What does a flight paramedic do? A transcript of Episode 11 of Slate’s Working Podcast.

On Working in a Flying Ambulance: Slate’s Working Podcast Episode 11 Transcript

On Working in a Flying Ambulance: Slate’s Working Podcast Episode 11 Transcript

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Nov. 27 2014 12:31 PM
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Slate’s Working Podcast: Episode 11 Transcript

Read what David Plotz asked a helicopter paramedic about his workday.    

141126_WORK_Ep11

Photo courtesy David Plotz

We’re posting weekly transcripts of David Plotz’s Working podcast for Slate Plus members. This is the transcript for Episode 11 featuring flight paramedic Jeff Ennis. To learn more about Working, click here.

David Plotz David Plotz

David Plotz is the CEO of Atlas Obscura and host of the Slate Political Gabfest.

You may note some differences between this transcript and the podcast. Additional edits were made to the podcast after we completed this transcript.

David Plotz: What's your name and what do you do?

Jeff Ennis: My name’s Jeff Ennis, and I’m a flight paramedic with Air Methods based out of Edenton, North Carolina.

Plotz: And how did you become a flight paramedic?

Ennis: Well, I worked as a ground paramedic for a 911 service in a rural country for about four and a half years, and I got a lot of good experience there and some extra education. And I always wanted to fly, and Air Methods gave me a chance.

Plotz: The flight paramedic is not the pilot, correct?

Ennis: That's correct, yeah. And the girls always want to meet the pilot. A typical configuration, this is the most common configuration in air medical, is a pilot, a nurse, and a paramedic. And we function—the medical crew members function—as copilots, meaning that we assist in navigation, in managing the radios, awareness around the aircraft, and those sorts of things, and we assist the pilot in all of his flight deck duties. But we do not actually typically touch the controls of the aircraft.

Plotz: Let’s talk about a typical day. I take it you don’t work 9-to-5 Monday to Friday, first of all?

Ennis: Most certainly not, and that is all of EMS. I work a 24-hour shift. Our schedule is, I work 24-on, 24-off, and then 24-on, and then I’m off for five days, and sometimes I’ll pick up a couple of shifts at local 911 services during that time. But, we work 24-hour shifts.

Plotz: And what time does a 24-hour shift start? Does it start in the morning, afternoon, evening, or does that vary?

Ennis: It starts at 7:00 in the morning.

Plotz: And what do you do when you get in at 7:00 in the morning?

Ennis: So, actually my dad doesn’t start when I get there at 7:00 in the morning, it starts the day before. And the reason I say that is that, the flying is mentally and physically exhausting, and so there's a lot of prep work that I do the day before. I prepare good meals, I prep cook things to cook at the base so that I can just throw them on the grill and have good things to eat, and I get plenty of sleep the night before.

When we get to work what we actually do is, I come in and the very first thing we do is, we meet with the offcoming crew. We talk to them about how their shift went, if they had any flights, if there were any issues with the aircraft, if there's any equipment that needs to be replaced on the aircraft, those sorts of things. And then we will proceed to do the shift narcotics count, and so we get together all four of us and we will do an inventory of the narcotics that are supposed to be there. We’ll all sign that those are, you know, that we haven’t gone missing any, and we’ll secure them, and then the off-going crew is free to leave.

Plotz: You've done your narcotics check. The previous crew has left. So, then what happens?

Ennis: At that point we will go out to the aircraft, and if there's any equipment that the other crew has used that hasn’t been replaced we will replace that. But we have a check-off sheet, an extremely detailed check-off sheet in the interior of the aircraft. We have all sorts of pockets, which I have numbered 1 through 11 and all of these different bags. We have a red bag, a green bag. And I know exactly what's supposed to be in each one of those pockets. And sometimes some of the drugs are expiring, you know? They’re good for 45 days from the time we take them out of the fridge. At the end of the month we will double-check that, because that's something you need—that's usually when they go out of date. But we’ll check all the drugs that are on the aircraft, any equipment that needs to be replaced going out of date, and make sure that everything is there. Because the off-going crew, you know, they may have been tired at the end of their flight. Mistakes get made. They maybe forgot to replace something. And so we try to have systems of checks and redundancies, so that we’re not relying on any single point of failure.

Plotz: What's the aircraft you guys fly?

