Life and death juggling act

ShandsCair dispatcher must keep constant track of units in the sky and on the ground

By Alexis Bajalia and Alisha Kinman

 

Every day, UF Health ShandsCair paints the sky orange and blue as highly skilled crews on the ground and in the air work together to get sick and seriously injured patients from life-threatening situations to safety. Now celebrating its 35th year of service, ShandsCair has saved more than 72,000 lives and continues to provide ground and flight transportation to those in need here and abroad.

Founded by Richard Melker, M.D., Ph. D., the ShandsCair program began operating out of Gainesville with a fixed-wing aircraft that specialized in transporting premature infants. Not long after, the team recognized the need for more air medical and ground vehicles to serve patients of all ages.

The flight crew now consists of the adult/pediatric team and the neonatal/pediatric team, which caters to the tiniest of patients. In 2014, ShandsCair added a state-of-the-art Airbus EC-155 helicopter, known as the biggest, fastest and most advanced civilian aeromedical helicopter in the Southeast.

The ShandsCair fleet now includes one fixed-wing aircraft, three helicopters, six ambulances and two medical discharge vans. ShandsCair has also expanded its number of bases, with one in Perry, Florida and another in Summerfield, Florida.

Today, the ShandsCair team is operated by David Meurer, M.D., medical director for adult and pediatrics; Michael Weiss, M.D., medical director for neonatal; and Staccie Allen, M.S.N., ARNP, E.M.T.-P, CFRN, program director. The ShandsCair family consists of more than 130 employees who are specially trained to care for the most critically ill patients.

While much has changed in the last 35 years, the courage and dedication captured in the iconic image of Chopper Doc, created by Melker’s son Jeremy and which adorns most ShandsCair vehicles, remains a constant.

Over the following pages, you’ll meet some of the dedicated people behind the scenes of this extraordinary lifesaving operation.

Life and Death Juggling Act

ShandsCair dispatcher must keep constant track of units in the sky and on the ground

By Alexis Bajalia

Alison O’Connor

When a 911 dispatcher contacts ShandsCair’s Alison O’Connor, E.M.T. and A.C.S., she begins working immediately.

As a ShandsCair dispatcher, one of O’Connor’s many jobs is finding the closest aircraft and most appropriate team to send to those in need of emergency medical assistance, and she knows she has no time to waste.

“It’s a split-second decision you have to make,” she said.

O’Connor, who has been a communication/transportation specialist for 13 years, fields calls all day concerning people across the country who need to be transported to a hospital or emergency room, and soon.

“Even in dispatch, there are some calls you remember forever,” she said. “It affects you just as much as it affects the person who just responded to the emergency situation.”

O’Connor’s tasks include responding to and coordinating interfacility transports, ambulance or flight requests and trauma alerts while also ensuring the medical specialists who arrive at the scene are the ones who are most qualified to help that particular patient.

So if O’Connor receives a call about a child who has been in an accident, she does her best to make sure someone who specializes in children, such as a pediatric nurse, is on that helicopter.

“I think about the group of people I’d want to be there if it were my kid,” she said. “We’re one of the only flight programs that can mix and match any combination of a nurse, medic, neonatal nurse, respiratory therapist… We mold to whatever the person needs, sometimes even flying our medical director.”

Though a computer system tells O’Connor where the closest aircraft are and how long it will take them to arrive at their destinations, she and two other dispatchers work together to make instantaneous decisions about who to send where, when and how. O’Connor and her team also refer calls to transient aircraft if they are closer to the patient in need or if ShandsCair’s aircraft are all being used at the time.

“It’s all about prioritizing, multitasking and thinking outside the box,” she said. “You have to think about who needs you most, and you have to keep the patient first.”

While ShandsCair flight teams are in the air, O’Connor tracks and communicates with them to make sure they aren’t in the same air space as other aircraft – sometimes monitoring up to five helicopters at a time.

“It’s our job to not only know where they all are but also to make sure they know where they all are,” she said.

But O’Connor’s responsibilities don’t stop there, as ShandsCair’s dispatchers are also licensed emergency medical technicians, some being former firefighters.

While at work, O’Connor spends about 75 percent of her time in dispatch and 25 percent of her time on ambulances taking care of patients. Though every day is different, O’Connor said doing both jobs allows her to better understand the ins and outs of the system.

“One of the bonuses of driving and dispatching is you never know what will unfold,’’ she said. “You can come to work to dispatch and end up on an ambulance to do a transport or vice versa.”

Whether she’s on the phone or on an ambulance, O’Connor said her main goal stays the same: Get the patient to UF Health Shands Hospital as soon as possible.
“When we finally get a patient here, I know they’re safe,” she said. “Because I know they’re going to get the care they need here.”

