Pilots and paramedics recount the history of medical air evac, from its genesis in the jungles of Vietnam to its evolution in the Arizona wilderness.
Vietnam central highlands, 1969: The heat rises like a mushroom cloud from the dense jungles below a forest green Huey helicopter, dubbed a “slick” for its lack of guns. Inside the cockpit, U.S. Army pilot Dave Ruhlman blinks sweat from his eyes and squints through the windshield, looking for smoke signals in an endless tableau of steaming trees. In his headphones, he can hear a platoon on the ground, calling for rescue, running and panting heavily into their radios. The sound of rapid machine gun fire riddles every dispatch.
Ruhlman follows the breaths and bullets and bomb-flashes to the area where five outnumbered U.S. soldiers are fleeing heavy fire, and slowly lowers the Huey toward a small and perilous clearing near the forest stand that covers them, hovering and hollering into his radio, his armored but unarmed chopper taking fire now, too. The men appear in the clearing near the hovering Huey and dash to the skid, climbing up and pulling each other aboard in seconds, flying up and away to safety. A good day, when everyone lived.
More than 45 years later, it’s still a day Ruhlman remembers like it was yesterday. “There’s nothing as rewarding as coming in, those five guys jumping in the helicopter, and off you go,” he says. “And they’re wounded, they’re beat up, they’re this close to being captured, and there’s nothing like it.”
“Until you get to this job,” he continues, “and you go out and you find a five-year-old or a six-year-old that’s been lost for a day or two. I don’t know how many times we’ve found a lost person, and they’re so far gone that as you hover over them, they’re dead. They’re not moving, there’s no reaction. If you had a helicopter 10 feet above you, you’d think [there’d be movement] if they’re still alive. But there’s nothing. Carry them to the hospital, [they live], and their parents meet you there and they’re so thankful – that’s the neat part of the job.”
The job Ruhlman refers to is flying helicopters for emergency medical evacuations and rescues throughout Arizona. Like many pilots in Vietnam, that’s what he did for decades after the war. It’s pretty fitting when you consider that the first expedited medical evacuations via helicopter happened during the Vietnam War, and Arizona was the launch pad for some of the first civilian medical helicopters, now a nationally commonplace feature of trauma care. What started as a U.S. military assistance program for civilians in the late 1960s morphed into a pilot program run by the Arizona National Guard and Arizona Department of Public Safety in the 1970s, and eventually ebbed as commercial medical helicopter services proliferated throughout the 1980s into today’s robust (but now significantly less crowded) air med evac industry.
DPS still does air rescue, but most medical transport has shifted to companies like PHI Air Medical, which operates 14 bases throughout Arizona, with additional bases in New Mexico. The equipment, technology and training have all evolved to state-of-the-art status, but the mission remains the same: stabilize and deliver people to an emergency medical care facility as quickly as possible, thus saving lives and improving outcomes.
And it remains a rewarding and exciting job for the pilots and paramedics. “No day is the same,” says Louise Sandoval, a former flight nurse and current manager of business operations at PHI Air Medical. “You never know where you’re going to end up or what you’ll be doing.”
Flagstaff, circa 1984: “Dave, you’ve got to get in here. We’ve got a mission up at the Grand Canyon. The governor’s missing.”
Shortly after receiving the call at home around 10 p.m., Ruhlman was in the air with his supervisor and the sheriff of Coconino County, on his way to the Grand Canyon to try and find Governor Bruce Babbitt, who had failed to rendezvous with his security guards after a hike.
“We checked the rim – no signal flash, no flares, nothing. And this was before night vision goggles,” Ruhlman recalls. “There was no moon, but I could see where the river is, because it’s a different shade of black, if you can imagine.”
Flying into the canyon and following over the river to avoid hitting anything, Ruhlman headed for a campfire he saw burning along the riverbank. “We get there, I landed on the beach, the sheriff and my supervisor jump out, and lo and behold, the governor is there,” Ruhlman says. Babbitt and his guides had determined they couldn’t hike back out to the rendezvous point before nightfall and decided to camp. “Everybody’s relieved, everybody’s happy,” Ruhlman says.
After that rescue mission, the chairman of the board of RICO – which allots seized money from crimes to government and public service programs – was impressed enough to procure a few goggles (being developed at the time by Litton Night Vision) for the DPS air rescue program, which served as a “test bed” for the products. The advent of night vision goggles in the 1980s was one of the most significant technological advances in air med evac. “I used to fly without them,” Sandoval says, “and then when we got them, I was like, ‘How did we exist without this?’”
