SALT LAKE CITY -- When an air ambulance passes overhead, Jamie Kinder sends out "good thoughts and well wishes." She's thinking not just of the patient, so sick that speed is crucial, but of the crew, as well.
Kinder knows that emergency rescue can be dangerous. Ten years ago today, her dad, paramedic Tim Hynes, died along with pilot Stan Berg Jr. and nurse Shayne Carnahan as they were trying to ferry a badly injured skier to University Hospital in their AirMed helicopter. David Anderson had been caught in an avalanche that afternoon at Snowbird. He, too, died in the crash.
Reeling from the tragedy, AirMed began an intensive process of self-review to see if it was doing all it could to be safe. It had been 15 years and thousands of air rescues since Utah's only air ambulance disaster. AirMed pilot Louis Merz died in a crash in April 1983.
At its LDS Hospital headquarters, Life Flight, Intermountain Healthcare's air ambulance service, was looking at itself, too. AirMed and Life Flight are separate, but back each other up. When the AirMed helicopter went down in Little Cottonwood Canyon, the program's devastated staff suspended operations for a few days. Life Flight took up the slack. Later, AirMed would return the favor. The crews are often friends, always colleagues, the mutual respect constant. They share the same risks, braving altitude and weather because someone needs them.
For the two Utah programs, the decade that followed would bring policy changes, new safety procedures, better equipment and a strengthened resolve to put crew safety first. It would see new aircraft, new technology, new training programs. But it also would be punctuated by two more crashes, this time involving Life Flight -- one a day shy of the fifth anniversary of the AirMed crash, on Jan. 10, 2003, and another the following June.
The January 2003 Life Flight crash of a helicopter near the Salt Lake airport, in thick fog, killed pilot Craig Bingham and paramedic Mario Guerrero. Miraculously, grievously injured flight nurse Stein Rosqvist survived. In June, a flight crew returning from rescuing a stranded hiker went down near Wasatch Boulevard when part of the tail rotor failed. Nurse Denise Ward and paramedic Brian Allred walked away with relatively minor injuries, a feat they credit to pilot Brent Cowley's skill. Cowley died.
The January 2003 crash was the first in which a crew member was lost during Life Flight's then-25-year history.
The wall in the AirMed command center is dominated by the portraits of Carnahan, Berg and Hynes, along with a photo of the helicopter that hit a mountain when it was caught in a storm. There are no captions -- they know who the men are: much-loved reminders that life is precious and their task sometimes perilous.
In a separate room, dispatchers watch computer monitors and take calls for help.
The area itself has changed, part of major construction and renovation that brought University Hospital a new emergency room, among other improvements. The dispatchers have new radios, the antennas atop the taller building. AirMed has satellite tracking inside its four helicopters and two planes that track location, speed, altitude and heading every 30 seconds. The system is voice-data capable, so when they're out of radio range they can still talk. Life Flight uses satellite, as well.
Both also now use night-vision goggles -- with an expensive retrofit of the aircraft -- and pilots are specially trained to use them and are also instrument rated. It's the direction the entire industry is going; Utah's rescuers got there a little earlier, spurred in part by the crashes.
Flight crew members know how to shut down the aircraft, drain the fuel tanks, use the radios, lock and unlock cockpit doors. They are comfortable with the craft's emergency equipment.
Still, danger persists. Every year, about a dozen medical transports crash in the United States. Each triggers a safety review and more introspection.
The Federal Aviation Administration is considering stricter crew and weather rules, terrain-monitoring equipment, risk-assessment program development and formal dispatch and weather information systems for all flights. The Utah crews already have adopted most of that.
AirMed program director Brian Simpson says the U.'s planes have a special GPS-based system that says how close they are to terrain. That's in the works for Life Flight, too.
On the U. Hospital roof, where the helipad is located, orange tubing melts ice and snow. The pilots can control the lights remotely.
AirMed is 120 people strong, including 22 pilots and mechanics who work for Colorado-based Air Methods under contract to the U. The rest are U. employees.
Life Flight's 14 helicopter and 13 plane pilots work directly for Intermountain. Its control center is now east of the airport in its own building and hangar. The fleet of three planes and four helicopters (two are hoist-capable) are based throughout the state, helicopters assigned to Intermountain Medical Center, Utah Valley Regional Medical Center and McKay-Dee Hospital. One of the planes is kept in St. George.
While the goal of saving a patient will never change, crew safety today trumps everything, say Simpson and Life Flight director of operations Bill Butts.
What used to be a pilot's sole discretion is now officially "three to go, one to say no" in both shops. Any crew member can say, "I don't feel good about this," and the mission is over.
Pilot interaction and information is deliberately limited so the decision to fly is based on flying conditions alone. It's hard to say no when you're told a 3-year-old will die if you don't help. But the patient can't be helped anyway if the aircraft can't safely reach and transport him.
Butts and Simpson say crew members not only care for the patients, but also act as extra eyes to spot obstacles, weather conditions and other perils.
Life Flight has a checklist that helps pilots decide to accept a call. Pilot experience, weather, whether the location is unfamiliar or it's night are among factors assigned points. When the total reaches 25, the pilot can't accept the call without checking with Butts or the chief pilot.
"If it gets to that point, the answer's probably really no, and they know it," says Jerry Morrison, Life Flight executive director. "We've tried to give the pilots all the tools they need to safely go up in all kinds of environments."
The June 2003 crash, attributed to mechanical failure, was a nightmare for the program. "We function now with the reality that if we get it 100 percent right, we can still end up with a loss of life. That's humbling," he says.
