Springtime in Charlottesville usually means Fridays After Five, lazy days, wildflowers - and great weather for flying helicopters. "We get spring fever," said Robbie Hamilton, a paramedic for the Pegasus flight operations program stationed at Charlottesville-Albemarle Airport.
But these flights are far from joyrides for the Pegasus crew, a group that is dedicated to providing emergency flight care for critically injured patients.
Pegasus, the University's aeromedical trauma service, includes one helicopter and a ground transportation unit.
The University created the program in 1984 to transport and care for critically injured patients in need of a level one trauma center, such as University Hospital. These hospitals have medical resources - such as operating rooms and emergency room care - available 365 days a year, 24 hours a day.
Flying at speeds of up to 150 mph, the Pegasus helicopter is the fastest medical helicopter in Virginia and provides a quick and effective means of care and transport. Pegasus is one of nine flight operation programs that service the Commonwealth.
The University began leasing this midsize helicopter in 1996 from Texas-based Omni Flight Helicopters, Inc., for about $30,000 a month. It costs an additional $3,000 per day to have the helicopter available, plus about $1,000 per flight, Fields said.
Every day a crew of two staffed mechanics meticulously cares for Pegasus. According to Fields, most well maintained helicopters can expect at least 20 years of operation.
Ground unit
Though many people think of Pegasus only as the behemoth Bell 230-twin engine helicopter, last year Pegasus started providing a ground unit ambulance. Both means of transport are part of the University Health System.
With more equipment than a normal ambulance, the ground unit is referred to as a Mobile Intensive Care Unit. Fully equipped, the ambulance carries a price tag of $185,000 - about double that of a normal ambulance.
The ground unit also has an extended cab that allows four passengers in front, permitting family members to ride along with the patient. It even has a television so younger patients can watch cartoons en route as they are receiving care.
Lending a helping hand
Pegasus has received much praise over the past 17 years - dozens of gold and bronze plaques describing its excellence decorate the front wall of the Pegasus operations building.
"Highest praise for life saving," "outstanding service" and "airborne excellence" are just a few of the phrases used to recognize the program.
The service targets patients whose lives rely on "the golden hour," the theory around which Pegasus is designed.
The golden hour is the first hour after a victim has been injured. Medical professionals say treatment during this period provides the best chance of survival for a critically injured patient.
As of October 2000, Pegasus safely transported more than 10,000 patients. Overall, it services nearly 800 flight transports a year in a 100-mile flying radius. It averages three flight transports per day and 20 ground unit transports a month.
"We are the busiest program in the state of Virginia," Pegasus Program Manager Mary Ann Himes Fields said.
The crew
A 26-person crew staffs Pegasus, and its members range in age from 29 to 53. There are 16 paramedics and nurses - including three women - four drivers, two mechanics and four pilots. A paramedic, nurse and pilot comprise the ground crew that responds to calls made by Emergency Medical Services squads - who are either police, rescue squad or fire fighters - and decide if the helicopter is needed.
"There are guidelines that EMS workers use to help them determine whether to use Pegasus," Fields said.
The crew calls in the helicopter depending on the injury, or if the patient is in a rural area and needs quick transport to a hospital with a higher level of care than a closer facility could provide.
Patients who are transported by helicopter can expect an average bill of $5,000 for a 20- to 30-mile flight. But Pegasus Clinical Manager Bob Knox is confident that "we overall diminish the hospital stay and cost by getting them there quicker."
By rotating 12-hour shifts three days a week, two sets of crews are available every day, with one crew working the night shift. Pilots work six shifts per week - three days and three evenings with a six-day break afterwards.
In addition, the crew members work about four hours per week on special projects such as educational programs or seasonal events, including delivering Christmas presents to children.
Only the best
Because flight medicine is such a dangerous profession, Pegasus' crew members all have many years of experience. Pilots must have at least 2,000 flight hours to even be considered, according to Fields. In addition, all current pilots have military flight experience.
Paramedics must have at least four years of strenuous EMS experience, and nurses at least five in critical care.
In addition, all crew members must bring a great deal of what Fields calls "progressive EMS experience" from metropolitan areas.
According to the National Transportation Safety Board, there was one fatal EMS accident last year, resulting in four deaths. But Pegasus helicopter crews have never encountered any serious threats of danger, in large part because of the skill of the pilots and mechanics, said Knox, who is one of three remaining original crew members.
"We operate under very conservative safety margins," Pegasus paramedic Scott Keim said. For example, any member of the crew can call off a flight if they feel unsafe in any way - no questions asked.
Working under pressure
Citing the adrenaline rush and the availability of rare skills and challenges found at Pegasus, crew members said the program offers them a chance to give to the community as well as provide a unique camaraderie between staffers.
And give to the community they do. Pegasus Nurse Donna Hill described an incident at a nearby ski resort in which a man's neck was sliced so severely that Hill could slip four fingers inside the wound. She had to make a controversial but integral choice to perform a risky procedure that ultimately saved the man's life.
"There are times when you're scared," Hill said. "This isn't the kind of job with a cook-book formula for how to do things."
Because of the nature of their jobs and the pressure under which they work, expectations for crew members are high. The crew must provide rapid transport and care equivalent to the quality received at University Hospital - all in a limited amount of time.
"Procedures you see on 'E.R.' we do daily on the side of the road," Knox said.
And of course, all this must happen with the strictest of safety concerns.
But in the heat of it all, the most pressure and the highest expectations come from crew members themselves. "We expect a lot of each other," Keim said, "but nobody expects as much of me as I do."
True to form, despite the dangers of flying and the threat to their lives, the crew at Pegasus remains thankful for the opportunities it has to serve the local community.
"It's nice to hear someone say 'Hey, I'm getting to graduate high school because I took a ride on the helicopter,'" Hamilton said.
Although it is a vital part of the medical community, the crew of Pegasus typically is hesitant to claim credit for its life-saving actions. Knox described its job as simply offering resources and talents to the community.
"We're just a small part of a team that saves someone's life," he said. "We're just the most visible"
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