It had already been a busy day for Air Rescue North (ARN), Miami-Dade (FL) Fire Rescue's (MDFR) northernmost flight crew, when the call came in: a 36-year-old male in cardiac arrest five miles off shore on a Norwegian cruise ship. Sundown was coming but not yet here. Immediately, Commander Joe Rivers and Flight Medic Captain Andy Borges started working on their game plan.
What was the mission? Hoist an unresponsive male from the Norwegian Getaway onto their helicopter and quickly transport him to the nearest hospital. The City of Miami fireboat had arrived and determined the seas were too rough for a ship-to-ship transfer and the United States Coast Guard had deferred to fire rescue because of the advanced life support (ALS) needs of the call. Though they do provide hoist work, they do not have medics aboard their helicopters.
What equipment was needed? A stokes basket. The Bell 412 helicopter's max weight limit is 11,900 pounds, and this doesn't leave much room for extra equipment. Bring too much, and you overweight and crowd the aircraft; bring too little, and you're out of luck.
In the watch office, the commander and captain discussed the mission plan while Pilot Steve Vandesande confirmed GPS coordinates and pulled up the weather radar. Outside on the pad, as the sun was setting, Flight Medic Ozzie Alvarez began stripping down and configuring the aircraft for an open-water night hoist.
They had one chance to get it right. There was no going back to get equipment, no additional crews coming to back them up. They'd been called because no one else was able to do this. Somewhere on a ship a young man was fighting for his life, and they were his best shot.
Air Rescue Bureau
MDFR's Air Rescue Bureau is comprised of two stations of operations, ARN out of Opa-Locka Executive Airport and Air Rescue South out of Tamiami Executive Airport. The fleet consists of four Bell 412 helicopters, each with a Breeze Eastern hoist and 250 feet of cable. Both stations have an alert helicopter on duty 24/7/365. MDFR has more than 2,000 personnel including 47 flight medics and 18 pilots. Each aircraft holds four crew members: two pilots (a commander and copilot) and two flight medics (an officer and firefighter). All crew members, including pilots, are firefighters. The pilots must pass the fire academy and become certified firefighters to work at Air Rescue. Every flight medic has been a paramedic for at least five years and is a member of MDFR's Dive Rescue Team.
Air Rescue is a special ops platform. Crews are trained in search and rescue, rappel, and hoist and as air deployable divers. Paramedics can drop down into the Everglades or Biscayne Bay, hoist someone up, and perform all department ALS procedures on their patients if necessary, including intubations, decompressions, cricothyrotomies, transcutaneous pacing, cardioverting, defibrillating, and administering of meds.
Air Rescue performs aerial firefighting via bambi bucket and can transport sling loads to remote locations, as it did for the 1996 ValuJet crash site in the Everglades. They also provide air transport for medical patients, usually ST segment elevation myocardial infarction (STEMI) or stroke alerts, to the appropriate medical facility. But most often they transport trauma alerts (and there is a lot of trauma in Dade County) to Level 1 trauma centers.
Air Rescue performs approximately 1,500 missions a year and responds as far south as Key West and as far north as Palm Beach. They work with numerous agencies including United States Coast Guard, Fish and Wildlife, Everglades National Park, Biscayne National Park, City of Miami Fire Rescue, and Hialeah Fire Department. They often respond in conjunction with MDFR's fireboat for marine-based calls.
Lately Air Rescue has been on a roll. In the past few months, they have pulled victims from the Everglades and sea via strop, rescue basket, stokes basket, air deployable diver, and the fireboat. These calls encompassed lost canoeists, capsized boats, floating migrants, and then the Norwegian Getaway.
ARN cut over the Atlantic. It was dusk, a tricky time of transition when color leeches from Miami's normally bright blue sky, dimming it to a desaturated gray. It is a time too light for night vision goggles, although the pilots had them ready on their helmets, and too dark to see well without them. Fortunately Norwegian Getaway was a large target and hard to miss.
On arrival, Alvarez hoisted Borges down to the front of the ship and set him on a bright yellow smiley face. It was a space designed just for hoisting, too small for the aircraft to land but large enough to manage a load. It was a high hoist. Visibility was falling rapidly, and the commander wanted to stay well clear of the ship's flagpole and obstacles. Just the tiniest tap of a rotor blade would bring the entire aircraft down. But controlling an 80-foot cable with a man dangling at the end beneath roaring rotor wash is not always the simplest of tasks. Their training and experience would have to serve them well.
When Borges landed on board, he met with the ship's medical crew, who informed him the patient was alive but unresponsive. He had been resuscitated and intubated and would have to be ventilated during the hoist back up to the helicopter. Borges radioed ARN for the basket and backboard to begin preparing the patient for pickup.
The mission began at dusk but ended in darkness. Once the stokes and backboard were lowered (Air Rescue prefers to use their own equipment), Borges packaged and transported the patient up to the deck. He configured the basket's tag line then turned to a knowledgeable Getaway crew member who would work the tag line and advised him of his duties. The tag line man's main objective is to keep the basket from spinning beneath the whipping rotor wash, which could render the captain dizzy or even unconscious if it picked up enough speed. With the crew member briefed and the deck cleared, Alvarez lowered the hook. Borges clipped himself into the basket and rode it up while he manually bagged the patient.
Eight minutes later, ARN arrived at Jackson Memorial Hospital and turned the patient over to medical personnel.
The hospital reports that the patient will make a complete recovery. The mission was a full team effort and success! The crew of the Norwegian Getaway, City of Miami fireboat (which provided a hover reference for the commander), and ARN all worked together to complete their mission and save this man's life.
This is the power of the fire service. It is the ability to respond rapidly on land or at sea, in fires, rivers, or beneath crumpled skyscrapers, day or night, fair weather or foul, with highly trained personnel who risk themselves to preserve the lives of all people within our borders. We will train, adapt, and fight for the life of anyone, wherever they may be and whoever they are. This is the strength of the fire service. Always ready, proud to serve.