Over a decade later, after hundreds of missions flown, patients treated and decisions made, Ben Suttlemyre remembers one night, one woman, and one tragedy more clearly than any other.

"It was like a Grimm fairy tale: dark and stormy night," he recalled. "Car crossed the center line and hit another car."

The incident occurred near Clayton, Wash. Suttlemyre, a registered flight nurse who was just beginning his Northwest Medstar career, arrived by helicopter, landing close to the roadway. The scene was nightmarish - he saw a woman gravely injured, her family standing beside her, shaken, terrified. "Mom, don't die," the children kept saying, over and over.

The woman did not survive. Suttlemyre's crew treated the drunken, belligerent man who had caused the collision, loaded him into the chopper and flew to a hospital.

"And unfortunately, that story has repeated itself," said the 45-year-old Suttlemyre, now a 14-year Medstar veteran who lives in Dalton Gardens. "That story repeats itself time and again."

He was not especially young or impressionable when he touched down in Clayton; he was an experienced nurse, a man who knew emergencies and how to handle them. But this was something different, Suttlemyre thought, so raw and so painful, unlike anything he had seen in a hospital room. The loss cut very deep, and the memory of that dreadful night can still bring tears to his eyes, even now.

"Yea, I remember that one," Suttlemyre said quietly.

And yet he kept flying, racking up missions, treating and transporting countless patients. He helped save lives, and he carried on.

"You get to make a difference in people's lives almost every time you work," he said. "Some of them make remarkable recoveries... some that you really didn't think had a chance to live a healthy, productive life afterward. That makes it all worthwhile."

Taking flight

Suttlemyre grew up in the high desert of southern Utah. His hometown, Monticello, was 7,000 feet above sea level.

He attended Weber State University, where he studied nursing. While living in Salt Lake City, Suttlemyre would watch helicopters fly over his apartment on their way to the medical center, carrying patients and pilots and flight nurses. That, he thought, was a job he'd like to have.

After college he began his career as a registered nurse, working at LDS Hospital in Salt Lake City. In 1992, he moved to Idaho and Kootenai Medical Center in Coeur d'Alene. Northwest Medstar - the region's only airborne medical transport service - often landed at the KMC helipad, and once he had the requisite experience, Suttlemyre tried for a Medstar spot in 1996.

"When the opportunity presented itself to interview for a job, I took it," he said.

He got the job.

"We need very skilled people, with very specific skills," explained MedStar Director Eveline Bisson. "Sometimes we have to pull from other parts of the country. It's a select group. When you think about it, we're taking care of the sickest people, and we need very sharp (crew members) taking care of them."

A large and efficient operation, MedStar transports 3,500 patients every year, Bisson said. Crews are based in Spokane, the Tri-Cities and Moses Lake. They use helicopters, fixed-wing aircraft or ambulances, depending on the mission scenario.

The twin-engined choppers, Eurocopter EC-135's, carry one or two patients and three crew members - a pilot, flight nurse and respiratory therapist. The Pilatus PC-12 and Beechcraft King Air 200 - both fixed-wing, turbo-prop driven aircraft - are much faster than the helicopters, and used for long distance flights.

"Over 90 percent of our transports are hospital to hospital," Bisson said, though MedStar choppers do occasionally land on-scene, if need be (sometimes outpacing the local emergency crews).

A MedStar aircraft is like a flying intensive care unit, Bisson and Suttlemyre said. Everything the crew needs to keep a patient alive is onboard, including ventilators, defibrillators, IV pumps and stores of medication.

Versatility defines the operation. With its multi-purpose aircraft, ground vehicles, regional bases and highly-trained crews, MedStar can respond to almost any emergency in Idaho, Washington or beyond.

"We're taking the ICU to the patient, and obviously moving them in an ICU to where they need to be," Bisson said.

On the job

From the start, Suttlemyre realized Medstar was a whole new ballgame.

In hospitals, he had always worked alongside doctors, men and women who knew exactly what they were doing and how they wanted it done. Suttlemyre followed their lead, assisting when he could, following directions. The protocol was quite limited, he explained. He was rarely forced to make life-or-death decisions; there was always a white coat nearby, someone to offer guidance or counsel.

But then Suttlemyre joined MedStar, and suddenly he was supposed to call the shots. He had more freedom, more opportunity to use his skills, but also greater responsibility. It took some getting used to.

"That was a very different situation," Suttlemyre said. "We have very broad protocol, and a lot of room for independent thought and discretion. It allows you a degree in autonomy that you don't have in the hospitals. And that's very scary at first."

These days, with 14 years under his belt, the anxiety is long gone. He can assess the situation, make the right call and get on with the job. Like most of the people he works with, Suttlemyre is an old hand.

"I really enjoy that autonomy now," he said. "I think that is why a lot of our staff is so senior, and has been there so long. Almost all of my teammates have been doing this a long time. We have a very senior crew."

Suttlemyre lives in North Idaho, but travels to Spokane or Richland for his MedStar duties. He works two or three shifts every week, either 12 or 24 hours. When he arrives at the base he looks over his medical equipment, making sure everything is right where it should be. Then he waits.

"It could be a very slow day, or it could be busy all day long," Suttlemyre said. "You just don't know. It makes it interesting. And there's sort of the unspoken rule: if somebody calls, then more people are gonna call."

The challenge of life-saving

A successful MedStar mission requires sound planning, efficiency and speed. When a call comes in, the dispatchers and other personnel start making decisions - who to send, where exactly to send them, what aircraft or vehicle they should use, and so forth.

If the weather is particularly bad, or multiple calls come in at once, these decisions get more difficult. It's a puzzle of prioritization, resource management and gut feeling, where time is always of the essence.

Because of MedStar's versatility, the mission could be anywhere. Some flights are nothing more than a hop between hospitals, or a quick trip from a rural medical center to a large facility like KMC. Other missions call for a long voyage to a remote wilderness area, like someplace in the Cabinet Mountains. The chopper only needs a daytime landing area of 75 by 75 feet, which means wilderness response is entirely possible.

"The more remote you are, the more serious a problem becomes," Suttelmyre said. "A broken leg is a serious problem for someone who's hiked in 20, 25 miles."

Once on-scene, the crew springs into action.

"I'm primarily responsible for patient assessment when we get there. I need to get a feel for how sick this patient is," Suttelmyre said.

Then comes the toughest part: transporting a very sick patient in a shuddering, rumbling helicopter while providing the best possible care. The crew might attach lines or pumps, which can easily dislodge.

"The challenging part is when you're moving 'em from stretcher to stretcher, bed to bed, vehicle to vehicle, you don't pull this stuff out," Suttlemyre said.

And the clock is ticking. There's a very short window for heart attack or stroke patients, just a few hours to work with. In the Inland Northwest, the only hospitals that perform invasive cardiology - surgery - are in Coeur d'Alene, Spokane, Wenatchee and Richland. If the transport is several hundred miles, time gets tight.

"There's more to it than speed, though," Suttlemyre said. "Speed is only one component of it."

The crew must maintain ICU-type care throughout the flight, with limited resources, he added, "And that's where the art comes in, along with science. You've gotta keep that level of care up during transport. And that's the hard part."

When the mission goes well, when the patient is delivered safe and sound, a life is often saved.

And so, despite the inherent challenges of his stressful profession, Suttlemyre remains airborne. The missions are difficult, sometimes tragic, but he enjoys the experience of MedStar, the scenery from the helicopter windows, the view from his "office."

"I know the Inland Northwest very, very well," he said. "And I've been given the opportunity to see it like few others do."