Choppers Are Costly, but Save Lives and Enhance Public Image of Hospital

Rotors whirling on the top and rear, cardiac monitor blinking deep inside, the helicopter carrying the 2-month-old baby whose heart had gone haywire whap-whap-whapped its way through the thick Southern California air.

Fifteen miles and a mere six minutes later, the chopper touched down on the helipad atop Memorial Medical Center in Long Beach. A doctor and nurse bounded off, detached the life-support unit with the baby inside and bundled the whole package onto a gurney for the trip two floors down to the pediatrics ward.

The chopper lifted off, its place taken within minutes by another helicopter, this one based at UCI Medical Center in Orange. Pilot Joe Sulak off-loaded the snakebite victim he had ferried from Catalina, cleared up the paper work and headed back through what he called “the wild brown yonder” to Orange.

The helicopter, which takes off and lands on a fenced-off square of concrete at the UCI Medical Center parking lot, acts as an angel of mercy on an average of once a day, rescuing surfers battered by the waves at Dana Point, motorists over the side of Ortega Highway and critically ill infants in Brea, as well as snakebite victims on the island 26 miles across the sea.

Operated by Memorial Medical Center and known as Partners in Lifeflight, the flying ambulance service is one of about 155 such operations across the country. With the demise of the helicopter service operated by Western Medical Center in Santa Ana last December for financial reasons, the UCI chopper is now the only hospital-based helicopter in Orange County.

Wendy Biggar, a flight nurse who is the Lifeflight program director, said that although some police departments and the Orange County Sheriff’s Department have helicopters, their primary missions are law enforcement, while the sole mission of the hospital copters is medicine.

“It’s our whole purpose in life,” Biggar said. “We don’t fight fires, we don’t do search and rescue.”

Most of the helicopter flights are transfers of patients from one hospital to another, generally to an institution better equipped to handle a problem. Very few are rescues of accident victims.

In either case, a helicopter “can be a life-saving tool” for a hospital, said Dr. Kym Salness, director of the emergency department at UCI Medical Center and a leader of the campaign to base a helicopter there. “It saves time, and time is of the essence, time is salvage.”

The helicopters do not come cheap, however.

An hour in the air costs about $3,000. Insurance may take up the bulk of that cost, but the hospital loses about $570 for the hour’s flight, Biggar said.

Why do they do it? It is good public relations, according to many in the industry.

“You hope they do things for marketing,” Salness said. A helicopter lets a hospital point to its new toy as an example of its high-tech services, right up there with the latest heart monitor or blood analyzer, he said.

The tall, blond and handsome doctor--who keeps a football on his bookshelf along with tomes on emergency medicine and snakebite treatments--said that in arguing for basing a helicopter at the medical center, Salness told hospital officials that “it’s got to do something for the internal pizazz of the institution.”

“It’s investing in a concept, really,” Salness said. “It’s a reflection of what we think the whole darn hospital ought to be doing and can be a highly visible gadget that makes you feel good about the institution.”

Nina Merrill, executive director of the Assn. of Hospital-Based Emergency Air Medical Systems, said most of the flying ambulances across the nation are leased by hospitals from private companies, which also provide the pilots.

Memorial Medical Center’s two helicopters, for instance, are supplied by Rocky Mountain Helicopter, which also provides eight pilots, most of them Vietnam veterans.

Sulak, who flew the snakebite victim from Catalina, piloted a helicopter for the Army’s 101st Airborne Division 20 years ago not far from Hue, scene of one of the fiercest battles in the Vietnam War. In those days, he worried about gunfire from the Viet Cong and North Vietnamese. These days, his worries are different.

On the snakebite flight, another helicopter was using the primary landing site, Pebbly Beach on Catalina, so Sulak headed for the backup site, the golf course near the small hospital on the island. There was a brief, unexpected delay before landing. “We had to circle so some players on the golf course could play through,” Sulak said.

Sulak, a Garden Grove resident as wiry as the frames of his aviator sunglasses, taught helicopter operations to Iranian military students in the days of the shah. Joe Parr, the pilot who brought the 2-month-old baby into the Long Beach hospital and who flew for the Marine Corps in Vietnam, piloted a chopper for a Los Angeles television station before hooking up with Lifeflight.

Parr said emergency medicine has become “the newest segment of helicopter aviation, so everybody wants to do it. . . . It’s the most rewarding, getting people to the hospital and transferring the critically ill, knowing that you are getting them there faster than you would normally.”

The nurses, who all have extensive training beyond what is required for most hospital nurses, work for the hospital, which assigns them to Lifeflight.

Flight nurse Christie Wilson had spent five years working in intensive care, cardiac care and open-heart surgical units when a Lifeflight mission showed up one day at the hospital where she was working in the San Fernando Valley.

“I didn’t even know that an organization like that existed,” Wilson said. “I got the name of the organization and sent them my resume.” Two years later, the program finally had an opening, and Wilson signed on. That was January of 1983.

At Lifeflight, “you get the call and you’re airborne and you never know what you’re going to get until you get there,” she said. It’s a good job because “you have a real independent role and it can be extremely challenging, extremely diversified. In a 24-hour shift, I can be in Catalina picking up an acute MI (heart-attack victim), be in Big Bear picking up a patient there, and then doing a peds transfer (of a child) from Santa Barbara. For me it’s a lot more challenging and rewarding than being in a controlled environment of a hospital setting.”

Pilot Parr gives the nurses he works with high marks in the cool category: “They walk in, everybody is running around; they calm people down, take control, and we’re off.”

Parr said he has never been pressured to risk a flight in bad weather to pick up an ill patient. A spate of accidents involving helicopter ambulances in recent years led to speculation that such pressures had led some pilots to fly in adverse conditions. The accidents led to a sharp increase in insurance costs and concern about the future of some of the programs, which now carry about 70,000 patients a year nationwide.

Last year the Federal Aviation Administration limited pilot shifts to a maximum of 12 hours, rather than the previous 24-hour limit.

In 1981, when there were about 30 programs in the country, there were six crashes and six deaths, Merrill said. In 1987, with about 150 programs, there were four crashes and 12 deaths. Biggar said in the 10 years that Memorial has operated the program, there has been only one helicopter “hard landing,” in 1981. A flight nurse was injured, but no one was killed.

Sulak said he and the other pilots are “the ultimate authority in accepting a mission or declining a mission, usually for weather.”

“We’re not cavalier here,” Sulak said. “We don’t jump on the white helicopter and go out and save the world. If we can do the mission, we do.”

Merrill said it generally costs about $1 million to start a helicopter-ambulance program and $800,000 to $1 million a year to keep it running. Biggar said the annual operating costs can be higher if a hospital charges everything to the helicopter program, rather than laying off some expenses to emergency departments or other operations. She said the two-helicopter operation at Memorial is budgeted for about $4.4 million a year.

Wayne Schroeder, president of the hospital group that includes Western Medical Center of Santa Ana, said that although the hospital ended its 6-year-old helicopter service last December for money reasons, the service might resume later this year.

“More and more congestion on the freeways is going to cause the private sector to look at this (helicopter-ambulance service) as a business opportunity,” Schroeder said. He said programs could be financed through added fees for driver’s licenses, having hospitals pay for using the services or increased insurance payments.

Schroeder said it cost Western at least $40,000 a month to operate the service. When Medicare cut back reimbursements and some hospitals ended their contributions, the financial situation became intolerable, he added.

Although the demise of Western’s helicopter service led to a slight increase in Lifeflight operations, Biggar said public safety was not affected.