The helicopters have become more advanced over the years as well (see slideshow at end of this article), and certainly more abundant since air med evac began in Arizona on Memorial Day of 1969 with a project called Air Medical Evacuation Services (AMES). The project was financed by a $304,000 grant from the U.S. Department of Transportation and realized through partnerships with the Arizona Department of Public Safety Highway Patrol and Arizona Helicopters Inc. (now Air Services International). AMES started with six highway patrol officers, five pilots, and two Fairchild Hiller FH-1100 helicopters.
Modeled after the U.S. Army’s Military Assistance to Safety and Traffic (MAST) program – which began in San Antonio, Texas in early 1969 – AMES aimed to reduce fatalities by getting people to trauma centers in 60 minutes or less, a window known as the “golden hour,” says Arizona DPS Aviation Administrator Terry Miyauchi: “It was during that Vietnam era that the ‘golden hour’ concept came… they said, ‘If we can get the trauma patient to the trauma center in an hour or less, their chances of surviving are greatly enhanced.’”
Ellery Kramer was one of the first pilots for the AMES program, which launched in Arizona because of the great distances (at the time) between trauma centers in the Western states. Phoenix and Tucson were budding desert metropolises, but emergency care was needed in rural nooks as well. “They saw the need for more medical services in remote areas… we used to go out west of Wickenburg, on the 60, before the 10 was there,” Kramer says. “We met the hearse from the funeral home, because that was how they got people to the little clinic there.”
In 1970, the Arizona National Guard and DPS took over the program, keeping the five-pilot roster. By 1972, surrounding Western states including California, Colorado and New Mexico had started to see the advent of commercially owned air ambulance services.
In 1975, DPS began training medics to be in-flight paramedics. This added another important dimension to air med evac: the ability to start IVs and keep patients stable during transport. Gregg Girard was in the first graduating class. A self-described “ground pounder in the Marine Corps” during the Vietnam War, Girard says the early challenges of air med evac included load limitations, and recounts a collision of two semi-trucks at a high elevation point on the old Route 666. “The truck drivers… they were very heavy – and we tried to get out of there with both of those trauma victims, both of those truck drivers, and couldn’t. The aircraft just wouldn’t perform,” Girard says. “So the pilot says, ‘Hey, we’ve got to leave some equipment here with the highway patrolmen.’ And we did, and we still tried to lift off and couldn’t, so we took the most severely injured, treated him, and had the ADOT personnel on the scene transport the other guy to a rest area further down, altitude-wise. Took the first victim to the Morenci hospital, dropped him off and came back and picked up the second one. Now that’s a challenging situation.”
Expansion of the Arizona DPS air program helped alleviate some of the burden. The Tucson air rescue station opened in 1978 with five pilots and five paramedics. All of the pilots had flown in Vietnam, and three of the paramedics had been combat medics during the war. Pilot Pete Sadler was among the original crew. “While they were still trying to complete our quarters and base out at the airport, we actually started operations out of the University of Arizona [medical center],” Sadler says. “They gave us a hospital room for crew quarters, and they had a helipad down on the ground. When we got calls, we’d grab our gear and run down and hop in the helicopter and take off.”
In October of 1983, the Arizona DPS air rescue program suffered its first (and so far only) fatal helicopter crash. “During the real heavy floods that came down through Marana and Tucson, our crew had responded to a vehicle trapped in a wash, west of Tucson,” Sadler recalls. “It was about 1:00 in the morning when they finished up that call and they were going to head back to Tucson, back to base. And it was raining, and as they took off and headed back, they received a call to try and divert to north of Tucson – it might have been around the Oro Valley area – and they were in determination of trying to make the decision whether they were going to be able to head over there, and then they were just trying to get back into Tucson… unfortunately, the weather was so severe, and we think that they just lost visual contact and they ended up flying into the ground.”
The decision to fly a rescue mission in questionable or hazardous conditions ultimately rests with the pilot, Sadler says, but “There’s always an unwritten rule, especially in the medical evacuation field: We’re going to give it a try.”
“Our philosophy as medics and pilots is, ‘Nobody dies in the helicopter; let’s get them to a definitive care facility,’ and that’s what you try to do,” Girard says. “[But sometimes] even in the end, they can’t save them. As hard as you try, sometimes it still doesn’t work out, and you still carry those missions in your mind.”
