Flying along with the aerial rescuers of Erlanger’s Life Force
Traveling at 150 miles per hour two-thousand feet over the hilly valley just south of Cleveland, Tennessee, a nurse and paramedic are preparing themselves for any eventuality. When the helicopter they are in lands, they could be facing anything from a pregnant woman to a man suffering massive trauma as a result of a car crash. “We like to say that we bring the hospital to the patient,” says Paramedic Seth Gentry. One look around the medical bay of the aircraft proves him right.
When helicopters were first pressed into service as air ambulances they were Bell H-13s. We’ve all seen them on the popular TV show M*A*S*H. Combat medics would try their best to stabilize a wounded soldier then strap him to a litter mounted on the skids outside the aircraft. Then came the dangerous and very bumpy ride to a Mobile Army Surgical Hospital where their chances of survival were increased exponentially.
Today, the aircraft can carry a patient in relative comfort (barring any turbulence), surrounded by state-of-the-art medical technology, tended to in flight, by a medical crew that is board certified in critical care transport—a standard achieved by only five percent of air transport programs in the country. And when they land at the region’s only Level 1 Trauma Center for adults and children, once again, their chances of survival are better than ever.
The equipment on board includes an EKG heart monitor, a ventilator, an ultrasound, and a device that can test blood chemistry in a matter of seconds. They even carry two units of whole blood and two units of plasma in a cooler on the aircraft. And to help prevent shock, there’s even a small blood warmer to heat the blood before it’s administered to the patient.
“We’re actually able to start treatment in the aircraft,” says Autumn Redmond, Flight Nurse. “We can actually—for strokes—get their labs, and [we’re] able to take them straight to CT (Computed Tomography) without going to the Emergency Department first to get that done.”
She then adds, “That saves time, and time is brain.”
Back in the 1970s, the term “Golden Hour” was coined by former combat surgeon R. Adams Cowley. He determined, using data from as far back as World War I, that patients suffering trauma had a much higher survival rate if they received definitive medical treatment within 60 minutes of injury. Using an aircraft to get patients to a medical facility faster than ground transportation had already gone a long way in getting treatment within that golden hour.
The specialized training of the crew and the advanced equipment in the helicopter allow the medical team to go as far as performing certain emergency surgical techniques like an airway or chest irrigation before ever reaching an Emergency Room.
Many hospitals are lucky to have access to an air ambulance. Erlanger Medical Center has five. Strategically located around the area, each aircraft services a 75-mile radius around its home base. None of them are any longer based at the hospital…the hospital is now just the location of the EROC—Erlanger Regional Operations Center. In a control room that looks very much like NASA was overtaken by doctors, trained dispatchers monitor the status of each aircraft in the fleet as well as those of some other air ambulance services in the region. When a call comes in that Life Force may be needed for transport, these dispatchers check availability and put the appropriate crew on alert.
While visiting the newly-commissioned base for Life Force One at the Cleveland airport one such alert was issued to the crew I was interviewing. “We may need to postpone this interview,” Ryan told me, “We’re on stand-by for a transport.”
Being the curious type, I asked what the call was about.
“We don’t know,” replied the pilot.
“You mean you don’t know what kind of call you’re going on?” I queried. “Then how do you prepare for your flight?”
Ryan explained to me that they never know what type of call it may be. He further explained that he and the other crew members need to be able to make an unbiased decision on flight conditions to determine if it’s too dangerous because of weather or other conditions to take a call.
He added that if the call is of an emotional nature, such as those involving children or the elderly, that the air crew may be tempted to push the envelope of safety to respond to the call, endangering the crew and the aircraft. By being ready for anything and logically analyzing the prevailing conditions, the crew can best assist those in need.
When it comes to determining flying conditions, Erlanger’s pilots are some of the best in the business. “Each base has at least one grey-hair in it,” says Ryan, meaning that there’s at least one pilot who’s been in the business for a very long time at each of the five bases. He tells The Pulse that at a recent gathering of Life Force pilots, they calculated that there’s more than 100 years of Emergency Medical Service experience between them all.
As for Ryan, he learned to fly helicopters from Uncle Sam in 1970. He flew Huey slicks and Cobra gunships in Southeast Asia. Once he returned home he began flying crews to and from offshore oil rigs in the Gulf of Mexico. In the mid ‘80s he started flying for an air ambulance service in Louisiana before answering the call to the new Life Force service 23 years ago. He has logged more than 14,000 hours as Pilot-in-Command of a helicopter.
Ryan is more comfortable flying his high-performance Airbus EC135 than most people are behind the wheel of their car. “We went from one single Bell 412, then we got two,” recalls Ryan. “And we put the world’s first GPS (Global Positioning Satellite) approach into Erlanger Hospital.” Now there are 28 GPS approaches (ways to use GPS data to find your destination during instrument flight) in five different helicopters. As experienced as Ryan is, the other two members of his crew are just as impressive.
Paramedic Seth Gentry has been with the crew for several years, Nurse Redmond for ten years. The team works because they work together—all the time. When an air crew is formed, they stay together because it is so important that in a crisis situation, each member of the team knows they can completely depend on the others. Each has a specific job, although the Paramedic and Nurse are cross-trained.
“Generally, most procedures that we would do in an ambulance or in the E.R., we can also do in the helicopter with just enough space,” explains Gentry. Ryan is content to spend his time in the front seat making sure the aircraft gets from point A to point B safely. “We made a deal with them 25 years ago,” says Ryan. “We wouldn’t try to start an I-V and they wouldn’t try to fly. And it’s worked out pretty well.”
The teams have a unique work schedule. They work seven days straight, twelve hour shifts. Then they get a full seven days off and come back for another week, this time working the night shift. They sleep at the helicopter’s base just like firefighters sleep at their station house.
Multiply that schedule times five bases covering 90,000 square miles and residents of the four state area served by Erlanger Medical Center and Children’s Hospital at Erlanger can count on the best chance of surviving the worst.