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Vital signs at 1,500 feet

Medevac pilot whisks patients to hospitals

By Neil Osterweil
MedPage Today Senior Associate Editor

Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical profile from MedPage Today appears each Tuesday.

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Medevac pilot Bill Rypka has been flying helicopters since he joined the Army in 1981.

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PLYMOUTH, Massachusetts (MedPage Today) -- For more than 20 years Bill Rypka's career plans have been up in the air, and there are plenty of people alive today who can thank him and his colleagues for it.

As one of 10 pilots for the critical care transport system, Boston MedFlight, Rypka has had to snake his helicopter through dense jungles of construction cranes to set it gently down on a helipad that's just a little bigger than a basketball court.

At times he has led a fly-by-night existence, attempting to land in the small hours of the morning on a stretch of remote unfamiliar highway guided largely by his training and instincts, the sharp eyes of the flight nurse and paramedic who accompany him on each rescue flight, and the lights of emergency vehicles below.

At a moment's notice the 48-year-old Rypka and his fellow rescuers may be called on to rush a car-crash victim from the island of Nantucket to a Boston hospital, or a critically injured child and her mother from a small town on the New Hampshire border to one of Boston's pediatric trauma centers.

If things had worked out the way he'd originally planned, Bill Rypka might today be ferrying commercial airline passengers around the country or overseas on business trips and pleasure jaunts. Instead, he's flying within a 100-mile radius in southern New England, and he has to work three 12-hours-days, followed by three equally long nights, for six straight days.

Helicommuter inspires dream

Rypka was bitten by the flight bug as a child when he heard about a local man who commuted to work by helicopter.

His first experience with emergencies came as a dispatcher/special officer for a police department in the southern New Jersey town of Medford, where he also went on occasional patrols.

In 1981, at the age of 23, he decided to join the Army to pursue his dream of flight training. He earned his wings on UH-1 Huey helicopters -- Army workhorses used in both combat and in medevac flights -- and on OH-58 Kiowa Warriors, used for observation and reconnaissance.

He transferred to the Coast Guard in 1986, where he flew missions out of Elizabeth City, North Carolina, Prince William Sound, Alaska, in the aftermath of the catastrophic Exxon Valdez oil spill in 1989, Cape Cod, and Boston.

As he approached the two-decade mark in the military and contemplated a life outside the service, he began to think about making a switch to bigger aircraft.

Change of flight plan

"I thought I wanted a change in life and wanted to become an airline pilot, and I had gotten all my ratings, and then 9/11 happened and the world changed," he said,

In the aftermath of the events of September 11, 2001, there was a sharp dropoff in air travel, forcing many airlines to cut back on their hiring and expansion plans.

It was through a friend and fellow pilot that he found his place in the ranks of Boston MedFlight pilots.

Boston MedFlight is a non-profit organization supported in part by a consortium of Boston teaching hospitals affiliated with the Harvard, Tufts, and Boston University medical schools. The service transports patients to hospitals without regard to their ability to pay. Each mission is a coordinated effort combining the contributions of both airborne flight crews and ground-based communications specialists, mechanics, EMT drivers, and specialty medical teams.

Flying the golden hour

In trauma care it's known as "the golden hour," a 60-minute window from the time that an accident happens or an acute illness sets in to the moment the patient starts to receive hospital-based care.

Rypka had flown medical missions for the Coast Guard and knew the drill, but he acknowledges that for even the most experienced pilots (he has logged more than 6,000 hours of flight time) there can be some white-knuckle moments.

"Every now and again we might be transporting someone and they're fine one minute and in crisis the next," he says. "If the patient has, say, a ruptured aorta, things changes pretty fast and it gets pretty busy - more so for the people in the back than for me."

Other challenges include flying in high winds, the hazards of negotiating a flight path through a forest of construction sites, and landing at night in an unfamiliar landscape in which the hazards may be obscured until the copter is right on top of or alongside them.

Yet in all the time he has spent in the air - more than 250 days when all of the hours are combined - he has never suffered an engine failure or had a major accident.

Rypka credits Boston MedFlight with having a top-notch safety program involving everyone from mechanics to medical staff. For example, before each takeoff a highly trained medical crew member performs a startup, standing outside of the aircraft to report anything that might jeopardize flight operations, such as an oil leaks or an open latch. Crews also receive continual safety training as well as biennial drills.

"We really do work as a team," Rypka says. "Everybody's good about feedback, and everybody's got a thick skin. It doesn't bother me if someone tells me, hey there's something you didn't see on the ground, and I go around and go back and re-evaluate before attempting a landing,"

The ultimate decision to fly or not to fly is dictated by the pilot in command and not by the needs of the patients or outside pressures, Rypka adds.

"Sometimes pilots will turn something down a flight and people will wonder why. It's because we don't' feel it's safe enough for us to do it, and that really reduces the chance for an accident."

As a husband and father of a 5-year old boy, he knows that there is a certain glamour and prestige to being a airline pilot responsible for the lives of hundreds of people at a time. But for him, keeping the life of his passengers and crew mates safe is quite enough.

"It was the best decision I ever made," he says.

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