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Depending on where in Imperial County the emergency has occurred, flight time to San Diego, which has both Level I, the highest level of care, and Level II trauma centers, can be 45 minutes to an hour. Desert Regional Medical Center in Palm Springs, a Level II trauma hospital, is a 45- to 55-minute trip. Although the flight time to Loma Linda University Medical Center, a Level I center in San Bernardino County, may be an hour and a quarter, "If certain heart ailments exist or if there are extensive burns involved," says McNabb, "the flight nurse may elect to skip Desert Regional and fly to Loma Linda. And if for some reason we can't get to Children's Hospital in San Diego, Loma Linda also has a very good pediatric ward."

Mercy Air employs the crews who staff its two San Diego helicopters, one of which is based at Gillespie Field, in El Cajon, and the other at McClellan Palomar Airport, in Carlsbad. Typically an emergency medical services crew consists of one pilot, one nurse, and one paramedic, but, says Steen, "We work with UCSD's Emergency Residency Program." During some months of the year, resident doctors at UCSD take six to eight shifts each per month on a Mercy Air helicopter as part of their training. At Corporate Helicopters, the nurses and paramedics are provided by another San Diego company, Medevac, which also provides the dispatch and housing at the Imperial County Airport for the on-call crew.

Mercy Air quarters its on-call crews in converted hangars at Gillespie and Palomar. Crew quarters have a kitchen facility, common room, bathroom, office area, and sleeping area. The common room at Gillespie Field has comfy La-Z-Boy chairs and a TV. The day I visited, the team had just left on a call. Someone's clogs had been kicked off in the middle of the room. A pair of jeans lay in a heap on the floor.

At Corporate, McNabb says, "The pilots are five days on and five days off. The five days on, they have 12-hour shifts. On the five nights on, they have 12-hour shifts. So 9:00 a.m. to 9:00 p.m. and 9:00 p.m. to 9:00 a.m. We switch back and forth. Sometimes you're days, sometimes you're nights." At Mercy Air, the shifts run 8:00 to 8:00 and are for four days at a time. Four pilots at Gillespie and four at Palomar rotate the shifts.

"All of our pilots live in San Diego, and all the nurses and paramedics," McNabb says of the El Centro crew. "If you've ever been to Imperial, it's a challenging place. It's difficult to find the qualified pilots or nurses and paramedics for this program out there. What's tough about our program is that it's a two-hour drive from San Diego. Typically the night pilot -- you know, he's on from 9:00 p.m. to 9:00 a.m. -- if he likes he can drive two hours back and spend the day with his family here before his next duty shift. It's kind of awkward because it's during the day and the family could be at school or at work, but he could do that. The day pilot is sort of stuck there for the whole five days."

Most local EMS pilots are men. "I think that's a function that many of the pilots come out of the military and go into civilian helicopters," McNabb says. "Women have been a fairly recent phenomenon in the military side of the house, and they just haven't been showing up in a lot of numbers in the civilian side. We have one female pilot. She's fairly new. She's just going through the ranks and doing the student instruction. She's wonderful. You know, I flew with females in the Navy. I think it's great."

Pam Steen, Mercy Air's program director for San Diego, Riverside, Orange, and Imperial Counties, says, "I have 17 pilots. We have a float pilot also because we do a lot of training and we need someone to help cover. Out of the 17 pilots we have one woman. She's located up in Orange County."

At Mercy Air, the average age of the pilots is "late 40s, early 50s," says Steen. "A lot of them are ex-military, either Navy, Marine, Army; we don't have any Air Force. Most of them are from that Vietnam era, and they're getting older. We are getting some younger faces coming onboard, but most of the pilots tend to be older."

There's no mandatory retirement age. "The airline pilots, like Southwest's, do have an age limit," McNabb says, "but I don't think there is an age limit for this. Actually, we have two pilots who are pushing 60. The oldest pilot that we have is 57. I know people as old as 60, 62. You don't see much beyond that. Usually what happens is that their eyesight goes. They sort of figure out, 'I can't fly anymore.' They just give it up. What's funny is that some pilots will have glasses on their nose so that they can see the instruments close, and then they look up and [look above their glasses]. They are wonderful pilots, absolutely great pilots, but they have the glasses-on-the-nose thing."

Jeffrey Emery, who is 48 and a pilot at Mercy Air, was trained by the Marine Corps. "I always wanted to fly as a kid. I went into the Marine Corps at a young age. My goal always was to work on aircraft or to fly them. I made that progression. I started working on jets in the Marine Corps. After a certain period of time I was accepted for an officer transition course and performed well through the whole thing and was selected to be in the aviation pipeline. Got into that. Did an intro flight in a helicopter and said, 'This is great. I can see the ground. I can see the trees. Which is a lot better than jets up there at high altitude.' I decided I was going to go with helicopters."

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