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Chapter Eight starts to define the path of the book along the path of investor pressure on costs affecting our flight operations. A cheaper alternative to backup helicopters almost killed a patient one night.
CHAPTER EIGHT – MONEY COUNTS, OUR SAFETY DOESN’T
Those of us who flew medevac over the years watched insurance companies continue to intrude more and more into medical care decisions and squeeze hard on funding to support our operations. In aviation, there’s constant tension between the money interests and those concerned about safety. When it’s correctly balanced, the flying is supported with good training and maintenance and those responsible for the fiscal side of things are paying the bills and reporting a profit.
If it tilted too far toward the money interests, as with the insurance companies driving the process, training and maintenance suffered. For us in the air medical business what was already a dangerous endeavor was becoming intolerable.
One example: medevac programs have backup helicopters in place so service can continue even if the primary aircraft is out of service. Backups at bases with larger aircraft like the 412 had always been the same size and type as the primary ship, so that medical crews could work in the same cabin environment regardless of aircraft status. But economic pressures ended that. Backups, even for the larger helicopter programs, were now cheaper, single-engine types.
One night in 1993 in Michigan our Bell 412 was down for maintenance and we had to fly our smaller backup, a Bell LongRanger. It had its own issues. That night they threatened our patient’s life.
If you parked the LongRanger next to the 412, its lineage was immediately obvious. It was a miniature version of its larger cousin. The tiny cabin behind the two pilot seats forced the nurses to operate with only their field packs, leaving behind all the special equipment - defibrillators, special drug dispensing systems and other advanced care tools stowed in the 412’s massive interior.
The patient was loaded fore and aft into the left side of the aircraft, taking up half the width and the entire length of the LongRanger’s interior. Nurses forced to work from the two seats crowded right next to the patient while juggling equipment in the cramped space were not happy campers.
That night, we took a call to pick up a trauma victim at a clinic sixty miles out in the country. It was a calm, clear night so we had an uneventful flight to the facility.
The report that came in with the call stated that the victim, Joe “Blaze” McDaniel, and his wife, Sarah, had been traveling on their motorcycle. As they passed through a small town working their way back to the freeway Blaze had gunned his motorcycle across a parking lot to gain access to a nearby onramp.
The front wheel of the motorcycle struck a stray block of concrete. With the sudden stoppage Blaze flew up and over the front fork, landing on his head and chest and sliding almost fifty feet. Sarah landed on her feet as the motorcycle fell over, and ran to Blaze. A passing driver saw her and the wrecked motorcycle, stopped to help and called 911. The ambulance was there eight minutes later. We arrived at the ER an hour later.
I shut down the helicopter and joined the nurses in the ER. As I walked up to them they were conversing in short, tense bursts with the doctor. I picked up shreds of the discussion.
“So, with this guy’s trauma score, why did you call us?” one of them asked the doctor, who shrugged his shoulders and said it hadn’t been his decision. The patient’s trauma score, which considered the severity of his injuries, damage to his vital organs and his level of response to stimuli, labeled him too badly injured to transport under any circumstances.
With that, our nurses, Sandy and Anne walked a short distance away, then turned to each other and began an intense, whispered discussion. Sandy was tall, blonde, her hair gathered up in a ponytail. Anne was about the same height but had dark hair. Her brown eyes were soft and pleasant most of the time, but they could look straight through you if she was on a mission and needed hard answers. They stood close as they talked, struggling with what sounded like a big issue.
They’d let me know what we were doing when they were ready, meanwhile, I walked into the small room where our patient was lying.
Blaze was a short, stout man, still wearing the shreds of his motorcycle club shirt, vest and jeans, all that was left after the ER team cut them away to work on him. His wife stood near him, crying softly, her hands gently resting on his head. She wore motorcycle club garb as well. They had been together a long time.
Blaze was heavily sedated and intubated, which meant the ER crew had inserted a tube down his throat that was connected to a machine to manage his breathing. ER teams only took this drastic step with patients whose breathing was badly compromised by illness or injury.
Sandy looked at Anne and shrugged. Anne nodded. I could tell we were going to take this guy, even if his chances of survival were poor. They turned to me.
I nodded. “We’re taking him, right?” I asked.
Sandy nodded tersely. ‘Nuff said.
The deputies who’d responded to the call were standing nearby waiting for the outcome so they could complete their report. I explained we were going to fly Blaze and they volunteered to help move him onto a gurney and push it to the helipad. Sandy and Anne supervised us on the move to the gurney. The local ER staff were nowhere in sight, seeming to have washed their hands of Blaze and his situation.
I trotted ahead to open the door on the LongRanger, a long, multi-folding affair that opened up the entire cabin. It was an ingenious design but if you didn’t know how the sections folded you could jam it half open and create a real mess.
I folded it out of the way just as the deputies arrived with the gurney. We adjusted its height so the litter would slide into the helicopter and I motioned for them to move him in. It suddenly stopped with a clunk, jammed tight.
I leaned in and saw the problem. One of the litter clamps, the ones that worked so well in the 412 but were smaller and more delicate in the LongRanger, had broken, freezing the litter in place. I yanked on the clamp, but it was bent and firmly implanted against the litter.
We didn’t need the clamps once the litter was in place. With the big door closed it was tightly contained. Climbing into the cabin, I put my boot against the offending piece. With one well-placed kick, it popped out of its mount and fell with a clink to the cockpit floor. The deck was clear and the litter slipped by the now defunct clamp and clicked into place.
“That’s it, guys,” I said. “We’re loaded.”
The deputies stepped back as I closed and secured the big door.
“Thanks, gentlemen,” I said. They waved and walked away.
