The call comes in at 10:45 a.m.
It's a newborn in northwestern Saskatchewan who needs transportation to the neonatal intensive care unit (NICU) at Royal University Hospital (RUH) in Saskatoon.
Bryan Lester, a flight nurse with Saskatchewan Air Ambulance, jumps to respond to the call. He's been flying for seven years and regularly boards the small King Air planes that fly him across the province and the country to bring the sickest and most injured people to a higher level of care.
While Bryan prepares for the flight, his colleague Stan Wiebe coordinates the logistics from Air Ambulance's Provincial Aeromedical Coordination Centre (PACC). For this call, Stan is arranging to have two nurses from the NICU accompany Bryan on the flight. Normally, the flights are manned by a flight nurse and flight paramedic, but with a newborn baby in distress on board, two neonatal nurses will accompany Bryan to provide specialized care.
That doesn't stop flight paramedic Pat Morris from lending a helping hand. The veteran, who's been practicing paramedicine for nearly 40 years, transfers an incubator for the baby onto the plane while the team waits for the NICU nurses to arrive.
The Air Ambulance team takes an incubator to the plane for a neonatal patient in northwestern Saskatchewan while waiting for NICU nurses to arrive. Flight nurse Bryan Lester just prior to take-off on a journey to northwestern Saskatchewan to pick up a neonatal patient.
The next call comes less than an hour later – another patient in northern Saskatchewan is having difficulty breathing and needs to be transferred to RUH for advanced care. This flight is in the air within the average 23-minute span from call to take-off with a typical crew: one flight nurse, one flight paramedic and two pilots.
Last year, Saskatchewan Air Ambulance received 4,573 calls through PACC. Air Ambulance responded to 1,460 of these calls. The other calls were responded to by STARS Ambulance for helicopter transport, by ground ambulance, or by private air carriers for emergency and non-emergency transportation in La Ronge and Stony Rapids.
"We transport patients for many different reasons," Saskatchewan Air Ambulance Manager David Mandzuk says, explaining that two-thirds of the patients transported by Air Ambulance typically require advanced care or critical care services for conditions that range from heart attacks and strokes to motor vehicle collisions.
"The other third is when it's logistically necessary to use a fixed-wing aircraft, such as taking a stable patient who requires heart surgery to Edmonton," he says, adding that the planes will go as far as Vancouver and Toronto to transport patients.
Saskatchewan Air Ambulance – one of the oldest aerial medical services in the world
Founded by former Premier Tommy Douglas in 1946, Saskatchewan Air Ambulance was designed to transport rural patients throughout the province to central and regional hospitals. The service came into existence shortly after World War II, at a time when planes – and veteran pilots who knew how to fly them – were readily available.
Flight paramedics haven't always flown with Air Ambulance. When it began more than 70 years ago, the crew consisted of one flight nurse and one pilot, who often had to land the plane in a farmer's field.
Flight paramedics joined Air Ambulance in 1993, when the program, which had been predominantly based in Regina, was moved to Saskatoon because of the city's central location and proximity to northern Saskatchewan.
Pat Morris was one of the first flight paramedics to fly with Air Ambulance.
"Air ambulance isn't much different than ground ambulance. I find it just as easy to work here as the small ambulances we used to have on the street," says Pat, who was a ground paramedic for 14 years before joining Saskatchewan Air Ambulance 24 years ago.
"It's been rewarding – connecting with patients, the different people you meet, the variety," he adds. "In any given day, we could see this whole province."
Pat is one of 14 paramedics who work at Air Ambulance, in addition to 24 flight nurses, 30 pilots, a handful of administrative staff, including a manager and medical director, and maintenance engineers and mechanics. The service has two crews and three planes – the planes fly so often, one is usually under maintenance.
Behind the scenes with a flight paramedic and flight nurse
Pat is on the second flight of the day to northern Saskatchewan to pick up a patient who is having difficulty breathing. Today, he's paired with flight nurse Lisa Stewart, who worked on the intensive care unit at RUH for 10 years before joining Air Ambulance in 2011.
"Whatever you see in hospital will happen here – we even deliver babies," Lisa says, as she mentions that since becoming a flight nurse, she's acquired two stork pins – one for each of the babies she's helped to deliver in the sky.
"It's an intense moment until you know the baby is well," she says of the deliveries, "and it gets hot in here. We get the pilots to turn up the heat because the baby needs temperature regulation, so we're all sweating because we want to keep the baby warm. It's a pretty exciting experience and fun to carry a beautiful baby into the hospital.
"Sometimes we're so busy with our patients we'll have pilots banging on the wall, saying, 'put your seatbelts on!' because we're not ready for landing," she continues, adding that being able to work with paramedics is one of the highlights of being a flight nurse.
"They bring a different perspective," she says of her paramedic counterparts. "As a critical care nurse, I do a lot of thinking ahead – what's going to happen rather than what's happening right now. Our paramedics help us move things along quickly."
