Sky’s the Limit

At 1:16 p.m. on an unseasonably warm Middle Tennessee Saturday in late December, the page goes out to the crew of LifeFlight 1, which is based in Lebanon, Tenn.: “ADULT LVL ONE: SCENE: Vanderbilt LifeFlight 1: ETA 10: 18 yom c/c MVA, pt is ett’d poss head inj. BP109/57: HR110: SA02 100%: Unresponsive.”

Pilot Greg Stoddard and flight nurses Kathy Nippers and John Kennedy immediately leave their base and fly two counties north, landing at 1:47 p.m. at the scene of an accident. There they find a 17-year-old male who so far has managed to survive a lengthy extrication from his mangled automobile.

During his accident the young man sustained multiple injuries to his skull, a spleen laceration, pulmonary contusions, facial fractures, and a lacerated right kidney, and somehow aspirated fluid into one of his lungs. Unconscious and intubated, the patient is being hand-ventilated by the EMS crew on the scene.

The man is quickly loaded into the back of LifeFlight 1 for the flight to Vanderbilt University Hospital, arriving at the Vanderbilt skyport at 2:23 p.m., where his lengthy hospitalization begins.

Most of us will never hold the outcome of a critically ill person’s survival in our hands, or know the surge of adrenaline, anxiety, stress and awesome responsibility that comes with critical care medicine. As if it isn’t challenging enough to keep someone alive long enough to get them to a hospital, imagine the skill and concentration necessary to practice critical care medicine inside the belly of a noisy helicopter—bouncing up and down on air thermals—traveling 120 miles an hour at an altitude of 3,000 feet.

For Vanderbilt University Medical Center’s LifeFlight crew, it’s a typical day at the office.

“These are people who do extraordinary things under extraordinary, difficult circumstances daily,” says Dr. John A. Morris Jr., professor of surgery and director of the Division of Trauma and Surgical Critical Care. “You just have to look at the back of the aircraft. It’s like practicing intensive-care medicine inside the space of a bathtub that’s traveling at 3,000 feet and bumpy.”

Morris should know. He’s been at the helm of LifeFlight for a quarter century now.

Since its first flight on July 6, 1984, LifeFlight has logged more than 33,000 patient transports and now averages 250 patient transports a month. LifeFlight is VUMC’s most visible brand—walking, flying and rolling billboards. LifeFlight staff serve as Vanderbilt ambassadors in every community within the medical center’s 65,000-square-mile catchment area (see sidebar). Today, LifeFlight consists of several distinct and complementary components: five helicopters, a turbo prop airplane for long-range transports, a highly sophisticated communications and data center, ground ambulance transportation, and a newly launched “event medicine” program.

Football Field as Landing Zone

LifeFlight’s day-to-day operations, with myriad moving parts, are managed by Jeanne Yeatman. A former LifeFlight flight nurse with more than 1,000 patient transports under her belt, Yeatman has risen through the ranks and has been its program director since 2003.

“As a flight nurse you really feel like you’re doing something that matters,” says Yeatman. “You’re being invited into someone’s life at its very worst moment. But being in these situations has also caused some of the most difficult times in my own life. When you’re in the moment, you may not realize the stress of what you’re doing, but afterward, when you remove yourself from that moment, you recognize that what you see as a flight nurse isn’t normal. It’s very much like being on the front line of a war.”

LifeFlight’s program concept has always been to use specially trained nurses with an expanded skill set who can take Vanderbilt’s services into rural communities rather than merely transport patients to the hospital.

While saving lives is the goal, Morris says the program’s biggest challenge and most important product from day one has been safety. “Without a doubt, the balance between safety and cost, and the appreciation of that balance by the enterprise, has been the most gratifying part of this job.”

