One moment Tiffany King was driving down the road, chatting with her client about seat belts.

The next, emergency workers were cutting her out of her car.

It was as major a crash as could be. An elderly man had crossed the center line on Route 17 in the town of Washington, hitting King and her passenger head-on. The elderly man died, the front of his car a nearly unrecognizable mass of metal.

King’s car was no better, a crushed bundle of blue resting on the side of the road against a small grove of trees.

King’s client walked away with only minor injuries; King suffered broken bones and was trapped behind the wheel. First responders couldn’t rule out internal or spinal injuries. It took them 15 minutes to get her out of the car.

“I’m really trying not to scream!” King said as emergency workers secured a compound fracture in her elbow.

Weeks later, King would remember only a few details about the accident. The extrication, yes. And the pain.

And LifeFlight.

“I really just wanted to get to the hospital,” she said. “It seemed like moments and I was there.”

It’s the kind of response that LifeFlight’s crews have spent the past 10 years working for.

Gone in five

Created in 1998 by Central Maine Medical Center in Lewiston and Eastern Maine Medical Center in Bangor, LifeFlight is Maine’s only statewide licensed emergency medical air service. With one helicopter based at CMMC and one at EMMC, two crews (each consisting of a pilot, a nurse and a medic) cover the entire state 24 hours a day, 365 days a year.

Its first call: a Washington County worker critically injured when he hit a high-voltage power line with his excavator. The man was in the woods, nearly a half-mile past the closest road, making it difficult for an ambulance to reach him quickly. As the helicopter approached, the man’s fellow workers chopped down trees to create a landing zone. He was at EMMC 14 minutes after being loaded into the aircraft.

LifeFlight has transported more than 9,000 patients since then. It gets a lot of attention for calls like that first one – or like King’s – when it swoops onto a scene to whisk the patient away to a trauma center.

“We’re stereotyped that all we do is go scrape people off the streets,” said Lori Metayer, who serves as program coordinator in Lewiston and as a flight nurse and medic.

But only 30 percent of LifeFlight’s calls are scene to hospital. Seventy percent are hospital to hospital, usually for a patient at a small, rural facility who needs the specialists and equipment of a larger medical center – fast.

The decision to send LifeFlight on a call – with an average patient bill of $6,500 – is based on protocols set by the Maine Emergency Medical Services Board. Three deciding factors:

• The need for speed;

• Ground transportation is impossible or too risky;

• The need for specialized care that only LifeFlight offers. (See related story.)

For hospital transportation calls, the patient’s doctor decides whether to bring in LifeFlight.

For on-the-scene emergencies, first responders make the decision. In King’s case, the severity of the accident and the concern that she had internal and spinal injuries prompted first responders to call in LifeFlight.

No matter what type of call – scene or hospital transport – when their radios tone, the crew’s goal is to be out the door and in the air in 12 minutes or less.

When King’s call came, they were gone in five.

Safety first

It was about 10:15 on a Tuesday morning when LifeFlight’s dispatch got the call. In LifeFlight’s Lewiston office – in the basement of CMMC – the tone came over the crew’s radios. Pilot Nathan Sargent, nurse Jackie Turcotte and medic Metayer learned there was a call in Washington, a small Knox County town about 20 miles west of Camden.

The pilot accepted the flight.

They don’t take them all, both because the patient might not need them and because there might be a safety concern. Bad weather? Not sure the patient can be securely transported by helicopter? Feeling unsafe? Anyone – the pilot, nurse or medic – can cancel the trip at any time, even if the others want to go.

Safety is an issue, given recent national news surrounding medical helicopter accidents. In 2008, 13 were involved in crashes. Twenty-eight people died.

Although Maine’s former medical helicopter service, Airmed, based in Portland, closed down because of a fatal crash, LifeFlight has never had an accident in its 10-year history. LifeFlight Executive Director Thomas Judge spoke at a recent National Transportation Safety Board hearing held to discuss medical helicopter safety. This week, he’s speaking to Congress about the need for state oversight over clinical aspects of air medicine.

LifeFlight takes all of the traditional safety precautions, which include maintaining its aircraft, keeping a well-trained and certified crew and buying state-of-the-art equipment. It also takes the not-so-common step of denying crew members information that could take their focus away from safety.

For example, nurses, medics and pilots don’t know how many flights the nonprofit needs to break even financially. Another example: Pilots are kept in the dark about the patients they’re picking up until well into the flight. The reasoning: Crew members won’t try to push the perimeters of safety if they don’t know the waiting patient is a teenager who needs to get to Boston for a lung transplant.

Ignorance, crew members say, is bliss.

“We really don’t want to know,” Metayer said.

For King’s call, the crew was in the helicopter before they learned they were going to the scene of a head-on car crash. They were at the scene and looking for a landing spot – a gravel driveway was good, but nearby power lines could have been an issue – when they were told they were there for woman in her 20s or 30s whose arm was broken. Emergency workers on the scene couldn’t rule out a spinal injury.

As they landed, the crew got their first sense of how truly bad the crash was and how badly their patient might need them.

“Her vehicle is completely demolished,” a voice over the radio said.

Some days aren’t fun’

King’s call was the second of the day for the Lewiston crew. The first was also a car accident.

Generally, working for LifeFlight is a lot like life in a fire station, with long, slow periods punctuated by bursts of activity.

Then there are days like one recent Thursday: three calls in a row for the Lewiston crew, including a trip to far northern Maine to get a man who had run through all of the blood in tiny Houlton Regional Hospital.

On those frenetic days, the crew doesn’t eat, take bathroom breaks or stop to rest. It can be exhausting. And emotionally draining.

“Some days aren’t fun,” said Lewiston nurse Cathy Case. “Days with kids aren’t fun.”

