What can you do in seven minutes? If you’re in good shape, maybe run a mile. Go through the drive-thru at In-N-Out Burger. Unload your dishwasher.
It’s not a terribly long amount of time — but that’s how quickly flight nurse Ernie Acebo can spring out of bed in the dead of night, get his gear and be ready to fly. Time is the most precious commodity, because dilly-dallying can definitely be the difference between life and death.
Acebo, 41, works for CALSTAR, which calls itself the biggest nonprofit air ambulance company on the West Coast. CALSTAR isn’t as well-known as REACH, famous for its red helicopters that have transported patients for more than 20 years, but maybe it should be.
According to company spokesman Gene Hall, CALSTAR (which stands for California Shock Trauma Air Rescue) has never had an accident in its history, which dates back to 1984. As CALSTAR struggled in its infancy as a company, its lone helicopter crew didn’t have a set base, operating out of different airports like vagabonds.
Eventually, the company established CALSTAR 1 base at Buchanan Field in Concord, and now there are 11 bases spread out around Northern California. CALSTAR has three separate bases that respond to calls in San Joaquin County (located in Concord, McClellan and Jackson).
Acebo flies out of Concord, working two
24-hour shifts a week, which is standard for flight nurses. The base consists of two trailers at Buchanan Field, a small one for storage and a much larger one that operates as a living quarters. The large trailer resembles a college dorm, with a living room and kitchenette, and rooms with small beds for the nurses and pilots to sleep in. Although each flight takes plenty of prep and is then followed by paperwork, there can still be ample downtime on a slow shift — therefore, it isn’t surprising to see the DVDs and video game systems connected to TVs in the trailer.
It’s Tuesday morning, and so far it’s been a rather uneventful day for the CALSTAR 1 crew. Pilot Gary Garavatti has been checking weather conditions, which he said can change very quickly and hamper the ability to fly. If conditions get too dangerous, the flight crew won’t respond out of safety concerns, but that doesn’t happen often.
Tim Castelli is Acebo’s partner nurse once a week, and the two have an easy camaraderie that’s apparent when they interact. After inadvertently answering a question almost identically the way Acebo did, Castelli can only laugh.
“We’re kind of in sync,” Castelli said of Acebo. “We work together a lot.”
Castelli, 45, lives in Wilton, but previously lived in Galt and is very familiar with the Central Valley — his parents live near Jackson. The father of three was rather aimless after high school, he said, so he went to college and chose the major of all aimless recent graduates: business. He worked for a collection agency after college, and hated it so much he decided to go back to school.
Nursing hadn’t really occurred to him as a possible career, he said, but as he learned more about it, he made the choice to go to nursing school. While studying at UC Davis Medical Center, seeing a flight crew bring in a patient piqued his interest in air ambulances. After tagging along on a flight, he decided CALSTAR was a good fit for him — and 10 years later, he’s still providing patient care in the sky.
Acebo had a more active background in emergency care, having worked his way through nursing school as an EMT in one of the most notoriously dangerous and hectic cities in the country: Compton. Made famous as a hotbed of crime and violence by ’80s rappers like NWA, Acebo said Compton certainly lived up to its reputation.
“During the day I was Mr. Student Nurse in my white clothes saying ‘please’ and ‘thank you’ to all my patients; and then at night I’d go into Compton and have to tie people down, and try to keep them from spitting on me,” Acebo said. “I was just a white boy from a quiet cowboy town trying to figure out how to deal with all of this.”
Acebo ultimately performed emergency care in different locations for more than 15 years, and was working in the ER at John Muir Medical Center in Concord before applying with CALSTAR six years ago. Emergency experience helps him handle chaotic situations well, he said, and working as a flight nurse is actually much less stressful than previous jobs he’s had.
Abruptly, all of the phones in the trailer start chirping and a buzzer sounds outside. Further details will have to wait, because a call has just come in — it’s time to fly.
Providing air support
The Concord flight crew responds to incidents in a wide radius, venturing to southwest San Joaquin County, as well as parts of Contra Costa, Alameda and Marin counties. Two of CALSTAR’s other bases (McClellan and Jackson) respond to other parts of San Joaquin County, including Lodi and Galt.
