Atlas and Database of Air Medical Services (ADAMS)

Transcription

1 Atlas and Database of Air Medical Services (ADAMS) FOREWORD On behalf of the Association of Air Medical Services (AAMS) and CUBRC s Center for Transportation Injury Research (CenTIR), we are pleased to present the 9th Edition of the Atlas and Database of Air Medical Services (ADAMS). The following pages contain national and state maps which show the locations of air medical rotor and fixed wing bases and aircraft in the U.S. in Summary tables for each state are also provided. This information is a subset of the information contained in the full ADAMS Geographic Information System (GIS), available on the password-protected website at ADAMS is a result of a project partnership between AAMS in Alexandria, VA and CUBRC in Buffalo, NY. AAMS is an international, non-profit professional organization that serves both air and ground ambulance transport services. CUBRC is a not-for-profit research organization that performs systems-oriented research to reduce the occurrence, severity and consequences of motor vehicle crash injuries. ADAMS is currently funded by the Federal Highway Administration (FHWA). Initially, emphasis in the ADAMS project was placed on collecting data on rotor wing (helicopter) services which respond to trauma scenes. However, ADAMS was subsequently expanded to include rotor wing services which perform inter-hospital emergency transports as well as fixed wing services which perform longer distance transports. ADAMS was originally conceived as part of an effort to improve delivery of emergency medical care to car crash victims in order to reduce the average (over last 5 years) of 40,000 deaths and 250,000 serious injuries occurring each year along U.S. roads. It is well known that motor vehicle crashes kill more children and young adults than any other single cause in the United States ( It is believed that many crash victims who suffer injuries that currently result in death or serious disability, could benefit from the more timely delivery of available emergency care resources. Smart use of communications, automated message routing (supported by information from ADAMS) as well as the expanded use of automatic crash notification (ACN) technologies, offer the opportunity to reduce the high personal and economic costs of motor vehicle crashes injuries. Motor vehicle crash injuries represent just a portion of the injuries seen in the US each year. Statistics from the Centers for Disease Control (CDC) [ and the National Safety Council (NSC) [ indicate that in a typical year, there are: 124,000 unintentional injury deaths 26 million disabling unintentional injuries 3 million (inpatient) hospital discharges 42 million emergency department visits According to the NSC, the economic impact of these fatal and nonfatal unintentional injuries amounted to $702 billion in Over the past twenty years, organized regional and statewide trauma systems have been developed to address the unacceptably high costs of all types of injuries. Air medical services, performing trauma scene and interfacility transports, are an important element in this everyday trauma system response. In addition, air medical services play an increasingly important role in the response to natural and man-made disasters. It is our hope that this edition of ADAMS will prove useful in the continuing the effort to more effectively and efficiently employ air medical resources, wherever and whenever they are needed. Marie Flanigan & Alan Blatt Center for Transportation Injury Research, CUBRC Dawn Mancuso Association of Air Medical Services 1

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3 PREFACE Air medical rotor wing services are often called to the scene of serious motor vehicle crashes. Such crashes are the cause of about 40,000 deaths, 500,000 hospitalizations and more than 250,000 serious injuries per year in this country. With the growing availability of automatic crash notification (ACN) technology, there may soon be new opportunities to reduce crash-related deaths and injuries, especially in rural areas. To maximize the benefits of this technology however, ACN crash alert messages must be automatically routed to the appropriate 911 center within minutes of a crash. Although actual dispatch decisions would still remain local, providing an additional alert to both the air medical service and receiving hospital in the crash vicinity, could enable preparations at these locations to begin earlier and could well shorten the timeline for getting crash victims to definitive care. Implementation of this automatic ACN message routing to air medical services requires a national geographic database containing the exact locations of all air medical Rotor Wing bases which support scene response and emergency inter-hospital transport. In anticipation of this need, USDOT has supported the development of ADAMS to provide this critical element in the public safety / emergency message and data routing infrastructure. 3

