Critical Air: A Flight Nurse’s Adventures from Alaska to Nepal

By Gwen Hutchins

Get ready to wince, shudder, and even laugh. Critical Air: A Flight Nurse's Adventures from Alaska to Nepal will transport you to the world of patient care in some of the most challenging regions on earth.

Find out what it took for flight nurse Gwen Hutchins to reach and treat people in remote areas under brutal conditions, such as:

• Alaska, including the Aleutian Islands, during major storms
• Zhengzhou, China, during rolling blackouts
• Nepal, amid post-earthquake rubble
• Cebu City, Philippines, where circumstances led to Gwen's detention for ransom

Gwen writes unflinchingly. She uses gripping narratives and raw details — at times injected with a dose of humor, one of the tools in her survival kit. Critical Air offers a walk down memory lane with Gwen that is not for the faint of heart. Throughout her career as a flight nurse, she boldly went where most of us would never dream of going. You won't soon forget her incredible story!

• Language: English
• Publisher: Hutchins Family Foundation
• Release date: Apr 22, 2024
• ISBN: 9798989945825

Book preview

CRITICAL AIR

A FLIGHT NURSE’S ADVENTURES FROM ALASKA TO NEPAL

GWEN HUTCHINS

Copyright © 2024, Gwen Hutchins

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical (including any information storage retrieval system) without the express written permission from the author, except in the case of brief quotations for use in articles and reviews wherein appropriate attribution of the source is made.

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Because of the dynamic nature of the internet, web addresses or links contained in this book may have been changed since publication and may no longer be valid. The content of this book and all expressed opinions are those of the author and do not reflect the publisher or the publishing team. The author is solely responsible for all content included herein.

This book is based on the author’s actual experiences as a flight nurse, but uses fictional names, dates, places, dialogue, and descriptions of patients, pilots, and others to create stories surrounding each real medical emergency in which the author played a key nursing role. Other than the author, her husband, her daughter, and Hima, any resemblance to actual persons, living or dead, or other identifying factors is purely coincidental.

Library of Congress Control Number: 2024901685

Cover design by Fabio Bologna

Edited by Cathy Cruise

Interior design by Jetlaunch

FIRST EDITION

Dedicated to Jean Hudkins—a driving force in my life, giving me motivation, direction, and friendship. Jean was a visionary educator whose profound love of nature, reading, and art helped inspire so many to love life, give back, and live a simple life.

Acknowledgments

To my loving husband, Eddie, whose constant hounding kept me on track to get this book published; my daughter, Ingrid, for her love and emotional support; and the pilots, coworkers, and patients who were willing to contribute their stories.

To Dayna Verstegen, whose friendship and talents are limitless, but especially for her journalistic interviews that brought out the vivid details of my many adventures.

To Linda Linssen for her professional expertise, editing skills, creativity, common sense, and friendship.

Contents

Chapter 1: Slim Catches a Taxi

Chapter 2: Take My Hand

Chapter 3: Mabel Hitches a Ride

Chapter 4: Ma’am, We Need to Inspect Your Box

Chapter 5: Disposable Women and Children

Chapter 6: Survival Rule #1 — Remain Visible

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About the Author

1

Slim Catches a Taxi

SLIM

Late October

Dutch Harbor, Alaska

SLIM WASN’T HAVING a very good day.

Screw you. Slim was drunk and hunched over the bar at the Thirsty Fish on the Bering Seafood Company property. As he said it, he lifted his head to look sideways at his antagonist on the stool next to him. He couldn’t remember what the guy had said, but it pissed him off. Slim had to raise his head further to meet the man’s eyes. The dude looked like a mountain. He must have been over six foot four with shoulders to match. Slim barely managed 140 pounds on his five-foot-six frame and so, while his mom had named him Stanley, everyone always called him Slim.

Slim didn’t have time to realize his mistake before a massive fist caught his cheekbone and knocked him to the floor. He felt a metal-toed boot in his stomach and more blows to his head. He curled into a fetal position and waited for it to end. He knew how to take a beating. His old man had been a real son of a bitch.

