDARY ENEFIT FINANCIAL SUPPORT AND MAINTAINING QUALITY AT THE TRAUMA CENTER... 3-12 Economic Benefit of Air Medical Access... 3-13 Patient Volume and Trauma Center Performance... 3-14 Medical Staff Recruitment and Retention... 3-15 TERTIARY BENEFITS SAN FRANCISCANS INJURED IN SAN FRANCISCO AND NORTHERN CALIFORNIA... 3-15 ADDITIONAL BENEFIT TO THE BAY AREA REGION... 3-15 CONCLUSIONS... 3-16 CHAPTER 4 HELIPAD SITE STUDY INTRODUCTION... 4-1 HELIPAD DESIGN CRITERIA... 4-1 OBJECTIVES... 4-2 DESIGN CRITERIA... 4-2 Heliport, Helistop or Helipad?... 4-2 POTENTIAL HELIPAD SITES... 4-8 Rooftop Helipad... 4-8 CONCLUSIONS... 4-17 STRUCTURAL CAPABILITIES... 4-18 Code Requirements... 4-21 Building Description... 4-21 Assumptions... 4-21 Conclusions... 4-22 ELEVATOR REQUIREMENTS... 4-22 PRELIMINARY COST ESTIMATES AND SCHEDULE... 4-24 Timeline... 4-25 HELIPAD PERMITTING PROCESS... 4-25 Federal Government... 4-25 State Government... 4-25 City and County of San Francisco... 4-26 ii
Table of Contents CHAPTER 5 SAFETY ANALYSIS SAFETY ASSESSMENT AND ANALYSIS CRITERIA... 5-1 Types of Compatibility Concerns... 5-1 SAFETY... 5-2 Measurement... 5-3 Basis for Criteria... 5-3 HEMS Accident Data Base... 5-5 When Do HEMS Accidents Occur... 5-7 SFGH Accident Potential... 5-8 HEMS Accident Rate Comparison... 5-9 Risk Assessment Factors... 5-10 Deaths and Injuries in the Community... 5-10 AIRSPACE PROTECTION... 5-11 Compatibility Objectives... 5-11 Measurement... 5-12 Compatibility Strategies... 5-12 Basis for Criteria... 5-12 OVERFLIGHT... 5-13 Compatibility Objectives... 5-13 Measurement... 5-13 Compatibility Strategies... 5-13 Basis for Criteria... 5-14 CONCLUSIONS... 5-14 CHAPTER 6 NOISE ANALYSIS INTRODUCTION... 6-1 NOISE IMPACT CRITERIA... 6-2 Noise Measurement Methods... 6-2 Impact Criteria... 6-5 EXISTING SOUND LEVELS... 6-5 PROPOSED FLIGHT PATHS... 6-7 HELICOPTER MODELS... 6-8 HELIPAD NOISE PREDICTION... 6-8 Helipad Noise Analysis... 6-8 Noise Impact Assessment... 6-10 Helicopter Noise Abatement Options... 6-11 On Approach... 6-11 On Departure... 6-12 Conclusion... 6-13 CHAPTER 7 COMMUNITY OUTREACH GOALS OF OUTREACH EFFORT... 7-1 PUBLIC MEETINGS... 7-2 iii
Neighborhood Groups... 7-2 Healthcare Provider Community Groups... 7-2 Civic Organizations... 7-2 Description of Community Meetings: Neighborhood Groups... 7-2 Description of Community Meetings: Healthcare Provider Organizations... 7-6 Description of Community Meetings: Civic Organizations... 7-8 Expert Opinions and Letters of Support... 7-8 Helipad Hotline... 7-9 COMMUNITY OUTREACH MATERIALS... 7-9 SUMMARY OF COMMUNITY CONCERNS... 7-9 CONCLUSION... 7-9 APPENDICES A Glossary of Terms Used in Study...A-1 B Trauma Scene and Interfacility Transports...B-1 C Profile of injury In San Francisco...C-1 D Community Noise Measurements...D-1 E Handouts from the Community...E-1 F Expert Opinions and Letters of Support... F-1 G Community Outreach Materials... G-1 H Structural Engineer s Report...H-1 I Elevator Engineer s Report... I-1 FIGURES 2-1 Trauma Air Medical Catchment Areas (Without Proposed SFGH Helipad).. 2-13 2-2 Trauma Air Medical Catchment Areas (With Proposed SFGH Helipad)... 2-14 4-1 Primary Flight Path: North Departure... 4-6 4-2 Primary Flight Path: South Departure... 4-7 4-3 SFGH Helipad Site Options... 4-9 4-4 Alternative 1 (Wing C) Site Location... 4-12 4-5 Alternative 2 (Wing A) Site Location... 4-14 4-6 Alternative 1 Site plan... 4-19 4-7 Alternative 2 Site Plan... 4-20 4-8 SFGH Helipad Building Permit process... 4-28 6-1 Noise monitoring Locations... 6-5 6-2 Muni Routes... 6-6 6-3 Proposed Flight Paths... 6-7 6-4 Average Day DNL Contours... 6-10 6-5 Busy Day DNL Contours... 6-12 iv
Table of Contents TABLES 1-1 Bay Area Air Ambulance Providers... 1-13 1-2 Bay Area Air Rescue Ambulances... 1-14 2-1 Designated Trauma Centers in the Greater San Francisco Bay Region... 2-5 4-1 Hospital Helipad Final Approach and Takeoff Area (FATO) and Safety Area Size Requirements... 4-4 4-2 SFGH Helipad Site Study Summary... 4-18 6-1 Land Use Compatibility Chart... 6-4 6-2 Noise Monitoring Around SFGH... 6-6 6-3 Helicopter Usage... 6-8 7-1 Community Concerns... 7-11 v