Rob Pietro pulls the stick into his lap and lifts the big Sikorsky helicopter off the roof. The sun blinks like a strobe light through the spinning blades as Pietro, 42, follows a route he knows well, retrieving a car wreck victim from a suburban hospital and flying him to the Level I trauma center at MetroHealth, the public hospital in Cleveland.
These conditions are perfect for flying, yet both Pietro and his co-pilot Dario Garcia, 32, stay busy. As Pietro climbs over the snowy streets of Cleveland, Garcia monitors the instrument panel to make sure the helicopter's engines don't overload. Next Garcia uses the radio to warn two local airport towers, two hospitals and all the planes in the area that his bright yellow helicopter is about to traipse directly across their dedicated flight paths.
"Even flying with two pilots, workload can be an issue," Pietro says before the flight. "If you're flying single-pilot in bad weather and you're trying to land on a highway, it gets real scary. There's just not enough hands to do all the work."
Both single- and double-engine helicopters are common in EMS work, but most medical helicopters fly with just one pilot. Metro Life Flight is one of just a handful of programs in the country that always flies choppers with two engines and two pilots. Founded in 1982, the program has logged just under 66,000 patient flights without a single accident. "I wouldn't fly any other way," says Drew Ferguson, Metro Life Flight's lead pilot. "I don't want to die." Cleveland Metro's Sikorsky S76A started life as a taxi for corporate executives. It is heavy, fast, and more expensive to operate than the average medical chopper. Yet even with these added costs, "we still made money last year," says Ferguson.
The workhorse of the helicopter EMS industry is the Bell 206 JetRanger and its successors. If you've seen a TV news helicopter, you've probably seen a Bell 206. It's popular because it is a lightweight craft that's relatively inexpensive to fix and fuel. But many versions of the 206 don't have the space or the engine power to carry the safety equipment needed to fly at night or in bad weather. Flying an underpowered helicopter blind in foul weather is a common cause of fatal crashes, safety experts say. "There's nothing wrong with the Bell 206, but you have to recognize it's a small aircraft," says Vernon Albert, who founded 34 EMS flight programs, 15% of the nation's total fleet. "But where I get the rub is when the weather turns bad or gets dark. It's pretty limited in those conditions."
Buying more expensive equipment doesn't guarantee safety, however. As the FAA's Peggy Gilligan points out, a number of programs that fly beefy, dual-pilot helicopters with sophisticated safety technologies have crashed, while programs flying small, single-pilot helicopters with nothing more advanced than radio altimeters have perfect safety records. "Operating a medical helicopter is not an inexpensive proposition, and it's not something that people do lightly," says Dawn Mancuso, CEO of the Association of Air Medical Services.