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Help From On High

When things go awry—whether it's an accident on the highway or a heart attack at home—getting expert help, fast, can make all the difference. In a rural area, that often means calling an air-rescue service.

June 29 is a special day for Mike and Sue Newman. It's the birthday of both their grandchildren—brother and sister Jason, 12, and Emma, 10, born two years apart to the day. Last year, the youngsters chose to celebrate the occasion at EBA's, a pizzeria in Hanover, N.H. The Newmans planned to join the children and their parents—their son, David, and his wife, Laura—for dinner there.

As the Newmans were getting ready to head for Hanover, Mike kept an eye on the weather. It had been raining off and on all day, and by mid-afternoon, given the forecast for more rain, he suggested leaving early for the hour-long drive from Springfield, Vt.

Mike used to work in the town's formerly thriving machine-tool industry; when his employer of 44 years shut its doors in 2001, he switched to selling real estate. Sue had worked as the office manager for a local optometrist ever since their two sons had left home. The Newmans had celebrated their 46th anniversary a few months earlier.

When they traveled together, the couple usually took Mike's truck—a blue 2004 Chevy Colorado with an extended cab. That day, with the weather looking more and more ominous, the rugged vehicle seemed like an especially sensible choice. Sue opened the passenger door and slid a large grocery bag filled with the kids' wrapped presents onto the floor behind her seat. She climbed in and buckled her seatbelt. She knew Mike eschewed seatbelts, choosing to rely on his reflexes and good driving record. It was a point of contention between the Newmans, but a battle Sue had long since given up. As Mike backed out of the driveway, he glanced at his watch and—given the looming clouds—was glad to see that they were ahead of schedule.

A few minutes later, the first drops of rain speckled their windshield; Mike set the wipers to intermittent and turned on the truck's parking lights. The rain was coming down harder by the time they reached I-91 North; as Mike merged onto the highway, rooster-tails of spray from passing cars and semis required him to turn the wipers on full.

With visibility declining, traffic was slowing from its usual 70-miles-an-hour interstate pace down to 60. Mike switched the truck's headlights on full, too, but the rain was so heavy most of the light was just reflected back into his eyes. But he kept them on, hoping it would help.

Soon the rain was coming down in sheets. The Newmans passed several cars that had pulled off into the breakdown lane to wait out the storm. Mike glanced in the rearview mirror; it was like looking through shower-stall glass at distant, fragmented lights. He slowed down still more, worried about hydroplaning. The noise of the rain drumming on the truck roof and of the wipers slapping at the windshield was deafening. Suddenly a red sedan sped by in the passing lane, "doing a hundred miles an hour," Sue recalls, shocked by the driver's idiocy. The spray from the passing car blasted their windshield, jolting them both back in their seats. Sue looked over at Mike, who had fallen silent as he concentrated on the road, both hands gripping the steering wheel.

As the Newmans swept past the exit for Windsor, Vt., Sue peered through the deluge at the overpass ahead; she could just make out a tow truck parked above the northbound lanes. "At the time," she recalls, "I wondered why it was sitting there, thinking maybe the driver was also playing it smart, choosing to wait out the squall." But looking back on the day now, she realizes that while much went "horribly wrong, . . . many of the elements to help us were already in place." The tow truck, as it happens, was one of those elements.

Before Sue had time for another thought, the blue pickup hit a surge of water flowing across the road; it grabbed at the tires and threw the truck off balance. Mike fought to regain control of the vehicle, but the back of the Colorado was already whipping around. "It was like a loud zipping noise," he recalls. The truck slid and smashed into the metal guardrail, ripping 12 feet of it out of the ground.

Then the truck pitched sideways and rolled. And rolled. Grass, mud, and rain tore through the cab. Sounds of crunching metal and shattering glass echoed in Sue's ears. The truck slammed repeatedly into the muddy earth before finally settling, driver's side down, in a ravine. "It seemed like it took forever for us to stop," Sue recalls. She was hanging sideways fromher seatbelt, her upper torso wedged behind Mike's seat. Suddenly she realized that her husband was no longer beside her.

"Before I had a chance to panic," she says, "I heard Mike groaning." Sue had no idea where he was, but knowing that he was alive—and that she wasn't seriously hurt—helped her stay calm.

