Eighty-five cubic feet, or about the size of the inside of a VW Beetle.
That’s the amount of room available inside one of Guardian Air’s medical helicopters for a pilot, a nurse, a medic and all of the equipment that’s normally carried in an ambulance.
With seven bases that span an area from Kingman to Tuba City to Show Low, the air ambulance service transports patients from some of the most remote and rural places in northern Arizona. Medical staff see everything from trauma cases to heart attacks to high-risk maternity cases.
But because the main cabin in the helicopter is already a squeeze, in the rare occasion that a patient goes into cardiac arrest, for example, it’s a struggle for the nurse or medic to give CPR that could help save a person’s life, said Dean Hoffman, one of Guardian Air’s medics.
It’s frustrating and taxing, he said.
“You’re trying as hard as you can and you might not be delivering adequate compressions,” he said.
Those chest compressions are what keep oxygenated blood circulating to the heart, brain and other organs while medical staff work on getting the patient’s heart contracting regularly again.
It’s the cornerstone of a successful resuscitation, because without oxygenated blood the heart and brain start to die, Hoffman said.
A couple of years ago, Guardian Air conducted a study that confirmed its medics and nurses weren’t delivering the necessary force or compression rate when they were delivering CPR on test patients in the helicopter.
“We’re just too space-limited,” Hoffman said.
Using a mannequin, he demonstrated what it’s like trying to give CPR in the cramped cabin while the aircraft was parked at Flagstaff Pulliam Airport on Tuesday. His body barely fit between the mannequin and the ceiling, leaving little room for his arms to do the necessary compression movements.
So instead of humans, Guardian Air looked to machines and found an automated chest compression device. Studies show the device, with a band that wraps around a person’s chest and contracts at a preset rate and pressure, is more effective at providing chest compressions than humans in a moving device like an ambulance or a helicopter.
It doesn’t need as much room to operate and can also deliver constant compressions while providers ideally need to switch out every two minutes, which can be hard in the cabin of a moving helicopter.
It also frees up providers to focus on other tasks like helping guide the helicopter, administer medication or think about treatment options, said Dustin Windle, interim program director for Guardian Air.
The company is trying out one machine at its Winslow base, which has a high call volume, to assess the logistics and effectiveness on patients. If the trial period goes well, the hope is to get the funding, whether through grants, donations or the company’s budget, to buy seven of the $11,000 machines to have one in each of the helicopters, Hoffman said.
The machines are already in use by Guardian Medical Transport, the emergency ground service that is under Northern Arizona Healthcare’s umbrella along with Guardian Air.
Battalion Chief and paramedic Pete Walka said the ambulance service uses the automatic chest compression devices whenever paramedics are moving a patient to and from the ambulance or in the ambulance. It’s virtually impossible for people to deliver high quality compressions during those times, Walka said.
Five years in, the machines are used on every cardiac arrest patient transported from the scene of an accident to the hospital, Walka said. He estimated that Guardian Medical Transport treats 75 cardiac arrest patients per year.
The remote nature of Guardian Air’s service area makes the automated chest compression device even more valuable, Hoffman said. The Navajo Nation, the Hopi Reservation and the more rural areas along Interstate 40 have fewer facilities, more often necessitating long transport to a larger hospital like Flagstaff Medical Center, he said. The medical facilities in those places also are not as well-equipped so a patient might be in worse condition than if they were being treated at a metropolitan hospital, Windle said.
Hoffman estimated that the device would be used relatively rarely, though it could have life-altering outcomes.
"In my mind, any critical patient, this would be put on them and if they were to experience a cardiac arrest all you would have to do is push a button," he said.
The Maverik gas station on Butler Avenue near Sinagua Middle School and Knoles Elementary School has been testing the neighborhood waters about applying for a beer and wine license. The store sent out notices to neighbors a couple of weeks ago, according to Meadows resident Elizabeth Elgin.
The postcard-sized notice, which was also available at the store, stated that the store was working with the city of Flagstaff and the Flagstaff Unified School District on the possibility of applying for a license to sell beer and wine at the store. It also stated that it had the support of both the city and the school district in the endeavor.
Elgin said she was particularly concerned because she has grandchildren who attend one of the schools. She also has neighbors who have raised concerns about the possibility that alcohol sales would attract transients to the nearby Foxglenn Park.
Elgin said she spoke with the principals from Sinagua and Knoles and a representative from the FUSD district office. All three told her they had never spoken to Maverik about the possibility of applying for a license and had not given their support to the matter. She also called the city of Flagstaff and was told that no license application was on file for the store.
Calls and emails to Maverik were not returned before press time. The website with a tab for a survey to collect suggestions from the community about the possible license was still up, but the survey had been replaced with “Thank you for your input.”
Karin Eberhard, the district relations coordinator for FUSD, said, “Due to the proximity of this Maverik to both Sinagua Middle School and Knoles Elementary School, FUSD is not in support of liquor sales at this Maverik.”
