The helicopter is a Sikorsky S62A helicopter. It is a civilian helicopter, never used in the US Coast Guard, who has 99 of this model up the US coast. This model was the main US rescue helicopter servicing the US coastline for 20 years. Other than in times of war (except for the Bel Huey) this helicopter still today holds the record of saving more lives than any other helicopter in the world. The craft is actually a boat and can land on water. “This is an ambulance, full stop, not a chopper,” said Ronald Shortis, president of Aeromedical Services, S.A. Inside, there is enough room for three stretchers. For the main one, there is space for a medic at the head of the patient, and a flight nurse at the foot. The craft is equipped with emergency services, such as oxygen. All staff is on a communication system so they can communicate with the pilot.
Initially, Ronald Shortis and the helicopter came to Honduras from Australia when it was leased to a Honduran company for tourism purposes. When the 12 month lease expired, the craft was supposed to go back to Australia. Shortis saw a need in the Bay Islands for an aeromedical service and convinced the Australian owners to keep the craft in Honduras to perform aeromedic duties. It took six months to go through the paperwork to comply with all regulations for the DCGA. To date, this is the only fully dedicated ambulance helicopter in Honduras. The service received final licenses in April of 2010.
Shortis decided to base Aeromedical Services in Roatan for three reasons: Jet fuel is available there; It is a central location for which to serve the Bay Islands; And it has the largest concentrated population.
According to Honduran law, the company is not a charter service. The Honduran government did not give a permit to charge for services. This means Shortis can not charge for services and is not allowed to accept any monies from insurance companies. “This is not a business,” said Shortis. “If it were, it would never get off the ground. It is a self-supported public utility. As such, it has been set up so that we never have to ask the government for assistance. But we have to be self-supported enough to where we can reach as many people as possible.”
Aeromedical Services is dependent completely on funding from fees charged to members. It is a private operation that is a benefit for club members who pay a monthly subscription. Fees are: $30/month for a single person, $40/month to cover a family and their dependents, and $400 for the year if paid up front. What constitutes a family? A dependent is defined according to the definition of a “dependent” in the member´s home country, whether Honduran or foreign. There is no limit to the number of dependents. Corporate plans are available and several resorts, banks and businesses in the islands have signed up for their employees. There are also plans for households, which would include the property watchman, as well as special concessions for vacation homes as long as the property is occupied less than 60% of the year. Short term coverage is available for visiting family members to cover the time they are in the Bay Islands. Shortis has defined special plans for local communities according to need and income. “This is not an elitist service,” he said.
According to Shortis, one member is a gentleman who has two families. Both his spouse and the mother of his other children are all dependent on his income. “We are not like an insurance company. We do not discriminate, nor do we get involved in people´s personal lives,” said Shortis. “An insurance company is set up to make money for shareholders. We´re set up to take care of needs for members in medical crisis. We don´t look at it as how not to give you coverage. You’re a member of a club.” Shortis considers club members as the leaseholders for the helicopter, collectively leasing it from the Australian owners, Sun City Helicopters based in Geraldton, Western Australia, who specialize in leasing vehicles for search and rescue and medical reasons.
With a passion for helping people, Shortis does a significant amount of fundraising for emergencies that may arise in the local population. For this, he relies heavily on Rotary. A Rotarian for seven years, Shortis adheres to the basic principles of Rotary and the devotion to “learning to work together for the good of all.”
The helicopter is owned by Sun City Helicopters, not Aeromedical Services, leased by the members of Aeromedical Services. Just the engine alone costs $¼ million. Every 1000 hours costs $165,000 to overhaul, which translates to $165 per hour to fly. A similar amount of money is required for the airframe. Insurance costs $1500/week. Aeromoedical operations by their very nature frequently occur in very adverse weather conditions. The craft is extremely expensive to insure, given that the insurers, Lloyds of London, classify mainland Honduras as a “warzone.”
What members receive is a ride to La Ceiba or San Pedro Sula, any time, night or day, as well as ambulance service if needed. The medivac service takes patients to public and private hospitals, depending on the preference of the patient. Private hospitals currently served are Vicente D’Antoni in La Ceiba, and Cemesa Hospital in San Pedro Sula. Depending on the severity of the situation, the crew will make necessary decisions as to which hospital to visit. Oftentimes, it has been necessary to stop first in L Ceiba to stabilize the patient in critical condition before flying the extra time to San Pedro Sula.
