![[Photo: LifeFlight heli at an accident scene]](lifeflt01.lg.gif)
Residents of Central Campus hear it, sometimes early in the morning, and sometimes in the middle of the night. Probably the undergraduate freshmen on North Campus, where the buildings are shaped like the letters "L-I-F-E", hear it too. And chances are that some resident in West Virginia, perhaps in an evening walk, has once heard the very faint whup-whup-whup of its blades and glanced up to see a helicopter, lights flashing, making its way across the evening sky.
This helicopter is one of the three helicopters known as LifeFlight, Duke Hospital's emergency helicopter service which responds to acutely ill or injured patients. LifeFlight responds to calls in North Carolina, South Carolina, Virginia, West Virginia, and some parts of Tennessee, as it can travel up to 200 air miles. 95% of LifeFlight's patients are flown in to Duke from other hospitals, and 5% are brought directly from the scene of an accident.
In the case of a 78-year-old man suffering heart attack in Louisburg, North Carolina, LifeFlight was summoned after he was rushed to the hospital. He was in his home when he began to have a heart attack. His wife began CPR and called for an ambulance, which rushed him to Franklin Regional Hospital. After his arrival, the physician there quickly called Duke Cardiology which advised him to give the patient streptokinase, an agent used to break up blood clots. Duke Cardiology then summoned LifeFlight to get the patient.
Within minutes, LifeFlight left the landing pad at Duke Hospital. The two nurses on the flight, Cindy Detomo and Amy Price, arrived to find the patient very unstable and complaining of chest pain. The nurses brought him onto LifeFlight and tried to relieve his pain and stabilize his blood pressure in the helicopter. Upon landing at Duke, Cindy and Amy rushed the patient to the Intervention Cardiac Catheterization (ICC) lab. Dr. Mitch Krucoff, the ICC attending physician, told them that the patient had the worst coronaries he had ever seen on a live patient. The patient underwent four graft bypasses the next morning and is currently recovering in Duke's stepdown unit.
Such a flight is typical of LifeFlight's calls. For the patient, he was able to receive Duke's excellent cardiac care because of LifeFlight. "LifeFlight is an extension of Duke's quality patient care and advanced technology delivered directly to the referring community," Rita Weber, Program Director of LifeFlight, says. "When the helicopter goes out, we take Duke Hospital directly to the patient, and we begin our therapeutic intervention right there."
LifeFlight, as opposed to a ground ambulance or other Emergency Medical Service (EMS), is an intensive care unit. LifeFlight transports patients who require critical care; often the patients' needs exceed the training of an ambulance crew and the resources of their local hospital. Such patients include trauma patients injured in an accident, heart attack victims, premature babies, or a person suffering from a drug overdose.
The RNs, or registered nurses, who staff each flight, have advanced skills in critical care. "From the outside looking in, you can really tell that these nurses are very qualified for what they do," says David Craft, a pilot for LifeFlight. The nurses must have experience in critical care and be certified as a Registered Nurse (RN), Emergency Medical Technician (EMT), and in Advanced Cardiac Life Support (ACLS), Basic Trauma Life Support (BTLS), and Pediatric Advanced Life Support (PALS).
Not only must they have these certifications, but, according to Patrick Salvey, an RN for LifeFlight, "They must also have the proper personality: they've got to be cool under pressure, flexible, able to work with different people in stressful situations.... Unless they've got the personality to be useful under pressure, they're useless."
The nurses can bring specialized equipment, often on the cutting edge of technology, onto the aircraft to meet the needs of their patients. Many times this equipment is already built into the helicopters.
LifeFlight's intra-aortic balloon pump (IBP) is one example of this technology. The IBP, used for patients with a severe heart attack or coronary disease, pumps blood, giving a weakened heart a chance to recover. It is inserted with a catheter in the groin area, and has a balloon which inflates and deflates in synchronization with the patient's heart rate, which can be monitored with blood pressure or EKG.
Such specialized cardiac equipment is a part of Duke's active cardiology program. A large number of LifeFlight's patients are cardiac patients because Duke offers excellent cardiac care. In addition to its cardiology program, Duke has also been a leader in critical care services, including its trauma service and prenatal nursery.
![[Photo: Technicians and equipment by the helicopter]](lifeflt02.lg.gif)
LifeFlight began as an idea to extend these services to patients outside of Duke and Durham who might not have access to such services in their local community. Duke Hospital commissioned a task force in 1984, chaired by Duncan Yaggy, the Chief Planning Officer for Duke Hospital, to conduct a feasibility study. The task force, which included hospital administrators, doctors, and nurses, looked at the clinical services which Duke offered that might not be available elsewhere. It visited several helicopter programs at other hospitals, including those at the University of Michigan, Herman Hospital in Houston, Harris Hospital in Ft. Worth, and Geissinger Hospital in Pennsylvania.
At the end of the two year study, the task force decided that LifeFlight was desirable. Weber, part of the task force, says, "We made the decision that it was practical for Duke to have a helicopter, that we are a tertiary care center, we are a referral center, and we needed to provide some mechanism of extending that tertiary care out into the community." In tertiary care, a hospital has the subspecialists and the technology to deal with the most acute situations.
LifeFlight's official startup was March 1, 1985. Weber remembers the first call. It was a heart attack call from another hospital. The patient was picked up from Sampson County Hospital in Clinton, North Carolina for a recurrent ventricular tachycardia. LifeFlight brought him to Duke's Coronary Care Unit and he did well after treatment at Duke. LifeFlight celebrated their eighth birthday this past March 1.
Since then, Weber says, Lifeflight has been increasingly used. "The volume [of LifeFlight patients] has continued to grow," Weber says. "I think patients are sicker, and our radius is a little bit larger now than when we first started out." LifeFlight flew about 1200 patients in its first year, and now flies about 1800 patients a year.