An instant later, Sue saw a woman's face peering into her window. Karen Jacobi—a part-time Hanover firefighter and an ambulance driver for the Dartmouth-Hitchcock Advanced Response Team (DHART)—identified herself as an EMT. She, like the tow truck, was another of the day's fortuitous elements.

Jacobi had been on her way home to Hanover from Claremont, N.H., when she saw the accident unfold in front of her. "I had slowed down with most of the traffic," she says. "The next thing I saw was a truck suddenly veering backward off the road going airborne. I pulled over as quickly as I could."

Dressed just in casual slacks and flip-flops, Jacobi slid down the muddy slope to the bottom of the ravine. She was relieved, as she peered in at Sue, to see that at least one of the truck's occupants was alert and able to say that she was okay. "At that moment, I heard a groan and looked down at a man pinned under the truck," Jacobi recalls. "He told me he was having trouble breathing, and seeing the wheel pressed against his chest, I immediately started digging out the mud underneath his back." Her efforts brought a little relief for Mike.

"Though I was the first person [on the scene]," Jacobi says later, "I was quickly joined by two other EMTs who also happened to be on the interstate—ironically, people I'd known and worked with in the past. When Windsor ambulance arrived and started working on the man, I placed a blanket on him so he wouldn't go into shock and stayed by his side, holding his hand. I wanted him to know someone was there just for him," she explains.

Jacobi was "very reassuring," says Sue Newman. "She stayed with us a long time, telling me help was on the way. And it was."

Nicole Buck was another of the good samaritans who got there early. A graduate student in Dartmouth's Department of Earth Sciences, she, too, is a firefighter, as is her husband. Nicki Buck had heard the call come in on her pager. "Like all volunteer departments, we worry about daytime coverage," she says. "When I arrived at the station, only one guy was there. We rolled with just two of us on the engine." And with the news of an entrapment, she called Windsor Dispatch to get additional help from that town's fire department.

"When we arrived," recalls Buck, "the rain had stopped and Windsor ambulance was already there. Seeing how unstable the truck was, I called Meunier's Towing, a company we use a lot for interstate accidents, as its station is located near Exit 9." Her thought was not just that the tow truck would be needed to haul the wreck away, but that its cable could be used to stabilize the vehicle while rescuers worked to free the trapped driver. And, as chance would have it, it was a Meunier's truck that Sue Newman had seen on the overpass—now just seconds from the accident.

Meanwhile, Windsor Fire Chief Ron Vezina headed south to set up a traffic control point below the accident. He knew nothing would be rolling in the northbound lanes for a while. Soon, the Vermont State Police sent a cruiser further south, to Exit 8, where I-91 traffic was rerouted onto side roads.

For the emergency personnel who continued to arrive on the scene, the sight of the twisted guardrail and the battered truck was gut-wrenching. When they heard that the driver was pinned beneath the truck, they feared for his survival. "This particular three-mile stretch of road," Buck says, "for years was so bad that anytime it rained,my husband and I drove to the station and waited for our pagers to go off. And they almost always did."

When Windsor ambulance got there, Jacobi directed the four EMTs on board. Rich Bowman, Timothy Lang, and Kelly Young—all "intermediate technicians"—and Barbara Thomas, a "basic," headed right for Mike, muddied and partially hidden in the foot-tall grass. They got on their hands and knees and dug away more of the mud under himwhile also starting an IV. Themiracle of the situation was that he was lying in a slight V-shaped depression; the sloping sides of the embankment supported much of the Chevy's weight. And although the slippery mud made navigating on the hillside hard for the emergency personnel, the heavy rain proved to be a blessing, for it had softened the ground enough that it gave under the weight of both Mike and the truck.

The Meunier's wrecker arrived quickly on the scene and backed perpendicularly across the highway—its rear bumper resting against the guardrail. The firefighters attached its cable to a hook on the undercarriage of the blue pickup and then signaled to the driver to take up the slack, preventing the pickup from sliding any further. Lateral movement was now the rescuers' main concern. A call went out for chocks—16-by-6-inch wooden blocks—to help stabilize the truck. Nicki Buck doffed her heavy firefighter's "bunker coat" and dashed back to the engine, returning with a plastic milk crate full of blocks and then sliding them down the embankment to waiting hands. The rain had stopped by then, but the rescuers were laboring under increasingly oppressive heat and humidity.

