Carilion Clinic's Lifeguard helicopter EMS program in Virginia knew it had a drone problem and had to do something. Several drone encounters, on scene and near its hospital helipads during both day and night, had delayed patient transports as early as 2015, and with the explosive growth of both recreational and commercial unmanned aircraft into the national airspace, the problem was only going to get worse. Federal regulations to deal with drones were still in their developmental stage, and any meaningful enforcement could be years out.

Carilion operates Virginia's oldest helicopter EMS program, beginning with a single Bell 206 in 1981 and today operating three EC135 twins in partnership with Med-Trans, it flies from six hospitals with headquarters in Roanoke. Susan Smith is the program director, and the drone problem "became really personal" for her one evening in 2015 when three helicopters were inbound to the rooftop hospital pad. Someone was flying a recreational drone from a soccer field dangerously near the hospital. Because there were railroad tracks between the helipad and the field, Smith had no way of contacting the operator or reaching them expeditiously to advise that helicopters were inbound. That was the catalyst for the program to begin to take local action.

"My initial reaction was that it is never going to be okay to share airspace with these UAVs, but then reality set in and I realized that it was going to happen,” Smith said. “So we might as well figure out how to make it happen as safely as we possibly can, because we know that drone usage is just in its infancy and is going to continue to expand."

"The big concern is delay," said Carilion pilot Tyson Le Roy. "Those few minutes can make a difference. Ten minutes when you are waiting to get in touch with the drone operator before you can take off or land is really the life and death scenario that we are dealing with. Unfortunately that has become pretty common."

"In the back of our minds, unfortunately, we thought nothing is going to really happen until [there is a fatal accident]," said Smith.

"With 10-minute delays there're already dead bodies, but there is no way to quantify how many of those 10-minute delays killed patients that would have otherwise made it to the trauma bays. That's the hard part," said Le Roy.

He emphasized that not all drones are equipped with running lights, and those that are typically have LEDs that are not visible when flight crews are wearing night vision goggles (NVG). "There isn't a broad IR [infrared] spectrum to LEDs," he noted, adding that since 2007 the FAA has published an advisory for certain red LED tower lights that, according to the FAA, “fall outside the...visible and near-infrared spectrum of NVGs” and thus might not be visible to the NVG wearer.

Carilion's approach was two-pronged: reach out to both the drone community and to landing zone (LZ) commanders to make them aware of the drone threat. In December 2015, in the weeks before the Christmas gift-giving rush and with the help of the local television news channel, Carilion began to run a series of public service announcements to help educate the public on safe operation of recreational drones. It also hosted a series of open public forums for LZ commanders and drone operators to discuss the challenges and risks presented by drones in the national airspace system and how to handle encounters with the program's helicopters.

"We encouraged drone operators to use the DJI drone app that includes boundaries and ATC contact advisories," explained Nick Mathiesen, Carilion's business development manager. Mathiesen said other useful apps, such as the FAA's "B4UFly," were also discussed, as well as the importance of consulting TFRs, monitoring winds during flights and using observers. LZ commanders were reminded of the need to clear an area for drones and the need for looking higher than 400 feet, especially at scenes such as car accidents and fires that tend to attract attention.

LeRoy said that the current FAA rules do not require recreational drone operators to obtain permission when flying within five miles of an airport, they just need to notify the airport operator. For the purpose of the rules, helipads and EMS scenes are considered airports. However, not all helipads are listed in FAA facilities directories or on VFR sectionals or on the various apps used by drone operators, and of course scene locations are highly variable. Through no fault of their own, the drone operators don't know whom to contact in many cases.

"We're just trying to get them to notify us, and this is difficult," he said. "We need a means by which operators can find our contact information, so part of the public outreach has been to fill that void."

LeRoy said it is essential for local HEMS programs to conduct public drone outreach, as the FAA has few resources for that beyond registration of drone operators and after-the-fact enforcement.

Mathiesen said that the local drone community has been receptive of Carilion's efforts.

"In our experience, most drone operators are very receptive to landing the drone because we have an air-medical helicopter coming in."

The issues of de-conflicting drones and helicopters is going to become a much bigger problem, according to LeRoy. "It's just a difficult thing to do, to share that area so close to the ground with helicopters and not interfere. They're a lot smaller and more maneuverable and that sound is masked. And you can't see them until the last second. It's going to be a deliberate act to de-conflict that traffic."