BY AIR AND LAND, TRAUMA SERVICES COOPERATE; EMERGENCY CREWS HELP DURING `GOLDEN HOUR'

No matter whether it's a critical, life-threatening injury from an accident, a heart attack, stroke, or complications of premature birth, the "Golden Hour" often means the difference between life and death for a patient.

"The quicker the patient receives surgical intervention at a hospital after an injury or emergency situation develops, the greater the chances of their survival. That's what the Golden Hour is all about," says Becky Sparks, flight nurse with the Air Evac air ambulance service at the St. Francis Medical Center in Cape Girardeau.

The fact is the farther and more remote the patient is from the hospital emergency room, the more important the Golden Hour. That's where the air ambulance helicopter comes in. "The big advantage of the air ambulance is speed," says Mike Craig, manager of the land-based Cape County Private Ambulance Service in Cape Girardeau.

Since the start-up of the two helicopter ambulance services in Cape Girardeau in 1987, a close-knit, working relationship has developed between the two air ambulance services and the ground-based ambulance service that's been in operation here since 1968.

Instead of competing with each other for patients and business, as many people erroneously believe, the air and land ambulance services cooperate and pool their resources to provide one of the most comprehensive emergency trauma services in the state.

"Patient care and the needs of the patient come first," said Sparks, and Mark Sprigg, chief flight nurse with Life Beat at Southeast Missouri Hospital.

There was a time when prompt, professional trauma care wasn't available in Cape Girardeau County, or any other rural county in the state. Until 1968, ground ambulance service was usually provided as an extra service by the local funeral homes. They did it because no one else wanted to.

But the emergency service was primitive, often nothing more than a stretcher, a bottle of oxygen, and whatever first aid training the funeral home personnel had received.

In the 1960s, legislation was passed by the General Assembly setting standards for state-wide ambulance health care service.

The Cape County Private Ambulance Service was founded in 1968 by George and Theresa Rouse, and their sons, Donald, David, and Michael. The Rouses later sold the company to the John and Joseph Russell families, who continue to operate the service.

The company now has 16 fulltime and nine part time employees. The four ground ambulances are staffed by ten paramedics and 6 emergency medical technicians. (EMTs) The company's operating area is within Cape Girardeau County, but they will go into other areas at the request of family members, law enforcement agencies, or other ambulance services.

The Life Beat air ambulance service began in August 1977, and now has five nurses, five part-time and three full-time paramedics and four full-time pilots.

Air Evac also began operations here in 1987, and now has a staff of three full time pilots, and three full time nurses. The air ambulance service uses local, off-duty paramedics who are employed by ground ambulance services, hospitals, or fire departments, to fly on missions.

Since the beginning of air ambulance operations four years ago, the number of calls has continued to increase each year as more and more people realize the value of rapid transport of the critically injured during the "Golden Hour."

At the same time, the number of calls to the land based ambulance have continued to increase, says Craig.

That's because air and land ambulances each offer a different type of emergency trauma care service. While the ground ambulance service normally operates in Cape County, the service area for both air ambulances is within a 150 mile radius of Cape Girardeau.

"The majority of our calls are outside Cape County," said Don Dorsey, lead pilot with Air Evac. "We make flights to just about every county in Missouri and Illinois, within 150 miles of Cape Girardeau."

On any call outside the county, the air ambulance services routinely contact the ground ambulance service in the county they are responding to. (if it involves a non-hospital emergency)

Sparks said the ground ambulance usually arrives at the scene first and begins evaluating and triaging the patient or patients. If needed, the crew with the ground ambulance can also advise the incoming helicopter of a landing site and current weather conditions at the landing site.

"When a Cape County Private ambulance is called to an emergency in the county that may involve a serious or critical injury, or may involve a lengthy extrication process, and the location is in a remote area of the our county, we contact one of the air ambulance services and put them on standby," said Craig. "Who we call depends on which helicopter is available, and the final destination (hospital) of the patient. That's something we have to deal with everyday. If the patient is returning to St. Francis, and air transport may be involved, obviously we'd call Air Evac. But if they are on another call, then we would contact Life Beat."

Craig said it is not unusual for the Life Beat ambulance to transport a patient to St. Francis if Air Evac is on another call, and vice versa.

Recently, one of the air ambulances had an out-of-stated transfer. While it was out of the county, the other air ambulance provided protection.

"Patient care and patient needs are the deciding factor," said Craig. "It's the "Golden Hour" that we're all concerned with." Craig said a recent example in Cape County was an accident that occurred last fall at an abandoned quarry north of Trail of Tears State Park. A teenaged Cape Girardeau boy was critically injured.

"Remember, the patient was injured at least 30-45 minutes before we arrived. It would have taken us another 45 minutes to carry him down the railroad tracks to the park marina where our ground ambulance was parked," said Craig. "The boy needed immediate care. By calling for air ambulance support, the patient was transported to the medical facility in less than 15 minutes.

Craig said an air ambulance is always put on alert when a ground ambulance is called to a remote area of Cape County where time may be a life-threatening factor, such as a logging accident deep in the woods, or an ATV roll-over in an isolated area, well away from the ground ambulance.

On more than one occasion, both air ambulances have been called the same accident location because of the number of serious or critical injuries.

At other times, after being placed on alert, an air ambulance will go ahead and take off, but hover in the air until it is actually called, or released from standby.

While ground ambulance drivers depend on maps, highway signs and landmarks to guide them to their destination, air ambulance pilots must usually rely on electronic navigation. It's called LORAN, Low Frequency Radio Navigation.

Dorsey explained the operating area of the air ambulances is divided into grids on a map. To reach a destination, the pilot "punches" the grid number coordinates of the destination into the LORAN navigational system on board the helicopter. It can fly the helicopter to within 100 feet of the landing site, but after that, it's up to the pilot and the crew to set the chopper down safely.

Sparks says landing locations range from highways, school yards, soybean or corn fields, and railroad tracks, to the top of a barge on the Mississippi river to pick up an injured person off a towboat.

"I've climbed over more than one barbed wire fence and walked through a lot of muddy bean fields to get to my patient," she laughed.

Sprigg and Sparks say by working together with ground ambulance paramedics, there is no wasted time at the scene. By the time the air ambulance arrives, the patient, or patients, have already been triaged, evaluated, treatment started and ready for transport. If not, the air ambulance nurse and paramedic work alongside the ground ambulance crew to prepare the patient for transport as quick as possible. Again the credo is patient care and needs.

The emergency care providers who work in the air, or on the ground, are proud of the professionalism and quality of service they offer to the sick and injured in the region. "We don't compete, we cooperate for the welfare of the patient," said Craig.