We look forward to the meeting, which will also address the next steps in the study process.

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1 Airport & Aviation Consultants November 26, 2013 Mr. Randall Malik Ms. Michelle Hannah Executive Director Project Manager Cuero Development Corporation TxDOT Aviation Division 212 East Main Street 125 East 11th Street Cuero, Texas Austin, Texas Re: Dear Mr. Malik and Ms. Hannah: is pleased to submit Working Paper 2 of the. This working paper addresses demand and capacity issues associated with the existing Cuero Municipal Airport and a potential replacement facility. Air ambulance (medevac) issues are also addressed. This working paper will be the topic of discussion at a meeting with the airport advisory committee. A date and time for this meeting has yet to be arranged. We look forward to the meeting, which will also address the next steps in the study process. Sincerely, Ronald F. Price, P.E. Principal Enclosure 58 Laurel Oak Road Telephone / Facsimile Amelia Island, Florida

2 CUERO MUNICIPAL AIRPORT STUDY WORKING PAPER 2 November 26, 2013 DEMAND / CAPACITY ANALYSIS Introduction Working Paper 2 presents an overview of the ability of the existing Cuero Municipal Airport to meet long-term aviation demand levels and facility requirements identified in Working Paper 1. Additionally, airport sites analyzed in the 1995 Airport Feasibility and Site Selection Study and currently available for acquisition and development are reviewed as to their capability to serve future aviation demands. The analysis also considers the need for air ambulance (medevac) services in the Cuero community. In the discussion that follows, the term "new Cuero airport" is utilized to distinguish it from the current Cuero Municipal Airport. The new Cuero airport could imply improvements to the existing airport facility or its replacement. Aviation Demand and Basic Airport Facility Requirements The long-term (20-year) aviation forecasts for an airport serving Cuero identify a demand for basing 28 aircraft, including 3 business jets, and accommodating some 8,400 annual operations (takeoffs and landings.) An airport meeting the ultimate design standards associated with a General Aviation, Business/Corporate as defined by TxDOT should be the objective for the City of Cuero when considering new potential airport sites. This would allow a runway length of at least 5,000' served with nonprecision instrument approach procedures (minimums of 250-¾) to each runway end. The terminal area should approximate 4,560 sy for based and transient aircraft tiedowns, another 16,400 sy for hangar storage for 20 aircraft, and an additional area of some 7,800 sy to accommodate a terminal building (welcome center) and maintenance hangar. In practice, the terminal area facilities will be located in that area along the length of the runway and its parallel taxiway for a depth of 710', which allows for maintaining a 35' building height beyond the limit of the runway primary surface. Addition of the land area associated with the runway protection zones generates an overall airport area of between 165 acres and 200 acres, depending on whether the runway is served with parallel taxiways on each side of the runway. It is recommended that the City acquire all land in fee simple. 1

3 Current Cuero Municipal Airport and Potential New Airport Sites It has been long recognized that the Cuero Municipal Airport does not meet nor can it be expanded to meet the above basic facility and area requirements. A windshield survey of the remaining sites (Site 16 and Site 18) available for development of a new Cuero airport is illustrated in Figure 1 and includes for reference a previously identified Site 3 and a potential new site. Figure 1 Remaining and Potential New Airport Sites 2

4 Figure 1 highlights that: Site 16 is located about 1.5 miles south of the current Cuero Municipal Airport and some 0.3 miles east of Route 236. The site is judged to have development potential to meet the needs for a new Cuero airport. Site 16 is essentially equivalent in terms of access to sites of interest in the Eagle Ford Shale Play as is the current Cuero Municipal Airport. Pilots and aircraft owners residing in the Victoria area would also find Site 16 to be equivalent in terms of travel time and distance as the current airport. Site 18 is located on land now owned by the Texas Department of Corrections some 3 miles north of downtown Cuero and about 0.6 miles east of FM 786. It may be possible to acquire or obtain a 99-year lease from the Department to construct a new Cuero airport. The alignment of a runway on the site will be influenced by the location of an existing water tower structure. A potential site, located north of Ed Blackwell Road, south of U.S. Highway 183 and in the vicinity of Old Gonzales Road may offer potential for a new Cuero airport. This site is located west of Site 3 as identified in the 1995 Feasibility and Site Selection Study. Because Site 3 is now owned by an oil and gas company, it is not likely available for development as an airport and encumbered with tall communication towers. The potential site west of Site 3 would be the most convenient to those traveling to the Eagle Ford Shale Play and the furthest distant from the majority of pilots and aircraft owners in the region that populate areas nearer to Victoria to the southeast of Cuero. In sum, in order to provide a suitable airport to meet long-term aviation demands, the City of Cuero will need to construct a new airport. There appears to be three viable sites for such development. These will require detailed study to determine a preferred airport configuration, final land area acquisition program, and environmental impact considerations. This does not exclude the option to retain the current Cuero Municipal Airport to meet essential air transportation needs of the community. Selection of this "as-is" option will be addressed in a subsequent working paper and incorporate the medevac and emergency response services described in the following section. Medevac Emergency Response Considerations The term "medevac" is an acronym for medical evacuation. This and other terms referring to a type of medical emergency response are used interchangeably in the United States. Other terms include "helicopter emergency medical service" and "air ambulance." The value of air access to remote locations or in the event of an emergency is not generally recognized until it occurs and it is difficult to place an economic value on such capabilities. Oftentimes, the primary means of reaching a community immediately after a major act of nature such as a flood, hurricane, tornado, wildfire or landslide is via air transport. Both fixed wing and rotary wing aircraft (helicopters) are used in medical emergency response situations. Patients are flown by fixed wing aircraft for many different reasons. These can range from the stable patient involved in an accident or with a long-term medical condition wishing to relocate closer to family for rehabilitative care, to the critical heart failure patient requiring intensive care transfer to receive a transplant. The fixed wing environment differs from the rotary wing environment primarily in that fixed wing aircraft travel farther, faster and higher. The fixed wing aircraft is primarily a facility-to-facility transport and typically is used for long 3

