In the second part of Dean Mischke’s two-part series on a day in the life of an EMS pilot, he describes the outcome of a scene flight. Part 1 can be found at www.www.verticalmag.com/vertical_online.

En route to the scene of the motor vehicle accident, we’re getting further information about the victim through our pagers. This information generally includes the patient’s sex, age, injuries and for my purposes, the patient’s weight. I begin thinking ahead about the weight and balance calculations needed for bringing a “220-pound/55-year-old male” back to Reno. We’re also given latitude and longitude to fly to, and a frequency to use (though I’ve been flying here for so long that I generally have the latter ready before take-off). The crew reads the lat/long, while I feed it into the GPS. Before long, I start getting the radio frequencies set up for any airports I will be flying close to along the way.

Getting to the accident site involves flying through the restricted areas of Naval Air Station Fallon and its “Top Gun” school. There have been times in the past, when I have been at 1,000 to 2,000 feet above ground level and had F/A-18’s fly under me, at practically warp speed! Highway 50 extends through the restricted areas, and a clearance by Fallon Desert Control is a must, for the obvious reasons. While we don’t have a Letter of Agreement with Fallon Approach/Fallon Desert, we have a good relationship with them, so they are very accommodating. Thus, we don’t experience any air traffic problems as we make our way east right over the huge Naval Air Station (NAS) Fallon ramp with rows and rows of Russian-painted fighters. I believe that one of the reasons why they are so obliging is because, over the years, Care Flight has transported many Navy people to Reno hospitals, and I think that they appreciate our effort. They will not hesitate to shut down a Restricted Area for us to transit through, if needed.

I’m now about 30 minutes into the flight and it is time to start thinking about going to one of the microwave repeater towers that occasionally dot the Nevada moonscape. In this case, it’ll be Cory Peak Microwave. I give our dispatch center the required position update every 15 minutes. In addition to these regular position reports, all of our helicopters are equipped with satellite tracking devices, allowing the dispatcher to follow along on a dedicated computer screen in the dispatch center. (That information is updated every minute or so.) About five to 10 minutes out, I call whoever I’m told will be on scene. Sometimes there are 10 emergency vehicles on scene, and sometimes there are none. It all depends on how remote the patient’s location is.

In this case, there is a Nevada Highway Patrol (NHP) trooper – with basic CPR training but no other medical qualifications – who has been on scene for about 20 minutes. The ambulance from Fallon is about 15 minutes away, so it seems we will be the first medical personnel to reach the scene. The medical equipment we carry on board the helicopter is similar to what would be found in an Intensive Care Unit (ICU), only miniaturized to fit in our small cabin. Our medical crew is qualified to insert chest tubes, central lines, and even a needle into the heart. These are skills that many doctors would not have practiced since med school. Yet, they are needed to save Jacobs’ life on this loneliest highway.

Arriving on the Scene
It is five minutes later, and we still have not received a reply from the trooper on scene. Failure to receive an immediate response is not unusual. When that happens, we assume the trooper is busy with the patient. From about 4,000 feet AGL, I’m able to see the accident scene from seven miles away. When landing on a freeway, there may be several miles of backed-up traffic – sometimes just to open a landing zone (LZ) for me on the road. However, this particular morning, out on “America’s Loneliest Highway” all I see is a big-rig and the Trooper’s Nevada Highway Patrol (NHP) blue sport utility vehicle with flashing lights on top.

We descend to 1,000 feet and perform a 360-degree turn around the scene to check for the usual helicopter catchers: wires, poles, and antennas. From 500 feet, evidence of accident becomes obvious, with the debris field extending about 100 feet out into the bushes. At the end of it, we see the Trooper and another person (we guess it is the trucker) squatting next to a prone body. We complete our circling reconnaissance and see nothing in the way of obstacles near our intended LZ, which is on the highway about 100 feet from the patient’s position.

