March 1992
Flight for Your Life
You’re hurt. If you don’t get to an emergency room in a hurry, you’ll die. What you need is a medical helicopter to take you on the …
ALL AROUND HER WAS THE ROAR OF THE helicopter and the smell of her own lost blood. Fourteen-year-old Patricia Bowen focused her frightened eyes on the flight nurse crouched over her head. “Am I going to die?” she asked. Patricia had been stabbed twelve times and was bleeding from her neck, chest, abdomen, and hands. As the helicopter flew at 130 miles per hour toward Houston’s Hermann Hospital, nurse Georgie Brown grabbed IV’s and began pumping fluids into Patricia. “No, honey,” replied Georgie. She carefully locked eyes with her patient. “Hang in there. Don’t give up.”
Slightly more than half an hour earlier, Patricia had answered the door of her middle-class home amid tall pine trees in northwest Houston. A fifteen-year-old boy stood before her. He asked her for a cold drink. Reluctantly, she agreed. Once they were in the house, the boy grabbed her, held her to his chest, and slit her throat with a knife. Again and again he stabbed her. Twice she felt the knife rip into her chest. When she held up her hands to protect herself, he slashed her fingers. Then he fled through the front door. Patricia stumbled after him, collapsing on the front lawn. A neighbor ran over, took one look at Patricia’s bloodstained body, and telephoned 911 for help.
Georgie Brown’s pager went off with a high-pitched whine at 2:19 p.m. on December 10. Within five minutes, Georgie, paramedic Guy Stevenson, and pilot Taylor Jordan converged on the helipad of Hermann Hospital and were soon lifting off. In flight, Georgie and Guy checked their equipment, popped their fingers into rubber gloves, and listened to information via radio about Patricia’s condition from an Emergency Medical Service ground crew. What they heard from the para-medics wasn’t good. Patricia’s blood pressure was dangerously low, between fifty and sixty, and there were decreased breath sounds in her left lung. She was bleeding to death. Inside the helicopter, Georgie’s and Guy’s adrenaline levels soared like those of a couple of runners trapped behind the starting line. Nothing focuses the mind and heightens the physical senses as does the battle with death.
It took only sixteen minutes by air to reach Patricia. The helicopter floated over her neighborhood, dodging pine trees and electrical wires, until it came to rest in the middle of her street. Patricia was rolled on a stretcher through the rear of the helicopter, and soon she was en route to Hermann Hospital. A chorus of beepers signaled her arrival to a team of trauma surgeons, surgical and emergency room residents, respiratory therapists, nurses, and x-ray employees. Suddenly the room filled with all kinds of noise. The electric door swung open. Georgie and Guy rolled Patricia in; heavy machinery was being pushed around. Over the roar came the authoritative sound of Georgie’s voice: “I have here a fourteen-year-old white female who has been stabbed approximately twelve times.”
The trickiest part of the surgery was repairing two punctures near Patricia’s heart. Two surgeons worked side by side. One of them was Dr. James H. “Red” Duke, the director of emergency services and the medical director of Life Flight at Hermann Hospital whose health messages have been syndicated on television and have made him a celebrity. “The principle at work here is for everybody to hold their hosses,” said Duke, as he reached into Patricia’s chest, rolled her heart over, and then held his finger on a wound beneath her heart to stop the flow of blood. He looked like a highly skilled plumber plugging a leak. Dr. Neel Ware, the other trauma surgeon, stitched up a nearby hole. Together they worked on closing the other ten.
The next morning, Duke dropped by the intensive care unit. “How ya feelin’, Patricia?” he drawled. “Pretty good,” she replied. Duke peered at her through thick bifocals and twirled his heavy moustache. “That’s good, honey, because ya sure got a hell of an airing out yesterday.”
Patricia Bowen looked at Duke blankly. She had no idea how lucky she was to be alive. She was lucky to be among the 40 percent of Texans who have access to a 911 system. She was lucky to live near a fully staffed trauma hospital. Most of all, she was lucky to have gotten a ride on the $1.7 million helicopter that saved her life.
“IT’S AN ABSOLUTE TRAGEDY THAT THE PUBLIC continues to deny the presence of the epidemic called trauma,” fumed Red Duke. “We are in mass de-NI-al, and believe me, de-NI-al ain’t no river in Egypt.” Duke was seated near the coffeepot at the Life Flight offices at Hermann Hospital, haranguing on his favorite subject—the crisis of trauma-related injuries in Texas. To judge by the state budget, trauma doesn’t even exist. No state money goes to pay for treating trauma. By comparison, about $10 million of state and federal money is spent on AIDS. “Trauma in Texas is sort of like the elephant in the living room,” said Duke. “Everybody talks about the elephant, feeds it, and cleans up after it, but nobody really sees it or does anything about it.”