Ennis: The aircraft we fly is an Airbus EC135 P2. It's a twin-engine, medium-lift aircraft. It has a travel speed of give or take 150 miles an hour. We can carry one patient in it. It’s a marvelous twin-engine aircraft with all the bells and whistles. But the pilot—so, when he comes in in the morning, he will do a walk-around on the aircraft. He’ll check all the things that the pilots check to make sure it's ready to fly. He’ll also complete what we call a risk assessment form, and it's something that he’ll look at - he has a computer, like a spreadsheet, that he fills out - and it will assign a numerical value to various risk factors. For example, if the medical crew members, if it's a new mix of crewmembers. If we’re going to be flying at night. If the aircraft is coming up on a maintenance, a scheduled maintenance soon. If we’re flying close to our maximum takeoff weight. Those sorts of things. All of these things have various negative—or, various numerical values—some of them even have negative values. For example, if we’re flying - our aircraft is equipped with a collision avoidance system, which is something that will chime and tell you if there's another aircraft nearby—if we’re flying with MVGs on, which we always do at night, that deducts from our score.

So this will generate a score—it could be, like, 27, all right? 27 would fall in the low category. And if we were 35, that doesn’t necessarily mean, okay, we don’t take any flights because we’re at 35, it's just like, okay, we’re at 35, we need to be thinking about why are we at 35? Like, what's going on that we need to be cognizant of, that we need to be thinking about?

Plotz: Okay, so there you've done your pre-flight prep and you have your risk assessment. How do you actually get to work? How does work happen? Or, does work not necessarily happen? Could you just be sitting around?

Ennis: All right, so at that point the pilot will come in, and he will do a crew brief. This is usually while some of us are cooking breakfast. But we’ll sit around together and he will go through the risk assessment, and he’ll review emergency procedures with us. We’ll make sure that, you know, we’ve all gotten plenty of rest, that we know what's going on. We’ll talk about what the weather is going to be like that day, if there are any advisories in the area. For example, if the President’s landing somewhere, you know, that might mean that we could fly in with a patient but we couldn’t leave—which, you know, that's not a problem. But, let’s see—

Plotz: Just to interrupt you there, when you're doing that briefing do you guys talk to each other—is this a formal process? Or are you talking to each other in a causal way that you talk to a colleague?

Ennis: It's a little of both, because the pilot is going down these checklists and that is something that, you know, has been written very much about, the use of checklists in the hospitals and in aviation and everything. And we firmly believe in them, and that is why, you know, he will print off his checklist and we’ll go through it. We work together all the time and so there is some level of, you know, casualness about it. That being said, we all take it dead serious. We’re not joking around. During the crew brief, I said we might be cooking breakfast, but we’re paying attention. This is serious stuff.

Plotz: So you're getting your briefing?

Ennis: Right, so, a lot of times that period of time in the mid-morning, like, you know, 8:00 to noon, is sometimes our non-busiest time, you know, that we typically have the lowest call volume during that time. So personally I usually try to grab a nap then. My partner says, you've got to sleep when the baby sleeps and I firmly believe in that. I’ll try to bank some sleep, and that came from my time in EMS, because sleep when you can.

And I’ll usually try to get a couple of hours of sleep then, and that way if we had to go until morning the next day I’ve had a little bit of rest and I’m not so exhausted. And things always look a little better after a nap. Then we get up, and we always have ongoing education. It’ll be, you know, computer courses, training, these things are assigned to us and made available to us, and I’ll usually try to complete as much of that as I can. And that is an ongoing thing. After I’ve been with the company for many, many years, they’ll still be doing that.

Plotz: Okay, so you’ve had your continuing education. Is a call coming? Is there a call coming?

Ennis: Okay, so, there's a call coming! Yeah, we’re waiting on the phone to ring. All right, so we do two different types of transports, and that is both scene - where let’s say, an ambulance calls us to go meet them somewhere - or a hospital calls us to pick up a patient and take them from one hospital to another hospital. And those are two totally different things.

And that's why I say, even the very best paramedic, when you show up at best you've only got about 40% of the picture. Because you know the pre-hospital stuff, the scene call stuff, but the nurse, that's where their expertise is, is in the inter-facility stuff. So that's why they pair us together, because we really complement one another.

