Helicopter lifeline

The alphanumeric phrase on the tail of Enloe FlightCare’s helicopter reads “N922RJ,” shining white on the aircraft’s ink-blue paint like clouds set against a dusky sky. To most, it looks like a random jumble, holding no more significance than a DMV-assigned license plate, but to the 17-member-strong Enloe Medical Center FlightCare team it is a tribute, a warning and a constant reminder.

On Sept. 22 (9/22), 2001, FlightCare pilot Ron Jones (R.J. to his friends) was killed and two nurses injured when the helicopter they were flying in crashed while responding to an auto accident in nearby Butte Meadows. The crash was no fault of the pilot or the craft—dust and dirt churned up by the copter’s blades created a “brownout” condition, and the aircraft hit a tree while Jones was trying to pull out.

“We have his picture all over the place and we named our aircraft after him,” said FlightCare head pilot Marty Marshall, who has been with the program since its inception in 1985. “We do it to honor him, but it’s also to remind us we work in a very unforgiving environment. We were extremely safety-conscious before the crash, and even more so now.”

Indeed, Enloe’s FlightCare program has been an industry innovator since takeoff, and in October was honored with its second three-year accreditation by the Commission on Accreditation of Medical Transport Systems (CAMTS). FlightCare is one of only six CAMTS-accredited air-ambulance services in California.

“CAMTS’ entire focus is on performance improvement, quality assurance, safety and best practices,” said Marshall.

Additionally, FlightCare recently won two awards from Aviation Specialties Unlimited and helicopter-industry publication Vertical Magazine—a 10-Year Service Award and a Community Awareness Award, the latter for pioneering the use of night-vision goggles to enhance safety.

FlightCare has been using night-vision goggles since 2001: “Thankfully it’s not a rarity anymore, but when we started we were the second to start using them,” Marshall said. “When we started … we took every opportunity to talk them up. Some of us attended industry conferences to talk to program directors—we just started preaching the gospel.” Now, he said, night-vision goggles are the standard.

Marshall and chief flight nurse Judy Cline, herself a 13-year FlightCare veteran and 24-year Enloe employee, agree that the value of the goggles—which magnify ambient light and are the same as those used by the military—cannot be understated.

“It’s very scary up there at night,” Marshall said. “It’s so black that for all practical purposes you don’t have visual references. The goggles take the dark out of the night, and a lot of the stress out, so you can concentrate on taking care of the patient and not worry about hitting birds or ducks. Not to mention trying to go into the landing zones we get put into. There’s some scary places that make your knees shake.”

“They’ve changed everything, from how we feel about flying at night to how effective we can be,” said Cline. “You can see aircraft 300 or more miles away.”

“The sky is constantly full of shooting stars—it’s amazing, but can be awfully distracting,” added Marshall. “If there’s a full moon, it can blind you.”

To maximize sight and safety, two members of the three-person flight crew—pilot, nurse and paramedic—wear the goggles on night flights, while the third scans the normal visible spectrum. Even this shared responsibility is an innovation. “Sharing the workload between medical staff and pilot is a newer concept that has become industry-standard,” Marshall said. “Using the medical crew as an extra set of eyes allows us to do a lot more, like land at much higher landing zones.”

The Eurocopter AStar 350 B2 helicopter used by Enloe is more than just an air ambulance—it’s also a flying emergency room. “The interior of our very small little aircraft is just like an intensive-care unit,” said Cline. “We have all the equipment you’d find there for life support and monitoring, just miniaturized.

“One of the most critical skills we provide is advanced airway management,” she continued. “If someone is not breathing well and needs assistance, we carry medications that would normally only be given by an anesthesiologist or E.R. doctor. We carry equipment that would normally only be used by an E.R. doctor or trauma surgeon, and are able to perform advanced life-saving procedures.”

Among the aircraft’s more recent accessories is a GlideScope, acquired in 2008. The GlideScope is a fiberoptic camera device that allows for easier intubations (the insertion of a tube to help a patient breathe).

On the flight side of things, 2009 saw the addition of traffic-collision-avoidance software and hardware. “If we’re flying around, any aircraft in our vicinity with a transponder will tell us where it is and how close it is,” Marshall explained. “Even though you’re trained from the time you start flying to constantly scan for aircraft, it’s amazing the things we pick up now that we could have never known were there before.”

Even with the best equipment, risks abound when flying rescue missions in the largely mountainous North State areas that FlightCare serves. Cline and Marshall concur that every flight is an adventure.

“Almost every patient the medical staff takes care of is the sickest of the sick—they don’t transport patients by aircraft unless they’re seriously ill,” Marshall said. “So there’s no respite for [staff]; they have to be ‘on it’ 100 percent of the time. And these are uncontrolled situations, not like in the O.R. or E.R. where you have all these people that are helping and you get great lighting conditions. These guys are down in the dark and the mud and the rain.”

“Emergency medicine in general tends to draw people that like to perform under pressure and can think on their feet quickly,” offered Cline. “Our stress is not typically what people think it is—caring for the patient. [Rather,] it’s more that we’re flying around with other aircraft in the sky, listening to multiple radio traffic trying to discern what’s what.

“The patient-care aspect is second nature for us because we’ve all been doing that work for so long before we’re eligible to get on a helicopter.”

