Airborne to SaveMarch 9, 2013
Story by Jason Recker
Photos by Dave Weatherwax
As the helicopter lifts from the ground, three men inside know neither the specifics nor the severity of the situation that awaits.
They carry with them radios, and they’d just been paged — a wailing alarm that silenced their lunch break — to transfer a patient from Memorial Hospital in Jasper to Indiana University Health Methodist Hospital in downtown Indianapolis. Six minutes later, a pilot, nurse and paramedic were strapped in, helmets on and visors down, for a mission that included countless variables and one certainty.
The LifeFlight team at St. Mary’s Medical Center in Evansville is here to accept every challenge thrown in its direction. Many lives are saved. Some are lost. No flight is the same. The margin for error is paper thin.
If it seems a bit hyperbolic, consider this: When LifeFlight interviews possible paramedics and nurses, it’s basically looking for a version of a special forces soldier.
“When LifeFlight arrives,” said Pat Rauscher, the program’s director, “everyone else thinks it’s OK to leave.”
Fifteen-minute ETA. Risk code: minimum. Two hours of fuel. Four souls on board. All set? We’re moving off the ground.
It is protocol for the pilot to relay such information, details that force those on board to face mortality. They encounter death often but must accept that the patients whom they transport, many of whom are in critical need of care, aren’t the only ones at risk. In the last four months, air medical helicopter crashes in Illinois, Iowa and Oklahoma resulted in eight deaths. A survival kit for the crew includes food, blankets and a water purification system; it is on board for every LifeFlight journey.
There is something about life on the edge that lures.
Keith Miller is LifeFlight’s lead paramedic, a 32-year-old Barr-Reeve High School graduate and Haubstadt resident who stretched his professional and personal roots in Dubois County. He worked in the emergency room at the former St. Joseph’s Hospital in Huntingburg — that’s where he met his wife, Schnellville native and Forest Park High School graduate Bonnie (Turner) — and for the county’s emergency medical service while earning his advanced emergency medical technician’s certification at Vincennes University Jasper Campus.
He has never been interested in becoming a pilot. But an affinity for flying tugged at him.
LifeFlight was founded in 1982 and its employees are some of the hospital’s elite; St. Mary’s intensive care director, the director and executive director of the emergency room and the chief compliance officer all have LifeFlight experience. LifeFlight personnel have been among the most qualified and talented medically. But an aversion to flying keeps some grounded.
In 2006, the allure of a greater challenge drew Miller to what he considered the next step in his career.
“You can teach skills and techniques and those things are necessary to save a patient,” Miller said. “That’s like teaching someone at Toyota to build a truck. But that critical thinking, thinking on your feet, you can help nurture those skills, but you can’t teach an engineer how to think. You have to operate outside the box, have a sixth sense and intuition. We operate in a gray world.”
70-year-old woman. 160 pounds. ... During a stress test, she showed signs of a stroke. ... Stabilized.
A dispatcher relays information to Miller and 40-year-old flight nurse Jason Doughty, and as the flight lifts over Evansville, Doughty jots notes on two strips of white tape he’s pasted just above both of his knees.
LifeFlight staff carry with them at all times small cards denoting dosage information for medicines, an industrial-strength scissors that can slice through belts, jeans and jackets, and a pen. As they buzz toward Jasper, they cruise just west of Holland and over the southwest section of Jasper. They touch down on the Memorial Hospital helipad less than 20 minutes after they climbed aboard.
Seven air medical programs service Indiana; LifeFlight is the one most commonly linked with Memorial Hospital. On this trip, the crew is somewhat at ease. This patient is not in grave danger, and Miller is not ashamed to be relieved by what more or less amounts to baby-sitting missions.
He acknowledges the crews have not seen it all. But they have seen the worst of the worst, and they are prepared for chaos.
They must fall within 10 percent of their recommended body mass index and annually pass through an obstacle course of sorts that measures strength and flexibility as they relate to the job. They also practice disaster training, and those tests include what they call a Code 1000. In the past, they created a scene in which a helicopter crashed into a school in Mount Carmel, Ill. Volunteers flipped desks on their sides and acted as victims scattered amid hallways as LifeFlight worked with the area’s fire departments, schools and emergency services. A previous Code 1000 involved a flight that lost contact with dispatchers somewhere over Daviess County. They landed on Miller’s family’s farmland and waited 30 minutes for somebody to find them.