But the good days outnumber the bad, and are worth every challenge, Girard says. “You take a trauma patient in, you’ve worked hard to keep them alive, and you take them into the trauma center, and after they work on them a while and you’re cleaning up your stuff outside the trauma room, and the trauma doc comes out and says, ‘If you hadn’t done what you did in the air, we wouldn’t be in there doing what we’re doing now’ – that really sticks with you. That makes you feel good.”
Phoenix, February 2016: It’s a clear, warm afternoon on the smooth black tarmac of the PHI Air Medical air strip at Phoenix Sky Harbor Airport. Members of the PHI Air Medical team including pilots, flight nurses, respiratory therapists and even the lead mechanic have gathered for a photo in front of one of PHI’s signature utility-yellow helicopters. Business operations manager Louise Sandoval opts out of the shot to watch from a distance and talk up the team, who are laughing and joking with each other. “They’re very humble,” she says.
“Can we Photoshop this?” respiratory therapist John Cefaratt asks, inciting more laughter.
The crew clearly has camaraderie. Most of these folks have been working for PHI Air Medical for 20 years or more. Lead mechanic Mark Bigelow has been doing maintenance and repairs on PHI’s planes and helicopters for 42 years. It’s a rigorous regimen: All helicopters undergo daily maintenance checks on things like fluid levels and cowlings, and every 12 years, a helicopter gets disassembled down its last nuts and bolts so every part can be checked, and then the helicopter is reassembled from the ground up.
“Safety is our number one priority,” respiratory therapist Roy Kerns says, a priority that permeates every aspect of working for PHI Air Medical, especially the employee training. “I was amazed by the training when I came here. It was just impressive.”
In addition to completing PHI Air Medical’s initial training school upon hire, PHI personnel must also attend annual training sessions to stay up to date on the latest equipment, procedures and policies. “It’s constant training,” Kerns adds. “It takes a lot of dedication for what we do.”
PHI Air Medical has bases all around the country, and is one of the largest air med evac companies in Arizona among a small group that also includes REVA Air Ambulance, AeroCare and SkyMed. The PHI Air Medical base at Sky Harbor specializes in neonatal and perinatal care, and there’s an area between the hangar and the runway lined with incubators covered in plush and bright animal-print blankets. When a woman with a high-risk pregnancy goes into labor or has a delivery with complications outside a hospital, this crew is called to transport her to the hospital, and/or provide rescuscitation for mother and child. Every member of the crew has his or her own bedroom on the base, and Sandoval says the company encourages them to eat and sleep well so they’re at their best on calls. The strictly by-the-book operations, fleet of state-of-the-art helicopters and healthy bankroll is a big leap from the early days of air evac in Arizona, and it’s been a boon not just to business, but to the quality and continuance of countless human lives. PHI Air Medical alone flies an average of 30,000 patients a year nationally.
Jay Helm has been flying since 1978, including six years for the U.S. Army, 14 years for the National Guard, and now a total of eight for PHI Air Medical. “PHI Air Medical has just a phenomenal set of people,” Helm says. “Their clinicians are highly trained. PHI does not scrimp on the training. And they are some of the most superb professionals with whom I’ve had the privilege of working. And I got to work with combat medics in Afghanistan, and they were top-notch. They were at the top of the heap, as well, so I have a standard by which we can compare those things.”
“We were on a call up in the foothills of the Galiuros. It was one of those rock climbing vehicles,” Helm continues. “An accident involving one of those. Very badly injured individual. The crew I was with brought that person back from a trauma code twice. 99 percent of the time, that’s not going to happen, so within that one percent margin, they did it two times, and I got to watch that happen. That patient was successfully brought to the next level of care and made it to the operating room alive. That’s the caliber and quality of people with whom I get to work as an aviator.”
Working closely together for decades on such unpredictable shifts, with the high stakes of human lives and the heat of the desert air all around, can lead to lifelong bonds. For the pilots and paramedics in the early years of Arizona’s program, many of whom are Vietnam veterans and retired DPS officers, keeping in touch has been a mission most successfully accomplished. They have monthly meetings in Phoenix, and annual meetings in Flagstaff, Tucson and Payson. “We’re all a bunch of retirees. We all get together and reminisce,” Girard says. “And the stories get better each time you hear them.”
Sadler, now retired and living in Flagstaff, also looks back fondly on his pioneering years in the air. “Those early days in air rescue were some of the most memorable of my flying career,” he says, adding, “At this stage in the game, going back 40 years, you could say thousands [of lives have been saved by air rescue]. You really could.”
These Birds Have Flown
Some of the helicopters used throughout the history of air med evac:
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