The day that stands out the most in the professional life of flight paramedic Kevin Robert of Mechanicville began with a flight to northern Vermont to transport a teenager critically injured in an automobile accident. Once he delivered her to a trauma center, he was on his way to a plane crash in Great Barrington, Mass., where he helped transport survivors to Albany Medical Center. From there, he boarded the helicopter once again to head to the scene of an accident near Newburgh, where a patient with a critical head injury needed to be transported rapidly to Westchester Medical Center.
All in a day’s work. “It was an exhausting, draining day,” said Robert, who works as a flight paramedic for LifeNet of New York.
The exhaustion, though, is welcomed by the men and women who staff the emergency medical helicopters in the Capital Region, because they know that their service might mean the difference between life and death for the patients who end up onboard.
“It’s an odd kind of fatigue from the physical and mental drain,” said Colonie flight paramedic Oscar LaRosa. But you get the feeling he wouldn’t have it be any different.
Two entities in the Capital Region provide medevac services. One is Lifeguard Air Rescue, a collaborative effort between the New York State Police and the town of Colonie Emergency Medical Services Department that began in April 1993. The town provides 20 flight paramedics and the state police provide the helicopters and the pilots, a mix of state troopers and state Department of Environmental Conservation civilian pilots.
The other is LifeNet of New York, a subsidiary of Air Methods Corp., based at Albany Medical Center. LifeNet, which provides services to the 25 counties in the medical center’s service area, celebrates its 15th anniversary this month. It began service with helicopters landing three blocks from the hospital at Notre Dame Drive. In April 2000, AMC, a level one trauma center, built a helipad on top of the eight-story patient tower, reducing the time from helicopter to the emergency department by as much as 12 minutes. Today, LifeNet uses an American Eurocopter EC-135 helicopter.
LifeNet also operates a medevac helicopter from the town of Glen in Montgomery County.
Helicopters, which were used widely for medical services beginning with the military in the Korean War and later made their way into civilian service in the 1970s, are now a critical part of the health-care system because they allow for a dramatic decrease in the time from injury to hospital. In medical circles, providers talk about the “golden hour” or the “magic hour.” If a patient can get care within the first hour of injury, chances of survival increase exponentially.
One reason that paramedics and nurses choose to work for medevac services is the professional challenge. Their responsibilities increase in the air, and the level of care they are able to provide is greater. “Being a flight medic is more challenging than being a paramedic on the street,” said Robert, who has been working as a flight paramedic for 10 years.
“We get to do so much more, and the responsibility is a lot more,” said Kelly Callaghan, a flight nurse and medical base supervisor for LifeNet. Callaghan, a flight nurse for six years, worked as an intensive care unit nurse for 20 years before becoming a flight nurse.
Ground work first
Working on the ground for several years prior to taking flight is essential. “You have to be at the top of your game and very knowledgeable at your skills in taking care of critical patients,” said Mary Pat Provost, a Colonie flight paramedic who worked as a ground paramedic for seven years before doing medevac flights.
“You need that stuff to already have become second nature to you so you can get used to working in those different environments with different agencies — that added level of challenge.”
There is increased responsibility on medevac flights, combined with more difficult conditions. The quarters in a medevac helicopter, which is a certified ambulance, are cramped. Provost describes the helicopter as “a tiny, little mini-version of our regular ambulance.”
The state police aircraft used for Lifeguard’s missions is a Bell 430 utility helicopter outfitted with a removable “pedestal” that has the medical equipment and monitors that the two flight paramedics on board use.
In LifeNet’s helicopters, there is the pilot and the medical crew, always a combination of a flight paramedic and flight nurse, plus the patient and sometimes an orientee riding along as part of his or her training. “It’s tight in the back of the helicopter,” Callaghan said.
Robert said that getting used to the close quarters can be difficult, at first. “You know your space constraints and you get used to them. There’s nothing that we have to do for a patient that we can’t get done in the aircraft.”
Another difficulty is the nature of the helicopter itself: the vibration and the noise.
Weather is also a huge factor in the ability to make flights. “Sometimes it’s rough,” Provost said. “It’s windy or humid or there are storms in the area, sometimes you get a little bit of a bouncy ride.” Sometimes the weather conditions could change in the middle of a mission. Bad weather, such as freezing rain, could prevent a flight altogether. Flying at night with night vision goggles adds an extra element of danger.
The pilot and the medical crew work together to ensure safe flights. “The flight paramedics help us out immensely,” said Sgt. Donald Dorn, station supervisor for the State Police Aviation Unit at Albany International Airport, noting that they’ll frequently program the GPS and be on the lookout for wires and other impediments to landing. “They’re an integral part of our flight crew,” he said.
Medevac pilots and personnel work collaboratively with emergency services personnel on the ground. The flights need a space at least 100-by-100 feet to land, with a minimum of wires, poles and unsecured items. “We give off a lot of rotor wash,” Provost explained, noting that the wind produced by the helicopter will move lightweight objects on the ground that are not secured.
“We do a lot of education with the local fire departments,” Callaghan said. As a result, they do a great job of locating sites where the flights can land safely.
However, landing conditions are often unknown, requiring adaptability on the part of pilots and crews.
“From the pilots’ point of view, the most challenging thing about medevac is going into places you’ve never been, and you don’t know exactly what you’re flying into. It could be nighttime, low visibility — just the uncertainty of what you’re going into,” Dorn said.
There is uncertainty, too, for the medical personnel who will exit the helicopter to care for the patient once it has landed. Last winter, Provost staffed a flight that had to land in a snow-covered field.
“My partner and I had to hike with our stretcher in 2 feet of snow to the road where the patient was,” she said. Another time, she had to hike one mile down to a patient injured at the bottom of a waterfall in the Plotterkill Preserve in the town of Rotterdam.
Robert remembers one day so cold that a patient’s IV lines froze during the transport from ambulance to helicopter.
“The most challenging part of the job is the conditions that you find yourself in,” Provost said, noting that each flight generally presents a new challenge.
LifeNet, formerly known as Med Flight, and Lifeguard Air Rescue work together to provide a high level of acute care for Capital Region residents as well as those in neighboring counties and states.
Their services complement one another. They work collaboratively to provide trauma care, with one responding to trauma calls on odd days and the other on even.
Then there are unique services that each provides. LifeNet transports patients between facilities, for example, a premature infant who needs to come to AMC’s Neonatal Intensive Care Unit. Lifeguard performs rescue missions, such as retrieving an injured hiker. Hoists on its helicopter allow for stretchers and personnel to be lowered and lifted back up to the helicopter. LifeNet is available 24 hours a day, while Lifeguard operates from 7 a.m. to 11 p.m. seven days a week.
Air ambulance crews care for the most critically ill and injured patients, often providing care above and beyond what can be done by personnel on the ground. For example, they might perform a rapid sequence intubation or an emergency escharotomy for a burn patient. They can also administer more advanced medications.
“We’re not just a fast ride,” Robert said. “A lot of people unfortunately have that impression. We provide a very high level of care. It’s a critical care service, and we can do a lot for a patient that ground services are not able to provide.”
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