Air medical evacuation is expensive, but the service saves lives. Minutes saved in getting a patient to an appropriate facility can have a huge impact on the patient’s prospects for survival or favorable outcome. In emergency medicine, the “golden hour” refers to the hour following a traumatic injury, during which there is the highest likelihood that prompt medical treatment will prevent death.
Due to the limited number of aircraft and the high cost, a medevac flight is dispatched only for patients in critical or very serious condition. Medevac team members must be prepared to deal with more grievous situations on a daily, or even hourly basis.
Flight nurse Nick Cooper, of Seebert, worked in an ICU for five years before joining an air medevac crew.
“We flew a kid that was on an ATV without a helmet and hit a deer,” said Cooper. “When we got there, he was in really bad shape. I truly don’t think he would have made it, had we not been able to get to him quick enough. He was going downhill quick. We did a lot of good things for him there on the scene. We got him in the helicopter and got him to the facility at WVU Hospitals. He actually walked out of there about two months later and he’s been able to keep in touch with us.
“We see a lot of bad stuff – a lot of death and dying and just misery – and that can really wear on you. But to have one patient like that, who comes back or sends a card that says, ‘hey, without you guys, we wouldn’t be here today,’ that’s what makes it all worthwhile. You might only have a couple of those but that drowns out the rest of the bad stuff and keeps you going.”
Carl McCormick worked as a field paramedic for 10 years before joining an air medevac crew.
“In this job, we definitely see the worst of the worst,” he said. “When I was in an ambulance, I saw mostly day-to-day car wrecks and minor injuries. I would occasionally see a bad injury. In this job, almost every injury is life threatening. Everyone is looking to us for the advanced treatments.”
Joshua Gillespie worked as a paramedic and emergency room nurse before joining an air medevac crew.
“You really have to sharpen your critical thinking skills and think outside of the box,” he said. “On the ground, as a paramedic, you do that quite often, almost every transport that you take care of. But once you step into the air medical world and you advance your knowledge and your skills, you have to step it up. You really have to become sharper than what you were on the ground. You have to give the best you have for yourself, your patient and your team members.”
“It’s a little more challenging,” said flight nurse Austin Browning. “You have the patient care plus you have the aviation side. You always have to be alert for any wires or anything that might be out there to get us.”
In order to work in air medevac, medical personnel must have years of experience, receive advanced training and obtain additional certifications. Nurses and paramedics must be certified in critical care transport (CCT) by the state. Private employers often require additional training.
Cooper, McCormick, Browning and Gillespie work for HealthNet Aeromedical (HNA), a Charleston-based air medevac company. In order to become a full member of an HNA flight crew, all new medical staff must complete 10 weeks of training that the company provides at its academy in Charleston. During the training, new hires learn advanced medical techniques, how to work in the confined space of a helicopter bay, and also receive actual in-flight orientation.
HNA medical director Dr. Mike Peterson, a graduate of the West Virginia School of Osteopathic Medicine, said HNA training exceeds state requirements.
“The state only requires that they go through an orientation process, that they have a certain number of flights, that they demonstrate competency, and then they can start doing the job. We don’t do that. We require the flights, but we also require 10 weeks of training beyond that. Only by demonstrating really good competency will we allow them to proceed to the next level, which would be a full member of the crew.”
Cooper worked in the intensive care unit at Ruby Memorial Hospital in Morgantown for five years before starting work with HNA. The veteran nurse said the academy is “no joke.”
“It’s pretty rigorous, they’re putting guys through the wringer,” he said. “They’re trying to imitate scenarios the best that they can and put them on the spot. They’re very strict. This academy has brought a consistency to our organization. Everybody goes through it. It’s the same training for everybody. It’s very consistent.”
Cooper said working on a flight crew is different than working in a hospital.
“The autonomy of the helicopter setting is the main difference,” said Cooper. “Morgantown’s a training hospital, so I had six doctors all around me, plus 20 other nurses that I could call upon for help in an emergency. In the helicopter, I have a medic and a pilot, and the pilot usually can’t help at all.”
HNA contracts with Air Methods, a Denver helicopter company, for aircraft operation and maintenance. Air Methods provides all of the company’s pilots.
Air Methods employee Frank Figueroa is a pilot and flight manager assigned to HNA’s Base 6 in Buckhannon. A Major in the West Virginia Army National Guard, Figueroa learned to fly in the Army and is a veteran of the war in Afghanistan. His overseas service includes both medevac and combat missions.
Like their medical teammates, Figueroa said civilian medevac pilots must be able to work independently.
“This job is a little different because it places a lot of the responsibility on one pilot,” he said. “In the military, you have two guys that operate the helicopter; one that’s actually on the controls and the other one, that’s providing assistance in monitoring systems, copying down frequencies, et cetera. If one individual gets tired or wants to switch off, the other pilot takes control. In this role, we fly single-pilot, day and night NVG [night vision goggles] operations, which means that one pilot is on the controls and we do not have the benefit of a second pilot.”
Medical crew members work a 24-hour shift and pilots work a 12-hour shift. Bases are equipped with a kitchen an sleeping quarters for all crew members.
On a typical day, the team responds to three to five emergency transport calls. A recent shift for Figueroa, McCormick and Browning was typical.
The day started with a morning flight from Base 6 to French Creek Elementary School, where the crew provided a safety class for school children. The crew instructed the students on a variety of safety topics, including bicycle and ATV safety. The excited youngsters got a tour of the aircraft and Figueroa explained the function of the different parts of the helicopter.
Prior to the conclusion of the safety class, the crew was alerted to respond to the scene of a traffic accident in Buckhannon. Ten minutes later, the helicopter landed at a pre-designated landing zone along Corridor H, where ground emergency responders transferred a patient to the air crew.
Twenty-five minutes prior, the patient, a female in her 20s, had been involved in a traffic accident, sustaining serious injuries. McCormick and Browning quickly loaded the patient through the rear clamshell doors and the chopper departed for Morgantown.
Twenty-five minutes later, the helicopter landed on the helipad at Ruby Memorial Hospital and the patient was whisked away by hospital staff. The air medevac crew delivered the patient within the golden hour – an impossible task by ground. Fortunately, the girl’s injuries were not considered life-threatening.
After re-fueling at the HNA base in Morgantown, the crew departed for Base 6. Before arriving back at base, the crew was alerted to another emergency call. Some days, like this one, the calls come one after another. Other days, the crew gets a break between calls. A few days, due to inclement weather or a lack of emergencies, the crew will receive no calls in a 24-hour shift.
“During the peak time of the year, which is the spring, summertime and early fall, we average three flights per day and two flights per night,” said Figueroa. “That can increase or decrease, but normally, we stay very busy.”
Figueroa wanted to send a message to his military colleagues in harm’s way.
“Be safe out there,” he said. “We’re thinking of you. We love you. We also want to give a shout out to the families who are home, waiting for our soldiers to come home. God bless you all. We’re praying for you. We wish you to return safely to us.”