Lessons Learned: A (Very Early) Day In The Life Of A Med Flight Pilot

I'm on call for St. Patrick Hospital Life Flight.

BE-BEEP...BE-BEEP...BE-BEEP...

It's 2 a.m. on a Friday in February of 2004. The King Air was preflighted at the start of my shift. I will need to evaluate any flight prior to our dispatch center confirming the flight with the requesting medical facility.

The weather forecasts call for mostly IFR conditions across our service area. Most of the airports that we serve regularly were reporting marginal VFR conditions at 7 p.m. when my shift started.

BE-BEEP...BE-BEEP...BE-BEEP...BE-BEEP...

I sit up on the edge of the bed. My heart is racing from the abrupt awakening. I pick up the pager: FIXED WING TO SALMON

Rebecca stirs beside me. "Where to?"

"Salmon, Idaho."

"Be careful."

After a quick weather check, I call dispatch to accept the flight. That decision will be reviewed as circumstances change. Life Flight protocol states that "it takes three to go, one to say no." At any time during the mission, any team member can raise concerns that might lead to aborting the mission.

I fast file an IFR flight plan with the "Lifeguard N242LF" call sign, alerting ATC that this is a priority medical flight.

There's a skiff of snow on the driveway as I leave the house.

BE-BEEP...BE-BEEP...FLT 3127, FW-SMN, PATIENT WT=145#.

I use the drive time to the airport to think through the various considerations for this routine mission.

Larry and Keith are the medical team; experienced---the best.

Weather should be okay. No pilot reports, but a good chance there will be some icing. No airport surface condition reports; the field is unattended.

My decision to accept the flight is critical. If we can't get in at Salmon and must return to Missoula, it will add many hours to the transport. Ambulances would be used, and our flight team would go all the way to Salmon and back by ground. At least six hours on the road.

As I drive through the airport perimeter security gate, I'm struck by the isolation of the brightly lit Life Flight hangar. It stands apart like a citadel.

The hangar ramp is free of snow. The mountains surrounding the airport are dimly outlined in the faint light. The peaks disappear into the cloud bases.

The big hangar is lit by a single fixture above the personnel entrance. The airplane is a shadowy presence in the center of the room. I hit the switch to activate the overhead lights and open the hangar door. No ground support personnel in our operation. I'm working alone.

The medical crew has arrived.

I'm in the left seat of the King Air with ship power and lights on. The crew boards with their equipment and drugs and confirms verbally that the cabin door is secure.

I use a standard "flow" pattern to go through the engine start and pre-taxi checks, then verify my actions with the printed checklist.

I listen to the ASOS, then key the radio transmitter to activate the pilot-controlled airport lights.

The control tower is closed. I key the mike: "Missoula area traffic, Lifeguard 242LF taxiing from the Life Flight hangar to Runway 29.

During taxi, I contact Salt Lake City Center to obtain the IFR clearance to Salmon. Approach control is also closed in the middle of the night. Cleared as filed, report airborne.

"All secure in the cabin?" "Cabin secure," the crew confirms.

"Missoula area traffic, Lifeguard 242LF departing runway 29. Initial climb to the west on the DIDLY3 departure."

Pre-takeoff flow is complete, power levers forward, takeoff torque set.

The brightly lit runway seems to rush at us out of the black void that surrounds it. Airspeed through 90 knots, smoothly apply back elevator to bring the aircraft up into the initial climb attitude. I am immediately flying the plane on instruments; there's nothing to see straight ahead over the nose. Gear up, landing lights off, anti-ice on.

The brightness from the runway lights quickly falls away. Climbing to the west, my night vision improves. I begin to see lights on the ground and clouds above. The rising terrain that surrounds the valley is a lurking presence on each side of the aircraft.

"Center, Lifeguard 242LF is airborne at Missoula, climbing through seven thousand for one five thousand." I reach for the after-takeoff checklist.

"Lifeguard 2LF, Center, radar contact, 12 miles west of Missoula at seven thousand six hundred."

I've started the turn, "position and altitude check, 2LF." Rolling out of the turn, I've lost sight of the ground. We've entered the base of the broken cloud layer.

