Ralph Hylton paused at a traffic light on the Eastern Shore. Thirty miles away, the crew of a Maryland State Police MedEvac helicopter cleaned up after dinner in a drab office in a hangar at Martin State Airport in Middle River.
It was 8:20 p.m., Sunday, Aug. 27, an unspectacular day closing one of summer's final weekends. Then suddenly, Mr. Hylton was slammed against the driver's door of his small pickup truck and whipped across into the caved-in passenger side. Within minutes, a call went out for one of the state's 11 MedEvac helicopters, sending Trooper One to the rescue.
MedEvac helicopters have been saving lives in Maryland for 25 years -- longer than any other public-service airborne-ambulance program in the country. Now based at eight sites, the rescue service has flown more than 64,000 patients to the Maryland Shock Trauma Center in Baltimore and other hospitals around the state with a survival rate greater than 90 percent.
A Sun reporter and photographer rode with Trooper One for the 3 p.m.-11 p.m. shift Aug. 24 through Aug. 27, during which the helicopter airlifted eight patients. The severity of their injuries varied, but each flight of Trooper One proved to be another race against the helicopter's relentless and formidable foe -- time.
And if ever time was critical in saving a life, it was for Ralph Hylton.
State police in Kent County said Mr. Hylton -- a 50-year-old heating, ventilation and air-conditioning mechanic driving home to take his wife to dinner -- pulled his small pickup truck into the path of a full-size pickup truck at U.S. 301 and Route 313.
The larger truck smashed into his truck's passenger side and drove it head-on into a guardrail.
The first paramedic to reach Mr. Hylton called for a helicopter as soon as she found him choking on his own blood in his crumpled front seat. She detected only a faint pulse.
Trooper One gave Mr. Hylton his only chance for survival.
Despite nearly dying from multiple injuries upon his arrival at Shock Trauma, he has survived there for two weeks -- where he remained yesterday in critical but stable condition.
"If it wasn't for the helicopter and if it wasn't for Shock Trauma, Ralph would be dead by now," said Mr. Hylton's wife, Joan, who with family members drives two hours every day from the Massey in Kent County to sit by his bedside. "The doctors say he still has a rocky road ahead of him. But he's hanging in there. I just know he's going to make it."
'Circling the drain'
On these evening shifts, Trooper One's rapid-transit service for the critically injured rested with two men.
Norman Molter, 45, a former Marine pilot, was at the controls as the helicopter flew over the Chesapeake Bay at 160 mph toward Mr. Hylton's mangled truck. The pilot was lured to this job two years ago after his mother was saved by a MedEvac helicopter after a car wreck.
At Mr. Molter's side was the 1994 National Flight Paramedic of the Year, Trooper Walter Kerr, 35. He spent his 16th birthday riding an ambulance as a volunteer emergency-medical technician. Since becoming a MedEvac paramedic in 1989, he's kept a list of every mission he has flown. The list tops 2,000.
Mr. Molter landed the helicopter on the northbound lane of U.S. 301. Bent over slightly as he cleared the churning blades, Trooper Kerr hurried toward Mr. Hylton's wreck. He huddled with Elizabeth "Cricket" Beck, a Massey paramedic, who briefed him about the wreck and Mr. Hylton's injuries.
Neither she nor Trooper Kerr knew the man on the stretcher. That didn't matter. The two paramedics methodically went about their work -- the calm center of a chaotic scene of flashing lights, blinding spotlights, sweat, broken glass and overpowering noise from the waiting helicopter's spinning blades.
Medics loaded Mr. Hylton into the helicopter, Trooper Kerr climbed in, Mr. Molter lifted off and the race to Shock Trauma began. Trooper Kerr hooked Mr. Hylton to monitors. He tried to keep the oxygen mask over Mr. Hylton's mouth, but the barely conscious man was in a combative state and tore off the mask and ripped out his IV. Blood ran down his left arm onto the helicopter's floor.
"His color's bad, because he's not getting enough oxygen," said Trooper Kerr, wearing gloves as protection against hepatitis and AIDS. "He's probably bleeding like a sieve inside."
"We're about two minutes," Mr. Molter said into his headset to Trooper Kerr, "two minutes from landing."
From this moving perch in the sky, downtown Baltimore twinkled like lights on a giant Christmas tree. But Camden Yards was dark; the Orioles were in California. Mr. Molter steered Trooper One around the ballpark and, at the University of Maryland Medical Center on downtown's western edge, smoothly set down on Shock Trauma's roof. The 30-mile trip had taken 15 minutes.
