Lifeguarding Into the Night

Saving lives from the sky

June 1, 2006

The harsh ring of the "bat" phone breaks the silence of the night at 1:30 a.m. Rubbing the sleep from my eyes I clear my head while listening to the California Department of Forestry dispatcher. There is a motor vehicle crash on Highway 1 along the California Big Sur coast 56 miles away. As I quickly don a Nomex flight suit and boots, my mind starts to cover the dozens of variables that will affect our ability to perform this flight safely. It's a challenging flight in a mountainous area on a moonless night, and the area of the accident is remote without ground lighting. The only ground reference we can expect will be from the lights of the emergency vehicles responding. Even if this flight is possible, it won't be easy.

Each day and night hundreds of patients are flown by air-medical helicopters in lifesaving efforts throughout the country. Inspired by the medevac helicopters of the Korean and Vietnam wars, today's air-ambulance helicopters are state of the art, providing not only fast transportation to hospitals but also a very high level of medical care. It's a miniature version of an emergency room at 135 knots. I am a helicopter captain flying for California Shock Trauma Air Rescure (CalStar).

While I check weather at the computer, the two flight nurses, Chris McIntosh and Ken Smith, stand quietly behind me. Is it back to bed or will they go to work to save a life? It's apparent this will have to be an IFR flight as there are weather issues. All airports are reporting a low marine layer with bases from 300 to 500 feet. Obviously the accident scene doesn't have an instrument approach, so there may be a problem in transitioning from the IFR to VFR environment.

Dispatch tells me that a volunteer fire unit driving to the crash just reported "seeing stars." This is a vital piece of information as it indicates that the marine layer has not moved into that part of the coast, at least not yet. I look over my shoulder and nod to the nurses as I print the latest weather. I explain the flight plan to the flight nurses and we all accept the flight. It's a go.

Minutes after our wake-up call, we are at our Bell 222 helicopter, a single-pilot IFR twin-turbine-engine helicopter. I call Northern California Approach direct on the cell phone from the helicopter to get an IFR clearance. As a priority lifeguard, we have a great working relationship with air traffic control. I get our IFR clearance with void time in less than a minute. I spool up the engines and quickly run through the checklist. The Garmin 530 and 430 are programmed with the IFR clearance. A few minutes later we are in the air in instrument meteorological conditions flying a departure procedure.

The autopilot is engaged flying a course and is preset to level off at 7,000 feet. The marine layer is prevalent and as we continue to climb, we can see the soft glow of lights emanating up through the clouds. We have departed our home base, Saint Louise Regional Hospital in Gilroy, California, and will be flying down the coast via PEBBS Intersection on Victor 27, Pebble Beach on the Monterey Peninsula.

This routing is advantageous for several reasons; it avoids the worst of the St. Lucia Mountains with a grid minimum (the minimum IFR altitude for an aircraft not on a published route) off-route altitude of 8,200 feet. Just as important, it has us coming from a direction to the crash scene where the Salinas Valley lights will be visible to our left. This will become important when we transition to VFR flight. Over PEBBS at 7,000 feet a course change is made and the autopilot gently turns the Bell left to the southeast, and parallel to the coast. We are flying at 145 knots, burning 530 pounds of Jet A per hour, and the engines are loping at a mere 57-percent torque. I have entered the latitude and longitude of the crash scene into the Garmin 430 and we are just seven minutes out.

The soft glow of surface lights we were flying over is long gone and there is nothing but blackness, although I can see the distant glow of the towns in the Salinas Valley 25 miles to my left. Five minutes from the scene a pair of headlights is seen weaving through the tight curves of Highway 1. A few minutes later the Code Three lights on the emergency vehicles are seen. IFR is cancelled and ATC is informed that another IFR clearance will be required in about 20 minutes.

Still at 7,000 feet, we will be landing on Highway 1 a few hundred feet above sea level. We make the transition to VFR flight and use the vehicle lights as a ground reference. We start descending with S-turns, always turning toward the scene, so that visual contact is never lost, remaining offshore west of the highway and away from the mountains. East of the highway is no man's land, where the mountains can go from sea level to 5,800 feet in a matter of a few miles.

Traffic on the highway is at a standstill because of the accident, and there are several cars waiting for the road to clear. One of the flight nurses radios the volunteer fire unit on scene to get all the vehicles to turn on their headlights. The lights are now more plentiful and more spread out, and this helps our visual reference.