Anne and Sandy were already in the cabin setting up their monitors and drugs while we were loading. As soon as Blaze was in place they went to work hooking him up and plugging in his IV lines.
In minutes, we were on our way home. We climbed to 500 feet and I pulled in all the power the little LongRanger could give us. The needles on the engine gauges were at the top of their yellow arcs.
Their tense conversation over the intercom told me Sandy and Anne were worried. Working on him in the cramped cabin was an act of contortion, leaning one way for a task, then the other for something else. I could hear them breathing hard, crawling around each other and the patient trying to check his vitals and IV lines.
“He’s coding,” Sandy said.
“Paddles are coming,” Anne replied.
As they pressed the electric paddles to his chest the helicopter lurched with his convulsions as the voltage jolted him. But Blaze did come back to us.
“We’ll be on the ground in fourteen minutes,” I told them. Time was not on our side tonight.
“Dispatch, please have the crash cart meet us at the pad. ETA is fourteen,” Anne said over the radio. The crash cart in this case had nothing to do with us crashing. It was a team of doctors and nurses with a cart equipped for every kind of life-saving intervention, meant to be used on a ‘crash’ basis.
Blaze slipped closer to death every mile we flew, even as Anne and Sandy worked feverishly to keep him with us. We swooped onto the pad and landed next to the crash crew. Bending over and covering their heads from the rotor wash they moved in to help the nurses. Anne pushed her door open and ran around to the left side. She yanked the litter door open. As she was slamming it out of the way, the crash crew pushed their cart up near the opening in the cabin. Sandy slid out and helped pull the litter out of the helicopter onto the waiting gurney.
I shut off the engine and yanked on the rotor brake to stop the rotor blades. With crash crew members milling around concentrating on saving their patient, the image of one of them being cut in half by a wobbling rotor blade kept popping through my head.
“Dammit, the litter is stuck,” Sandy yelled.
I got out of the cockpit and trotted around to the left side as Sandy and the crew yanked and tugged at the stuck litter.
“Woody, our patient is stuck halfway in and out of the helicopter, and he’s coding again,” she gasped.
I slipped into the crowd around Blaze as they worked to revive him. Another litter clamp had jammed as the litter slid out of the cabin.
“Give me a second, guys,” I said, squeezing around everyone into the cabin and putting the heel of my boot against the offending clamp. With the second deft kick of the night it popped loose and fell to the cabin floor next to the other one.
“OK, we’re clear,” I said, easing the litter the rest of the way out.
The crash crew gently lifted Blaze onto the gurney. One of them leaped on top, straddling him, working on his chest. The rest pushed the gurney at a dead run into the ER, punching through the swinging doors and joining up with the waiting trauma team.
Now alone with the LongRanger I surveyed the mess, rivet holes in the litter frame ripped open where I’d sent the two clamps flying. We wouldn’t be doing any more patient flights tonight.
I walked into dispatch. Debbie, the duty dispatcher, sat at her console, her headset in place as she concentrated on radio traffic about a nearby emergency.
She turned as I walked in. “Woody, what’s up, man?”
“We’re out of service, Deb. The LongRanger litter is pretty torn up.” I told her how our patient had gotten stuck while we were loading him and then again when we were unloading.
“OK, out of service until further notice,” she said. “Let’s hope Jim can get the 412 up in the morning.”
“Yeah, then he’ll have a real project trying to rebuild that piece of crap litter,” I replied.
I walked into the ER to see how Blaze was doing. Anne was standing in the hallway.
“How’s he doing?” I asked.
“He expired a couple minutes ago,” she said. “His chances were never very good,” she said, shaking her head. “They should never have called us.”
I told her we were out of service for the rest of the night because of the broken litter.
Sandy came over as I gave them the news. “Guess we can go sleep the rest of the night,” she said.
When Jim arrived in the morning I was on my first cup of coffee standing near the LongRanger. He stared at the shattered litter.
“This must be quite a story,” he said.
I gave him the highlights and pointed to the broken litter clamps.
He shook his head. “This is the worst litter setup I’ve ever seen,” he said. “If you look here, and there,” he pointed at a riveted patch on the litter bed and then at another one, “this thing has been repaired two or three times. It’s just a bad design. All of our LongRangers have the same problem.”
“So, I didn’t do something bad when I kicked the shit out of those clamps?”
“Hell no, you had the get the patient out of the aircraft.”
It was my Friday so I agreed to help Jim for a while putting the 412 fuselage panels back on and getting it ready to fly today. Over the next few weeks he repaired the damaged litter. Afterward he proudly showed me the bigger, stronger clamps he’d made. If we had to use that thing again it might even work.
The changes driven by cost cutting we were seeing every day, these smaller, cheaper backup helicopters notable examples, added up to a pretty grim big picture for pilots and med crews.
Truth was, if we spared no expense to make our operations as safe as possible, the whole enterprise would collapse under the financial burden. On the other end of the spectrum, if management kept on cutting backup aircraft, along with other infrastructure we watched being torn away, there would be a day when the risks of flying a mission would be more than any of us would be willing to accept. When we tried to ask the managers we could talk to what was going on they gave us the company line: we need to control costs or we can’t stay in business. And that was that, no insight, no thoughts on the future. It was frustrating but the message was clear: it’s going to get worse.
We were at the point where I dreaded night shifts, knowing that I might be called 100 miles out into the wilderness to pick my way through weather and darkness. I didn’t want to look for another job but what choice was there, stay and get killed?
Like so many situations employees everywhere face, you take it a day at a time, avoiding the issue and hoping it’ll get better. The difference between us and most employees: we weren’t facing poor working conditions, we were trying to stay alive.
Copyright © 2021 Woody McClendon. All rights reserved.
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