First In Flight

Area hospitals rescue thousands with helicopters
Story by Christopher Clukey

The journey begins with a rushing noise like a stiff gust of wind being forced through a pipe. From under it comes another sound, an oboe-like bass note that levels off as a loud drone with a high-pitched whine mingled in. The rotors begin to turn, and soon the air is filled with their clatter. It’s been said that helicopters don’t so much fly as beat the air into submission, and that’s what this blue and silver craft seems to be doing. The helipad windsock is stretched by a strong winter wind, but the helicopter rises effortlessly on its own manufactured gust. A few hundred feet up, it hovers, rotates, and with a dip of its nose, picks up speed and departs on its mission.

Aboard is a young woman with a failing heart, tended by a crew dedicated to extending a lifeline of care from Rockford and Madison to hospitals like Freeport Memorial.

Bringing “DUSTOFF” home
Rescue helicopters have a surprisingly long history. The first helicopter rescue was a rescue of three downed airmen by a Sikorsky R-4 helicopter in the highlands of northern Burma in April, 1944. The craft was so under-powered that only one man could be rescued at a time, but the concept showed promise.

By the time of the Korean War, a helicopter evacuation system for wounded troops had been established. Pilots flying the Bell Model 47 (the “fishbowl” helicopter made famous by the M*A*S*H TV series) would transport two wounded troops from an “evac station” near the battlefront to a Mobile Army Surgical Hospital (MASH) a few miles to the rear. By the time of the Vietnam War, the Bell UH-1 “Huey” was the workhorse, flying in and out of combat zones, usually under the callsign “DUSTOFF.” With helicopters and other improvements the military’s medical system had been refined to a point where men with wounds that would have been fatal during World War II were not only saved, but often returned home healthy. Some even finished their combat tours.

The medical personnel who made this network function were at the core of a revolution in emergency medicine in America in the 1960’s and early 1970’s.

“When the physicians and nurses came back from Korea, and also from Vietnam, they saw a completely different system than the one that they had seen in the wars,” says Karen Daub, the newly appointed chief flight nurse at OSF St. Anthony’s Lifeline service. Air transport of patients was almost unheard. Ambulance crews drove slightly modified hearses, had little medical training and almost no lifesaving equipment.

Returning medical veterans realized that the military system could be adapted to civilian use. The Paramedic and Emergency Medical Technician positions were developed so that first responders would offer crucial medical care in the first moments with a victim. Hospital departments, and even whole hospitals, began to specialize in the treatment of trauma.

They also discovered “the golden hour.” The term was coined by Dr. R. Adams Cowley, who studied accident mortality statistics and found that victims who were seen by trauma specialists within an hour of their injury were far more likely to survive. In fact, Cowley found that those patients who took more than an hour were almost certain to die. “It’s quite an abrupt shelf,” says University of Wisconsin Hospitals spokesperson Tim LeMonds, describing graphs of the patient survival rate.

“They saw that it’s ‘out-of-hospital’ time that matters,” says Daub, adding that speed can be even more helpful if the patient is bound for a facility that specializes in treating their particular problem. “If you move quickly and trauma patients are going to a trauma center, pediatric patients are going to a pediatric hospital, cardiac patients are going to a cardiac center…the results can be wonderful.”

Helicopters are a crucial part of the network, especially for hospitals in smaller communities like Freeport.

Working together for specialized care
“We’re certainly doing a lot,” says Denise Brook. Brook is the clinical leader of the Emergency Services Area at Freeport Memorial Hospital, and “a lot” is an understatement. “We had 26,000 patient visits [in the emergency room] in 2005,” she says.

The hospital is served by three regional helicopter ambulance services: Lifeline from OSF St. Anthony, REACT from Rockford Health System and Med Flight from the University of Wisconsin Hospitals, based out of Madison.

Emergency room patients aren’t the only ones who sometimes require helicopter transfer, says Brook. Patients requiring advanced neurological care, open heart surgery or pediatric/neonatal intensive care are often transferred to Rockford hospitals, as are many mothers who are having premature birth or other drastic birth problems. Some infectious disease cases and patients requiring microsurgery to save a limb are sent to Madison. Transfers to Madison also occur if burn and neuro wards in Rockford are full. All three health systems maintain Level 1 trauma centers. To qualify as a Level 1 facility, the hospital must have surgical teams on duty around the clock.

“It’s very rare for them to come here directly from an accident scene,” Brook says. “they have to take weather into account, but if they respond to an accident they usually take the patient right to Rockford. When they’re responding to an emergency they can give the [first responders] at the scene an ETA and they can make decisions based on that. Sometimes they meet ambulances here if that will speed things up.”