So we’ll talk about scene calls because that's my expertise and what I’m more interested in. What will happen is, let’s say somebody gets hurt or somebody gets sick and they call 911, and the paramedics show up, and they say this patient is really sick, they have a time-sensitive injury or illness, and they need to go to a regional trauma center or stroke center or cardiac cath lab, that sort of thing. Those things once you get out of the cities are not available. There are eight of those centers in North Carolina—that's pretty typical—and there is a lot of empty space in between those. And what air medical allows us to do is, about two thirds of the US population has access within one hour to getting to a trauma center, within an hour of their injury, and if we didn’t have air medical that number would be much lower. So, the paramedics on scene—

Plotz: Just to interrupt, so what happens is that this person is in accident or they’re in their home and something happens. So, always there's an ambulance that's gotten there before you? And they make a decision, like, we need air medical because this person has to get to a trauma center faster than we can possibly do it?

Ennis: Yeah, it doesn’t always even have to be the ambulance. Sometimes the first responder is the firefighters, and they show up to a car wreck and they say, this is bad, we need some help. Or we’ve got more patients than we can manage here with the resources available. But yeah, one of the first responders, one of the ambulances will call us, and so we’ll get en route. They’ll get on the radio to their dispatch center, and they’ll say, “We need Air Mobile 2 from Edenton to meet us at the airport, at the hospital, whatever our predetermined LZ is.” And they’ll say, okay, we’ll call and check with them. They will call our dispatch center—

Plotz: Yeah, actually I want to ask, so, I just realized, so you're not landing on the middle of the highway. You have to go meet them—so, the ambulance or the paramedics on the scene have to get to somewhere where there's landing?

Ennis: Not necessarily. If there's a wreck out here in the middle of the interstate, we could certainly,you know, if it's safe to do so—and we spend a lot of time training first responders to look for obstacles, wires and stuff. That is almost impossible to spot from the air during the day, much less at night, even when you're MVGs. It's very hard to spot those things. So, they have training in knowing what is safe place to land an aircraft, and we don’t necessarily have to go to—I mentioned a predetermined LZ—it could just be on the interstate somewhere. But if we’re going to a predetermined LZ, that makes things a lot simpler. We know where it is already, we know how to get there, and we know that it's relatively secure. So, that's going to be a safer place to land. But it's not always. Sometimes we do land on the highway, yeah.

Plotz: So, you've had a call. Take us through an interesting one that you’ve had recently.

Ennis: Recently we got a call from a county to come and meet them, and we got no information from the patient, about the patient at all. And that happens sometimes, we’re just going into this blind, we don’t even know how much he weighs. And so, we’re on our way and we get a call back. I tune in to the radio to their local EMS channel so I can talk to them, and I hear them tell their dispatch center that they have changed their destination from the LZ to the local hospital. That's never a good sign, because that tells us that the patient is probably not stable enough to transport at that time. They wouldn’t be going to hospital if they were stable enough to wait for us to get there to take them to where they really need to go, because the little hospitals typically can’t fix whatever’s fundamentally wrong with them. So, we said, “All right, that's no problem. We’ll meet you there.”

Plotz: Let me just interrupt you before you even get further. First of all, how did you decide, okay, we do take this call? And second of all, how quickly are you in the air?

Ennis: All right, so, they’ll call—our dispatch center will call the pilot, and he’ll say—they’ll tell them, we have a request to go to this county, and they won’t tell me anything about what it is. Because you don’t want - you know, if it's a 3-year-old kid versus, you know, an elderly person, the pilot’s emotions could factor into that and they might be inclined to do something that they otherwise wouldn’t, and we don’t want that emotional factor. So, we don’t get any information about the patient on the ground. They will just say, can you go to this place and take them to this place? And the pilot will look at the weather and say, yeah, we can do that or we can’t. At that point, we’ll go out to the aircraft. We will complete walk around, all three of us, and make sure it's ready to go. One of us will jump in and start looking through the radio book to figure out, what are the frequencies we need to talk the people where we’re going? Help the pilot get through his preflight. The other crew member will stay outside and watch while we start the engines on the aircraft to ensure that, you know, flame doesn’t shoot out from one of them, which he could see put the pilot in the cockpit wouldn’t be able to see. So, that whole procedure to get it up and running and us off the ground, typically eight minutes or so would be about right, maybe a little less but about eight minutes. At that point we’re in the air and we are headed towards our call, and that's when I’ll be tuned in on the radio listening to the local traffic.