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5 ACKNOWLEDGEMENTS This Atlas could not have been compiled without the support of Dr. Kunik Lee from FHWA, the knowledgeable assistance of Dawn Mancuso and her staff at AAMS and the interest and cooperation of the air medical services whose many members provided inputs. We further thank the Federal Highway Administration (FHWA) for its generous financial support. Special acknowledgement this year goes to the ADAMS technical team, in particular Maile Miller, Kevin Majka, Rachel Case and Nicole Ganger from CUBRC, and Dale Wiles from General Dynamics Advanced Information Systems. From a historical perspective, we also acknowledge Mr. Louis V. Lombardo (National Highway Traffic Safety Administration (NHTSA, retired) who provided the original vision for this project. This work was conducted at CUBRC in Buffalo, NY as part of the Center for Transportation Injury Research (CenTIR) Project and is based upon work supported by the FHWA under Cooperative Agreement No. DTFH61-07-H from FHWA to CUBRC. Any opinions, findings and conclusions or recommendations expressed in this report are those of the authors and do not necessarily reflect the view of the Federal Highway Administration. Marie C. Flanigan, PhD Alan J. Blatt, MS Principal Investigator Director Center for Transportation Injury Research Center for Transportation Injury Research CUBRC CUBRC userreg@adamsairmed.org 4455 Genesee St., Buffalo, NY

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7 TABLE OF CONTENTS FOREWORD... 1 PREFACE... 3 ACKNOWLEDGEMENTS INTRODUCTION DATA PROCESSING ORGANIZATION OF ATLAS NATIONAL & STATE OVERVIEW OF AIR MEDICAL COVERAGE IN Service Provider ID Pediatric Air Medical Transport Services Comparison with Previous Year AIR MEDICAL ROTOR WING COVERAGE OF U.S. ROADWAY SYSTEM & POPULATION Highway Coverage Population Coverage DESCRIPTION OF STATE MAPS & TABLES State Maps State Data Tables ATLAS OF STATES Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska

8 Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming APPENDIX A. Summary of State Traffic Fatalities and Fatality Rates B. Alphabetical List of Air Medical Service Providers with Service Provider ID # and Corporate Location 8

9 1 INTRODUCTION ADAMS The Atlas and Database of Air Medical Services (ADAMS), is a compilation of information on air medical services in the United States who respond to the scene of a trauma or medical emergency, or who provide emergency (or scheduled) inter-hospital transport. ADAMS currently contains detailed descriptive and geographic information on air medical rotor wing (RW) and fixed wing (FW) services, including information on their corporate office, airport and helipad bases, communication center, rotor wing and fixed wing aircraft and the major hospitals and trauma centers which receive their emergency transports. It is believed that more than 95% of RW services and 90% of FW services are included in ADAMS. The ADAMS database includes all types of air medical organizations including for-profit and not-for profit, dual-use public service (police/fire), as well as several military units who routinely provide transport for civilian victims in remote areas or during poor weather conditions. ADAMS is more than a standard tabulation of air medical services. First, ADAMS includes both corporate and satellite base locations for each service as well as the FAA registration numbers (N#) for all RW and FW aircraft utilized for trauma scene response and inter-hospital transport. Second, ADAMS is structured as a relational database, an important distinction since it allows data to be accessed, extracted or reassembled in many different ways without having to reorganize the original database tables. Third, the relational database has been imported into a Geographic Information System (GIS), a software program which enables the user to view the database in a map context and link various mapped objects with text information. ADAMS is currently implemented in a web-based GIS. Password-protected portions of the ADAMS website (containing descriptive data and interactive maps) are made available to registered air medical service providers, regular AAMS members, Automatic Crash Notification (ACN) technology developers, disaster response and homeland security groups, emergency medical and trauma system researchers, flight safety personnel and researchers, and various public health and safety agencies. In addition, the ADAMS website contains data collection web forms which enable registered air medical services (with appropriate password) to edit or add data for their own service at any time. Modifications made on these webforms are regularly incorporated into the GIS. This document is the 9th edition of the publicly available Atlas which contains national and state maps showing air medical rotor and fixed wing base locations along with summary tables for each state. This document is available on the public portion of the ADAMS website located at 2 DATA PROCESSING ADAMS data was collected using web forms customized for each Air Medical Service. The data were subsequently imported into Microsoft ACCESS (relational database software) and then into the ESRI ARCView 8.3 GIS program. Street locations were geo-coded using the ArcView software coupled with the Arc GIS StreetMap USA (2003) streets database. This geo-coding process essentially converts a street address to a latitude/longitude and assigns an identifier to both a map feature and to a data record. The elevation data used to produce topographical maps came from ESRI Data & Maps (2003). Finally, all maps were projected using the North American Equidistant Conic Projection. The maps shown here were created on a PC desk-top computer running Windows XP. The web-based GIS contains a subset of the full ADAMS database and was created using ESRI ArcGIS Server (Version 9.3). 3 ORGANIZATION OF ATLAS Section 4 provides a national map illustrating air medical rotor wing service coverage and fixed wing base locations throughout the United States. In addition, a summary table and several bar charts provide detail on the number of services in each state as well as the number of RW and FW bases and aircraft in each state. Also in Section 4 is a brief discussion of pediatric transport services. At the end of the section, two maps which highlight the changes in the number of RW bases and RW aircraft (since last year) are presented. One of the objectives for developing ADAMS is to help improve emergency medical response to car crash scenes, given that such crashes are the leading cause of trauma in this country. Toward that end, Section 5 provides two national maps showing current coverage of major roadways and current coverage of the US population by air medical RW services. Section 6 provides a description of the individual state maps and state data tables which make up the major portion of the Atlas. The actual maps and tables showing RW and FW base locations are provided in Section 7. Finally, Appendix A provides statistics on the number of fatalities from car crashes during the last several years. An alphabetical listing of all air medical services currently included in ADAMS is provided in Appendix B. 9