When they land at the La Ceiba airport, then the service pays for the ambulance from the airport. This eliminates the need for people to have to worry about carrying or getting cash for anything.
To fly at night, it is at least more than $1000 the cost. Shortis has to pay air traffic controller overtime, airport and security charges, and runway lights at the departing RTB airport at night. Shortis has clearance to take off from Roatan´s airport at night, but not to land. Therefore, he is not able to return and has to pay for hotel rooms for all paramedics and staff on board. If he must return for other patients, such as if a group tragedy occurs, then he has to ask for a special dispensation to return.
Shortis must maintain strict policies when it comes to making the decision to fly. Because it is so expensive to fly, he must make difficult decisions to protect the members and their investment.
Once he embarked on a search and rescue mission at sea, only to find that the man was hiding with his girlfriend. Another search and rescue mission found the culprit in jail in Belize, rather than lost at sea.
Since receiving licensing in April, the busiest time the service has seen is 16 flights in 21 days. All flights were for patients in critical condition. Fortunately this is not the norm, and the average is about three critical flights per week with current membership.
If any foreigner dies in Honduras, Honduran law requires that an autopsy must be carried out in La Ceiba or San Pedro Sula. Aeromedical Services recognizes that taking care of the deceased is an important part of assisting the family in their grief. Membership privileges include this important function and have carried a number of deceased.
The Way This Works
A doctor has to give a recommendation that the patient needs to be medivac´d to the mainland. Shortis will only fly if it is a serious injury or medical condition. “We´re not going to fly anyone over for a broken finger,” he said. If a patient requires oxygen, he will fly. If the patient is confused, the patient may have blood on the brain. If no doctor is readily available, Shortis can use the satellite phone to get approval from a doctor, even one abroad if the patient has a family doctor outside the country.
In La Ceiba, they can land straight at the airport or land in a field beside the Vincent D’Antoni hospital within 27 minutes. To get to San Pedro Sula takes one hour and six minutes and they are required to land at the international airport. Their preference is to take patients to La Ceiba for initial assessment and aid. They will remain in La Ceiba until the hospital tells them whether or not the patient requires further transfer to San Pedro Sula.
If they have to spend the night, they will bring the patient back if the patient is ok. “This is not a dump and go,” said Shortis. “It´s a club that looks after its members and their well being.”
“I think it´s important for people to know a few things: I´m here; I´m through all the paperwork hassles of getting set up; I´m here to stay; and people will have difficulty accessing our services if they are not members,” said Shortis.
There are apparently enough people on the Bay Islands who feel that the service is worth the membership fees. In just three weeks, Shortis has exceeded the membership goals he expected would take 3-4 months to achieve.
Eventually, Shortis would like to purchase a jet so that he has the option of taking Bay Islands residents to the United States for medical treatment if needed. It takes three hours to travel from Roatan to Miami. For this, he´ll need a hanger and a jet, and while he originally thought this might take three years to achieve, membership is growing so fast, it might be much sooner before it becomes a reality.
On February 6, Ronald Allen Shortis had completed 50 years in aviation in Australia. He gave war service and has flown more than 600 combat missions. Some of the missions involved in fighting against children soldiers. “This was a horror, a total horror, an aberration, and unbelievably wrong,” he said. Consequently, feels very strong in his desire to help children, to save children. Since the service started, he has been able to a number of children´s lives. “This is the greatest reward of all. To see a child you know would have died go back to school.” Shortis recognizes that he can not provide this service on his own indefinitely and must look to the future. He is looking for support staff. Two pilots will be trialing with him, beginning in July. “Hopefully both will prove satisfactory and able to provide long term future for this service.” Though he is supposed to be retired, his passion for the medical field, which he was never able to pursue as a younger lad, and his passion for flying are the foundation for what has become Aeromedical Services.
Cyndie Peterkin, head flight nurse, is originally from Peru, and is fluent in Spanish and English, Spanish being her original language. She worked for 27 years in the emergency room, trauma level 1 in the North Broward Hospital District.
Originally from Barbados, Joe Peterkin, paramedic and flight coordinator, worked as a paramedic, trauma helicopter crew chief and firefighter in Broward County, Florida. He currently also trains firefighters in Roatan.
