Not all of the medical treatment at Firelands Regional Medical Center takes place on the ground.
Medical helicopters have been growing in use at the hospital, which recorded 200 helicopter flights last year, well over the previous record of 170 flights 2010. As of Tuesday, 88 flights were tallied this year at the hospital.
Working on medical helicopters is routinely described as one of the most dangerous jobs in America. The risk of crashing exposes the patient as well as the crew to peril, sparking debate on whether medical helicopters are worth it.
But the Journal of the American Medical Association reported in a 2012 study that use of medical helicopters is associated with a greater survival rate for patients.
Firelands officials who work with medical helicopters say two factors help patients transported by air rather than by ground.
For many medical conditions, minutes count, said Christine "Tina" Ammanniti, director of cardiac services at Firelands.
Firelands has a standing arrangement with Fisher-Titus Medical Center in Norwalk and with Bellevue Hospital to transport by helicopter heart attack patients who need catheterization to open up a blocked coronary artery, Ammanniti said.
"The sooner you get that artery open, the more heart muscle you save," Ammanniti said.
The elite crews aboard helicopters also contribute to improved survival rates. Each medical helicopter crew includes a nurse and a paramedic aboard to work with the patient. They typically have more medical training than the crew of an ambulance.
Firelands normally uses medical helicopters to send patients to Toledo or Cleveland when those bigger hospitals offer a specialty Firelands doesn't have. Medical helicopters also are used to transport trauma patients with multiple injuries, such as badly injured motorcycle riders, to top-level trauma treatment hospitals.
Firelands officials offered a few possible reasons for the increase of medical helicopter use from the hospital.
Catheterization services to treat heart attack victims, an expanded area of service at the hospital, is now available 24 hours a day.
The growth of violent crimes in Sandusky also may have contributed to the number of helicopter flights, they said.
Firelands has a helicopter pad located near the emergency room; at night, it becomes well-lit when a copter is coming in for a landing. The hospital has had as many as three helicopters coming in at the same time and has alternative landing spots elsewhere on the grounds.
A variety of medical helicopter services use the helipad, including Cleveland Metro Life Flight and services associated with University Hospital, the Cleveland Clinic and Akron Children's Hospital.
But the service that comes to Firelands most often is the Life Flight associated with Mercy St. Vincent Medical Center in Toledo, which has six helicopters stationed at various locations, including one at North Central EMS on U.S. 250 near Ohio 13, and one at the Sandusky County airport in Clyde.
The service is celebrating its 35th anniversary in August, said Lori Mizia, RN, senior director of Mercy St. Vincent Life Flight.
During that time, the service has had two crashes. One, in 1983 in foggy conditions, left two dead. A 1998 crash during snowy conditions caused injuries but no deaths.
The Federal Aviation Administration says there are about 75 air ambulance companies in the U.S. flying about 1,500 medical helicopters. In 2008, a particularly bad year, five air ambulance crashes killed 21. From 2011 to 2013, there were seven air ambulance accidents that killed 20.
On Feb. 20 this year, the FAA issued new safety rules, including requirements for more safety equipment and requiring all pilots to be instrument rated to be able to fly in bad weather.
St. Vincent's helicopters don't fly in thunderstorms, during severe icing or in zero visibility, Mizia said.
Federal rules forbid telling helicopter crews the names of the people they will be treating or what their medical conditions are, because weather-related decisions on air travel are supposed to be made strictly according to safety rules, she said.
When a helicopter lands, all three crew members, not just the pilot, are expected to look down to spot possible hazards. EMS crews are trained to mark out a safe landing spot with orange cones when they call a helicopter to an accident scene and to alert pilots to power lines and other possible hazards.
One of the St. Vincent crews stationed in Milan consist of pilot Ben Kao, certified flying nurse Heather Parmenter and transport paramedic Kurt Schafer.
Parmenter likes being out in the field, enjoys knowing she is helping critically injured people and likes the challenge of difficult situations.
"Being inside a trapped vehicle makes me happy," she said.
Schafer had been a paramedic for years and routinely worked with medical helicopters.
"When we needed help, we would call the Life Flight," he said. "It was kind of a natural progression for me."
Kao had formerly worked as a tour pilot in Nevada, flying people over Las Vegas and through the Grand Canyon.
"Flying tours, you do the same flight every single time," he said. "With this job, every day is different."