"If you look at the model for critical care transport in the world, nurse-paramedic models are very common because there's a synergy between their skill sets and how they see things," David says, explaining that flight paramedics are great at the initial rapid assessment of a patient, whereas flight nurses excel at managing the patient for the duration of the flight.
"They have different approaches that are complementary," he adds. "That's why they make such a great team."
The Air Ambulance team works with paramedics to transfer a patient from a flight and onto a stretcher. The paramedics transport patients to hospital via ground ambulance.
Flight nurses and paramedics: the best of the best
Lisa remembers days as an intensive care nurse when she heard that Air Ambulance was bringing a patient to the hospital.
"I'd see these iconic people come in, and I'd want to be like them," she recalls. "And now I'm working with them. It's like 'Wow, how did this happen?' – it's fabulous!"
According to David, her manager, it happened through a lot of hard work – the training and experience required of flight nurses and paramedics is demanding. Before they can even consider applying for the job, flight nurses must have a minimum five years of nursing experience in an intensive care unit, critical care unit or pediatric intensive care unit – some also have emergency nursing experience. Flight paramedics are required to have at least three to five years of experience as an advanced care paramedic – the highest level of care provided by paramedics in the province.
After being hired, both flight nurses and flight paramedics must participate in a four month critical care and emergency medicine training program through Air Ambulance, as well as aviation training through Transport Canada similar to the training flight attendants receive.
Each year, they also participate in a minimum of 40 hours of learning that includes simulation labs, where they're presented with different scenarios related to trauma, and time spent in hospital operating rooms with anesthetists and other healthcare professionals, in addition to completing re-certifications for adult, pediatric, neonatal and obstetric care.
"These are the highest trained nurses and paramedics in the province, alongside STARS," says David. "We can do needle decompression of a chest for a collapsed lung. This is something physicians normally do in hospital, but our flight nurses have been doing it here for years."
"I work with the best of the best," Lisa says, adding that it took her about a year to feel comfortable in her new role as a flight nurse.
"I would feel like I was going to throw up," she says, chuckling. "I'd be nauseous because I was out of my comfort zone. In an intensive care environment, we have everything at our disposal – specialists, experienced nurses, in-house physicians – whereas out here, it's just me and my paramedic. I can phone someone if I need assistance – we have transport physicians available – but it's really my medic and me working together.
"On average, our trips are about three hours by the time we get the patient to where they need to be delivered and we're ready to go again," Lisa continues, explaining that the flight nurse and paramedic will typically follow the patient to the hospital and remain with them until they are admitted.
At times, flight nurses and paramedics may leave equipment behind for their rural counterparts.
"Sometimes the community has depleted everything they've got after a really sick patient," explains Lisa. "They're in a secluded area where it's hard for them to get equipment, so we'll empty our bags and leave whatever we have.
"I think we have great relationships with the communities," she adds. "We'll come and they'll say, 'Oh, it's the angels from the sky,' and we'll say, 'No, no, you guys have done such a good job,' because what the communities do before we get there makes all the difference."
Last but not least, the flight pilots
As soon as a call comes in to PACC, the pilots are notified.
"A rule here is that we don't tell the pilots what we're going for," says Lisa. "If there's a reason we can't fly into a community, that's all we need to know."
Reasons for not being able to fly are usually related to weather, such as poor visibility. If the plane is unable to land on the receiving runway due to runway maintenance, the plane will still be able to fly but the crew will have to find an alternate location, such as a runway in a nearby town, to land.
"If we ask the pilots, 'Where can we get to?' that's cue for them to know there's something we really need to get to. Then we'll work as a team to figure out how we can pick up the patient," Lisa explains, adding that she has complete trust in the pilots.
"I couldn't do my job if I didn't trust the pilots – they're fantastic," she says. "I feel safe. I'm never concerned or nervous about flying."
Pilots working for Air Ambulance are able to fly their planes with a cabin pressure in the range of 2,000 to 4,000 feet based on patient needs.
"As a passenger of Air Canada or West Jest, you're flying in a 7,000 to 8,000 foot cabin, so you become hypoxic (deficient in oxygen), so you get off commercial flights tired," flight paramedic Pat, who also has some experience flying planes recreationally, says.
Pat explains that the Air Ambulance flights are much more comfortable for both staff and patients because the cabins are pressurized at a level comparable to the altitude at sea level at their destination.
"Say we leave Saskatoon at 1,600 feet above sea level and we go to Calgary," says Pat. "We have to climb the cabin to 3,500 feet because that's where Calgary is above sea level. We do that slowly so that the patients can get used to a higher pressure."
Flight pilots Nathan McLean and Brent Harrold say that being able to help people is the most rewarding part of their job. They also like the diversity.
"It's different every day," says Brent, who's been with Air Ambulance for two years. "You never know what it's going to bring. About a month ago, we picked up a guy who had a steak knife sticking out of his head."
Bryan, who has returned from his trip to northern Saskatchewan for the neonatal patient, concurs.
"It's the best job," he says. "I can't think of a place I'd rather go."