As good as Crescent City's hospital and medical establishment may be, the fact remains that this is a rural community with limited resources.

Enter air ambulances.

In rural communities that lack certain services, like neurosurgeons, air ambulances provide a much-needed function. They take patients that need services rural hospitals can't provide to facilities that can.

Currently, Cal-Ore Life Flight is the only company providing air ambulance service to the area.

"I learned to fly in high school," said Cal-Ore Life Flight owner Dan Brattain. "In more ways than one this is a labor of love."

Brattain isn't the only Cal-Ore pilot that learned to fly in high school.

"I learned to fly at Del Norte High school in 1952," said flight coordinator Robert Walker. "This is a very rewarding job but sometimes it can be heart-wrenching, especially the kids."

Brattain said that Cal-Ore currently has five planes in active duty, four turbine jet engine Piper Cheyennes - jet-props - and one propeller-driven Cessna 421.

"The jet props do about 300 miles per hour," Brattain said. "The Cessna is our backup plane. It can manage about 230 miles per hour."

Walker, who's been with Cal-Ore since 1995, couldn't stop extolling the Cheyennes.

"These are great planes," he said, pointing at the two shiny Pipers sitting in the hangar. "They're excellent in bad weather, they're fast and can carry a good load."

Another air ambulance company, Del Norte Ambulance, was grounded by the Federal Aviation Adminis­tration because changes are needed to its training and flight manuals, CEO Ron Sandler said.

"We are in the process of getting some paperwork cleaned up," said Sandler. "Unfortunately, our manuals referenced aircraft other than we had."

Local residents shouldn't worry, however, that there are not enough air ambulances. Del Norte Ambulance plans on being in the air again, and Cal-Ore Life Flight has been flying patients successfully since 1988.

"Prior to them going out of service we were doing about 90 percent of the flights anyway," Brattain said.

According to Brattain, flying air ambulances isn't as simple as flying a personal or even passenger plane.

"This business requires constant checks on equipment and training," Sandler said. "Not only do you need qualified medical staff and special insurance, but your pilots have to be tested every six months. It's like taking the complete drivers test, written and all, every six months - and they change it up."

Brattain sums it up, "there is a separate set of regulations air ambulances have to adhere to."

This makes it difficult keeping planes ready to deliver patients at a moment's notice.

"We have three to four planes ready to go at any given time," Brattain said. "We have 10 pilots, and 25 flight nurses."

Brattain said that Cal-Ore averaged about 1,000 flights last year, approximately 85 a month.

"Some days you don't get any, others you will have two or three," he said. "But you're always ready."

It's not just the pilots that need special training.

"The training for what we do here adds to what many nurses can do at the hospital," said general manager Joe Gregorio.

Like the pilots, training for Cal-Ore's flight nurses never ends.

As Gregorio was talking about the company's medical staff training, he introduced Sim Man, who is sometimes replaced by Sim Baby.

The $70,000 simulator, a full-sized man or baby, can simulate almost everything that can happen to a patient, from needing CPR to a breathing tube, Sim Man and Sim Baby connect directly to a computer and let the trainer know how well a particular scenario is being performed.

"I can make him close his mouth so that it's impossible to ventilate," said Gregorio. "I can make him talk, even change his breathing patterns."

With each example the eerily lifelike mannequin changed, whether making gasping sounds or shallow fast breathing, all it took was a stroke or two of a keyboard.

Both Sandler and Brattain agree that running an air ambulance company is all about the patients.

"We were both businesses vying for the same market," Sandler said. "But it's not just a business, it's taking care of patients."

Brattain agrees that it is all about the patients and adds, "it's also all about safety."