10 4 NATIONAL & STATE OVERVIEW OF AIR MEDICAL COVERAGE IN 2011 Figure 1 is a map of the United States showing main and satellite base locations of all the Rotor Wing and Fixed Wing Air Medical Services in the US in The gold stars indicate main office locations and the orange circles indicate 10 minute fly circles around each base where a RW is stationed 1. The size of the 10 minute fly circle varies with the cruise speed of the particular RW make and model resident at that base. The white blocks show bases (airports) where Fixed Wing aircraft are based. Summary statistics on numbers of services, bases and aircraft are provided at the bottom of the figure. Figure 1. Air Medical Service Corporate & Satellite Rotor & Fixed Wing Base Locations. Table 1 lists the number of air medical services headquartered in each state as well as the number of out-ofstate services with bases in that state. This is followed by the number of bases with RW, the number with FW and the total number of bases in the state. Note that if a single air medical service has a base with both RW and FW, the base is included in the RW base inventory and in the FW base inventory, but included once in the total base inventory. For this reason, the sum of Bases with RW and Bases with FW may or may not equal Total Bases in the state. In addition to an inventory of bases, Table 1 also includes data on the number of RW and FW aircraft in each state. To place all these figures in context, state populations and geographic area are provided for reference. National totals for each category are provided at the bottom of the table. Figures 2 and 3 are bar charts which graphically display the information in Table 1. Finally, Table 2 lists the number of each type of service (RW only, RW/FW, FW only) headquartered in each state. 1 Note that a 10-minute fly circle actually translates into a ~20 minute response time since 7 to 12 minutes are usually required for initial preflight and launch. 10

