“Not all just blood and catastrophe”: 14 hours on the road with the air rescuers

Shortness of breath, 61-year-old patient. The control center pulls the crew from breakfast at 10:13 a.m.: Hauke, the emergency doctor, Ingo, the pilot, and Torsten, the paramedic. They put on their shoes and run through the hangar. They put on their helmets and buckle up. Four minutes later, the rescue helicopter "Christoph Weser" takes off, climbs steeply to 250 meters, and zooms over houses, the Weser River, gardens, and houses.

Looking for a suitable landing site: When the air rescuers are called, time is of the essence.

Source: Saskia Heinze

Seven minutes later. Landing pad 23 has been reached. Or rather: a small patch of meadow on the outskirts of town. This time the ambulance is already there – but without an emergency doctor. Hauke is just supposed to quickly assess what medication is needed to ensure the patient can get to the nearest hospital. "Such missions happen often," explains Torsten as the helicopter lands back at the airport at 11:02 a.m. "It's not all blood and disaster."

The "Christoph Weser" takes off from Bremen 600 to 700 times a year. In an emergency, every second counts. The air rescuers treat critically injured patients and fly them to the appropriate hospital as quickly as possible. They care for truck drivers after a crash on the highway. They also care for children infected with the RSV virus who are having difficulty breathing. They rush to fires, treat trapped limbs, complicated fractures, and heart attacks. The control center calls "Christoph Weser" even when all other ambulances on the ground are already occupied.

Two-thirds of the missions are now "secondary": That is, the "Christoph Weser" transports intensive care patients who have already received initial treatment from one hospital to another. This is due to capacity constraints and because not every hospital can handle everything. For example, a heart attack patient from a rural district hospital may need bypass surgery in a specialized urban hospital. A child with severe burns may be transferred from the scene of the incident to a large children's hospital. Or a patient with severe pneumonia may be transferred from the intensive care unit to a distant rehabilitation clinic to learn to breathe without assistance again.

A flight distance of around 500 kilometers is possible on one tank of fuel from Bremen, at a maximum speed of 270 kilometers per hour. The "Christoph Weser" often flies across Lower Saxony to transfer patients – especially during the summer holiday season, for example, regularly to the North Sea islands. It takes 45 minutes from Bremen to Borkum. Recently, they were called to transfer a stroke patient to Heligoland. But they also fly to the coast, to Cuxhaven – for a speedy transport to Lüdenscheid near Dortmund. Flight time, there and back: three hours. "Distances like that are relatively normal for us," explains pilot Torsten.

Two hours pass on the Bremen ward when the beeping starts again. The control center announces: A patient in his early 60s, unconscious, on a ventilator, weighing 94 kilograms, collapsed at work that morning, the cause unknown. "Less time-critical," explains Torsten, looking at his cell phone. "Classic secondary." To free up beds in the intensive care unit in the Bremen metropolitan area, this patient is to be transferred to a less busy one in the surrounding area. Pilot Ingo quickly checks the weather; if the clouds are too low, they can't take off. But: "Everything's stable." After eighteen minutes, the helicopter takes off again.

Patients requiring intensive care are transferred to a stretcher and pushed into the helicopter for transport.

Source: Saskia Heinze

"Should we just move him?" the paramedic asks a few minutes later. The unconscious patient is rewired. The IV lines and ventilator are replaced. Then the air rescuers push the patient on a stretcher into the helicopter.

He doesn't notice the eight-minute flight to the clinic 40 kilometers away. He doesn't notice the rattling and humming. He doesn't notice the view over the houses, the harbor, the meadow, the forest. He also doesn't notice that after arrival, the cables are swapped and the equipment is changed again, or that the helicopter emergency doctor tells the staff there about his medical history. It's still not entirely clear why he collapsed that morning in the first place.

Return flight. It's windy, and your stomach feels it. At 3:46 p.m., we head back to the ward. The mission lasted two hours. "Strong coffee?" the pilot asks the group. That's supposed to help with the nausea. The crew says that such time-consuming and exhausting transfers of intensive care patients from hospital to hospital are likely to increase significantly in the future, especially due to the centralization of hospitals.

This is also the view of DRF Luftrettung, and applies to all of Germany. A statement from early January 2025 makes it clear: We must prepare for an increasing number of transfers – including by helicopter.

At first glance, Germany appears to be well positioned, with 94 rescue helicopters in operation nationwide. However, there are still "white spots," especially in rural areas. These are regions where ground rescue services simply cannot be on-site within minutes in an emergency. And stroke patients simply cannot be flown to a suitable hospital within an hour of receiving an emergency call.

With the hospital reform, the trend is more likely to be toward the closure of numerous smaller hospitals. Instead, specialized centers in urban areas are gaining more importance. This also means that transport distances are becoming longer for some patients – especially those living in rural areas.

Wasting no time: They run through the hangar. At the same time, the air rescuers discuss information about the flight and the patient's condition.

Source: Saskia Heinze

Another alarm, 4:47 p.m. Truly time-critical. A patient with an aortic aneurysm, discovered by chance during a routine examination. If it ruptures, the air rescuers explain as they goose-step to the helicopter, it will lead to death within seconds. What if that happens during the flight? "There's nothing you can do," says Torsten.

River, fields, wind turbines, sea. First destination: Bremerhaven. A brief exchange with the relatives at the hospital. They still want to give her a cell phone and a change of clothes. "There's really no time for that in an emergency like this," the paramedic explains. The patient needs surgery as soon as possible. In Hamburg, a half-hour flight away.

Pilot Ingo Reckermann approaching the University Hospital Hamburg-Eppendorf.

Source: Saskia Heinze

Meadows, Altes Land (Old Country), a bit of rain, more wind, more nausea, the Elbe River. Past the stadium, the zoo, the Elbphilharmonie. The pilot becomes more focused. There's more going on in Hamburg: another helicopter, a passenger plane, a transport plane. The patient? She remains stable until she gets to the university hospital. The emergency doctor and paramedics are with her in the back seat. The monitor beeps steadily.

Arrival in the emergency room. The opposite of calm. The chief physician greets the crew, saying, "You did a great job, the scan is about to begin, then surgery." Six people in scrubs bustle through the room. Prognosis? Hard to say. The air rescuers' job is done at this point. "In the vast majority of cases, we don't know what happens next to the patients," says Torsten. They don't have the time to inquire about all their fates. "There's sometimes a misconception about the profession."

Paramedic Torsten Freitag pushes the stretcher from the emergency room back to the landing platform.

Source: Saskia Heinze

He often feels that the work of air rescuers is not properly understood. For example, when a helicopter lands on private property under time pressure, and residents express extreme outrage over a broken vase or marks on the lawn. When they rush to an accident and a crowd forms around them, taking photos and videos of the injured and the team without permission, thus ultimately hindering the rescue operation. But also when they are alerted and it turns out on the scene that the emergency isn't actually an emergency.

6:54 p.m. The crew lands back at Bremen Airport. Now they're hoping for some peace and quiet. To document their missions. To check supplies, medical equipment, and technology. To eat something, go to the bathroom. Maybe a bit of a workout, table tennis, or watch football. There are days when not much happens. But most days, they're deployed at least three times after 8 a.m. – like on this shift.

The air rescuers are on call until sunset. After that, their helicopter is no longer allowed to fly, according to regulations. Will the control center get in touch now? Unlikely, they speculate. But anything is always possible.