Sue had been told to stay where she was, for fear any movement might cause the truck to shift. She lay there quietly, listening to the muffled sounds of the emergency personnel working feverishly to extricate her husband.

Once the rain stopped, sunlight poured in through the truck's smashed back window. Soaking wet and covered inmud, Sue welcomed the warmth on her head and shoulders. Wedged in as she was, her only view was down through the remains of Mike's side window, toward the mud and mangled grass just 18 inches from her face. She remained calm but grew increasingly worried about Mike. Then, with a sinking feeling, she remembered the family members who would soon be waiting at the pizzeria, wondering what had happened to them.

The rain rolling through the Upper Valley on that late June afternoon had the personnel at the DHART hangar concerned. In bad weather, their two air-rescue helicopters were grounded. When that happened, anyone in critical 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 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 the other door open and his white helmet on. He climbed into the aftfacing seat at the head of the stretcher, then clicked the buckle on the four-point shoulder-lapbelt and snugged it tight. Next, he plugged a black cord dangling from his helmet into the so-called Carter box—a black device the size of a deck of cards connected to the aircraft's communication system. Rylander ducked his head as he slid into the forwardfacing copilot's seat, then he, too, buckled up and plugged in. Both lowered the visors on their helmets before sliding their doors shut and securing the handles. It was cramped in back, but that allowed for easy access to the neatly stowed equipment and supplies, including the green and chrome oxygen valves mounted on both interior sides.

Another DHART crewmember always helps with preflight operations from the tarmac. That day, paramedic Jason Johns, wearing regulation ear protection, stood next to the big APU, or auxiliary power unit, plugged into the right side of the aircraft. He was waiting for Clark to start the engines; this saved battery power for restarts away from the hangar. As the rotors slowly began to spin, Johns unplugged the black cable from the side of the helicopter and wheeled the APU to the edge of the landing pad, 40 feet away. Now standing at the nose of the aircraft, he waited for Clark to give him the "thumbs-up" signal while he kept an eye on both the aircraft and the surrounding area to be sure everything was secure for takeoff—no compartment doors ajar, nothing hanging from the aircraft, no other personnel on the helipad.

Clark, meanwhile, was going through his own preflight routine. Belted in, helmet on, and visor down, the pilot swung his microphone down from the side of his helmet and rested it against his lips. He checked with Pippy in dispatch to get the scene coordinates and the incident commander's radio frequency. Then he gave the "thumbs-up" to Johns, who responded in kind before ducking and heading back to the hangar—his flightsuit whipping in the slipstream from the rotors.

"When you're ready, gentlemen," Clark radioed to the crew. "Can I have the checklist, please?" Vota responded, reading down the take-off portion of the take-off and landing checklist—a laminated sheet posted on the frame of one of the doors in the crew compartment.

"Thank you, sir," Clark said as Vota read off the last item.

"DHART 1, DHART Comm," Clark radioed to Pippy, 30 feet away inside the dispatch room—"Comm" being shorthand for communications.

"Go ahead, DHART 1," Pippy replied, watching the helicopter through dispatch's big plate-glass window.

"We are three onboard, two hours of fuel," Clark added.

"DHART Comm, DHART 1," Pippy responded. "You are number 410, clear at 15:48."

"Thank you, sir," Clark acknowledged.

Through their helmets and seats, the crew could both hear and feel the two powerful Pratt and Whitney engines revving as Clark gently pulled up on the collective—the flight lever. The Eurocopter rocked slightly on its white metal landing skids as they parted from the tarmac. The rotor wash sent the puddles swirling in ragged arcs away from the aircraft as it slowly lifted off the helipad. Leaves on nearby trees and grass around the pad shuddered in the torrent of wind and water thrown their way. Clark used the 150-foot-tall smokestack on the DHMC power plant to guide the helicopter on its ascent. Then he eased its nose to the left, dipping it slightly, and headed off to the southwest. The sky was still dark and filled with gray clouds, but a shaft of late-afternoon sun suddenly broke through and lit up the hills in front of them. The Eurocopter swept across the Connecticut River in no time flat.

