PRESCOTT - The vehicle had rolled down an embankment in the Cliff Rose neighborhood the morning of Jan. 18.The driver, a man in his 60s, was trapped briefly in the wreckage, having been battered by the tumble from the residential street and by a loose bowling ball that bounced around inside as the vehicle rolled.He had some very serious pre-existing medical conditions, so rescue crews made the decision to have him flown to a Phoenix hospital.Minutes later, Native Air Ambulance 4, an Airbus A-Star 350 B3 jet helicopter, was overhead and preparing to land on Oriental Avenue. Firefighters "waved off" the helicopter when a wayward blue plastic tarp blew into the landing zone, followed by a large plastic toy truck. The firefighters collected the objects and the helicopter set down, the victim was loaded, and then Native 4 lifted off for Phoenix's John C. Lincoln hospital.It was just another day at the office for the three-person crew.The two Yavapai Regional Medical Center campuses in the Quad Cities are the home base to two medical evacuation helicopters, Native Air 4, at the west campus, and Native Air 14, at the east.They see frequent use, because the YRMC hospitals are designated "Level 4" trauma centers, but major, life-threatening injuries require the services of larger "Level 1" trauma centers, found in Flagstaff or Phoenix.Pilot Josh Micale, 36, has worked six years for Air Methods, the Denver, Colorado company that owns Native Air. He's accumulated 3,000 hours in helicopters, having worked his way up from flight instructing to flying crews and equipment to off-shore oil rigs in the Gulf of Mexico. The nature of the job takes the helicopter to diverse and challenging landing areas."If we're going out into a forest, we're dealing with a lot more high obstacles, like the trees," he said, but when they land "off-airport," there's always a trained fire or medic crew to watch for trouble and wave off the helicopter if there's an unsafe situation."Some of the scene calls can be a little bit dangerous," he added, but not for the reasons you might think. "When there's people around" the idling aircraft, "if they come up and try to approach the helicopter, that can be dangerous."Safety RecordOn Dec. 15, 2015, just before 5:30 p.m., Native Air 5 crashed near Superior, killing the pilot and flight nurse. The flight paramedic survived and was able to signal a rescue helicopter with a flashlight.The helicopter had refueled at Phoenix-Mesa Gateway Airport and was flying to a hospital base in Globe.There was no patient on board.The National Transportation Safety Board's investigation on the cause of the crash will take several months to complete. There are about 1,000 helicopters flying emergency medical service in the U.S., and, according to the Atlas & Database of Air Medical Services, nearly 60 in Arizona alone. The safety record of helicopter emergency medical services, or HEMS, is a hot-button topic in the aviation community.According to the NTSB, there were 220 HEMS crashes in the U.S. between 1990 and 2015, resulting in 214 deaths. In 2007, a researcher at the University of Chicago Hospitals said that, statistically, HEMS pilots' fatality rates "far exceed any of the high-risk occupations."In February 2014, the FAA issued new rules for helicopters, including air ambulances, which mandated safety equipment and new operating procedures, in an effort to decrease crashes.But there will always be an element of risk associated with helicopter EMS. One man who knows that fact intimately is Jerry Foster.Now retired, Foster was the country's first helicopter pilot/reporter. He was a fixture on Valley TV newscasts for years, as often as not, foregoing a great news story in favor of saving a life with his helicopter. But before that, Foster pioneered civilian air rescue as chief pilot of the Arizona Department of Public Safety's Air Medical Evacuation System in the 1969.It was designed to see whether lessons learned about evacuating patients from the battlefields of Vietnam could be applied to saving civilians in the U.S."That's what we showed here," Foster said, which led to DPS getting into the helicopter business "as did every other state in the county." Private companies, like Air Methods, followed.Foster said EMS pilots face tough conditions."EMS is a very demanding job, because it's one of those where you fly in all weather, day or night, and somebody's life is probably depending on that flight," he said. "It's a very difficult job."And, he added, Arizona has long been recognized as a "hostile environment" in which to operate helicopters."The reason for that is, you have, for example, dust storms which are very hard on the rotor blades and hard on the engines; you have high-altitude stuff, (and) you have low-desert stuff."There's always the unexpected, particularly weather," Foster said. Still, "with helicopters, you can get into some pretty bad weather and do some pretty amazing things."While weather will always be a factor in helicopter operations, Air Methods has placed the choice to fly squarely in the pilot's hands."We don't get the patient information until after we've accepted the flight, so we can't consider the condition of the patient in order to make a go / no-go decision," pilot Micale said. "If I don't feel safe or the crew doesn't feel safe, we don't go."The lack of detail about the patient's condition imparted to the crew "is done on purpose to not influence our decisions."Micale said he's never been asked or told to fly Native 4 when he felt it was unsafe, which was not the case in previous jobs."I have in the past (been told to fly when he felt it was not safe), with other companies, quite frequently, but Air Methods has a policy where management is not allowed to question our weather decisions."Loving Their JobsThe remainder of the crew is made up of Flight Nurse Joe Uridil, 41, and Flight Paramedic Erin Davidson, 38. The three are a close-knit team, with Davidson calling the tall, burly Uridil "our male nurse, or merse," Uridil referring to the petite Davidson as "the short one," and both calling Micale "the baby of the group."Uridil has a military background, having been a Navy corpsman. He was a paramedic and has worked in a hospital's neuro-trauma intensive care unit.The job he has now, though, is "the best of every world," because it allows him to use all his skills "outside, in a helicopter."He points out that, while "a lot of nurses aspire to this job, not everyone can do it."It's a challenge to treat a patient in the small space of the helicopter, and there's always time pressure. Even the fact that they wear helmets means they can't use a stethoscope.His favorite story about saving a life is not about a dangerous rescue, but an inter-hospital transfer of a young father with internal bleeding who had to be moved to Flagstaff Medical Center. "Because we were able to provide the care we did en route," Uridil said, "the surgeon came back and said, 'He's going to be OK.'"That's why I come to work."Davidson said the public tends to ask about "the worst thing" they've ever seen, a question she doesn't like to answer. "A lot of time, the worst things we see - that's what stays within us. We don't share that," she said. "We talk amongst each other about things that might be bothering us, but we keep that to those of us who understand it."We don't want bad things to ever happen to anybody, but we take a lot of pride in being able to do something about it. I love coming to work."Recently, as they were landing at a hospital, a patient being transported said to the crew, "You guys really like your job, don't you?""If our patients see that we enjoy what we're doing, that means we're doing a good job," Davidson said. "That's a huge compliment."Follow Scott Orr on Twitter @AZNewsguy. Call him at 928-445-3333 ext. 2038 or 928-642-7705.