HOLTVILLE — To say the stylishly mustachioed Paul Nilson has done it all is not hyperbole, to call him a Renaissance man is not a cliché or an understatement.
The 41-year-old Holtville native is an accomplished musician and photographer, who has worked in newspapers, traveled as a freelancer with his camera, worked as a middle-school band instructor and has been separately a park ranger and a firefighter.
He’s also dabbling in farming, something he hopes to pursue more seriously as he gets older.
But today, for the last several years, actually, he’s found his love and his groove as a registered nurse, specifically as a flight nurse with REACH air-ambulance service.
For 24-hour shifts at a time, Nilson dresses like an extra out of “Top Gun,” climbs aboard a waiting chopper stationed out of the Brawley airport, and helps save lives.
“I am absolutely passionate about my job. … I really love being on an elite team. I think it’s amazing,” he said recently. “I love my job. It is so fun to fly around in a helicopter.”
That’s mostly the kid in Nilson talking. The man, well, he’s a bit more introspective when considering the gravity of his current situation.
As one might imagine, Nilson is a busy guy these days, as one part of a three-person crew fully embedded in the county and state’s fight against the formidable COVID-19 virus that has so far killed nearly 100 people from Imperial County and has infected more than 6,500 Imperial County residents since the first week of March.
Nilson is a key player in the more than 500 patient transfers that have occurred of the COVID-infirmed out of Imperial County hospitals since the pandemic started. Although county emergency officials did not provide a breakdown between air and ground ambulance cases recently, Nilson and the various REACH crews, the others of which are stationed out of the Imperial County airport in Imperial, have taken part in a high percentage of the 270-plus patient transfers through June 24 and the total of 480 transfers over a two-month period (May-June).
After El Centro Regional Medical Center and Pioneers Memorial Hospital in Brawley went on a temporary “divert” of their emergency rooms in the first part of May and could no longer accept patients for a several-hours-long period, it’s like a COVID bomb dropped on the community and waves of ground and air transports began from that point on.
Nilson has had the unique perspective of both being in the middle of the madness and witnessing from afar.
As a member of the crew of the only “visual flight rules” REACH helicopter based in Imperial County, his crew sometimes has to opt out of certain runs where weather or cloud cover might be a factor. “VFR” crews have to maintain sight with the ground at all times, and if fog or clouds are present, his team will stand down for one of the “IRF” choppers (“instrument flight rules”) out of Imperial that can fly through heavy cover.
It’s been on those occasions in recent weeks where Nilson has sat back and listened to the radio traffic coming out of the hospitals and airports.
“We were at Brawley by ourselves, and we heard the radio traffic” around the time of the diverts, he said. “It was airship after airship after airship landing.
“Crews would land, jump off, grab patients and take off again. The coordination on the radio was incredible,” Nilson said. “It was non-stop.”
As part of the mix, though, it can be even more overwhelming, and tiring, he said.
“It’s safe to say that all our of medical providers are feeling that way. I know a lot of crew members are feeling emotional and physical stress. We are tired. We come off our shifts tired. We show up to our shift anxious because ‘We know we’re going to fly,’” Nilson said.
He said there is nothing more satisfying than being in the healthcare industry, because people don’t do the job merely for money or prestige, but to make a difference.
However, he implied the COVID pandemic is a different sort of animal, and all nurses, medics and ER staff, all transport crews, whether on wheels or in the air, have talked shop and compared notes.
“It’s exhausting, emotionally and physically … It’s uniquely trying,” Nilson said simply.
On the Frontlines of a National Crisis
Like a lot of first responders, especially fire crews, air-ambulance flight crews work in 24-hours shifts, live, train, and respond together and then are off for extended amounts of time.
REACH crews, as is the industry standard, cannot fly more than 24-hour stretches, so Nilson works 24 on, 24 off, 24 on again, and then five days off, before starting the rotation over.
Wash, rinse, repeat … at volume 10.
In the normal course of things, and by that, Nilson means pre-COVID-19, a crew might do two to three transfers in a 24-hour period, which last about three hours a transfer due to travel time and patient prep on and off the chopper.
With COVID, it might be five to six transfers in a 24-hour period, with an average of five hours per transfer due to flight preparation and “gross decon” measures, or the massive decontamination efforts that must be done to insure the highly virulent disease does not remain on the crew or its equipment and transfer to others.
Lately, Nilson said, in a 24-hour shift, there is no downtime or sleeping. He said the crews are on the run constantly.
Nilson took a reporter on a “virtual” patient transfer to Cedars-Sinai Medical Center in Los Angeles as an example.
He said it’s an eight-minute flight from Brawley airport to El Centro Regional. If the crew knows it’s a COVID flight (and they are still moving out patients with the everyday ailments like strokes and heart attacks), they have to suit up in the layers of personal protective equipment, which for flight crews are gowns, N-95 masks, face shields and two sets of gloves (“I wear two sets so I can peel one off and save time”).
“It takes sometimes an hour to get equipment hooked up to our pumps and ventilator,” Nilson said, and to get the patient inside the helicopter situated.
What might be a 45-minute flight usually is already going on an hour and 20 minutes to get to Cedars-Sinai, he said.
Nilson said that upon arrival the crew hands off the patient and has to carefully strip off all the PPE in such a way as not to contaminate themselves or anyone else. Before leaving Cedars, the crew has to conduct its “gross decon” of all the gear, the gurney, the ventilator and pumps, “anything touched gets wiped,” he said.
