Being a Medivac Pilot
by Daniel E Tyler, NRMA‑CareFlight, Sydney © 1996
I am often asked, "What's it like as a medivac pilot? Gee, you must have the best job around."
"But you must see some really terrible things," others have said to me.
I usually say something like, "Oh, it's pretty boring, really." "Just like any job." And it can be, too. But sometimes it is not just like any other job. And sometimes things take too much explaining to really understand. And so I just play it down. But that plays down the contributions of some of the really great people I work with, so it is not fair to them.
Being a medivac pilot is not unlike working in any of the other emergency services ‑‑ police, ambulance or fire services ‑‑ or being a health care professional. Like members of those professions, medivac pilots witness life's extremes of joy and sorrow; victory and defeat; suffering and euphoria ‑‑ all in a slightly more concentrated form and from a closer perspective, than others may see.
For me, being a helicopter pilot for almost thirty years and an EMS pilot for much of the last twenty years means a collage of mental snapshots etched indelibly into my brain. Some have gone a little blurry around the edges but most are crystal clear. In fact, some of the oldest snapshots in my mind are the most vivid. I'll try to describe some of these mental images as a way of expressing what it is like to be a medivac pilot.
Being a medivac pilot is landing your helicopter at a cross‑roads in the middle of a rubber plantation near the Vietnam‑Cambodian border to pick up a wounded South Vietnamese soldier who's been stitched across the chest with four machine gun rounds. It's listening over the intercom to the door gunners guiding you down into the little "hover‑hole" and knowing that the NVA are hiding just down the road in at least two directions with you in the sights of their AK‑47's. It's watching the patient jostle and bounce like a sack full of apples as four members of his rifle squad run out and throw him onto the floor of the helicopter and then dive for cover.
Being a medivac pilot is pulling pitch to get the hell out of there and looking over your shoulder at your crew chief who's got one foot out on the skid, holding a plasma bottle up with one hand and an M‑60 machine gun in the other -- the chewed stump of a cigar poking out under the microphone boom ‑‑ blazing away at the bad guys down the road and stopping every couple seconds to call out your main rotor and tail rotor clearances before firing another long burst in the direction of the closest muzzle flashes.
Being a medivac pilot is watching the four expanding circles of red seeping through the bandage across your patient's chest as you nose it over to gain maximum speed ‑‑ wondering if you'll get to the evacuation hospital in time. It's noticing, as you start your descent into the dust‑off pad, that the soldier hasn't moved and the crimson circles haven't gotten any larger in the last five minutes and knowing it's all been in vain.
Being a medivac pilot is looking back from the cockpit at a soldier with three "M"'s written in black grease pencil on his forehead with the times of each pain‑killing injection written beside them ‑‑ watching him try to smile because he knows he's going home and because he's so full of morphine he's actually happy ‑‑ wondering if he has any idea how stupid he looks trying to smile with only his top lip and with his bottom jaw blown away.
Being a medivac pilot is hearing the screams from the back of the helicopter over the sounds of the engine and rotor noise and even over the sounds of the door gunners laying down suppression fire; it's looking over your shoulder at a soldier with his leg blown off by a land mine and realising the rotor vibration is being transmitted through the cargo floor directly onto his shattered stump ‑‑ wondering why no one gave him morphine before they called for a medivac.
Being a medivac pilot is landing beside your first road accident scene as a civilian EMS pilot and learning first‑hand that blunt trauma caused by a speeding car impacting a tree can be just as devastating as bullets or shrapnel. It's hovering next to the base of a coastal cliff to pick up a body washed onto the rocks and seeing that the crabs have gotten to it first.
Being a medivac pilot is landing just before dark at a wide spot on a mountain road next to an overturned timber truck and seeing the mangled cab covered with half a tonne of 4x2's and 6x2's. It's finding the driver trapped by the legs under all the rubble and watching the volunteer rescue squad working frantically in the dark to free him while the doctor hangs upside down through the shattered windscreen trying to get an intra‑venous drip set up to counter the effects of shock.
Being a medivac pilot is being told by the doctor that the driver has liver lacerations and is haemorrhaging internally and that he needs to get to the hospital ASAP. It's loading and launching into the darkness ‑‑ only to fly into cloud at 300 feet on climb‑out ‑‑ realising too late that with nightfall the temperature has plummeted and so too the overcast has dropped down to just above the trees. It's concentrating on the transition to instrument flying and hoping that your memory of where those powerlines crossed between the hills is accurate and that you will reach a safe altitude before that point.
