In June 2001 after years of planning and a lengthy certification process, Intermountain Life Flight was given FAA approval to conduct external load hoist rescue operations.

This team is currently the only civilian operated air ambulance service in the United States to operate such a program and the only rescue hoist operation in the Intermountain region.

Our adult rotor-wing nurses, paramedics, and helicopter pilots go through extensive quarterly ground and live training to maintain rigorous FAA guidelines to rescue victims in "hard to reach" environments and extract them to a safe landing area. This service not only saves lives by cutting down the ground time for the patient's care, but also saves local search and rescue teams hundreds of man-hours by flying directly to the patient in just a few minutes.

Search and rescue time is donated by Life Flight; patients are not charged unless they are transported to a hospital.

Since the beginning date through early 2010 there have been over 140 hoist missions many of which have involved the hoisting of more than one patient. These operations are completed in conjunction with local Search and Rescue, EMS, Fire Department, or Law Enforcement personnel from the county where the hoist request is initiated.

Life Flight’s initial hoist training in 1999 was provided by the Swiss Air Rescue agency known as REGA. REGA was chosen since they operate the same helicopters, the same hoist mechanism, and have successfully conducted many hoist missions.

The Life Flight hoist team is comprised of eleven pilots, twelve nurses operating the hoist and directing the pilot, and twelve hoist rescuer paramedics who are lowered to and package the patient for extraction. Life Flight operates 2 Agusta 109 k2 twin engine helicopters equipped for hoist operations and well suited for high altitude performance. The maximum weight capacity of the Breeze-Eastern hoist mechanism is 450 pounds with 150 feet of useable cable.

Annual “live” training is conducted quarterly for all team members and Search and Rescue agencies are regularly invited to participate as well. A Hoist Ground Team Training Course is also available to agencies who may be involved in a hoist operation.

What Decisions Are Made for a Hoist Rescue?

A hoist rescue is a great tool for extracting patients from challenging environments however this type of operation does have some limitations. Good communication between the requesting agency and Life Flight is critical in creating a plan to best serve all agencies and the patient safely.

Mission planning should begin with these types of questions:

  • What is the nature of the search/hoist rescue?
  • What is the weather at the scene?
  • What do you want Life Flight to do?
  • What is the plan if Life Flight cannot complete the mission?
  • Patient information (i.e. location, MOI, condition, anyone with the patient, contact)
  • Is there a Command Post? (location, IC contact, radio frequency)
  • Is SAR at the scene or deployed?
  • Is there a Landing Zone? (near the patient, near the Command Post)
  • Nearest location of jet fuel?
  • Is there anything else you want us to do before we leave the area?

Factors That Limit Hoist Operations:

  • Winds are greater than 20 mph, poor visibility, or severe weather
  • If total weight of patient and equipment exceeds 450 lbs.
  • Hoist Operations are not conducted at night however search & rescue and shuttle operations can be conducted.
  • Over water

We may not be able to complete a hoist if:

  • There are unresolved communications or safety problems
  • Dusk
  • If patient location requires technical rescue
  • Avalanche hazard at patient location

Hoist risk assessment: evaluation of an indication for a hoist rescue

  • Life threatening injury or illness
  • Time dependent injury
  • Ground evacuation may endanger patient and/or other personnel
  • Ground evacuation would be time consuming
  • Ground evacuation is not possible
  • No landing zone near the patient

If your agency is unsure if a hoist should be part of your plan, please contact the Life Flight Communications Center 800-321-1911 to discuss your needs.

Three methods of patient packaging and extraction:

  • Seat Harness: A seat harness allows the rescuer to put a harness on a patient that is uninjured or sustained only minor injures. After the patient has the harness in place, the rescuer then hooks the patient up and is extracted in the sitting position.
  • Rescue Net: A patient lies prone in the net, which has eight lanyards attached to a carabineer and then attached to the rescue hook. The patient and rescuer are then extracted with the patient in the prone position and the rescuer in the sitting position next to the net.
  • Bauman Bag: This method is commonly used during winter rescues where the patient needs to be kept as warm as possible or for a patient who has been immobilized on a backboard. The internal mattress is a large vacuum splint that can be shaped to fit the patient prior to evacuating the air. The mattress is then placed in an external bag fitted with a webbing suspension system. A tag-line may also used with the Bauman Bag to prevent spin.
  • Rescuer Backpack: The backpack that accompanies the rescuer contains the patient Seat Harness, Rescue Net, and other equipment to facilitate the extraction of a patient. It also includes some limited BLS medical equipment to manage an airway problem, bleeding, splinting, and cervical spine immobilization.

In addition, both the nurse (hoist operator) and the paramedic (rescuer) will wear a specialized harness during the hoist operation. An evaluation of the terrain, obstacles to performing a hoist, the method of extraction, alternative methods of patient extraction if a hoist is not possible, and finally all crewmembers must be in agreement of the plan.

A plan may also include shuttling SAR personnel/search or avalanche dogs to a location closer to the patient, insert a SAR member with the rescuer to the patient location, and/or extract SAR personnel and equipment. All of these options will be discussed during the planning stage.

It is important that a command post or an alternate landing zone be identified to off-load non-essential equipment (for weight reduction) and to be used as a rescuer/patient re-insertion point. After the hoist extraction is completed the equipment will be placed back in the helicopter prior to leaving the area. It is likely that we would use ground personnel to help us with this task.

During the insertion of the rescuer we would ask that the ground teams be mindful that the rescuer may spin and to allow enough room for the rescuer to get their footing and detach the cable hook from his/her harness. During re-insertion of the cable/hook the hoist operator and pilot will bring the “hook” to the rescuer. The rescuer will use hand signals to help with this part of the operation.

Occasionally, if the patient/rescuer/equipment weight exceeds the 450 maximum pounds, a patient may be extracted alone with a tagline to prevent spin. In this scenario the ground teams would be briefed to receive the patient in the Bauman Bag and monitor the patient while the nurse and pilot extract the rescuer and return to the patient LZ. On re-insertion of the load at the designated LZ, the helicopter lands close by after the hook/cable is returned to the stowed position. The RN and paramedic evaluate the patient and medically treat as necessary making a decision to transport immediately, release to ground EMS, or release to Command Post personnel.

Good communication is the key in organizing missions like these especially due to the logistics of working in a backcountry area. The more information that can be gathered regarding this type of operation the better we can prepare and help your agency understand how our service may fit into your plan. A routine internal post-flight review of these missions is standard.

We always work to improve our program, safety and our relationship with local law enforcement and SAR agencies who have the ultimate legal authority and responsibility in these backcountry operations.