Leaning into gusts from the helicopter's still-swirling blades, three Shock-Trauma specialists wheeled a stretcher onto the roof. They whisked Mr. Hylton into an elevator and descended to Shock-Trauma's frenzied admitting area. As soon as they placed him on a table in one of Shock Trauma's 10 bays, Mr. Hylton went limp.
"He's circling the drain, folks," shouted a doctor.
Trauma specialists descended on Mr. Hylton. "Does he have any pulse at all?" one asked. "It's not great, but it's there," another answered. Trooper Kerr remained at the patient's head, inserting a breathing tube into the trachea. Then as many as 20 nurses, doctors and assorted specialists worked frantically to save Mr. Hylton's life -- and succeeded.
Trooper One had delivered Mr. Hylton to Shock Trauma at 9:26 p.m. -- an hour and six minutes after his crash, far quicker than an ambulance could have driven him to a trauma center. The closest one to the wreck was in Delaware, nearly an hour's drive away.
Time was the impetus a quarter century ago behind the creation of MedEvac. The program was the brainchild of Dr. R Adams Cowley, Shock Trauma's founder and first director. He said the best chance for saving critically injured victims was to get them to a trauma center within that first "golden hour."
The state program began in 1970 with two helicopters transporting 197 patients. It grew and became a national model, conducting police, search and rescue missions but specializing in medical evacuations. Last year, its 11 helicopters, 42 paramedics and 52 pilots airlifted 4,179 patients. The busiest of the state's eight bases was at Martin State Airport, home to Trooper One.
The service's annual budget runs $16.9 million. Seventy-two percent of that comes from $8 taken from each state vehicle registration fee. The rest comes from state general funds. Patients are not charged for the helicopter transport.
No one ever complains about the $8 fee, said 1st Sgt. Mark B. Gabriele of the aviation division: "They consider it their insurance premium to get to a hospital in a hurry."
"What a gorgeous evening," said Mr. Molter, as Trooper One lifted off the runway at Martin State Airport with the ease of a glass elevator in a hotel. "Look at that sunset out there," said Trooper Kerr, nodding toward a sky flush with purple and pink beyond Baltimore's skyline.
Trooper One then turned to the north -- toward Cecil County for "a shooting victim," as the call had put it. MedEvac crews know nothing beyond such cryptic descriptions when they're sent on calls. This time, it turned out to be a 45-year-old man who had shot himself in the head with a .22-caliber rifle, leaving his face swollen and bloody.
The ride there was smoother than in a commuter plane. Trooper One leveled off at 1,000 feet, the perfect altitude for gazing on mirror-like inlets of the Chesapeake and tiny boats leaving long graceful tails in their wake. The trees looked like broccoli and the subdivisions like Monopoly houses.
Trooper Kerr spoke by radio to the paramedics in the town of North East, who were waiting with the patient. "This guy sounds real bad," Trooper Kerr said.
The man was unconscious, flat on a stretcher in the ambulance. Despite a bullet in his brain, he survived the 17-minute flight to Shock Trauma. He died there at 4:45 a.m. the next day, accomplishing what he had set out to do nine hours earlier. He is not named here because he committed suicide.
"A patient is like an engine is to a mechanic," Trooper Kerr said later. "That's the way you have to look at it to deal with it. I've got to trouble-shoot it the best I can."
In the ambulance before loading the patient onto the helicopter, Trooper Kerr inserted a plastic tube down the man's throat into his trachea so that oxygen could be forced into his lungs.
On the helicopter, the paramedic connected the patient to several monitors and evaluated his vital signs. Then by radio he briefed Shock Trauma about the patient's condition. Finally, the patient vomited blood in the helicopter.
"I was on an adrenalin high," Trooper Kerr said. "I got to do my job. I got to do what I was trained to do. It was challenging. It was fun, as sick as that might sound. Even the embalmer in a funeral home has got to like his work."
All the MedEvac cases aren't so challenging. About 25 percent are life-or-death. The rest, if not routine, are quick hops to the hospital. Whipping up great clouds of dirt and debris, the helicopter sets down on an athletic field or a parking lot where an ambulance has driven with the patient on a stretcher, stabilized, waiting for a lift.
