Ambulance of the sky

If things go extra badly for you and you need a fast ride to a Portland or Eugene hospital, chances are you’ll end up riding a REACH Air Medical Services helicopter.

The company is one of three quickly available to Sweet Home Fire and Ambulance District, and REACH’s base in Corvallis is the closest. Other companies that serve the area are Lifeflight and Airlife.

SHFAD turns to REACH and other air ambulance services whenever the helicopter can get to a trauma facility faster than a ground ambulance €“ in the Green Peter area or beyond milepost 60 on Highway 20 for example. Those are areas where transport time on the ground would be excessive with a life-threatening trauma, SHFAD Fire Chief Mike Beaver said.

They provide patients the chance to reach a hospital during what’s called “the Golden Hour,” he said.

“From the time we arrive on the scene till the patient’s at the hospital, if people get to the facility within the Golden Hour, their odds of a good outcome increase considerably.”

The air ambulances are equipped to deal with patients who are more seriously injured, carrying blood on board, for example, he said. Staffing includes a paramedic and a nurse.

REACH and other air ambulances are not used to simply supplement ground ambulance services, Beaver said.

“It’s for the rare occurrence when we need to get someone there very quickly.”

When the logging industry was bigger around Sweet Home, Beaver said, it would often take an hour or two to get to an accident site. Then someone would have to go down one or two thousand feet and bring the patient back up. The helicopters were especially useful then.

Most times an air ambulance is called in it’s because of a trauma, he said. The numbers are inconsistent, but he estimates that SHFAD calls for a helicopter six to 12 times a year.

It may be none or once a month, he said, or sometimes, it might be three times in a month.

SHFAD maintains a good working relationship with REACH, he said. REACH has involved itself in local community events, such as the mock crash for high school students at Husky Field in May and the Safety Fair in June.

“They also come on our drill night so we get to know their people, their capabilities and what they expect,” Beaver said.

Because of REACH’s proximity, the company can be in Sweet Home in phenomenally quick times.

There have been times that SHFAD has called and REACH has been in Sweet Home in less than 10 minutes, he said.

REACH’s Corvallis base is one of 10, most of them in California, said Base Manager David Brown. The company has been in Corvallis for three years.

The base has one helicopter, an Augusta A-109.

“It’s actually the fastest of the HEMS (helicopter emergency medical services) helicopters,” Brown said. The Italian-made helicopter is capable of reaching 190 mph but usually flies at about 163 mph.

The chopper uses landing gear taken from French Mirage fighter planes, he noted.

A crew of three rides in the helicopter €“ the pilot, a paramedic and a nurse. The patient rides on the left side, occupying the rear and the area where the left-side pilot would sit.

The helicopter can carry a patient and one rider, Brown said, but it rarely takes a rider. Decisions are based on weight. If there is a rider, it’s usually the parent of a pediatric patient.

Weight is the reason the helicopter is kept only 70 percent fueled, Brown said. That allows them to take a larger patient. With a light clinical crew, the helicopter can carry a 360-pound patient.

If called on a longer run, to the coast for example, the helicopter can be fueled quickly, Brown said.

REACH serves primarily the Willamette Valley and the coast, from Reedsport to Astoria. To the east, REACH has responded to the Highway 20-Highway 226 Junction, Redmond and Mt. Bachelor.

Calls are primarily for hospital transfers and trauma scenes.

The crews work 24-hour shifts, said Jan Acebo, the base outreach coordinator. The base has 19 staff members, including 10 clinical staff members, two mechanics, four full-time pilots and three administrative staff members. Brown runs the base operations. Acebo works with medical services and hospitals.

Administrators work typical day shifts. Pilots work 12-hour shifts, seven days on and seven days off. Medics work 24-hour shifts in four groups, 24 hours on, 24 hours off, 24 hours and then five days off, working a total of 7.3 shifts per month.

The flight nurses and flight medics are pretty much synonymous, Acebo said.

“They both do the same job, and we have the same expectations of both,” Brown said. Having the flight nurse on board technically provides a critical nursing component.

Together, it’s a similar concept to having an emergency doctor and trauma surgeon rolled into one, Brown said. “Individually, you’re not as strong apart as you are together.”