11 Table State Summary of Air Medical RW & FW Services, Bases & Aircraft Currently in ADAMS. State Services Headqrtd in State Out of State Services w/bases in State Bases with RW Bases with FW Total Bases (a) 11 RW Aircraft (b)(c) FW Aircraft (b)(c) Total Aircraft (b) State Population (Y2000) Total State Area (Sq Mi) (d) Alabama ,779,736 52,423 Alaska , ,425 Arizona ,392, ,006 Arkansas ,915,918 53,182 California ,253, ,707 Colorado ,029, ,100 Connecticut ,574,097 5,544 D.C , Delaware ,934 2,489 Florida ,801,310 65,758 Georgia ,687,653 59,441 Hawaii ,360,301 10,932 Idaho ,567,582 83,574 Illinois ,830,632 57,918 Indiana ,483,802 36,420 Iowa ,046,355 56,276 Kansas ,853,118 82,282 Kentucky ,339,367 40,411 Louisiana ,533,372 51,843 Maine ,328,361 35,387 Maryland ,773,552 12,407 Massachusetts ,547,629 10,555 Michigan ,883,640 96,810 Minnesota ,303,925 86,943 Mississippi ,967,297 48,434 Missouri ,988,927 69,709 Montana , ,046 Nebraska ,826,341 77,358 Nevada ,700, ,567 New Hampshire ,316,470 9,351 New Jersey ,791,894 8,722 New Mexico ,059, ,593 New York ,378,102 54,475 North Carolina ,535,483 53,821 North Dakota ,591 70,704 Ohio ,536,504 44,828 Oklahoma ,751,351 69,903 Oregon ,831,074 98,386 Pennsylvania ,702,379 46,058 Rhode Island ,052,567 1,545 South Carolina ,625,364 32,007 South Dakota ,180 77,121 Tennessee ,346,105 42,146 Texas ,145, ,601 Utah ,763,885 84,904 Vermont ,741 9,615 Virginia ,001,024 42,769 Washington ,724,540 71,303 West Virginia ,852,994 24,231 Wisconsin ,686,986 65,503 Wyoming ,626 97,818 Totals ,745,538 3,787,419 a) If a single air medical service has a base with both RW and FW, the base is included in RW base inventory and in FW base inventory but included once in Total Bases. Therefore, sum of Bases with RW and Bases with FW may or may not equal Total Bases in State. b) State RW/ FW totals for Alaska and North Carolina include aircraft from selected military units which are routinely used in civilian rescue. Alaska: 17 RW & 8 FW from Air National Guard and Coast Guard; North Carolina: 3 RW from Marine Corps Air Station. c) Throughout fleet, 50 RW and 5 FW are listed as SPARES. d) State total area (land & water) from which references World Almanac of the USA by A.Carpenter and C.Provorse, 1996.

12 Figure 2. Bar Chart Showing Number of Bases with RW and Bases with FW by State in Figure 3. Bar Chart Showing Number of Aircraft by Type (RW & FW) and by State in

13 Figure 4. Number of Rotor Wing Bases and Rotor Wing Aircraft by Year (ADAMS ) 13

14 Table 2. Service Types Headquartered in Each State in 2011 State RW only Services RW / FW Services FW only Services Total Services Hdqrt in State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Totals Total Services with RW = 261 / Total Services with FW =

15 4.1 Service Provider ID Within the database, each service provider in the country is assigned a five character Service Provider ID (SPID) which is the home state abbreviation (where main office is located) followed by 3 numeric digits (e.g., AL001, NY001, NY002, etc.). This unique SPID is used to label all bases for a given air medical service, whether these bases be in their home state or another state. (See Appendix B for an alphabetical listing of all Air Medical Services in ADAMS and their assigned SPID numbers.) 4.2 Pediatric Air Medical Transport Services With few exceptions, pediatric transport services perform emergency inter-hospital transports only (i.e., no scene response.) Since emergency interfacility transports from a local hospital emergency room to a trauma center are an important part of the trauma system response, these services were included in ADAMS starting in Table 3 lists the pediatric services which have their own in-house, dedicated, air medical RW or FW. There are a number of other pediatric transport services which are basically ground transport services which utilize other local RW services when they receive a request for air transport. Table 4 lists these pediatric transport services along with the outside air medical service which they utilize. The blue shaded columns in both tables highlight the air medical services included in ADAMS. ADAMS ID# Table 3. Pediatric Transport Services with In-House Air Medical Rotor or Fixed Wing Aircraft (Included in ADAMS) Children s Transport Facility City State # # # Service Bases RW FW Emerg Interfacility AR003 Angel One Transport Arkansas Children s Little Rock AR 2 2 Yes No Hospital CA005 Children s Hospital of Los Children s Hospital Van Nuys CA 1 1 Yes No Angeles Emerg. Transport of Los Angeles CA025 Air George Children s Hospital Madera CA 1 1 Yes No of Central California GA004 Children s Transport Air of Children s Atlanta GA 2 2** Yes Yes Atlanta Healthcare of Atlanta FL010 Life Flight (Miami Miami Children s Opa Locka FL 1 2 Yes No Children s) Hospital MO005 Children s Mercy Critical Children s Mercy Kansas MO 2 1* 1 Yes No Care Transport Hospital City OH008 Air Bear Akron Children's Akron OH 1 1 Yes No Hospital TX013 Children s Medical Center Dallas Love Field Dallas TX 1 1 2** Yes No Dallas Transport Service TX023 Teddy Bear Transport Cook Children s Ft. Worth TX Yes No Medical Center ** One is a SPARE. Shares RW and RW base with Lifeflight Eagle (MO009). Table 4. Pediatric Transport Services Utilizing Another Air Medical Rotor Wing Service Already in ADAMS Children s Transport Service (NOT Listed as Service in ADAMS) City State Air Medical RW Service Supporting Children s Transport * ADAMS RW Service ID Children s Hospital Neonatal/Pediatric Transport Columbus OH Medflight of Ohio OH004 Program Children s Hospital Transport Program Boston MA Boston Medflight MA001 Children s Medical Center Dayton OH Careflite (Dayton) OH001 Children s Memorial Transport Team Chicago IL UCAN or Loyola Lifestar IL010, IL008 Driscoll Children s Hospital Corpus Christi TX Halo Flight TX008 Methodist Children s Hospital Transport Services San Antonio TX San Antonio Airlife TX015 PANDA Transport / OHSU Transport Portland OR Lifeflight Network OR002 * Medical Crew Provided by Children s Transport Service or Outside Air Medical Service Scene 15

