"That's weird", said Dan, my partner and pilot, "they just scrambled us and told us to crank up and stay where we are." I jumped up off the couch, leaving "The Simpsons" to their own devices and grabbed my flight helmet on the way out the door. I'd been a flight medic for the Marion county sheriff's department for only a few months and had learned that on this job you had two speeds, endless tedium and full speed ahead. We'd just switched gears.

We made our way to our helicopter, a military surplus UH-1H "Huey" helicopter much like the gunships of Vietnam, untying and unplugging this and that as we went, preparing for take-off. The universal prayer of pilots, paramedics and other likewise employed people everywhere came into my head. "Dear lord, please don't let me screw up." As I finished belting myself in the pilot's words came back to me. "That is weird", I thought, "Why didn't they give us a place to fly to?" Just then I got my answer. One of our ambulances came screaming down the ramp, lights blaring in the dark, headed right for us. "Oh, hell", I thought, there coming to us. This meant that I had to very quickly unbelt, disconnect and get out of the helicopter.

Seconds later I opened the back door of the ambulance, heart pounding, anxious beyond belief even after a decade on the streets. Inside was a flurry of activity, four or five paramedics and EMT's from the fire department and local ambulance service were sweating, stretching to reach in, talking in short, hushed sentences over our patient. She looked young, maybe 25, obviously unconscious, a paramedic breathing for her with an ambu bag. He had just, I could tell from the equipment scattered around him, intubated her. "Her compliance is bad", said Scott, the medic rhythmically squeezing the bag. He was having trouble getting air in, not a good sign. I stepped up into the ambulance and took off my helmet. "What's the story?" I asked. One of the fire-fighters piped up; "She was in a small car, just up the road. She went off the road, hit some kind of heavy equipment. They're working on the road. Don't think she had a seatbelt on. We found her in the passenger seat; her cloths were ripped mostly off by the impact. Lots of passenger space invasion got the windshield. She was unconscious when we got there. BP was 70 palp, heart rate's in the 140's. I have a driver's license, her name's Kelly.

"Kelly...is dying." I thought. "What do her lungs sound like?" I asked. Another medic put his stethoscope in his ears and leaned over her. "Diminished on the right, a little gurgly all over". I turned to ask one of the medics for a needle decompression kit and she was holding it out for me. We all knew where we were. Something, probably the jagged end of one of Kelly's newly fractured ribs, had pushed through her tender lung and the hole it created was letting air from her lungs into her chest cavity. This balloon of air, called a tension pneumothorax, had probably mostly compressed her right lung, and in short order would push hard enough to kink closed the great vessels in her chest where they went through her diaphragm. If this happened Kelly's blood would stop circulating, and she would die. There was only one thing to do, pop the balloon.

I opened the kit, pulled out the needle, antiseptic solution and scalpel. "Please lord..." I thought again. I Put my right hand on the center of her chest, found my landmark, "One, Two, second space" I recited. I took the scalpel and made a tiny slit so the very large needle could go through Kelly’s skin unencumbered, then placed the tip of the needle at the slit and applied steady pressure. There was a pop, and the needle began to slide in more easily. I was in. There was no air rush, every book I’ve ever read on the subject says there's supposed to be a whoosh of air, but I knew from doing it half a dozen times already that sometimes there was no whoosh. I waited anxiously. If there was blood rather than air in Kelly's chest, her chances were near zero.

I thought for a minute about Kelly's mother, her boyfriend, her best friend in high school. They were all sleeping now, probably, and didn't know that Kelly's life, and theirs from this day forward, hung at this very moment on a breath, by the thinnest of threads. "Please Lord..." No blood....okay. I attached a flutter valve to the needle's hub to let air out, but keep it from going in, and taped it down. "Lets go", I said. Kelly's second problem, as if the airway problem wasn't enough, was that she was bleeding to death. A person can survive losing roughly half of their blood volume, but no more. Kelly, I could tell from her vitals, had already lost nearly a quarter, and her accident had happened barely ten minutes ago.

I knew from experience that the only thing that could keep Kelly alive now was surgery, and that I couldn't do for her. We needed to be in the air.

A very long minute later we had disentangled the wires and tubes that bound Kelly to the ambulance and transferred her into the helicopter. Sherri, a fire-rescue paramedic, accompanied us. People ask me all the time how I can deal with seeing blood and guts, and my answer is always the same. When there’s blood around I’m usually much too preoccupied to think about how I feel. Kelly needed another IV; I needed to re-check her lungs, I was supposed to restrain her arms and legs so she couldn’t pose a danger to the pilots and three hundred other things that all needed to be done at once. We were in the air, which meant I had 15 minutes at best to do all of this.

Sherri and I began almost automatically to work on the more important of these tasks. She began setting up an IV and I tried to get an idea about how her breathing was going. This is a simple task on the ground; a careful listen to her lungs with a stethoscope and you learned volumes. In the air, under a helmet, two feet away from a 1400 horsepower jet engine running at full speed, lung sounds were impossible. I studied her chest expansion and skin color, and was reaching for an oxygen saturation monitor when it hit me...right in the lip. It took me a second to realize what had happened. It was Kelly. She was waking up, cold, scared, and confused. I smiled, my lip growing larger as I did. "Nice right hook", I thought. Kelly, who until now had been passive in the battle for her life had just picked up a rifle and joined the fight. Restraints, I thought, had just moved considerably higher on the to-do list.

It seemed like scant seconds before we were on the roof of the hospital. A short elevator ride and we brought Kelly into a trauma room alive with nurses, doctors and screaming machines, all anxious for Kelly’s attention. The blood Kelly so badly needed hung, waiting. The surgeon, visibly impatient, was already trying to hurry her to a waiting surgery suite. She was awake now, fear and confusion in her eyes. Sheri and I kneeled in the hall way amongst our discarded equipment, our cloths soaked with sweat, blood smeared on our gloves. We looked at each other and smiled. She was going to live past her twenty-fifth year because today...we didn’t screw up.