I decrease my speed a little more at 300 feet, and then come to a stop in order to do a quick out-of-ground-effect (OGE) hover check: unnecessary here, but a good habit to have. I check for both power and tail rotor control and then slowly descend to the ground. The medical crew is scanning their respective sides for anything that we might have missed (we have pre-briefed that if I hear the word “stop,” I will freeze the helicopter right where it is). I land at a 90-degree angle to the road because most of our highways are slightly elevated, and this allows me to put the tail rotor out over the edge, keeping it away from any over-zealous person who might appear in our LZ and approach from my rear. This precaution also enables me to see both ways down the road for any cars coming up – if needed, I can shine my lights at them.

Quick Action at the Scene
About 5 minutes after shutting down, the ambulance arrives on scene with a sheriff, so I ask them both to park across the road in order to protect the LZ from the possibility of an offending motorist. The medical crew establishes that the patient has a collapsed lung. The likely cause is what we hear on TV a lot: “blunt trauma.” This was likely caused by Mr. Jacobs crashing into the steering wheel or hitting something while being ejected.

This critical injury makes it essential for the crew to carry out an uncommon surgical procedure to save Jacobs’ life at the scene. This procedure involves making a 1-inch incision in the side of the chest; with the fingers, feeling through the ribs, muscle, and tissue to the lung; and then inserting a long tube to drain out any liquid and re-inflate the lung. This is done right where the patient lies, out in the sand and scrub bushes. Next, he is placed on a back-board and strapped down to immobilize him. This will prevent any further injury. As six people lift the patient into the aircraft, it’s my job to collect the big trauma bag, monitor, suction pump, and all the other medical-type stuff now strewn all around where Mr. Jacobs was nearly dying in the scrub. Think of what you see on TV – the aftermath of an ER ordeal with needles, plastic IV lines, syringes, containers, even blood strewn all around – now put all of that outside on a nice, clear sunny morning in the high desert. It can be a very surreal sight.

Now its time to load the patient and all of our gear into the helicopter; it takes exactly 20 minutes from touchdown. The medical crews aim for around a 10-minute on-scene time, yet it’s impossible to pre-determine the quantity of time it will take to complete the necessary procedures at the scene before placing the patient on board, since accidents are highly variable. After everyone is aboard, I close the left door, and do a complete walk around the helicopter. This time, I’m looking for anything inadvertently left hanging out of the aircraft, plus any equipment left on scene. I climb in and start it up, taking care this time to reset the GPS mileage.

I call our dispatch and let them know our fuel, the number of passengers on board, and which hospital we’re going to: “Care Flight Dispatch, Care Flight One is off with one hour 10 minutes of fuel, four on board, one patient for Renown, ETA of 1010.” I contact Navy Fallon Desert Control to let them know I’m on the way out. With the chest tube inserted and oxygen traveling to his brain, plus an IV allowing fluids and medicine to get into his body, Jacobs’ condition is getting better by the minute. At around 10 minutes away from the hospital, we get a “patch” from dispatch. This allows the medical crew to talk on the med radio directly to the emergency room and prepare them. If needed sooner, we can contact the hospital any time with our on-board sat phone.

On final approach I can see a team from the hospital ER waiting with a gurney. After years of doing this, it never ceases to amaze me that these highly educated doctors and nurses will stand right by the pad and get blasted by the rotor wash. I always do a little internal smile at this as I land. As the blades come to a stop on the hospital pad, the crew yanks the door open and, before I can complete my log entry, they are gone. I rarely hear the patient’s story after this. Sometimes, if the patient is a badly injured child, I will search out the med crew and ask about it, as I have three children of my own. (In this case, Mr. Jacobs ends up staying in the hospital for 18 days, undergoing surgery to repair three broken ribs, a broken leg, plus spleen and lung damage. After five months of rehab, he is able to resume a normal life.)

This is the weird part of EMS flying. After all the rush and excitement of quickly planning and navigating to somewhere you’ve never been to before, getting a critically injured patient and then flying back to the hospital now I’m all alone on an empty helipad. I sometimes pause a minute or two, just sitting alone in the cockpit, to reflect on the job in general and in particular the good work our team has just done. That over, it’s time to fuel, plug electrical cords in, and get our helicopter ready for the next one which could come at any time.

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.