Vanderbilt was among the first academic medical centers to add air medical transportation for critically ill patients. In 1983, Dr. John Sawyers, professor and chairman of the Department of Surgery, and Dr. Joseph Ross, MD’54, professor of medicine and associate vice chancellor for health affairs, made the decision to add a patient transport helicopter to the services of Vanderbilt University Hospital. The move was part of a larger strategy by the medical center to build and brand top-level trauma surgery and emergency medicine programs.

The following year Morris joined the faculty, starting his tenure several weeks ahead of time in order to coincide with the arrival of the medical center’s first helicopter.

“I remember the first day. Needless to say, we were all excited. Our first lesson in aeromedical medicine was how to open the door of the aircraft,” Morris says with a chuckle. “We paid close attention to how to open and close a door because you don’t want it opening at 3,000 feet. It was that basic and demonstrated just how new the whole concept of air medical transportation was to academic medicine.”

As the hands-on father of LifeFlight, Morris recalls a flood of vivid memories. “We did things 20 years ago that were the right thing for the individual patient,” he says, “but were horrific in terms of the risks we took—though we didn’t know we were taking them at the time.

“We once landed an aircraft on Garland Avenue [the street in front of Vanderbilt University Hospital] so we could treat a guy with a stab wound to the heart, and we got that guy to live. Imagine landing a helicopter in the middle of Garland Avenue to do this. But we knew from the flight nurse’s report that the patient wouldn’t make it the 500 yards from the football field [LifeFlight’s landing zone during its early days] to the ER. There are those kinds of heroic but horrendous stories.”

Nearly 25 years later those few people and that one aircraft known as LifeFlight have evolved into a large, fully integrated critical-care patient transportation system.

“The elements of the LifeFlight program have been determined by the needs of the Vanderbilt enterprise, and by the needs of the community we serve,” Morris says. “What we found over time is that a huge amount of transportation is needed by the enterprise.”

“You can’t afford to become complacent,” says Program Director Yeatman, whose years of experience as a flight nurse give her great insight and empathy into the extreme challenges her staff often faces. “I may not have walked in every staff member’s shoes in every situation, but I have a better idea of what they face because I’ve been out there on more than 1,000 flights.”

Despite the cramped quarters, noise and turbulence inside an aircraft, Yeatman says the environment becomes a familiar venue where nurses are able to focus their considerable skills on patients, achieving a remarkable success rate. LifeFlight’s flight nurses typically have multiple years of critical-care nursing experience as a prerequisite to selection for the program.

“Each nurse’s role is very clear. You and your partner develop a rapport, and much of what is done is unsaid as far as the patient’s care,” Yeatman says. “But you must communicate with EMS personnel on the scene and with the patients’ families. Communicating with the families about what to expect is a big part of what the flight nurses do.”

A leader with a clear passion for her work, Yeatman says, “I tell my staff that if you ever get to the point that you’re so OK with what you’re doing that you’re not tempted to jump out of the aircraft on occasion, then it’s time to get out.”

Kevin High, who has been with LifeFlight since 1993 and now serves as manager of the trauma program, agrees. “I have been on five or six missions during which I’ve been so scared of what was going on—of what was happening to my patient—that if I could have jumped out, I would have,” he says.

“We are called upon to make decisions that most people in the span of their lives will never have to make—I mean walking up to somebody and in 30 seconds sizing them up and saying ‘he’s going to live’ or ‘he’s going to die’ and walking on. There’s no way you can train somebody to do that. It’s something you have to want to do, and it’s something that you have to want to keep doing.”

The toughest part of Yeatman’s job, she says, is “staying ahead of the curve and feeling like I am being proactive and not reactive, that I am constantly keeping the program’s core value—that safety is our No. 1 product—at the forefront. Yet I am also staying abreast of everything going on around us inside and outside of Vanderbilt, such as with the Federal Aviation Administration.”

A successful air ambulance program also must contend with various hospital regulations, community EMS regulations, and specific air ambulance/air medical regulations. Staying current with regulatory compliance is one of the most challenging aspects of the air medical industry, says Yeatman. “Basically, it always comes down to putting safety first and doing the right thing for the patient.”