Brook notes that St. Anthony’s is the “resource hospital” for the Freeport Health Network in the state’s trauma network. This means that St. Anthony’s assists FHN with continuing education and training in emergency issues as well as providing the radio equipment that they use to contact the rescue helicopters. “The trauma system here in Illinois is one of the oldest and most advanced in the country,” she says. Freeport has been part of the helicopter network from the time it was implemented. Brook recalls that before the wing housing her department was built, the hospital’s helipad was in a space that is now used for parking. Helicopters would also set down in Bidwell Park across Lincoln Boulevard from the hospital.

“What’s nice about this system is the good relationships and communications,” she says. The system allows local patients access to ultra-specialized care that even the best community hospitals can’t provide.

Ronald Meadors, the Emergency Services Manager at Rockford Health System (RHS), agrees. “You have a very good community hospital there,” he says, “but tertiary care requires a different system.” Primary care is the care you receive from when you first enter the system, either with your doctor or a first responder. Secondary care requires more specialized skills or equipment, and is usually provided by a hospital or specialist. Tertiary care is highly specialized care such as that provided by trauma centers, cardiac hospitals and neonatal intensive care units.

The flights and the fliers
The three services have similar missions, but they approach them with differing equipment and techniques.

According to Meadors, REACT has been operating since September 1987 and transported about 1,000 patients in 2005, with 176 transfers out of Freeport Memorial. Meadors notes that the service uses a rear-loaded helicopter (the MBB BK-117) and they often load an advanced isolette and an augmented flight crew with a respiratory therapist and a neonatal nurse to provide advanced care for premature infants. Normally the craft flies with a three person crew: Pilot, trauma nurse and paramedic. REACT owns their helicopters rather than leasing them, Meadors says, because of the reduced cost. “We try to keep costs down for the patient, and sometimes we’ll use a ground ambulance instead of a helicopter for just that reason.”

Madison’s Med Flight has two helicopters in service at all times, with a third for training and backup. While most services use a crew with a flight nurse and paramedic, the Med Flight teams have a nurse and an ER physician. Med Flight spokesperson Tim Le Monds says it is “a big financial commitment” to have doctors on the flight crews, but that it is worth the cost. He cited a recent case where a woman was being transferred for cardiac trouble, and the doctor was able to diagnose the problem while en route. Instead of being seen by a doctor in the ER, she was routed straight to cardiac surgery. “She was minutes from death, and she wasn’t bogged down [in another department]…time is critical.” Med Flight, Le Monds says, is one of only three services in the nation that uses flight physicians.

Karen Daub agreed that the physician approach works for Med Flight, possibly because their coverage area is more rural than the area covered by most EMS helicopters. She noted that studies show that flight teams with a paramedic and nurse have a clear advantage in patient survival.

Daub says she became interested in flight nursing when she was in high school, working as a unit desk clerk at the emergency room in Rochelle, often with just one nurse on duty. It was common for them to call helicopters in for transfers. “It looked like exactly the sort of thing I wanted to do,” she says. Her interests run in the family; Daub’s mother was an ER nurse there.

Daub prepared for flight nursing by serving as an ER “nurse extern” at St. Anthony’s during her final year of nursing school, followed by three years of ICU experience, several years of service in the emergency room and study for extra certifications.

On a typical day, she says, the crew does a preflight inspection on their Bell Model 222 helicopter and inventories their equipment and medical supplies. They then receive a crew briefing on weather conditions and planned missions. In some weather (what is called “condition yellow”) they must re-check the details of the weather every time they lift off. Then the team moves on to other daily duties while they are on-call between flights. Not surprisingly, they do a lot of paperwork. This includes following up on the care results of every patient they transport. They also provide lectures and training for EMS and hospital personnel so that the system is as helpful to those local caregivers as possible.

Daub says that TV viewers who’ve seen the interior of Donald Trump’s helicopter have a good idea of what her “office” is like. “It’s based on a corporate transport, so it has a similar [general] layout. The cabin has good noise isolation.” The equipment and crew, she says, transforms it from an expensive passenger model to “a flying ER and ICU.”

“But you’re not allowed to give birth while you’re flying with me,” she jokes. “That’s a rule.”

Le Monds echoes Daub’s assessment of the helicopters as “flying ERs.” “Our mission,” he says, is to bring the ER to the patient, instead of the other way around.”

“We’re ready to fly anytime,” Daub says, “and we’ll take the patient wherever they need to go.”