- Email: [email protected]
And ‘the best job in the world award’ goes to…
And ‘The Best Job in the World Award’ Goes To…
Classic Lifeguard
Shane Otis, RN, CEN, CFRN
Photos by John Bingham, CEP
“Medic One, Medic Three: 9-1-1 to the North Rim ranger station. Fall with possible serious head injuries. Unknown patient condition at this time.”
John, my paramedic partner, groaned and laid down his fork, the first bite of a perfectly cooked steak not even tried. I acknowledged the call as we scrambled into boots, ran down the back stairs, and gathered up drug bags and gear before getting into our waiting Bell 407 helicopter. Within minutes we were airborne, headed for the north rim of the Grand Canyon. Our pilot made radio contact with the National Park Service (NPS) ranger base and gave them our estimated time of arrival. Meanwhile, in the back of our aircraft, John and I went over our patient packaging and treatment plan. About halfway through the flight, NPS called with an update: the patient, a 37-year-old man, was conscious and combative. John and I looked at each other and simultaneously said, “RSI.” This meant rapid sequence intubation; we were going to paralyze our patient, put a tube down his trachea, and breathe for him. None of us—pilot, paramedic, or nurse—
wanted to fight a combative patient with a head injury in the back of an aircraft. However, on arrival to the North Rim helipad, we found our patient was indeed conscious but not combative. Instead, he was a non-English speaker from the Netherlands who had fallen approximately 25 feet from Bright Angel Point. He had landed on his shoulders and head and could not feel or move his legs. Unable to communicate, “Dutch” was panicking. He obviously was critically injured, with a great deal of blood coming out of his left ear, unable to breath other than very shallowly, signs and symptoms of shock, and paralysis of his lower extremities. We helped the NPS medics complete his packaging on a backboard with cervical collar, head blocks, and spider straps; started a second IV lifeline; and then moved Dutch to the helicopter. We delayed loading him until his wife and children had
The quick and appropriate response by the NPS medics, the rapid transport with early interventions to a definitive care 28
Air Medical Journal 23:1
the opportunity to tell him goodbye (we feared they would never see him alive again), then finished loading and securing our patient. During the 27-minute flight to Flagstaff Medical Center (FMC), we gave high dose steroids intravenously in an attempt to stop or reverse the damage to his spinal cord, monitored his vital signs and oxygenation, and attempted to calm our frightened and gravely injured patient with sign language and lots of “OK?” Despite my worries, Dutch survived the flight. The trauma team at FMC accepted him and began working on him almost before we got him into a trauma room. John, our pilot Tom, and I returned to the helicopter and flew north to our base in Page, Arizona. The next day we did a patient follow up and learned that Dutch had a basal skull fracture, contusions to both lungs, a large laceration to one kidney with resulting pressure from the hemorrhage behind it, and fractures to four lumbar vertebra in his back, leaving him irreversibly paralyzed from the waist down. Three weeks later, Dutch returned home to the Netherlands from his holiday in America. Sadly, he was changed physically forever, but the quick and appropriate response by the NPS medics, the rapid transport with early interventions to a definitive care center, and the advanced care provided by the trauma center ensured that he would survive his potentially fatal fall. The above call is not rare; as a matter of fact, the nurses, paramedics, and pilots of Classic Lifeguard respond to this type of call frequently. We routinely are called to boating accidents and drownings, shootings and stabbings, motor vehi-
The 7500-squaremile service area runs from Phoenix to Salt Lake City.
