A hospital, at 130 mph.
Each Mayo One helicopter—and there are now four of them—carries a ventilator, IV fluids, 70 medications, various blood products, a handheld blood analysis lab, and, sometimes, an isolette for preemies.
The three-member crew in the retrofitted Airbus EC145 can transport critical patients up to 150 miles one way, insert a chest tube, realign a broken femur, and transfuse blood (most likely donated by Mayo employees).
All at 130 miles per hour, and 5,000 feet above the ground.
About half the time, when their radio goes off—when the dispatcher’s voice comes over their handhelds—here’s all the crew of Mayo One knows: Where they’re flying to.
They have little or no idea what they’ll find when they get there.
"Mayo One, we’ve got a trauma in Austin."
That way, if the weather’s at all questionable—a yellow status—they have to make the decision whether they should fly based on the destination, on safety of the crew alone.
That way, they can’t be swayed by, say, a call about a kid.
If there’s such thing as a typical flight for Mayo One it’s this, stats-wise: A 55-year-old male in cardiac arrest.
A couple in a car crash.
A 16-year-old who’s been in an ATV accident.
A 75-year-old woman who hurt her head in a fall on an icy sidewalk.
"Cardiac arrest, stroke, motor vehicle accidents, ATV accidents," says Meghan Lamp, who just celebrated her 40th year at Mayo Clinic, including 26 as a flight nurse for Mayo One. "And plenty of falls. Falls are the leading cause of trauma in Minnesota."
But there’s no typical flight for Mayo One.
Instead, there’s the time in 2012 they landed in a farm field to find Nels Gunderson, a farmer who had been working on a commercial rototiller. The rototiller, according to Gunderson, "decided to jump up and landed on the end of my work boot. And before we could get it shut off, it sucked me into the rototiller." Gunderson’s leg was completely severed four inches below his knee. Mayo One—which had been dispatched when the first 911 call came in—landed just minutes later. They administered seven pints of blood en route to surgery at Mayo Clinic. Gunderson not only survived. He was back home in five days.
"I’m living proof of how important [Mayo One] is," Gunderson told the Associated Press. "Because, without it, I may or may not have been here."
And there’s the time in 2015, when Mayo One landed at a small regional hospital to pick up Amber Manning, who had just given birth by emergency C-section. Doctors performed an emergency hysterectomy. Amber, though, would not stop hemorrhaging. She needed to be moved to an emergency trauma center. Amber was bleeding so much, in fact, doctors feared she would die on the way. The Mayo One crew was able to administer blood and plasma on the flight to Mayo Clinic. Once there, Amber received another 30 units of red blood cells and 15 units of plasma. By the time surgeons were able to stop the bleeding, her total blood volume had been replaced "four times over." Amber (and her daughter, Amaya) survived.
For 40-year-veteran Lamp, there are the times she was part of a team that flew to remove organs from a donor and bring them back to a patient waiting at a Mayo O.R. for a life-saving surgery. "My mother-in-law’s sister was waiting for a heart transplant," says Lamp, who also helped run the Grand Meadow ambulance service for 35 years. "I’ll never forget the flight when we delivered her heart to her."
"It’s humbling to bring back a gift for others."
There’s the teen suicide attempt and the girl who was burned trying to save her brother from a house fire and the new mom-to-be with a fetus in distress.
There’s the five-year-old kid on the bike who just got hit by a car.
"Even after all this time," says James Tempel, who has spent 25 years at Mayo, including the last 14 as a flight nurse, "my adrenaline gets going when I know it’s a kid."
Roughly 20 percent of Mayo One’s 1,000 annual flights—and that’s just the Rochester location—are triggered in the form of an "auto-launch," a dispatch based on 911 calls from southeastern Minnesota and northeastern Iowa and western Wisconsin.
Mayo One is auto-launched when that emergency call includes certain criteria, like: a vehicle accident at highway speeds, a vehicle rollover, passenger ejection, a death in one of the vehicles, a fall from "significant height," near drowning, burns over more than 20 percent of the body.
