Into the Wild Blue Yonder
It’s a sunny and surprisingly warm morning on the first Monday in October. On Pier 7 in Canton, but for a couple of men hosing down a sailboat, all is quiet on the waterfront.
Pier 7 is the base site for Lifeline’s new helicopter. Painted Hopkins blue, emblazoned with the Johns Hopkins Medicine logo, the American Eurocopter EC145 sits on a landing pad near the water. In a small trailer, on alert for the next assignment, is the crew: Lisa Denton, a Johns Hopkins Lifeline flight nurse, pilot Carl Jordan and paramedic Luke Haynes, both of STAT Medevac, the air-medical transport service that owns and operates the helicopter in partnership with Hopkins. They’re taking care of all the administrative details involved in keeping a helicopter ready for emergency service at any hour of the day or night.
Suddenly, at 9:15 a.m., a siren shrieks. The crew, attired in black, flame-resistant jumpsuits, hurries out of the trailer and heads for the helicopter. Donning white helmets outfitted with two-way radios, they buckle up their seatbelts. A man in Gettysburg, Pa., they soon learn, needs emergency bypass surgery.
“Turning one,” announces the pilot, as he fires up the first of the bird’s two engines.
As the aircraft’s rotors begin turning, the water surrounding the pier breaks into thousands of foam-capped ripples. Moments later, the pilot checks the caution lights before announcing that both engines are ready to fly. The helicopter lifts off and rapidly ascends, the sun glinting on its whirring, silvery rotor blades.
From the ground, the triangular logo, painted on the bird’s belly and announcing the most famous hospital in America, is clearly visible. Then it gradually disappears into the blue as the helicopter sets off on its first mission of the day.
Every year, the Johns Hopkins Lifeline helicopter logs about 750 flights, averaging 70 per month. It transports patients who are critically ill and injured, among them accident victims, cardiac patients, people with brain injuries and severe burns, women with high-risk pregnancies and perilously premature newborns.
The helicopter is only one form of transportation offered by Lifeline. The Department of Emergency Medicine provides ground transportation via taxi, sedan, limo and ambulance. It has access to airplanes that transport patients to Hopkins from all parts of the country and abroad. Some Lifeline staff specialize exclusively in transporting critically ill patients within the hospital. Everything is coordinated out of the Communications Center, which altogether handles about 27,500 transports a year.
Lifeline was established in 1992. The idea of adding a helicopter to the program came to James Scheulen, Lifeline’s founder and chief administrative officer, about five years ago. That’s when Scheulen noticed the challenge of transferring certain patients to Hopkins Hospital.
“We began to see that we were getting referrals from farther away,” says Scheulen, also Emergency Medicine administrator. “Meanwhile, the acuity of the patients being transferred was incredibly high. We were transporting sicker and sicker patients over longer distances. We were really facing patient care and safety challenges.”
Up until then, the state police had kindly offered their helicopters to transport patients to Hopkins. But as the number of transfers increased, it became clear to both parties that a more efficient service was needed for the sickest patients located within a 150-mile range of the hospital.
Scheulen faced a choice: Purchase a helicopter and pay for its upkeep, or partner with a private company. “I didn’t necessarily want to be in the helicopter business, because it’s not the core business of what Hopkins does,” says Scheulen.
So he struck a deal with the country’s largest private provider of helicopter medical service, STAT MedEvac. The partnership, he says, has turned into a win-win relationship. “STAT MedEvac bills the patient or insurance company, and Hopkins gets a service we very much need.”
Lifeline’s helicopter service allows sick patients to avoid being stranded for hours in an ambulance stuck in traffic. It takes about 30 minutes to transport patients from the Eastern Shore, whereas an ambulance ride over a congested Bay Bridge could take hours.
“Some people think it’s a pricey way to get from one hospital to the next,” says pilot Carl Jordan, “but I say that by the time patients get into these situations, the ride often costs only about 1 to 1.5 percent of the total cost of their treatment.”
