The crew of nurses, doctors and pilots heading Survival Flight, Michigan’s oldest emergency air transportation program, face critical situations everyday, and at 1,000 feet in the air, their job is like no other in the medical profession. Michigan Daily Staff Reporter Maria Sprow and Photographer Danny Moloshok spent a day with the people who make Survival Flight one of the most reputable transport systems in the country.
Memphis residents Tracy and Matt Hooten will never forget the day five months ago when their newborn daughter, Rachel, was flown to the Intensive Care Unit at C.S. Mott Children’s Hospital.
It was June 10, and Rachel was just five days old. Three days earlier, she had been diagnosed with hypoplastic left heart syndrome. The left side of her heart was underdeveloped, keeping it from pumping blood into the rest of her body.
According to the University Congenital Heart Center, if left untreated, HLHS kills 95 percent of its victims within one month. It’s responsible for 25 percent of cardiac-related deaths occurring in the first week of life, though it only affects about one in 5,000 newborns.
The local Memphis hospital was unable to care for her and her life was on the line when the University Hospital’s Survival Flight crew arrived in Memphis to transport her to Ann Arbor.
“She pretty much slept the whole way,” says Tracy Hooten, recalling the family’s first flight and the work of the nurses and doctors who cared for Rachel during the trip. “They were watching her oxygen levels because her oxygen levels dropped. … They saved her life.”
Nearly five months and two heart surgeries later, Rachel took another ride on Survival Flight, the University’s equivalent to an airborne ambulance that travels across the United States and Canada to transport trauma and medical patients needing the expertise available at the University’s health system and medical centers.
“It’s been a roller coaster since we’ve been here. At one point, we weren’t sure if she was ever going to go home,” Matt Hooten said. “It seems like every time she was getting better, something would happen that we’d take a few steps back.” But Rachel finally went home Nov. 8, and the family is again thanking Survival Flight.
“She’s not real stable, even with her trach,” Tracy Hooten said, adding Rachel’s unstable condition made transportation back to Memphis by car impossible. “It was a big relief to find out that they were willing to fly us home, because up until that point, we were unsure how we were going to get her there.”
All in a day’s work
Survival Flight – which started in 1983 with one helicopter and half a dozen flight nurses – now consists of three Bell 430 helicopters, one medically configured fixed wing Cessna Citation jet, 19 flight nurses, nine pilots, seven communications specialists and four mechanics.
For the specially trained flight nurses and medical doctors on the crew, there is no average day, only good days and bad days, some when the calls never stop and others when the calls never come.
Still, the crew makes 1,200 to 1,400 missions every year, with an average of three to four calls a day.
“Every case is different, every case is new. But when you do 1,200 flights a year, there is bound to be a point in there where things are going to get routine,” Flight Nurse Specialist Kris Nelson said.
Days with flights like Rachel’s – when patients are finally healthy enough to return home – make the job especially rewarding. But not all flights are as smooth or as successful.
“You have days when things don’t go the way you want, and a patient’s life is hanging in the wings. Sometimes, your best intentions don’t always work out,” Flight Nurse Specialist Wilson Bowers said. “There’s an emotional component involved in some of the flights we do. No matter how tough you are and how seasoned you are, occasionally you are going to get a patient that you can’t put out of your mind.”
The nurses rotate working in pairs during four 12-hour shifts – 12 p.m. to 12 a.m., 7 p.m. to 7 a.m., and two pairs that work from 7 a.m. to 7 p.m. – that keep the service going 24 hours a day, 365 days a year. Whatever their schedule, any thoughts of home and rest are saved for later if an emergency comes up.
Long hours are nothing new for the Survival Flight nurses, who came either because they were looking for something different or because they wanted to expand their medical knowledge and have a greater impact on patient care.
“This is a great place to work because of the ways nurses are treated. You have more of a role in Survival Flight,” Bowers said. “You have the ability to advance your practice to the next level.”
Working in the air can be stressful – the space inside the helicopters is tight and, unlike in the Emergency Room, every patient picked up by Survival Flight is in critical condition. More often than not, the nurses are operating with very little knowledge of the patient and decisions must be made quickly.
“It’s like apples and oranges,” said Flight Nurse Specialist Paul Hyssong. “You are still doing patient care, but it’s a whole different environment. Here, it’s one patient at a time. In the emergency room, it’s many. Some are sick, some aren’t so sick. Here, it’s generally more critical, where time makes a difference.”
When in the air, the pilot is in charge but the patient is first priority. Just like an ambulance, Survival Flight gets the right-of-way to other traffic in the air.
“What the pilot says, goes. If he says we are going to stop and land in a field, we are going to stop and land in that field,” Nelson said. “We aren’t going to do any good if we aren’t safe.”
Reasons for trips vary, but the vast majority of them involve flying prenatal infants and elderly patients. Every flight involves a different degree of difficulty.
Life in the wings
When an afternoon call comes in, nobody is sure what to expect. The patient is an infant staying at an area hospital suffering from respiratory distress, and the decision to go comes easily. It’s a 15-minute flight, tops, and the suburbs quickly fall behind as the helicopter makes its way.
“We ran out here with only a name and an age,” Nelson says. “We didn’t have a weight, which is important when administering medicine, and we didn’t know if the kid was going to be intubated or if we would have to do that.”
Because of the infant’s condition, the baby’s flight proves to be more stressful than most for the nurses.
As the baby’s right arm reaches out of its hospital blanket, Nelson injects medication into its tiny body. The flight’s doctor, Michael Overbeck, a medical resident who works in the emergency room, spends the duration of the flight making sure that the baby is breathing. They are 1,000 feet in the air and traveling at 160 miles an hour.
A heart monitor hangs from the helicopter’s wall. Wires attached to machines connect to its chest. Nelson’s general hypothesis is that the baby is either suffering from a severe heart defect or a critical infection.
Either way, the baby’s condition, though better by the end of the flight, isn’t good.
“This is a sick kid,” Overbeck says after the flight. “This is not something we enjoy.”
Roughly 10 percent of calls are to trauma scenes , which can be dangerous. Flight nurses undergo special emergency training sessions each year, as well as routine practice drills. They wear flame retardant jumpsuits, boots and gloves, just in case they are ever caught in a flashfire.
Before accepting a flight, different questions must be weighed – weather conditions, distance, amount of available personnel, number of open beds, patient status and weight. “Can we do it and do we want to do it? There are a lot of factors that go into play,” Nelson said.
But an emergency is an emergency, and the crew is trained to be in the air within five minutes if necessary.
While the calls may be slower one day than the next, the Flight Nurse Specialist’s life never stops. When not in the air, they are in meetings, teaching, checking equipment, following up on patients and filing reports. “We are the first people the family sees from the University,” Nelson said. “When we follow up, they are usually very grateful.”