Turning southbound on V23l, we break out of the clouds into a majestic moon-lit vista. The white carpet of clouds below looks like gently drifted snow on an endless prairie. Stars sparkle above. The ride is smooth as we level at 15,000 feet.

Cruising on the airway is serene. Cruise checklist complete; a great time to use the autopilot and take care of some paperwork.

It is very quiet. There is no sense of motion from this altitude above the clouds, even though we are cruising at nearly 300 miles per hour. The King Air purrs along. The flight and engine instruments are static, each showing a normal reading. It is almost hypnotic.

The spell is broken by the voice of another pilot calling center to report on frequency.

Time to get busy again.

"We are about 15 minutes out," I say. "I'll tell dispatch," says Keith. A volunteer ambulance crew will meet us at the airport to transport the Life Flight medical team to Steele Memorial Hospital.

"Center, 2LF, we are planning the VOR/DME-B approach into Salmon."

"Roger, 2LF. You can expect that. Descend pilot's discretion to maintain one two, twelve thousand."

"Discretion, one two thousand, 2LF." The plate for this procedure is clipped to the yoke. (See approach plate.)

We are 25 miles from the LKT-VOR, the initial fix for the approach.

"Lifeguard 242LF. Cross the VOR at or above one two thousand, cleared VOR/DME-B approach to the Salmon airport."

"Cleared for the approach, 242LF." I listen to the AWOS: 4,000 broken, visibility 10 miles. This will be tight.

Crossing the VOR, I use the prescribed holding pattern to reverse course and line up with the final approach segment between the VOR and the airport.

Reduce power, select approach flaps, adjust elevator trim, confirm anti-ice is on, lights on.

Crossing the VOR inbound, I select landing gear down. There is a steady hum from the electric gear motor, then a comforting thump. The red light in the handle is out. Three green lights confirm gear down. I begin the final descent to the minimum altitude of 8,100 feet, one of the highest minimums in my experience, due to the high terrain that closely surrounds the airport in this narrow end of the valley.

"Everything secure in the cabin?" "Affirmative," Larry says. No idle conversation now; they know I'm very busy and focused on the approach.

Before landing checklist complete. Looking out the side window, I note that we are still in the clouds; no ground contact. The wing inspection light reveals a trace of rime ice.

"242LF, radar contact lost. Switch to the advisory frequency is approved. Report your cancellation on this frequency or with Flight Service."

"Switching to advisory. 242LF." I'll cancel with Flight Service by phone. We're still IMC, but I activate the airport lights.

"Salmon area traffic, Lifeguard 242LF, inbound on the VOR/DME-B approach. Six miles southwest descending through niner thousand."

My plan is to reach the minimum altitude promptly. If I don't see the airport and the area around it clearly upon reaching the fix over the field, I will execute the missed approach procedure and climb back to a safe altitude.

This approach procedure does not line the flight up with the runway nor does it descend anywhere near the field elevation of slightly more than 4,000 feet. I must be able to descend visually from 8,100 feet to the runway.

Night circling procedures are considered to be quite hazardous, and this one, in a mountain valley, is definitely hazardous. A thorough familiarity with the terrain and winds is essential, as are a high level of skill and confidence with the aircraft.

At 8,500 feet, we are clear of the clouds. Airport in sight.

In this narrow valley, there is no normal approach from 8,100 feet. From experience, I know that I must start the descent to normal traffic pattern altitude, 5,500 feet, right away. My plan is to cross over the airport and enter a left downwind for runway 17. Once established on downwind, I continue to descend while slowing the aircraft to 120 knots. I will make the turn to base leg over Idaho Highway 28.

"Salmon area traffic, Lifeguard 242LF, entering left downwind for runway 17."

In a larger urban environment, the city lights would reflect from an overcast cloud layer. But there are not many lights to be reflected from a sleeping town of 3,200 people.

Turning final, I spot the VASI lights to the left of the runway threshold. This is a classic "black hole" situation: a well-lighted runway surrounded by few visible features. Without the aid of a VASI or an electronic glide slope, a pilot could easily misjudge the distance to the runway and find themselves prematurely low on the approach.

Speed checks, full flaps, slowing to 100 knots for landing. Before landing checklist is complete.