Enloe Medical Center’s FlightCare program has braved the skies to save lives for more than a quarter-century

The alphanumeric phrase on the tail of Enloe FlightCare’s helicopter reads “N922RJ,” shining white on the aircraft’s ink-blue paint like clouds set against a dusky sky. To most, it looks like a random jumble, holding no more significance than a DMV-assigned license plate, but to the 17-member-strong Enloe Medical Center FlightCare team it is a tribute, a warning and a constant reminder.

On Sept. 22 (9/22), 2001, FlightCare pilot Ron Jones (R.J. to his friends) was killed and two nurses injured when the helicopter they were flying in crashed while responding to an auto accident in nearby Butte Meadows. The crash was no fault of the pilot or the craft—dust and dirt churned up by the copter’s blades created a “brownout” condition, and the aircraft hit a tree while Jones was trying to pull out.

“We have his picture all over the place, and we named our aircraft after him,” said FlightCare head pilot Marty Marshall, who has been with the program since its inception in 1985. “We do it to honor him, but it’s also to remind us we work in a very unforgiving environment. We were extremely safety-conscious before the crash, and even more so now.”

Indeed, Enloe’s FlightCare program has been an industry innovator since takeoff, and in October was honored with its second three-year accreditation by the Commission on Accreditation of Medical Transport Systems (CAMTS). FlightCare is one of only six CAMTS-accredited air-ambulance services in California.

“CAMTS’ entire focus is on performance improvement, quality assurance, safety and best practices,” said Marshall.

Additionally, FlightCare recently won two awards from Aviation Specialties Unlimited and helicopter-industry publication Vertical Magazine—a 10-Year Service Award and a Community Awareness Award, the latter for pioneering the use of night-vision goggles to enhance safety.

FlightCare has been using night-vision goggles since 2001: “Thankfully it’s not a rarity anymore, but when we started we were the second to start using them,” Marshall said. “When we started … we took every opportunity to talk them up. Some of us attended industry conferences to talk to program directors—we just started preaching the gospel.” Now, he said, night-vision goggles are the standard.

Marshall and chief flight nurse Judy Cline, herself a 13-year FlightCare veteran and 24-year Enloe employee, agree that the value of the goggles—which magnify ambient light and are the same as those used by the military—cannot be understated.

“It’s very scary up there at night,” Marshall said. “It’s so black that for all practical purposes you don’t have visual references. The goggles take the dark out of the night, and a lot of the stress out, so you can concentrate on taking care of the patient and not worry about hitting birds or ducks. Not to mention trying to go into the landing zones we get put into. There’s some scary places that make your knees shake.”

“They’ve changed everything, from how we feel about flying at night to how effective we can be,” said Cline. “You can see aircraft 300 or more miles away.”

“The sky is constantly full of shooting stars—it’s amazing, but can be awfully distracting,” added Marshall. “If there’s a full moon, it can blind you.”

To maximize sight and safety, two members of the three-person flight crew—pilot, nurse and paramedic—wear the goggles on night flights, while the third scans the normal visible spectrum. Even this shared responsibility is an innovation. “Sharing the workload between medical staff and pilot is a newer concept that has become industry-standard,” Marshall said. “Using the medical crew as an extra set of eyes allows us to do a lot more, like land at much higher landing zones.”

The Eurocopter AStar 350 B2 helicopter used by Enloe is more than just an air ambulance—it’s also a flying emergency room. “The interior of our very small little aircraft is just like an intensive-care unit,” said Cline. “We have all the equipment you’d find there for life support and monitoring, just miniaturized.

“One of the most critical skills we provide is advanced airway management,” she continued. “If someone is not breathing well and needs assistance, we carry medications that would normally only be given by an anesthesiologist or E.R. doctor. We carry equipment that would normally only be used by an E.R. doctor or trauma surgeon, and are able to perform advanced life-saving procedures.”

Among the aircraft’s more recent accessories is a GlideScope, acquired in 2008. The GlideScope is a fiberoptic camera device that allows for easier intubations (the insertion of a tube to help a patient breathe).

On the flight side of things, 2009 saw the addition of traffic-collision-avoidance software and hardware. “If we’re flying around, any aircraft in our vicinity with a transponder will tell us where it is and how close it is,” Marshall explained. “Even though you’re trained from the time you start flying to constantly scan for aircraft, it’s amazing the things we pick up now that we could have never known were there before.”

Even with the best equipment, risks abound when flying rescue missions in the largely mountainous North State areas that FlightCare serves. Cline and Marshall concur that every flight is an adventure.

“Almost every patient the medical staff takes care of is the sickest of the sick—they don’t transport patients by aircraft unless they’re seriously ill,” Marshall said. “So there’s no respite for [staff]; they have to be ‘on it’ 100 percent of the time. And these are uncontrolled situations, not like in the O.R. or E.R., where you have all these people who are helping and you get great lighting conditions. These guys are down in the dark and the mud and the rain.”

“Emergency medicine in general tends to draw people that like to perform under pressure and can think on their feet quickly,” offered Cline. “Our stress is not typically what people think it is—caring for the patient. [Rather,] it’s more that we’re flying around with other aircraft in the sky, listening to multiple radio traffic trying to discern what’s what.

“The patient-care aspect is second nature for us because we’ve all been doing that work for so long before we’re eligible to get on a helicopter.”