There’s been two separate car accidents on Highway 4 in Brentwood on the same stretch of road, and a REACH helicopter is already on its way. CALSTAR dispatch is sending the Concord crew to provide secondary support, and their chopper is right behind the red REACH helicopter.
In the back of the helicopter, Acebo takes a piece of masking tape and sticks it onto his leg, then begins writing details on it with a marker. It’s what he calls his “notepad,” where he takes important notes for each emergency call.
The helicopter has the capacity to carry two patients and three crew members, depending on weight. If necessary, crew members can be left behind in order to transport patients, and it’s happened a few times before.
One such incident involved Acebo being left with a fellow nurse in San Francisco after transporting a patient to the hospital. After landing, the pilot was forced to take off again quickly due to incoming inclement weather. Acebo and his partner were forced to take BART back to Concord, lugging their equipment packs (which can weigh around 40 pounds) with them.
“It was an adventure,” Acebo laughed.
As bystanders watch from afar, the CALSTAR helicopter lands about 40 yards from the REACH helicopter, a short distance from Highway 4. Emergency crews wheel a critically injured man into the REACH, then a second patient toward the CALSTAR chopper. A woman in her late 50s, she is being airlifted out more as a precautionary measure, Acebo said.
A total flight averages a little more than an hour, but most of that consists of waiting. Once a patient is loaded up, they’re at the hospital within 15 minutes almost every time.
“We get as much done in those first 15 minutes as an emergency room would,” Acebo said.
The patient is headed to John Muir Medical Center, and just minutes after going airborne she’s already back on the ground, being carted off on a stretcher and transported into the ER. Acebo talks to her casually on the way in, asking if she’s warm enough and keeping a sense of calm. He’s used to dealing with very sick folks, and today’s patient is far from the worst he’s seen. It’s easy for him to stay calm, he said, even when dealing with tragic situations; calls involving children who desperately need medical care are the hardest.
“It’s always a handful (of incidents) that kind of stick to you, that you’ll always remember,” Castelli said, “and invariably, (they) always involve a kid.”
“During flights, it’s not quite emotional,” Acebo said. “But sometimes after the flight I just need a moment ... to collect myself and move on with things.”
Even though Acebo said he stays calm during emergency situations, he hasn’t ever become numb when dealing with patients — that could be very dangerous. If you’re too detached, he said, you’re not caring enough about your patients, who have to be the No. 1 concern.
Once the car crash victim is safely in the emergency room staff’s hands, members of the flight crew greet some familiar faces in the hospital and are then on their way out. The woman is complaining of pain in various areas of her body, but Acebo said he doesn’t believe she has any broken bones — she should be fine. The flight crew’s job is complete, and it’s time to load up into the helicopter and return to base.
A life-saving machine
Garavatti, 53, worked as a police officer for 27 years, and its apparent in the way he handles himself. Professional and no-nonsense, he’s very straightforward without being aloof. He’s been piloting helicopters and airplanes for years, having previously flown a chopper for the Hayward Police Department. Garavatti prefers helicopters, he said, because they allow for more freedom: With planes you have to find a runway to land on, but you could land a helicopter on a baseball field or city street if necessary.
On Tuesday, he’s spent most of his morning waiting for a mechanic, and is starting to get a little impatient.
“I’m about to fly over to the truck driving school and have them look at (the helicopter),” he jokes.
CALSTAR pilots work firefighter-like hours, putting in 12 hours shifts for seven days straight, followed by a week off. Garavatti flies an MD Explorer helicopter, one of six recently purchased new helicopters at the company. The 6,000-pound behemoth can travel at speeds of more than 150 miles per hour and climb 2,000 feet per minute.
“They’re the Mercedes of helicopters,” Hall said.
Even though the massive machine regularly travels at 100 to 120 mph during flight, Acebo said he feels safer in a CALSTAR helicopter than he does in a car. Statistically, flying is certainly less risky than driving, although that’s hard to keep in mind when you’re 14,000 feet above land.
But wasting time worrying is a luxury a CALSTAR flight nurse can’t afford. Soon the phones will be chirping again, and whether it’s a slow afternoon or the middle of the night, the flight crew will have to race out in mere minutes — because in this business, minutes can mean the difference between life and death.
Contact reporter Fernando Gallo at firstname.lastname@example.org.