5 distance air transport and includes a range of multi-engine turboprop and small jet aircraft specially equipped and staffed to respond to patient needs while en route. Rotary wing service is typically engaged for moving a patient from an accident or incident scene to a trauma center and for air transport of stable patients and are also suitably staffed and equipped for these missions. Not all medevac transport is associated with an emergency situation. Many involve medically appropriate, hospital-to-hospital transport on a scheduled basis. Therefore, medevac service providers are actively engaged in both emergency response and critical care transport. The Association of Air Medical Services has reported that critically ill and injured people are airlifted once every 90 seconds in the country, which illustrates the life-and-death role that emergency medical air transport plays in the healthcare system. The Association also highlights the following facts related to air medical services provided by rotary wing aircraft: Medevac helicopters provide both a higher level of medical care than is typically found on a ground ambulance as well as a speedier response. The crews on medical helicopters are highly trained, with physician-level capabilities. A typical crew consists of a specially-trained critical care nurse and a paramedic, but can also include other specialists such as a neonatologist or respiratory therapist as necessitated, depending on the patient's condition. Almost exclusively, these crews handle the most critically ill and injured patients, thus giving them more experience in dealing with severe cases than typical ground emergency medical service responders. Medevac crews, coupled with the advanced drugs, blood and blood products and sophisticated patient monitoring tools and equipment they have on board, typically bring a higher level of medical intervention than is sometimes available in the area, which may only be served by primary care facilities. This is especially true in outlying areas, where air medical services have formed a rural healthcare safety net for underserved communities or cities experiencing budget cuts. Medevac helicopter crews do not self-dispatch. The request for an air medical transport is generally made by a physician, nurse, law enforcement officer, fire service crew member, ground ambulance paramedic or other certified emergency medical personnel as regulated by local, regional or state protocols. Increased medevac helicopter usage is partially the result of aging "baby boomers," whose related health care problems, most notably stroke and heart attack, are placing a greater demand on the overall healthcare system as well as creating a need for highly time-dependent, emergency medical response. Greater reliance on medevac helicopters is particularly prevalent in rural and sunbelt retirement areas and in places that have experienced emergency department closures or cutbacks in local, community based ambulance services. 4

6 In Texas, the provision of medevac services is driven by the marketplace and regulated by the Texas Department of State Health Services. There are a number of medevac service providers throughout the state, and these must be licensed to operate in the state. However, there are no state regulations that control which provider is to respond to a call for assistance. The entity requesting air transport may contact a medevac service provider of their choice, taking into consideration which provider is best equipped for the air transport mission. For example, pediatric and neonatal patients require specialized equipment in the aircraft in order to be transported to a trauma center or other hospital facility. In emergency situations, the availability of the medevac service provider and the response and transport time are the critical factors in the selection process. The State has certified a total of 268 trauma centers in Texas by classification into four levels as indicated below: Level I -- comprehensive trauma facilities (16) Level II -- major trauma centers (17) Level III -- advanced trauma centers (48) Level IV -- basic trauma centers (187) Of the 16 Level I trauma centers, 2 each are located in Austin and San Antonio, and 3 are located in Houston. There is one Level II trauma center located in Corpus Christi. These are the trauma centers most likely to be utilized in transporting medical patients from the Cuero area; however, there is a preference to transport to Level I trauma centers. The Cuero Community Hospital is a Level IV trauma center and typically transports its patients to higherlevel trauma centers or specialty service hospitals, as opposed to receiving such patients or organs for transplant. There are four locations for medevac operations within Cuero. These are the helipad at the Cuero Community Hospital, the current Cuero Municipal Airport, the scene of the emergency incident, and a rendezvous point other than these three locations. Rotary wing aircraft can operate from any of these locations; fixed wing aircraft must utilize the current Cuero Municipal Airport. The Cuero Community Hospital and primary providers of medevac services in the Cuero area were contacted to obtain an indication of the frequency of their activity. The information provided by those contacted is summarized below. The Cuero Community Hospital typically utilizes its helipad for the transport of patients to other hospitals in Austin or San Antonio, each some 30 minutes flight time distant. Depending on the type patient and the medical issues and concerns, a medical care facility in another city may be the receiving hospital. Accident or other incident patients in the Cuero area are initially transported by ground emergency medical services to the Cuero Municipal Airport or the Yoakum Municipal Airport for medevac transport to the appropriate trauma center. Usage records of the Hospital helipad were not available. However, Hospital emergency medical services staff indicated that the Cuero Municipal Airport was utilized for 12 landings during 2012 and 5 landings through the first 10 months of Helicopter medevac services landed at the scene of an accident or incident in the Cuero area 17 times during 2012 and 12 times in the first 10 months of

