Photos by Eric Brady | The Roanoke Times

Technicians Ron Rosenoff (left) and Ron Kier work Monday on the Virginia State Police helicopter that remained on the roof of Carilion Roanoke Memorial Hospital for four days. The broken helicopter was airlifted off the roof Saturday.

Jeff Echternach works in Carilion Clinic's dispatch center, which sends out Life-Guard 10 and Life-Guard 11.

Helicopters in Virginia have been used in medical emergency response for only 27 years, but they first took flight in Roanoke.

During the nearly three decades since Carilion Clinic became the state's first to introduce the faster way to transport patients, air response has evolved rapidly.

Susan Smith, director of Carilion's critical care response, said the relative newness of the air ambulances also means that ways to standardize safety and emergency response procedures are still being set.

"Since this started, we have a lot more technology and we are more focused on safety," said Smith, adding that she works with other agencies to standardize practices.

Fifteen helicopters are now designated to respond to medical emergencies in Virginia. Carilion's two helicopters serving the Roanoke area average six trips a day.

Lewis-Gale Medical Center in Salem works with four air transport providers including Life-Guard 10.

As news spread of a collision Sunday that killed six people aboard two medical helicopters in Arizona, those who work with Carilion's helicopters said it served to underscore the importance of safety precautions taken when transporting patients by air.

Safety is one reason Carilion will be upgrading its air ambulances at the end of the year, when it retires both of its helicopters.

Life-Guard 10, which has been in operation since 1990, will be replaced with a new helicopter in December. In January, Life-Guard 11 will be exchanged for a newer version of the same helicopter.

Although both helicopters are being leased, Carilion has opted to purchase the helicopter that will replace Life-Guard 10 for $6 million.

Among the features to improve safety, the new helicopters will be outfitted with night-vision goggles and an altitude awareness system that has, until recently, only been available on airplanes, not helicopters.

The altitude system, called Terrain Awareness and Warning System, alerts pilots when they are too close to the ground. Because airplanes fly at higher altitudes, Smith said the program didn't work with helicopters until recently.

Other safety precautions are in place on the ground, where the helicopters are monitored from a communication command center next door to the clinic's hangar, said Charlie Coffelt, the communication center's director.

The center, a short drive from Carilion Roanoke Memorial Hospital, is secure and quiet, Coffelt said. Dispatchers were recently given headsets to help control the background noise and distractions even more, he said.

"We are constantly evaluating and looking for improvements," he said.

Recently added technology is also playing a part, with the center upgrading its GPS system and including a new radar program that allows the center to monitor all helicopters in the air that coordinate with Carilion.

Even with the advancements in air ambulances, sometimes the mechanics fail -- as they did last week when a Virginia State Police helicopter was stranded on the rooftop helipad at Roanoke Memorial for four days.

Transmission problems made it unsafe for the helicopter to move on its own, and a National Guard Black Hawk had to airlift the craft off the roof Saturday.

Since then, the disabled helicopter has been undergoing repairs in Carilion's hangar.

Smith said the work to standardize practices among the different agencies has made their relationships strong and facilitated the response to the situation.

The police helicopter should be back in the air and available to back up the Carilion helicopters today, said Todd Daneker, director of maintenance for the Virginia State Police.

Getting the helicopter moving means renting a transmission for $85 an hour while the other transmission is sent off to be fixed, Daneker said.

Last time, the final bill was about $220,000; this time Daneker said he expects the price tag will be about $325,000.