Utah Adventure Journal

The hour is growing late and a small group of backcountry skiers are facing some critical decisions.  Their companion has just sustained a fall and appears to have a broken leg.  It’s clear that he will not be able to negotiate the difficult terrain ahead and they’re deep in a drainage that has seen the last glimmer of sunshine for the day.  They attempt to self-rescue, but after a few hundred torturous yards of trying to drag their injured friend, it appears impossible.  Fatigue and panic set in as the reality of the situation begins to take hold.  A phone call is placed and they’re assured help is on the way.  After what seems like an eternity to the weary group, the thwock-thwock-thwock of chopper blades furiously beating the air can be heard in the distance.  The helicopter sets down up ahead and two men in red step through the maelstrom of swirling snow and begin their decent towards the party.  “We’re here to help,” says one of the ominous characters as he kneels beside the injured man.  Within moments the patient is packaged, and on the way out of the forest towards a safe LZ.  A few words of gratitude are exchanged and the hand-off goes smoothly.  The whine of the turbine engines drowns out the fear and hopelessness as the doors close and he is whisked into the sky.

For over three decades, the men and women of Utah’s air ambulance programs have been turning the tables on tragedy and made a world of difference for thousands of critically injured patients.  Through the cooperation and diligent efforts of Intermountain Life Flight and University Healthcare’s AirMed, adventurers statewide can rest assure that when the unthinkable happens, a dedicated staff of highly trained individuals is there to back them up.  Although each program has a unique story, they both strive to assist those in need and work to overcome the greatest of challenges.

The Beginning:

In 1977 Amy Cutting was working as a critical care nurse at LDS Hospital in downtown Salt Lake City.  During her tenure, she worked as a flight nurse on a fixed wing aircraft and specialized in adult intensive care.  She also had a deep appreciation for the mountains and enjoyed spending her free time hiking and skiing.  By 1978, the addition of a rotor-wing aircraft to assist in the rapid response and hospital-to-hospital transport of critical patients lifted the program to the next level.  “All the flight crews were hand picked and when I joined in 1979, there were five flight nurses, several paramedics, two pilots and one mechanic,” said Cutting.  After its inception, the program underwent a series of evolutions that allowed the flight crews to develop their own methods and procedures.  The initial uses of the helicopter as facility transport soon morphed into a way for medical crews to respond to scene flights.  Responding to ski resorts and backcountry areas became a regular part of the job and the skills of each flight crewmember had to adapt. “It was a really exciting time to be involved because there wasn’t much of a precedent set.  We were kind of creating the field and a science,” said Cutting.  She also noted that they had extraordinary physician leadership from Dr. Terry Klemmer.  “He had a vision for being able to expand the trauma services at LDS Hospital to the community.  We were always trying to adapt a set of principles from a variety of specialties and blend them into something new.  You felt that you were on the leading edge of something really important,” added Cutting.

The Intermountain Life Flight program represented the seventh air medical helicopter service in the nation and it utilized aircraft that could be modified to fit the needs of flight crews.  The French-made Alouette was the original choice of Life Flight due to its spacious cabin and powerful engine.  It was capable of accommodating the additional medical equipment required by the crews and it enabled quick loading and unloading of the patient.  “I liked the Alouette because the cabin configuration allowed us to be in non-verbal communication with the pilot. It meant a lot to be able to see the look on his face when we were going into a tricky situation,” said Cutting.

Soon after Life Flight’s foray into air medical transport, the University of Utah realized the potential for having its own rotor-wing fleet.   Stemming from the belief that the University wanted to provide its patients with the highest quality care available.  The main purposes of AirMed’s helicopters were to facilitate hospital-to-hospital service and respond to emergency situations around the state when ground transport was impractical.  As the program grew, it began to incorporate more aircraft and became responsible for a larger geographic area.  Flights to and from Wyoming, Idaho, and Nevada meant faster and more reliable care for critically injured or terminally ill patients.

Turning the Corner:

For AirMed and Life Flight, the first decade of operation saw dramatic advancement in protocols and equipment.   “We used to hang it out there a little more.  Hover loading [keeping the helicopter off the ground during patient load] used to be a cutting edge technique.  Now we have safer methods like hoist rescue,” said K.D. Simpson, former Life Flight paramedic turned customer service and public outreach coordinator. The development of new technology in aircraft also prompted the addition of more powerful helicopters to the organizations’ line up.  The Italian-built Agusta 109 K2 was brought over to Life Flight’s base in Salt Lake City to demonstrate its superiority as a mountain rescue and medical transport airframe.  “We went to great lengths to train with the crews and the ship because we understood its value,” said Simpson.  The K2 would prove to be one of the most versatile aircraft and the Intermountain Health Care management saw its potential for future missions.

AirMed also began updating its fleet and incorporating more comprehensive training for its staff during the early 1990’s. “As we’ve added technology we’ve had to increase the amount of training required to operate it. The University of Utah has always strived to be on the leading edge when it comes to safety and technology,” said AirMed Program Director Robert Stantus.  The implementation of advanced airframes, such as the Bell 407 and 430, and better equipment keeps the program on the upswing.  In 1998, AirMed joined Life Flight as a Commission on Accreditation of Medical Transport Systems (CAMTS) certified organization.  Between the two providers, Utah boasts one of the most progressive air ambulance systems in the world.