The paramedics all have at least five years of ground experience, Brown said. They are all certified paramedics in Oregon.

Some of the nurses come from out of state, but most are from Oregon. With the types of shifts they work, they live all over.

The nurses come from emergency departments at hospitals, Brown said, while the medics come from the ground systems.

Two of the four pilots and the mechanics live in the area, Brown said. One of the other pilots commutes by plane from Roseburg and the other commutes from Portland.

Most often, the pilots have a military background, Acebo said.

One-third have a civilian background.

“All of our pilots have said they wouldn’t do anything other than EMS,” Acebo said.

Personnel are usually highly tenured, Brown said, although some turnover comes based on family choices.

The Corvallis base receives about one call a day, Brown said. “When we’re called, it’s someone who really needs us.”

Both he and Acebo worked in the ground ambulance service before going to work for REACH.

“Ninety percent of the time, calls were boredom with 10 percent excitement,” Brown said of working on the ground. “It’s the opposite of that for us.”

Almost always, in the air ambulance service, the crews are carrying a patient from the scene in critical condition, Brown said, and they can make a difference on almost every call.

“I have a huge appreciation for what our EMS providers do,” Brown said. “They’re the gatekeepers for our system. We have tremendous respect for that. They do their jobs.”

When he was in the ground service, in that 10 percent, “I know I saved that person’s life,” he said. To bring someone back from cardiac arrest is to bring them back from death.

That’s the satisfaction in the job, and the ground medics do the job well, he said.

It’s a tough job, especially in smaller communities, Acebo said, and REACH is there to help them.

“We are part of their system, not the other way around,” Acebo said. “They know when something would exceed their ability to provide service.”

The helicopter may be the first on scene, but that’s rare, Brown said.

Generally, Acebo said, the ground crew arrives first and may call for an air ambulance. When the helicopter arrives, the crew may get into the ambulance to examine the patient and receive a report from the ground crew. Then the crews will typically carry the patient to the helicopter.

EMS providers have the REACH phone number, but normally, they contact 9-1-1 centers, which contact REACH. The process works through the Public Safety Answering Point system by law.

The law does allow REACH to be contacted directly for logging accidents, which are usually remote, Brown said. REACH still coordinates those through the PSAP.

“Really, we’re the only ones that get to those places in a timely manner,” Brown said. Maps are often out of date regarding logging roads. The helicopter is not troubled by this, so direct access to the air ambulance service is critical to the logging industry.

Dealing with intense trauma constantly requires crew members to maintain a calm detachment, avoiding subjectivity, Brown said. They need to process information and apply the science to the situation.

They certainly care about their patients, he said. Saving lives is why they do the job.

“But you have to detach,” he said. “They care so passionately, they have to maintain that objectivity. The pilots are doing the same thing. They’re piloting. When something happens, the first thing they do is fly the plane.

“It’s a fun job, and it’s very rewarding. Saving a life is one of the most rewarding things you’ll ever do in your life.”

Flight nurse Kenny Nealy came to REACH from intensive care and emergency care out of the Swedish Medical Center in Seattle. He holds a degree in nursing.

“I’ve wanted to fly since I was old enough to remember,” Nealy said.

He has worked for REACH since 2006 when the Corvallis base opened.

Alan Sisson, 43, is the lead pilot at Corvallis.

“I’ve always wanted to fly helicopters,” he said. “This is the best job I’ve ever had. You work with professional people and help others.”

He has been flying for 20 years, he said. He did a variety of jobs for nine years so he could fly an air ambulance for the past 11.

The pilot pool used to be dominated by Vietnam-era fliers, and it’s more civilian than it used to be, he said. The service still gets quite a few pilots from the Coast Guard and veterans of Desert Storm.

They are passionate about what they do, both the flying and the medical work.

“You’ve got to love what you do,” Sisson said.

And it’s just as interesting for the medics, Brown said. “They know they’re saving lives by doing what they’re doing.”

For Sisson, it’s a challenge. He recalled seeing a Coast Guard helicopter with pontoons land on Loon Lake when he was a kid, he said. He was able to try it himself later, landing the helicopter on a bike path up against a tree line, slipping in among boats and tents.

“We love being here and serving the Mid-Willamette Valley,” Sisson said.