The flight nurses have been working hard at obtaining patient and hospital status, and reviewing medical procedures that they may have to perform. I radio the landing-zone personnel and receive vital information concerning our landing zone. This includes any potential hazards such as loose dirt, wires, winds, fences, signposts, trees, and severe slopes. The Mid Coast Fire Brigade is a volunteer unit that has received specific training regarding helicopter operations. Its help is vital for these challenging nighttime operations, and the volunteers do a great job communicating potential hazards. There are no wires, but there is a cliff going up to the east alongside the highway.

The landing will be on asphalt, but there is a little loose dirt on the highway shoulder that the fire crews are wetting down. This dirt will go airborne from the helicopter rotor wash, if not wetted down, and create a dangerous condition known as a "brown out." A brown out can reduce the pilot's ability to see ground references and control the helicopter. A prelanding briefing is conducted, and everyone is aware of his or her specific tasks regarding particular hazards. The flight nurse on my left has the very important task of watching the cliff at all times as we land. All the external aircraft lights are on, including the "night sun." This is a 30-million-candlepower light that is controllable from the pilot's collective flight control. Not only can this light move up, down, left, and right, but also the beam can be widened or focused tightly.

At 4,000 feet the focus of the night sun is tightened, and definable ground references come into view. The white surf crashing on the rocks always stands out well under the night sun and that is what I see first. Cleared to land by landing-zone personnel, I begin a final approach from 3,000 feet. Instruments and ground references are continually and smoothly scanned without jerky head movements. Airspeed, vertical speed, and the radar altimeter are priority instruments in monitoring a closure rate with the ground. It is important to keep all eyes moving and not fixate. We are all constantly looking for wires or other hazards that may have been overlooked by landing-zone personnel.

They did their job well and we find no surprises. As we ease over the southbound lane, the tail rotor is brought over the highway and we set down next to the double yellow line. As soon as we land, both flight nurses are off to attend to the patient as I begin planning for the VFR departure and eventual IFR flight. The engines are left running as we won't be here very long.

I look into the aft-cabin area as the patient is being loaded on board. The patient is in critical condition and will require transport to a trauma center in San Jose, about 70 miles away. IFR airports along the route that are near hospitals with helipads are also an option should the patient suffer cardiac arrest en route.

In a few minutes the patient is loaded and the flight crew briefed on the takeoff procedure. Once again "eyes are out" as the helicopter is eased up at full power. At 100 feet a 90-degree pedal turn is executed so that the nose is pointed toward the east and the mountains, with the tail toward the ocean. We climb up at maximum power with aft cyclic so that the helicopter is going up and backward toward the ocean; we are flying the approach path backward. In this way visual contact with emergency-vehicle lights is maintained. One cannot transition too early to forward flight or the visual references will be lost, and ascending orbits also are not possible because of the high terrain east of the highway.

At 2,000 feet it is possible to increase the airspeed to 65 knots while remaining west of the highway and maintaining visual contact with the surface lights. We are now at V Y and are climbing at 1,500 feet per minute. ATC is expecting us, and I promptly receive a new IFR clearance and proceed northwest up the coastline.

The blackout curtain separating the aft cabin from the cockpit is closed and all the aft-cabin lights are on. The flight nurses are working together, quickly performing critical medical procedures. Lifesaving care continues and they are very busy communicating with each other. I adjust my intercom volume lower so I can listen to ATC better. Norman Y. Mineta San Jose International Airport is reporting a ceiling of 800 feet and visibility of four miles. Thirty minutes later we are cleared for the ILS 30L into San Jose.

At 700 feet I cancel IFR and we break off the approach with a special VFR clearance to the trauma center, just a few miles away. We are met on the rooftop helipad by a multitude of hospital personnel. The patient is whisked away to a trauma room in the emergency department as dozens of people go into action performing a choreography of tasks. My role is over, and I go coffee hunting around the nurses station. It has been a busy hour and a half since the bat phone rang, and my caffeine-low light is on.

In less than two hours from the time of the accident the patient was admitted to a Level 1 trauma center. Hundreds of people were involved in this patient's outcome; the 911 dispatchers, scene personnel, air traffic controllers, and the countless people it takes to operate a large trauma center. Flying an aircraft for any reason is enjoyable, but flying an aircraft in a challenging environment to help save a life is particularly satisfying. Twenty minutes later we depart VFR back to our base in Gilroy. Refuel, replenish supplies, paperwork, and then back to bed — until the bat phone rings again.


Mark Lavenson, AOPA 996893, of Aptos, California, is an air-medical helicopter pilot for California Shock Trauma Air Rescue (CalStar).