Being a medivac pilot is landing on a fire trail in bushland to attend an 18‑year old who's come off his dirt bike and is now lying beside the trail paralysed from the neck down. It's watching the doctor and paramedics poking his feet and legs with needles and asking, "Can you feel this? Can you feel this?" and the lad wondering what they're talking about and why don't they just help him get back on his bike. It's watching a distressed, middle‑aged father puffing and panting and running up that fire trail and the momentary look of relief that comes across his face when he sees that his son is conscious and talking and looks okay. And then it is seeing the look of hollow horror that slowly settles across his face as he starts to grasp what the doctors and ambulancemen are saying and as he slowly begins to realise that his family's life has just taken a sharp turn down Shit Street and it's a one‑way street.
Being a medivac pilot is landing in the back yard of a 5‑acre farm on the suburban outskirts where a 4‑year old has fallen from his father's lap and been run over by a ride‑on mower when the wheel hit a stump that was concealed beneath the grass. It's watching the doctor and paramedic fighting desperately to stop the bleeding from the almost unbelievable number of gashes all along the child's leg, torso and arm while the mother cries out because she cannot comfort her frightened child. It's watching a young father slumped against the side of his house, crushed beneath the overwhelming weight of guilt and concern, asking himself the questions that cannot be answered.
Being a medivac pilot is knowing that ‑‑ because of the helicopter ‑‑ the doctor and paramedic got there in time. It is knowing that ‑‑ despite all the blood ‑‑ the child is actually going to be okay because of the expert care he's received; it's knowing that the screams are really a healthy sign but that there is no way the distraught parents can be made to understand that now.
Being a medivac pilot is flying out to a country hospital in the middle of the night with a humidicrib and a medical team to pick up a newborn baby with some condition that can't even be pronounced ‑‑ let alone understood. It's flying along on the return leg in the pitch blackness, watching the wavy green line from the cardiac monitor reflected off the helicopter's windscreen against the blackness. It's watching the line go squiggly and noticing over your shoulder that the doctor and nurse have their hands inside the cot, working furiously to stabilise the child. Then it's watching the green line regain its regularity just as the lights of Sydney begin to appear on the horizon ‑‑ hoping that it stays that way until you get to the Children's Hospital. It's flying along as the lights get closer and brighter and looking down, wondering if any among the three million‑odd souls tucked away in their beds down below can see or hear that helicopter flying several thousand feet above them and somehow sense the drama of the life‑and‑death struggle going on inside it.
Being a medivac pilot is having the doctor tell you over the intercom that the baby being transported has just gone into cardiac arrest and asking you to land at the closest hospital and to radio ahead for a crash cart and a resuscitation team to meet the helicopter. It's arriving at the hospital helipad to find that ‑‑ at 3 am ‑‑ the resuscitation team consists of one nurse and a security officer. Being a medivac pilot is pitching in as best you can in the fight for life ‑‑ even though the idea of performing CPR on a patient so tiny you can only use two fingers seems terribly unfair.
Being a medivac pilot is being asked, since no one can find the hospital chaplain at that ungodly hour and you're the captain of the ship, so to speak, whether you would baptise the baby before the doctor calls it off and pronounces life extinct. It's trying to remember the words which you had heard so often ‑‑ always on happy occasions ‑‑ but never, ever thought you would be called upon to speak. Being a medivac pilot is wondering whether the human spirit can ever possibly be resilient enough to spring back into shape again after watching a baby die; and wondering how those doctors and nurses can possibly cope with it happening so many times.
Being a medivac pilot is straining forward against your shoulder harness, willing the helicopter to go faster without actually over‑torque‑ing as you respond to a rock fisherman swept off a shelf by a freak wave. It's squinting at the waves as you round the last headland, anxiously scanning for a bobbing head or a waving arm. It's the sadness and disappointment you experience as you spot the fisherman face down in the water with arms outstretched ‑‑ then the incredible elation as the body suddenly moves and the head comes out of the water ‑‑ the victim hearing the helicopter and finding one last ounce of energy after having given up the fight. It's watching the rescue crewman step off the skid and plunge into the surf beside the exhausted victim, supporting him until he can be winched out and lifted ashore ‑‑ so profoundly fatigued that his legs won't even begin to support him. Being a medivac pilot is to be continually bewildered and awed by the minuscule dividing line in water rescue jobs ‑‑ those few precious seconds that determine whether the victim spends a few hours in hospital suffering hypothermia and exhaustion before going home to live happily ever after ‑‑ or goes to the morgue and remains dead forever.