(Roughly 75 percent of auto-launches, though, are canceled before Mayo One arrives. When other first responders get to the scene, they let the crew know whether they’re needed or not.)
Most Mayo One flights—maybe 80 percent—go to area hospitals, either those with recently admitted ER patients who need to be transferred, or longer-term patients who need more specialized care (such as a patient in need of a transplant or a preemie who is not responding like they should). A few times a month, Mayo One flies to a hospital to pick up an organ for donation.
The radios sound. The team, already suited up in flame-resistant Nomex coveralls, grabs helmets from their "offices"—the lockers set in the large garage-like space attached to the helipad atop St. Marys.
Regardless of the call type, the crew immediately begins their pre-flight checklist. The pilot reassesses the weather status ("green" is a go; "yellow" means other factors like distance and topography need to be considered; "red" is a no-go, often based on FAA weather minimums).
Since weight is extremely important, the helicopter is pre-fueled to a standard minimum amount. If the flight is longer—or requires an extra crew member, the pilot adds fuel.
One of the medical crew removes the blood cooler—carrying whole blood, packed red blood cells, thawed plasma, and platelets—from the refrigerator and loads it onto the helicopter.
All three crew members perform a walkaround of the helicopter, looking for any abnormalities, like signs of a fluid leak.
The pilot takes the starboard side seat. Straps an iPad—displaying navigation and weather information—to his or her leg. Starts the engines. Lifts off.
The entire process, from call to liftoff, should take place in less than 10 minutes. Mayo One averages just over eight.
For the first two minutes of flight, none of the crew members talk to each other. The only acceptable communication comes from and to the pilot and the dispatch. And here, maybe for the first time, the crew will get a hint of what they’ll be dealing with.
"Mayo One. We’ve got a five-year-old male with serious head trauma. Car versus bike."
Roughly 100 team members—including 30 nurses, 30 paramedics, 10 mechanics, and two dozen pilots—make up Mayo Clinic’s medical helicopter (and airplane) units.
The standard helicopter flight crew consists of a pilot, a flight nurse, and a paramedic. They work 12-hour shifts (7:30-7:30) three or so days a week. Some days, some nights. The team is staffed every hour of every day.
"We always have a nurse on board," says Kathleen Berns, a 26-year-flight nurse with 41 years at Mayo Clinic (who now serves as Clinical Nurse Specialist at Mayo Clinic Medical Transport). "And all of our nurses come out of the ICU, so that brings that critical care component to the team."
And they are, says Lamp, teams. "People that work in EMS often like chaos, the unexpected. This is where they thrive. There are many things that are very rewarding about taking care of patients in some of the worst situations they’ll ever face. And you do it together. Your crew becomes like your family."
Today’s flight nurse is James Tempel, who also works occasional shifts in the Vascular Radiology department.
"James worked at an ICU setting for many, many years before he came to this job," says Bruce Goodman, today’s paramedic. "You should see him take charge in an ICU."
Goodman, an 18-year veteran, was part of the team that saved a 54-year-old Goodhue man by performing CPR. For 96 minutes.
"I thought we’d revived someone who in my opinion couldn’t survive what he’d been through," Goodman said after that incident. "He’d been down an hour and a half. The likelihood of him walking out of the hospital with any kind of life in my mind was zero." A few days later, when Goodman went to visit the patient, "he stood up and greeted us when we came in," he said.
Pilot Maxwell Conrad started flying for Mayo in 2013, after stints as a helicopter instructor for the Army and at the University of North Dakota. He spent a year in the Gulf of Mexico transporting people and equipment to offshore oil rigs. He’s a Minnesota kid who made his way back to the Midwest.
Piloting a Mayo medical helicopter is not a fresh-out-of school job. You’re required to have logged at least 2,500 hours of flight time just to apply.
Conrad, though, has no formal medical training. That, for the pilots, is by design. "I’m here to focus on flying," he says.
That First Flight
Mayo bought its first helicopter in October of 1984. At the time, it was described as "the first hospital-based air medical transport service in the state and the largest aeromedical craft made."
But Mayo One’s inaugural medical flight was unplanned.
