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ST. LOUIS – In a small cockpit they're responsible for saving the lives of tens of thousands of people in need of critical medical attention.

Arch Air Medical works in conjunction with fire, EMS, and local law enforcement professionals, as well as 911 dispatch centers. NewsChannel 5 was able to follow them along for a mock rescue effort to see how they operate.

Time is of the essence for these men, and their office is in the sky.

"The nurse will be in charge of the patient and on the next flight the medical will be in charge," said pilot nurse James Burnett.

Burnett is the pilot of this crew, but he's not trained medically.

"In fact I prefer I wasn't, so I don't get involved emotionally on what's going on in the back of the aircraft," said Burnett.

And that can range from a critically injured child to someone who's willing to put up a fight.

The helicopters can fit up to five people in the crew compartment, but things can get tough if they have a patient who is combative, someone who might be trying to pull out their IVs or pulling on medical equipment.

"They don't really know what they're doing, they're high on drugs or they're drunk. They're fighting us and we can't really have someone trying to undo their seatbelts and wanting to get out of the aircraft when they're at 1,500 feet," said Burnett.

Combative patients aren't their only worry.

St. Louis weather is crazy. It can be all over the place," said flight paramedic Davey Davis.

"The FFA throws up walls that we have to fly through or around and over," said pilot Robert Little.

During the summer, Arch Air Medical transfers about four patients a day. During the winter they average about to. They can't fly during severe high winds and thunderstorms.

Little has been flying for more than 30 years. He doesn't give in to the pressure.

"When I'm in the cockpit, what I have in front of me is what my focus is," he said.

And even when he gets to the destination, "There's a lot of intersections here that we literally know by heart," said Little.

Landing the helicopter presents its own challenges, depending on the size of the landing area or any boundaries set up by emergency responders.

On the ground, a critically injured patient may be in desperate need of hospital attention. But in the air the pilot is still trying to figure out how to ground the aircraft.

"Our aircraft generates a lot of down wash- with its winds from the rotor system and depending on the wind on the ground the down wash can affect the accident scene itself," said Little.

The air ambulance service isn't cheap.

"It's no secret. They can be anywhere from $15,000 to $30,000 for an average flight," said Mike Kennedy with Arch.

But saving a life is priceless.

"I constantly get calls and updates that say, hey you flew my mom, she had bypass, she's home, she's doing well," said Burnett.

"I do enjoy flying, it's really nice. It's peaceful up there. It's a unique job and I feel very lucky to have it," said Davis.

Arch Air Medical has seven based in the Missouri and Illinois region. It has provided coverage to the area since 1979.

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