Copyright 2006 Worcester Telegram & Gazette, Inc.
All Rights Reserved
By ELIZABETH COONEY
Telegram & Gazette (Massachusetts)
WORCESTER, Mass. — Nineteen years ago Life Flight helicopter pilot Jack Loadholt asked nurse Cheryl A. Coyle to come for a ride with him.
She’s been flying ever since, as flight nurse and later medical crew chief aboard the helicopter that has transported more than 23,500 patients across New England from all-too-common accidents on the highway or horrific scenes such as The Station nightclub fire in 2003.
She trained as a surgical nurse at the Medical College of Virginia and draws on her experience in intensive care and emergency to be a flight nurse. Other nurses also have expertise in pediatrics, which helps when they transport children, from critically ill premature babies in isolettes to teenagers strapped onto the helicopter’s stretcher. The common thread is training in critical care medicine, translated to the cramped quarters of a helicopter.
“It’s like working in a miniature ICU or emergency department,” Ms. Coyle said.
Last week she took her first ride in UMass Memorial Medical Center’s new air ambulance, an American Eurocopter EC145 customized and leased from Air Methods Corp. of Colorado. Life Flight’s four pilots and eight flight nurses must be trained on the new aircraft, which will replace an earlier Eurocopter BK117 that has been in service for 20 years.
The blue and white helicopter has more room, makes less noise and operates with more advanced pilot controls, including dual autopilot capability and the option of adding night vision later.
The new model still has that new chopper smell, joked Air Methods pilot Randy Warren.
It also still had one of the many stickers Ms. Coyle papered the interior with, indicating just where vital equipment should go. The air ambulance is fitted out with a heart monitors, intravenous pumps, an electrical defibrillator and equipment for intubation and resuscitation. IV bags for fluids, blood or medications can be hung from the ceiling by shiny carabiner clips, the same kind sold to rock climbers at EMS, Ms. Coyle said.
Behind black mesh in a cabinet between two seats is something of a first: heated towels.
“That’s a nursing thing,” Ms. Coyle said. “When patients are critical, we need to think about what’s comforting for them.”
The medical crew also includes a physician on every flight. Each month a third-year resident trained in emergency medicine is on board, making Life Flight the only program in New England to routinely fly with a doctor. The three crew members — pilot, doctor and nurse — work 12-hours shifts and are dispatched by a communications center at UMass Memorial.
Calls come in from first responders across the region requesting Life Flight assistance. The state Department of Public Health has established trauma triage guidelines for air medical services. They take into account the patient’s condition, road conditions for ambulances, how far away the patient is from a hospital, or, in the case of multiple patients, whether the nearest hospital can handle the number of people who need to be treated. The helicopter has a top speed of 160 miles per hour and a range of more than 400 miles.
The pilot makes the call on whether it is safe to fly, depending on the weather. No information is disclosed about the patient in order to keep that decision unbiased. But the pilot pays attention to the medical crew’s assessment.
“We have a philosophy: It takes three to go and one to say no,” said Mr. Loadholt, who has been flying Life Flight since 1983, one year after the first-in-New-England service began. Like many air ambulance pilots, he has military experience. He was an Army helicopter gunship pilot in Vietnam. One Life Flight pilot is now serving with the Army.
Sometimes the medical crew doesn’t know what kind of case they’ll find until they are in the air. About 70 percent of the time Life Flight transports patients from one hospital to another, using hospital helipads. The rest of the time the helicopter lands on an improvised landing pad, which could be a highway or intersection cordoned off by police or firefighters. Ball fields, farmland or other open spaces can serve, too, as long as the area is about 100-feet-by-100-feet wide. At night they look for flashing fire engine or police car lights when they get near an improvised landing zone. Local fire departments guide them in over the communication system.
Last week Mr. Warren lifted off from the UMass Memorial helipad next to Lake Quinsigamond, bound for Milford Regional Medical Center. The aircraft hummed to life after he, Ms. Coyle and two observers were strapped in.
“Four souls on board,” he told the FAA controller.
The helicopter floated up above its shadow, then zipped away from the medical center, above a crew rowing on the lake below and cars crossing the bridge to and from Shrewsbury. Baseball diamonds and expansive backyards looked like they could be landing pads amid highways and treetops.
Eight minutes later, Milford Regional was in below. Hospital security SUVs blocked the parking lot near the helipad. Pedestrians stopped in their tracks to look up at the helicopter, shading their eyes as the aircraft circled. Before touching down, dust clouds swirled like tornadoes. Blades of grass flattened like startled minnows fleeing underwater.
The ride was gentle on this sunny afternoon, cutting a half-hour or more off what would have been a 40-minute ride on the ground. Mr. Loadholt stayed behind in Worcester, in case the still-operational older helicopter was needed.
“There are days we could keep three helicopters busy,” said Dr. Marc C. Restuccia, medical director of Life Flight and emergency medical services at UMass Memorial. He regrets the cost-cutting loss in 2000 of a second helicopter that served Western Massachusetts, which is now covered by programs in Hartford, Albany and Hanover, N.H.
Medical flight services across New England cooperate, backing one another up when the need arises, he said.
The same can be said for the team inside Life Flight.
“It’s the greatest feeling when it works,” he said. “The bond between the nurses and pilots is especially strong.”
For all the new helicopter’s advances, it’s still a difficult place to work in.
“It’s a cramped environment, you have to remain strapped in, you’re wearing a helmet, there’s all this vibration, and it’s a lot more dangerous,” Dr. Restuccia said. “Inside an ER, you’ve got plenty of help if you need it. Here it’s up to you.”
The mission of Life Flight is to minimize the time an ill or injured patient spends outside the hospital, he pointed out. More heart attack patients are being transported to receive prompt cardiac catheterization.
That speed comes with a price. Just to send the helicopter costs $5,000, plus more once the patient is on board, Dr. Restuccia said. But maybe that patient would spend one less day in ICU, which costs $10,000, he countered.
When the flight nurses are not in the air, they work in the Emergency Department, lending an extra pair of hands when needed. They also teach injury prevention in community programs, work closely with local fire and police departments, and instruct paramedics on clinical issues.
In the air, crew members stay alert to hazards inside and outside the helicopter. The nurse rides up front, next to the pilot, on the way, spotting trouble in the form of wires or other obstructions. When transporting a patient in the back, the nurse assesses whether a family member will be helpful coming along in the helicopter or better off following on the ground.
Ms. Coyle’s 19 years of experience make her cautious as she looks out for her patients.
“We’ve learned to never take anything for granted,” she said.