Back to the call where we’re going. We land at the local hospital and we grab all of our equipment. So, what we always take in with us, we have a cardiac monitor which has all sorts of advanced monitoring and defibrillation capabilities. We have a bag that has everything we need for advanced airway management, trauma, all of the typical stuff that we would need for any of that, and a ventilator so that if the patient’s not breathing and requires mechanical ventilation we can provide that, that's no problem. So, we’ll grab those items and a portable oxygen tank, and put that on the stretcher and we go into the hospital. We walked into the hospital this day and there's no one around, no one at all. They’re all somewhere. And we’re like, looking around, and I hear some frantic activity in the back room, and we walk in and what I see is a young man. He’s immobilized on a backboard, he’s laying on the bed there. There's a flurry of activity around him, and we still have no information at all about the patient. So, we’re trying to figure out what's going on.

So, I walk in and I say, “Hey, my name’s Jeff, this is Damien, can you guys tell us what's going on?” And they say, “We have a young male patient here and we’re not exactly sure what happened. We think he was running from the police, and one witness said that he ran into a parked car and another witness said that he just fell down in the road unconscious, and that's all we know.” And so, the paramedics got there and they picked him up, and they got him in the back of the ambulance, and he went into cardiac arrest. His heart stopped.

And the paramedics, they intubated the patient. They placed a breathing tube into the patient’s throat. They did CPR on the patient and they got a pulse back. And so that is all the information that we have, and he’s just laying there on the bed. So, I walk in to do a patient assessment and I take out my stethoscope. I reach down to feel for a pulse. I place my stethoscope on the patient’s chest because I want to listen and make sure that the breathing tube is placed properly. And that point my partner says, “Hey, did you just knock a lead off?” Meaning, did I accidentally disconnect the cardiac monitor?

And I said, no. And he said, “Have you got a pulse?” And I was like, no. We’re like, well, start CPR, okay! I literally walked in and touched the patient and he coded into cardiac arrest. So, we began CPR on the patient, and we administered a drug called epinephrine—which is adrenaline—and we managed to get the patient back again with a pulse.

And so at that point I’m looking for the cause. Something is causing this to happen, and if we don’t figure out what it is, you know, we’re not going to be able to stop this from happening again.

This is at a tiny ED, you know, out in the middle of nowhere. This guy probably doesn’t typically see patients that are this sick because they shouldn't even be at this hospital. And so, more often than not the doctors are comfortable letting us do whatever it is that we need. The nurses will give us whatever we ask for, you know, in the way of the epinephrine. We ask for a dopamine drip and those sorts of things. At that point, they’re typically very supportive of whatever it is that we’re trying to do, because this is our specialty, you know? This is the kind of patient that we deal with, and so they tend to let us do our thing.

So with our patient we manage to get him back, and I continue with my assessment. And this is getting really puzzling because there are just a few things that will cause a patient to arrest like this that can be fixed. There aren’t very many. A popped lung could do that, blood around the heart could do that, a lot of bleeding somewhere could do that, not enough oxygen, those types of things. So, I’m looking for all of the usual suspects. We can’t figure out what's wrong with this guy. I can’t find any obvious trauma on him. It doesn’t seem like he’s hit his head that hard.

So when I don't know what's going on, when I get confused or don’t know what to do next, I go back to my ABCs. This is what we learned in EMT School, Airway, Breathing, Circulation. I’ll look at the basics and say, “Okay, he’s got an airway, we’re breathing for him. We’re working on his circulation, and that's all that we can do for this patient at this point, and we are not going to solve this problem right here, right now. I don't have the tools to do it. This is going to require, you know, an advanced facility.” At that point we want to transfer the patient to our monitor. We’re going to hook up the ventilator and begin breathing for the patient, make sure all of that's managed. If he needs IV fluids, if he needs drugs that are going to increase his blood pressure and those sorts of things, we can do those things to support him hopefully until we can get to where he needs to go. And so, that's when we would transfer the patient to our bed.

Plotz: From the time you took off from the base, when did you land at the hospital and how long are you in that hospital before you're bringing him back out to your aircraft?

Ennis: So, it took us about eight minutes to get to this place in the aircraft, and we -

Plotz: And how far is that?

