Friday, January 16, 2015

Cox Air Care: 25 years of care at 2,500 feet

Over the past quarter century, Air Care crews have changed lives with more than 19,000 flights.

Every time you see the Air Care helicopter lift off at Cox South, the crew on board is about to add another story to their history. Like all emergency responders, they’re moving quickly, but they’re always headed to the same place: A turning point in a stranger’s life.

For the last 25 years, CoxHealth’s Air Care crews have raced to that spot over and over again – a place where lives are won or lost. It’s lonely being one of a handful of people at that spot. Some days, you’re left second-guessing what you could have done differently. Some days, you’re the shepherd of someone’s second chance.

“I wanted the worst of the worst, the most challenging patients,” says Jim Lawrence, a flight nurse who has flown with Air Care for 23 years. “That’s what I prayed for: Put me in a situation where I can provide someone the best chance to survive.”

Like most emergency responders, Lawrence can rattle off memories of patients who remind him of why he chose the field.

On a flight early in his career, he met a 6-year-old boy who had been hit by a car and suffered a severe head injury. It didn’t look like the little boy would survive. After he made it to Springfield and received what Lawrence describes as “heroic” neurosurgery, he began his recovery.

“I’d go to see him in the PICU and he couldn’t move the left side of his body, but he was a happy boy,” Lawrence recalls. “And his mom was so grateful – she had her boy.”

After months of rehab, the boy and his mother came back to visit Lawrence and the Air Care team.

“I was amazed, he was running around – he had a mild limp, but he was happy. The first time I got that experience, I knew I was where I needed to be.”

Air Care director Susan Crum says those moments are the big payoff for racing to scenes day after day, year after year. The desire to provide care at someone’s turning point has driven the Air Care program throughout a quarter-century of service.

Crum has been with the Air Care team since its founding in 1989. She was working in an ER in Osage Beach when a ride-along in an air ambulance sparked her interest. She was drawn to the excitement of emergency response and the independence required to work in the field.

“It’s a challenge – there’s no doctor or other staff members. You have to be educated, skilled and prepared,” Crum says. “When you think you’ve seen it all, you’ll get caught.”

Like all of us in health care, the team spends significant time training and keeping abreast of the latest standards of practice. Skills labs, re-credentialing and regular air care conferences are designed to keep the team ready for anything they might encounter.

“We do chest tube insertions and other things many nurses don’t do. We see pediatric to geriatric patients – we’re everybody’s nurses,” says flight nurse Shelly Elsey, who joined Air Care in 1997 after spending a decade working in ground ambulances.

Each flight holds the potential for a positive outcome – to change the next life. Creating the best possible odds requires both clinical excellence and a commitment to safety. Safety is a top concern for the flight medicine industry and Air Care is ahead of the pack: 25 years – that’s more than 19,300 flights – with no accidents.

Some of that success lies in improved technology – the new helicopter, added in 2007, includes terrain-avoidance systems and CoxHealth was only the second hospital in Missouri to add night-vision goggles in 2009. The core of safety success, though, is in solid processes, such as walkarounds by every crew member before a flight, and a TeamSTEPPS-style approach that allows any crew member to call a time out.

“Twenty-five years accident-free is huge in this industry,” Lawrence says. “That has to do with the experience of the medical crew, the aviation side, the mechanics, all of us working together.”

Air Care is well known for its teamwork. Crum says the group is more like family than co-workers, supporting one another after difficult cases and sharing the successes of those with positive outcomes. The group even gathers each Jan. 16, to celebrate Air Care’s official “birthday.”

“The longevity here – with so many who have 10 or 15 years in flight – that’s huge. Sometimes, I wonder if I’ve I hogged this spot too long, I’m sorry to all those who didn’t get to do it,” Lawrence says with a laugh.

Crum says she’s thinking about what the future will bring for the Air Care family. Like everywhere in health care, patients’ needs will grow and the program will have to meet them. Air Care recently restarted a ride-along program that lets nurses, physicians, EMS staff and ER nurse interns see what it’s like to practice medicine at 2,500 feet. Crum knows that among those riding along, there will be someone who will feel the same calling she did 25 years ago: The call to be there at someone’s turning point; to collect their own stories of times they made a difference.

Elsey says those times keep you going, and they get you through the tough cases. She remembers once when she was working in the Air Care office on the ground floor of Cox South and a man appeared in the doorway. She barely recognized him.

The last time they met was on the bank of Table Rock Lake, where Elsey had helped revive him. It was winter and the car he was in had crashed, plunging him into the water.

“He had made it to shore, but he literally was frozen from lying on the bank overnight. When he was discharged from the hospital, he came back specifically to find us, see us and say ‘thank you.’ He brought us all flowers,” Elsey recalls. “Those things are why we do what we do.”

Air Care: fast facts

  • The Cox Air Care helicopter, an MD 902 Explorer, has a cruising altitude of 2,500 feet. 
  • The enhanced safety features, like terrain avoidance and night vision, allow pilots to put the helicopter into some very confined landing zones that are common in rural areas. Between 60 and 70% of Air Care’s missions are scene flights, making those features especially important. 
  • Each flight has at least three crew members, along with the patient. 
  • The typical service area stretches as far north as Benton and Morgan Counties (a 30-40 minute flight), south into Arkansas and to Texas County in the east. Air Care also does transports to Kansas City, Columbia, St. Louis, etc. 
  • Becoming a staff member requires licensure as a flight nurse or a flight paramedic. Flight nurses are required to have three years of critical care experience, and paramedics at least two years on an advanced life support  ambulance.