Perspective: Caretakers of souls<br>

Perhaps it's the way Patrick Moran refers to his passengers as "souls" when he's speaking to his radio controllers, or maybe it's the red cross emblazoned on the side of his aircraft, but everything about Moran's job screams one vital truth -- he is in the business of saving lives. The reservist Marine Corps helicopter pilot is no stranger to the life-saving business, having flown many missions in the service of the United States. But now his home is at PennSTAR Flight, Penn's airborne ambulatory service. "It's all the things I like about the Marine Corps without the frustrations," Moran said. "It's a real team organization [and] a great bunch of people." For most of those people, flying is not only a career, but a passion. "Flying is the second greatest thrill to man," heralds a sign in a small office on the 10th floor of the Ravdin Building at the Hospital of the University of Pennsylvania. "Landing is the first." For the 12 pilots, 15 nurses and 15 paramedics that make up the PennSTAR flight crews, landing quite often means access to one of the nation's best health care facilities. Moran's helicopter -- an MBB-BK-117 "Space Ship" known as PennSTAR II -- is not roomy by any stretch of the imagination. It could be, were it not for the gurney, the heart monitors, the oxygen tanks, the intubation kits and the pumps, switches and tubing that occupy every nook and cranny in the rear of the aircraft. But the helicopter, like the other two that PennSTAR operates 24 hours a day, has been transformed into a flying ambulance. Like all of PennSTAR's pilots, Moran flies two medical professionals employed by the Hospital of the University of Pennsylvania, but is not an employee himself. The pilots and maintenance crew of PennSTAR work for Allegheny, Pa.-based Corporate Jets, Inc. The company also owns two of PennSTAR's three helicopters. Its service area -- a circular patch of land and sea 100 nautical miles in radius around Penn that includes two other bases besides the heliport at HUP -- covers the states of New Jersey, Delaware, Maryland and the eastern half of Pennsylvania. Explaining its usefulness to the dozens of communities PennSTAR serves, crew coordinator Kevin Thomas points out that without his crews, the vital link between a trauma patient and a trauma center would be lost. "We are keeping them inside an intensive care atmosphere," Thomas said. As Penn's link to trauma cases all over the region, PennSTAR's flight crews have logged thousands of hours transporting patients. They can and have transported every type of patient imaginable, from cardiac cases to crash victims. "We usually see the worst of the worst," said George Bevilacqua, a flight paramedic who has been with PennSTAR since the program's inception. On one recent run, flight nurse Nancy Scanzello and Bevilacqua served as Moran's crew as the three embarked on an inter-facility transfer of a patient from Atlantic City to Presbyterian Medical Center. According to Thomas, of the nearly 1,500 missions flown a year, around 40 percent are devoted to inter-facility transfers. But the rest of its missions are what make PennSTAR famous. From the heliport at the top of HUP, the PENNCOM communications station is on constant alert, waiting for a call from a county supervisor or fire chief to come and airlift a badly injured patient to one of the Philadelphia area's world-class trauma centers. Like when Bevilacqua and his crew transported a victim with multiple stab wounds on June 20, 1988. Although Bevilacqua already was a veteran paramedic with 11 years experience at the time, that case was his first flight and the blood and gore was a little hard to handle at 500 feet in the air. But Bevilacqua cannot imagine a better job. "For me, it's a personal challenge," he said. "When you get calls, you play detective. You try to figure out what's wrong." Figuring out what's wrong is what Bevilacqua does best. "I've been doing this a long time," said Bevilacqua, who is also a paramedic supervisor in Chester County. "You get a lot of personal satisfaction out of it." For each PennSTAR crew, professionalism is the order of the day. Their primary responsibility is to maintain the welfare of the life they have been entrusted. "You have to be able to do what you can in the short amount of time you have," Bevilacqua said. But, in a helicopter, time has been sacrificed in order to deliver a patient to a facility in the shortest amount of time possible. "We can pick up a patient much farther than an ambulance can and bring them back faster," Thomas said. A trip that might take an ambulance two hours to travel from Atlantic City to Philadelphia would take only a half an hour for one of PennSTAR's helicopters. "That's where the golden hour comes in," Thomas said, explaining that so long as a patient with trauma sees a doctor in under an hour, the chance of serious damage is minimal. "That's where you save lives," he added. In that period, a patient might have to be stabilized, given drug treatment, have an IV opened or have his heart started. "There's a lot we can do on the way in," Scanzello added. As flight nurse, Scanzello sits in the rear of the aircraft and monitors every indicator of a patient's welfare. "I'm very comfortable working in the back," Scanzello said. "I know where everything is, I know how I'm going to have to move around to get to do the things I want to do, like start an IV." For some of PennSTAR's medical team, the paramedics are pilots themselves. Just this year, Bevilacqua earned his private pilot license, in part because of the love of flying he developed while working for PennSTAR. "I'm not doing [this] because I need to do this," Bevilacqua said. "We come in, we laugh, we have fun." Sometimes, however -- as in the emergency room or the intensive care unit of a hospital -- a patient cannot be saved, and the joy of flying is eclipsed by a feeling of loss. For Scanzello, her 32 years experience has reinforced the reality that death is a part of the job. "Sometimes, people get sick and they die," Scanzello said. "It's very frustrating...it happens, but very rarely." According to flight paramedic Jim McCans, death is the one part of the job that takes a lot of getting used to. "I think everybody has their own way of trying to deal with that," McCans said. "I've been flying here for 13 years.... To tell you the truth, I don't know how we handle it." Whatever the case, whether the patient has no chance of living, "I'm going to give them my best shot," Scanzello added. "You realize that you got to turn to your partner, good or bad, and say you did a hell of a job," McCans said. But when patients do pull through, PennSTAR's crews reward themselves by visiting the people they helped save. "Visiting people that we picked up as they're going home is one of the more rewarding parts of the job," Scanzello said. "They'll say, 'You know, I don't remember that helicopter. Can I take a look?'" "We really try to do follow ups, because a lot of [the patients] have questions," McCans said. "It is their way of understanding the event they've been through." And when the mix of art and science that is medicine cannot guarantee a favorable recovery, a miracle may occur. Scanzello will not attribute medical success to divine providence, but he also won't dismiss the occasional miracle. "I'm sure it certainly contributes."

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