ST. DAVID — Hidden inside an inconspicuous building along a rural stretch of road sits a small, $6 million red helicopter just waiting for a phone call. You hope the call is not about you because if it is, you’re in trouble. Still, you can be thankful that little whirlybird and its crew — a pilot, a nurse, and a paramedic — are also waiting for that call.

One thing is certain: They know how to deal with a diverse array of problems.

“If it’s medical, we do a lot of stroke or heart attack, COVID lately, respiratory distress,” base medical manager and flight nurse Stacy West said. “For scene (work) we also add in the trauma.”

Meet the crew — at least this day’s crew — of the Arizona Lifeline Med-Trans air ambulance service, which is owned by Global Medical Response. Staffing the site on this particular day are EMS helicopter pilot and base aviation manager Dave Bostick, flight nurse Naomi Maakestad and flight paramedic Jessica Bass. During the medical crew’s 24-hour shift and the pilot’s 12-hour shift, they are all devoted to their mission to stabilize an injured or sick patient enough to get him or her safely to the place that can best address the patient’s needs.

Three to go

Bostick has been flying the air ambulance for 18 years, but just to qualify for the job he had to have instrument training and 2,000 hours of flight time. Prior to this job Bostick flew a helicopter for 27 years for the Tucson Police Department. Flying the air ambulance is a job as complex as it seems. Before he can accept a flight, Bostick has to make sure it’s safe to fly, beginning with the weather. Any lightning, storm activity or high winds, it’s a no-go. If the combined weight of crew, patient and equipment are too heavy for the fuel that’s available, it’s also a no-go, although Bostick said he can make a fuel stop along the way, though that takes precious time. Finally, if any of the crew has reservations about the flight for any reason, it is also a no-go. They have a saying:

“Three to go, one to say no,” West said.

“I don’t want to become another incident,” Bostick said. “My job is to safely get my crew to the spot and then from that spot to the (next).”

About half the flights the crew makes are interfacility, for example, from Northern Cochise Medical Center in Willcox to Banner University Medical Center in Tucson. A far flight will be about an hour and a half to Phoenix. The other half of the work is what they call scene flights: life-threatening accidents on Interstate 10 or a local farm, for example. In fact, any event when someone needs serious medical attention now. Of the two, it’s the scene work that’s more difficult.

“Scenes are more hazardous for us because we’re going into an uncontrolled environment to where we have to look for hazards for the helicopter,” Bostick said. “We have to make sure that we have enough room to land safely and have enough power to take off and land again as well. One of the biggest hazards for us is at night: wires, poles, trees, debris on the ground. We don’t want anything blowing up into the rotor.”

Fortunately, local law enforcement agencies and fire departments are aware of the problems that could arise when a helicopter has to land, and they will brief Bostick on where he may safely set down.

At 64 years old, Bostick is only beginning to consider retirement. He’s always checking his skills, making sure he isn’t slowing down and making bad decisions.

“It’s been an awesome job; I love the job,” Bostick said. “I’m not ready to retire but the reality is I’m 64; I’m getting older and (I’m) always evaluating myself (for) a clear head, good health. I have to pass a medical every year ... We want to be the first one to say there’s something wrong, not one of these folks that we’re flying with.”

Expanded roles, cramped space

On any given day, besides the pilot, there is a flight nurse and a paramedic on staff. The difference between them is their scope of practice. The paramedic is the first to work with patients because she is trained to stabilize patients, get them ready for the next step. The nurse is trained to focus on what’s needed after the patient has been stabilized, but in this job both practice in expanded roles and must work as a team.

Even without a patient aboard, the helicopter is cramped at best. Still, there is just about everything in that chopper that you would find in a hospital emergency room, according to West. The main difference is the size of the tools. Most are travel-sized for the med crew’s convenience and are stowed efficiently. There is not one inch of wasted space. In fact, West said, the biggest learning curve in becoming a flight nurse is learning where everything is stowed so she can put her hands on it in an instant.

Patients are strapped into a gurney-like board that sits next to the pilot, feet toward the front, with the nurse and paramedic sitting in the back seats. Although the space is limited, if a patient needs heart resuscitation, for example, lack of space cannot be an impediment. The med crew finds a way to work. In fact, the nurse and medic can perform almost any task needed that is performed in a hospital emergency room.

“We basically carry anything that would be in an emergency room or intensive care unit,” West said. “We don’t have an operating room. We try to get them to the OR quickly.”

Just because they don’t have an operating room doesn’t mean they cannot do invasive procedures.

“We have surgical interventions if we need them,” West said. “We can put in a chest tube if they have a collapsed lung. We can do a surgical airway. We can do all that in here.”

Still, a lot is done on the ground before patients ever go up.

“They spend more time getting the patient ready before they get them in the aircraft,” Bostick said. “There’s a lot of time they’re working with the patient for a lot longer than the actual flight itself takes. It’s harder to work on the patient in here in the aircraft so they’re packaging for 20 or 30 minutes at the hospital.”

“At a scene, we try to be 10,” West added.

While they were being interviewed, Bostick got a call to stand by. That means paramedics have been called to a scene but do not yet know if they will need the air ambulance. Everyone springs into action. They are already dressed in their fire-resistant flight suits so they grab their gear bags and personal helmets with visor and intercom, go out to the helicopter pad, and both the pilot and med crew begin a visual inspection of the helicopter. They have not yet been called out, but in case they are, this has saved at least 10 important minutes in the life of the patient.

“Elfrida’s not a far flight so we usually stay here,” West said. “If we’re going somewhere like Portal or even like San Simon, places that are distant, we’ll get in the air and start heading that way.”

“Sometimes they ask for what’s called an airborne standby, in which case we’ll start heading in that direction so we’re that much closer,” Maakestad added. “That’s their call, on the ground. (It depends) on how severe they think it is and how close they want us.”

Finding no problems with the relatively young — only about a year and a half old — helicopter, the crew members don their helmets and goggles, take their seats, strap in, and then they wait. On this day they waited on the ground. Finally, the stand down order came through. It’s not always like this.

“There are days we don’t get any calls and there are days we do this five times, and that’s usually when it’s 110 degrees,” Bostick said.

There are years of experience when you count up how long everyone has been doing flight work: West, more than five years; Maakestad, nearly 10 years; and Bass, 18 years. Why do they do it?

“In the moments when a patient can’t help themselves, and you’re able to stand in the gap until they’re able to stand on their own again, those are what make it worthwhile,” Bass said.