With Friends Like That..........

 The exact location and date of this scene flight is a little hazy to me. I am pretty sure the location was about 5 miles west of Missoula, Montana and bracketed between O'Brien and Deep Creek roads, on the west side of the Clark Fork River. I was working for St. Patricks Lifeflight and flying a B3 Astar. The date was sometime between 2003 and 2007.

St Patricks rooftop helipad (St Patricks Hospital)

Working for St Pat's was one of the best jobs I ever had. Great people being number one. The crews were some of the most outstanding medical professionals I have ever worked with. On top of that, they are just good people. Number two was the helicopter; a very new, powerful and fast B3 model AS-350 Astar.

Larry Peterman in 911MT (St Pats Image)

On this late afternoon flight we were paged out to a scene involving a single car rollover. We were given a latitude and longitude coordinate. After a quick look at the weather computer, I walk out the door of our rooftop offices, do my walk-around, and strap myself into the machine. As I am going through the quick start procedures, the rest of the crew boards the aircraft, and quickly give me the "All Secure." I entered the coordinates and select the frequency for the first responders enroute to the scene. With a final check of the instruments, and a look at all our doors, I ask for a "Clear Right," and we lift, flying a direct route to the scene. The coordinate is less than 8 miles away and will take me right through most of the Class D surface area for MSO airport. The tower there is well versed in Lifeflight operations, and clears us direct to the scene.

We are the first on the scene, due to it being a few miles up a dirt road, paralleling a creek. From what I can see from my high recon, we will be descending into a bit of a hole, facing up the drainage. 70-100' trees ring the landing zone, which will be the front yard of a fairly nice, log cabin residence. I don't like facing up- mountain when making a final approach to a landing zone, but in this case the elevation is less than 5000' above mean sea level, with cool temps and winds negligible. On short final, I catch a glimpse of a tan Jeep 4x4 laying on it's top, near the edge of our landing zone. Very near the Jeep is a man laying on his back, spread eagle fashion. A young, 20 something woman, is kneeling next to him and seems to be in  hysterics, or going into shock.

I land a safe distance away and the crew immediately exits with the gear they anticipate needing for this type of call. In any moving vehicle accident, they will bring a rigid backboard, spider straps to secure the patient, a heart monitor / defibrillator, drugs, oxygen, airway intubation and ventilation gear, and lots of medical tape. I usually spend the 30 seconds needed to cool down the engine, by (admiringly) watching these professionals go to work. Calm, cool and collected, they immediately get a report from whoever is nearby, and begin to rapidly triage the patient. By now the engine is cool and I shut it down by moving the engine control switch from "idle" to "off." I flip a couple more switches, apply the rotor brake, and then do a quick walk around of the aircraft.

I had a reputation for helping them as much as possible, and today was no exception. (Yes, there is always a little morbid curiosity, everyone has it, whether they admit it or not. For myself, I had already learned not to go look at something, just out of curiosity, unless you were prepared to have that image permanently seared into your memory). After my walk around, I don my gloves and kneel down by the paramedic. Well. I had never seen this before.

The 20 something year old patient is still flat on his back. (Oh good, he's small so I will have no problem lifting him in the helicopter out of this LZ). The girl is an emotional wreck, but very mobile, which is good sign she's mostly uninjured.  I start my own patient assessment. I first look for blood and see some around his ears. I also see few lacerations on his face. His head looks misshapen somehow. I notice he has a serious set of dreadlocks in his hair, possibly the nastiest I have ever seen. Not surprising for Missoula though. The medics are very concerned about his chest. I hear them say he has a flailed chest and agonal (see 2 below) breathing. I notice his entire body is shuddering and making a horrible sound with every quick breath.

Airway control is probably the single most important item in triage; if the patient isn't breathing, he's dying. Secondary to airway, is bleeding, of which there seems to be very little externally. Internally, who knows what's lacerated so they usually feel around their belly, and start a saline IV.

Several of his limbs clearly have broken bones, due to bends in places they don't belong. What's this? He has an erection. What the hell? I've never seen that before in a patient. I make a mental note to ask the paramedic about this later, in a way that doesn't make me seem either gay, or stupid.

