In the first of a two-part series, helicopter emergency medical services pilot Dean Mischke describes a typical morning in the life of an EMS pilot – and the circumstances leading to a typical scene flight.

On an early Tuesday morning, Mr. Melvin Jacobs (not his real name), a 55-year-old man from Fallon Nev., is driving his 1977 Chevy pickup truck on Highway 50, 100 miles southeast of Reno, Nev., when his vehicle rolls over. Often described as the “UFO Highway” and the “Loneliest Highway,” Highway 50 is desolate stretch of road where one can drive for miles without seeing another vehicle. While traveling along it, Jacobs, who is not wearing a seat belt, falls asleep at the wheel and drifts off the road. The truck rolls over several times and Jacobs is thrown from his truck, landing 50 feet away. He lies in the middle of scrub bushes for 30 minutes before a big-rig truck driver comes upon the scene and finds him.

Our Care Flight Air Ambulance Helicopter, stationed at Renown Medical Center, is dispatched to the scene. Within minutes our medical crew – consisting of a Flight Nurse and a Flight Paramedic – are with me in the air, traveling at 120 knots towards the scene of the accident. We finally observe the tell-tale signs of Jacob’s steering over-correction: the tire marks toward one side of the road, abrupt marks coming back onto the road, skid marks going 45 degrees across the pavement and what appears to be the site of an explosion. Then, we see the upside-down truck. Next, the nurse and paramedic assist me in locating a clear 100-square-foot area; minutes later, I land on the nearly deserted highway.

The medical crew quickly determines that the victim has a life-threatening injury – a collapsed lung. And the severity of the injury compels them to act quickly, performing a rare and serious surgical procedure on site to save Mr. Jacobs’ life. In minutes, we are again in the air and I’m flying the victim to the hospital over the desolated, high desert terrain of northern Nevada. Time from getting the call until Mr. Jacobs is in surgery: one hour and 40 minutes. The drive into Reno would have taken an hour more, and the ambulance crew would not have been able to re-inflate Mr. Jacobs’ lung. In other words, the advantages offered by helicopter emergency medical services include not just the time saved, but what the crew brings directly to the patient often in the middle of nowhere, and in the middle of the night.

The Pilot and Program
I am an EMS helicopter pilot who flies with the Care Flight Air Ambulance service in Reno, Nev. Care Flight has been in existence since 1981. In my more than 13 years of employment with the program, I have flown the SA316B Allouette, the MD900 Explorer and the Eurocopter AS 355 TwinStar. Currently we fly the Eurocopter AS 350B3 AStar. We fly 24/7 and all personnel are trained with night vision goggles (NVGs). We have found lost and injured people out in the high desert from 20 miles away using the NVGs and the light from their cell phone.

Typically, programs like ours use a helicopter vendor that provides all the pilots and mechanics. When I retired from the United States Army in 1997, the vendor this program used was Rocky Mountain Helicopters. In 2002, Rocky Mountain Holdings, LLC (RMH) was purchased by Air Methods Corporation (AMC) which is the leading publicly owned emergency medical services helicopter operator in the United States, possessing a fleet of over 300 medical transport helicopters.

Care Flight operates three in the area of northern Nevada: in Reno, Nev.; Gardnerville, Nev.; and Truckee, Calif. I work at the original base in Reno. The pilots at each base can determine their own work schedules. We stagger the start times at each base, so if a pilot is close to his Federal Aviation Administration (FAA)-mandated duty time limit, another base will be able to accept the flight. The shift change times in Reno are 8 a.m. and 8 p.m. We work 12-hour shifts. At Reno, the pilots work a 7/7 schedule (seven shifts on, seven days off). Of those seven shifts, I work Monday to Thursday on days, and then switch to nights on Friday to Sunday. Then, I have a week off.

Pilot’s Work Day Begins
I arrive to work approximately 25 minutes early, at 7:35 a.m., about the time Jacobs is beginning his ordeal in the shrubbery of northern Nevada. The first thing I do is log into the Air Methods computer network on the company computer, which is called “the 411”. It helps verify that I have my aircraft qualifications, day/night/NVG currency, and medical; and complete the other administrative tasks that allow me to fly in accordance with both FAA and company requirements. I also have to acknowledge that I checked the weather and the Notices to Airmen (NOTAMs) for the day. Straight away, the system issues me the “flight release.” This is required before taking any flight. (If the system is down for some reason, there is an 800 number I can call to achieve the same result, verbally.) I find out who the med crew is and complete a weight and balance worksheet for the day. All of those tasks together last about 10 minutes, then I proceed to the helicopter for a pre-flight check.