Ennis: We go about two miles a minute, so it would be, what, 16, 20 miles? We like to keep scene times. Now, this is becoming—this was a scene call that is now becoming an inter-facility call, which is a little bit complicating, a little bit of both. We like to keep scene times to less than ten minutes, and that's usually—we go in, we get a report, everything looks good, we’re ready to go, we’re usually out in about seven or eight. In this case, we walked in, worked a code, got the patient on the ventilator, the monitor, and everything else, and, you know, troubleshooted all the horses that we could think of, and still got to the aircraft and off the ground in 18 minutes. So, we do everything and we do it fast. Because that's what they’re calling us for. They’re calling us because either, if it's something we can’t fix on the spot, then they need to get going and we need to get headed towards the trauma center.

Plotz: Wait, so when you get back in the aircraft, is one of you sitting with the pilot? Are you both back with the patient? How does that work?

Ennis: So, when we’re going to a scene one of us sits up front with the pilot and functions as a copilot, but when we have a patient on board both of us are in the back with the patient, and that's where most of our attention is focused.

Plotz: How big is that space? What does it look like?

Ennis: It's a small space. And we actually have a relatively luxurious aircraft, but it's about the size of a very small closet. And a lot of people fly aircraft that are smaller than ours. But the patient will lay on the stretcher with his head near one of our laps, so that we are there and can manage the patient’s airway and the other provider can get alongside the patient and administer drugs through an IV and those sorts of things. But we need to have a good assessment done and any IVs, those sorts of things, we try to have that done before we get in the aircraft because everything is much more difficult in the aircraft. And, you know, we can’t listen to lung sounds, for example, is another thing. Everything’s more difficult.

Plotz: How do you decide where you are then taking this patient? Has the hospital you're going to decided, or you guys make a decision?

Ennis: Usually if it's an air facility call then that has already been arranged. For scene calls we are typically going to go to what we call the closest appropriate facility, and that is the facility that is going to have the surgical capabilities or the cath lab or the stroke center, whatever it is, the specific needs for this patient. If it's a burn patient, a badly burned patient or a pediatric patient, we might bypass the closest trauma center and take them to a pediatric specialty facility like Duke University or the Burn Center at the University of Chapel Hill. But it's the closest appropriate facility.

Plotz: And how far could you go?

Ennis: The rule of thumb is about 150 miles. That could be more or less. Usually we wouldn’t have to go that far. We have picked up some burn patients in the Outer Banks that needed to go to Chapel Hill, and that's probably pushing 200 miles, which is generally further than you want to go in a rotor-wing. Usually if you get over 150 you want to use a fixed-wing aircraft, but we do what's right for the patients and what's available, you know?

Plotz: You had a facility you were going to, and what happened then?

Ennis: We get in the aircraft with the patient and we get him secured, and look down and his blood pressure is 50/30 and he is fixing to code again. And at that point, we had already asked the hospital to prepare a dopamine drip, which is a drug that will cause your blood pressure to go up and your heart to beat a little harder and a little faster. And we already had that prepared. We connected that to an IV pump in the aircraft and began administering that infusion to the patient. And that, along with, you know, IV fluids and oxygen, was enough to stabilize that patient’s vital signs. And we monitor that very closely. Too much or too little is a big problem, and you have to titrate it to the effects. So, we’re monitoring that blood pressure continuously as we’re doing this.

Plotz: Do you know the patient’s name? Are you responsible for making sure a family is notified? Or, is that totally a different department?

Ennis: Yeah, I don't think about that stuff at all. I maintain some barrier of impersonality between me and the patient, and it's not because I’m cold or because I don't care, it's because it's what enables me to do what I do. So, I don't think about his name. The hospital did give us a face sheet as we were going out the door, so I had his name on a piece of paper. But once we arrive at the trauma facility if we call a code trauma, there's about 15 or 20 people that are going to show up. And that will be, you know, all the residents on staff, radiology will show up, the respiratory therapist will show up, and in that mix will even be a chaplain. And typically it's the chaplain’s responsibility to contact family members if necessary and take care of those types of things. But that was something that really surprised me, because I never really worked around hospitals much, that a chaplain is a standard part of the response team for major traumas.

Plotz: But in your case, you have the name but that's about it?

Ennis: Yeah. I don't tend to think of it as the name, I tend to think of as a 28-year-old male with altered LOC, you know? And that's what it is to me, and that's how I think about it. Once again, I want to emphasize that it's not because I don't care, it's because I have to maintain the ability to think objectively and to think clearly about what's happening. And moreover, I’ve got to be ready to go on the next call when I get back to the base.

Plotz: In this case, what then happened?