Saving the tiniest patients

ShandsCair’s neonatal/pediatric unit strives to keep stricken babies alive

By Alexis Bajalia

A premature baby is born with a life-threatening medical issue. A newborn is experiencing cardiac or respiratory difficulties. A toddler accidentally consumed something poisonous. Whatever the emergency might be, if the child is under the age of 5, ShandsCair’s neonatal/pediatric flight team is ready to handle the situation.

When Laurie Whidden, B.S.N., RNC-NIC, EMT-B, and Lily Irwin, R.R.T., are informed that a newborn needs to be taken to one of UF Health’s neonatal intensive care units, they decide how they are going to get the baby from point A to point B. Several factors play into this decision: weather, distance, availability of vehicles and, of course, the severity of the baby’s health condition. Whidden and Irwin weigh their options before preparing their equipment and making their way into the clouds.

While in the air, Whidden and Irwin work tirelessly to improve the baby’s outcome. Active cooling for hypothermia therapy is a device that lowers a baby’s body temperature to a certain degree to protect the baby from brain injury. Nitric oxide therapy uses a specialized gas to dilate the lungs if the baby is undergoing respiratory issues. Extracorporeal membrane oxygenation, or ECMO, is a heart-lung bypass machine that moves the baby’s blood to an artificial lung and back into the body, ultimately taking over the work of the heart and lungs if the baby is experiencing a life-threatening condition.

Whidden and Irwin have have even flown out of the country to pick up babies who are ill and transport them to UF Health’s neonatal intensive care units, although most of the time they stay in Florida and its surrounding areas.

For babies who are in critical condition in Florida, neonatal medical professionals like Whidden and Irwin might be their one shot at survival.

“State law says that if a baby is under a certain age or weight, he or she has to be transported by a neonatal/pediatric team,” Irwin said.

This means that some infants cannot arrive at an emergency facility by a county ambulance. So if the weather is bad, ShandsCair’s neonatal/pediatric team drives their own ambulances and picks up the babies themselves.

“Our team is unique because we’re pretty much the only people that can transport that small baby,” Irwin said. “There are very few neonatal/pediatric teams across the state of Florida.”

To be able to care for more than one baby at a time, ShandsCair has two neonatal/pediatric teams on duty each day. If one team is on a longer flight, a second team remains ready to respond to a new call. And in some cases, Whidden and Irwin transport pregnant mothers and older children to the ICU as well.

Working 10- to-12 hour shifts and often taking night calls, Whidden and Irwin say what keeps them going is “the joy that comes with working with kids,” who become happy and playful when they begin to feel a little better than they did before.

“For as long as I can remember, I’ve always had a passion for kids,” said Whidden, who worked at a UF Health neonatal intensive care unit for eight years before joining ShandsCair. “The most rewarding part of my job is seeing the babies we pick up who were very, very tiny and very, very sick be able to go home with their parents.”

Without a second to waste

ShandsCair teams often en route before paramedics summon them

By Alexis Bajalia

When a ShandsCair dispatcher contacts Todd Brooks about an accident, he and his flight crew prepare for the worst.

“We’re already en route before the paramedics even truly know they need us,” said Brooks, R.N., EMT-P, C.E.N. “We try to get off the ground as fast as we can.”

As members of ShandsCair’s adult/pediatric flight team, Brooks and a critical care paramedic remain on “flying standby” until first responders tell them whether they need the flight team to arrive at the scene of an accident.

“That cuts off a few minutes right there,” Brooks said, noting that minutes are precious when it comes to reaching a person who is in critical condition.

If it is decided that one or more patients need to be flown to the emergency room, Brooks and a critical care paramedic head straight to the scene, where they evaluate the person and get them into the helicopter. All of this activity happens almost in an instant.

“Our goal is to be on the scene for less than 10 minutes,” Brooks said. “Then we do everything we need to do en route to the hospital.”

While in the helicopter, Brooks and the critical care paramedic work quickly to ensure the patient receives quality care that could potentially save the person’s life.

“ShandsCair works to send the most specialized team for each case,” Brooks said. “It’s not only about sending a team immediately. It’s about sending the best and most appropriate team.”

If a patient is at risk of heart failure, Brooks might use an intra-aortic balloon pump to help the heart pump blood throughout the body until the patient reaches the hospital and undergoes emergency surgery. If a patient is experiencing respiratory failure, Brooks might use rapid sequence intubation to temporarily paralyze the patient and stabilize his or her airways.

But no matter what procedure he is conducting, Brooks stays calm in these often stressful and always fast-acting situations.