In less than five minutes, they were closing in on the site of the accident—easily a 20-minute drive from DHMC. Clark, who by then had his radio keyed to the incident commander's frequency, was already talking to the ground coordinator to get landing instructions. The crew could see two lines of unmoving traffic in the northbound lanes, stretching more than a mile to the south.

The accident site suddenly came into view as Clark banked and swung the helicopter around a cluster of conifers and maples. Multiple emergency vehicles ringed the scene—State Police cars, the Windsor ambulance, Hartland and Windsor fire engines, and rescue trucks. Amid the flashing blue, white, and red lights, the crew on DHART 1 could see the late-model blue pickup on its left side in the ravine. Clark radioed the crew, asking for the landing checklist. Calmly, Vota read down the list. "Check," Clark responded after each item. He slowed the descent of the helicopter as it slipped over the last of the emergency vehicles. The whine of the rotors changed to a louder, almost metallic "whup, whup," vibrating the whole compartment. Looking out their respective sides of the aircraft, Vota and Rylander confirmed to Clark that both areas were clear.

Clark touched down on the highway 70 yards beyond a parked state police car and radioed Pippy: "DHART 1 has landed."

"On scene at 15:55," Pippy radioed back.

Once the rotors had slowed to a near-stop, Vota and Rylander both radioed Clark—"Going off mike," they said—then doffed their helmets. Jumping quickly out of their respective side doors, they met at the rear of the helicopter. Rylander ducked underneath the tail extension and unsnapped two recessed clasps, swinging the bowed clamshell doors down and away fromthe aircraft. Vota helped him slide out the gurney, its legs snapping into place before its wheels hit the tarmac. Strapped to its top was a vital signs meter called a Propac and an oxygen tank snug in a greenand- black canvas sleeve. Clark, too, had by then stepped out of the compartment, carrying a portable radio so the crew could stay in touch with DHART Comm to keep Pippy apprised of their status.

As they rolled the gurney toward the scene, the DHART crewmembers glanced at the stretch of mangled guardrail. They'd seen such sights many times before, but the violence of amotor vehicle accident still hadn't lost its power to disturb them. They were glad to learn that in this case, despite the evidence of a horrific impact, the trapped victim was still alive.

By that time, the firefighters had the truck well braced with chocks. But the ground was still soggy and slippery. Transporting the patient up the ravine wasn't going to be easy. Suddenly, a call rang out for more people to help stabilize the truck.

Clark, a burly man who stands exactly six feet tall, had one leg over the guardrail on his way to go help before he was quickly (and good-naturedly) rebuffed by Vota. "If you get hurt, who's gonna fly us?" Vota asked, giving Clark a "what were you thinking?" look.

Clark chuckled. "Yeah, I guess it's not such a hot idea," he said. No matter how severe an accident is, first responders often find that a light note has a way of settling the mood. The DHART crew would have to wait for the EMTs in the ravine to haul the victim up to the roadway.

Vota had already gathered the driver's name and vital statistics from the onsite personnel: Mike Newman, age 65, weight 240 pounds. Clark took out a calculator and factored this information into his "weights and balances." With a patient that large, he might need to take the aircraft aloft to reduce its weight by burning off some extra fuel, so they could make the return flight safely. But Clark's calculations indicated they were safe as is.

Steam rose from the roadway as the puddles evaporated under the intense heat of the late-afternoon sun. Sweat poured off the emergency personnel who were struggling to hold the Chevy in place while also digging out the driver.

For Mike, the reality of his situation had been brought home by the insertion of the IV needle. "The last thing I remember before waking to a sudden sharp prick of a needle was seeing the guardrail race toward me," he says. "I opened my eyes realizing someone was talking to me, as I found myself staring up at my truck on top of me. I don't know how I was thrown out. I don't remember anything."

The difficulty that faced the rescuers was that not only was Mike pinned by the truck, but his left leg was partially wrapped around the rear axle. They feared multiple fractures, as well as the possibility of internal injuries.

