Life on the Magic Carpet:

In the winter of 1996/97 I found myself in an unexpected and wonderful position. Due to a great deal of effort on the part of a great many people, the sheriff’s office in the county I worked in managed to lay their hands on a helicopter that they set up for emergency medical service or EMS flights. Through some previously laid in hard work and not a small parcel of luck I suddenly found myself in the dream job of dream jobs in EMS. I became a flight medic.

There are two main reasons flight jobs are so sought after in EMS. First, flying around the countryside in a helicopter is a hell of a lot of fun. Second, flight medics see the worst of the worst. No one calls a helicopter for a rash, so flight medics see life and death trauma all the time. In my area a street medic might see three or four really serious, "life in the balance" trauma calls a year. A flight medic in the same area would see three or four a month. This proved to be a greater challenge than I first imagined.

Me and seven of my colleagues all started this endeavor as new flight medics at the same time. Our experience began with a week long course on helicopter operations put together by the pilots. I like to call the course "A thousand things that will kill you on a helicopter." It quickly became apparent to all of us that this helicopter business was serious and dangerous. A car has a few thousand parts, but can basically be broken down in to a few basic components that make the thing work. An engine makes power, some gears transfer the power to the wheels and the steering wheel and the brakes keep the thing under control. Helicopters contain maybe twice as many parts and probably four times as many separate systems, all of which will turn the occupants of the helicopter into a smoldering grease spot and a quiet ceremony should something go wrong. For instance, let’s say you’re in a bit of a hurry dealing with some mangled patient and you don’t quite get your door latched when you get in. On an ambulance this is no big deal. You turn a corner, the door flies open, and spills out two or three hundred dollars worth of medical supplies. You see it, close the door at the next red light, and quietly replace your supplies when you get done. No harm, no fowl. On the helicopter things are quite different. You forget the latch, the door flies open at about a hundred and fifty miles per hour, breaks loose, hits the tail rotor and you spiral to the ground where you and your crew make a very large mess. The week was filled with dozens of these kinds of quaint little examples. As they joyfully relayed this information to our nervous little group we began to see the point. In helicopter EMS, you have to stay wired pretty tight.

Having been sufficiently terrified by our new coworkers we were off for adventures in airborne medicine. We’d all imagined that medicine from the back of a helicopter would be challenging, but I don’t think any of us fully appreciated just how challenging things were going to be. First off, the people we picked up were really, really screwed up. I found myself, after seven years on the street having to go back to my medical books and learn about trauma on a whole new level. I decompressed chests, inserted surgical airways and did a dozen other formerly rarely performed advanced procedures more in my first six months on the helicopter than I had in the previous seven years on the ambulance. It was fantastic, I was really making a difference. The reasons we had to wear fireproof clothing and a crash helmet to work were always in the back of my mind, but I loved every single minute. Things did not always go completely like clockwork, but we managed.

Although flying EMS in helicopters is fraught with danger, I felt very comfortable with nearly every aspect of flying. The pilots were all extremely proficient and competent men, with whom I would to this day confidently fly through the gates of hell, without any doubt that I’d be home for dinner. The mechanics we had were as fine and careful a group of men as you could ever hope for. The men who work on Airforce One are grease monkeys compared to these guys in my eyes. One thing always scared the bejesus out of me, though, and that was landing at accident scenes. I worked nights, and found myself constantly trying to look at a dozen things at once in the dark as we tried to put ten thousand pounds of screaming machinery down in some windswept convenience store parking lot. About every fifth landing had to be aborted because we saw some power line or other lethal hazard at the last minute that the guys on the ground, already pretty tied up with whatever calamity they’d called us for, hadn’t seen. This always unsettled me. On one occasion it unsettled me so much I made a small mistake.

We got a call for a woman who’d been found beaten unconscious on the side of some remote two-lane road. The ambulance, being nearly an hour from the nearest hospital and the patient being in dire straits, they needed us. They arranged to meet us at a truck stop. From the ground, I’m sure the truck stop only looks like a mildly scary place at three in the morning, but from the front seat of a helicopter it looks like the Omaha Beach on D-day. Dozens of light poles reached upward for a chance to shatter our rotor blades, trucks were parked haphazardly so as to channel any gentle breeze into a helicopter flipping gust, and a half a dozen or so barely visible power lines all waited for their chance at the rotors. I watched all of these threats grapple for our helicopter as we eased toward the ground, talking softly to the pilot as we descended. "You see that stick at nine-o’clock?" I’d mutter. "Got it." He’d reply, watching his own set of "sticks" or light poles out his side as we descended. Once we’d set the helicopter on the ground I breathed a small sigh of relief. This was sort of a micro-vacation between the struggle to land safely and the struggle I was about to step into for the life of our battered patient. As I reached for the door handle I looked at Pat, my pilot, and smiled. "That was fun." I said with my usual sarcasm. He smiled back and just as he did, the helicopter lurched upward and plopped back down again. We both went pie-eyed. Pat started scanning instruments and I tried to hear or feel any abnormality in our fragile machine. It was at that point that I noticed that something about my left hand wasn’t quite right. Then the answer to our mystery struck me with shameful clarity. I’d been reaching for the door latch while I was talking to Pat and had missed the latch and instead grabbed the "collective". The collective is a flight control that sits on the left of the each front seat. It makes the helicopter go up and down. I’d just grabbed it and pulled up in an effort to open the door. "Uhh…hey Pat." I said. He looked at me nervously. " I figured out what happened." He looked at me quizzically for a second and then saw where my hand was and put it all together. He shook his head, and I smiled again as I pulled the door latch this time, and went off to take care of my patient.