Due to his agonal breathing and mechanism of injury, they insert a breathing tube into his airway and start the portable ventilator. Tubing someone is a really big deal. Using powerful drugs, they paralyze you, stopping your breathing, and hopefully, give you a tranquilizer. He's also got the heart monitor, BP cuff and a large bore IV going. After carefully transferring him to the backboard and gurney, and with the help of a local ambulance crew we load this man into the helicopter.

There's this thing in EMS called the Golden Hour. It states that, generally, if you can get hospital level treatment to the patient on scene, and get him to a trauma center in 60 minutes or less, he will most likely survive. (I'm paraphrasing, but you get the point) We are way inside the Golden Hour on this guy. He's very lucky we were only 4 minutes away.

After a normal take off and short flight back to St Pat's, I land on the rooftop helipad. The medics barely had time to call in the report before we were on final approach. Met on the roof by emergency room personnel, he is whisked to the ER in minutes.

The medics usually stay in the ER with the patient, assisting the staff there until they have transferred all responsibility and given a full report. Returning to the roof top pad with their gear, they begin the clean up process and start on their charting, which can take hours to complete.

Later on that evening I pulled aside the paramedic and asked him, obliquely, why did that dude have an erection. He told me it's called priapism (see 1 below) and happens in some cases with a very traumatic head injury. Ah! I see. He says they see that all the time and I asked him if he liked that sort of thing. haha. (Gallows humor is important coping mechanism for all of us). I also asked about the agonal breathing and he told me he was on the verge of death when in that state.

Later that night, the crew clued me on a few more details about that scene flight. Apparently the patient and the girl were racing down the mountain in their Jeep. Hauling ass and with a couple friends following behind them in a pickup truck. The jeep failed to negotiate a curve in the dirt road and plunged off the side, rolling down the mountain to the log cabin's front yard. Neither of the occupants were wearing seat belts and both were ejected.

The truck following them proceeded down the road, turned into the cabin's driveway, and knocked on the door; presumably to ask for help for their injured friend. There was no answer so they broke into the house. Did they immediately call 911? No. They robbed the house!! Then they called 911 and drove off, leaving their friend to die in the front yard of the cabin.


One day, a couple weeks later, I saw this patient riding in the elevator on a gurney . He was conscious and alert, but with all his dreads shaved off, (good!) and with an obvious hole in his skull (bummer!), where they operated. Later I found out the kid went through multiple operations and will survive. Unfortunately, his head trauma was so severe he would probably spend years relearning to tie his shoes. No joke.

1. Priapism: a potentially painful medical condition, in which the erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours.
(The name comes from the Greek god Priapus (Ancient Greek: Πρίαπος), a fertility god often represented with a disproportionately large and permanent erection). {HAHA! {added by author}}

2. Agonal respiration: an abnormal pattern of breathing characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.

 (definitions from Wikipedia)

Learning to Fly

September 30, 1986. A date I can never forget. Anyone who has served in the military knows their date of entry into active duty. This was mine. The basis for all calculations involving everything from leave accrual to retirement. On this date I departed for Ft. Knox, Kentucky from the MEPS Center in Des Moines, Iowa. I caught an Ozark Airlines flight to Loiusville, KY and rode a Greyhound Bus to Ft. Knox.

From Stripes, 1981

Ft. Knox is cool. It was the home of the Armor Training Center (tanks) and the location where they shot the movie Stripes; one of my all time favorite movies. Our bus, full of a very eclectic group of new recruits, pulls up in front of the initial reception hall. Just like in the movie, Officer and a Gentleman, a bunch of drill sergeants jump on the bus, and spew and endless torrent of expletives. Thus duly motivated, we rapidly exit the bus with our stupid looking personal suitcases, and pour into the hall. All of us have the scared look on our faces, the one that says, "What did I get myself into?" People are afraid to stand up, ask a question, or even go to the bathroom. This was just the beginning.

The real fun wouldn't even start for a few weeks yet. We spent some time getting an initial issue of fatigues and the oh-so-cool, brown underwear with a choice of boxers or briefs, and the brown t-shirts. Most fun were the brown towels; they were more like a squeegee, with no absorptive quality whatsoever. We had our heads shaved, had the standard Auschwitz look-alike basic training photo taken, and lined up for a hundred immunizations. Some fat-boys were singled out, and sent to a private hell to get them in shape before basic even started. They had restricted diets and endless physical training (PT). I felt sorry for those guys.

