TRUCKEE - Greg Poirier has both feet and both hands working controls as he steadies his four-passenger Care Flight helicopter into a climb.
With his right hand on a joystick, his left hand on the throttle and two feet working pedals that stabilize the craft, Poirier and two registered nurses lift off from the Martis Valley and head into a mild snowstorm, whirling toward a six-car pileup near Gerlach.
Details of the accident come in over the radio as Poirier urges the helicopter forward.
Behind Poirier - surrounded by an emergency monitor, a ventilator, a stash of nearly 70 types of drugs and a gurney - and nurses Marti Robinson and Christopher Bourn ready themselves for arrival.
"It's like a miniature (intensive-care unit) or (emergency room)," said Robinson of the back seat of the helicopter.
But before the aircraft climbs over the Sierra and drops into the desert, the call is canceled and the Care Flight crew choppers back to base at the Martis Valley fire station near the Truckee Tahoe Airport.
Mid-air cancellations and turnarounds are not unusual for the trio, who are on call at all times.
Not much is out of the ordinary for the crew who can be sent at a moment's notice to any type of emergency within a 150-mile radius.
One day the chopper could be flying to aid injured back-country skiers or snowmobilers, and the next touch down on a highway to fly a car accident victim to a trauma center.
"It's pretty dynamic," said Poirier. "You have to be on your toes."
And that's what Robinson, a seven-year veteran of air ambulance nursing, likes about her job.
"I love being outside, and the constantly changing situations - the variety," she said.
Bourn and Poirier were recent additions to Care Flight since the company upped its presence in Truckee from 12 hours a day to a permanent 24-hour operation. The company also operates helicopters out of Reno and Gardnerville.
"There was a need here we were not meeting," said Deb Milliner, Care Flight director, of the reason the Truckee base went from a daytime operation to a permanent base. "There were flights we were missing because we were not here."
When not in flight or readying equipment, Bourn is often tilted back in one of the office's numerous brown recliners with one of a basket load of medical books he is reading.
When an emergency call comes, some of the information in those books may become critical in a crunch.
"You have to have a vast knowledge base because you never know what you'll run into out there," he said.
Poirier, an ex-Colorado ski patroller who recently flew helicopters to offshore oil rigs in the Gulf of Mexico, has more than six years experience at the controls of a helicopter.
Each crew member is fitted with a special pager that vibrates when an accident is called in.
Once the official call comes for the helicopter, the chopper is expected to be in the air within eight or nine minutes.
Sitting in their office - a room with a television, kitchen and recliners that is used with permission from the California Department of Forestry - some members of the crew become superstitious about what can prompt a call, Poirier said.
Flipping to certain television channels or getting up to make something to eat is sure sign that an emergency will crackle in over the radio, some crew members believe.
Poirier, who has been with Care Flight for only months, has not developed a belief in those omens quite yet.
Once a call comes, the eight minutes until liftoff are structured for the team.
Poirier checks the weather conditions on the computer, both in Truckee and at his destination.
"The first thing you want to think about is weather - can we make it there or not?" Poirier said. "It's better to err on the side of safety."
Meanwhile, Bourn and Robinson have their own procedures, assuring that all the medical equipment is ready.
"We never know what we are going to get," Robinson said.
Once in the helicopter, the crew falls silent, allowing Poirier to concentrate on operating the chopper during takeoff.
With all four limbs manipulating the controls, and speaking coordinates and takeoff protocol into his headset, Poirier guides the crew into the sky and to the aid of a distant victim.
It's a task that is more fulfilling than his previous job shuttling oil workers onto ocean platforms.
"There's a little more meaning to it than flying out to an oil rig," Poirier said.
Care Flight, which is celebrating its 25th anniversary this year, has introduced a new membership plan that, in cooperation with insurance, will pay for all of the costs of a patient's flight.
The flight plan, offered at a yearly membership of $55, is also honored by other air ambulance programs in the West, including nearby CALSTAR.
For more information on the plan, go to www.remsa-cf.com.