Just as a LifeFlight of Maine helicopter crew was conducting a safety course for EMS responders in a small rural community, a call came in to help a hemorrhaging pregnant woman. Fortunately, the training and emergency were both occurring on Vinalhaven Island.
LifeFlight landed nearby and found Megan Day, 38 weeks pregnant, on the floor in her home. She needed to get to a hospital on the mainland as quickly as possible, but she was an hour’s boat ride away. LifeFlight got her there in five minutes.
Doctors at a Rockport hospital delivered baby Kyra with a C-section. Kyra’s heart was beating but she wasn’t breathing, so they resuscitated her. Then she had seizures and had to be transported to a larger neonatal hospital wing in Portland. Meanwhile after hours of surgery to find the source of her bleeding, doctors determined Megan had a pregnancy-induced renal artery aneurysm and temporarily stabilized it. LifeFlight then flew her to the same Portland hospital where Kyra was recuperating, and doctors there were able to save Megan’s kidney.
“In the space of an instant on a hot afternoon in August 2004, 150 people have to do everything right,” LifeFlight of Maine Executive Director Tom Judge said. “Now, there’s a happy 14-year-old.”
As word spread about the lifesaving rescue, it started to sink in that Mainers really needed this critical care air ambulance service, recalled pilot Dave Burr, rotor wing manager for contractor SevenBar Aviation, who has been piloting for LifeFlight since 2000.
“That was the foundation we began to build upon, especially around the (Penobscot) Bay,” Burr said. “They began to believe in us and what we do.”
Kyra and others saved by LifeFlight of Maine recently donned LifeFlight “Survivor” t-shirts for a campaign that is raising money for this critically important non-profit during its 20th anniversary.
“I found out if we had been even two more minutes longer getting off the island, neither Kyra nor I would be here today,” Megan posted on LifeFlight of Maine’s Facebook page as part of the Survivor campaign. “So, LifeFlight is pretty special to our family. Every year around Kyra’s birthday, I send pictures to share as a small way of saying thank you.”
Unique Statewide System
Maine is one of a very few states with a single, statewide non-profit air ambulance service. LifeFlight is studied throughout the world for its successful model that combines low patient costs, high safety, top-of-the-line equipment and extreme efficiency born from adaptability. Such a statewide critical care transport system probably wouldn’t have been possible without Maine’s harsh weather, heavily wooded landscape (Maine has the highest percentage of forest land in the Lower 48), more than 300 islands, relatively low-income residents, and the oldest and most rurally dispersed population in the Lower 48. Private for-profit air ambulance companies just didn’t see Maine as a place where they could make money; that left a huge void.
When a single company tried to start a medical helicopter service in 1993, the state wanted to support it so badly that it waived a requirement for twin engines. Within six months, the company’s helicopter crashed into Casco Bay after running out of fuel, killing a patient and two clinical crew members, then shut down.
But plenty of people were suffering premature death without any air medical service, too. Judge was part of a team that set out to create a statewide non-profit critical care transportation system that now is funded by all of Maine’s hospitals and more than 200 mostly small communities.
“It’s this universal participation that makes LifeFlight unique in the country,” said Judge, who also serves on the volunteer fire rescue department in his small settlement of Port Clyde. “All of these communities see LifeFlight as an extension of their local healthcare system. We’re a private non-profit, but we’re a public good.”
The state government has floated three voter-approved bond issues to help create LifeFlight’s infrastructure that includes hospital helipads, weather stations, fuel trucks, GPS approaches, and emergency communications. The state does not provide annual government appropriations.
The survivor t-shirts are just the latest in a series of LifeFlight fundraisers. A recent annual fundraising 3-mile swim raised a cool half-million dollars this year. Hundreds of small fundraisers have taken place in tiny rural communities such as Guilford (population: 1,448), where the Lovell family’s hardware store has conducted an annual fundraiser ever since LifeFlight rescued a young family member. LifeFlight purchased its first next-gen rotorcraft in 2017 through the generosity of 602 donors who gave a combined $6 million.
Efficiency Creates Lower Costs
LifeFlight of Maine averages a $14,000 patient charge per flight, and only half its patients can even afford to pay. The average U.S. company charged Medicare $30,000 in 2014, according to the latest Government Accounting Office study. Other studies have found prices reaching $50,000.
LifeFlight’s lower cost doesn’t come from cutting corners. It owns three Leonardo AW twin-engine helicopters, with two AW109E models and a newer AW109SP that features the latest global navigation satellite system. They operate out of three bases with four pilots at each base. They have eight mechanics. LifeFlight also owns a fixed-wing Beechcraft King Air B200 for longer flights to major hospitals so helicopters are not tied up for an entire day.
LifeFlight of Maine also contracts with local ambulance companies for critical care ground transportation during bad weather, bringing its highly skilled contract flight crew and equipment to others’ ambulances when needed. Sometimes its air and ground equipment exceeds that available at smaller hospitals. LifeFlight eats all its costs for ground transports, giving all the proceeds to the ambulance companies in exchange for the use of their vehicles.
Another way that LifeFlight of Maine keeps down costs is by contracting or leasing with hospitals to provide flight crews on an as-needed basis. This also eliminates any temptation to keep such employees busy by conducting unnecessary flights. LifeFlight of Maine has a strict protocol to make sure only critical care patients are transported by air, with only medical professionals authorized to order flights. Last year it transported 1,929 patients via air and ground from 124 communities, with 87 percent of flights to hospitals and 13 percent to the scene. Three-fourths of the transports were by air. The annual operating budget was $11.6 million, while the LifeFlight Foundation budget of $3.5 million last year covered capital costs. Requests for services increase 7-11 percent annually.