Indeed, time is the helicopter’s great advantage when it comes to dealing with seriously ill patients. It means, though, that Lisa Denton only has the patients for about 30 minutes. Nevertheless, she enjoys meeting the families and assuring them that the flight will be safe. Few patients, she notes, have ever flown before.
“That amazes me,” says Denton. “You try to convince them as much as you can about the advantages of the helicopter, but you don’t want to stress them out.”
Fortunately, most patients relax when they see that the cabin is more spacious than they thought it would be. This, despite all the trappings of a miniature intensive care unit, including cardiac and fetal monitors, a defibrillator, a ventilator, bags of blood and narcotics, and even ECMO (extracorporeal membrane oxygenation), an elaborate heart-lung machine for infants.
To keep the cabin clean, the team often lays out a sheet of disposable foil wrap before patients are moved in. “Blood can corrode wires if it gets into the aircraft, so we try to keep as much as we can contained,” says Denton.
Most of the patients the crew picks up are headed to Hopkins for services their own hospital can’t provide, such as high-risk obstetrical procedures. That doesn’t mean all babies are willing to wait, however.
“Once, I delivered a baby on a flight,” says Denton. The 34-week baby boy weighed in at 6 pounds. It was a fantastic experience, she says—aside from the fact that it took place at 5 a.m.
A morning in Pennsylvania
Lifeline’s four pilots, five paramedics and six Hopkins nurses fly mostly in Maryland, Pennsylvania and West Virginia. Most often, they transport patients from outlying hospitals to Hopkins. Occasionally, the team also assists other institutions. That is what happened on that first Monday in October.
After transporting the cardiac patient from Gettysburg Memorial Hospital to York Hospital, it didn’t take long for the crew to realize that they were in southern Pennsylvania on a particularly busy, and tragic, day.
Only minutes into the flight back to Baltimore, they received a call from Hanover, Pa., where a woman had developed a bleed in the brain after falling on her face. After shuttling her from Hanover to York Hospital, the crew was put on standby twice, once for the victim of a car accident who suffered an amputated leg. And once for the school shooting of the Amish children in Nickel Mines.
Both standbys were canceled (the victims of the school shooting were flown to Children’s Hospital of Pennsylvania and Penn State Hershey Medical Center), and finally, four hours after leaving Baltimore, the crew returned home to Hopkins.
“No one is too sick to transport”
When you work on the Lifeline helicopter, there’s the all-consuming task of helping sick patients. During the down time, there’s the administrative work and seeing to it that all the equipment and medical supplies are up to date.
When they’re working, Denton and her colleagues live in the trailer by the harbor in Canton. Inside, it’s fully outfitted with an office, bedrooms, living room, bathroom and kitchen. “Whoever makes the dishes, washes them,” says Jordan.
Unlike Denton and paramedic Haynes, who work 24-hour shifts, pilot Jordan is limited to working 12 hours because of federal aviation regulations. Sitting in the cockpit, he’s separated from the two other crew members in back by a material divider that stops any light in the back from blinding him at night.
That’s not the only way Lifeline pilots are kept in the dark. Jordan is not given the details of his next mission until he’s actually at the hospital picking up the patient. The idea is to avoid having a patient’s condition influence his piloting. Once he does learn the details, however, he takes into account the patient’s weight, fuel load and weather conditions to make sure the aircraft will be balanced and fly safely.
Weight is a critical issue. Lifeline crew members can weigh no more than 200 pounds—one reason you won’t find any candies or junk food in the trailer. Because patients often weigh more, Jordan at times must burn off fuel to compensate.
The only truly limiting factor is Mother Nature. The crew does not fly if it’s too foggy or if there are thunderstorms. “Otherwise, no one is too sick to transport,” says Denton. “We brought one woman from Wilmington with her chest wide open to Hopkins. We all thrive on helping the sickest patients.”
The long shifts can be busy and tiring. Still, in Denton’s mind, she has the best job available in nursing. “When it’s just a paramedic and nurse, it’s really up to us,” says Denton. “It’s a nice feeling to have done something on your own without too much back-up.”