Then, the crew has to go fuel up somewhere nearby and head back to base.
Once at Brawley airport, that single call continues, whether considered officially or unofficially, because Nilson said the chopper has to be stripped of “everything not bolted down” and cleaned again, and that means flight manuals and books, electronics and medical equipment, flight suits have to be laundered and laid out in the sun (if the sun is out).
That can last for up to five hours or longer, depending on the distance of the transfer.
Nilson said since the divert, health officials “always want a helicopter somewhere in Imperial County waiting to go,” and so there are often REACH crews from other areas like Victorville, Temecula and Oceanside standing by while Imperial County crews are busy.
Over the last two months, those flight crews have included fixed-wing airplanes from Sacramento and Bishop here for 10 days at a time.
What the Chiefs Don’t Want You to Hear
For those working the frontline in Imperial County, it’s no secret by now that all the talk in hushed corridors among the doctors and nurses is what is happening in Mexico and it’s affect on the hospitals in Imperial County, especially ground zero: ECRMC.
It’s no different for the flight crews and those in the business of transferring patients.
A few brave enough to not give a damn have talked to the media (“The Rachel Maddow Show” on MSNBC). Some of those vocal enough have been travel nurses who don’t have to worry about their jobs, but it’s been rare to hear from nurses who work and live in the community.
Word has gotten around that some nurses have been reprimanded for being vocal, and there has been talk that between 20 and 40 percent of all emergency traffic related to COVID at the local hospitals has been from those who call Mexicali home, whether they are legal resident immigrants with addresses in Imperial County or U.S. citizens living in Mexico for whatever reason. Either way, these patients cannot be denied healthcare in the United States.
Nilson understands that. He talked about Mexicali with kit gloves, too. “It’s a touchy subject,” he said.
“We can’t blame it all on Mexico. We still have 200,000 people (here), but the reality is, we have an uncounted population not counted in these stats,” Nilson said. “We should take these statistics (local COVID numbers from the county Public Health Department) with a grain of salt.”
“Lots of people are crossing the border with COVID and seeking healthcare from the United States. Why wouldn’t you, if you’re able to be treated in La Jolla instead of Mexicali?” Nilson asked rhetorically. “But we’re two very small hospitals trying to serve a population that we’re not accounted for.”
That’s all Nilson would say. He made no judgment either way. He didn’t demand the borders be closed to those ill with COVID, like some in the healthcare industry have and do.
Within REACH of the Perfect Profession
Still, Nilson said he nearly has the prefect job, and he loves it with all his heart. In fact, he knew he would the minute he got the notion that this was his life’s goal while trying to figure out what to do next.
The vagabond musician and itinerant photographer graduated from the University of Montana with a Bachelor of Arts in International Business with a minor in Spanish (he can’t even remember the year), but for a guy whose decidedly more artsy, that was never going to stick.
After several years working at one of the local newspapers as a photographer and traveling around again for a spell, Nilson was roped into being the band instructor at Holtville Middle School for a year starting around 2006.
He loves music. Nilson still gets together with a band of alt-country diehards in Los Angeles in a group called Wet Texas, where he sings and plays mandolin and harmonica, and gigs during extended times off, “But I do not enjoy middle school students,” he joked recently.
“I didn’t have any interest in being a teacher. I did it for a year as a favor,” he said.
After his year was up, still searching for his purpose, Nilson took a job as a part-time U.S. Bureau of Land Management emergency medical services ranger during off-road season at the busy Glamis dunes.
He was unprepared and ill-equipped to deal with the job, he said, and that season, they had 14 fatalities and hundreds of trauma calls, and “I loved it!”
Nilson said he remembers one particularly hairy situation where he and others didn’t know what to do and were all but panicking and in comes a bright red REACH helicopter, and off jumps a nurse who was in total command of the situation. Nilson said the nurse put everyone at ease and knew his stuff.
“I made a goal and set my sights. I knew I wanted to work for REACH,” he said.
To get there, he would need to become an EMT, then a nurse, log time in an emergency department and chip away at several layers before landing his dream gig.
“I got on at the Holtville Fire Department while I was getting my EMT certification,” Nilson said, while going to Imperial Valley College to get his nursing program pre-requisites.
He then got hired on at ECRMC as an “ER tech” while still going to nursing school at IVC, from which he graduated around 2010/2011 with his registered nursing certification. He then worked several years in the ER to gain experience before leaving for REACH, where he has been for more than three years.
Where Nilson is Going?
Nilson, who has 50 percent custody of his 4-year-old son, Otto, recently purchased some land outside Holtville from his family’s trust and plans to try his hand at a future in farming, although not in any serious way for some years.
All he’s got now is a 1963 antique Farmall tractor and a lofty dream of planting a “corn maze” and “pumpkin patch” someday with Otto.
He still loves his job with REACH, he just knows that at some point, his knees are going to start yelling at him as he jumps off and on a helicopter for several more years.
Today, he’s still working on the irrigation system and series of canals around his 10 acres. Maybe he’ll plant some “wheat or oats or alfalfa or onion seed” by the end of the summer.
“I’d like to plant some vegetables, but I don’t have the equipment,” he said.
“I’m good for the next 10 years before retirement, or so to speak,” Nilson said.