Still, crew members typically live for those busy times.

“I like showing up and they’re always glad you got there,” Case said.

King definitely was.

A bone protruded through a tendon at her left elbow and her right ankle hurt. Strapped to a backboard, she cried out at even the slightest movement.

By ground, it could have taken nearly an hour and a half to get to CMMC, the closest trauma hospital. (LifeFlight often brings patients to CMMC, EMMC and Maine Medical Center in Portland. Sometimes it goes to Boston.) By air, the trip to Lewiston would take less than 15 minutes and the ride would be less bumpy.

After assessing her condition, the crew gave her pain medicine and antibiotics, re-secured her elbow and loaded her onto the helicopter with help from EMS workers on the scene. King closed her eyes and again told everyone she was trying not to scream.

Later, King said she couldn’t imagine enduring the trip by ground.

“Not at all,” she said. “Oh, my god.”

King wasn’t the only one glad LifeFlight had arrived. Emergency workers thanked the crew for coming.

“‘Bye, Tiffany,” one of the workers said as King was loaded onto the helicopter. “You’re in wonderful hands.”

‘I love you guys’

King’s flight lasted about 12 minutes. Like all patients, she rode in the back of the helicopter, strapped to the LifeFlight stretcher and covered for warmth.

The roar of the aircraft makes it impossible to carry on a conversation, so crew members wear helmets or headphones equipped with speakers and microphones so they can talk about flight time and medications and what the patient needs. Shouting to be heard over the noise, Metayer kept King apprised of what was going on.

The inside of the helicopter is small, with just enough room for five adults, two in the front and three in the back. Most of the time, LifeFlight transports one patient at a time, but Lewiston’s can take two when necessary. (Bangor’s has less room in the cabin because it keeps extra fuel on board.)

The crew doesn’t mind the cramped quarters.

But some patients do.

“I had one patient who said, ‘Get me out of here. Now!'” Case recalled. “We took him by ground.”

Crew members learn how to handle unruly or scared patients, though there have been a few close calls. One patient nearly kicked out a window as he came out of sedation. Another decided he didn’t want to be part of the flight anymore and put a crew member in a headlock.

Crew members can refuse to take a patient they believe will be a hazard. More often, they will sedate or paralyze and intubate the person.

King didn’t need to be sedated or intubated. Pain, not fear, was her biggest problem.

Metayer and Turcotte gave her pain medicine throughout the flight. At landing, they injected a short-lasting but powerful drug to get her through the jostling she’d have to endure as they unloaded her from the helicopter and wheeled her inside.

“I love you guys,” King told them.

Lucky to be alive

King’s worried parents were waiting when the aircraft touched down. They had been in the Lewiston-Auburn area when they got the call. On their way inside, Metayer and Turcotte paused the stretcher for a brief moment so they could speak.

“Mom, I’m OK,” King said.

Metayer knows what it feels like to be that family member waiting outside. Her husband, Shawn, needed LifeFlight in 2005 after a motorcycle crash. He was first taken to a small hospital in Boothbay Harbor, then flown to a larger hospital with a trauma unit.

Metayer and her husband were LifeFlight crew members at the time.

“When I see parents who have gotten that call, I almost feel worse for the parents (than the patient),” Metayer said. “I know what they’re going through.”

Inside CMMC, the LifeFlight crew handed King off to a waiting trauma surgeon and an ER doctor. They rattled off her medical history, the medications given en route and her condition at the scene.

Then, just over an hour after they first got the call, the crew walked away.

Crew members sometimes wonder about the patients they transported. Did that teenager get his lung transplant? Did the injured baby recover? Did they save the life of the elderly woman in the car accident?

“I have a super soft spot for old people,” Metayer said. “Older people and kids who don’t have a chance.”

They try not to think about the ones they couldn’t help.

“If you took to heart every patient you couldn’t save, you couldn’t do this job,” Metayer said.

But they sometimes can’t help checking in, just to see how the person fared.

“If I’ve ever really wondered, I’ve found out,” Metayer said.

And, sometimes, patients call them.

In the weeks after her accident, King and her husband, Brian, thought about calling the crew, but they weren’t sure whether such contact was OK. They credited LifeFlight for saving her life by getting her to a trauma center so quickly, and they wanted to let them know.

It turned out that both of King’s legs were broken and her kidneys shut down. She spent two weeks in the hospital.

“She’s lucky she’s alive,” her husband said.

King’s flight cost about $7,500. Her insurance company paid without complaint.

“If they did (complain), I’d tell them, ‘Too bad. Pay them twice as much,’ because they deserve it,” her husband said.

Insurance companies rarely balk at paying for flights, LifeFlight officials said. Insurance companies like the fact that air service quickly gets a patient the care they need. Delay in care can mean more – and more expensive – treatment later on.

“That helicopter has just taken $20,000 off your bill or $50,000 off your bill,” Metayer said.

Patients without insurance are billed. They can apply for charity care.

King will spend at least the next eight weeks recuperating. She and her husband believe it could have been much longer if the accident had happened, say, more than 10 years ago.

“I think it’s the best thing they ever had,” King said.

Cost of helicopter: $5 million

Average cost of a transport: $6,500

Types of transports: 70 percent hospital to hospital, 30 percent scene to hospital

Number of helicopters: 2 (based in Lewiston and Bangor)

LifeFlight’s time in service: 10 years

Number of patients flown: more than 9,000

Number of employees: 71 (including 10 pilots and 34 nurses and medics)

Cost to stay in business: $8.5 million a year

Shifts: 12 hours

*Flight crew: 1 pilot, 1 nurse, 1 medic

* Bangor’s LifeFlight also runs a critical care ground ambulance crew.