An hour or so later, as we were heading home, I sat quietly in my seat trying to piece the call together in my head for my report. "Hey, Rod." Pat said. I answered and he said "Hold out your right hand" I looked at him funny and complied. "Okay, now hold out your left." I did. "Now put them both on your helmet" he continued. I complied again, wondering where this airborne game of hokey-pokey was going. "Yeah, okay, so what’s the game?" I asked. "No game", he said. "Just wanted to keep them away from the flight controls. You can put them down when we get back on the ground." He smiled broadly and then began to laugh as I brought my hands back down. "I guess I deserved that." I said. "Yeah", he said, "…you did. You damn near gave me a heart attack."

Medical care from the back of a helicopter offers a completely new and interesting set of challenges for the flight medic. All paramedics are detectives. Their job is to service a very complex system, namely someone’s body. They decide based on what they hear, see and feel what’s wrong with said body so said paramedic can figure out how to fix it. While the manufacturers of fancy medical monitors would try to convince you differently, a paramedic’s best tools are eyes, ears and hands. A helicopter is basically an aluminum tool shed with a jet engine strapped to the inside of the roof. It hangs from a set of rotor blades that are never quite completely in balance, which make the ride rather busy. In this environment it is impossible to hear something so subtle as lung sounds, and any attempt to feel for a pulse, or anything else is jammed by the constant shudder of the aircraft. This makes for some very challenging medicine. You can’t hear a blood pressure, you can’t feel a pulse, and if anything goes wrong with the patient you’re hard pressed to figure out what’s happening. With some experience, and the help of some instrumentational wizardry we all managed to prevail, but the environment is not terribly conducive to delicate medical procedures. This added to the overall incredible severity of the injuries of most helicopter patients made for a very challenging job. As much as most paramedics would not like to admit it, though, the most important thing that any paramedic does for a trauma patient, short of correcting a breathing problem or stopping any serious bleeding, is to move them as rapidly as possible in the direction of a surgeon.

Is a man his soul, or the sum of his physical parts? None of the above are true if you’re a trauma patient. If you are a trauma patient, you are a plumbing system with a very serious leak. IV fluid is helpful to some limited extent, but what you truly need is a plumber to stop your leaks. In the trauma business, this man is called a trauma surgeon. Endless studies have shown that if you and your leaky plumbing aren’t lying under the careful hand of a surgeon in less than an hour, your chances of survival are not so good. For this reason, helicopter EMS in rural areas is a hands-down lifesaver. After looking at the research and considering the benefits, one might imagine that a sensible society would place EMS helicopters in every rural area possible. This is sadly not the case. Helicopter programs are breathtakingly expensive. It costs around $800 an hour to run an EMS sized helicopter and that doesn’t include the cost of paying pilots and paramedics to sit and wait for the half day or so between flights. Then there is the problem of their rather shaky source of income. Most of the people who are in serious car accidents are young. The leading cause of death in Americans from 1 to 44 years old is trauma and the vast majority of those deaths are automobile related. Most young people and a great many older people carry $10,000 or so in personal injury protection insurance and little else. It is not at all unheard of for a seriously injured trauma patient’s care to cost upwards of a half a million dollars. This means that the helicopter ride that cost the agency who provided it $1500 or so dollars might get reimbursed a few hundred if they get anything at all. Most helicopter programs are run by hospitals, and nearly all are run at a huge loss. Hospitals engage in this unsound business practice because they get some public relations benefit out of it, and because they know it saves lived. In an odd bit of irony, the areas that need it least, big cities, are the areas that most often have EMS helicopter systems. Only the very large hospitals found in large cities can afford to lose a few million a year on an EMS helicopter, generally speaking. Major cities, in general have more than one hospital that can handle serious trauma, and ground ambulances can usually cover the relatively short distances from big city accident scenes to big city hospitals faster than a helicopter. As a result of this irony many rural areas lack adequate helicopter coverage and many big city helicopter programs find themselves flying to get trauma patients from small rural hospitals after the golden hour has long passed in a futile attempt to un-spill spilt blood. This is not to say that big city helicopters do no good. This is far from the case. They make huge contributions to the lives of people in those cities, and in the communities that surround them. All I’m saying is that more helicopters spread more every across the country would save thousands of lives. What’s the solution? I don’t know. I do know that if you’re an elderly male who’s heart was ravaged by years of high stress office life, like, say a senator, and you need bypass surgery to save your life, the government will pay about $60,000 through Medicare for you to have it. This will on average add two or three years to your life. If you are a 20-year-old who needs $500,000 worth of trauma care, which will typically add another fifty years to your life, you might be out of luck.

The helicopter I worked on was shut down by the sheriff’s department for financial reasons after 9 months of operation, and we were all put out to pasture. Sometimes as I lie in my bed at night I think of Pat the pilot, and the fun we had together and I smile. I also wonder how many more lives we might have saved. How many 25-year-olds didn’t see the other side of the golden hour because we weren’t there? I hope it isn’t many, but my fear is that this is not so.