Flying heavy: A medevac pilot’s balancing act between safety and survival

In 1985, I took over the UCLA MedStar program based at the UCLA Medical Center where an Agusta A109A operated from the center’s rooftop heliport. A charter company supplied the helicopter, pilots, and maintenance, and I was brought in to start an in-house program. We hired a new cadre of pilots and planned to fly the A109A until we could replace it with an aircraft of our choice.

The 109A was a sleek, beautiful aircraft but didn’t have the power to carry all the medical equipment, medical crew, and fuel for our missions. Our helipad was located six stories above the campus on the roof of the medical center. Even though we were diligent in computing our weight limits from the flight manual, every takeoff was a guessing game.

Standard procedure was to pick the helicopter up to a hover and verify we had adequate power. In the 109, we were using power close to the red line just to hover, so as we left the roof behind and were suddenly six stories high, we had to add what little there was just to keep flying. That often left us trading height for airspeed, a minor adventure in itself as the helicopter staggered along over our busy campus.

On one of my first duty days, we got a call about a flaming SUV wreck. The emergency medical technician (EMT) at the scene told us that the badly injured driver weighed about 150 pounds (68 kilograms). With the fuel we needed for the flight and our two nurses and their medical equipment, I had calculated a 150-lb. patient would put us at the maximum allowable weight to take off and climb out of the mountainous terrain surrounding the accident.

As we touched down at the accident scene, I looked out at the carnage. The SUV laid on its back, its wheels still spinning idly. Fenders and doors ripped away in the crash were strewn around the highway. The victim laid perilously close to the car, his arms and legs splayed out, the ambulance crew squatting next to him assessing the damage and pumping meds through the IV lines they’d stuck into his arm. I stared at him, his girth the reason the paramedics hadn’t moved him. The guy had to weigh over 250 lb. (113 kg).

A chill ran through me. The 109 didn’t have the power to lift his bulk off the highway. As I sat in the helicopter, engines idling while the med crew was out doing their work, a light breeze blew in from the right side. The departure path in that direction was clear of wires and trees. If I could somehow coax the helicopter into a hover, then ease the nose around into the wind, we could take advantage of it to climb away and fly.

New to the whole process of flying trauma patients, it never occurred to me to refuse to take this guy. He was being rolled toward the helicopter, we needed to save his life, and it was up to me to fly us out of there. I felt the helicopter settle on its landing gear as they loaded the patient, confirming my worst fears.

Once the doors were closed and the med crew was settled in, I started pulling in collective. The power needles were touching the red limit lines as the 109A staggered into a low hover. I eased the nose around into the wind. The 109 bobbed up and down, seeming eager to fly. I pulled in what little extra power we had and nosed forward. I remembered from our training that the 109A rotor would begin to lose revolutions per minute (RPM) the instant the torque or temperature needles touched the red line.

So for us this night, the first few seconds were heart-stoppers — the 109 lurching along, then drifting downward a few inches toward the bushes. The wheels slashed through the tops of the underbrush. Even though I was freaking out, I caressed the 109 along until suddenly it burbled its way up to climb speed and we flew off into the night.

Afterward, I was collecting my thoughts about the evening’s adventure. What a scrape this flight had been, literally, as we crunched through the bushes. What was I thinking? Bottom line, I’d taken off too heavy for us to get out of there and only pulled it off because of a stray puff of wind. Why had I thought we could take that big patient out of there when we were way outside the performance data in the fight manual?

I had just discovered the rule of life for a medevac pilot: If I had refused to take off from that highway, that young man would have bled out and died. No other type of flying in the civilian world puts a life-or-death decision on every flight. If that was the case, why weren’t we better organized? Did ambulance crews not understand the importance of patient weight to a helicopter crew? I asked around and it appeared few of them received any training about working with helicopters. I’d seen the huge binders of data they referred to for treatment protocols and for managing an accident or a crime scene. It was pretty clear, though, that they didn’t have a binder on helicopter operations.

While remote landing zone operations have improved a lot since those days, it’s still up to us to make sure details like patient weight are within the limits of what we can deliver. And, as in my situation that night, if there’s an issue, we must point it out and stand our ground, otherwise, we’re creating a license-revoking violation. Offering an imaginative alternative, maybe leave one medical crewmember at the scene, for example, should be your contribution to preserving life and limb. However you choose to handle the situation, it’s your responsibility to ensure the solution prioritizes survival while offering a viable alternative to address the issue.

In case you missed it, check out more stories from Woody McClendon in this episode of The Helicopter Podcast with host Halsey Schider.

In his 50-year flying career, Woody McClendon has flown corporate jets across oceans, turboprops and jets on air medical and organ transplant flights, and helicopters in a wide range of roles — from training and demonstration to surveillance and air medical tasks. As a former Boeing flight test engineer, he has brought his technical expertise to bear on a wide variety of operational and mission-related challenges over the years. He has also written articles for a number of aviation trade publications and recently published When the Angel Calls, a timeline of the air medical business from its inception 40 years ago to its present struggles with mission safety while facing pressures to cut expenses.