CRANBERRY TWP - With luck, you'll never need to know exactly what goes on inside of a STAT MedEvac medical helicopter. But in case you're wondering who's on the aircraft and what's going on in there, here's a rundown.

Whenever a STAT MedEvac helicopter goes on a mission, the crew is ready to deal with any emergency.

"There is a misconception" about medical flight services like STAT MedEvac, said Chuck Ammon, a flight nurse based in Youngstown, Ohio. "We're not a flying ambulance. We're there not just to get you to a hospital quickly. It's not load and go. This is an intensive, higher level of care. We're a flying ICU."

"Whatever can be done in an intensive care unit, we can do on the helicopter. We have some equipment on board they don't even have in a small community hospital's intensive care," added Melissa Butcher, a flight paramedic based in Cranberry Township at UPMC Passavant Cranberry. "We treat you on the way."

About 75 percent of all STAT MedEvac flights are hospital-to-hospital transfers, often with critically ill patients on board who need critical care during the flight. That includes cardiac patients and those with neurological problems, possibly stemming from head injuries, aneurysms, or blood clots, all of whom require care not available at their current health treatment facility.

It also includes those needing specialized surgical procedures as well as newborns with difficulties, said registered nurse Todd Morando, the base coordinator in Cranberry.

There has been at least one in-flight birth, said Mark Rudolf, a Cranberry- based helicopter pilot.The remaining 25 percent of STAT MedEvac flights are from accident scenes to trauma centers.The number of trips STAT MedEvac helicopters have made from trauma scenes has stayed about the same from 2003 through 2004. In the past, the number of trips had been rising and topped out higher than the current average before declining to the present rate, said John Chamberlin, outreach manager."More trips from trauma scenes are generated in the summer," said Ammon, who cited more motorcycles, four-wheelers and boats in use as the reason."The response to a motorcycle accident is not necessarily a call to STAT MedEvac unless it is warranted by the mechanism of injury," said Greg Porter, a flight paramedic based in Cranberry.The "mechanism of injury" is the trigger for summoning helicopter evacuation from an accident scene, and it's "based on clinical physical criteria," said Chamberlin. "Emergency medical technicians who attend at the trauma site are trained to apply the guidelines. Those guidelines have not changed recently."When it comes to which base sends a flight to an accident scene, the closest helicopter goes.In trauma situations, and based on the mechanism of injury, a medical facility with the expertise in the injuries is chosen. The patient and the patient's family can request a destination, although the closest facility is typically chosen, Chamberlin said.STAT MedEvac flights usually head for UPMC Presbyterian or Mercy Hospital because those hospital emergency rooms have the facilities to deal with trauma victims."We often fly to Shadyside Hospital and Children's Hospital," said Rudolf .Once the call for a flight is received, the team is airborne in a few minutes. Traveling at 120 miles an hour, few destinations are more than 15 minutes away.If the destination is an accident scene, the flight nurse and flight paramedic already have an idea of the type of injuries they may be dealing with once they are on the ground. This information has been relayed to them by the emergency medical technicians who responded to the initial call.

EMTs on the ground use a global positioning system device to provide the coordinates of the site and the pilot uses a GPS on board to set the flight path.A landing zone with an adequate safety perimeter, preferably 100 feet by 100 feet, needs to be established before the helicopter's arrivals. Firefighters and emergency medical personnel are trained to recognize possible landing sites for the helicopter and how to set up a landing zone, said Porter.Hospitals have fixed landing zones.Once a patient is on board, the nurse and paramedic assess the patient and begin any needed medical procedures."We can start IVs, do airway techniques such as tracheotomies and give blood," said Morando.Four units of Type O negative blood are carried on each helicopter. Cardiac monitoring equipment is on board and the team can begin treatment if necessary.The team member seated near the head of the patient is the one who attends to everything above the shoulders. The medical team member sitting next to the gurney attends to the chest.The flight nurse and flight paramedic are crossed-trained in both areas and can act interchangeably.Once the patient is on board in the patient area, "we're off the ground in under 10 minutes unless there is a good medical reason," said Morando."We try to meet each patient's needs in every way - make them comfortable, stable and pain-free if we can," Porter added.Takeoff, flight and landing are smooth rides without jolting or rough vibrations to add to the patient's discomfort.The team members wear helmets throughout the flight and can speak to each other through microphones and are in constant communication with the receiving medical facility. The pilot also can hear and speak to the medical team.A curtain separates the cockpit from the medical bay so what goes on in the back does not interfere with the pilot's job of flying the aircraft.Once on the landing pad of the receiving hospital, the medical flight team accompanies the patient into the emergency room, continuing their reporting on the critical care they have administered during the flight and on the patient's condition.After the receiving medical team has taken over, the flight crew begins the paperwork to complete each transport.While the pilot attends to the needs of the helicopter, the flight medical team turns their attention to cleaning the medical bay inside. It is spotless before the next takeoff.