Before prom season each spring, the Vincennes school corporation simulates an automobile accident on a football field and gathers students to see lifesaving extremes up close. Everyone wears microphones and LifeFlight floats in and buzzes out with patients aboard.
“What we do is open to scrutiny,” Miller said. “Everything we do is on the local news. People are always watching and holding us to a higher standard. Maybe it’s better that way.”
We’ll do all the work. All you have to do is cross your arms and give yourself a hug.
The code of conduct framed on a wall of the LifeFlight office ranks safety as the top priority. The rest: Do the right thing; team before me; get the job done; open communication. They all relate, in some fashion, to the patient. When Miller and Doughty enter the ER at Memorial in Jasper, they introduce themselves to the woman whose life had, within 30 minutes, been turned sideways. They hold her hand and call her “honey.” They explain where they’ve come from and where they’re all be going and wonder if she’ll mind the mode of transportation.
Some patients are given medication to ease anxiety. The idea of flying excites others; Miller has been asked by patients if they can look out the windows as they fly.
They lift the woman from the ER bed to the LifeFlight stretcher when Doughty says he’ll make it easy on her.
“Light like a feather,” Miller says and smiles as they complete the shift.
The goal at accident scenes is to be in and out in 10 minutes or less. Hospital layovers, with equipment changes, are often longer.
They wrap the patient and when the wind outside repeatedly peels away the cover, they gently replace it. On a blustery winter day with the sun unable to budge temperatures in the 30s, they briskly roll her through the parking lot and insert her, feet first, into the blue chopper. They place headphones over her ears to muffle the rumble.
Seven Sierra Mike. We will continue at 1,600. We are over the stadium in Bloomington. ... There’s a stadium underneath me right now.
Another helicopter, this one bound for another hospital in Indianapolis, hovers along the same flight path as the LifeFlight machine identified by call digits 7SM (Seven Sierra Mike in aeronautical language). The pilot checks the horizon for any tiny dots, and Miller and Doughty scan the sky to the left and right.
The LifeFlight staff augments St. Mary’s ER department, making rounds daily and, when not on a mission, using its acute skills to thread IVs into uncooperative veins and help in situations that involve trauma.
Airborne medicine requires attention that spreads like tentacles. Nurses and paramedics are always listening for a hum or buzz or ping that might signal some malfunction, and they notify the pilot of obstacles like birds and buildings.
All the while, they are but a couple feet from the patient. Paramedics have access to a patient’s pelvis and up (patients’ feet stretch toward the nose of the helicopter), and the tight quarters make some tasks impossible; chest tubes, for example, are inserted while on the ground. The cab includes a ventilator, two units of blood and bins stocked with IV pumps, IV fluids, bandages, splints, suction devices, oxygen and nearly every drug commonly used in an ER or ICU. Vital signs are tracked by something called a Zoll ProPaq MD, which measures cardiac and respiratory statistics as well as blood pressure, blood oxygen saturation and temperatures.
It is a compact, mobile ICU, but one that is prone to unforeseen dips and sways.
Flights are relatively smooth. But pockets of air create the brief feeling of descending a roller-coaster hill, and there is the constant whirring and chopping of a machine that thrusts 850 horsepower and can fly 150 miles per hour 2,000 feet off the ground. Multiple flights in one day can leave aches and pains mimicking those created by an automobile accident or a long-distance race.
Focus is paramount.
“Once we’re airborne, it’s all business,” Miller said. “I don’t really have to brace myself, but I have to formulate a game plan. We have to understand our roles. We have to have the pieces in place so that the minute the skids hit the ground, everything goes smoothly.”
We’re heading down. ... There’s the pad. Boy, it sure is rather windy down there. ... Tail coming left. Clear. Shutting down.
Amid the Indianapolis skyline, Miller and Doughty wheel the 70-year-old woman toward staff waiting at Methodist Hospital. The exchange is rather brief, about 15 minutes total. They relay medical data and a computer disc of the patient’s brain scan and Miller finds a copy machine to complete paperwork (each flight generates about three hours of desk work). On the top floor, pilot Jim Croce reclines in a corner chair.