Safety to the Rescuers:

Although each program has taken the utmost precaution to ensure the wellbeing of its staff and patients, unfortunate circumstances have arisen that have claimed the lives of several people.   In 1983, AirMed lost pilot Louis Mertz in a crash just outside of the University.  Mertz could not vector his way back to the pad during inclement weather and the ship struck the hillside south of the “U”.  During a rescue in 1998, AirMed 4 was leaving a scene flight in Little Cottonwood when the ship succumbed to a snowstorm and crashed into the North side of the canyon.  Tim Hynes, Stan Berg, Shayne Carnahan, and one patient were killed in the crash.

For Life Flight, tragedy struck twice in 2003 and the program lost three courageous crewmembers.   In January 2003, Life Flight 6 went down just outside of SLC International airport in thick fog.  Pilot Craig Bingham and paramedic Mario Guerrero lost their lives in the crash.  Five months later, a Life Flight helicopter was returning from a hiker rescue when the tail rotor assembly failed.  Although pilot Brent Cowley attempted to land the ship, he was fatally injured in the crash.

These incidents serve as a constant reminder that the members of AirMed and Life Flight engage in missions that are often perilous.  Their dedication to saving the lives of strangers warrants great respect and we as outdoor enthusiasts should understand the dangers associated with their job.  In the aftermath of the fatalities, each program has re-evaluated its procedures and performed necessary changes to how it conducts rescue and transport. Over the last ten years, AirMed and Life Flight have adopted the mentality that constant innovation and attention to detail will keep them at the forefront of the industry

Current Affairs:

In a well-lit corner of the Life Flight Operations Center near SLC International Airport, two dispatchers monitor activity from the five bases across the state.  They are charged with keeping flights organized and supporting the flight crews through state-of-the-art tracking and communication software.  Each dispatcher has a specific set of duties to ensure that operations are carried out safely and promptly.  Across the hall in a spacious hangar, a staff of full-time mechanics stands at the ready to resolve maintenance issues that may arise.  This facility also serves as storage for a Life Flight auxiliary helicopter and fixed-wing aircraft.  The amount of resources and preparation that goes into making the entire program tick is simply amazing.

AirMed’s Command Center is equally impressive and is located at their main base at the University of Utah.  From this hub, operations from the five Utah bases, and the Rock Springs Base in Wyoming, are coordinated to keep the flight crews organized and on task.  The teams are separated into their respective specialties (adult/pediatric and neonatal/high-risk obstetrics) and engage in pre-shift meetings to develop a game plan for the next 24 hours.  Weather, aircraft status, and ground conditions are all taken into consideration, as well as previous missions and concerns.  Before any ship leaves the pad, a deliberate check of all instrumentation and equipment is performed and each crewmember has a list of responsibilities that must be accounted for.  “It takes four to say Go and one to say No,” adds flight paramedic Jay Fearnley.  He recounts his years with AirMed and notes, “We have to look at the big picture.  From scene management to patient care, there are many factors to consider.  The difficulties of working in a confined space and dealing with sensory deprivation means we have to stay sharp at all times.”

It is clear that the nerve centers for both organizations are top-notch and merit kudos from those within the industry.  In addition, Life Flight and AirMed have several tools at their disposal that are unique to Utah.  The first is the Breeze-Eastern hoist mechanism that Life Flight employs to assist in difficult mountain rescues.  After receiving FAA approval in 2001, teams began training on this highly specialized piece of equipment.  Working with the Swiss rescue organization REGA, Life Flight staff spent months developing aerial procedures.  Each hoist crew must also undergo quarterly training and be comfortable with its intricacies in order to remain current.   Life Flight has two hoist-capable ships and is the only civilian air ambulance in the country to be certified to carry out hoist missions.  In the past ten years, there have been over 140 hoist missions, several of which involved multiple patients.  Another useful piece of equipment is the Long Range Receiver (LRR).  The LRR is capable of locating victims buried in avalanches (provided they are wearing a beacon) from the air, which keeps rescue personnel out of harms way.  AirMed and Life Flight, as well as the Wasatch Powderbird Guides, are certified to use this invaluable search and rescue device.  A third piece of technology that helps flight crews carry out their jobs is a night vision goggle (NVG) system.  The NVG system, first adopted by AirMed, gives pilots and crew the ability to navigate complex terrain during night rescues.   The system has proven its place in the industry over the last several years and Life Flight crews have also implemented the technology to complement their repertoire of advanced gear.

Future Ambitions:

With thirty years of experience and thousands of patient transports, AirMed and Life Flight move into the next decade with renewed vigor and dedication to excellence.  “Life Flight has committed to purchasing four Agusta AW109 SP Grands for future operations.  Our goal is to standardize the fleet to a multiuse/interchangeable airframe,” said Simpson.  AirMed is also looking to replace its Bell 430 with the more powerful and spacious EuroCopter 145.  The addition of the new series of aircraft will enable each program to carry out its missions with greater efficiency and more attention to crew and patient comfort.  However, the continued support of the public, professional search and rescue organizations, ski resorts and other interest groups will remain paramount to their continued success and development.  To learn more about everyday operations or to view training schedules, check out intermountainlifeflight.org and healthcare.utah.edu/airmed. 

Special thanks to Amy Cutting, K.D. Simpson, Robert Stantus, TaLyse Francisconi, and Beth Fisher for their help and inspiration.