My jobs in the US tended to be in isolated rural clinics, where the nearest trauma center might be 300 miles away.

Thirty years ago, that meant either we docs send would have to transfer someone in a three plus hour ambulance ride (yes, sometimes at 100 miles and hour) or, if it hadn’t rained and it wasn’t snowy, to fly them out in the Piper cub of our local funeral director whose plane doubled as an air ambulance.

He landed either on the road, or, at night when it was dry, on a nearby soybean field, which had landing lights.

Needless to say, there wasn’t much we could do in case of an emergency at 5000 feet with a medical bag, oxygen, and an IV pump.

Thank goodness things have improved, and now air ambulances come straight to you. Sometimes they actually can land at the site of an accident, but usually they would land next to the small rural hospital or clinic on a helipad.

Modern air ambulances includes staff and equipment to keep the patient alive. Usually it is a nurse, but not always. We’ve had doctors come along when children were involved.

In the North woods of Minnesota this meant landing on a helicopter pad behind the hospital; but if it was foggy or windy, it meant a run to the “nearby” airport 28 miles away, or 34 minutes in good weather to be picked up by a “fixed wing aircraft”.

When possible, we sent by ground. Sometimes the family would say: Why a five hour ambulance drive when a helicopter could make it in one hour? To which I would reply: Well, yes, but your father/uncle/mother isn’t that critical, and sometimes the helicopters crash.

You see, thirty years ago, I lost a pregnant patient in an air crash. It was a “fixed wing” aircraft, not a helicopter.

Our patient, whose name was Ruth, was expecting her third baby, and we suspected placenta Praevia because she kept bleeding.

Back then, to help us sort out our “high risk” patients, we had a grant to allow specialists to come up once a month and check our patients. They brought an ultrasound along (most hospitals didn’t have one back then) and sure enough, complete placenta previa. We worried that a long bouncy ambulance ride could have caused fatal bleeding. So the docs said: No problem. we have room in our plane (a six seater with only three passengers).

On the way back, they landed in one city to drop off one doctor and the equipment, and then took off for the fifty mile flight to the referral hospital, but never made it. The plane stalled on take off, and the pilot attempted a landing. The doctor and pilot lived, severely injured, but the patient and her baby did not….

.  .  .  .  .  .  .  .  .  .

USA Today has an article about air ambulance crashes: there have been four such crashes since December 30th.

Most of the crashes were due to ground clearance problems, and at least one was at night, and all were in helicopters, not fixed wing aircraft, which tend to be more stable.

It’s up to the pilot to decide when things are safe, and most of them know their job. But sometimes things go wrong, including weather conditions that deteriorate in the midst of a flight (as shown in Senator Wellstone’s plane crash, God bless his soul).
I remember one patient who we hospitalized with what we thought was a routine case of Pancreatitis. But late in the afternoon, he suddenly deteriorated. I’d seen cases of Hemorrhagic Pancreatitis go into shock and die quickly, so I called the air ambulance to come over to transfer him to a hospital with a good ICU.

Usually the ambulance could pick up our patients in an hour to an hour and a half, but I was so busy with the patient that I didn’t realize that it took them two and a half hours to arrive.

What took you so long, I asked, a car wreck? (If there was a car wreck, often we’d have to wait for the back up helicopter).

Nope. The hail storm, the pilot replied.

I looked out, and it was clear, so I thought he was joking.

Well, anyway we shipped the fellow off, and I went home, only to turn on the TV find that between us and our referral hospital there had been a huge hail storm.

The air ambulance had to go miles 100 around the storm, which included stopping and refueling, before he arrived. Luckily the storm was gone for the return flight to the hospital, and the patient survived.

…..

So today I’d like to salute those “everyday Heroes”, the fellahs and gals who man the air ambulances that save lives everyday but rarely get thanked.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog.

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