Brooks, who is also a teacher to students who plan to enter the field, said he begins his introductory classes by asking students if they consider themselves athletes. He proceeds to ask them what they consider to be the most important game they’ve ever played in, and he uses their responses to put the job of an emergency medical technician into perspective.

“That high school state championship game was nothing compared to what you’re about to do,” Brooks tells his students. “Now, you’re about to be one-on-one with a person who is dying. That is the biggest competition of your life, and at the end of that battle, you’ll either win or know you did the best you could do.”

Brooks, who started out as a ShandsCair flight paramedic before he was promoted to a flight nurse, has faced dozens of these battles. He recalls one instance when an elderly couple was in an accident and the woman was trapped inside the vehicle.

“Is she going to make it?” the woman’s husband asked Brooks.

“Why don’t you tell her goodbye?” Brooks told him as he watched the man kiss the woman on the cheek and tell her he loved her for the last time before she passed away.

“There are a few times in my career I’ll never forget,” Brooks said.

Though there are some battles he will win and some he will lose, Brooks said he looks forward to his 24-hour shifts, the excitement of not knowing what might unfold that day and the possibility of saving a life or two.

“Every single day, you have the potential to do something good,” Brooks said. “Every single day, you have the potential to help people.”

GroundCrew

When ShandsCair aircraft can’t get there, count on the ground transport team

By Alexis Bajalia

Chad Thomas

If an adult patient does not meet flight criteria or needs to be transported when weather conditions are making it unsafe to fly, ShandsCair’s ground transport team comes into play.

Ground team members, including Chad Thomas, EMT-P, transport patients from outlying medical facilities to UF Health Shands Hospital, released ICU patients back to their original facilities, and help with other interfacility transports as needed.

“ShandsCair bends over backward for patients, regardless of what insurance card they carry, where they’re at or what their life story is,” Thomas said. “For the most part, we’ll go and get anybody and bring them back to the hospital where they can receive quality care.”

As a critical care paramedic, Thomas said preparation is the key to making sure the process of transporting patients runs smoothly. He said members of the ShandsCair team are required to complete intensive training and continued education to ensure they are prepared for whatever situation they might face.

“We’re expected to know everything we know but in five minutes,” Thomas said. “If you get called to someone who is not breathing, you’re there in five minutes. Everything you’ve ever learned in your career, you’re expected to bring to that patient – all your skill sets, all your experiences, your special senses — you’re expected to know it all.”

Thomas, who calls ShandsCair’s ambulances “mobile ICUs,” said working both rapidly and meticulously and remaining calm on the job are skills that come with practice and experience.

“If you’re well-skilled, well-versed and have the knowledge, it almost comes as muscle memory,” he said. “It’s all about the patient and the patient’s needs, ensuring they receive the highest-quality care we can provide in a timely manner.’’

The team transports patients ranging from those who require minimal monitoring to those who are in need of clinical care to their new destinations.

ShandsCair’s ground team keeps the vehicles well-stocked with medical supplies such as medications, ventilators and balloon pumps at all times. Vehicles also include equipment for hemodynamic monitoring, which allows paramedics to measure patients’ blood pressure, blood flow and oxygen in the blood.

Having worked in the health care field for more than a decade, Thomas said there has been more than one instance when a patient made him feel proud to do his job.

“You meet amazing people. You witness amazing stories where someone shouldn’t have survived and they did,” he said. “On a daily basis, we know we are truly having a positive impact on someone else’s life, whether that be through a simple smile or something we did clinically to improve someone’s chance of survival.”

Available 24 hours a day and seven days a week, Thomas said the ShandsCair teams work together to give patients a second chance at life.

“When someone shows up in a ShandsCair shirt or fight suit, you know you’re getting top-notch, quality care.”

Winning effort

Football coach credits ShandsCair team with saving his life

By Alisha Kinman

In March, Ronald “Ronny” Pruitt, the head football coach for Union County High School in Lake Butler, and his wife, Robin, packed their bags for a spring break trip to the Bahamas. Before leaving, Ronny had the beginning of what seemed like a cold. His family physician prescribed a Z-Pak and Ronny hopped on a plane to Nassau with Robin to enjoy a vacation with their children and grandchildren.

Soon after they arrived, Ronny’s condition quickly deteriorated.

“I said to my wife, ‘If I don’t feel better, I’m going to need to see a doctor,’” said Ronny, 49.

Three days later, Ronny was overcome with fatigue and had a persistent cough. A resident the Pruitt family knew from previous trips took Ronny to a hospital where doctors found his oxygen-saturation level was below 70, with normal oxygen levels of around 90. He was put on a ventilator.

