PARAMEDIC'S CAREER GETS OFF THE GROUND

When Greg Keith started out as a paramedic in 1975, he worked with a ground ambulance crew. In 1988, his new career with an air ambulance service got off the ground.

"It's a lot different, because when we respond, there's usually a ground unit already on the scene or we respond to the hospitals, and the patient's already been initially assessed and treated," said Keith, a flight paramedic with LifeBeat, Southeast Missouri Hospital's air ambulance service. "We basically load them and transport them in a rapid manner. Plus, I'm working with a nurse. In a ground crew, you've got a paramedic and an EMT (emergency medical technician). Here, you're working with an RN, and that's another difference."

LifeBeat and Air Evac, which services St. Francis Medical Center, are among 10 state-licensed helicopter ambulance services, said Steve Hise, director of the Missouri Health Department's Bureau of Emergency Medical Services. Hise said 17 helicopters are currently licensed to provide medical transport in the state.

In 1994, helicopters made 8,039 health care flights statewide, Hise said. Of those, roughly 20 percent were hospital-to-hospital transfers and the rest were scene flights.

Rodger Huffman, chief flight nurse for LifeBeat, said the service averages between 550 and 600 calls a year.

In 1988, LifeBeat's first full year of operation, crews responded to 349 calls. In 1994, the total was "right at" 600, Huffman said, "so it's getting close to doubling in that time frame."

Overall, Huffman said, 34 percent of the calls to which LifeBeat responds are cardiac patients, and 22 percent are trauma cases. The breakdown for the remainder includes: obstetrics, 10 percent; pediatric, 7 percent; general medical-surgical, 8 percent; neurological, 6 percent; respiratory, 4 percent; poisoning or overdoses, 1 percent each; and other flights, such as transporting blood or supplies from one hospital to another or search and rescue operations, 6 percent.

Air Evac representatives could not be reached for comment on the types or numbers of calls they handle.

Paul Guptill, director of planning for the Missouri Hospital Association, said air ambulance services are geared toward moving the critically ill or injured from the scene of the incident or from smaller rural hospitals to trauma centers as quickly and safely as possible.

Huffman said helicopters can travel "about twice as fast" as ground helicopters, an important factor when time is a critical element in providing medical care.

In addition, helicopters can go a lot of places ground ambulances can't.

"We can land on barges," Huffman said. "In some rural areas, just because of access, where there's no roads, we can get to them." And helicopters can land in "big, super-muddy fields" that ground ambulances can't travel through.

"In the flood of 1993, we flew into some areas that the ground crews couldn't get to because they were isolated (by floodwaters)," Huffman said. "When that tornado came through south of here and cut through Southern Illinois in 1994, there wasn't a lot of damage to homes, but there were a lot of trees down across the roads, and the ground ambulance just couldn't get to one patient who needed help."

But there are situations when the helicopters can't be used, Keith said, and if ground ambulances can't travel safely through floodwaters or down icy roads, helicopters can't fly in nasty weather, such as storms or fogs.

"Weather is one of our biggest limiting factors," he said. "When the weather gets crummy, our business slows down, because we're not supposed to go out."

The biggest concern, Keith said, is making sure patients get the care they need, and he credits "good cooperation" between ground and air EMS crews and police and fire departments in providing treatment at the scene and making sure the scene is secure for whichever EMS service is responding.

Pilots routinely check current weather conditions and forecasts to determine if it's safe to fly.

Accidents like the one in which three LifeBeat crew members were injured Sept. 20 shake everybody up, Keith said. Concern Network is a nationwide bulletin issued whenever an air ambulance is forced down, whether because of mechanical or meteorological problems.

"We all keep track of each other," he said. "It's like one big brotherhood. It's just a chance you take. I've been in two (ground) ambulance wrecks since 1975, and I went ahead and got back in the ambulance. This is no different. I try not to let it bother me."

"The accidents do bother us, but I think, for the most part, it would be the same if a ground ambulance had an accident," Hoffman said. "They would be a little nervous about it, too."