The store applied for a beer and wine license in 2012, before the convenience store and gas station were built, but withdrew the application after it faced stiff opposition from FUSD and the neighbors. The Flagstaff City Council recommended the state deny the license.
According to Arizona Revised Statutes, a business can apply for a liquor license from the state if the business is more than 300 feet from a church building, school building or an activity field adjacent to a school. According to Coconino County’s GIS maps, the store is more than 700 feet from the main buildings on the Sinagua property, 187 feet from a portable classroom on the Knoles campus and around 150 feet from the ballfields at Foxglenn Park. However, the ballfields and the park are owned by the city, not the school district.
According to state law, the city could approve an exception to the distance restriction, if it designated the area an “entertainment district.” However, state law defines an entertainment district as an area of no more than one-square mile and less than one-eighth of a mile that contains a “significant number of entertainment, artistic and cultural venues.” The area surrounding the Maverik on Butler Avenue is mostly residential, with the exception of the schools and the park.
DENVER — From its headquarters in Washington, D.C., the U.S. Bureau of Land Management oversees some of the nation's most prized natural resources: vast expanses of public lands rich in oil, gas, coal, grazing for livestock, habitat for wildlife, hunting ranges, fishing streams and hiking trails.
But more than 99 percent of that land is in 12 Western states, hundreds of miles from the nation's capital. Some Western politicians — both Republicans and Democrats — are asking why the bureau's headquarters isn't in the West as well.
"You're dealing with an agency that basically has no business in Washington, D.C.," said Colorado Republican Sen. Cory Gardner, who introduced a bill to move the headquarters to any of those dozen states: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington or Wyoming. The Bureau of Land Management manages a combined 385,000 square miles (997,000 square kilometers) in those states.
Colorado Republican Rep. Scott Tipton introduced a similar measure in the House, and three Democrats signed up as co-sponsors: Reps. Kyrsten Sinema of Arizona, Jared Polis of Colorado and Ed Perlmutter of Colorado.
Some Westerners have long argued federal land managers should be closer to the land they oversee, saying Washington doesn't understand the region. Now they have a powerful ally in Interior Secretary Ryan Zinke, a Montanan who is leading President Donald Trump's charge to roll back environmental regulations and encourage energy development on public land.
Zinke said in September he wants to move much of the Interior Department's decision-making to the West, including the Bureau of Land Management, which is part of the agency.
The Washington Post reported last month Zinke's plan includes dividing his department's regions along river systems and other natural features instead of state borders, and using them to restructure oversight.
A big part of the bureau's job is to lease drilling, mining and grazing rights on public land to private companies and individuals. That puts it at the center of a heated national debate over how those lands should be managed, and by whom.
Some recent disputes:
— Much of Bears Ears National Monument in Utah, created by President Barack Obama and greatly reduced by Trump, is on Bureau of Land Management land.
— Rancher Cliven Bundy's long battle against federal control of public land, which culminated in a 2014 armed standoff in Nevada, began on bureau acreage.
— More than 50,000 square miles (123,000 square kilometers) of Bureau of Land Management land in the West is at the heart of a debate among conservationists, ranchers and energy companies over how much protection to give the shrinking population of the greater sage grouse, a ground-dwelling bird.
The bureau manages more public land than any other federal agency, ranging from about 1 square mile (3 square kilometers) in Virginia to nearly 113,000 square miles (293,000 square kilometers) in Alaska. That doesn't include national parks or national forests, which are managed by other agencies.
It has about 9,000 employees, with fewer than 400 in Washington. The rest are scattered among 140 state, district or field offices.
"The larger issue is that states and counties that are predominated by public lands are deeply affected by decisions made by BLM," said Kathleen Sgamma, president of the Western Energy Alliance in Denver, which represents the oil and gas industry. "So it makes sense (for the headquarters) to be in a state where there are a high percentage of public lands."
In Nevada, where the Bureau of Land Management manages 66 percent of the land — a bigger share than any other state — Republican U.S. Rep. Mark Amodei called the idea intriguing but stopped short of endorsing it.
"I'm excited about the fact that they're looking at it," he said.
Amodei said he has spoken with bureau officials in Washington who know so little about Nevada they thought the land under a highway interchange was wildlife habitat.
Few say moving the bureau's headquarters would tilt its decision-making toward commercial use or preservation and recreation.
But some environmental groups question whether it would produce real benefits.
Aaron Weiss, media director for the Center for Western Priorities, said Zinke has been limiting opportunities for local comment on national monuments and BLM planning, and moving the headquarters West wouldn't reverse that.
Weiss also suggested Zinke could use a headquarters move as a cover to get rid of employees he considers disloyal.
"We absolutely question his motives," Weiss said.
Zinke's spokeswoman, Heather Swift, said Weiss's claims are false. More than 2 million people submitted comments during the Interior Department review of Bears Ears and other national monuments, and Zinke held more than 60 meetings with local people, she said.