I can see the runway markings through a thin skiff of new snow on the surface. Looking for any animals that may have strayed onto the runway, I quickly review the memory items for an aborted landing and missed approach. No time to look at charts or checklists now. I'm focused on the landing.

We touch down. Power to idle, gently apply the brakes. Reverse thrust produces a thin cloud of snow in front of the plane that reflects the landing lights. I ease off the reverse; braking action feels good. We exit the runway and taxi to the ramp, where the ambulance is waiting.

Engines are shut down using a flow pattern. Cabin lights on.

"Dispatch knows we have landed," Larry says.

I assist the crew in moving their equipment and the stretcher to the local ambulance.

Back in the ship to run the shutdown checklist. I call Flight Service to report our landing and cancel our IFR flight plan.

The ambulance is already on its way to the hospital. Back outside, I walk around the ship with my flashlight to do a quick post-flight inspection. The thin ice collected during the descent is gone.

Just as I climb back into the King Air, the timer-controlled runway lights extinguish. Now it is really dark on the ramp. Just the steady flashing of the airport beacon and my flashlight. Half the time the FBO office building is bathed in alternating white or green, and half the time it is just a shadowy shape hidden behind some trees. It has started to snow lightly, adding to the eerie visual effect. How many hours have I spent alone with an airplane on a deserted ramp in the middle of the night? I hear a coyote howling somewhere near the airport.

I close the cabin door (to keep the bears out!), then move back to the cockpit to complete the paperwork for the first leg.

Next, a call to Flight Service to get a weather update and file an IFR flight plan for our return. The briefer is quite chatty; must be a slow night for her.

Snow has stopped.

Temperature is -4˚ Celsius. I probably have another 30 minutes to wait before the return of the crew.

Time to consider how to obtain our clearance for departure. I choose the surest method: a call to Flight Service prior to starting the engines to get a "void time" release. That means I have a time window in which to depart and contact ATC, after which the clearance is void.

Here comes the ambulance. Battery switch and lights on. I help load the patient, an elderly woman who is connected to a ventilator to assist with her breathing. I don't ask about her condition; I don't want to know. My job is to fly the aircraft in the safest, most efficient manner in order to deliver her to St. Patrick Hospital. After loading, I move to the cockpit, phone for the IFR clearance and prepare to start. We are cleared as filed. I have 15 minutes in which to depart and climb to an altitude from which I can talk to ATC.

We depart on Runway 35. This allows a straight-ahead climb to the AHEHU fix on the standard departure procedure. Climbing through 9,000, we are IMC as I contact Center.

"Center, Lifeguard 242LF out of niner thousand five hundred for one four, 14 thousand. Request AHEHU direct WURTH for the VOR/DME-B approach into Missoula."

"Lifeguard 242LF, Center, radar contact, 14 miles northeast of the Salmon VOR. Maintain one four thousand, cleared as requested, expect the Bravo approach."

I tune in the ATIS at Missoula: 5,000 broken, visibility 7 miles, light snow. I should be able to maneuver visually for the arrival. Another circling approach but in a much wider valley with a lot more reflected light from the city.

Crossing STEVI, I see the airport. "Center, Lifeguard 242LF, airport in sight. Cancel IFR."

"2LF, Center, roger, cancellation received. Maintain VFR and switch to advisory at this time. Good night."

"Missoula area traffic, Lifeguard 242LF, five miles south descending through six thousand on left base for Runway 29."

The runway here also has a dusting of snow as we land.

"Missoula traffic, Lifeguard 242LF clear of 29, taxiing to parking via GOLF."

I taxi onto the ramp and shut down.

"Dispatch knows we are here," says Keith.

The procedure to transfer the patient to the ground unit is choreographed from many repetitions: Everyone knows their job and does it with little conversation.

I refuel the King Air and then tow it into the hangar.

It's 4:45 a.m.

I take a couple of minutes to review and evaluate the flight: Any maintenance issues with the aircraft? Any procedural or safety issues to discuss with the medical team? And, most importantly, how did I do my job?

I'm headed for home. As I step out of the hangar, I feel a nice sense of closure. Mission complete.

It has started to snow again.

BE-BEEP...BE-BEEP...BE-BEEP...FIXED WING TO BOEING FIELD. 

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