During the fishing season from October to February, Slim lived, worked, and drank on the Bering Seafood compound in Dutch Harbor, Alaska. His employer owned more than 40 boats—trawlers, processors, tenders, and freighters—that fished salmon, cod, pollock, crab, flounder, and tilapia.

Fishing was about the only way to earn a paycheck in Dutch Harbor. Slim ended up here five years ago after he jumped bail for an armed robbery in South Dakota. No one had bothered looking for him. If they knew where he was, they probably thought that living here was punishment enough. But Slim had come to appreciate how people stayed out of his business. He also didn’t mind the near constant rain and snow in the Aleutian Islands. It suited his mood.

Slim slept most nights in the Bering employee bunkhouse with the other fish processors and laborers. When he wasn’t processing fish, he spent his waking hours at the bar, drinking and complaining about the fucktards in Washington, DC. Most days he consumed little else than beer and whiskey. This was day three of another bender. He had been sitting alone at the bar since 9:00 a.m. and was wasted by noon. Slim had no friends because he was a mean drunk.

It was late October, and the fishing season was off to a slow start, so Slim had extra hours to drink at the Thirsty Fish, which was open 24/7. He was a scrappy guy. Years of processing fish from the Bering Sea had made him strong and wiry, but today he was not his best.

Slim was too drunk to stand up to his abuser and quickly found himself unceremoniously hoisted off the sticky floor and tossed out the door. The cold snow hit his face as the door opened, and he felt a little better. The relief did not last, as he slipped and hit the icy ground. He landed in the parking lot, turned over, and threw up on the wheel of a rusted pickup parked in front of the bar.

Booze hadn’t made him sick in many years, but the boot to the stomach messed him up. He crawled to a sitting position against a snowbank, holding his belly, and contemplated a short nap. It was snowing so hard that, after sitting in thought for a few minutes, he was covered in it. Remembering a previous nap in the snow that resulted in the loss of two toes and part of one ear, he finally managed to haul himself to a standing position. He wished he was wearing more than a T-shirt and a black hoodie. Damn. Where was his coat? Fuck. It must be in the bar. Well, he wasn’t going back to find it with the mountain man still there.

Located at the end of Sea Drive in Dutch Harbor, the Bering Seafood Company owned the largest piece of land in Dutch Harbor. The compound sat alone at the base of a mountain, hanging over the water. The property was a cross section of roads, dilapidated buildings, and empty lots of scrub vegetation. In addition to the processing plants, bar, and bunkhouse, the 60-acre property included a mess hall, warehouses, ice house, cold storage, service buildings, offices, and a church.

Most of the roads were paved for the big trucks, but there were no sidewalks or trees on this barren property. The buildings were dingy and rusted from the constant onslaught of the Bering Sea. After five years, Slim knew that Dutch Harbor had only two seasons: winter and mud. It had been a long time since he had looked at the ocean and admired its beauty. During the fishing months, he saw only a volatile, windy beast reluctantly coughing up fish and seafood, and occasionally taking human lives in exchange.

Waves of nausea hit Slim again as he looked around the parking lot. His body hurt, and he was having difficulty orienting himself in this familiar place. Although he knew it should be daylight, the snow was so thick that no light shone through. He knew the bunkhouse was nearer the mountain—up a hill, about 500 yards from the bar—but he was blinded. Slim started to shiver uncontrollably but thought he saw the black of the hillside and started in that direction to what he hoped was the bunkhouse.

The two-story building had high ceilings that left the rooms so cold you could see your breath in the morning. Each floor housed 50 or more men and women. Men were on the first floor, women and men on the second. There were always more men than women, but who could tell the difference? The women were some of the toughest motherfuckers he had ever met.

The new male recruits—along with men who didn’t behave well toward the women—had to live on the colder first floor, which smelled like cat piss, because the ferals would always find a way into the building on cold nights. In the morning the place smelled like fish and shit, and in the evening it smelled like fish, sweat, and feet. Slim was permanently stuck on the first floor, despite his tenure, after one of the women said he assaulted her in the bathroom at the bar last February. He denied it, but they didn’t believe him. He couldn’t really remember anyway.