Ennis: I get on the radio and after we get his vitals stabilized, everything looks pretty good. I call the trauma center and I send a trauma alert, which was a little awkward because I’m like, well, we can’t find out exactly what the trauma is but we’re pretty sure there must be some and we’re going to need all hands on deck when we get there. And we’ll be there in about five minutes.

And at that point, you know, they’ll have everybody - they’ll put their gowns on. They’re waiting on us with all of their equipment ready to rock when we walk in the door, so there's no delay. And the pilot will talk to us at that point. He’ll say, do you want to do this hot or cold? And what that means is, with the aircraft running continuously or we going to take a minute and shut it down? Generally if it's super time-sensitive or a relatively simple patient, we’ll do it hot. In this case we had the ventilator going, we had the IV pumps going, and yeah, you can do that hot but it makes things a little easier for everybody if you shut it down. Because when we walk to the back of the aircraft you're standing between two jet engines, and I’m sorry, everybody’s IQ drops 30 points when you get back there. It's just, you know, the nature of the beast. So, it makes things a little easier, less mistakes get made if we shut it down, which is what we did and took our time getting the patient in to make sure we don’t make any mistakes.

So, when we walk in to the trauma bay, there will be a huge group of people looking at us. They’ll have a bed laying there with a big light shining down on it. And usually the attending surgeon will say, “Okay, start talking.” And at that point, this is something I had to get used to, you're not giving a report to any particular person, you're giving a report to everybody. And they’ll say, okay, and then they’ll take over at that point. And generally it's the trauma residents there in the ER, the students, and they’re going down, and they’ll say, “Okay, left leg is clear. Okay, chest is, you know, solid.” And they will be talking out loud as they’re going through the whole procedure, looking for fixable causes of what's happening. And at that point, I will make sure that a good and thorough report is given and make sure to answer any questions of the team if they have any, but that's usually the point at which it's time for me to step back, and take a breath, and kind of rethink everything that's going on and try to think if I’ve missed anything. Or, is there anything I can add that’s going to be meaningful to this process? But the care of the patient is out of my hands at that point.

Plotz: Once the patient is handed off like that, you guys are done?

Ennis: More or less. So, I’ll take a step back and, like I said, rethink everything. I’ll get a couple of signatures from the staff that certify that they received the patient, that I actually did what I said and brought them there. If there's a chart involved, I’ll make a copy of it and leave a copy there with the receiving facility, and take a chart back for my charting purposes.

Plotz: And do you know what happened with this patient?

Ennis: We just managed the ABCs, which is all that called for. I’m afraid in that particular case that that patient’s injuries were probably too severe for his brain to survive. That being said, he’s a young man in good health, he’s got a heart, he’s got two lungs, he’s got two kidneys, he’s got a liver—which is enough to treat two patients—and he was an organ donor. And so because the paramedics on scene and the hospital—and we managed that patient, you know, aggressively through the end—he was a viable organ donor, and that could potentially go on and save seven more lives. So, sometimes even if you can’t save the patient in front of you, you might save more, you know, that aren’t—

Plotz: Now, maybe you don’t think about this at all, but at what point do you think, “This guy is not going to live?” Do you even think about that, or that's not your - you can’t afford to think about that?

Ennis: In a way it doesn’t matter because a lot of that is decided before I ever got there. I didn’t cause that person to have that aneurism in his brain. I didn’t cause his injury. What's at stake is if I do everything I can do to help that person. So I’m going to show up and I’m going to do my job, and do it professionally and make sure that I don't miss anything. And if I do all those things then the outcome is out of my hands and I’m able to sleep at night knowing that I did the best I could.

Plotz: Maybe this isn’t your department, but how are you getting paid from all of that? What’s the economics that allows you to take this trip and do this?

Ennis: I know very little about the business of it. I’m a clinical person and I’m fortunate that Air Methods, they mostly give me the tools that I need to do my job and they don’t pressure me much about business or those sorts of things. But in a general sense, typically patients have insurance - Medicaid, Medicare, private insurance - and we would file a claim with the insurance on behalf of those patients. And even if that claim’s denied we’ll appeal it and pursue those things, and that's how they get the reimbursements.

Plotz: But there's never a situation where you're in the air and you're like, no insurance? We’ve got to drop this guy.

Ennis: Never, absolutely not, and that is - I believe that healthcare is fundamentally a human right. I’m here to help people, I’m here to save lives, and that's what I want to do. And fortunately my employer, Air Methods, has never placed any - they’ve never even asked that question. We don’t ask that question, we never think about it. 911 paramedics don’t think about it, it's not an issue. We give everybody the same care regardless of ability to pay.

