Nightingale swoops in for the rescue

Leslie Peterfeso doesn’t recall much about her time aboard the Nightingale Regional Air Ambulance in January.

Knocked senseless by an oak branch five inches in diameter as it fell while being cut at her home in the remote Russell Point neighborhood of Suffolk, she drifted in and out of consciousness as paramedics tending to her waited for the helicopter to arrive and land on the neighbor’s lawn.

She awoke as they were lifting her into the back of the helicopter, and she felt as if she were being placed into an MRI machine, but then she noticed there were other people inside with her. During the flight to Sentara Norfolk General Hospital, she remembers hearing the roar of the rotors above her.

As a secretary in Sentara’s quality management division for the past 10 years, Peterfeso sits in an office at Norfolk General’s River Pavilion, and she sees the helicopter launching and landing outside her window throughout the day while she is at work.

But her recent experience aboard the aircraft changed everything for her.

“I have a new respect for head injuries and a new appreciation for Nightingale, for sure,” she said in February, not long after finally being released by a doctor to return to work. “I hope people appreciate what they do, especially for remote areas like Suffolk.”

Last year, Nightingale crews flew a total of 671 flights, including 102 to Suffolk. For more than half of those flights, the destination was the scene of some trauma or another — a car crash or a mishap at home like Peterfeso’s or an industrial accident, for example.

“It’s like a flying ICU,” said Dale Gauding, a public relations consultant for Sentara, which owns the helicopter service.

But this ICU moves faster and has a smaller team than any other in the area. During the 15 minutes it takes to fly, for example, from Holland to Norfolk General, a paramedic and a flight nurse work to keep the patient stable and prepare him for treatment at the hospital. The pilot flies the aircraft, but both of the medical staffers are on alert for things that would affect the safety of the flight and ready to jump into action as an air crew, if needed.

That’s one reason the Nightingale program has a perfect safety record nearly 30 years after the first helicopter launched from Norfolk General.

“This is a helicopter first and then an air ambulance,” said program manager Chris Cannon, who also serves in the rotation as a flight nurse. “The pilot is ultimately in command.”

Nightingale pilots are on contract to the program from Omniflight Helicopters Inc. They are required to have at least 2,000 hours of flight time. But those who fly Nightingale are far more experienced, even, than that. The program’s four pilots have an average of 26 years experience each, with the most senior having served the Nightingale program alone for 25 years.

Medical staff are similarly well qualified, Cannon said, bringing special skills to the job, learning how to transfer those skills to the foreign environment of a flying ICU and then staying on the job — sometimes for decades.

“I think, overall, this is kind of a cherry job,” flight paramedic Jeremy Miller said. “People don’t leave.”

“We’ve got a great office view and really good, good people,” agreed flight nurse Maggie McCauley, a 15-year Nightingale veteran.

Turnover in the Nightingale program is extremely low, and there is a waiting list of people who wish to be a part of it. But there are some definite benefits to having crews with so much experience on board.

“It creates a very mature group,” Cannon said. “And maturity means stability, and in this industry, stability means safety. The environment (aboard the helicopter) can be out of control. They are very good at putting things back in control.”

None of which should be taken to imply that flying medevac missions is easy work.

After six years as a nurse in an ICU, McCauley came to Nightingale the same way that almost all of the non-flight staff has — without any in-flight experience.

“To go from being a hospital nurse to operating entirely in a helicopter and other hospitals — it’s a big transition,” she said. “You have less resources available to you, and there’s definitely a lot of pressure involved in that. None of us are aviators. We have to learn that environment. But now, I’m just very used to being inside a helicopter.”

One of the big things crews have to get used to is the variety of calls to which they respond. Most people know about Nightingale’s flights to provide quick, advanced medical care to accident and gunshot victims and other patients with traumatic injuries. But nearly half of the trips the helicopter flew in 2010 were transports from various hospitals throughout Hampton Roads, including Suffolk’s Obici Hospital.

Heart and stroke patients in need of surgery or other specialized treatment are often transported from one of Sentara’s outlying facilities to the heart hospital on the campus of Norfolk General Hospital. The decision to do so hinges on the time element involved.

For heart attack and stroke patients, Cannon said, the time element can be even more crucial than it is for some trauma patients. And in an area legendary for its traffic snarls and tunnel backups, sometimes even a short hop across the Elizabeth River is the only way to assure that advanced medical care can be provided quickly and efficiently.

“You have to weigh an eight-minute flight versus a 45-minute drive,” Cannon said.

For Peterfeso, the drive likely would have been much longer from her neighborhood behind Lake Prince. With her head traumas — the branch hit the top of her head, and then she fell and hit her forehead on the concrete driveway — paramedics were taking no chances.

“I thought, ‘I’m in the helicopter; I must be bad off,’” she recalled. “I mean, it’s bad enough to have the ambulance come to your house, but they thought it was bad enough that they called Nightingale.”

“It’s very emotional for me,” she said. “I’m very proud of them.”