Being a medivac pilot is hovering at night just above the trees and up against the base of a cliff in the Blue Mountains while below you the rescue and medical teams work to secure a critically‑injured rock‑climber into the rescue stretcher so that he can be winched out. It's watching your fuel gauge steadily drop and wishing to hell they'd hurry up down there -- but knowing they're working as hard as they can under difficult conditions. It's murmuring a little prayer as you hover there ‑‑ saying, "Please, God, don't let the Nightsun burn out just now" or "Please, God, don't let those curious souls who are scrambling around, trying to get a better view from the cliff top above, dislodge a rock down into my rotors."
Being a medivac pilot is concentrating so hard on holding the cyclic stick stationary as you descend into a canyon to rescue a bushwalker with a broken back that you worry you might crush the handle; it's watching the sandstone walls just beyond the tips of the rotors and wondering whether you might be about to see sparks flying as you grind into the face. Being a medivac pilot is remembering how the victims of the last plane crash you attended had been burned and how their faces had looked like rubber masks ‑‑ and wondering if you will look like that too if you misjudge the distance ‑‑ or if it will be even worse.
Being a medivac pilot is to stand in awe of the crew who fly with you. It's seeing how they dangle beneath the helicopter on a 3/16 inch cable as you winch them onto a metre‑wide rock ledge above a fifty‑metre drop or deal with the horror of car crashes and industrial accidents ‑‑ and still tell a joke on the flight back to base. It's marvelling at how these unflappable characters who just defied death without batting an eyelid can ‑‑ on the very next flight ‑‑ re‑assure an apprehensive patient with a tenderness that defies comprehension. It's feeling the immensity of the responsibility that goes with being the captain of the ship carrying such great and important people.
All of these perceptions, thoughts and emotions and hundreds more encapsulate what being a medivac pilot has been to me over the years. I've been witness to a lot of heroism in my time as a medivac pilot. I'm not just referring to the rescue and medical crews who fly with me; or to the ground parties who do all the hard work. They are heroes, all right. But let me tell you about some of the unsung heroes who have made it all possible.
All of the emergency medical service flying that I have done in Australia has been for community‑based services ‑‑ Lifesaver, Child Flight, and CareFlight. Working for those non‑profit services has allowed me to work with some truly extraordinary people ‑‑ people who will never get their name or their photo in the newspaper and who will never feature in a story about a dramatic rescue or medical flight ‑‑ and the majority of whom I will never meet or even know their name.
To be an EMS pilot for a community‑based service is to understand that much of the money needed to carry out the sort of work I've been describing comes from people who often can't afford to give anything but do so anyhow because they feel a responsibility ‑‑ and because, who knows, maybe next week it will be one of their children or their neighbour's who will need your services ‑‑ or because that's just the kind of people they are.
Being an EMS pilot for such a service means wondering how the CEO from a major corporate sponsor will explain to share holders that dividends are down but the company will increase its support for the rescue helicopter service anyway. Being an EMS pilot is knowing that a group of elderly ladies from out west use their pension money to buy fruit, make jam, and sell it at the local school fete ‑‑ and send you the proceeds to help pay for that new two‑way radio or blood gas monitor that you need.
Being an EMS pilot is finding out that the extensions to your hangar were paid for by a group of truck drivers who were battling increases in fuel taxes and decreases in revenue and who struggled to make their leasing payments ‑‑ but whose hearts were as big as their rigs and who still found a way to help you.
Being an EMS pilot is knowing that the Jet Fuel you burn ‑‑ which is already heavily discounted by your supplier in recognition of your charitable status ‑‑ is paid for with the proceeds from charity balls and golf days and games nights ‑‑ fundraising functions that have been organised by people who already have enough to do but do it anyway. It is knowing that ordinary Australians ‑‑ people who worry that they won't be able to buy their kids the Christmas presents that they want this year ‑‑ can still find the money to buy a raffle ticket to support the work that you do.
It's pretty humbling to be an EMS pilot. People talk about heroics and drama and they often talk about you that way. But when you've got a six million dollar twin‑engine helicopter with automatic flight control and stabilisation, satellite navigation and all sorts of other whistles and bells ‑‑ you don't need to be a hero to fly it.
Being an EMS pilot is knowing that the real heroes of helicopter emergency medical service operations are those people who make it happen behind the scenes ‑‑ CEO's and pensioners and truckies and housewives and all the rest ‑‑ people who never ask for any recognition or thanks and usually don't get any either. Being an EMS pilot is knowing that you get the recognition those people deserve ‑‑ and wishing that you could be worthy of it.