Plotz: That was a pretty exciting, dramatic, and sad patient you talked about. Do you have one of those a day? Is that five of those a day? First of all, how often do you get a call? Is there a pattern to what they are?

Ennis: There is no pattern. Sometimes we’ll go a day or two and not have a call. Sometimes they’ll have four in one day. I can tell you that doing more than two really takes a lot out of you. It’s tremendously exhausting work. You wouldn’t think that it would be, but there are, you know, what we call stressors of flight. The aircraft vibrates, it's loud, the vibration inhibits your ability to sweat. The Nomex suits that we wear are hot, you know?

Plotz: The vibration inhibits your ability to sweat?

Ennis: Yeah, the aircraft vibrates. It's not smooth like a commercial airliner, and that does actually inhibit the ability to sweat. There are all sorts of things. For example, the rotor blades passing over, have you ever been driving and seen sunlight coming through the trees? And it flickers, and it kind of makes you feel sort of funny? That's called flicker vertigo. That can actually induce seizures, but more typically it's just a really uncomfortable feeling.

And so, you know, we’ll wear our visions down, and I try to keep my eyes down on sunny days. You don’t want to be looking up through the rotor system, because you can have a seizure, you know? But there are all sorts of things—the fact that you're cramped in this tiny space, you don’t really have any good support, you're wearing a helmet which you can’t rest against the bulkhead or anything because it will just chatter your teeth out of your head. You’re having, you know, to position yourself constantly and use all of your body’s muscles, and you don’t think about it at the time but when you get back, you know, you're beat. Like, you're ready to get something to eat and take a nap, if possible for sure.

Plotz: You told us about one particular case, but over the last—think of your last six shifts–what's the variety of things that you dealt with over that period?

Ennis: That is something that's very specific to the bases, the mix of patients that we have. We have typically seen calls mostly that come from the local EMS systems, and the patient before this one was - I had a patient who was suffering an acute stroke. I was studying neurology that day while I go out and see this patient - and he has facial drooping, he’s unable to move one side of his body, and he has what we call expressive aphasia - which means I’m speaking to him and he’s able to demonstrate he understands what I’m saying, but he can’t speak. And that's called Broca's aphasia or expressive aphasia. That's a pretty simple presentation, that patient just needs to get to a trauma–or a stroke center, as quickly as possible, which is what we did for him.

I had a patient on the Outer Banks who had an unfortunate incident. His hand went into a table saw. And he was, because of his location, would have been four and a half hours by ground to get to a trauma center, and we were able to get him to, you know, a surgical facility in 32 minutes. So, that is, you know, that is limb-saving, you know, care that we provide to the patients.

Plotz: Are there ever calls that aren’t urgent? Are there ever things which you can plan for? Or every one is an urgent call?

Ennis: Almost every one of them is a very urgent call. It would be unusual for us to get something that is not critically life-threatening. That being said, one legitimate reason to call for an aircraft is, say you're in a poor county and you’ve just got one ambulance with one paramedic. And if you have to send that paramedic, you know, to Norfolk that's going to leave your county without coverage for five hours. And so, let’s say, you know, you have a patient that needs to be transported to an emergent dialysis facility, which would need to go a tertiary care facility. You can’t afford to tie up your county and leave them without 911 coverage, and so we might be called to transport that patient. And that would be a totally appropriate thing to do, because once again it's not about just the one patient but also about public health as well.

Plotz: Do you ever see these patients again? Do you ever hear back from patients?

Ennis: It’s unusual that we hear back. More often I will hear about it from the local county EMS. Sometimes I work part-time shifts with them and help them out a little bit, and those are the folks that really know the people in the area. They know what happens. These are small towns and they’ll say, you know, oh, she made a fully recovery. She was discharged from the hospital three days later. Or, you know, unfortunately he didn’t make it. Typically I’ll hear that from those guys.

Plotz: How old are you, Jeff?

Ennis: I’m 32.

Plotz: Is this a kind of job that you can do until your 65? Or is this a young person’s job?

Ennis: I’d like to think it's something that I can do. We’ve got pilots that are older than that. They flew in Vietnam and they are still 100% on their game. And so, I fully intend to do it until I can’t do it anymore. There's nothing else that I’ve ever wanted to do.