cle crashes, hunting accidents, and assorted and sundry falls. We also respond to medical emergencies in the field— strokes, heart attacks, overdoses, respiratory difficulties, and kidney failure are but a few of the medical emergencies we see. Additionally, we transport patients from one facility to another as their continued and advanced care requires. At times our patients are very critical, requiring all of our skills and expertise to keep them alive; at other times it’s a pleasant outing for all. Our missions run the gamut from transferring the critical heart patient on a ventilator with six different drug drips from Page Hospital to FMC to the young man in Havasupai with a fractured jaw, also to FMC, for oral surgery. The only type of patient that we do not routinely transport is a mother in active labor. Would you want to deliver a baby in the back of a helicopter? We also perform two more duties. One of these is as a search and rescue (SAR) unit. We work closely with law enforcement, fire, and emergency medical agencies and the NPS to locate missing or stranded people. It is not rare that we return from an SAR mission shaking our heads and wondering just what that visitor to this area was thinking when he went
center, and the advanced care provided by the trauma center ensured that he would survive his potentially fatal fall. January-February 2004
29
Hapless vacationers give Classic Lifeguard plenty of SAR missions.
hiking/climbing/cycling in the (fill in the blank) area. Of course, when on vacation, the rules don’t apply. Thanks to that reality, we have all the SAR flights we could wish for. The other duty we perform is that of education—teaching helicopter and landing zone safety, demonstrating proper packaging for helicopter transport, and explaining what our limitations are to our referring agencies. This outreach helps ensure better care for the patient because we all are on the same wavelength, and it protects both the air medical crew and the scene responders by making the scene/landing zone area as safe as possible for all of us. Classic Lifeguard started in the Lake Powell area on Memorial Day weekend, 1988. The first crews consisted of two basic EMTs and a pilot. One helicopter was based at the airport in Page, and the crew was housed in a rented house nearby. Now, more than 5000 flights later, we have two helicopters 24/7 (the Bell 407 and a Bell 206), with two full crews of RNs, paramedics, and pilots available. We have our own hangar at the Page Airport and crew living quarters in the same building. To quote a medic who has been with Classic for many years, “No more scraping snow off the helicopter in the winter!” Our chief flight nurse, Michial Smith, RN, NREMT-P, is in contractual negotiations to add a fixed-wing aircraft in the next month or two. These negotiations, thanks to his persistence, are proceeding very well. Rumors are that the new plane will be a jet. This aircraft would be used primarily for interfacility transports of the critical patient needing faster and farther flights than the helicopters are able to provide. However, until that time, our average flight time is approximately 1 hour. The closest trauma center to the Page/Lake Powell area is about an hour in any direction. Page Hospital, although not a designated trauma center, is a very valuable resource to us
for stabilizing patients who otherwise would not make that 1hour flight time. We work closely with the NPS, Navajo Nation EMS, Arizona and Utah Highway Patrol, Page Fire Department, and various other agencies in these two states. Our service area extends from Phoenix to Salt Lake City and Grand Junction to Las Vegas—an approximate 7500-square-mile area! Safety is always our number one concern. If you call us and we turn down the flight, it is because the flight crewmembers have reason to question the safety of the mission because of weather or potential aircraft problems. One last recollection: It had been storming for days, and we had to skirt thunderstorm cells all the way to Farmington to take a little boy with a head injury to San Juan Regional. We launched from the hospital at about 1:30 am to return to Page and were thrilled that the rain finally had stopped and the clouds parted somewhat. A gorgeous full moon was shining over the landscape and off the bottom of the clouds. Our pilot, Matt, had Stevie Ray Vaughn playing over the intercom, my feet were up on the aft-facing seat, and a bottle of icy cold Gatorade was in my hand. Life was pretty good, but then it became pretty great. Below us was a moon rainbow, arcing gracefully over Monument Valley. My thoughts at the time included, “And I get a paycheck for this, too!” Yes, I would say that the pilots, nurses, and paramedics of Classic Lifeguard have the best possible jobs in the world! Shane Otis, RN, CEN, CFRN, is a flight nurse with Classic Lifeguard Aeromedical Services in Page, Arizona. 1067-991X/$30.00 Copyright 2004 by Air Medical Journal Associates doi:10.1016/j.amj.2003.12.001
Below us was a moon rainbow over Monument Valley. My thoughts included, “And I get a paycheck for this, too!” 30
Air Medical Journal 23:1
Classic Lifeguard
Shane Otis, RN, CEN, CFRN
Photos by John Bingham, CEP
“Medic One, Medic Three: 9-1-1 to the North Rim ranger station. Fall with possible serious head injuries. Unknown patient condition at this time.”