7 The medevac service providers that typically operate in the Cuero area include PHI Medevac and San Antonio AirLife. PHI Medevac is based at the Citizen Medical Center in Victoria and operates Eurocopter 135 rotary wing aircraft that are equipped for instrument flight rule (IFR) weather conditions. PHI Medevac has transported patients from the helipad at the Cuero Community Hospital and usually responds to emergency response accidents or incidents by meeting the ground emergency medical service providers at the Cuero Municipal Airport. San Antonio AirLife is based at the Baptist Medical Center in downtown San Antonio and operates Bell 430 helicopters that are IFR-equipped. Records of activity were not available. Other medevac service providers contacted include REACH Air Medical Services operating from San Antonio, Houston, Pearsall, and Sequin; STAR Flight based in Austin; and HALO-Flight based in Corpus Christi. These medevac service providers do not typically serve the Cuero area unless they are contacted directly and operate only rotary wing aircraft in Texas. In addition to, or as included in the number of landings reported by the Cuero Community Hospital at the Cuero Municipal Airport or the scene of an accident or incident, anecdotal information from the Hospital emergency services staff suggests that PHI Medevac and San Antonio AirLife are operating to the Cuero area on an average of three times per week collectively. The medevac service providers contacted expressed a preference to operate from an airport facility for the following reasons: An airport is an established aviation facility and usually presents an obstruction free operating environment. Ground service emergency medical response units can rendezvous with the medevac operator at the airport. This allows both them and the ground transport emergency responders to be en route to the airport concurrently. There is usually current aviation weather information available at the airport. Airports typically provide an opportunity for re-fueling. Airports can serve as an alternate destination in the event a flight is diverted for weather or mechanical reasons. Continued interpretation of the federal Emergency Medical Transport and Active Labor Act (EMTALA) that requires patients taken to a hospital helipad undergo a screening examination and be stabilized prior to transport by air medevac to another medical care facility. This favors the use of an airport versus the privately-owned hospital helipad. However, this interpretation is no longer valid inasmuch as the federal government has rendered an opinion that if the helipad is being used solely to effect the transfer of a patient between the ground emergency medical service unit and the medevac aircraft, then the presence of that unit and patient on the hospital grounds does not incur an EMTALA obligation for a screening examination and stabilization. 6

8 Medevac Service Implications Communities distant from medical care facilities with comprehensive services and capabilities, especially Level I trauma centers, should have access to a responsive medevac service. Providers of such services are located primarily in the San Antonio area, about a 30-minute flight time from Cuero in a rotary wing aircraft. Others are located in Austin, Corpus Christi and Houston. There is an apparent preference to operate from an airport as opposed to responding to the scene of an accident or incident. Flights to and from the helipad owned by the Cuero Community Hospital can be conducted, but these appear to be limited to hospital-to-hospital transport and not necessarily on an emergency basis. Medevac operators that serve the Cuero community currently utilize rotary wing aircraft. Should the Cuero Municipal Airport be closed and not replaced with another airport, an alternative site designed and equipped to serve as a transfer point to the medevac rotary wing operator should be designated within the City. In those instances when a fixed wing aircraft is required for medevac transport, the airports in Yoakum and possibly Victoria are viable options. A new emergency helicopter landing facility, equipped with lighting to support nighttime operations, an instrument approach procedure, and an automated weather observing system would fulfill this service role and likely encompass a physical area of about ¼-acre. The helicopter landing facility should be clear of obstacles in the surrounding navigable airspace. The heliport is best located adjacent to major highways and roadways, with multiple ingress routes. The siting of the heliport will require an airspace determination by the Federal Aviation Administration and funding for the heliport may be eligible for federal and/or state airport improvement grants. 7

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