- Associated Press - Monday, May 15, 2017

ABERDEEN, S.D. (AP) - There’s limited room inside a helicopter, but working within that space to provide critical medical care is something the Avera Careflight crew must know how to do.

The smaller environment with fewer resources poses challenges that grounded medical personnel don’t encounter, said Anna Vanden Bosch of Sioux Falls, a clinical care manager for Careflight.

But even with the tight space, the helicopter packs plenty of accessories.

“There’s a lot of equipment that’s unique to our environment. We have a video laryngoscopy. We always carry blood on every flight, which is unusual, but it’s a very life-saving thing,” Vanden Bosch told the Aberdeen American News (http://bit.ly/2pUrFqd ).

A video laryngoscopy is a tool used to see down a person’s throat to determine whether there’s an obstruction.

One procedure the crew is trained to perform is creating a “surgical airway.” That involves making an incision in the patient’s neck to provide an alternative airway when there’s an obstruction.

Flight nurse Bobby Hegge of Sioux Falls said the hospital provides the crew with the autonomy necessary to keep a critical-care patient alive until the helicopter can get to a medical center that offers a higher level of care.

“There are facilities that frequently call us that we’ll go to repeatedly, like Redfield, Oakes (N.D.), Mobridge,” he said. “We’ll either transport them to Fargo (N.D.) or we’ll take them to Sioux Falls. If we have a motor vehicle accident, we’ll usually bring them back (to Aberdeen) where we’ll stabilize them and assess them, then if they need further higher care we’ll take them to Sioux Falls or Fargo for that care.”

Traveling at high elevations in rural areas often puts the crew out of radio and cellphone range.

“A lot of times we’re just kind of on our own so we can’t phone a friend or doctor to ask them for advice,” Hegge said. “So they train us for a lot more for complex interventions and situations and trust us to do the right thing.”

The team uses specialized equipment that can adapt to its environment, Vanden Bosch said.

“We have specialized ventilator, monitors and IV pumps that are very specific to air transport. Even altitude affects our patients. There’s also the noise, vibrations and the most important thing is watching our environment to make sure we as a crew, along with the patient, get home safely,” she said.

Ten people comprise the tight-knit Aberdeen Careflight team tasked with providing emergency medical care to patients who are far removed from a hospital or clinic. There are other Careflight stations in Mitchell, Sioux Falls, Yankton and Marshall, Minn.

John Kirk, one of Aberdeen’s four Careflight pilots, spent years rescuing people in the Coast Guard before turning to a civilian career helping those in emergency situations. He said he has 22 years of flying experience.

“A lot of the pilots you’ll find in this industry are ex-military. In fact, almost exclusively,” said Kirk, from Sioux City, Iowa.

With eight years of experience, Hegge said the extra training required of the Careflight crew is worthwhile, but being a member of the team is challenging.

“It’s not for everyone, that’s for sure,” he said.

Vanden Bosch has worked as flight transport clinical care manager for 10 years.

“There’s a lot of other expectations, like getting off late. I think a lot of our families know that. At the end of the day, you’re not necessarily going to get off at 7 p.m.,” she said.

Rarely does the crew allow anyone other than the patient to ride along in the helicopter.

“Typically we don’t take anybody else. The aircraft is small. You can take one more, we have one more seat in the aircraft. But typically there’s a lot of good reasons not to take them along,” Kirk said. “It’s not because we’re heartless, it’s because we’re focused on the patient care, and to have an extra person on there really inhibits their ability to work with the patient. If it’s a loved one, it can be really difficult to watch - some procedures look awful, but it’s for their own good.”

The bill for Careflight services can often exceed $10,000, and crew members say they do their best to avoid passing expenses along to patients and their family members.

To that end, the helicopter won’t pick up a person and start medical care if the person is going to die, Vanden Bosch said.

However, she said, the Careflight can respond to a call and provide medical treatment at no cost to the patient. A person is only billed for Careflight services if he or she is transported by the helicopter.

As a pilot, Kirk is very attuned to the environment, particularly the weather conditions. He pays close attention to the weather radar and constantly updates his flight plan as conditions change.

“We’re on call, and I don’t know when we’re going to get a flight, so you always have to be prepared,” he said.

Conditions that compromise safety are considered when determining whether Careflight will respond to a call.

“Our pilot in command is our No. 1 safety priority, we would never jeopardize that,” Vanden Bosch said. “Obviously, we live in South Dakota where weather changes very quickly and that can change, but we’re trained that nobody has to go on it unless we’re all OK with it. I think on the backside, I don’t think people realize how much goes into the preparation for the flight. There’s so much safety that goes into it. That’s our priority.”

Even so, there can be problems.

In 2002, three members of a Careflight crew and a patient were killed when the helicopter crashed in a field near Doland. The cause of the crash was determined to be pilot error.

A Careflight helicopter pilot crash landed near Aberdeen in 2012 after the engine started to make strange noises.

Vanden Bosch said the mechanics of the helicopter are closely monitored throughout the day, drastically decreasing the chances of breakdown.

Much of the time, the Careflight team is on standby in the event there’s a call. But the crew also helps at the Avera St. Luke’s Hospital.

“We’ll help out in the emergency room if a critical patient comes in, just to give them some extra hands, because we’re all on the same team,” Hegge said.

The job is both physically and emotionally demanding, but it’s worth it, Vanden Bosch said.

“I think at the end of the day it’s not about the save, it’s about the whole community and family that you’re there to benefit,” she said.

“Unfortunately you do have those patients that will pass away, but you will never forget those families that you stood there, side by side with them to provide that care. Obviously I think pediatrics have a soft spot in a lot of people’s hearts, and it’s not that any one person’s life is more valuable than the other, but it’s always harder (when a child is involved). I always think that they haven’t lived their life and it’s always harder,” Vanden Bosch said.

After difficult transfers, crew members take time to decompress. They tend to understand each other.

“Sometimes it’s not even saying anything to each other, it’s just respecting each other and knowing that it was hard,” Vanden Bosch said.

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Information from: Aberdeen American News, http://www.aberdeennews.com

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