Help From Above

Despite a recent crash, the medical transport helicopter team at the U. of C. Hospitals is among the nation's leaders in safety and has rescued hundreds. Still, some critics say the skies are becoming too crowded.

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Photo: University of Chicago HospitalsAeromedical Network (UCAN)

On January 3, 1944, with a snowstorm punishing the Atlantic coast, the USS Turner, a navy destroyer anchored off Sandy Hook, New Jersey, exploded with such force that the blast was felt 15 miles away. All told, 138 crew members died. The survivors were taken to a hospital in Sandy Hook where large amounts of plasma were needed to save them-but the blizzard was making ground travel difficult and airplane travel impossible.

The previous month, Frank Erickson, a Coast Guard lieutenant, had started the world's first helicopter school, about ten miles away in Brooklyn. When the Coast Guard called to ask if he could pick up plasma in Manhattan and fly it to Sandy Hook, Erickson jumped into his Sikorsky R-4. Ignoring gusting winds, swirling snow, and almost zero visibility, he flew from Brooklyn to Battery Park, attached two cases of plasma to the Sikorsky's floats, and continued on to Sandy Hook. The flight saved many crew members' lives. "Weather conditions were such that this flight could not have been made in any other type of aircraft," Erickson boasted later. "But for a helicopter, it was simple." It was the first recorded emergency flight by a rotary-wing aircraft.

From the beginning, the helicopter had its critics. Compared with the average fixed-wing aircraft, it was expensive and slow; it couldn't carry much; it had limited range. But Erickson's flight proved that helicopters had one thing planes didn't: maneuverability. A helicopter can hover; it can reverse; it takes off and lands vertically, travels anywhere, and lands anywhere with a clearing of roughly 100 by 100 feet.

In the Korean War, around 20,000 wounded Americans were taken by helicopter to field hospitals, which significantly cut down the casualty rate-and revolutionized the way wars were fought. During the Vietnam War, U.S. military helicopters transported nearly one million people.

In the early 1970s, Denver's St. Anthony Hospitals developed the first civilian hospital–based helicopter rescue program in the United States. Other urban hospitals introduced helicopter emergency medical services programs of their own, giving them quick access to rural areas. In 1983, the University of Chicago Hospitals became the 51st U.S. facility to do so-and the first in the Chicago area.

Ira Blumen was an emergency medicine resident working at Lutheran General in Park Ridge when he saw his future on the helipad. "There were two helicopters there at the moment," he recalls. "One lifted off, and I just thought, Wow, this is cool." He landed a job at MedStar, the helicopter team at St. Mary of Nazareth Hospital Center in Chicago, where he worked until that program ceased operations in 1987.

Later that year, Blumen took the head position at the University of Chicago Hospitals' helicopter program. He immediately noticed that other areas of the hospital had barely heard of UCAN; those who had were not using it. So he met with department heads and explained that UCAN could take over the whole emergency transfer process-the paperwork, the legwork, the phone calls-and would transport the patient themselves. It all sounded too good to be true for time-crunched doctors; many asked what it would cost them. The answer was: nothing. Patients or insurance companies generally pay the cost of air transport.

Blumen worked nonstop-nights, weekends, holidays-to get UCAN's name out in the hospital community. He even slept on a couch in his office, prompting the crew to joke that he should get his mail forwarded there. The number of flights began creeping up, and by 1992, UCAN had amassed 5,000 consecutive accident-free helicopter missions. In the mid-nineties, ER, NBC's Chicago-based medical drama, came calling, and UCAN rented out its helicopter and crew to film complicated scenes. When George Clooney's character snapped, "Call Ira Blumen; tell him to get his damn chopper over here in a hurry!," 30 million people heard the line. When the wife of a flight program manager in Pittsburgh asked for Blumen's autograph, he realized that UCAN had landed.

In the 1980s, hospital-based helicopter programs didn't make a profit; the publicity and new patients they brought in were enough. Those days are over. Now UCAN is expected to make ends meet. The reason for the shift is increased competition from a new kind of helicopter program: the independent, for-profit provider that must recoup investment costs. "Our advantage over hospital-based programs is that this is all we do," says Michael Dermont, president and CEO of Air Angels, which he calls a "community-based" program. "The U. of C. provides a lot of services, but 100 percent of our resources, our time, our energy, is dedicated to emergency services." Headquartered in West Chicago, the company has one helicopter in Bolingbrook and one in South Bend, Indiana, which enables it to provide service across the region.

The number of such programs has risen in recent years, transforming helicopter rescue into a big business. UCAN's days of having fun with the helicopter-like Santa Claus's annual landing on the helipad to greet young patients with presents-are few and far between; it's too expensive now. The operating costs have dramatically increased, and so has the bill for a ride. (A 60-mile ambulance transport costs about $2,000; a helicopter ride can run a patient three times that amount or more.) Competition is fierce. A recent New York Times story recounted an incident in which an independent company that had listened on its emergency scanner for accidents raced to a scene before its rivals. In the Chicago area, UCAN shares the skies with Air Angels, a company called Flight For Life, and Loyola University; two more helicopters are based in Rockford, two in Peoria, one in Champaign, and two in Indianapolis. In other words, it's getting crowded up there.

A chorus of doubters in the health care field argue that urban helicopters aren't any more effective than ambulances. One of their leaders is Clayton Shatney, associate director of trauma at Santa Clara Valley Medical Center in San Jose, California, and clinical associate professor of surgery at Stanford University. In 2002, Shatney published a study on helicopter transport in The Journal of Trauma Injury, Infection, and Critical Care that was damning. Three years later, he hasn't toned down one bit. "For the vast majority of urban trauma patients, helicopter transport is unjustified," Shatney says. "In urban areas like Chicago-with an abundance of trauma centers and all kinds of traffic-it's basically a wash between lives saved and potential lives lost."

Part of the perception that helicopters are an improvement over ambulances stems from misleading data, says Shatney. "When the helicopter folks talk about how quick they are in getting to the scene, they're only talking about flight time," he says. "What about the 8 to 12 minutes it takes to get to the helipad? Or the time it takes to find somewhere to land? When you add it all up, ambulances are just as fast-and much less expensive. But the ground [ambulance] folks are so scared, they don't bother to look at the numbers."

If the spread of helicopter programs is, in fact, a triumph of public relations over practicality, Air Evac Lifeteam is a good case study. The fast-growing Missouri-based indie, with 58 rural locations in the United States, sells $50 annual "memberships" that allow customers to call for transport with no out-of-pocket costs. To draw clients, Air Evac has tried everything from distributing literature outside Wal-Mart to making sales calls at assisted-living homes, and instead of calling 911, some members call Air Evac. "Some of the areas we serve do not have a 911 center," says Julie Heavrin, Air Evac's public-relations manager. "In some cases it takes more than two hours [by ambulance] to get to a trauma center." (Only 2 percent of Air Evac's calls come from members, but the company could not exist without its membership program.) Air Evac, which transported more than 100 people in the Gulf Coast to safety following Hurricane Katrina, has added eight to ten new outposts a year in recent years. "If you would have asked me in the nineties if an independent company could survive, I would have said no," says Blumen. "But things have changed."

This article appears in the November 2005 issue of Chicago Magazine.

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