John, my paramedic partner, groaned and laid down his fork, the first bite of a perfectly cooked steak not even tried. I acknowledged the call as we scrambled into boots, ran down the back stairs, and gathered up drug bags and gear before getting into our waiting Bell 407 helicopter. Within minutes we were airborne, headed for the north rim of the Grand Canyon. Our pilot made radio contact with the National Park Service (NPS) ranger base and gave them our estimated time of arrival. Meanwhile, in the back of our aircraft, John and I went over our patient packaging and treatment plan. About halfway through the flight, NPS called with an update: the patient, a 37-year-old man, was conscious and combative. John and I looked at each other and simultaneously said, “RSI.” This meant rapid sequence intubation; we were going to paralyze our patient, put a tube down his trachea, and breathe for him. None of us—pilot, paramedic, or nurse—
wanted to fight a combative patient with a head injury in the back of an aircraft. However, on arrival to the North Rim helipad, we found our patient was indeed conscious but not combative. Instead, he was a non-English speaker from the Netherlands who had fallen approximately 25 feet from Bright Angel Point. He had landed on his shoulders and head and could not feel or move his legs. Unable to communicate, “Dutch” was panicking. He obviously was critically injured, with a great deal of blood coming out of his left ear, unable to breath other than very shallowly, signs and symptoms of shock, and paralysis of his lower extremities. We helped the NPS medics complete his packaging on a backboard with cervical collar, head blocks, and spider straps; started a second IV lifeline; and then moved Dutch to the helicopter. We delayed loading him until his wife and children had
The quick and appropriate response by the NPS medics, the rapid transport with early interventions to a definitive care 28
Air Medical Journal 23:1
the opportunity to tell him goodbye (we feared they would never see him alive again), then finished loading and securing our patient. During the 27-minute flight to Flagstaff Medical Center (FMC), we gave high dose steroids intravenously in an attempt to stop or reverse the damage to his spinal cord, monitored his vital signs and oxygenation, and attempted to calm our frightened and gravely injured patient with sign language and lots of “OK?” Despite my worries, Dutch survived the flight. The trauma team at FMC accepted him and began working on him almost before we got him into a trauma room. John, our pilot Tom, and I returned to the helicopter and flew north to our base in Page, Arizona. The next day we did a patient follow up and learned that Dutch had a basal skull fracture, contusions to both lungs, a large laceration to one kidney with resulting pressure from the hemorrhage behind it, and fractures to four lumbar vertebra in his back, leaving him irreversibly paralyzed from the waist down. Three weeks later, Dutch returned home to the Netherlands from his holiday in America. Sadly, he was changed physically forever, but the quick and appropriate response by the NPS medics, the rapid transport with early interventions to a definitive care center, and the advanced care provided by the trauma center ensured that he would survive his potentially fatal fall. The above call is not rare; as a matter of fact, the nurses, paramedics, and pilots of Classic Lifeguard respond to this type of call frequently. We routinely are called to boating accidents and drownings, shootings and stabbings, motor vehi-
The 7500-squaremile service area runs from Phoenix to Salt Lake City.