If either Life Flight or AirMed turns down a flight because of weather, it immediately lets the other one know.
The AirMed mission started that Sunday afternoon when Anderson's party, cross-country skiing in boundaries, was caught in an avalanche that pummeled and buried Anderson. An AirMed crew immediately shuttled rescuers as close to the site as possible, but the winds got too high and it returned to the hospital, with a "call us when you've got him ready for transport."
It would be many hours before that call came, the rescue difficult, the terrain a horrific journey for those on the ground.
Ground rescuers don't get the attention and applause they deserve, says Simpson. "We're high-profile, and we get a lot of credit for what other people do. There are people on the ground at both ends, and we have a short snippet in between. Sometimes, we get all the credit."
Besides the heroic ground effort to rescue Anderson -- "hours slogging through the snow," Simpson says -- unknown numbers turned out to find the downed medical helicopter.
Kim Berg Walters, pilot Stan Berg's wife, says she got bare-bones information late that night. For the next few hours, Berg's family called his cell phone, so he would know he was not alone. "He never liked to be cold, and that was hard, knowing he was up in the mountains in that horrendous weather," she says.
Jamie Kinder was told rescuers had spotted a fire and wrongly assumed the men, all skilled at wilderness survival, had built it to signal for help. It was, in fact, the burning wreckage.
Early the next day, they all saw on the news that the wreckage was found, but no life. Soon after that, an Air Methods representative arrived and told them everyone on board died on impact.
Ten years later, the two programs are busy as ever and aware of the risks but still willing to take them.
Morrison says Life Flight averages 10 or 11 calls a day. Sometimes, it's not safe to fly and the critical care crew goes instead by ambulance.
AirMed takes around 2,500 calls each year. The fixed-wing planes take about 40 percent, usually those that require a longer distance be traveled.
Life Flight's hoist capability means it's sometimes called out for people stranded in awkward places, like on mountains.
Ward returned to duty shortly after the helicopter she was in crashed. "It was a little hard, but not enough to stop me from flying. I think we were safe before and we're safe now, but we do have more tools to enhance safety. And they really emphasize and encourage us to verbalize" questions or suggestions.
She says there's something special about what they do. They treat the sickest, at their most desperate time. They work with more autonomy than most nurses. They tend to be outdoor enthusiasts, self-starters, decisive. When one leaves the program -- both programs claim low turnover rates -- it's often to pursue advanced degrees in health care.
Their bosses call them the best of the best. To get in the programs, they must have honed skills and deep experience, including years in emergency care.
At the Life Flight hangar, one wall is adorned with a huge crocheted afghan that features a helicopter silhouette against the blue sky, "In Remembrance." Pilot Craig Bingham's wife made it, as well as a picture quilt.
During the dedication of its helipad recently, AirMed unveiled a plaque with portraits of those it has lost. All the families of the lost crews, even Merz's from the 1983 crash, were there. Kim Walters walked up to one of the pilots and held open her arms. "I need a pilot hug," she said.
Carnahan and wife Tami had just learned she was pregnant again. They never had time, together, to tell their families.
News reports said, correctly, that Carnahan left behind a wife and three kids, ages 8, 5 and 3. His fourth, Emily Shayne, is 9. Tami Carnahan laughs that Breanne is in college, Parker in high school, Kaitlynn in junior high and Emily Shayne in elementary school.
The little girl longs for the dad she never knew, so they tell her stories about him, the children who enjoyed the "very hands-on father" determined to make him real to her, too. After the crash, Tami hired an artist to draw a picture of the girl with her dad.
Rosqvist was one of Carnahan's closest friends. Each year, on the anniversary, he'd call and break down crying, she says.
When she heard that a Life Flight helicopter had gone down, her first thought was of Rosqvist. "Don't let it be Stein." He was the survivor, but it took a lot of hard rehabilitation work. The father of four wrote a book about the experience and remains close to the program, but he wasn't able to return to nursing. Wife Michelle is a nurse at Alta View.
Tami thinks Shayne would be proud of how self-reliant and socially adept his babies have become.
"It's not anything you get over, but you get resilient. But my kids won't leave the house or go to bed unless they tell me they love me and good night or goodbye."
Kim and Stan Berg had three children, the youngest son, Ryann, on a mission at the time for The Church of Jesus Christ of Latter-day Saints (Mormon). They had two grandchildren when Berg died; there are now seven. Children Chris, Jennifer and Ryann are doing well. Kim is now Kim Walters, remarried six years ago to a "nice man" who doesn't mind reminders of the man his family lost that day.
"I've become more patient and tolerant with things," she says. "I have more of an appreciation for life, because life is short."
She says it's "nice" to see a rescue helicopter overhead. "It makes me remember good times, although my heart still sinks a little bit when I see AirMed or Life Flight fly over. I think of my dear husband who's not with us, and it's bittersweet."
Hynes' daughter, Jamie Kinder, now 29, graduated from Brigham Young University and is married with two boys, 4 and 2. When an AirMed helicopter, by coincidence, flew over her wedding reception, she felt like her dad was checking in.
Her brother Jared works for Solitude's ski patrol. He, too, rescues those who cannot save themselves.
Kinder says her dad was "passionate" about air rescue. "I think they all know something could happen, although you don't plan on it. It makes me proud to say he was doing something good when he died."So she stops when air rescue flies overhead and thinks of him. "I don't want people to shy away from that job. I'm glad they know the risk is there and still they're willing to do it. I think the sound of that helicopter is probably one of the most beautiful things when you're the one that needs help." E-mail: firstname.lastname@example.org