BARRY WILLIAMS/Special

Rescue Air 1 flight paramedic Mike Stevens, front, and flight nurse Jennifer Jones, right, head out to assess a burn victim’s condition.

Flight nurses and paramedics call it the golden hour. Most trauma and critical patients need to receive medical attention
within 60 minutes to have the best chance of survival. Fighting the clock is always part of the job when rescue helicopter
crews get a call.

"Time is our whole game. This job is about speed and taking care of people when they're in such need," said Mike Stevens, NREMT-P, CCEMT-P, a paramedic with Rescue Air 1. "The purpose is to get someone from point A to point B quickly - whether it's from the scene of an accident to the hospital or from facilities of a lower to a higher level of care."

Flight crews take off with the equipment, skills and compassion needed to make the most of that critical hour.

Rescue Air 1 (formerly Baptist LifeFlight) operates four AS350 A-Star helicopters from airports in Peachtree City, Marietta, Covington and Blairsville. Flight crews (a pilot, nurse and paramedic) are prepared to lift off within five minutes of a call.

When on "ground alert," the crew loads the chopper and waits in position to hear the "launch" or "stand down" commands. "Air alert" puts the helicopter in the air and on the way to the scene. If ground emergency professionals decide an airlift isn't needed, the crew turns back, but if it's a "go" flight, they've already saved precious minutes of the golden hour by being in the air and on the way to the scene.

Stevens uses the flight time to prepare mentally.

"You're hearing information on your headset and you're building scenarios in your head about what to do as soon as you hit the ground," he said.

The goal is to be airborne again in 10 minutes. "Even if I'm spooked by the severity of a situation, I'm not going to show it,"
Stevens said. "These people are depending on us, and they need our care."

Stevens usually takes charge of the patient's airway and may have to intubate. At the same time, nurse Jennifer Jones may
be starting IVs and medications and telling the receiving hospital about the patient's condition and needs.

"It's a highly skilled team," said Tina Frey, BSN, CFRN, CEN, chief flight nurse and instructor for Air Rescue 1. "Generally, the medic is more oriented toward emergencytreatment skills and the nurse toward medication, pathology and managing care, but the roles are interchangeable. Both have to be totally confident of their skills, because there is no backup. They're working off protocols and often making life-or- death decisions."

In the air, the crew performs like an intricate ballet, with partners hardly needing to speak. "If I can't get to something, she's already reaching over me and doing it herself. It's a tight space, and we're both totally focused on the patient," Stevens said.

On the way out and back to the base, the medical team watches the skies, serving as the extra eyes for the pilot. At night, flying is much more dangerous. There are few lights in rural, mountain areas, while unlit antennas ("chopper stoppers") and other aircraft are a hazard in urban areas.

Ready to fly
Once back at the base, the crew may talk about the mission to relieve stress or nap to be ready for the next call. "My record is six missions in a shift, but even four is a lot," Stevens said.

Nurses and paramedics work 24-hour shifts; pilots fly 12-hour shifts.

"If you have four critical patients at night, when it's hard to see and you use up every bit of your adrenaline, it can feel like
you worked for three days," Stevens said. "The next day you're going to be mentally exhausted."

Yet Stevens said he would never go back to doing ground work. Being a flight paramedic offers him the opportunity to provide the kind of care he wants to give, the flexibility of doing what he's trained to do and the camaraderie of teamwork.

"I love helping people. I've found my calling," he said.

Frey calls it the ultimate nursing job. "My parents think I'm crazy and wonder why, with my skills, I couldn't get a more stable position, but I prefer the excitement and the adrenaline rush," she said.

Flight nurses are generally required to have at least five years of critical care or emergency room experience. They undergo
constant continuing education to keep their skills sharp.

"I like the autonomy and the challenge of working with patients who are so sick. I learn something from every case,"
Frey said.

"We learn from our staff physician, the patients and each other," echoed Pam Robertson, RN, BSN, program director.

She believes the challenge of facing the unknown every day has taken her skills to the next level. There's also the challenge of facing other factors in each call: What skills and resources will you need? Will the weather cooperate? Can you make it in
time?

"It's a pretty huge step to be out of the hospital environment, where you have other professionals to help," Robertson said.

"Working in a noisy helicopter and a helmet, you can't hear breathing or always palpate a pulse. You learn to use all your
senses and develop a different set of assessment skills."

"When we walk through the door, you see a sense of trust, a sense that things are going to be OK, on people's faces. It's that
sense of trust that we hope to live up to," Frey said.

Caring for children
"The care starts the minute we land," said Nancy Constable, RN, supervising nurse for Children's Response Air, the helicopter service of Children's Healthcare of Atlanta. "What we're bringing is a pediatric intensivecare unit to that child."

The Children's Response Air helicopter is outfitted with childsized respirators, incubators, IV pumps, cardiac and other monitors, and other specially designed lightweight equipment. Flight crews check equipment and supplies daily; everything must be balanced and secured so it doesn't become an airborne torpedo in the event of a rough landing.

"Our 12 nurses hold a lot of advanced certifications (such as PNCCT, pediatric neonatal critical care transport) and are trained to deliver intensive care immediately," Constable said."We're talking with our medical control doctor and the receiving doctor continually through the flight, starting IVs or respiratory therapy. There's no time wasted.

"I love my job. I'm always proud to be on that helicoptertaking a kid where he or shetaking a kid where he or she needs to be."

Constable had been a flight nurse for eight years before moving to Atlanta and taking a job in the pediatric intensive care unit.

"When the hospital got its own helicopter and asked me if I wanted to fly again, it took me about 10 seconds to switch roles," she said. "It's in my blood. I love lifting off the roof and being in the air."

During a typical 12-hour shift, when not checking equipment or practicing rescue scenarios, Constable helps out in the ICU. She wears her flight suit and keeps her cellphone charged and her walkie-talkie attached to her belt.

"Even if I think I might not be hungry, I eat a sandwich, because I don't know when I'll get another chance. When the call comes, I run to the roof," she said.

If the weather is clear, the crew can fly up to a 150-mile radius from its Atlanta base. "Weather is not always our friend and we have to accept that," Constable said.

The crews at Children's face a variety of calls.

One could be delivering a child hurt in an automobile accident to the ER or operating room. Another might be transporting a
preemie from a hospital to Children's advanced ECMO Center (with its sophisticated heart and lung bypass machines). Yet another could be taking a young heart patient to Children's renowned cardiac catheterization lab. One factor is constant: Time is of the essence.

"Often the child is so sick " Children's is [his or her] last chance and you know you might run out of time," Constable said.

The BK117 helicopter can carry up to two children, and, whenever possible, the crew tries to take a parent, especially if the child is young and being transported a long distance.

"The parent sits in the front but can talk to the child the entire way on the headset and hear from us how it's going," Constable said.

The job can be a combination of tragedy and triumph.

"Sometimes we do lose a child, and it's devastating, but at least you know that you did everything you could," Constable said. "It's very rewarding when you get a child there in time. There's always a sense of 'hey, team, we made it.' "