No one knows what will happen during an emergency medical flight shift. A machinery accident removes a worker’s arm, or a motorcyclist skids across the road during a collision. A patient in critical condition needs a transfer to another hospital. Once the “tone” sounds, flight teams are the only ones trusted to save these lives.
“We’re taking care of people on the worst day of their life,” says Lacee Combs, a Flight Nurse with Air Evac Lifeteam 46.
Two emergency medical flight providers serve the Evansville area. Air Evac Lifeteam 46 is based at Deaconess Midtown Hospital, while StatFlight 6 works as the primary provider at Ascension St. Vincent Evansville. Lifeteam 46 also answers calls as needed at Ascension St. Vincent.
Locations for Air Evac Lifeteam and StatFlight — both operated by private contractors — are staffed by four teams made up of a pilot, nurse, and paramedic. Nurses and paramedics work 24-hour shifts, while pilots take 12-hour shifts per federal law. They airlift patients from “scene calls” at the site of grave injuries or via hospital “transfers.” Lifeteam 46 typically retrieves patients within a 70-mile radius, while StatFlight 6’s reach extends 90 miles.
To work on emergency medical flights, nurses need at least three years in a critical care environment, emergency department, or intensive care unit. Paramedics need three years with Advanced Life Support emergency medical services.
Pilots must have 1,500 hours of helicopter flight experience. Lifeteam 46 pilot Paul Schroader accrued those hours between 2013 and 2023, which he says is an accelerated time frame. As a former flight instructor for the U.S. Army, he was in the air almost every day.
Those are just the minimum prerequisites. In the most stressful, time-sensitive, and traumatic situations a first responder can experience, having the right temperament for the job is crucial. Brian Short, senior program director with Air Evac Lifeteam, says he lets every candidate know what they are signing up for.
“A critical care air environment is very different from ground or hospital environments,” says Steven Weber, the air medical base supervisor for StatFlight 6. “You have to have someone who is confident. They almost have to like chaotic situations.”
“You can’t pull them off the street and throw them in a helicopter,” Short says.
JUST THE BEGINNING What are they in for? “A rigorous process,” Combs says.
There is a week-long orientation for paramedics and nurses to learn compliance, processes, and safety. New hires go to Air Evac Lifeteam’s headquarters in O’Fallon, Missouri. StatFlight’s new hires train at parent company PHI Air Medical’s headquarters in Phoenix, Arizona.
Combs gets Lifeteam 46’s new hires up to speed on operations with 8 a.m.-5 p.m. shifts and mock flights. Recruits also complete 24 hours of online education and participate in scenario-based simulations with a regional Air Evac Lifeteam educator.
Then comes a six-month internship with a preceptor, or trainer. Every Air Evac Lifeteam paramedic and nurse must keep current with around 20 certifications, including CPR cards, Advanced Cardiovascular Life Support, Neonatal Pediatric Transport, and more.
“Knowing you are capable of taking care of the sickest or most hurt patient you’ve ever seen with your partners, you’re confident in your skills,” Combs says.
At StatFlight, new hires go through two to four months of training after orientation. Paramedics and nurses must maintain 14 certifications to ensure they possess advanced skill sets above those of their paramedic and nurse colleagues in hospitals or ambulances.
“I really liked nursing, but I missed being out on scenes,” says Weber, a nurse of 23 years who started in EMS. “I have more autonomy and a bigger skill set on an aircraft than at hospitals.”
“I felt like I could be doing more,” says Ron Guth, Lifeteam 46’s assistant program director and Flight Paramedic, who worked ground EMS for 15 years in Vanderburgh County. “Air Evac Lifeteam allowed me to accomplish more in my career.”
Pilots must have commercial and instrument certifications. Air Evac Lifeteam onboarding pilots receive three weeks of training. StatFlight requires three weeks of live flying and simulated flights mimicking engine failures and hard landings.
Each team picks up patients within their radiuses in Indiana, Kentucky, and Illinois, and most flights return to the Evansville area. Pilots also regularly fly to regional drop-off locations in Nashville, Tennessee, Saint Louis, Missouri, Louisville, Kentucky, Cincinnati, Ohio, and Chicago, Illinois. Weber says the approaches at each location are different, so practicing and learning who is on the radio as they approach landing pads is imperative.
Both contractors encourage flight teams to continue their education with regular studying and evaluations. Each paramedic and nurse must pass quarterly evaluations. Pilots, Shroader says, take yearly written and flying evaluations.
DIVING INTO THE DAY “When you come to work, you never know where you’ll end up in the afternoon. Every day is an adventure,” Guth says. “Watching the helicopter land is like the first time every time.”
Each shift starts with a brief meeting between the outgoing and the incoming teams, which typically stay the same, allowing members to build a rapport.
“Those meetings set the tone for the day,” says Paul Cross, a Lifeteam 46 Flight Paramedic.
The oncoming team performs safety checks on all equipment and the helicopter, checking everything is charged and stocked. Air Evac Lifeteams ride in a 4,450-pound Bell 206 with a single Rolls Royce engine typically filled with 82 gallons of fuel for a maximum speed of 110 miles per hour. StatFlight operates an EC 135 P2 Plus helicopter weighing around 5,500 pounds fully fueled, with two turbine Pratt and Whitney engines propelling it up to 130 miles per hour. Mechanics regularly replace parts.
The teams also check the temperature of the blood products they have stored in a specifically designed refrigerator, which they move to a cooler on the helicopter when a transfer is needed. Lifeteam 46 carries packed red blood cells and liquid plasma, while StatFlight 6 transports units of whole blood containing red blood cells, platelets, and plasma. Weather conditions change constantly in the Ohio River Valley, so forecast checks are important since the conditions limit when they can fly. Schroader says Air Evac Lifeteam pilots are barred from landing if they cannot see the ground or taking off with limited visibility.
“The company is very pro-safety in that regard,” Schroader says.
StatFlight’s pilots can rely on instrumentation to land in low-visibility or no- visibility conditions. They cannot fly in lightning storms, ice, or high winds.
The views also are one of a kind. Whether from the top of a high-rise landing pad or in the clouds, “you don’t get better views from your office,” Short says.
“The things you get to see are not what most people see in their lifetime,” Combs says.
While workers are encouraged to rest, teams spend their on-duty hours studying for exams and evaluations.
“Sometimes, you’re doing education all day, and some days you don’t touch a computer,” Weber says.
Educating the community and other emergency responders is just as important.
Lifeteam 46 works with fire departments and EMS to acquaint them with best practices before deploying for emergencies. Often, fire departments are the first on the scene of trauma incidents, where there could be debris or downed power lines, so Lifeteam 46 teaches them how best to prepare a landing zone for the helicopter. StatFlight also offers ride-a-longs for those thinking about a career in emergency medical flights — and recruits always are welcome.
“It’s a team effort in so many ways,” Combs says.