The newly-formed team planned to spend an instructional week touring regional hospitals for introductory flights and demos. On Oct. 8, the new helicopter was in Whitehall, Wis., when a doctor in Oshkosh, 150 miles away, called Mayo Clinic. A patient who needed to be transported to Rochester, he said, would probably not survive the ambulance trip. Mayo called the helicopter team, which had paramedics aboard. They immediately cut the tour short and flew to Oshkosh. They picked up the female patient and were at Mayo in 80 minutes.
Mayo One—a specialty-retrofitted, twin turbine engine Airbus EC145, an $8 million aircraft—can fly at 130 mph with a 150-mile range. All while carrying a ventilator, IV fluids, 70 medications, a handheld blood analysis lab, and, if necessary, a neonatal team and a 350-pound isolette.
Onboard, the Traffic Collision Avoidance System (TCAS) monitors airspace around the aircraft. The Storm Scope system detects lightning strikes. All crew members have night vision goggles.
Mayo One features Dual Global Positioning Systems, a Helicopter Terrain Awareness and Warning System (HTAWS), something called a Duplex Autopilot.
Those fins above and below the cockpit are part of the helicopter’s wire strike protection system (WSPS), basically giant blades designed to cut through a 3/8-inch steel cable in case of accidental contact.
"Mayo has outfitted their aircraft to be some of the most advanced medical aircraft in the nation," says Kathleen Berns. "They are top-of-the-line when it comes to crew safety, and top-of-the-line when it comes to the equipment that gives the best care to patients. Our helicopters are some of the few with two engines. It’s twice the maintenance, more fuel, more cost. But Mayo understands the safety for crew and patients, and that shows in Mayo One."
And there are four Mayo Ones. All identical, from the cockpit configuration to the setup of the patient care compartment. Mayo has EC145s based in Rochester, and atop Mayo hospitals in Mankato and Eau Claire, Wis. The fourth helicopter, normally hangared in Rochester, serves as a back-up to all bases.
In its first year, 1984, Mayo One completed 57 medical flights. In 1985, that number had increased to 402.
Today, Mayo logs 2,000 patient transports, 3,000 flight hours, and maybe 250,000 miles every year.
And that’s just for the helicopters.
In 2016, Mayo added their first airplane—the $9 million King Air 350C twin turbo prop—to the Mayo Clinic Medical Transport fleet (MCMT).
"And the ‘C’ stands for that big cargo door," says Joel Kozlowski, the former pilot-turned-Director of Air Operations at MCMT. "That 52-inch door is actually a special-missions door that the Army uses overseas because they can load pallets of equipment in and out of it. We use it to load patients, which works great because it’s huge. And we can get a patient in there and even turn them if we need to."
The King Air, which is based at Signature Flight Support at the Rochester International Airport, can fly at more than 350 mph and can optimally cover 600 miles each way to and from Rochester. It makes 25 or so trips per month.
While the King Air is outfitted with exactly the same medical equipment as the helicopters, and carries the same medical crew (a flight nurse and a paramedic), it also carries two captain-rated pilots and an expanded medical team (and, sometimes, a patient’s family members as well).
Like all of the medical personnel, flight nurse Kara Grant can switch between helicopter and airplane shifts, though she spends "90 percent" of her time with the fixed-wing unit.
Although she’s been with Mayo since 2005, this is just year two as a flight nurse. When pressed, every crew member admits it took them a few years to really settle into the job.
"It takes a while to understand and process the stress," says Grant. "We’re thrown into situations that are high-intensity on a daily basis. These are some of the worst days for these people that we’re dealing with."
"The helicopter is more fast-paced, and it takes longer to get all of your logistics down on how to move in the aircraft," she says. "With fixed-wing, there are longer periods to prepare. It takes us longer to get off the ground. It takes us longer to get to the patient. But we’re able to be with the patient longer."
The Blood Bank
Mayo One is one of the few—probably the first, maybe still the only—civilian medical helicopters that carries whole blood in addition to units of packed red blood cells, plasma, and platelets (to promote clotting). Like a lot of Mayo One’s emergency medical decisions (including the re-institution of tourniquets), carrying whole blood was based on research from military medical choppers, especially those in the war in Afghanistan.
