A few hours ago Kenneth Heerdt had a heart attack. Now, with a weak pulse and a headache, he is strapped to a stretcher in the rear compartment of a helicopter 2,500 feet above the subdivisions and open fields of outer Du Page County.
Even so, the 47-year old accountant from Lemont is enjoying his ride to Loyola Medical Center in Maywood from a hospital in Grundy County, southwest of Joliet. ”Kenneth wants you to know he likes your flying,” flight nurse Maureen McSharry tells pilot Carlton LeJeune over the headset.
”Thank him for me,” says LeJeune, who adds that due to a solid tailwind ”our speed is 150 knots (about 172 miles an hour.) We`re smoking. We`ll be home in seven minutes.”
”Not bad,” says Heerdt into his headset. ”That`s about as fast as I drive.”
That Heerdt can joke up here makes him a rare patient on Loyola`s Lifestar helicopter. For the people transported aboard this craft are the sickest or most catastrophically injured.
Typically, not only don`t they trade small talk; they`re so incapacitated that later they can`t even remember flying. That`s if they survive to recall anything at all.
For many acutely ill or injured patients, the odds of survival have improved because of Lifestar and the hundreds of other helicopters serving hospitals across the nation. Loyola, for instance, credits its Lifestar helicopter with directly saving as many as 90 lives that might have otherwise been lost.
Lifestar is a descendant of the helicopters that ferried grieviously wounded troops to field hospitals in Korea, as portrayed in ”M+A+S+H,” the popular 1970s film and television series, and in Vietnam. It was in the early 1970s that a few helicopters began routinely setting down on civilian hospital pads. Now about 180 hospitals nationwide have their own helicopter ambulance programs.
Lifestar, started about 16 months ago, is a newer program. It`s one of two hospital helicopters in the Chicago area; the other serves the University of Chicago Medical Center.
Since its maiden flight, the $2.5 million, two-engine, German-made Lifestar helicopter and its crews-the S.W.A.T. teams of medicine-have flown better than 550 missions. They`ve plucked victims from accident scenes and brought critically ill patients like Heerdt into Loyola from other hospitals not as well equipped to treat them.
Trauma experts talk of ”the golden hour.” Get a patient to high-level care or bring such aid to the injured within 60 minutes of an accident and modern medicine has a good shot of saving life and limb.
The American College of Surgeons sets 20 minutes as the outside limit for how long it should take an ambulance to speed a patient from an accident scene to the hospital. In Chicago, even with Michael Reese Hospital exiting the city`s trauma network Feb. 17, an accident victim is still usually no more than 20 minutes by ambulance from the remaining six trauma hospitals, say experts, unless there`s a traffic snafu. ”Cities don`t justify helicopters but suburban and rural areas do,” says Dr. Wendy Marshall, in her soft British accent. She`s Loyola Lifestar`s medical director, a nationally respected trauma surgeon. ”There`s no reason in this day and age for anyone to die at an outlying hospital for lack of proper care.”
Marshall is the surgeon who made headlines last year when she saved the life of a Joliet gunshot victim by using her fingers to temporarily plug the holes in his heart during the flight to Loyola.
No city flights
Loyola is the only top-level trauma hospital covering a region of nearly two million people: suburban portions of Cook, all of DuPage and much of Kane and Will counties. Lifestar can get from a point in this area to Loyola at least two to three times faster than an ambulance.
But the helicopter isn`t limited to those places, having flown into Wisconsin, Michigan and Indiana. Surprisingly, as a rule Lifestar doesn`t make emergency flights into Chicago.
”It`s a politics thing,” says Connie Schneider, Lifestar`s aeromedical director who`s also a nurse. The Chicago Fire Department, which has two helicopters it can use for medical trasport, protects its turf, Loyola officials say.
But ”they`re not true medical helicopters,” says Schneider. For its part, the fire department says its policy as a public agency is not to use private helicopters.
Lifestar is truly a medical helicopter. It`s a state-of-the-art, flying-albeit cramped-emergency room. It can hold two patients and normally has a crew of three: a paramedic, a nurse and pilot.
Within its six-by-four foot cabin, Lifestar contains much of the same equipment found on the best ground ambulances with advanced life support systems. But unlike ground ambulances, it has sophisticated cardiac monitors rarely found outside hospitals.
Lifestar`s most important feature is its staff of 29 nurses and paramedics, each with at least nine years medical experience before being selected for the program. Each received three rigorous months of training in airborne emergency medicine and helicopter safety.
So they have more specialized training than the typical nurse or paramedic. (The University of Chicago program always sends a physician aloft but Loyola says the national trend is toward well-trained nurses and paramedics.)
Because of the Lifestar staff`s training, the helicopter carries a broad armamentarium of drugs usually not found outside pharmacies. Thus the crew can perform life-saving procedures not normally done in ambulances.
Bizarre rescue
One evening last October, for instance, Arthur Mutton`s car spun out of control, flipped over near the intersection of Roosevelt and York roads in Elmhurst and landed on its roof in a ravine. In a freak event, a metal fencepost three inches in diameter impaled Mutton, entering his right upper chest and exiting through his left buttock.
Minutes after it was summoned by the Elmhurst Fire Department, the Lifestar helicopter was on the scene, with its 10-million candlepower nose beam lighting up the area like a baseball diamond during a night-game.
”He was still in the car when we got there,” says Kent Adams, the paramedic on the flight. ”It was bizarre. He was conscious and alert, but definitely shocky, talking with this pole sticking out of him. The fire department had cut a piece of the pole off to shorten its length.”
Mutton was having trouble breathing; once the Lifestar crew got him into the helicopter, they temporarily paralyzed him by drug, then passed a a tube down his throat into a lung in order to keep his airway open, a vital procedure. Since regular ambulance crews don`t carry such drugs, ”the most we could`ve done in an ambulance for him was stick in an IV line,” says Adams who also works ambulances as a paramedic.