Cyndie and Joe retired to Roatan from the states six years ago. They originally came on a cruise ship and fell in love with the island. They have been married 34 years. They were enjoying a drink at Infinity Bay 3 years after their move to Roatan. When the owner introduced them to Ron, they knew immediately it was a good fit. Cyndie, whose father was a rescue helicopter polit in the Peruvian Air Force, feels like this is an opportunity for a new lease on life. “It´s in my blood,” she said. “We´re here to stay; and we have to give back to the community.” Cyndie and Joe have an extensive collection of emergency trauma gear in their house alone. “Without them this service never would have happened,” said Shortis.
Patty Grier, EMT, DMT, is from Chicago, but has lived on Roatan for 22 years. She came as a diver and worked at CoCo View Resort. Now she owns the Dockside Dive Center there, which does retail, repair, instruction, and rental. The last three years, she worked as a full time volunteer with the fire department. She is a specialist in diving related emergencies, which is a valuable addition to patient treatment in the Bay Islands.
As this is a non-profit business, everyone works on a volunteer basis, including Shortis, himself. “My main goal is taking care of people. It´s not about the money,” said Shortis. “I´m paid in the fact that I can still fly,” said Shortis. “I go nuts if I don´t fly.”
On July 10, there is a new paramedic coming from the states as a one month volunteer. Since the crew works under such intense circumstances, all new staff must be able to fit in. “We´re in such close workings that any square peg doesn´t work,” said Shortis. “A helicopter crew is a very close knit group of people. There is a very special bond between each other. We’re like family.”
Integrating Bay Islands Communities
Shortis is working on the best way to serve the communities. For example, in some of the more isolated Utila cays, it may be better to bring the doctor to the cays, rather than fly the patient out.
The Bay Islands Voice accompanied the medivac helicopter to Pigeon Cay on June 1, where it is 21 miles to the mainland and the rough seas can be brutal. On the cay, medical services are scarce. A dentist visits the island once a month and a nurse practitioner, infrequently. According to Henry Karpinski, owner of the Harbour House, seven to ten of the residents rely on fishing and diving, and the rest are shop keepers. The island has had electricity for 6.5 years and receives running water once a week, sometimes twice. On this Cay there are an estimated 300 to 500 people.
Approximately 20 people attended the meeting. Discussions included specific concerns of the local families. “The community needs to get together to govern themselves for this service,” said Shortis. He suggested the community designate an emergency coordinator on the island and for nearby Cay communities. The optimal spot on the Cay to land is on the property of Bess Diamond, which is essentially a vacant lot next to her house. “I wanted to meet the pilot before giving permission to make this the Cay´s landing pad. I thought it might be a small plane,” she laughed. “I think this is a very important service and would be very happy to have the land be used to help the people of the island.” The lot was full of trash such as plastic bags, which is extremely dangerous for landing and taking off conditions. Diamond said she had intentions of cleaning the mess and putting in gravel or sand to facilitate the landing pad.
The crew then landed at Coril Beach in the center of Utila Island. This particular part of the island is typically only accessible by boat as the access road is usually rough. Residents travel by hefty four wheelers. Most residents are equipped with basic emergency kits for animal attacks such as snake and spider bites, and but no equipment for serious injuries. Though an independent and self-sufficient community, residents here were particularly concerned with quick access to emergency hospital locations, because of the treacherous and long journey it takes to get to the nearest doctor on the island, if that person is available. According to resident Andi Sims, Utila Realty, “People who live on the South Shore pretty much like to be here and don’t like to leave. If we call for emergency service, there’s a good reason.”
The team then headed to the main airport in Utila. Immediately, the police arrived on the scene with warnings of severe action if they land as an unidentified aircraft, particularly at night. The crew met with several members of the Utila Town community to introduce the service. Kurt Halverson, retired chiropractor, orthopedist, physician, and acupuncturist, and who currently works with Utila Land Company, has been on Utila for 15 years. “I’ve seen a lot of injuries through the years in this community. This is a very valuable and necessary service,” he said after examining the helicopter and meeting the crew.
A perfect central landing location, Shortis is working with owner Kisty Engel to fortify, certify and register the helipad dock at Utila Lodge in Utila Town.