LifeFlight has three helicopters, two of which are active, and a third for backup. The LifeFlight team includes 9 pilots, 3 mechanics, 9 communications specialists, 26 nurses, and 7 medical control officers. The nurses who staff LifeFlight work twelve hour shifts, as do the pilots who fly the helicopters. There are usually six nurses working per shift during the day. They are split into three teams of pairs; one team for each active helicopter, and one for the intensive care ground unit, LifeCare.
While waiting for a call, the nurses catch up on paperwork. "We have a lot of work that we do when we're not flying," says Cindy, who has been a LifeFlight nurse since September 1987. "We're very heavily involved in outreach, so we do a lot of teaching in the community and for EMS. We also follow our patients: when we bring someone in, we continue to visit them on a daily basis while they're in the hospital, and we write letters... back to the hospital that sent them to us. We let the physician and nurses that were taking care of the patient in the outside hospital know what the patient's progress has been since the transfer."
The communications specialists relay information between LifeFlight and other parties. They also monitor weather conditions, although the pilot ultimately decides which conditions are suitable for flying. The day of this past February's ice and snow storm, the communications specialists tracked the storm during the day. The helicopters were eventually moved to a hangar at Raleigh-Durham airport to prevent any damage which the ice and snow might do to the aircraft.
LifeFlight's therapeutic intervention begins when the call comes in through a special 800 number. The communications specialists answer the call and obtain a minimum set of information from the requesting person, who is usually a nurse or physician from another hospital, or an EMS or law enforcement agency. The communications specialist then transfers the call to the LifeFlight team.
In case LifeFlight receives two calls with only one helicopter present, the medical control offficer, or MCO, decides which call takes priority. The MCO is a Duke physician and faculty member trained in intensive care. The MCO might also decide which calls warrant using the helicopters, and which patients would benefit just as much by coming in via the ground unit.
LifeFlight also works with other flight teams in the area, including East Care at East Carolina University, Carolina AirCare at the University of North Carolina at Chapel Hill, AirCare at Baptist Hospital, MAMA at Mission Memorial Hospital in Asheville, Winston-Salem Baptist Hospital, and Carolina Medical Center in Charlotte. The helicopter programs participate in mutual aid; if both LifeFlight helicopters are busy when Duke receives a request to pick up a patient, Carolina AirCare at UNC will pick up and bring the patient to Duke.
When the LifeFlight nurses and pilots are contacted by the communications specialists, they are informed of the type of call: Code Red, Code Red Scene, Code Green, Code Green Scene, Code Yellow, or Code Blue. In a Code Red, LifeFlight is called from another hospital, and the pilot, or two pilots if it is nighttime, and a team of nurses must take off within five minutes. One nurse runs to the blood bank, while the other nurse and the pilot prepare the helicopter for take-off.
LifeFlight is the only helicopter service in North Carolina which can bring blood on the call. The nurses bring the blood in packed form, meaning the blood is more concentrated and takes up less volume. Sometimes this blood can make the difference between life and death. By the time the first nurse returns with the blood, "the blades are already turning", says Cindy. Sometimes the helicopter takes off from the landing pad before the team even knows its destination.
If the requesting hospital is more than fifty miles, or 20 to 25 minutes away, the communications specialists inform the LifeFlight team that the call is a Code Green. The team must still leave with the blood within five minutes.
When LifeFlight is summoned to the scene of an accident, the call is Code Red Scene. Code Red Scenes involve mostly car accidents, but might also be fires, drowning, or electrocutions, says Karen Webster, an RN who has been with LifeFlight for about two years. The LifeFlight team was given a Code Red Scene when a fire broke out on September 3, 1991, in Hamlet, North Carolina, at the Imperial Foods, Inc. food processing plant. All the helicopter ambulances in the area were notified; LifeFlight's helicopters made three trips from Hamlet to Duke with patients, most suffering from smoke inhalation.
The LifeFlight crew has more time to react for a Code Yellow call. They have about ten to fifteen minutes to problems.
The smaller helicopter, LifeFlight II, has only enough room for one pilot, two nurses, and the patient. The nurses have about nine square feet of space and the patient lies with his or her feet next to the pilot. Fran Morrison, a LifeFlight nurse, says it is not too difficult working in such close quarters. "It's difficult in the sense that you have less room for equipment." The nurses have a little more room to work in LifeFlight I, the larger aircraft. LifeFlight I has room for additional resources, like the intra-aortic balloon pump, and it is large enough to transport two patients when needed.
Once they arrive at their destination, the pilot must land the helicopter. They might land right on the interstate at a car accident, or on a nearby flat, grassy area. "Sometimes securing the area is a big problem," David notes. "People come running up to the helicopter." The LifeFlight team must quickly get the patient onto LifeFlight and stabilize his or her condition until they arrive at Duke. They monitor the vital signs and perform additional care if necessary. Depending on the patient's condition, the nurses might use the intra-aortic balloon pump for a heart attack victim, assist a premature baby on a respirator in an isolette, intubate a patient to support the airway, or perform chest needle decompression for a patient with a collapsed lung.
Upon landing at Duke, the LifeFlight team takes the patient to a specialized unit - the Emergency Department, the cardiac unit, or the intensive care unit. The LifeFlight nurses' responsibility for the patient ends once he or she is in the care of the specialists. They might then sit down for a while, get a cup of coffee, or start the paperwork for the flight.
And after that? Karen smiles. "We'll gather our equipment and get ready for the next one."
At the time this article was written, Teresa Hsu was a Trinity College sophomore majoring in biology and English.
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