CHICO - Some residents in the neighborhoods around Enloe Medical Center may still fume when the FlightCare helicopter rumbles overhead. But for more than 14,000 patients transported by the service since 1985, the sound is as welcome as the next beat of their heart.
It was 25 years ago this month that the chopper lifted off the roof of the hospital on its very first mission responding to the critically injured victim of a vehicle crash on River Road.
While the patient survived and recovered, the inaugural outing didn't go as well as the crew would have liked.
There were delays in both launching and landing at the scene. Some emergency responders recalled that it would have been faster to transport the victim by ground ambulance.
It was an inauspicious start for an air ambulance service that nonetheless matured into one of the most honored in the U.S.
Ironically, on the exact day of its 25th anniversary, Aug. 1, FlightCare didn't respond to a single mission. The helicopter was down for routine maintenance.
FlightCare's quarter-century milestone is recognized in a cover story in the current issue of Air Medical Journal, a national publication.
FlightCare was the first hospital-owned medical helicopter service in California, and remains the only one today.
In 2008, the Commission on Accreditation of Medical Transport Systems awarded FlightCare a full three-year accreditation rare for air medical transport services.
In 1995, FlightCare launched its Membership Program, becoming just the second air medical helicopter service in California to offer membership privileges.
In 1998, FlightCare was honored for 5,000 consecutive, safe EMS missions.
The Federal Aviation Administration certified FlightCare in use of night vision goggles in 2001, making it one of just three air medical programs in the country to receive this recognition. FlightCare crews are often called on to give night vision goggle classes and seminars to other air transport operations.
In 2008, the service acquired Glidescope, improving first-attempt intubations (the placement of a plastic catheter into the trachea to protect the airway and provide artificial ventilation) to nearly 100 percent.
Most recently, the Enloe FlightCare helicopter was outfitted with a state-of-the-art collision avoidance system that sounds an alert when other aircraft are nearby.
Today, Enloe flies missions within about a 75-mile radius of Chico, but routinely transports patients to and from locales as far away as Reno and the Bay Area.
There are 19 on the FlightCare team, including pilots, flight nurses, flight paramedics, mechanics and clerical personnel. Most of the flight personnel work 12-hour shifts, changing at 6 a.m. and 6 p.m. daily. Paramedics work 24-hour shifts.
Statistics show that 55 percent of FlightCare calls are for responses to the scene of an emergency, and 39 percent are flown at night.
The early years
Marty Marshall was Enloe's first pilot. At 57 he still flies, but is also the hospital's director of emergency services.
He came to Enloe from the Army, where he flew Apache helicopters.
Marshall recalls thinking an Army buddy was crazy when he told him he wanted to fly helicopters for a medical transport service in Idaho.
After looking into it, Marshall concluded the industry, still a fairly new concept in 1985, might have a future.
He was attracted to Chico because of the lifestyle it offered, and because a company called Freedom Helicopters was starting an air ambulance service here, flying out of Enloe.
Freedom leased the chopper to the hospital and held the FAA license. When the company went bankrupt in 1985, Marshall and a handful of others involved in emergency medicine at Enloe jumped on the chance to buy the helicopter and operate its own hospital-based air transport service.
Enloe is surrounded by residential neighborhoods and the idea of a helicopter lifting off and landing on the hospital roof up to several times a day didn't set well with everyone.
Marshall, and FlightCare nurse Robin Kiutuu, now 56, recalled walking door-to-door in areas around the hospital talking with residents about the air service. They were joined by Jan Mitchell, then Enloe's emergency room nursing supervisor, and Dr. Terrence Fraters, then emergency room physician and early FlightCare organizer.
"We were just knocking on doors, talking to anyone and everyone," Marshall said.
The biggest topic then was noise, and it remains enough of an issue that Enloe abandoned plans to place a second landing facility on the roof of its new patient tower opening next year.
With just one landing zone at the hospital, the Enloe chopper must now lift off the roof to make room for other incoming medical transport helicopters. Marshal said having a second landing area would actually reduce helicopter traffic over the hospital.
Marshall recalled that one woman in particular, on Seventh Avenue, was concerned about the racket disturbing her sleep, and a flight pattern was devised to specifically avoid her house.
Marshall said most flights follow The Esplanade, which minimizes the noise impact in residential areas.
He admitted that one of his biggest concerns when FlightCare first started wasn't noise, but the possibility his helicopter would be shot at if he flew over clandestine marijuana gardens, especially in rural foothill areas. He said it never was.
Marshall said he liked Chico and wanted to stay. He explained that helicopter pilots lead itinerant lives, and starting a hospital-owned air service seemed like it would offer some permanence.
"I wanted to go home at night," Marshal said. That proved difficult at first since Enloe was short on pilots, and Marshall was working shifts of 24 to 48 hours. "That wouldn't be allowed today, but then we were kind of making up the rules as we went along," he said.
FlightCare also struggled into existence at a time when the air medical transport business was experiencing a high number of crashes. From 1980 to 1989, there were 31, claiming the lives of 87 people. Most were crew members, but some were patients, and the industry acquired a reputation for tolerating loose regulations and daredevil missions.
"FlightCare has always made safety a priority," Marshall said, adding that its policies allow any member of the crew to cancel a mission at any time if they are concerned it may be hazardous.
Once the service was certified, and an FAA license issued, educating the emergency responder community about how to utilize the new service became a major issue, according to Kiutuu.
"We did a ton of training with paramedics, fire departments and law enforcement about the most effective way to work with us," she said. "We wanted them to know how FlightCare fit into the puzzle. We wanted to make it clear when they should call us, and why they should call us."
Marshal said flying into smaller hospitals in the region, such as those in Quincy and Chester, was particularly dangerous. "We had to ask the hospitals to make some changes, such as relocating power lines that were in the way in Quincy."
To a person, early FlightCare organizers cite the helicopter's ability to cut life-saving minutes off transport time as its greatest advantage.
Fraters, still practicing medicine at 75, said as a level-two trauma center, Enloe needed to expand its primary service area from 20 miles to something more like 100, but couldn't do that relying on ground transportation.
Chester is a fairly common destination, and Fraters said a 20-minute flight down to Enloe is far preferable to a 90 minute drive on a bumpy, windy road.
He should know. Besides riding along on several FlightCare missions, Fraters was once a patient. He suffered a heart attack in the Chester area in 1990 and was in the emergency room at Enloe within about 40 minutes.
"FlightCare can perform some procedures and provide better quality emergency care than a person would get at some small hospitals," Fraters said.
Kiutuu reflected on traits common to FlightCare crew members: "You're dealing with people in a huge crisis. You can never underestimate how far kindness and sympathy will take you in that situation. You can't be arrogant, but self-confidence is important, and it doesn't hurt to even be a little cocky."
"We're so visible up there," she said. "People expect only the best, and that's what we have to be."