BEAVER - Veteran crewmembers call them "goober days." They're the first day on the job for new flight nurses and paramedics. It's the day when they get used to the helicopter - and get over the coolness factor of flying in it.
On their first flight, goobers often sit up front next to the pilot in one of HealthNet Aeromedical Services' choppers. It gives them a chance to sightsee, to get the joyride out of their systems. On their next flight, the rookies move back to the mini intensive-care unit that's crammed into the aircraft's fuselage. There, they observe the realities of critical patient care in hot, cramped quarters. Hopefully, they learn that their work isn't as glamorous as their new HealthNet flight suits might make it seem.
During the past two months, the Gazette-Mail flew several times with HealthNet Base No. 5 - HealthNet 5 - at Raleigh County Memorial Airport, just outside of Beckley. Daily life on the base is dictated by the emergency calls that beep on crewmembers' cellphones and sound throughout the base. But not every call involves a major car accident on the Turnpike. And some days there are no calls.
The flight nurses and flight paramedics at HealthNet 5 say the public might have misconceptions about their work - and their identities. They're sometimes confused for the pilots who fly HealthNet's gold and blue birds;
sometimes people they know don't recognize them without their flight gear. The public looks up, they say, and just sees a helicopter.
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Brandi McMullen, a flight nurse, and Jody Ratliff, a flight paramedic, joke that they fight over opportunities to perform intubations.
On a hot morning in mid-June, the duo sat in the back of their $6.5 million Eurocopter EC-135 at HealthNet 5 and checked the aircraft's medical equipment. They were "mission ready" in full-length, navy blue flight suits, but they'd rolled up their sleeves.
Intubation - when a tube is inserted into a patient's throat to facilitate breathing - is a challenging procedure to perform in a jostling helicopter. It's rare: From January to May, HealthNet 5 crews performed the procedure just eight times, and McMullen said on Aug. 26 that she's only intubated two patients all summer. But it's a rewarding procedure - an affirmation of competency and a chance to practice. So, when McMullen and Ratliff work together, they take turns.
Ratliff, a 40-year-old Union native and U.S. Navy veteran, has worked for HealthNet for almost eight years. He's tall, with a shaved head above a salt-and-pepper goatee, and tattoos peek out from beneath his flight suit. McMullen, 38, hails from Summersville and is an experienced emergency room nurse. She's tan, with shoulder-length sandy-blond hair, light-blue eyes and an athlete's build. She's been with the company eight years.
HealthNet began in 1986. President and CEO Clinton Burley, a former flight paramedic himself, said in June that the West Virginia State Police had once operated an air-ambulance service but its funding dried up in the mid-1980s. Mountain State hospitals saw a need and took action. Today, HealthNet is a nonprofit organization jointly operated and funded by Charleston Area Medical Center, Cabell Huntington Hospital and West Virginia University Hospitals.
The company has nine bases now, having opened its Lewisburg location in July, and during the past three decades, it's flown more than 75,000 patients, accident free. According to HealthNet, its average flight costs a patient about $15,000.
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On the sunbaked tarmac, Ratliff and McMullen continued to prep their aircraft. Moments earlier, they had walked around the helicopter with the pilot, who was looking for any signs of damage and abnormalities. Before that, McMullen had checked the base's supply of blood.
The blood, which is used for in-flight transfusions, is a new addition to HealthNet flights, McMullen said. It's kept in a small refrigerator inside the base's hangar, where Hogan - the base mechanic's German shepherd - sits and guards his red ball.
The hangar houses maintenance supplies and the crew's flight helmets. It's also stocked with lounge chairs, cornhole boards and an exercise bike. When crewmembers aren't completing fatigue self-assessments, ordering medical supplies and filling out paperwork, there's some downtime.
Upstairs is a TV facing two recliners, in which Ratliff might relax. There's a kitchen that McMullen - the base "mom" - tries to keep clean. She's labeled all the cabinets, and she's likely to chase fruit flies around the place, killing them with a portable bug zapper that looks like a small, red tennis racket.
Downstairs, adjacent to the hangar and the pilots' operations room, are the crewmembers' bedrooms. Crews can rest if they're on the 8 p.m. to 8 a.m. shift, or if they're on a 24-hour shift. Sometimes they can sleep through the night, but a busy day - five emergency calls in 24 hours - might keep them up.
