“You don’t know what waits for you out there,” Andy Miller says.

He’s a flight paramedic with DHART, a medical transportation service operating out of the Dartmouth-Hitchcock Medical Center in New Hampshire.

Nestled in the White Mountains, the hospital is the state’s only Level 1 trauma center. It serves nearly 2 million people, many in small towns separated by vast woodlands and mountain ranges. Reaching those residents when they’re in trouble can be tricky — which is where Miller comes in.

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A member of the DHART crew since 2008, Miller works with a team of nurses, pilots, mechanics, and communication specialists, along with other paramedics. The service operates around the clock; Miller works three shifts a week  — either 7 a.m. to 7 p.m. or the other way around, 7 p.m. to 7 a.m. His wife, Kati, also works at the hospital, in the intensive care unit.

Miller speaks calmly about the chaos in his air ambulance as he fights to help his patients survive. Every day is different. And every case is urgent. “You have to be prepared for that,” he says, “mentally and physically as well.”

Correction: An earlier version of this story misstated the location of the hospital.

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