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Damon Sanger, chief pilot for Memorial Hermann Hospital’s Life Flight, regularly witnesses the aftermath of grisly accidents and unspeakable tragedies—drownings, shootings, electrocutions. But however hard that is, it’s not the hardest part of his job. That would be something else: the disasters he’s unable to get to, most often because of weather conditions. 

“When you have to decline the flight, it’s the most challenging thing for me as a human being,” Sanger says. “As a pilot, though, it’s the right response. … It’s the harder right versus the easier wrong.”

Sanger has been flying helicopters for the hospital’s pioneering ambulance service—the only one of its kind in Houston, the first in Texas, and the second in the nation—for eight years. Before that, he was a pilot for the U.S. Army. “It’s not Afghanistan, where I’m going to fly out in the mountains—this is Houston, Texas,” he says. “We can’t just throw out the rules and regulations that keep us safe and in compliance.”

But they can upgrade their technology. In 2015 Life Flight—which had missed more than 600 flights, nearly 20 percent of patient requests, the previous year—implemented something called instrument flight rules (IFR), arguably the program’s biggest leap forward in its 42 years of existence.

IFR utilize advanced navigation systems and flight instruments—plus constant radar contact and communication with Air Traffic Control—to allow helicopters to fly higher in the sky, at maximum cruise speed, and through poorer conditions, not unlike the way airplanes do. All airline flights, in fact, use IFR.

Each year since implementing IFR, Life Flight has missed or aborted fewer flights because of weather. In 2017 the number was down to 348; this year, Memorial Hermann estimates, it will decrease to 295, less than half the number of emergencies the team couldn’t reach in 2014.

Still, Sanger is quick to clarify that flying with IFR doesn’t allow him to throw caution to the wind. Regulations still prohibit flight through some types of bad weather, including particularly dense fog or icy conditions.

“It’s not an end-all to everything,” he says. “We don’t push safety; we use it as a safety tool. IFR is a safe means of flight if used properly, and that’s what we really concentrate on.”

The tool was a godsend during Harvey, when the team received dozens of calls in one 24-hour period. “It was the Coast Guard, FEMA, and us,” Sanger remembers. Life Flight performed its usual patient transfers, along with emergency evacuations. But a unique problem presented itself: With no roads to travel, there were no doctors. The team loaded aircraft with stranded surgeons and used IFR to fly them to hospitals Harvey reduced to islands. As ORs became operational again, the team airlifted blood products and medications to outlying hospitals, too.

“You have to be ready at any time for the worst-case scenario,” says Sanger, thinking back. “My adrenaline kicks in after the fact. Then I’ll be like, ‘Wow. What did we just do?’”

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