Slim didn’t care. He didn’t have a woman. He barely had any family. He couldn’t remember when he last saw his sister in Montana. He didn’t even remember when he last ate, but he knew where one of the guys on the first floor hid a bottle of booze that he bought from a local with a home still. The home-brew made Everclear taste like high-end champagne, but at least it was strong. The guy bragged it was 190 proof.

Now that he was starting to sober up, Slim felt much worse, and it was getting harder to move his legs. He kept tripping over his own feet, but somehow managed to increase his pace from a shuffle to a slow walk. There were no street lights in the lot, so Slim was attempting to navigate by following familiar landmarks. Ice had begun to form on his mustache and eyelids. He clenched his fingers and toes to keep the circulation moving. Distracted by pain and snow and frozen eyelashes, he was not paying attention when he stepped into the thoroughfare leading onto the property.

He was nearly halfway across the road before he saw the headlights of a slow-moving vehicle. It was on top of him before he knew it, and once again Slim found himself on his back in the snow. He didn’t know why he felt such terrible pain in his legs, or why he burned his forehead on hot metal when he tried to sit up. His head fell back into the snow. It was throbbing from both a booze headache and his burned forehead. He really wanted a drink.

With the blizzard still raging, the driver could not see what she had hit, so she backed up the van and switched on her bright headlights to view the scene better. Unfortunately, Slim was under the van when the driver put it in reverse and drove over his torso. Now, in addition to injured legs, he had incredible chest pain, breathing trouble, and a head injury.

Slim had been struck by an Alaska Taxi—a van driven by a woman selling sex. He knew these vehicles, which were a common sight on the Bering property, because he had used the services of these women many times. The vans had no windows and a dirty mattress in the back. Some had a red light for atmosphere. There were not enough police to stop them, and they probably didn’t care anyway. That suited Slim just fine. He didn’t like rules.

Just now, however, the taxi was not a source of pleasure for Slim. He was lying in front of the van, illuminated by headlights. He was unconscious and breathing raggedly when the driver reached him. She began yelling for help, and two Bering Seafood employees somehow heard her calls through the wind and driving snow. Dutch Harbor did not have a hospital, and it was obvious that Slim would need medical attention to survive the accident.

The Bering Seafood workers called 911 and carried Slim to the office on a makeshift stretcher of wooden pallets. An ambulance was dispatched, and he was taken to the local clinic. The Iliuliuk Clinic had a small ER for triage and rotating care providers. Its primary purpose was to stabilize and transport critical patients, but it also provided basic primary care to locals. All specialized care required a trip to Anchorage or Seattle.

The nurse on duty met the ambulance in front of the clinic. She took one look at Slim and knew he didn’t have much time, so she arranged for him to be transported to Anchorage. Unfortunately for Slim, the weather was too bad to land a plane in Dutch Harbor, and the clinic there was not equipped to handle this level of trauma.

The Dutch Harbor clinic was privately owned, and the clinics in larger communities like Sitka and Ketchikan were satellites of the major medical centers like Providence in Anchorage. In the smallest communities, the clinics were funded and operated by Native tribes. Only a few medevac companies were operating in Alaska, one with seven bases: Ketchikan, Sitka, Juneau, Fairbanks, Anchorage, Kotzebu, and Dutch Harbor. In a state with over 665,000 square miles that is home to fewer than 750,000 residents, many, many places are not accessible even by plane or helicopter.

Precious time was passing. Slim regained consciousness but was writhing in pain. His breathing was rapid, and his oxygen saturation was at the low end of normal, so the nurse put him on nasal cannula oxygen.

Slim would have died in Dutch Harbor that day were it not for a bit of luck. The nearest US Coast Guard crew—Air Station Kodiak, based in Kodiak, Alaska, 950 miles north—was conducting water-rescue training exercises in Dutch Harbor. Despite the storm, the crew had arrived earlier that day, flying a massive helicopter—one of the few that can handle an Alaskan winter blizzard with winds in excess of 50 miles per hour. The US Coast Guard used these powerful, agile machines for land and sea rescues.

