In its quest to bring an ever-higher level of medical care to the people of Alabama, the University of Alabama at Birmingham (UAB) has upgraded its medical transport air service with a new jet. Dedicated on June 7 during ceremonies at the Birmingham International Airport, the $4 million 2000 Cessna Citation Bravo has been specially outfitted with a wide cargo door, the world's first modification of this kind on a Bravo. The plane can accommodate two adult stretchers or two newborn isolettes and has room for parents to fly with their children. UAB's Critical Care Transport (CCT) service transports approximately 400 babies a year. "The Critical Care Transport program is a valuable community service and gives UAB the capability of literally delivering 'medicine that touches the world'," says Marlon Priest, M.D., medical director of CCT. "With this new aircraft, we are now able to fly someone nonstop from Boston to Birmingham, for example, getting our patients where they need to go and shaving more than two hours off the total flying time of our (previous) jet. "The new aircraft has advanced avionics that will allow us to fly at higher altitudes, giving us even more efficiency and patient comfort," he said. The previous airplane was a Cessna Citiation 500 that served the program for well over 20 years, according to Robert Cofield, associate vice president of UAB Hospital. Increasing maintenance costs and the expense of technological upgrades required to keep the plane competitive were factored into the decision to retire it. The CCT program, says Cofield, was begun in 1983. He estimates that since its inception, the size and usage of CCT has more than doubled. "Our jet and ground program has really grown over time because our referral business has grown," he says. "And as it has grown, we've incorporated more human resources." For every trip, the service provides a team consisting of a physician, a critical care nurse and a respiratory therapist, all trained in flight medicine. Children's Hospital provides flight-trained personnel for pediatric transports. Due in large part to its staffing policies, says Cofield, CCT is the preferred critical care method of transport for many referring doctors. The new jet provides more and better-organized working space than the old plane provided. Removable seating allows for larger medical equipment, and an enhanced interior lighting system allows greater visibility for patient loading and for seeing inside drawers and cabinets. At the recommendation of its primary mechanic/pilot, the design of the plane includes features that will decrease the aircraft's downtime, keeping it more available for transports. It also has the ability to land at small rural airports, allowing CCT to continue to assist the small community hospitals that rely on it. And at the speed of 480 mph, the Bravo is 100 mph faster than the old plane, yet is more fuel-efficient. The Bravo's first transport, Cofield reports, occurred on June 2 when a patient in respiratory failure at a Selma hospital needed to come to UAB. "We started using it the day it was authorized to fly," he says, "and it had only been authorized about four or five hours before it was in the air. Since then, it has been used on a daily basis an average of two times a day." CCT provides transports to and from UAB, but also between hospitals unrelated to UAB. For example, says Cofield, a recent flight involved transporting a patient between two Arkansas facilities. He estimates that overall, about one-third of CCT's requests for service are for transports between hospitals other than UAB. In addition to the Bravo jet, the CCT service includes four super-sized ambulances that have been converted into mobile ICUs. The jet and vans have the staffing and equipment to maintain patients on life support, and in many instances, a patient's condition has improved en route. To gain access to the service for critically ill patients, all physicians have to do is ask. "They make a call to our physician at 1-800-UAB-MIST (1-800-822-6478) and ask the physician or operator to help arrange transport," says Cofield. "We have a demand for the service, so when it's necessary, we triage and prioritize through conversations between the physicians, but we can make arrangements quickly." CCT is the only hospital-based service of its kind in Alabama and is accredited by the Commission on Accreditation of Medical Transport Systems. UAB's Critical Care Transport is available 24 hours a day, 7 days a week, 365 days a year.