The Eyes and Ears of LifeFlight

Perched 180 feet above Medical Center Drive atop Vanderbilt University Hospital is LifeFlight’s skyport—an outwardly unassuming structure that is in reality a $4.5 million engineering marvel. The two-story facility was designed and constructed on top of VUH while the hospital and LifeFlight remained fully operational.

The opening of the skyport in December 2000 solved several of LifeFlight’s logistical issues, finally bringing together into one location several pieces of the program. One floor below the landing pad sit the flight crew quarters and the program’s administrative offices. The helipad has enough space to land two large helicopters, while the facility features a nearly 360-degree approach path for incoming aircraft. The Monroe Carell Jr. Children’s Hospital, thanks to a gift from the Christy-Houston Foundation, added its own rooftop helipad in November 2005.

Squeezed into three crowded rooms just off the VUH skyport’s helipad is LifeFlight’s Office of Emergency Communications, the program’s nerve center.

Inside these three rooms is enough specialized communications equipment to echo the look and feel of a Pentagon-like war room. As various radios crackle with updates from pilots, flight crews and ground ambulance crews, large flat-panel monitors surround the communications coordinators, displaying local and national news updates, Doppler weather radar, that day’s configuration of each of the five aircrafts’ flight crew, video feed from cameras monitoring the inside of hospital elevators and the four helicopter bases, and satellite tracking of each airborne aircraft’s position in real time.

Managing a phone call an average of every 45 seconds, 24 hours every day, the staff of the Office of Emergency Communications is constantly under the gun.

“We are known as Flight Comm,” says Jeff Gray, director of communications for Vanderbilt LifeFlight. “However, we not only handle LifeFlight dispatch communications, but our responsibilities also include the Neonatal Emergency Transport teams, LifeFlight Event Medicine, both of Vanderbilt’s emergency departments, all ground ambulances transporting patients to Vanderbilt, and paging of appropriate teams within the hospitals—such as the STAT teams, rapid response teams, paramedic teams and stroke teams—based on predetermined criteria. We serve as a communications funnel for all those teams.

“Within the last two years, we have added regional communications responsibilities, a state concept funded by Vanderbilt that places us as the communications resource for the 13 counties and 26 hospitals in this region.”

In 2006 the Office of Emergency Communications was designated as the EMS Regional Communications Center for the Mid-Cumberland Region by the Tennessee Department of Health. In the event of a large-scale disaster, the Office of Emergency Communications will serve as the point of contact for the region’s hospitals and emergency medical services.

And in 2007 the Office of Emergency Communications also assumed responsibility for Nashville Medcom, now serving as the traffic controller for Metro Nashville-Davidson County’s 11 hospitals. All 11 of the county’s hospitals share a unique radio frequency enabling ambulance services to radio in patient reports.

“With the regional medical center communications responsibilities, we are handling about 2,000 radio calls per month,” says Gray. “LifeFlight averages about 250 patient transports per month. Those flights involve many radio and phone calls. About 60 calls per month are associated with the various teams within the hospitals. So when you add all that up, we’re pretty busy.”

“You never know what a day at LifeFlight is going to bring,” says chief flight nurse Wilson Matthews, who has been with the program for 12 years. “I’ve met the president [of the United States] at work. I’ve had pizza delivered to a hayfield while at work. I’ve had dinner from a snack machine at a small-town airport while at work. You can never predict what you’ll be doing.”

And that’s no small part of the attraction for the more than 100 men and women who make LifeFlight run like clockwork. After nearly a quarter century of service to Middle Tennessee and tens of thousands of saved lives, LifeFlight is a growing, evolving entity that began with and continues the philosophy of safety first while bringing Vanderbilt to the patient.

“When people hear the roar of those rotor blades overhead, I always want them to remember two things,” says Dr. Harry Jacobson, VUMC’s vice chancellor for health affairs. “First, that a life hangs in the balance, and second, that this life is in the hands of the most expert and skilled team on earth.”