My Respects to Air Medicine

6 people--patients, nurses, EMTs, and pilots--died a in midair medivac collision yesterday in northern Arizona.

After reading the news on CNN.com last night and reading the story at EMS1.com this morning, I though I'd write about my changing attitude (and my company's general attitude) towards air medical crews.

First off, I am deeply saddened by this news, especially considering it involved two separate helicopters. My thoughts and prayers are with the family and friends of the patients' and crews'.

In my small area, air medical service comes primarily from the Portland Metro area, across the coast range. The service operates both fixed wing and rotor wing aircraft and while they do scene landings and transports, our primary use for them is interfacility transfers. Generally though, my company has a poor opinion of this air medical service, and I've allowed it to color my opinion.

We (in referring to my private transport company) often make fun of the air service. We joke about their hesitance to fly over the coast range, "it's dark out, they're not comin'," or "oh, I felt a drop of rain, I guess the helicopter isn't comin'." We are indignant towards the flight crews, as often they're treated like visiting dignitaries when they walk into the ER, "oh, you want an art line in the patient?" Oh, you want them foleyed? Sure, we'd be happy to do that for you. Can I get you a cup of coffee? A foot rub? Warm towel, perhaps?" It's true, some ER docs and nurses treat the flight crews better than the ground crews, but this is the exception rather than the rule. Some local fire departments seem to think that a helicopter is always the best choice in transport a critical multi-systems trauma, even though my ambulance can have them to a trauma center in less time it would take the helicopter to reach the scene.

There is a measure of professional pride (as ground ambulances) that colors our impression of the flight crews. A flight nurse and medic can perform more invasive procedures than the ground medic on an ambulance, a fact that one of our supervisors refuses to accept. Again, it has lead to a colored opinion in the company that "helicopters are no better than we are. Rubber over rotors." Also, it doesn't help to have an ER doc tell us "well, the helicopter wasn't available, so you were our next choice." Even though in my county we are the first and only choice of interfacility transport.

Again, I want to stress that when I say "we" or "our" I'm referring to my company and our position on the matter. Now, the company line on interagency cooperation is that we get along well with everyone, that we are all professionals, and that our highest priority is the patient. Keep in mind though that both we and the air medical service are for profit, private services.

What I've begun to realize and what was solidified this morning, is that my opinions (and those of my company) are misplaced and unfounded. I have no personal issue or quarrel with any of the flight nurses, medics, or pilots that I've met. These are people that are doing the same job I'm doing, they just have rotors instead of tires. Let management deal with the bureaucracy and politics between the companies.

The job of an air medical crew is extremely dangerous, more so than a ground crew. Weather is a much greater hazard to them than a ground ambulance. They must be concerned about weight and fuel restrictions. The are concerned with navigating in all conditions, not just following milepost markers or street signs. Usually, they have the most critical patients on board, where time is truly a factor in survivability.

I have the utmost respect for these air medical crews now, not just because of yesterday's accident, but because of a general reassessment of my attitude towards them. And while I may not be able to change my coworkers general attitudes, I can do my best to make sure that my partner and I are always speaking positively about them and towards them when we meet them. Again, I am deeply, deeply saddened by the loss of two crews and their patients. I hope that we can all take the time out today to think about them and their families. And I hope that we can all go about our jobs safely today.