On June 2, the crew met with Alberto Busmail N., manager of medical operations of Vicente D’Antoni Hospital in la Ceiba, in order to establish a protocol between the hospital and the Bay Islands. “This connection is just one of many in the safety net of providing professional safety services,” said Shortis.
Despite having extra bright lights, at night Shortis is legally required to land at the La Ceiba airport. However, Vicente D’Antoni Hospital is installing night landing lights so that in the future night operation landings to the hospital will become routine. They will have to go through the legal process to get landing pad approved for night operations. The hospital is slated to complete a direct access gate to the landing field in July. With this direct connection, Shortis can have a patient to the landing field in 27 minutes, and into the emergency room within 35 minutes of leaving the islands, versus the 66 minutes it would take to reach the San Pedro Sula airport, 15 minutes to transfer the patient to an ambulance (which sometimes does not have oxygen available), 30-45 minutes driving time, and 10 minutes to clear security and transfer to an emergency room. For this reason, Shortis prefers to use Vicente D’Antoni Hospital as the first stop to stabilize critical patients. As there are few specialists and surgeons on the islands, the hospital also has a wealth of specialists on standby.
Patients can always select which hospital or city they prefer to go, but in the event of emergency, Shortis and his crew will make whatever decisions necessary to stabilize the critical condition of the patient.
The most dear to their heart is the “miracle boy.” He fell from the second story at school when the balcony gave out. The result was a rebar impaled 2 ½ inches into his brain. He was stabilized in La Ceiba, then flown to San Pedro Sula. He died twice on the way. Cyndie brought him back. Now he is back in school and seems to be a perfectly normal young boy, with only partial loss of movement in his left hand. Shortis and staff can´t wait to go back and revisit him and take him for a ride. He has no memory of how his life got saved.
The ‘worst’ trip was taking a patient to San Pedro was the middle of the night, when it took three hours. Shortis had to keep back-tracking 40 minutes through the storm to see if he could find a line through the thunderstorm. He and the crew were carrying a gentleman severely injured in a road accident. They finished up flying through a bottom of a thunderstorm. “It was very unpleasant, not an experience we want to repeat in a hurry,” said Shortis.
Last year, Shortis was hit by lightning twice, one time causing a 6×4 inch hole in the blade. Despite his expert knowledge of flying in inclement conditions, he will refuse to fly if he feels there is any danger to the crew. “There is no sense in getting killed to save one life if we could save 40 next year.”
The warehouse of spare parts are in Australia. Transferring needed spare parts to Honduras can be a hassle. At the time of writing, Shortis was waiting on a package of “four little bolts,” which left Australia on a Monday and were in Honduras on a Friday. The cost of the bolts are no more than $10 each, but they are specially machined. Customs held up his delivery for weeks. He can not go to San Pedro because at the moment he is the only pilot. If someone needs his services, he needs to stay on the island.
Aeromedical Services has lots of bills, but not a lot of money. “Boats are a hole in the ocean, helicopters are a hole in the air,” said Shortis. He regards himself as a mere custodian of the members’ investment. “I’m not allowed to touch their investment. It’s a very delicate financial juggling act to maintain these services.”
A further challenge is the simple fact that they are the first aeromedical service in Honduras. “It has taken time for the authorities to realize that all I want to do is achieve something worthwhile for them and their country,” said Shortis. “Plus the fact that I’m an Aussie,” he winks. “Sometimes we’re a bit hard to handle.”
“As a business, we are still in diapers, trying to get into short pants,” said Shortis. “We don’t yet have the staff we need, and it’s possible we will get overloaded. We are not machines.” The whole staff can be severely affected emotionally by the distress they see, particularly when helping children in critical conditions. “With a child, I think that there´s 60 yrs left on this child, and only a few left in me.”
Another personal issue is that, being such a small community in the Bay Islands, the crew knows many of the people they fly, and always someone associated with the person. Taking care of friends in critical conditions is an entirely different kind of emotional strain.
There are limits to what a pilot can do: the number of hours a pilot can be on duty, and the numbers of hours a pilot can fly are internationally regulated. These limits have been developed by international aviation authorities based on stress, exhaustion, and decision-making ability. This is one reason it is so important new staff joins the team as soon as possible. In times of fatigue or sickness, Shortis must stand down.
“The final challenge to remember is personal,” said Shortis. “I´m the only one person who´s completely unprotected by this helicopter. If something happens to me, I have to go by boat!” [/private]