The flight crew removes a stretcher from the aircraft to make room for the patient.
SASKATOON — After landing in Ile-a-la-Crosse, the first challenge on this muggy afternoon presents itself to the Saskatchewan Air Ambulance team: Lifting the 35-year-old rollover victim, a hulking six-foot-tall man, safely on to the plane.
It takes three paramedics and a pilot to do the job, their faces strained as they carefully lift the stretcher above their heads and through the back hatch door of the plane. Flight nurse Kathy Sproxton guides the stretcher around a tight corner and into place.
The patient’s girlfriend, who is along for the flight, informs Sproxton it’s her first ever trip by plane.
"When we take off, you’re going to feel like you’re sliding down to the other end of the plane," Sproxton tells the woman — advice met with a look of panic as the plane starts down the short runway.
An hour or so earlier, at Saskatchewan Air Ambulance headquarters, the calls start rolling — and they don’t stop.
The 35-year-old man rolled his truck overnight, breaking his back and neck, and requires transfer to Saskatoon for surgery.
A physician in Nipawin requests that an elderly woman complaining of intense chest pains be airlifted to Royal University Hospital.
In Swift Current, a request comes to move a patient whose pacemaker needs to be re-paced to Regina.
A 10-month-old boy in Cumberland House who’s suffered head trauma requires help from the pediatric intensive care team and a transfer to Saskatoon.
The tight-knit crew, most transplanted from the adrenalin-filled environments of intensive care units, emergency rooms and road ambulances, sit in the lounge of the cramped hangar building, discussing upcoming home renovations and last week’s hailstorm.
A sleepy day at Saskatchewan Air Ambulance is suddenly awakened.
"It’s like the fire bell," says Cindy Seidl, the program’s high-energy manager and a longtime flight nurse, who will soon be on her way to Nipawin to help the woman suffering chest pains.
Saskatchewan Air Ambulance works like a virtual intensive care unit suspended above the province’s sprawling landscape.
Twenty-thousand feet in the air, in the tight, sometimes turbulent cabin of a turboprop aircraft, paramedics and nurses restart hearts, insert breathing tubes, deliver babies and save lives.
Air transportation is a critical part of Saskatchewan’s health system.
Air Ambulance flies patients out of province to waiting organ donors, transports critically injured collision victims and moves patients from small community hospitals to specialty centres in Saskatoon, Regina or out of province.
The program was the first non-military medical transport service in the world 65 years ago and remains a lifeline to remote communities without access to specialty care.
"We just quietly go about our business," Seidl says. "Every day we get to help people in needy situations."
Saskatchewan’s expansive boundaries mean specialized services are non-existent in most of the province, and air ambulance crews are responsible for bringing the province’s health system together.
The need for the service is growing as health facilities shut down in rural Saskatchewan and people live longer. The number of trips for the service have jumped from 1,140 in 2004 to close to 1,700 in each of the last two years. Outside of the military, Saskatchewan’s planes log more miles per year than any other of their make and model in the world. Last year, the planes were in the air for more than 1.2 million kilometres.
And with only two aircraft available and two crews working at any given time, all calls have to be juggled by a flight nurse working in the Provincial Aeromedical Co-ordination Centre, an airy ground-floor office that looks out over the airport ramp and runway.
On this day, Janet Conan is working the dispatch desk. She talks to the physicians and paramedics on the ground, getting a clear picture of the patient’s condition and, if needed, giving expert advice. The entire province is treated like a hospital’s emergency room, where the most critical patients — whether a 24-year-old woman who needs transfer to the maternity ward or a 45-year-old injured in a snowmobile crash — are given priority. With an increasing number of calls, low-priority transfers and return flights home often have to wait or are taken by private carriers.
"We need to have the best picture of what’s going on," Conan says. "I’m trying to draw as much information out as I can."
Down the narrow hallway, pilot Jeff Egeland, a 42-year-old former water-bomber pilot, is given the flight to Ile-a-la-Crosse to transport the man injured in the rollover. He pulls up a chair at his computer to check weather conditions for the 50-minute flight and begin a series of calculations to ensure the weight of the aircraft is within regulations. Once that job is finished, he prepares the plane, a task that in the coming year will be done by a second pilot as Saskatchewan upgrades its safety standards in line with the rest of the country.
Deep family connections are the norm, it seems, among air ambulance employees. In 1965, Egeland’s mother was transported from Spiritwood by air to Saskatoon after being rear-ended by a drunk driver at the age of 15, which broke her neck.
"She’s a survivor," Egeland said. "I’m a little partial to it. That’s always in the back of my mind."
The work gives him perspective, Egeland says.
"I’ve got four kids, all healthy," he says. "Yeah, they’ve got teenage issues. But that’s a drop in the bucket compared to what you deal with up here every day."
The flight nurse for the trip to Ile-a-la-Crosse, Kathy Sproxton, and paramedic Cary Serviss join Egeland aboard the plane.
Sproxton, a 17-year veteran of air ambulance who says she was attracted by the autonomy of working in the air, notes there are no washrooms on board, just a bedpan. Drinking coffee before longer flights isn’t recommended.
"If you have to go, there’s not a lot of privacy," she says.
In the cramped space, planes carry equipment, supplies and medications similar to those found in an intensive care unit, such as intravenous pumps, a ventilator, cardiac monitoring and a defibrillator. There’s enough room for two patients, if necessary, on stretchers.
The nurse and the paramedic bring complementary skills, says Serviss. The paramedic is an expert in the tight quarters of an ambulance while the nurse typically knows intensive care units inside out.
Trauma and heart attack victims, in particular, have the most to gain by getting expert care fast, he explains.
"Time is muscle," Serviss says, explaining the need to reach heart attack victims quickly. "You can’t waste any time."
As the plane arrives, the concrete runway at Ile-a-la-Crosse appears, nestled between the picturesque forest and lakes down a rough road about 20 minutes from town.
Crew members all have their own stories about help from the small communities they fly into. As the story goes, one night in the early 1990s, the lights had been shot out at the airport of a remote northern community’s runway as a crew approached to transport a critically injured child. The crew contacted the person in charge of the airport, who was at a town dance. Minutes later, with the plane circling overhead, dozens of cars showed up from the dance to shine headlights on to the runway. Egeland says in winter it’s common for teams of snowplows to be clearing runways as the air ambulance crew arrives.
The crew hustles out of the plane to meet the local paramedic crew and load the man onto the plane. Once the rollover victim is aboard, the nurse’s work begins.
Practising medicine in the sky presents its own difficulties. Space is a constraint in the compact plane. The depletion of oxygen and changing air pressure are medical challenges, which have to be constantly monitored in the sky, Sproxton says.
The noise, vibrations and temperature of the aircraft can present problems for the patient’s health and comfort.
As the plane ascends into the sky, the man is hooked up to the heart monitors and an IV. Clearly uncomfortable, he continues to stretch out his arms above his head, clenches his teeth, covers his face and tries to move his feet. Sproxton gives him a shot of morphine to numb the pain and has him lay his hand across her legs, which are inches away, for support. He stretches his arm out and holds his girlfriend’s hand.
"I don’t normally ask men to lay their hands across my legs," Sproxton jokes. "But (your partner) is right here."
One hour later, the plane is landing in Saskatoon.
The man’s girlfriend is relieved. An ambulance awaits to take him to Royal University Hospital and emergency surgery after that.
"I’m just thankful we arrived," she says, sighing.
"It’s been a long day."
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