Upon landing, Mutton was whisked off the helicopter while its blades still churned-a ”hot unload” in medevac jargon-into the operating room past hospital staffers ”who see a lot of nasty stuff” but were nevertheless stunned by the sight of a man with a fencepost protruding from his chest, says Adams. Amazingly, just over a week before Christmas (about two months later)
he was discharged and walked out of the hospital.
Independent action
”Flight nursing is the ultimate in nursing, an unbelievable challenge,” says Maureen ”Mo” McSharry who became a Lifestar nurse after feeling a little ”burnt out” from 12 years of nursing in intensive care units. The biggest difference between nursing in the air and on the ground? ”Working at the scenes,” says McSharry. ”When the helicopter lands, the (emergency crews) on the ground look to you. You`re in charge. If you look frantic, that`s not good.”
Though the nurses appreciate the independence from routine hospital life that comes from working in a helicopter scudding across the sky, it can be nerve-racking. Lifestar`s crew is in constant contact during a flight with medical control back at Loyola, usually Marshall or a colleague who give technical instructions.
But it can still feel a little lonely aboard Lifestar. ”If I get stressed out in intensive care, I can shout `Hey, somebody help,` ” says Jeanette Crescenzo, Lifestar`s chief flight nurse. ”But in the helicopter, it`s just me and my paramedic. Other than that, I`m out of luck.”
The worse moments for the air medics occurs during ”flights from hell,” those missions ”where someone is trying their best to die on you no matter what you do,” says Crescenzo.
While Lifestar crews grow baleful when they recall flights where patients will stubbornly deteriorate, what they fear most is bad weather. And not because they fly in it, but because they don`t.
Low visibility, icing or any other adverse weather means Lifestar is grounded. But that doesn`t keep Lifestar crews from being summoned however. Then they travel the old-fashioned way, by ambulance.
Loyola`s caution results from the accident-prone history of civilian medical helicopters. At a point in the 1980s, hospital helicopters had compiled the worst safety record in aviation. In 1986, for example, 22 medical helicopters had accidents, with 15 deaths and 18 injuries resulting.
”A lot of people were doing a lot of stupid things,” says Mike Eastlee, one of the four pilots leased to Loyola by Omniflight Helicopters Inc. of Janesville, Wis. Loyola also leases the helicopter from Omniflight.
”Pilots were getting emotionally involved with patients,” continues Eastlee who flew army choppers in Vietnam. ”If a kid was injured the pilot might think about his own kid at home and then decide to take it up in bad weather. That`s why our pilots aren`t told the patient`s condition until after the decision to fly is made.”
No doctor or hospital administrator can force the pilot up against his will either. ”And once we`re up if anybody on the crew thinks its too bumpy, we`ll turn right around,” says Eastlee. Weather has kept Lifestar from responding to about 10 percent of requests for its services.
Loyola believes it has exhaustively addressed the safety issue, from requiring its crews to wear crash helmets and fire-retardant jumpsuits to the hospital`s investment in a computerized weather system linked to a National Weather Service satellite. It allows pilots and dispatchers to view a Chicago- bound weather pattern hours before it arrives and to decide whether it`s green for go, yellow for marginal and red for no-go.
Traveling by ambulance in bad weather reminds Lifestar crews of the benefits of flying. ”It`s safer in the air,” says McSharry while the crew takes a lunch break in the hospital`s cafeteria. ”It`s amazing how cars won`t get out of your way. They have no respect for ambulances.”
Too long a ride
Ambulances also take too long. On a nasty night in January, McSharry and Schneider went to Morris by ambulance to pick up a nine-year old boy who had suffered abdominal and chest injuries in a car crash as he returned from a wedding rehearsal dinner with his family.
A flight back to Loyola would`ve lasted about 20 minutes. But the harrowing drive took more than an hour. The boy responded poorly to artificial respiration because of pressure in his chest from his injuries, pressure the nurses constantly relieved by drawing blood and air from his chest with dozens of needles while their ambulance negotiated the icy highway.
”We were really wishing we had the helicopter that night. We were sliding all over the place,” says Schneider. The boy survived the trip and was released from the hospital.
Shared adversity of this sort gives Lifestar members a military style esprit de corps. And because their work is among the most dramatic in medicine, a field known for frequent heroics, the Lifestar crew has a certain cachet. The Lifestar lapel pins they freely hand out, depicting their helicopter on a star background, ”are real status symbols,” says a trauma surgeon passing through the cafeteria.
”There are pros and cons to being in the public eye,” says Schneider.
”The ICU nurse may say `Big deal, they took care of the patient for an hour while I took care of the patient for a month.` But they don`t see you straddling a ditch.”
”Or being up to your knees in reeds, or out there when it`s 50 degrees below,” adds McSharry. Lifestar members tend to rely on each other for support. ”Others really don`t understand what it`s like,” says Schneider.
The patients and their families seem to understand. Last fall, the hospital celebrated Lifestar`s one-year anniversary, inviting Lifestar patients back for a reunion. Vic Serena, whose 17-year-old daughter Kelly died of car-crash injuries despite the best efforts of Lifestar`s crew, presented the medics with an exact, small-scale replica of their craft with the words,
”May God Protect You Always,” inscribed on a plaque. ”They work their tails off, he says. ”The stress must be incredible.”
And a year to the day after a 70-foot plunge nearly killed him, Peter Kocik, a 43-year old ironworker from Lockport, walks with the aid of a cane into the cafeteria and hugs the Lifestar crew. ”I`m glad you guys know your
(stuff),” he said, using an earthy expletive.
”That`s what makes it all worthwhile,” said Chip Kramer, a Lifestar paramedic.
