This is helicopter
145 November Gulf...
Sentara Healthcare’s air ambulance has been
saving time, and lives, for 35 years. And counting.
THE ROTORS THRUMMED TO LIFE and the blades picked up speed with the thup thup thup of so many movies. The seats shook.Diesel fumes flooded the cabin. “Tail coming right, nose left,” pilot Scott Nance said into his microphone. “Torque looks good.”
Sentara’s Nightingale air ambulance crew had been scanning the weather channel, quizzing one another on the optimal dose for this or that, restocking supplies and checking oxygen levels when the tone sounded.
A woman had suffered a heart attack on Tangier Island, an isolated fishing community in the middle of the Chesapeake Bay. The team scrambled to grab bags, walkie-talkies and medications before making their way to the chopper. They strode through the hospital hallways in their flight suits like astronauts on the way to the launch pad, small children staring in awe.
No one talked as Nance walked through his pre-flight check, his finger touching each switch and warning light before firing up the engines. Flight nurse Maggie McCauley pulled on her helmet and her flotation vest, with its beacons and oxygen tank and survival supplies.
Flight paramedic Joe Gasper walked the perimeter,confirming that the clamshell doors in the back were latched, the van-like sidedoors secured, that no fuel had spilled and nothing was on fire. Their top priority is safety. The patient’s, yes, but also their own.
“Here it’s three to go, one to say ‘No,’ ” Nance said,although really it’s four, because the dispatcher gets to vote, too. If any one of them feels it’s unsafe to fly, they stay grounded.
Gasper gave Nance a thumbs-up and climbed in. Fourteen minutes after the call the chopper took off. Patients and hospital personnel watched and waved from windows, as it cleared the hospital’s construction crane and headed out, all eyes scanning for planes and birds and the military aircraft that troll the river – anything that might endanger the crew or their mission.
“We normally don’t jawjack anywhere we go,” Nance said. “There are crews other places I’ve worked and they take off and they’re talking about what they were doing last night, and they’re not focused on flying.”
THIS YEAR MARKS the Nightingale’s 35th anniversary. Since Ronald Reagan was president, it has taken to the air to save lives, picking people up from scenes or transporting them from one hospital to another – any situation where extra minutes separated life from death.
The crew makes an average of 700 flights a year, the bulk of them in the summer, a time of drownings and neck injuries and auto accidents. This is the fourth chopper owned by Sentara Healthcare and operated by Metro Aviation. The hospital loses more than $1 million a year on the service, according to Dale Gauding, communications adviser. But
the chopper and its crew are not there to make money. They’re part of the hospital’s commitment to save lives.
Bryan Rhodes’, for example. In October his car spun out on a rural road in Isle of Wight County and slammed head-on into another car. The 22-year-old’s injuries included a collapsed lung, internal bleeding and what’s called a hangman’s fracture, high in his neck. His scalp was nearly gone.
Ground transport would have been too slow, too bumpy. Rhodes’ father, himself a paramedic for 30 years, knew exactly what he was hearing when he got the call. He knows the Nightingale saved his boy.
“If they would have ground transported him he wouldn’t have survived, not with the hemothorax,” James Rhodes II said. “Their motto –saving time and saving lives – definitely came into play.”
CALCULATIONS BEGAN once the Nightingale cleared the city. The woman’s chance of recovery was best if they got her to care within 90 minutes, and the clock was ticking.
It’s 60 nautical miles from Tangier to Norfolk General; 51 to Riverside Regional Medical Center in Newport News; 37 to Peninsula Regional Medical Center in Salisbury, Maryland.
“Do they have a cath lab at Peninsula?” asked Gasper.
The best choice for the patient was Salisbury, they decided, as the chopper’s shadow crossed tunnels and bridges, oyster beds and empty cargo ships at sea.
They’ve never had an accident, Nance said, but they’ve trained for it, strapped into a cage that rolled in a pool. They’ve trained to deliver babies, too, even though that would be difficult in the cramped confines of a chopper.
They came in trained – the nurses with a minimum of five years’ experience in intensive care units and emergency rooms, the paramedics from their full-time job with local fire departments and emergency response teams. But still they train and train, sometimes on the common and obvious, sometimes on what they call “high risk and low volume.”
Cricothyrotomy, for example. The crew trains quarterly in how to cut into an airway, a skill that sat dormant for the longest time. Then a 16-year-old boy smashed himself up so badly in an ATV accident that they couldn’t get a tube down his throat. Flight paramedic Scott McClain and flight nurse Lynn Manning performed the procedure.
There is never a day when the crew doesn’t learn. That’s an upside. Down sides are vomit and blood and winter calls at 3 a.m., when the wind blows straight through their clothes.
“But hey,” Nance said, “I get to fly for a living and help folks!”
They’d been in the air for 34 minutes and the island was in sight, the landing zone an air strip, a far easier spot to put the bird down than the muddy farm fields and narrow interstate lanes they’ve settled onto before.
Technically, to land, the helicopter is supposed to have an area 100 feet long and 100 feet wide, but the Nightingale has parked in Sunday traffic on I-64. Nance came in steep over trees and slid over the Jersey barrier into a spot so tight that only one of the ambulance’s sliding doors would open.
On Tangier, the patient waited warm and safe in the island’s only ambulance. Her neighbors stood next to their golf carts, watching. The Nightingale had been here before, for this patient and others, but still it was exciting.
McCauley took off her helmet, pulled her hair back in an alligator clip and slung a 50-pound blue duffel bag over her shoulder, filled with items she might need: intubation tools, pump tubing, laryngoscope, a pediatric blood pressure cuff, an oxygen saturation sensor, tourniquets, a drill, decompression needles.
“There are a lot of things we don’t use all of the time,” she said, “but it would be trouble if we needed them and didn’t have them on us.”
McCauley crossed the airstrip and wedged herself into the back of the ambulance, listening as the island’s paramedic described the case. She placed her hand on the patient’s arm and smiled. The woman stopped crying.
It took 10 minutes to get her into the chopper and take off. On the way to the hospital McCauley turned her attention to the EKG strip smoothed out across her leg. “Your blood pressure is still low,” she said, calling the patient by name. McCauley placed an inflatable sleeve over the IV bag and pumped it up to speed infusion.
When it was nearly empty she signaled to Gasper, who handed her a fresh bag. Words were not needed. The team is so comfortable that simple hand gestures are enough.
In Maryland, Nance landed the chopper so its skids aligned with the helipad’s Hand McCauley and Gasper wheeled the patient into the ER, explaining her condition and accepting her repeated thanks. It had been 80 minutes since the call, two hours since she was stricken. The crew knows that even if they can’t get patients to an ER within “the golden hour,” the difference they make is critical.
Back in the chopper, Nance began flipping switches and checking maps and weather again. “This is helicopter 145 November Gulf …” he said, before lifting off.
BACK AT THEIR OWN PAD the team re-hanged and re-stocked, checking bags and oxygen levels and the charge of the helicopter battery. Their movements were choreographed and efficient.
They spend long hours on standby, performing collateral duties but also hand-feeding squirrels at the launch pad and graciously agreeing to selfies with former patients.
Sometimes the crew makes the trek to the helicopter only to be called off if things aren’t bad enough to need a flight. Each time the heart rates rise.
The goal is always to be ready. Ready to help. Ready to serve. Ready for the tone to sound.
“When I begin not being excited about coming to work it’ll probably be time to let someone else do it, but unfortunately for them I’m still excited,” McCauley said. “I’m not giving this up.”