Zinke doesn't believe his proposed reorganization will result in job cuts, Swift said.
Athan Manuel, director of the Sierra Club's public lands program, said the Bureau of Land Management is already decentralized, and moving the headquarters would waste money.
"It's a solution in search of a problem," he said.
Some Bureau of Land Management retirees also are skeptical of the move.
The bureau needs a strong presence in Washington for budget and policy talks, said Steve Ellis, who was the agency's deputy director when he retired in 2016 after 38 years in civil service, both in Washington and the West.
"The relationships in the West are so important, but the relationships in Washington are also important," Ellis said. "You need the both for the agency to be successful and thrive."
PHOENIX -- Arizona may finally be ready to join the 47 other states who find the practice of texting while driving so dangerous that they have made it illegal.
But supporters of the ban, who have come up pretty much empty-handed for more than a decade, are having to agree to some limits to try to push the bill to the finish line and get it signed into law.
SB 1261 as approved Tuesday by the Senate Committee on Transportation and Technology, would create a fine of no more than $99 for a first offense and $200 for repeat violations.
Only if the person using the cell phone or similar device is involved in a mishap that causes death or serious injury would the offense rise to the level of a misdemeanor. But even then, the maximum penalty would be four months in county jail and a $4,000 fine.
Sen. Steve Farley, D-Tucson, who has made passage of some sort of restriction a multi-year effort, also had to agree to language which says that citations can be issued only if the texting was witnessed by a police officer or "established by other evidence.'' But motorists would not have to surrender a phone to an officer who wants to determine if that person was, in fact, texting.
And the legislation spells out that a conviction for a driving-while-texting offense could not be used by the Motor Vehicle Division to take away someone's license, nor be an excuse for an insurance company to raise a motorist's premiums.
The law would apply statewide like other traffic laws, but Farley told Capitol Media Services that cities like Flagstaff that already have a texting ban could continue to enforce their own laws as long as they are at least as strict at the state's.
The unanimous committee vote sends the measure to the full Senate. But the real challenge could be in the House where lawmakers repeatedly taken a harder stand against what some see as "nanny state'' regulations.
That logic drew a slap of sorts from Sen Bob Worsley, R-Mesa, who chairs the Senate panel.
"Sometimes it just seems like our political ideology gets in the way of common sense,'' he said, saying that lawmakers, in discussing this issue "have had a hard time ... to see through a common-sense lens.'' And Worsley had a message for the parade of people who testified, some holding pictures of loved ones who were killed by distracted drivers.
"I'm sorry it's taken so long,'' he said.
If it does get approved, that would leave just Montana as a state with no laws on driving while texting. Missouri law governs only motorists younger than 21.
SB1261 was crafted by Sen. Steve Farley, D-Tucson, who has waged a multi-year battle to outlaw the practice statewide. In the interim, some cities and counties have enacted their own bans. But that leaves vast areas of the state with no regulation -- and where motorists are free to tap away at messages while driving down the highway.
But even the local laws may not be truly effective.
Michael Infanzon who lobbies for American Brotherhood Aimed Toward Education, said he has been told that the Department of Public Safety, which patrols all numbered roads, does not issue citations to those who violate local no-texting bans. That leaves broad stretches of highways where those ordinances are virtually ineffective.
Infanzon also took a swat at the penalty provision.
"A misdemeanor for killing somebody is not enough,'' he said.
Farley, however, said the legislation does not preclude a motorist from also being charged with other offenses from the same accident, including reckless driving or even manslaughter. And Sen. Lisa Otondo, D-Yuma, said those who find the penalties inadequate need to recognize the political reality of the multiple failed attempts to enact any law.
"If this is the answer for now, we'll take it,'' she said.
The measure has something else going for it: Farley modeled after legislation approved last year in Texas which finally decided to ban the practice and become No. 46 among states with such a law. That occurred after the Texas Department of Transportation said 455 people died in the state due to distracted driving, with more than 3,000 serious injuries.
Aside from the limits on penalties, SB 1261 has a variety of exceptions.
For example, texting using a hands-free device would remain legal, even to the point of motorists being able to use their hands to activate or deactivate a function. So would using the device to play music as well as use the GPS and mapping functions.
This year's bill come a year after Sen. Karen Fann, R-Prescott, engineered approval Arizona's first-ever driving-while-texting ban, a limited law that applies only to teens for the first six months they are driving. That was a political decision, with Fann conceding at the time that anything more would not get approved.
To get her 2017 measure heard in the House, Fann also promised that it was not a precursor for more far-reaching restrictions. And she specifically vowed she would not be sponsoring an across-the-board ban on texting while driving in subsequent years.
Fann told Capitol Media Services she has kept that promise even though she is signed on the bill as the lone co-sponsor with Farley. She said that SB 1261 is officially Farley's measure.