cle crashes, hunting accidents, and assorted and sundry falls. We also respond to medical emergencies in the field— strokes, heart attacks, overdoses, respiratory difficulties, and kidney failure are but a few of the medical emergencies we see. Additionally, we transport patients from one facility to another as their continued and advanced care requires. At times our patients are very critical, requiring all of our skills and expertise to keep them alive; at other times it’s a pleasant outing for all. Our missions run the gamut from transferring the critical heart patient on a ventilator with six different drug drips from Page Hospital to FMC to the young man in Havasupai with a fractured jaw, also to FMC, for oral surgery. The only type of patient that we do not routinely transport is a mother in active labor. Would you want to deliver a baby in the back of a helicopter? We also perform two more duties. One of these is as a search and rescue (SAR) unit. We work closely with law enforcement, fire, and emergency medical agencies and the NPS to locate missing or stranded people. It is not rare that we return from an SAR mission shaking our heads and wondering just what that visitor to this area was thinking when he went
center, and the advanced care provided by the trauma center ensured that he would survive his potentially fatal fall. January-February 2004
29
Hapless vacationers give Classic Lifeguard plenty of SAR missions.
hiking/climbing/cycling in the (fill in the blank) area. Of course, when on vacation, the rules don’t apply. Thanks to that reality, we have all the SAR flights we could wish for. The other duty we perform is that of education—teaching helicopter and landing zone safety, demonstrating proper packaging for helicopter transport, and explaining what our limitations are to our referring agencies. This outreach helps ensure better care for the patient because we all are on the same wavelength, and it protects both the air medical crew and the scene responders by making the scene/landing zone area as safe as possible for all of us. Classic Lifeguard started in the Lake Powell area on Memorial Day weekend, 1988. The first crews consisted of two basic EMTs and a pilot. One helicopter was based at the airport in Page, and the crew was housed in a rented house nearby. Now, more than 5000 flights later, we have two helicopters 24/7 (the Bell 407 and a Bell 206), with two full crews of RNs, paramedics, and pilots available. We have our own hangar at the Page Airport and crew living quarters in the same building. To quote a medic who has been with Classic for many years, “No more scraping snow off the helicopter in the winter!” Our chief flight nurse, Michial Smith, RN, NREMT-P, is in contractual negotiations to add a fixed-wing aircraft in the next month or two. These negotiations, thanks to his persistence, are proceeding very well. Rumors are that the new plane will be a jet. This aircraft would be used primarily for interfacility transports of the critical patient needing faster and farther flights than the helicopters are able to provide. However, until that time, our average flight time is approximately 1 hour. The closest trauma center to the Page/Lake Powell area is about an hour in any direction. Page Hospital, although not a designated trauma center, is a very valuable resource to us
for stabilizing patients who otherwise would not make that 1hour flight time. We work closely with the NPS, Navajo Nation EMS, Arizona and Utah Highway Patrol, Page Fire Department, and various other agencies in these two states. Our service area extends from Phoenix to Salt Lake City and Grand Junction to Las Vegas—an approximate 7500-square-mile area! Safety is always our number one concern. If you call us and we turn down the flight, it is because the flight crewmembers have reason to question the safety of the mission because of weather or potential aircraft problems. One last recollection: It had been storming for days, and we had to skirt thunderstorm cells all the way to Farmington to take a little boy with a head injury to San Juan Regional. We launched from the hospital at about 1:30 am to return to Page and were thrilled that the rain finally had stopped and the clouds parted somewhat. A gorgeous full moon was shining over the landscape and off the bottom of the clouds. Our pilot, Matt, had Stevie Ray Vaughn playing over the intercom, my feet were up on the aft-facing seat, and a bottle of icy cold Gatorade was in my hand. Life was pretty good, but then it became pretty great. Below us was a moon rainbow, arcing gracefully over Monument Valley. My thoughts at the time included, “And I get a paycheck for this, too!” Yes, I would say that the pilots, nurses, and paramedics of Classic Lifeguard have the best possible jobs in the world! Shane Otis, RN, CEN, CFRN, is a flight nurse with Classic Lifeguard Aeromedical Services in Page, Arizona. 1067-991X/$30.00 Copyright 2004 by Air Medical Journal Associates doi:10.1016/j.amj.2003.12.001
Below us was a moon rainbow over Monument Valley. My thoughts included, “And I get a paycheck for this, too!” 30
Air Medical Journal 23:1