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The emergency medical services (EMS) helicopter "is an ambulance with a rotor system," Wilson explains. "We're an advanced life-support ambulance with a highly skilled medical crew with a rotor. We don't do cliff rescues. We don't do beach rescues. We don't go out in the water and pick people up. If somebody's been hurt or is sick, we go get them. Here at Carlsbad, it's mostly what we call scene-call work, which is highway accidents, the Marine Corps on the base has things happen up there, industrial mishaps, construction site accidents. We also do 'inner facilities' here, which is taking a patient who is in a hospital already to a higher level of care at a different facility. For example, we go up to Fallbrook quite often. They have a good community hospital, but it doesn't offer all of the test equipment or all of the specialties that are offered at Palomar or Scripps La Jolla."

Since April 2003, Imperial County has had an emergency medical services helicopter. It's owned by Corporate Helicopters of San Diego, a company based at Montgomery Field whose dozen other choppers are used in a variety of ways, including TV news, aerial surveys, and the film industry. Stephen McNabb, the general manager of Corporate and a pilot, says the emergency medical services helicopter is sometimes used in San Diego. "If the County of San Diego requires what they call 'mutual,' or mutual assistance, they will call the Imperial County sheriff's office. The sheriff will call us, and then we can respond."

In Imperial County, with a population of 150,000, many of the emergencies are accidents in the sand dunes at Glamis, Buttercup, and Gordon's Well, and increasingly at Superstition Mountain and Ocotillo Wells, where McNabb says people are migrating to escape the sheriff and BLM presence at Glamis.

"A lot of the more serious accidents that I've been involved with have been out in the dunes where people, you know, in the fall there are almost 200,000 people that show up at the dunes," McNabb says. "It's just like another city. There's a lot of dune riding, dune buggying going on. And a lot of drinking. Some of the crashes there have been really horrific."

McNabb describes a typical call. "Two in the morning, you're sort of hanging out or maybe taking a quick nap or something, the sheriff's office calls on what we call the bat phone. We pick it up, they say, 'Hey, we've got an ATV rollover in the sand dunes. Here's a general location.' Maybe a latitude, longitude, a GPS coordinate, if they've got it. 'Here's who's responding. A ground ambulance is on scene right now. Here's sort of an initial patient status.' We get suited up, if we're not already suited up, in our flight suits. We grab our equipment. The nurse grabs the medication, and we just make a mad dash out to the helicopter. The equipment is a whole-body-monitor system that's typically kept inside the crew quarters. It's portable, and they'll take it on scene.

"The pilot will immediately get in and start spinning up, start the engine, get it going. The crew hops inside. We take off. We check in with the sheriff's office to get more definitive answers on location and patient status. We check in with our 24-hour dispatch and let them know what's going on. They're getting prepared in back for what's going to be happening. The pilot's focusing on navigation. In Imperial County there are not a whole lot of lights. It tends to be pitch-black out there most of the time. There's not a whole lot of reference, so he's focusing on getting them moved safely.

"And then I would say it's maybe 10 to 15 minutes en route time to get there. We sort of survey the area as much as we can, looking for obstacles, power lines, other people who might be in close proximity to the landing area. Then we're in touch with the ground crew, so maybe they can give us an idea of where the winds are. We figure out where we want to land. We've done a lot of training with the fire departments and police departments out there, so they understand what we're looking for and what we need. They're really good at setting aside a large area for us to land in. We'll circle around. We'll have the Nightsun searchlight, which is super-, superbright. Turn that on. Shoot the approach. The flight nurse and paramedic are looking out both sides in case they see anything that might be dangerous that we might need to wave off on. We come down and land. As soon as we land, I'll take the power off.

"They'll run out of the helicopter and start assisting the patient. Stabilizing the patient. Putting them on the backboard or some type of board. I'll keep the helicopter spinning unless it's going to be a long time on scene.

"Typically we stay separate from the activity at the scene. On a scene call, we stay with the helicopter and keep it spinning. If we shut down because it's going to be more than 15 minutes on the scene, the pilot will get out, but even then he won't really get involved, because we don't have any proper medical training to provide assistance. At that point our job is more coordinating with the fire and police departments to ensure that we can get out of there safely. Make sure that the crowd that is there is kept away from the helicopter. Even if we do get out of the helicopter we don't get involved with the patient care. Whoever's on the scene, the police department or the fire department, will help them into the helicopter. Strap them in. Board up and go.

"Then it's taking off and navigating, figuring out which hospital is most appropriate. If it's a child, we probably are going to take them to Children's Hospital in San Diego. If it's a burn, we typically like to take burns to Loma Linda, just through the Banning Pass. Or if it's nothing specific, we can go to Palm Springs or San Diego."

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