Studies have concluded that some for-profit companies transport patients by air when a ground ambulance would be sufficient. The U.S. has a glut of medical emergency helicopters that also contributes to unnecessary flights, Judge said. The number of air ambulance helicopters in the U.S. has doubled in the last 15 years, according to a University of Chicago Aeromedical Network analysis.
Part of the reason for the glut stems from Medicare’s one-size-fits-all reimbursement rates that are based on air ambulances operated by hospitals using twin-engine rotorcraft, Judge said. For-profit companies can utilize single-engine helicopters and cut other safety costs to make more money. Meanwhile, federal law prohibits states from controlling air ambulance rates. Between 2010 and 2014, the average air ambulance patient charge rose from $15,000 to $30,000, according to Medicare data gathered by the U.S. Government Accountability Office.
Safety demonstrated
LifeFlight has never experienced any helicopter crashes during its 20 years of service, Judge said. It demonstrates its commitment to safety by using only twin-engine rotorcraft with autopilot capability. “Everything NTSB ever recommended is on board,” Judge said. Pilots must have a minimum of 2,000 hours of flight time to be hired, double that of some air ambulance companies, then spend 6-8 weeks training before getting full flight status. Pilots are required to have full IFR checkrides every six months as well as spot line checks.
LifeFlight nurses and paramedics undergo 500-800 hours of full-time orientation. LifeFlight also offers critical care training to emergency medical professionals across the state, including the use of a human patient simulator that can be customized to reproduce various scenarios. “These are simply the right things to do,” Judge said. “People are handing their loved one into the care of strangers, and they have to trust that every single person is going to do the right thing at the right moment.”
Every Maine hospital works with MedComm, LifeFlight’s communications center, and LifeFlight pilots must get MedComm approval to land at hospital helipads. This avoids the potential for tragedies such as a 2008 helicopter collision in Flagstaff, Arizona, that occurred when one of the pilots didn’t communicate with a hospital in the minutes before attempting to land. One of those who perished was Burr’s ops boss in the military. “Three days before the accident he called and said, ‘I’ve got to get out of here. This place is going to kill me,’” Burr related. “I think every day, ‘I’m so lucky up here.’”
Any LifeFlight of Maine crew member, and even dispatchers at the comm center, can cancel a flight if he/she feels uncomfortable. It’s happened to Burr five times. “Anybody at any time can say ‘No,’ and there will be no repercussions,” Burr confirmed. “It takes a lot of pressure off the pilots. Everybody feels an incredible responsibility to get to where we need to go.
“We’re playing for keeps. If we make a mistake, very bad things can happen.”
New hires tell him they appreciate the team atmosphere, which includes the communications dispatchers. That team spirit in turn fosters the adaptability that often is key for the flight crews. One day they might be flying to an island and boarding a boat to pick up a patient from another boat, and the next day they might be dismantling a tractor rototiller to pull out an injured patient, Burr said.
Planning for the coming 20 years
LifeFlight of Maine has built a statewide air ambulance infrastructure from the ground up over the last two decades. All its helicopters feature labs, pharmacies, ultrasound, blood and plasma.
Now it’s looking to use next-gen aviation, infrastructure, medical personnel, medical technology, and communications/decision support over the coming two decades to become even more cost efficient, safe, reliable, and ecumenical, Judge said.
We’re at this next pivot point,” he related.
For one thing, “We’re going to be in a very different airspace,” he said. Instrument flight will become required as airspace becomes more crowded, he predicted. To reach its goal of ‘tunnels in the sky,’ LifeFlight is moving to an LPV system that will offer the highest-precision GPS instrument approach; to do so, it will have to replace its older two Leonardo AW helicopters. Burr values the AW109SP’s four-axis autopilot as well, because “We have the ability to become systems monitors.” On foggy nights over mountainous terrain, he can focus on his surroundings and avoid potential vertigo.
LifeFlight officials also are looking forward to the Enhanced Flight Vision Systems (EFVS) technology for helipads, stemming from research by Elbit Systems with the FAA.
LifeFlight has a great working relationship with the FAA in its efforts to add landing zones, set up flight corridors for maximum safety, and update instrument approach procedures, Burr said. The FAA is doing most of the work on the latter, he added. “They really believe in what we do.”
On the medical side of future air ambulance service, Judge foresees an increase in remote mobile diagnostics that will reduce uncertainty and therefore reduce costs. For example, a team of doctors and critical care nurses could remotely manage patients in air/ground ambulances and homes.
A real-life case demonstrates how remote diagnostics can reduce costs: A road crew flagger was hit by a truck mirror in a remote area and rendered unconscious. Emergency responders could have driven him 40 miles to a hospital without trauma care if he suffered only a concussion, but he would have needed a 100-mile helicopter flight to a trauma center if his brain was bleeding. There was no way in the field to know which injury he had suffered, so the helo flight was chosen.
“How do we reduce uncertainty?” Judge asked rhetorically. In a case such as the flagger’s, the answer is CT scanners or similar technology onboard helicopters. A handful of U.S. cities already have CT scanners in ground ambulances.
While technology is rapidly changing, LifeFlight of Maine’s core goal is not. Treating all critically ill Mainers in a safe, cost-effective atmosphere will remain its primary aim.
Click here to see the Life Flight of Maine Video