First responders have to constantly train to provide the highest level of care in the most critical situations.
When REACH Air Medical Services' team hears a loud alarm, they race to the helicopter to respond to an emergency.
"The moment the tone goes off, my partner and my pilot and I are thinking safety first," Crystal Knutson, Flight Paramedic REACH Air Medical Services, said.
Before the helicopter leaves the ground, the team checks weather conditions and equipment.
"My partner and I strategize about what we're going to need on scene and how we are going to run the scene," Knutson said.
Knutson's flown for more than three years and has worked as a paramedic for 17 years.
During Wednesday's simulation, firefighters were already on scene stabilizing the patient.
In a rural state like Montana, time is critical and sometimes the nearest hospital is hours away.
"Time is of the essence because it takes so long for them to get to those patients where we can get there in a vastly timely manner," Knutson said.
In this field of work, time is crucial; it boils down to first responders only having a matter of seconds to safely airlift the patient.
Brad Smith, a firefighter with York Fire, said first responders need to be focused at all times and air crews and ground crews need to act as one.
"Don't screw up, I try to remember all the things that I've been trained and try to be as helpful to the team as humanly possible and keep that patient safe," Smith said.
Helena doesn't have a Level I or II trauma center so when Air Medical is requested, it's serious.
"It's really critical in flight that you stay ten to twelve steps ahead of whatever disease process or trauma or whatever's going on, we always try to plan out a few steps ahead of time," Travis Weiss, RN and CCRN Flight Nurse REACH Air Medical Services, said.
The H-125 Euro-Copter can fly 150 miles per hour and holds 147 gallons of fuel.
The helicopter can help patients reach major hospitals like Salt Lake City or Seattle to receive life-saving care.
"It's just different from sitting in a bed," Weiss said. "We're in a bed in the air at 24,000 feet flying somewhere so we have to have our ducks in a row."
He added that his job is fulfilling as it's an opportunity to save lives every day. Knutson agreed.
"I'm just blessed to do what I love to do and to fly in this beautiful state and help people who are critically injured or sick," Knutson said.
REACH Air Medical operates a helicopter and a fixed-wing aircraft in Helena and also has a helicopter base in Bozeman.