"Trauma season," the summer months between Memorial Day and Labor Day, tends to be busier. People are more apt to be on boats and ATVs and out hiking - and to have accidents. The number of "scene flights" - when their helicopter is dispatched to makeshift landing zones at accident sites - tends to increase. Other days are more routine, maybe a couple of "inter-facility transports," when a patient is airlifted from a smaller hospital to a larger one with more care capabilities.
HealthNet 5 never knows what a day will bring. It has to wait for the first call.
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McMullen, Ratliff and pilot Chris Kempler agreed to take the call, an inter-facility transport of a patient from Princeton Community Hospital to CAMC.
There were some pop-up thunderstorms in the area, typical for a mid-June afternoon, but their path south toward Princeton was clear. And since they had just come on shift at 8 a.m., their fatigue-risk levels were low enough to accept the mission. "It takes three to go and one to say no," as the company-wide saying goes, and all three crewmembers felt comfortable taking this flight.
System-wide, HealthNet crews had to refuse 1,303 flights from January to July, according to data provided by the company. In about 88 percent of those missed flights, the weather was the culprit. Of the 2,125 flights completed over the same period, roughly 70 percent were inter-facility transports.
Kempler pursed his lips in concentration as he lifted the EC-135 off its landing pad. He swung the tail left and climbed, eventually reaching 4,000 feet. In the back, McMullen and Ratliff had received more information about the patient in Princeton.
The patient was reported to have gastrointestinal bleeding.
They landed about 35 minutes later, picked up the patient and transported her without incident to CAMC. There, they waited out a thunderstorm before returning to base. When they landed at HealthNet 5, McMullen and Ratliff went upstairs and completed their post-flight paperwork.
McMullen's shift ended. Ratliff would stay on for another 12 hours. He'd be awakened in the middle of the night and don his night-vision goggles - another inter-facility transport (a man who'd had a heart attack), this time between two hospitals in Virginia.
The afternoon thunderstorms, high humidity and low winds had produced nighttime fog in most of HealthNet 5's 150-mile operating radius. With the exception of the flight to Virginia, the base's airspace was shut down.
The day ended with just two flights: about four hours of flight time - maybe two hours spent with patients.
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"If you write about the pilot, everyone will care," HealthNet 5 base manager Kay Eliason said. A sly grin appeared on her face as she rocked in one of the base's recliners on a mid-July afternoon.
The pilots and their birds are what the public finds interesting, she said. HealthNet crews joke with the pilots, call them glorified ambulance drivers. The pilots take it in stride. The patches on their flight suits read "Air Methods" - the company HealthNet contracts with for pilot services - but they're on the same team as the medical personnel.
"From the outside, it looks pretty glamorous," Eliason said. "Obviously, you're in a flight suit riding in a helo. But it's a lot of hard work."
In the adjacent room, a whiteboard hung on the wall. It listed 16 crewmembers - including Eliason, Ratliff and McMullen - and about 10 different lifesaving certifications each HealthNet employee had to maintain: Advanced Cardiovascular Life Support ("ACLS"); Pediatric Advanced Life Support ("PALS"); and Neonatal Resuscitation Program ("NRP") were among the first listed. In the same room were crewmembers' binders, which documented the outreach and education they had performed for various organizations, such as hospitals and law enforcement agencies.
"People don't know the level of critical care a patient can get," Eliason said, commenting on the number of trauma centers per square mile. There are just two Level 1 - the highest level - trauma centers (CAMC and WVU Hospitals) in the state, according to the West Virginia Bureau for Public Health. The state has about 24,230 square miles.
"You're gonna prepare half the time - minimally - to be ready to fly," Eliason said.
Earlier that morning, McMullen sat in the hangar and worked a new liner into her flight helmet. When she first learned they'd start carrying blood on flights, she said, she started a training regimen for the base. She made a batch of fruit punch and put it in the same type of clear bags. She practiced refrigerating it between 1 and 6 degrees Celsius. She rehearsed loading and unloading it on the helicopter. And she placed a sign in the aircraft's tiny intensive-care unit. "Got blood?" it reads.