The 4 Count Push Up! Ready! Begin! (trdefence.com)

SSG's Ernie Leonard and Jose Ogas would be our drill sergeants on the day we were marched to zero day of basic training. It was all I imagined it would be. Endless screaming and push-ups galore. There were several notable moments that day when some privates were asked questions and they gave the stupidest answers I had ever heard. They were dropped for exquisite push-up and mountain-climber attention.

Our drill sergeants were fair and tough. We were slowly transformed from self-centered individual punks, into a cohesive team of soldiers. Soon we were marching drill and ceremony, qualifying with individual weapons, and learning about a myriad of martial topics from A to Z.

During the night of my first field training exercise, an event where after a 12 mile road march, we would first spend the night in out GP Tiny two-man pup tents, I was pulled aside by my drill sergeants. They advised me to gather all my stuff and loaded me into a deuce and a half truck for the ride back to our company area. I knew something was very wrong when they showed me sympathy and kindness. I started to worry. I was directed to store my stuff in the company CQ area and to go to the commanders office.

Red Cross Poster from Wikipedia

Captain Blaine, my company commander, was a good man. Originally from Iowa, he spent a few minutes chit chatting with me about my hometown before he broke the news to me that my father was in intensive care in Des Moines, Iowa, the victim of a heart attack. I was told the Red Cross would immediately make arrangements to fly me to Des Moines. I was allowed to go outside to the payphone and call my mother. It was a really tough phone call. Mom told me dad was alive but he had a massive heart attack in the kitchen. He was taken by ambulance to the Ft Dodge hospital and later airlifted to Des Moines on a helicopter.

Before I could depart, I had to be issued my Class A dress uniform for the trip home. It was surreal. Sitting there being measured for a uniform I was very proud of, the tailor knowing why I was leaving, my heart heavy as I have to go through this weird event. All I want to do is go home.

The Red Cross and the Army delivered on their promise to get me home immediately. Something I would never forget; how much the Army takes care of its own. I arrived at the hospital the next day and made the long walk to the intensive care unit, wearing my Class A's and a long black coat. Before I knew it, I was looking upon my father. It didn't even look like him. He looked like someone who had lost half his life in an instant.

At that moment, for the first time in my life, I grew up. In that instant I realized how short life is. From this point on I knew my dad had been incredibly lucky, (thank God), and that every minute he experienced since then would be a gift from God. My dad was 45 years old. I am now 46.

He was happy to see me and seemed very proud of me. I was kind of in shock. I told him I would stay as long as needed but he urged me to get back to my training. That's what people of his, and mom's, generation do. They tell you to buck up, get back to business and not worry about them. So, after a few days I left and went back to basic. My parents were able to make the trip to my graduation from basic.

Old Rucker Gate (Armyflightschool.org)

After basic I boarded a bus for the drive to Ft Rucker, Alabama, the home of the Army Aviation Center and School. They place where I would attend Warrant Officer flight training and learn to fly helicopters. I had no idea what was awaiting me here. It was probably better I didn't know.



My first 6 weeks there would comprise of the Warrant Officer Entry Course. A rigorous weed-out process centered around an incredibly meticulous course in attention to detail and physical conditioning. Our personal living area was expected to be ordered and arranged according to the most anal standards anyone can ever imagine. Almost daily, it was all tossed on the floor and we would have to redo it, while writing military letters to the commander explaining why we will no longer violate the regulations, and do a better job in our personal living areas. Demerits were handed out like candy. I received my fair share, and more. PT started at 4 am or earlier, meals were eaten in complete silence. We attended classes all day and we're tested several times a week. No one was more shocked than I, when I completed this phase and was ready to move onto actual flight training. Graduating from the entry course gave me a confidence I sorely needed to move on to flight training. My parents came down for the entry course completion ceremony.

TH-55 Osage (airportdata.com image)

My flight training began in February, 1987. (Next month will be my 25th anniversary since becoming a pilot) We were issued a stack of training manuals at least three feet tall. We received our sage green flight suits, helmets, flight gloves and maps......tons of maps. We still had lots of PT, had to maintain a spotless personal area and attended classes half the day. I remember one day in this phase where the TAC Officers made us move the entire contents of our rooms outside and set them up.