Doctors told Robin they thought Ronny had pneumonia. She called her brothers John and Phillip, who live in Gainesville and know doctors at UF Health Shands Hospital. After consulting with doctors in Nassau, the UF Health physicians said Ronny might have H1N1, a potentially lethal virus also known as swine flu.

The physicians determined that Ronny should be taken immediately to Gainesville, and a UF Health ShandsCair emergency flight took off for the Bahamas in a Hawker jet. Crew members put Ronny on an ECMO machine, which provides cardiac and respiratory support for patients in acute respiratory failure.

En route to Gainesville, with Eddie Manning, M.D., a surgeon in the division of thoracic and cardiovascular surgery at UF Health taking care of Ronny, the ShandsCair aircraft stopped at the Orlando International Airport for customs. Once in Gainesville, Ronny was taken by ShandsCair ambulance to Shands.

A medical team continued to stabilize, assess and treat Ronny’s symptoms for H1N1. In addition, Ronny had developed blood clots that traveled from his thigh to his groin. “There was a 50-50 chance that they would have to take my leg,” he said.

Ronny also developed acute respiratory distress syndrome, a condition in which organs are deprived of oxygen, and his kidneys had stopped working. At the suggestion of Martin Rosenthal, M.D., a surgery resident at UF Health Shands Hospital, Ronny was placed in a RotoProne bed, which rotates and shifts organs around and moves bodily fluids. For a week, doctors rotated Ronny but oxygen still was not traveling to his brain. Doctors considered that Ronny may be brain dead.

On April 25, Ronny awoke after 33 days in a medically induced coma without brain damage and with both legs. Coincidentally, it was also the first day of spring football training for the Union County High Fightin’ Tigers.

For three months, Ronny continued to recover with the assistance of nurses, physicians and physical therapists at UF Health Shands Hospital. Ronny was taken off kidney dialysis, a medical treatment that can become a lifelong necessity, after three months. He left UF Health Shands Rehab Hospital after just 15 days even though doctors had expected his recovery to last a month.

Ronny’s care team still keeps in touch with the Pruitt family, and they have even attended Union County High football games this season.

“There were a lot of prayers, and I had some great nurses and doctors,” Ronny said.

Guardian angels

Flight crew and nurse save man who ‘died’ six times

By Alisha Kinman

Each day, Christina Arnette slides onto her finger a silver ring of the infinity symbol intertwined with a heartbeat. Stephanie Howard, R.N., a cardiac ICU nurse at UF Health, wears the same exact symbol. Both were complete strangers to one another until a life-changing event brought them together. Christina holds this infinity symbol dear as a reminder of the event that instantly shaped her life and the life of her husband, Jerry.

On Feb. 23, 2016, Jerry, 43, complained of chest pains and was taken by ambulance to a hospital near the couple’s home in the Citrus County community of Homosassa. After evaluating his symptoms, physicians diagnosed Jerry with a mild heart attack, and scheduled him for a heart catheterization, a procedure performed to evaluate problems with the heart.

“The night before my chest pains, I said to my kids, ‘If something happens, just remember I love you.’ It’s like I knew it was coming,” Jerry said.
Two days after his chest pains, Jerry returned to the hospital for his procedure.

“The last thing he remembers is joking with the staff before he went back for his catheterization,” Christina said.

During the catheterization, a complication arose, which triggered a massive heart attack.

The UF Health ShandsCair 2 adult flight team from Summerfield was dispatched and arrived to transport him to safety. However, despite being supported by a balloon pump, Jerry went into cardiac arrest multiple times prior to departure and remained in critical condition at the referring hospital. ShandsCair clinicians worked with the hospital’s team of physicians to stabilize him. Meanwhile, because of Jerry’s change in condition, the hospital ShandsCair was going to transport him to now declined to accept him — they were no longer a viable option. Subsequently, ShandsCair staff worked expeditiously with UF Health administrators to get him accepted to UF Health Shands Hospital to give him the best chance for survival.

Once Jerry arrived at UF Health’s cardiac intensive care unit, his condition continued to deteriorate.

“He died six times,” said Christina, who drove to Gainesville with her three children. “Doctors said he was the sickest patient in the hospital when he arrived. His resting heart rate was at 10 when a normal resting heart rate is between 55-60.”

At one point, nurse Howard insisted that her team continue to revive and stabilize Jerry. “You know how they say there’s a light in your soul? Stephanie said my eyes opened and she could see there was still somebody in there,” Jerry said.

“She will always be a part of my life. She’s my guardian angel,” Christina said.