Ten minutes after DHART 1's arrival, Mike was freed. Much to the EMTs' amazement, his leg appeared to be unbroken. Several firefighters carefully hauled him up the slope—neckbrace in place, shirt off, strapped to a bright yellow backboard—and then passed him over the guardrail to waiting hands. An EMT who'd been holding the IV bag passed it to another EMT on the road.

As Mike Newman was lowered onto the DHART gurney, Rylander leaned close to him. "Mike," he said, "my name is Alf Rylander. We'll be flying you out of here momentarily. How are you doing?" Rylander had to lean closer still to catch Newman's barely audible response. Meanwhile, Vota was attaching the Propac's sensors to Mike's body and checking the read-out hooked to the back of the gurney. He then secured a clear plastic mask to Mike's face and started a gentle flow of oxygen. The patient was quickly wrapped in a thin yellow insulating foam blanket, with a white cotton blanket over it. Rylander took the IV bag from the EMT. The initial assessment indicated that Mike had broken his scapula and also had some major bruising. Rylander placed the oxygen bottle between Mike's legs, slipped one of the gurney's restraints through the handle on the tank's canvas sleeve, clicked the belt shut, and cinched it tight. Then he clicked a second restraint across Mike's mid-section. Clark, several steps ahead of the gurney, was already radioing Pippy.

Rylander recognized Jacobi—now holding the "run sheet," with all the driver's medical information—and asked her to call it in to DHART. He knew with such a short flight back to DHMC that the crew would have its hands full. Jacobi walked to her Jeep, retrieved her cell phone, and called Pippy. In turn, Pippy relayed the information to the DHMC emergency department.

Within minutes, Clark got the "all clear" from the firefighter monitoring the landing zone and started the engines. Slowly, the blades began their rotation. Clark again asked for the preflight checklist. While Rylander worked on the patient, Vota read down the list. "Thank you, gentlemen," Clark radioed back.

Ahead, the highway was completely clear. With a burst of noise and a gust of rotor wash, DHART 1 lifted off the roadway and climbed quickly to 1,500 feet for the short dash back to DHMC. The cars in I-91's southbound lanes had slowed to a crawl as onlookers gazed down at the accident scene and up at the green-and-white helicopter now slicing through the late-afternoon sky. From the west and north, dark clouds were moving in again and blocking the sun. A few drops of rain fell on the newly dried roadway.

"DHART 1 Lifeguard to Lebanon Tower," Clark radioed to the air traffic controllers at the local airport. "Lifeguard" means "critical patient onboard."

"Go ahead, DHART 1," came the reply.

"DHART 1 Lifeguard requesting permission for a flyover," Clark said. He was asking for priority airspace so he could take the shortest route back to DHMC—which lay over the airport's runways. Permission was granted in seconds.

Mike Newman, by then alert and responsive, looked up at Vota and Rylander's helmeted faces and listened in as they checked his status, their voices coming through the headset they'd placed over his ears. "I felt like a sardine in that helicopter," Mike recalls. "There wasn't much room to move. Then again, I wasn't going to complain," he adds. He had asked about Sue's condition and had been reassured that she was doing well and was also en route, via ambulance, to DHMC. Of course his other concern was that their son and his family would by then be awaiting their arrival at EBA's, it surely being well past the rendezvous hour. He worried, hoping it would be possible to get word to themas soon as the helicopter landed.

But for the time being, Mike lay still, feeling the vibration and hearing the muffled sound of the rotors pulling him toward the helipad that now lay only seconds away.

Demarest, the author and illustrator of many children's books, has in recent years focused on real-life adventure, including flying with the Hurricane Hunters and the U.S. Coast Guard. An official artist for the Coast Guard, he traveled in May 2006 to the Persian Gulf to document its work in words and watercolors. The idea of chronicling the Dartmouth-Hitchcock air-rescue service arose from that trip, and he began doing occasional ride-alongs a year ago. He also used to be a volunteer firefighter in Thetford, Vt., and later in Meriden, N.H., so is familiar with the work of first responders. He's currently working on a book for adults about DHART and the history of medevac services. This feature tells the story of his first day with DHART; the patients involved have given permission for the story to be told, but their names and some identifying details have been changed to protect their privacy.

If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

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