From Indy to Evansville, Miller and Doughty can enjoy the ride. It’s Croce’s job to get everybody back in one piece. He’d just crossed over the state capital’s downtown district, soaring past Lucas Oil Stadium and over Victory Field before navigating scattered buildings that stretch toward the clouds in the formation of a random bar graph. A breeze of at least 25 miles per hour whipped at the neon orange wind sock on the helipad, but he gracefully lowered the machine, pivoted and landed on a helipad several hundred feet above the streets below.
That was rather routine. Miller’s most harrowing landing happened at a nighttime accident in Dubois County. The landing zone was on an uneven field bordered closely by woods. The helicopter’s spotlight and emergency vehicles on the ground provided the only beams of light.
In the way patients trust Miller and Doughty, the medical team trusts those in control of the aircraft. The confidence is merited.
One pilot, a 65-year-old military man named Jack Winternheimer, regularly flew presidents Carter and Reagan in Marine One. Croce, 55, is a comedic sparkplug with a story to match. He’s a former banker who ditched his job and lived in his van to save money for pilot lessons. He used to haul thousands of dollars’ worth of bank checks in California and later flew in Alaska, piloting tours and later hovering over the ocean to scout for schools of tuna.
LifeFlight’s staff consists of five paramedics and seven nurses, including Huntingburg resident and newcomer Jennifer Bayer, who work in 12-hour shifts. There are also two mechanics and four pilots, each of whom has contributed to a spotless record of well-being.
A plaque on the office wall in Evansville commends LifeFlight for 30 years and more than 10,000 flights without an accident.
“Some people don’t think that should be on the wall, or if it is on the wall, we shouldn’t talk about it,” Miller said. “At the same time, safety is one of the big points of our business, so why not brag about it?”
Look down and you’ll see Crane. All those bunkers with train tracks leading to them. I’ve always wondered what’s in those bunkers. What kind of secrets?
On the path home, with the patient successfully delivered and a refueling stop at Indianapolis International Airport complete, the conversation bends. Miller, Doughty and Croce trade stories of past missions and make note of the landmarks below — the bunkers under Crane Division, Naval Surface Warfare Center, Assembly Hall on the IU campus, the town of Winslow and Pike Central High School.
There is an hour to decompress, a necessity when your speciality brings with it gruesome scenes and ghosts of missions with depressing outcomes.
Trips involving children — especially since he is a father to a 4-year-old daughter and 2-year-old son — tear Miller’s heart. Radiator fluid, car exhaust, antifreeze, gasoline and blood form an aromatic cocktail that triggers recollections of assorted car crashes. Some images he cannot escape.
“The best way to cope is to sit and go through the whole thing,” Miller said. “You can’t try to distract yourself and not let it run its course. You can try to forget, but at some point, it’s going to come back. You can’t purge those things.”
St. Mary’s has a group that meets to process grief. Miller also engages co-workers who have seen what he has seen. At home, he leans on his wife, a labor and delivery nurse at St. Mary’s.
“Absolutely, I’ve cried,” Miller said. “Maybe not at the office, but on the drive home. There are things you encounter that, if you have any bit of humanity, you can’t help but be overcome. There are natural emotions, and not just crying, but anger, questioning things. You go through the spectrum.
“There is some level of callousness. ... But you have to have compassion to adequately function in our situations.”
St. Mary’s in sight. Heading down. Look at the kids. All waving at us. ... And that’s it. Shutting down.
Children at a playground are standing and waving as the helicopter glides toward the ground.
Another mission completed without pause. Miller, Doughty and Croce return to the office and wait.
Sooner or later, the tones will sound. Somebody will need them. They won’t know what they’re getting into. They’ll go.
“We might fly a kid who’s 4 weeks old and the same day a 90-year-old who fell and broke her hip,” Miller said. “We’re as prepared as we can be for anything. We have to adapt at a moment’s notice. That’s kind of what we’re paid to do.”
Contact Jason Recker at firstname.lastname@example.org.
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