At around 8:00 a.m., after the necessary pre-flight check lists are complete, the medical crew and I decide to go to the cafeteria for breakfast. The cook has been there for several years and is known for the best breakfast burritos in the Northern Hemisphere! The fact that I plan my whole shift around these tasty torpedoes has become a minor legend among the Care Flight personnel. Unbeknownst to us, this is about the time that Mr. Jacobs is experiencing a serious medical emergency as a result of injuries that he sustained in his accident he is unconscious, but his body is slowly dying.

The Tones Go Off
At 8:20 a.m., our tones go off. “Care Flight One, you have a flight request for a motor vehicle accident (MVA). This is going to be on Highway 50 about 43 miles east of Fallon.” I respond, “Care Flight One, Pilot/crew copy. Accept Bravo.” The “Bravo” indicates which of the four categories of risk – as determined earlier by means of the Air Methods Risk Assessment Matrix – we are required to use for every flight. It includes such things as weather, time of day, terrain, the experience level of the pilot and crew, and the type of aircraft. I subsequently wolf down the rest of my breakfast as we make our way through the labyrinth of the hospital. It is not unusual for the crew to be engaged in other activities at the time of dispatch: for instance, “doing rounds,” or checking the status of the patients we previously flew in. Therefore, we are not always at helicopter at the same time. This time, however, we arrive together, finishing the last of the greasy burritos.

Departing
The helicopter we use – the Full Authority Digital Engine Control (FADEC)-equipped B3 AStar – is a breeze to start. Its quick checklist includes: battery, fuel pump, and generator buttons pushed in, and then flip the starter switch. All I have to do is sit and keep an eye on things while it starts up. Once the generator is on line, I flip the master avionics switch and all of the radios power up; I perform the hydraulics check and a few other items. By the time the checklist is complete, the two Garmin 430 GPS receivers are synchronized and we’re ready to go. It usually takes two or three minutes from the time I climb into my seat, to time we’re all ready for take off.

Based on our morning crew brief – done over the burritos – I ask my crewmembers if they are ready prior to pulling pitch. If they reply yes, I’ll call dispatch on the No. 1 FM radio: “Dispatch, Care Flight One is departing with three on board, two hours 20 minutes.” I guesstimate the MVA to be around 80 miles away, with no winds this early in the morning. I assess that 40 minutes should do it. It is now 8:27 a.m.

Care Flight has no set time for launch. We take off whenever we can, avoiding any time wasted. Sometimes in the winter with all the snow covers on, and if I have to add extra fuel for a long flight, our take-off time may increase to 15 minutes or more. Today, it is respectable six. As I lift off, we all scan for the occasional aircraft that may be flying over the hospital. Since we are only 1.5 miles northwest of the Reno-Tahoe International Airport, we are in the airport’s class C airspace and the tower is aware that we could appear there at any time. Therefore, they tend to keep the general aviation (GA) aircraft on the other side. Our Letter of Agreement (LOA) with the Reno tower exempts us from having to call clearance delivery or get a squawk code and clearance.
 
We have assigned codes for each of our aircraft, and the tower gives our clearance and altimeter reading straight away. We also exclude the term “Lifeguard,” because it’s understood that unless we say otherwise, we are on a lifeguard flight. I switch to the No. 1 comm radio to talk to the tower before we get too high. We receive our clearance to go directly over the airfield heading east-southeast, and the medical crew is now looking for the other aircraft the tower announced earlier. We do not need to request a frequency change, because of our LOA; as a result, when our helicopter disappears from the radar, we are finished with air traffic control. Meanwhile, I’m dialing up the frequency for Pershing County Sheriff on the No. 2 FM radio. Though it is far away, I can usually hear them if I’m high enough. There are several mountain ranges east of Reno, so I’m climbing up to 9,500 feet for trip out east.

To be continued…

Dean Mischke, after serving for 22 years, retired in 1997 as a CW4 Master Aviator/Standardization Instructor Pilot from the U.S. Army. He flies for Air Methods Corporation (AMC) at the Care Flight program in Reno, NV. He has an ATP and over 12,000 accident-free hours in helicopters, 1,200 of them with NVGs. He is also on the Executive Board of OPEIU Local 109, which serves over 900 AMC line pilots.