Powered by two turboshaft engines producing 853 horsepower each, the MH-65 is capable of a maximum speed of 175 miles per hour and a range of 290 nautical miles. It had just enough power to take Slim from Dutch Harbor to Cold Bay, 178 miles away—up the chain of Aleutian Islands where the storm was lighter and a medevac plane could meet the helicopter.

Cold Bay is a tiny village (population 50 in 2020) with a massive landing strip (10,150 feet). Located 625 miles southwest of Anchorage, it is home to a former US Air Force base with a continental-defense radar station strategically placed to provide early warning of an attack by Russia.

It is a popular rumor in Alaska that Cold Bay is an alternative landing location for US space shuttles, but like so many Alaskan tall tales, that is not true. Space shuttles actually need at least 15,000 feet to land safely, and there has not been a recorded landing in Cold Bay.

In fact, very little remains of the former Cold Bay Air Force station. The base was closed in 1983, and an updated radar system was moved to a new location five miles away, which was redesignated Alaskan Air Command (AAC). Most of the buildings were crumbling or had been torn down. Only a few hangars, an office, former officer housing, and a few Quonset huts remained. The two asphalt landing strips—the smaller of which is 4,900 feet—had been well-maintained. Most importantly on this day, they also had massive lights for easier landing during inclement weather.

Cold Bay does not, however, have a medical facility. Slim was waiting for the medevac crew in a Quonset hut located beside the landing strip.

GWEN

Same Day

Fairbanks, Alaska

When the call came in from the Dutch Harbor emergency dispatch, it was a sunny 35-degree Fahrenheit October day in Fairbanks. I was in an airplane hangar owned by Sentinel Aeronautics, which housed planes and equipment for emergency medical flights. I had been in Fairbanks for four days, completing the final two weeks of the critical-care medevac indoc training program.

Sentinel’s main office was located in Fairbanks, but most of the training took place in remote locations, simulating actual emergency exercises. I had never been to Fairbanks before, so everything was new to me, and it was an exciting time. Fairbanks is beautiful, particularly in the summer.

During the comprehensive indoc training, medical personnel were taught general maintenance of the interior of the aircraft, procedures for towing the aircraft in and out of the hangar, and emergency procedures for fire or smoke in the cabin. We also learned survival skills in the event of a plane crash and general rules of survival. Much of the training is conducted in a remote wilderness area to best simulate an actual emergency.

Despite popular perception, it is not always cold in Alaska. In fact, the interior part of the state, which includes Fairbanks, experiences temperatures in excess of 100 degrees Fahrenheit in the summer. On those days, it isn’t unusual to see moose and bears cooling themselves in the Chena River that flows through the city. From a topographical perspective, Fairbanks sits in a basin between mountains, which traps and holds air that exacerbates the wide range of extreme temperatures. Those who like changing weather love Fairbanks’ temperature swings, which are among the most drastic in the United States, with sweltering summers and winters that can reach minus 60 degrees Fahrenheit.

A moose standing in a lake Description automatically generated

Moose are not an uncommon sight in Alaska. This one is cooling her heels in the Chena River.

Alaska is a place of extremes, and that includes insects. My training began in August, which is unfortunately mosquito high season. While we all had mosquito nets and were slathered with Deet, they stalked us ravenously. Even when they couldn’t make it through the mosquito net, the buzzing was maddening. Thousands packed onto the net covering my face. The thick cover of mosquitoes that blanketed anything with blood got so bad that we eventually had to move to an area without so much underbrush.

Completing the survival tasks was physically demanding, but doing so while constantly swarmed by mosquitoes was a grueling test of personal will. After completing this training, I never complained about the mosquitoes in my native Wisconsin again.

Despite the insect nuisance, I loved the training. I mastered starting a fire using only flint. I can now identify animal tracks—in particular, APEX predators like grizzly bears and wolves—but also others for tracking food. We learned methods for staying warm and layering clothing for extreme temperatures. We studied survival eating habits, including rationing of food and water, and of course how to forage for food. Every plane was equipped with a fishing net. I had fished many times with rod and reel, but it was a new challenge to find pools and crevices where fish hide and to catch them using such basic equipment.

