Imagine you’re deep in the Summit County backcountry when tragedy strikes. You’ve fallen and suffered a traumatic injury or maybe you’re experiencing a serious medical emergency, and all of a sudden, the need to get to a hospital is urgent.

Time is already running out. You can’t move on your own, and you’re miles away from the nearest road where an ambulance or search and rescue team would be able to drive. The situation is dire but not hopeless.

Back at St. Anthony Summit Medical Center in Frisco, a crew with Flight for Life Colorado has just been alerted. As soon as their phones and pagers start to light up, they’re on the move. Within seven minutes, they’re aboard a helicopter heading your way.

This is a reality for the thousands of people who are helped by Flight for Life and other medical flight transports around the state every year, whether it’s rescuing someone with a serious injury in the mountains, a skier buried under an avalanche or transporting a critical patient to a more capable facility on the Front Range.

“We like to joke that the helicopter is the No. 1 reason they call us,” said Sarah Karges, a flight nurse based out of Frisco. “But really, it’s for our medical care and our critical care knowledge and expertise. Our nurses and paramedics work well together. … They’re some of the best in their fields, and we like to think we make a really good team, offering different skill sets in the medical and EMS world.

“We pride ourselves on getting out there and helping people in the community who need it, whether they’re at a hospital already or on a mountain stuck in the middle of nowhere.”

First of its kind

Created in 1972 at the former St. Anthony Hospital in Denver, Flight for Life was the first civilian-based helicopter program in the country. The program has been operating continuously ever since under the oversight of Centura Health, the parent company for St. Anthony hospitals.

Today, the service provides critical care transport with five helicopters, four ambulances and three airplanes out of hospitals based in Frisco, Lakewood, Colorado Springs, Pueblo and Durango. In Summit County, the group uses a helicopter, Lifeguard 2, and an ambulance, Terra 2, based out of St. Anthony.

The service provides about 6,000 transports per year, about half of which are helicopter missions with the other half being a combination of ground and fixed-wing aircraft transports, according to Kathy Mayer, the Flight for Life program director and former flight nurse from 1984-1995. Mayer estimated about 70% of all missions are inner-facility flights, in which a patient is being transported from one medical facility to another that can offer more specialized care. There also are between 700 and 800 “scene flights” a year, which include a helicopter responding directly to the scene of an incident.

When they’re not on a mission, Flight for Life crews frequently do outreach and education work to help share their expertise with smaller hospitals, fire departments, search and rescue groups and more.

Flights typically include a pilot, a flight nurse and a paramedic. Mayer said flight nurses are required to have at least five years of experience in critical care, in either an intensive care unit or emergency department, before being accepted into the program. Paramedics are required to have at least three years of experience with a 911-transporting agency, such as an ambulance or fire department. Both paramedics and flight nurses also are required to complete a number of additional certifications after joining, showing continued growth in expertise.

That experience pays off — there are almost no restrictions in terms of what kinds of procedures or treatments the crews are able to provide in flight.

“There aren’t many things they can’t handle,” Mayer said. “We can intubate a patient, providing an artificial airway if their breathing fails. We can put them on a ventilator, insert a chest tube to help a lung expand if it’s collapsed, start an IV and administer virtually any medication. We can do CPR, and we can even provide intra-aortic balloon pumping to assist in a cardiac incident. … As all of our technology has gotten more transport capable, it’s really been a boon to us in terms of what we can bring to the patient.”

Always evolving

Mayer noted that new technology has helped to make flight operations much more efficient than in years past, in everything from the equipment crews carry on board to the helicopters themselves. Flight for Life chooses helicopters specifically for their altitude capabilities. The helicopters — AS350 B3e light utility helicopters manufactured by Airbus — summited Mount Everest in 2005. Even fully loaded with medical equipment, they are capable of rescue operations anywhere in Colorado.

Crews still don’t take any chances with weighing down the helicopters. Mayer said crew members are required to weigh in while in full gear at the beginning of each shift and must maintain a weight of 225 pounds or less to fly. Keeping the crew weight to a minimum allows the helicopters to carry more and better equipment so that crews are ready for anything.

“The technology that we can bring to patients is much better than it used to be,” Mayer said. “We now have very sophisticated ventilators that almost think for us and can automatically adjust to changes in altitude. We have IV pumps connected to online drug libraries that help us calculate the right dosages for the patient. We have cardiac devices that assist a patient’s failing heart — things that we didn’t dream about when I was flying. But it also has created a more complex environment for flight nurses and paramedics, who have to know those things inside and out.”

When individuals first join a Flight for Life team, they begin with a series of orientation courses in Denver, where they’ll have “basic training” in everything from operational policies and guidelines to gaining expertise in the devices and medications they’ll be using. After that, crew members take on more advanced training in areas like trauma care, field surgical procedures and even resiliency courses so they’re more mentally able to deal with difficult situations.

Crew members will continue training frequently at the Flight for Life skills lab or at the mobile simulation unit, which allows members to work through specific scenarios designed to serve as stress inoculation so that they’re able to perform under pressure when a real event happens. When they’re not out on a call, flight nurses and paramedics often lend a hand in the hospital’s emergency room assisting with other patients.

“The first two years has a lot of very intensive training both on the job and in the classroom,” said Karges, who served at the Swedish Medical Center ICU in Englewood and at the St. Anthony Lakewood emergency room before joining Flight for Life. “We all bring high levels of skills in critical care and 911 operations from our respective backgrounds, but we’re learning skills that go above and beyond that.”

Saving lives

The wide-ranging training comes into play frequently in the field. Flight for Life often responds to calls to assist with avalanches — including work with the Colorado Rapid Avalanche Deployment program, where they’ll deploy avalanche dog teams to slides — along with responding to calls from sheriff’s offices around the state, search and rescue operations and even the occasional call directly from someone stranded in the backcountry.

“If we’re called, we’re most likely going to respond,” Mayer said. “We don’t do a lot of filtering in advance to determine if we’re necessary or not.”

Flight for Life is one of two nonprofit flight organizations in the state. Mayer said that because of the group’s association with Centura Health, the service is in-network with virtually all of the major insurance companies. She noted that more than 93% of Flight for Life patients end up paying nothing, and those with no insurance or high deductible plans pay an average of about $200.

While the group operates around the sate, there are some unique challenges to flights taking place in areas like Summit County. Flight for Life pilots must adhere to FAA regulations in regard to visibility during snowstorms or if winds are gusting or reach speeds of 40 knots, which can ground the aircraft. The elevation also can mean trouble for some, particularly for obstetrical patients dealing with placenta issues or pneumothorax (collapsed lung) patients.

“It can be a problem for any patient dealing with trapped gas, and it can be extremely uncomfortable,” Mayer said. “Take a patient coming out of Summit. They’re at about 9,100 feet, and we cross the divide at about 12,500 feet. Then we descend into Denver to around 5,000 feet. In a single flight, you could subject a patient to altitude changes of 11,000 feet. That can be tricky to manage. And it can also be hard on the flight crews, who could be doing it multiple times a day.”

While the position is unquestionably challenging, crew members in Summit County say it’s also easy to remind themselves why they signed up for it in the first place.

“I feel really comfortable in the mountains myself, and I know what it’s like to be a recreational skier and a backcountry enthusiast,” Karges said. “I kind of understand how people get themselves in these situations. So helping the people who come up here when they need it most, especially at times when they’re not expecting it, is really something that’s important to me. I did a lot of this in the ICU. But we’re bringing this to people who need it in the mountains, in areas that in the past they may not have survived. That’s pretty special.”

This story previously published in the spring 2020 edition of Explore Summit magazine.