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Help From On High

condition had to be transported in one of DHART's ground units—meaning a loss of valuable time getting patients to Dartmouth-Hitchcock's Level I Trauma Center. At that moment, the two greenand- white American Eurocopter EC-135s sat glistening on the wet tarmac, rain running off their drooping rotor blades.

Inside the dispatch office overlooking the helipad, communications supervisor Mark Pippy and pilot Jim Clark monitored the weather on one of numerous computer screens. Pippy—a laid-back man with graying hair and a matching neatly trimmed beard—exuded a calm born of his years of EMT experience, many of them in northern New Hampshire. Clark—an Army veteran who had seen the world through many aircraft windscreens—sported military-style close-cropped hair and a clean-shaven face and wore a DHART-green flightsuit. Despite the differences in their background and appearance, they shared an obvious ease with one another.

Flight status was still "red," meaning the helicopters were grounded. But as they peered at the Rorschach-like splotches on the monitor, the two men could see the showers starting to dissipate. "We have a saying," Clark explains later. "'Three to go, one to say no.'" What that means is that just one crewmember who feels conditions aren't safe has the right to abort a mission. "Though I may be piloting the aircraft," Clark continues, "everyone has a say. Except the patient," he adds with a chuckle.

"I'd say we could be a go before too long," Clark said to Pippy.

"Let me know when you want to upgrade the status," Pippy responded.

"Roger that," said Clark as he left the dispatch office. He stepped into the galley kitchen, poured himself a cup of coffee, and strolled down the hall to the pilots' office—a small, cozy, always-dark 8- by-10 room with two desks and a single bed. There, he logged onto the computer to double-check the weather. Even though a glance outside showed the rain still pouring down, Clark saw a break in the front moving in from the west.

The two helicopters alternate calls. DHART 1's day shift starts at 7:00 a.m. and runs for 12 hours, while DHART 2's crew clocks in three hours later, likewise for a 12-hour stint. When DHART 1's day

The New Hampshire hills, reflected in a pilot's visor.

Flight status was still "red," meaning the helicopters were grounded. But as they peered at the Rorschachlike splotches on the monitor, the two men could see the showers starting to dissipate.

crew finishes up, a 7:00 p.m.-to-7:00 a.m. crew takes over, and similarly for DHART 2. The Federal Aviation Administration (FAA) mandates a maximum pilot workday of 14 hours and a minimum of 10 hours of preflight rest time. As a shift nears its end, the fresh flight crew will leapfrog the outgoing crew if it looks like a call could take the first crew beyond its time limit. It's not unheard of for a crew to fly to a site, only to have the recovery take longer than expected and for the pilot to time-out. In such a case, the pilot must literally walk away from the helicopter; the rest of the crew can stay on, but a new pilot must be flown in to take over. (Although the FAA sets no mandates for EMTs, DHART does put limits on its medical crew shifts.)

By mid-afternoon on June 29, both crews had logged two missions, so it was DHART 1's turn to take the next call. Clark, nurse Dan Vota, and paramedic Alf

Rylander were on the DHART 1 roster that day. Just as the rain outside began to abate, as if on cue, the phone rang in DHART's dispatch office. Mark Pippy picked up the receiver and learned from Windsor Dispatch of a "rollover on Interstate 91, with entrapment, near the Windsor exit." Pippy hung up and called Clark to see if he was ready to respond. "We're good to go," Clark said into the phone, as he turned to head out to the helipad.

Pippy pushed a button on the console in front of him, and the hangar resounded with beeps as everyone on duty pulled their pagers from their flightsuits and read the text message telling themof a scene call on I-91: amotor vehicle accident. Vota and Rylander pushed back their chairs from their computers in the crew room and headed for dispatch to get more information. Then they stepped outside and strode though shimmering puddles toward DHART 1 on the south end of the helipad. Clark was doing a walk-around of the craft, making sure it was flight-ready.

Rylander went around to the far side of the Eurocopter and slid open the door to the crew compartment. Vota already had

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