Here, in East Tennessee, you normally see them coming to a car accident. Actually, you hear them coming before you see them. It’s a faster, higher pitch vibration buzz versus the thump, thump, thump of the larger military helicopters that occasionally come overhead. As they near the accident, you hear the flight crew talking to the medical crews over the loud truck radio speakers. Before you know it, they are on the ground.
Wings II Bell 407GX after takeoff.
The flight nurse and paramedic exit the helicopter to meet with the ambulance crew, which already stabilized and prepped the patient for transport. The nurse checks the patient, while the paramedic works with the ambulance crew for the patient transfer. Together, with the support of a rescue personnel, the stretcher is taken to the waiting helicopter. The patient is loaded, and the chopper is gone as fast as it arrived.
En route to the trauma center the pilot is flying the aircraft, communicating on the radio and keeping an eye out for other traffic. In the back of the helicopter, the medical crew work one to keep the patient stabilized, performing additional procedures, if needed, and prep for the landing.
Upon arrival the opposite actions take place. The hospital crew help unload the patient with the assistance of the paramedic, while the fight nurse provides the patient transfer to the receiving medical staff. The debrief complete, the flight crew loads back onto the helicopter for the trip back to base to refuel and restock.
Wings II takeoff from the Greeneville base the day of my visit.
The truth is, it’s not always swoop in and soar out. There is bad weather that keeps them on the ground. Sometimes there are delays finding a suitable LZ in our hilly part of the country. Or, the flight and ambulance crews must take additional actions to stabilize the patient before they are safe to fly.
There is so much that can go wrong, yet they make it all look so smooth.
I was able to spend a day with the Wings II crew in Greeneville, TN last year and concluded that it’s one word that makes this go smoothly despite everything that can go wrong. That word is - purpose. Everything they do, is done with purpose.
The crew
The crew consists of the pilot, flight nurse and flight paramedic, all of which have equal share in responsibility of the success of the mission. Their shift starts with purpose. A daily briefing in which the status of the aircraft, flight crews, weather and daily schedules are reviewed on a conference call with all four Wings bases.
Preflight startup.
While all members of the crew are involved in the preflight of the aircraft, it’s the pilot’s primary responsibility to check airworthiness, weather and flight restrictions. The question I had was why the combination of a nurse and a paramedic? Why not two paramedics or two nurses?
Using an example of a motor vehicle accident, the ambulance crew assesses, stabilizes and preps the patient for transport. When the patient is transferred to the air transport crew, the flight paramedic, having the background in EMS operations, is the “lead” in that transition. Just as the flight nurse, having a background in hospital care, is the “lead” in the transition over to the emergency room. A small detail in the larger scope of patient care, but one that underlies that every detail of the process is reviewed and mapped for effectiveness, efficiency and, of course, purpose.
Small details, biner clips and cloth tape
Each crewmember seemed to have their own custom loadout, if you will, of personal equipment. While their equipment/survival vests vary in design, the smaller details I noticed were a carabiner on a nurse’s flight suit epaulette and the cloth tape on the paramedic’s leg.
A carabiner on the flight nurse’s epaulette or a medical device?
A carabiner, that could have been purchased for 99 cents, can easily become a medical device by holding an IV bag in an elevated position. A simple keyholding device, repurposed.
The tape on the paramedic’s flight suit leg becomes the log sheet for the patient’s vitals in an environment that can quickly become too cluttered with equipment. Upon arrival the information on the tape can be transferred over to the patient report.
The non-glamorous work
There are unseen parts of the job that are critical to mission performance. To maintain the highest uptime performance standard maintenance is purposely performed during the statistically lowest call time period. This provides for the highest available flight transport hours, but not a lot of fun if you are the dedicated mechanic getting up in the middle of the night.
The helicopter is not the only item with regular QA checks. Complete review of missions, reports and flights are completed, filed and peer reviewed before being closed. The purpose being to achieve high-quality patient care.
Behind the scenes
It was awesome to have the look behind the scenes, to see the interaction when they were not in the spotlight. Based on working with them in rescue and training capacities, I knew I would see professionalism. What I found was manufacturing and quality processes but with good bedside manner.
For example, the standup meeting at the start of the shift - common in many industries and a good practice all the way around. However, it was the explanation of the medical crew setup that left me with the lasting impression. The skill overlaps and specializations were to be assumed. How the interactions with the different medical crews, in the field and at the hospital, are mapped and developed show how all the smallest details are purpose driven.
No doubt about it, they have a cool ride. It’s the purpose they put into all of their actions, large and small, that was impressive.
Wings II N631MT (Med-Trans) returning to the Greeneville Base after a medical transport.
I would like to thank the Wings II crew for allowing me to spend a day with them: Nurse Mary Ketron, Pilot Jennifer Brannon, Paramedic Allen Dale Davis and Base Manager John Smith. I would also like to thank Paramedic Adam Williams who provided additional educational insights along the way.