What has Duke worried is that trauma is the number one killer of people under 44. Not only are trauma injuries increasing, but the number of hospitals in which trauma patients can be treated is dwindling. So many Texas hospitals have closed that in effect we have a hub-and-spoke system of hospital care: Patients who were once treated near the scene of accidents now have to be airlifted to larger, hub hospitals in big cities.
Helicopters can make the difference in such cases. In suburban Austin a teenage driver loses control of his car and suffers a head injury, a broken pelvis, and a broken leg when his car rolls down an embankment. A helicopter arrives within a few minutes, paramedics place a tube down his wind-pipe so he can breathe, and half an hour after the accident, he is in a hospital and on an operating table. Flight paramedics and nurses call cases like this one “neat saves,” which not only create the mystique of flight crews as white knights—the A-Teams of emergency medicine, heroes driven by an internal need to intervene in life-and-death situations—but also demonstrate why helicopters are effective: They save time. A thirty-mile ambulance ride can take up to forty minutes, depending on traffic, while a helicopter travels the same distance in twelve to fifteen minutes.
Helicopters were first used for trauma in the Korean War, where the concept of the “golden hour”—the sixty minutes following a traumatic injury, in which the odds of saving a patient are highest—was first discovered. During World War II, casualty rates were 4 deaths per 100 soldiers wounded. In Korea that number was cut to 2.5 deaths per 100 wounded, with the help of helicopters that transported wounded soldiers to physicians within the golden hour. In Vietnam, when helicopters came into their glory, the casualty rate dropped further, to 1 death per 100 wounded.
In 1972, St. Anthony’s Hospital in Denver became the first hospital in the country to provide EMS helicopter service. Duke started the first medical helicopter program in Texas in 1976 because banker John S. Dunn donated $135,000 to Hermann Hospital to build a helipad. “I had no idea what I was getting into,” said Duke. “I just figured if I had a helipad, I better damn sure go out and find some helicopters.”
After Hermann and five other hospitals with helicopter programs published studies showing that critically injured patients transported by air stayed in hospitals longer than patients brought in by regular ambulance, the race was on to fly in paying patients. Helicopters became flying billboards for hospitals, and flight crews became celebrities, visiting local schools and making appearances on the television news. By the end of 1986, there were 150 helicopter programs operating nationwide, and five Texas cities were included.
The hospitals wanted the cheapest helicopters they could get and wanted them to fly as much as possible. Often that meant single-engine helicopters flown by a pilot working a 24-hour shift. Helicopter leasing companies saw EMS as the answer to the downturn in their off-shore drilling business and were eager to make any deal they could.
“The push to fly in those early days was enormous,” said Mike Phillips, who flew for Life Flight in the late seventies and now flies for Austin’s Brackenridge Hospital—based Star Flight. “The hospital would tell us: ‘Go or the patient will die,’ and the leasing contractors would tell us: ‘Fly or you don’t get paid.’ ” Accident rates started to climb. In 1982 alone, there were about 25 EMS helicopter accidents nationwide per 100,000 patients transferred. “Guys were dying all over,” said Phillips. “First-rate pilots were flying into wires, all sorts of crazy things. The reason was, they were so tired. In the early years, there were times I was so tired after work that I couldn’t drive home, but I’d been flying for twenty-four hours with a helicopter full of people.” Finally, in response to lawsuits and bad press, the Federal Aviation Administration in 1988 issued new regulations for EMS helicopters that established rest requirements for pilots, as well as increased safety procedures. Since then, most helicopter programs have gone to four pilots working 12-hour shifts, instead of two working 24-hour shifts. Moreover, pilots are now the final authority on when it’s safe to fly and when the helicopter stays put. The result has been fewer accidents. In 1990, there were none.
Today thirteen helicopter programs are operating in nine Texas cities. Of the state’s biggest cities, Houston, Dallas, San Antonio, Fort Worth, and Austin have helicopters, but El Paso and Corpus Christi do not. The other programs are in Lubbock, Beaumont, Tyler, and Galveston. Between them, they cover all of the state except the Trans-Pecos, South Texas, and the tip of the Panhandle. All of the helicopter programs except Austin’s, which is operated jointly by the city, the county, and city-owned Brackenridge Hospital, are driven by profit. A basic no-frills program costs about $750,000 a year to operate; Hermann’s Life Flight, the busiest one in the state, costs $4.5 million. In most cities, helicopters are used more than half the time to transfer patients from one hospital to another rather than to pick up victims.
“When we first started out, we were kinda making it up as we went along,” said Duke. “We’ve finally figured out how to safely use the helicopters for covering vast distances within the golden hour. Now if we could just teach people not to do dumb things to hurt themselves, we could call it quits.”
