Pilot Danny Stevenson goes through his daily ritual of inspecting the Children's Hospital Central California helicopter that sports a bright picture of the hospital's giraffe mascot, George, on the side. He checks and rechecks everything to make sure that when the call comes he and a two-person transport team from the hospital can be in the air as quickly as possible.
Time is crucial when it comes to medical care. A few seconds can mean the difference between a life saved and a life lost.
The need to be able to transport patients as quickly as possible is complicated even more at Children's Hospital because it serves patients from an area covering 43,000 square miles. With a top speed of 145 mph, the EC 135 P2+ helicopter can cover a lot of ground quickly.
"We are different than just a regular ambulance or paramedic crew because we are an ICU critical car team, which means we are always dealing with very sick patients," says transportation coordinator and registered nurse Stela Morford.
Long before the blades begin to spin, a large team of experts are involved with making determinations about transportation.
The process starts when a call comes into a small office at the hospital filled with phones and computers. Two or three dispatchers field the initial call for transportation and then serve as a liaison between Children's Hospital doctors and the medical staff at the other end.
Ten dispatchers rotate through the shifts, which ensures that someone is always available to take calls. There are between 1,300 and 1,400 transports each year.
"Once the doctor makes the decision to send a team, it's then up to the dispatcher to decided whether we are going air or ground. They will call the pilot and he will say 'yes we will go.' That's when they call in the teams," says transport manager Denise Johnson.
The transport team travels with a gurney full of equipment -- including an incubator -- to handle any emergency that takes place along the way. Most of the time it's smooth flying, but if the patient should require an immediate procedure -- such as an IV or breathing tube -- the pilot will sit the helicopter down in the first safe location to allow the team to do their work before continuing on the trek.
Dr. Adam Holmes, one of the pediatric intensive care unit doctors, is the the medical director of the pediatric transport teams. He says the team is vital because they are an extension of what he does as a doctor.
"They are our extended hands. They are our eyes, ears, hands and brains when they are out there in the field accessing these patients. We have ongoing dialogue, but they are absolutely extension of us," Holmes says.
Stevenson is one of four helicopter pilots who rotate schedules -- one of them is on-call ready to take to the air. The pilots are employed by MedTrans Corp., who lease the helicopter and the services of the pilots to the hospital.
Stevenson works a 12-hour shift for a week and then is off for a week. The pilots alternate between working days and nights.
When a patient needs immediate transport, there's limited time for the pilot to prepare for the trip. That's why the first order of the day is to completely check the helicopter so it's ready to go. Even members of the transport team will make a visual check just before takeoff.
"Several pairs of eyes always better," says Morford.
All of the pilots spend their time between flights monitoring the weather to determine if it's safe enough to fly.
"There are times when it looks clear here but there will be a storm between us and where we are going. We have to keep an eye on the weather to keep an eye on any changes," Stevenson says.
Night trips don't bother the team because the pilots wear night vision goggles. But severe heat makes it tougher to fly, and elements such as fog or storms ground the unit.
Currently, the helicopters can fly only when there is clear visibility. That may change eventually if they can expand to use sensors to get through poor weather conditions.
It's the pilot who has the final say as to whether to fly. When it's thumbs down, the teams turn to ground transportation -- in one of the ambulances that is based at the hospital -- that can take them as close as downtown Fresno or as far away as Pasadena.
"We had to make a trip to Pasadena to pick up a baby to have eye surgery. A trip like that will have you tied up all day," says respiratory care specialist Dennis Tudman.
In general, the team members like traveling by helicopter because it is fast and a lot smoother than bouncing around in the back of an ambulance.
TV and movie critic Rick Bentley can be reached at (559) 441-6355, firstname.lastname@example.org or @RickBentley1 on Twitter. Read his blog at fresnobeehive.com.