My first ride in the helicopter, a TH-55 piston powered, two-seater, was with my instructor for initial flight training, a civilian, Mr. Earl Willis. Mr Willis was a former Alabama State Trooper who served under the infamous Alabama segregationist governor, George C Wallace. Mr. Willis happily regales me with tales of how he helped hose down civil rights marchers, and haul black men and women off to jail. Great! Just what I need. A racist asshole to make sure I don't offend, while I try to learn how to fly a helicopter. That guy made me really uncomfortable. He would always say, after he yelled at me about something, "Mr. Teppa, I'm tryin to hep ya." Lucky for me, my Hispanic stick buddy got most of the negative attentions of Earl Willis due to his skin color, I assume.

I didn't think I was gonna get it. I was put up for a check ride and during a simulated engine failure, I forgot to lower the collective, thus letting the rotor RPM decay almost out of the green arc. I was given a big fat pink slip, one of many. That was a low moment....one when you're riding the bus home from the stage field and you think you are not gonna make it as a pilot. I was immediately given a progress (prog) ride to see if I was at the level I should be for 12 hours of flight time. I did fine on that ride, making sure I lowered the collective this time. That pilot was a cool pro, and really gave me a boost to my confidence.

Time to solo. Wait, what? I have like 14 hours or something and you're gonna send me out to fly traffic patterns by myself? Holy shit. I am going to die. On the ramp at Hooper Stage-field, my instructor gets out, grabs a hand held radio, and goes and sits in the bleachers to watch 6 parallel lanes of solo students mix it up for four traffic patterns. I really was worried I might die. I had a death grip on the controls, using body-english and shouted commands, as much as actual control inputs, to safely make it around the traffic pattern 4 times.

Army Aviator Wings, Senior Aviator, and Master Aviator (DoD Image)

By the end of flight school, 9 months later, we were all wearing Ray Ban Aviators, had big watches and listened to Pink Floyd's Learning to Fly on our Sony Walkmans. We were qualified in the TH-55 and the UH-1. We were instrument qualified. We were night vision goggle qualified. We had learned to navigate using only a compass, watch and a 1:50,000 tactical map. We graduated flight school with right at 200 hours and I felt extremely comfortable and confident in the UH-1. My parents attended the graduation ceremony where we received our Warrant Officer bars and silver wings. My dad pinned my wings on my chest and my brother, an enlisted man, gave me my first salute.

Beer can pyramids and cougar fight

John Belushi in "Animal House" (Universal Studios, 1978)

 I briefly played football in college. I was recruited from a smash-mouth 3A catholic high school football team playing in northwest Iowa. Our conference was tough, but this was our year. We went 9-0 in the regular season. Our running back was All-State and several of us linemen were all-conference and recruited by smaller division II colleges. I got a full ride deal from an NAIA school and was recruited as a defensive noseguard, mostly on the strength of my foot speed and lateral mobiility. When I got to college I went crazy. I joke that my major was beer can pyramid building with a minor in head-butting. (Not really joking) Needless to say, despite good performances on the field, a very low GPA is probably not going to maintain a scholarship. Idiot.

After moving everything I owed in the back of a white Ford Pinto to Colorado Springs, I secured employment with a roofing company. (This was actually my 2nd job in Colorado. My first job as a gravel pit night watchman ended at 3am one night when two cougars engaged in a fight outside my shack, pinning me inside for 2 hours).

In my 2nd job I had been lucky enough to be given the opportunity to shovel gravel out of the back of a dump truck into a hopper all day, everyday. When I complained about my talents being wasted shoveling rock, I was afforded the opportunity to smear 42,000 square feet of roof flashing with plastic roofing cement. Have you ever seen this stuff? Its made from tar and comes in 5 gallon buckets. There is no humanly way possible to not be covered in this stuff from head to toe. I used gasoline to scrub it off before I could get back in the crew truck, for the dope smoke filled ride back with this bunch of miscreants.

Bill Murray in "Stripes" (Columbia Pictures, 1981)

That's when I decided to visit a local military recruiters office.