Weight is always a top consideration for airplane equipment, so everything we carried had to be essential—the lighter and smaller, the better. For example, our survival kit included a wire saw, and I learned to cut dead wood and saplings for fires. That same wire saw can be used to raze vegetation, creating a visible clearing for search vehicles in the air. We also carried items like rubber tubing for water extraction, flares, survival food (protein bars and jerky), parachute cord (sturdy yet lightweight), matches, water dye, and a multi-tool.

The most important lesson I learned during this training is to STAY VISIBLE in any way you can. In case of a plane crash, stay close to the aircraft, or whatever machine you have, because it is probably the largest and most visible object from the sky. Some crashes are survivable, but panicked passengers too often make mistakes that get them killed, like leaving the aircraft to find help. Instead, I learned to use bright fabric vests and light a controlled fire or smudge pot to improve visibility from the air. Other lessons: use flares or water dye if you hear search aircraft approaching, maintain hydration, and avoid hypothermia or heat stroke.

It was exhaustive and exhausting training for a good reason. Crashes among medevac planes, sometimes referred to as air ambulances, are painfully common.

One company alone—which operates in Alaska, Hawaii, and the lower 48 states—had four crashes between 2018 and 2023, including two crashes within just three months of one another. These disasters resulted in the deaths of 11 people: three pilots, three nurses, three paramedics, one patient, and a patient’s family member. The cause of the accidents were either cited as loss of control or are still under investigation because neither the planes nor crews could be recovered from the water. These planes do not maintain a flight data recorder, so we may never know.

The one thing all these flights had in common was that none had a copilot. Research conducted by Embry-Riddle Aeronautical University identified the same risk for air ambulance helicopters, concluding that Safety issues for discussion might include the single-pilot situation . . .

I felt so strongly about the importance of having a copilot that, when the company that employed me was sold and changed the policy to eliminate copilots, I resigned. But that would take another 12 years.

We were also required to complete training on the water. The fishing industry drove most of the need for medevac services, so we were trained by the Coast Guard on how to get into a life raft in open water. (Getting out is not as difficult.) The training was done in the Bering Sea, but thankfully it was a warm, calm August day when the other trainees and I were flown in a Coast Guard helicopter to the training location and were lowered into the sea wearing a wetsuit, life preserver, and radio tracking gear.

Our job was to get ourselves back into the Coast Guard raft, which was 15 feet long and 8 feet wide. When inflated, the raft rose more than three feet above water. It was wrapped with ropes to keep passengers attached to the boat, in and out of the water. It was these ropes that we used to pull ourselves into the boat, but not in the way you might think. Imagine trying to pull yourself up on your belly, wet and wearing nearly 40 pounds of gear. It would take tremendous upper-body strength to pull oneself up into a boat of that size and height. Instead, we were taught to brace the back of our heads against the raft, holding the ropes above our head, and raise our lower body from the water and do a backward somersault into the boat. I was 48 years old at the time and in good shape from running, but I was also the oldest in the training by 15 years, and this was tough. After a couple of attempts and a ton of intense encouragement from the others, I was able to get myself into the boat.

Lastly, we had psychological training to deal with crises, including the concept of resetting. The instructors taught us how to take a metaphorical step back—and take a deep breath to restore calm and logic—in order to make good decisions based on solid data, not emotion. STOP is an acronym for Sit, Think, Observe, Plan. Staying visible and resetting are the two survival training lessons that would save me a few years later when I was detained by the Philippine military. More on that later.

Back in the Sentinel office in Fairbanks, I was attempting to put together a takedown rifle. Every plane is equipped with one for protection and for hunting food. We spent time at the shooting range and had to learn how to assemble and disassemble the gun quickly. Most of the instructors were retired military, and while it might have been their teaching style, I think they enjoyed making students feel incompetent.

Having grown up in Wisconsin, I was familiar with guns and