In those cases, the paramedics' job is to monitor the patients, making sure they arrive at the hospital in no worse shape than when they were loaded onto the helicopter. The pilot's job never changes.
"You really should divorce yourself from what's going on in the back," said Trooper One's pilot, Mr. Molter. "I've always said even if it's someone in my family or someone I know, I don't want to know. My job is flying the aircraft. I don't need to be
The service's helicopters are state-of-the-art, twin-engine American Eurocopter Dauphins. They cost $5.4 million each. Their high-pitched, high-powered whine distinguishes them from the thup-thup-thup of other helicopters.
Six troopers have died in three crashes of MedEvac helicopters -- all Bell-Jet Rangers, the Dauphin's smaller, less-sophisticated predecessor -- in 1972, 1973 and 1986.
The 1986 crash on a dark, foggy morning into a wooded hillside of Baltimore's Leakin Park prompted an overhaul of the MedEvac program -- stricter safety regulations, top-of-the-line Dauphin helicopters, higher standards for pilots and additional training for flight paramedics.
Still, Trooper Kerr said, flying in a helicopter, even a carefully maintained, top-of-the-line Dauphin, carries its risks. "This isn't an E-ticket at Disney World," he said. "There's no guarantee you're coming back."
As they worked their shifts over this late August weekend, Trooper Kerr and Mr. Molter repeatedly stressed that they are just one of eight MedEvac crews on duty.
Each crew, they said, is just one link in the chain of Maryland's emergency-medical services system -- local 911 dispatchers, county ambulance crews, fire and police officers, MedEvac helicopter crews, their mechanics, a plethora of hospital workers and the operators for the state communications system that links them all.
But with their glistening tan Dauphins with Maryland's state colors emblazoned near the tail, the helicopter crews in tan flight suits draw the most public attention -- so much that some crew members feel a tinge of guilt.
"The guys slugging it out on the road, they're the guys who have the tough job," said Cpl. Thomas W. Colbert, 42, a state trooper for exactly half his life and a helicopter paramedic since 1988. "You only have to walk up to the wrong car the wrong way one time."
Yet Corporal Colbert has handled medical cases that haunted him for years. During a cursed two-week stretch several years ago, a dozen hopelessly injured patients he transported eventually died. For that he earned his nickname, "The Raven."
Injured children haunt all paramedics -- especially children hurt in drunken-driving wrecks or because they weren't wearing restraints. Even Mr. Molter, who tries not to notice patients from his pilot's seat, bristled and said:
"I've heard parents say that child restraints or safety belts are too restrictive. But hey, how restrictive is a wheelchair? You know what's real restrictive? A casket."
'I love you'
Mr. Molter landed Trooper One at Our Lady Queen of Peace Catholic Church in Middle River. The call: child struck. A block away on Bird River Road paramedics wheeled Rachel Jones, 13, toward an ambulance. She had ridden her bicycle to get a snowball, and on the ride home she had been hit by a pickup truck. The driver was charged with driving while intoxicated.
"Rachel honey, I love you," cried her mother, Grace, as paramedics placed the girl into the ambulance. "You'll be all right, I promise."
The ambulance drove Rachel to the helicopter, paramedics helped load her in, and Mr. Molter flew to the Johns Hopkins Children's Center. During the flight, which took four minutes, Trooper Kerr started an IV and tried to calm the girl, who was conscious but scared.
Her worst injury was a broken pelvis. She was discharged three days later.
Walter Ambrose, the Baltimore County paramedic who treated Rachel on the street, said he called for the helicopter because he feared the girl was bleeding internally from a ruptured spleen or liver. He estimated that the helicopter saved 30 minutes.
If she had been bleeding internally "and if I'd have had to drive her down to Hopkins," Mr. Ambrose said, "I'd probably have lost her on the way. That half hour could have been the difference between life and death."
Night after night, the efficiency of Trooper One's two-man crew -- Mr. Molter and Trooper Kerr -- turns the dramatic into the routine.
One injured body after another is borne by their helicopter with the sole focus on what that body needs in those few minutes. They seldom inquire afterward about the conditions of the injured. They don't get emotionally attached. They don't have time. They're often called to another accident before even leaving the hospital from the last one.
And then they'll run into Shock Trauma anesthesiologist Carole Freeland -- as Mr. Molter and Trooper Kerr did on the second of these four nights.
Pausing on her harried rounds, she looked up and said in the calmest voice imaginable: "Back again, so soon?"