16 4.3 Comparison with Previous Year Between September 2010 and September 2011, the total number of air medical services in ADAMS decreased by three from 309 to 306. The total number of bases with RW increased by 33 (from 731 to 764) while the number of RW aircraft increased by 29 (from 900 to 929). 2 The number of bases with FW increased by 8 (from 165 to 173) and the number of FW aircraft stayed the same (311). Figure 5 shows the states where the total number of RW bases and/or RW aircraft changed since last year. Twenty-two states showed an increase in RW bases and twenty-one states showed an increase in RW aircraft serving the state. Four states showed a decrease in the number of RW bases and six states showed a decrease in the number of RW aircraft. Currently, 50 (or 5.4%) of the 929 RW aircraft in ADAMS are specifically labeled as a spare or backup RW. Figure 5. Change in Number of RW Bases (top) and Number of RW Aircraft (bottom) by State since September of Last Year. 2 Included in these RW aircraft totals are RW which are listed as SPARES; these increased from 27 last year, to 47 this year. The number of FW listed as SPARES decreased from 5 last year, to 4 this year. 16

17 5 AIR MEDICAL ROTOR WING COVERAGE OF U.S. ROADWAY SYSTEM & POPULATION 5.1 Highway Coverage Motor vehicle crashes are the major cause of trauma in this country. Each year, an average 40,000 people die on the nation s highways and over 3 million people are injured. Two million of these injuries are disabling and 250,000 are life-threatening. This translates into an enormous cost, not only personally and financially for those involved, but economically for the entire country as well. Optimizing the placement of trauma system resources (such as air medical services), can help improve emergency medical response to these car crash scenes. ADAMS 2011 data was used to examine current air medical rotor wing coverage of the nation s highway system. Figure 6 shows interstate highways, principal arterials and minor arterials from the FHWA National Highway Planning Network (NHPN). The NHPN consists of over 400,000 miles of the nation's highways which are comprised of National Highway System routes, urban principal arterials, rural arterials and other smaller roads. Overlaid on the three major types of roadways in Figure 6 are the 10 minute fly circles (showing nominal 20 minute response areas) derived from the ADAMS September 2011 dataset. Calculations indicate that across the 50 states and the District of Columbia, 65.6% of interstate, 60.2% of principal arterial and 50.0% of minor arterial miles are now within a nominal 20 minute air medical RW response. Figure 6. Air Medical RW Coverage of the Nation s Highway System Nominal 20 Minute Response. ADAMS data is being used to support research directed at reducing the numbers of fatalities and serious injuries on the nation s highways 3. To highlight the magnitude of the traffic safety problem in the United States, 3 "Assessment of Air Medical Coverage Using the Atlas and Database of Air Medical Services and Correlations with Reduced Highway Fatality Rates." Marie Flanigan, Alan Blatt, Louis Lombardo, Dawn Mancuso, Maile Miller, Dale Wiles, Herbert Pirson, Julie Hwang, Jean-Claude Thill, Kevin Majka. Air Medical Journal, July-August 2005, p