"We have a wonderful blood bank, and that separates us from a lot of other groups," says Kathleen Berns, the Clinical Nurse Specialist. "The majority of our blood products come from our own employees."
Mayo Clinic’s employees donate roughly 40,000 units of blood—that’s nearly 5,000 gallons—each year.
On Mayo One, the blood products are carried in the Credo Cube, a military cooler made in Minnesota and used in the Afghan war.
"We work closely with the military medical helicopters," says Berns. "Unfortunately, we see a lot of the same types of patient situations they see."
Most of the time—maybe eight out of 10 calls—Mayo One is landing on a helipad at one of the regional hospitals. Austin mostly. Albert Lea. La Crosse.
But the on-scene flights—those landings on highways and in farm fields and near neighborhoods—require another level of attention. Another level of collaboration.
Roughly 15 percent of all Mayo One flights are on-scene. That number, according to Lamp, is down from nearly 25 percent just a decade ago. She attributes that drop to fewer critical car crashes since the implementation of MnDOT’s Toward Zero Deaths program.
Those calls, though, are often the most critical.
"One of the misconceptions is that a 911 call comes in, and we’ll fly right to that uncontrolled site," says flight nurse Rob Erickson. "We rely heavily on the first responders. If we have to land on a roadway of any sort—gravel, tar, freeway, highway—we rely on the local sheriff or fire department or whoever on site to set up a landing zone."
That landing zone, according to FAA recommendations, should be 100-by-100 feet, "flat, firm, and free from debris," well clear of overhead wires, downwind of the scene. For night landings, first responders should mark the touchdown area with five lights or road flares—one in each corner and one forward in the center to indicate wind direction.
Mayo One teams regularly meet with and hold training sessions with first responders.
"We’ll be the first to say those first responders are putting themselves out there doing some really important work," says Erickson.
Mayo One averages "around 10 minutes on the ground of a scene flight," according to Goodman. "We know we have to get those patients help immediately."
Back in the air, the next level of treatment may be just beginning. Because, inside Mayo One, one of the medical crew—they take turns—will take what’s called the "patient seat" and start the in-flight treatment.
Meanwhile, the second medical crew member will be relaying information to the necessary Mayo teams or other trauma centers. A patient with serious burns may go to Regions Hospital in St. Paul. Carbon monoxide poisoning cases may be flown to the specialized hyperbaric chamber at Hennepin County Medical Center. High-risk pregnancies—premature births and emergency C-sections—may go right to the helipad atop the Methodist Hospital’s Eisenberg Building (just north of the Kahler).
Most likely, though, they will be returning to St. Marys.
The helipad atop St. Marys Hospital—the heated concrete, 91-by-51-foot pad complete with fuel tanks—is the busiest private helipad in Minnesota. Four to five non-Mayo helicopters land there every day.
Mayo One (or one of the other Mayo choppers) makes a St. Marys landing another four to five times per day.
When Mayo One makes that landing, the specific department has already been alerted en route.
The emergency room. The operating room. The catheter lab. Vascular radiology.
"If we call a level one trauma, when we roll in there, they’ve got every person they could possibly need to intervene," says Goodman. "We’ll have people from x-rays there and somebody with the blood bank and the cath team. And you’ve got your medical side of the house and the airway people. You’ve got your trauma surgeon and his staff, and you’ve got a pharmacist. You’ve got maybe 20 or 30 people waiting in the ER."
An admissions person, with a rolling desk, meets the flight to check the patient in. But that process happens, many times, as the medical crew unloads the patient from the helicopter and gurneys them down the short hallway to the waiting elevator. Then it’s down to one of those specialty areas. It’s a two-minute trip.
"Our care doesn’t end until we put them in their bed," says Goodman.
Then the medical team’s priority, says Lamp, is to "ready the aircraft for the next request." Putting equipment back in designated locations. Restocking any items. Cleaning up blood.
Then, maybe, a quick discussion of the flight. A chance to decompress as the adrenaline slows.
Until that next radio call.