When examining Jerry, doctors said his symptoms indicated heart failure. In addition, doctors discovered that Jerry had developed pneumonia. Since Jerry’s heart was already weakening, physicians suggested they put Jerry on ECMO, a machine that provides cardiac and respiratory support for patients in acute respiratory failure.

“I said, ‘Do what you have to do to keep him alive,’” Christina said.

Jerry remained on ECMO for a week and was placed in a medically induced coma for a month.

“When he woke up from the anesthesia, he said, ‘I’m going fishing,’ and the nurse, Tiffany Reed, said, ‘No, you’re not,’” Christina said. “It was hard for him to sit still once he came out of it.”

Jerry was released to go home about a week after waking up from his coma. Now, he is seen every four months by Anita Szady, M.D., a cardiologist in the division of cardiovascular medicine at UF Health, to monitor his heart. In April, Jerry stopped by the ShandsCair 1 Hangar in Gainesville to visit the crew.

In July, Christina and Jerry celebrated their 20th wedding anniversary.

“I’m so grateful for everything that this hospital has done. It goes from the pilot of the helicopter to everyone here,” Christina said.

‘It’s my heart and soul’

ShandsCair director needs to know it all, from nursing to how to buy a copter

Q: How did you get started with emergency medical services?
A: Staccie Allen: I graduated from the University of Florida with a degree in finance and management and a minor in health science education. I thought I would go into hospital administration. While in school, I worked in Alachua General Hospital’s emergency department, and they did a lot of clinical on-the-job training. Upon graduation, I obtained a position as a budget analyst, but I still kept the tech position on weekends. I found that I was enjoying the tech position much more than my other position. One night, two ShandsCair employees came to pick up a really sick patient. I remember being drawn to the way they stabilized the patient, prepared the patient for transport and got them off to definitive care. I told my husband this is what I wanted to do. ShandsCair was a one-helicopter program and he made jokes that someone has to retire to get a job there, and I said, “No, no, I’m going to do this.” I went back to nursing school knowing that I wanted to fly for ShandsCair.

Q: What drew you to working with ShandsCair?
A: Allen: ShandsCair was nationally known as the top transport quality provider in the area. Its affiliation and partnership with UF Health gave it the opportunity to deliver the highest-quality care and more complex care. What drew me to ShandsCair was not only the people who were working here and the family atmosphere, but also the ability for the program to transport some of the sickest patients I had ever encountered. It’s amazing what these clinicians do together for patients and families. To get them here, to deliver them in better condition than they were when we picked them up, it’s amazing to me.

Q: What does ShandsCair mean to you?
A: Allen: It’s my heart and soul. Family. High quality. Safety. Those are some of the top things that come to my mind.  The ability to make a difference in a patient’s life.

Q: What excites you about the future of the program?
A: Allen: We’re about to embark on unprecedented growth again. We may have the opportunity to more than double the program size in the next year, and that’s enormous growth in this industry. Ultimately this expansion will help patients get to definitive care quicker, and that’s going to make a difference in their live.

Q: What have your responsibilities been in the past and what are they currently at ShandsCair?
A: Allen: I worked in the surgical intensive care unit at UF Health when it was a joint unit, which gave me an incredible basis for taking care of complex patients. I also worked in several emergency departments and as a ground paramedic for Bradford County. In 2005, I started working as a P.R.N. flight nurse/paramedic with ShandsCair and, in 2007, I was chosen to be a full-time flight nurse/paramedic. In 2009, I became the chief flight nurse. The program was under the director of trauma and aeromedical services. When that director left, they separated the services and decided to grow the program. In 2011, I had the opportunity to become the director. Back then, we were one helicopter, one fixed-wing and three ambulances. We are now three helicopters, two satellite bases, one fixed-wing and eight ambulances. We’ve also grown from about 45 people to over 130 people in the last several years. Today, my responsibilities include 24-hour accountability for the program’s operations and strategic planning.

Q: What is the most interesting and challenging part of your job?
A: Allen: It’s something new every single day. For example, never in a million years did I think I would lead a project to purchase a helicopter. You’d think it’s like purchasing a car — it’s nothing like that. When you take delivery of a helicopter, there are many things that you didn’t know previously that you go through, and if there are any bugs to work out in the first 100 hours, it’s all regulated. That was a tremendous challenge for me, learning the ins and outs of effectively purchasing and delivering an aircraft.

Q: What message do you want to send to the community about ShandsCair?
A: Allen: We’re so honored to have served the community for the past 35 years, and to have the support of UF Health gives us the ability to continue serving the community. Every person at ShandsCair is invested in making somebody else’s day better. Every single person here is 100 percent committed to taking the very best care of every patient and family we encounter.

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