18 Appendix A summarizes the most recent data that is available on state traffic fatalities and fatality rates. It is provided to complement the state air medical service coverage data provided in this Atlas. 5.2 Population Coverage Figure 7 shows a national view of population (from the new Y2010 census) and 2011 RW base locations. The RW bases are at the center of each of the 10 minute fly circles. Population clusters are shown as small dark gray dots, where each dot represents 10,000 people. Note that the locations of these population clusters are approximate. The position of each gray dot is randomized within the zip code area (boundaries not shown) where the population represented by the dot resides. This randomization technique is used to minimize overlap of the dots in congested areas and thereby enhance dot visibility. This type of map is called a dot density map. Using this year s fly circles, it is estimated that million people or 79.9% of the U.S. population (Y2010 census) are within a 10 minute fly circle corresponding to a nominal 20 minute air medical response. An estimated 62.8 million people reside outside this response area. Figure 7. Population Dot Density Map with 10 Minute Fly Circles Around RW Base Locations. 18

19 6 DESCRIPTION OF STATE MAPS & TABLES This section provides an introduction and brief overview of the state maps and data tables which are contained in the major part of the Atlas (Section 7). There are at least two pages for each state - a map page and a table page. 6.1 State Maps Service Provider / Topographical Map The top map for each state shows a topographical (elevation) map with 5 additional data layers. These layers include: 1) the main office locations for all air medical RW and FW services headquartered in that state (marked with a yellow star and service provider name), 2) all RW and FW base locations for both in-state and outof-state service providers (marked with an orange square), 3) ten minute Rotor Wing fly circles around each RW base, 4) the interstate highway network, and 5) three to five of the largest cities in the state. The size of the 10 minute fly circle around a RW base is determined by the cruise speed of the RW aircraft based there. (Bases with FW only are shown with the orange square but no fly circle.) Each RW and FW base is labeled with the Service Provider Identifier (SPID) of the air medical service which operates out of that base. The first two letters in the SPID indicate whether the base is operated by an in-state or out-of-state service. In congested regions of the map, some base labels may not be visible. However, all bases are listed in the adjacent data table on the next (facing) page Hospital / County / Population Map The bottom map shows county 4 boundaries in the state, 10 minute fly circles around the RW bases and the locations of major hospitals (H) which receive air medical scene transports. Note that not all hospitals in the state are shown, but rather a subset identified by the air medical services as the major destinations for trauma or emergency medical transports. This map shows RW fly circles only (no FW bases). The color coding of the counties indicates population level (Year 2010 census) with the population color scale defined as shown in the map legend. The first color category is for populations of 50,000 or less, which indicates a rural county. The same population color scale is used for all states. Note that if a county is completely covered by a fly circle (which is a transparent gray), the apparent population color is lighter than actual. 6.2 State Data Tables The page opposite the state map page shows four data tables. The top table lists the type and number of air medical services headquartered in the state as well as the number of out-of-state services with RW and/or FW bases in the state. The state area and population (Y2010 census) are also provided for reference. The second table summarizes the total number of rotor and fixed wing bases and aircraft operating in the state. If a single air medical service has a base with both RW and FW aircraft types, the base is included in the RW base inventory AND in the FW base inventory, but included only once in the total RW & FW base inventory. Thus, the total bases in the state may (or may not) equal the sum of RW bases and FW bases. The third table lists all Rotor Wing Services operating in the state along with the names of each base in the state (with city and zip code). RW services headquartered in the state (as indicated by the SPID) are listed first, followed by out-of-state services with bases in the state. The number of RW aircraft stationed at each base is provided as well. If the RW service also operates FW, the names of FW bases and the number of FW aircraft at each base are also listed. An indication of whether the base is located at an airport, a hospital or a stand-alone helipad is included. The actual number of aircraft at a given base at any given time can of course, fluctuate depending on need, maintenance schedules, etc. For the purposes of this inventory, each RW and FW aircraft, identified uniquely by aircraft N# (not shown here), is assigned to a specific base. The fourth table provides a list of Fixed Wing Only services operating in the state. Again, services headquartered in the state are listed first. Following the FW service name, the base name, city, zip code and number of FW stationed at the base are provided. The Atlas of States for ADAMS 2011 is presented in the next section. 4 Except in Louisiana and Alaska where parishes and boroughs respectively are shown. 19

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21 7 ATLAS OF STATES