The flight nurse and flight paramedic replenish any medical supplies used during the flight. Once everything is in order, the crew heads back to their base, but they are available for deployment from that time on.Accepting a mission is up to the pilot, said Rudolf."We have a weather operating limit that we follow. During daylight, there must be a minimum ceiling of 500 feet and one-mile visibility. For night flying, an 800-feet ceiling and two-miles visibility is required. STAT MedEvac flies while it's snowing, but not when there are icing conditions. We have the best weather program on our computers," he said."It is normal for each helicopter to have enough fuel and supplies for two (round-trip) flights if necessary," said Ammon.Not every base has a fuel depot for the helicopters, however. Cranberry has a 5,000-gallon supply of aviation fuel and it's not unusual for a flight from Youngstown, Ohio, to Pittsburgh to tank up in Cranberry.Between flights the crew catches up on paperwork, including flight statistics, and prepares equipment for later use.Flight nurses work a 24-hour shift.Morando has been a flight nurse on STAT MedEvac for six years and is also the base commander in Cranberry. He has worked in a hospital emergency room as a nurse and before that worked as a paramedic.His twin brother serves the public as well as a state trooper.Paramedics work various shifts.For Butcher, "the schedule is ideal. I have two kids, 7 months and 12 years. The work is exciting. We have a lot of autonomy, although we work under set protocols. As a paramedic we do a level and quality of care you can't do anyplace else."Rick Trowbridge, a paramedic from Mercer, who is based in Youngstown, agreed."We're allowed to do a lot more than a ground ambulance," he said. "This is what I want to do.""I've been a paramedic all my life and I love it everyday," said Porter, who does a 24-hour shift at least once a week along with other, shorter shifts.The Cranberry base has three rooms with beds for napping, if necessary. The pilot's office is also their on-duty resting quarters. Pilot Rudolf works 12-hour shifts from 6:30 to 6:30, four days on daylight, one day off, then a three-day night shift.Rudolf, who is married with three children and a native of New York, lives in Butler. He has piloted rotor aircraft for STAT MedEvac for six years."This is a job where I could put my flying skills to use in the civilian sector. Flying for STAT MedEvac isn't much different from flying for the military," said Rudolf, a former Marine who was based at Camp LeJeune, N.C."My military experience prepared me for this type of work environment. There wasn't much transition. It's the same type of high-stress environment. Pilots usually find out in the first few years if they like this kind of job. It has the potential to be a lifelong job."I'm never involved with the medical side. Pilots are busy enough operating the aircraft from point A to point B, and I have to keep my emotions out of the cockpit. That requires compartmentalization," he said."Repetition helps. My number one priority is to fly the aircraft safely. (That's my focus), not the medical team behind me. There is gratification in the job knowing that patients are receiving a higher level of care at the receiving facility," said Rudolf.Rudolf primarily flies the EC135, a rotor aircraft for which he has specialized training.Every six months, pilots have a flight with a check airman, a standardization instructor who makes sure policies and procedures for the aircraft are being followed properly.Aside from daily maintenance by a mechanic at Cranberry, the aircraft also has regularly scheduled maintenance at the Allegheny County Airport where the aircraft spends about a week undergoing an intensive maintenance inspection.

<b>STAT MedEvac:</b> A nonprofit organization completed its first patient carry in 1984.<b>Staff:</b> Each STAT MedEvac helicopter is staffed with a pilot, flight nurse and flight paramedic. All are paid professionals.<b>Types of aircraft:</b> STAT MedEvac flies four types of helicopters: BK117, Bell 430, Dauphin S365N and EC135. The EC135 that operates from UPMC Passavant Cranberry can carry one patient and if necessary, one passenger. The EC135 costs $4 million.<b>Flight operations:</b> The helicopters can generally fly one hour, 10 minutes without refueling. The average air speed is about 120 miles per hour and the helicopter routinely flies about 900 feet off the ground. Flights operate in about a 100-mile radius from the base.<b>Missions:</b> STAT MedEvac is off the ground within four minutes of receiving and accepting a mission. The average mission lasts about two hours. Cranberry STAT MedEvac flies about 80 missions a month or an average of about 2½ trips per day.About 75 percent of STAT MedEvac trips are hospital-to-hospital transfers while about 25 percent are from trauma scenes.<b>Butler base of operations:</b> Cranberry STAT MedEvac, which is Base 3 at UPMC Passavant Cranberry in Cranberry Township, is a fuel base, storing 5,000 gallons of aviation fuel. It also has cache of extra medical supplies.<b>Cost:</b> The average cost for helicopter transport is $6,000 from an accident site and is typically covered by insurance. For medical patient transports, the cost is about the same.