Boston Medflight crew: (from the left)
pilot John Marden, EMT-P Todd Denison, CEO Suzanne Wedel and CCT transport nurse Bill Cyr.

Safety and Care in the Air

By Terry Pommett

Nantucketers often refer to the Steamship Authority as their “lifeline to America,” and on a day-to-day basis, that is certainly true. The island depends on the Authority for the steady flow of “stuff” the carrier brings, as well as for a means of taking residents and vehicles on and off “the rock.” Many people, though, are unaware of another link to the mainland whose mission is focused on life itself. Now in its 20th year of service, Boston MedFlight has transported thousands of critically injured and seriously ill Nantucketers to life-saving treatment off-island. In most cases, the requisite care was beyond the ability of Nantucket Cottage Hospital to provide, and time was crucial to a positive outcome.

Based at Hanscom Air Force Base in Bedford, Massachusetts, with a satellite station in Plymouth, Boston MedFlight is a non-profit charitable organization. It was founded in 1985 by a consortium of Boston’s finest teaching hospitals, including Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham & Women’s Hospital, Children’s Hospital Boston, Massachusetts General Hospital and New England Medical Center. It is the only successful cooperative venture that has ever been spawned by these institutions.

Sandy Weedon, MedFlight’s Director of Development, explained that there is no other consortium arrangement like this in the country: “They had the foresight to know they didn’t need six helicopters to devise an air transportation service. That would be inefficient. They eliminated redundancy by creating a system with a menu of options, combining ground, rotor wing and fixed wing transport. They can accommodate any situation that arises, which is not the case with most air ambulance companies.”

After Alister Conn, a trauma surgeon who set up the program, left Boston MedFlight, his wife, Susan K. Wedel, substituted as CEO until a replacement could be found. “I was a critical care physician and I kept saying, ‘We need someone with a CC background because we do CC transport, not just trauma,’” recalled Wedel.

That was 18 years ago, and Wedel is still running the ship as head of MedFlight. Although the romance of aviation is certainly a factor in drawing people to work for Boston MedFlight, the real story is the patient. “People outgrow that attraction after they’ve been here a while,” explained Wedel. “They learn they really make a difference that has nothing to do with image. The bottom line is that people are hurt, people are sick. I’m interested in getting them the attention they need.”

In its history, Boston MedFlight has benefited over 28,000 patients who have been carried to hospitals all over New England. They never refuse a transport, regardless of a patient’s ability to pay or the nature of the incident. Although they budget every year for a zero balance, they never make any money. In fact, they are always in the red. In 2005, their budget was $15,000,000. Some 90% of MedFlight’s revenues came from 3rd party payers of insurance, leaving the operations with a $1.5 million operating deficit. This had to be made up by the consortium hospitals, along with small private donations.

As the range and demand for its services grow, it is important that the awareness level in the public arena keeps pace. This system needs more than good will to maintain its track record. Business as usual is not an option: there are now more than 450,000 uninsured citizens in the Commonwealth. An average flight costs approximately $5,500. Nantucket alone receives an average of 200 flights a year, by both fixed-wing craft and helicopter. Neither the sending hospitals nor the receiving hospitals contribute any money to Boston MedFlight. Fundraising, then, has become a serious issue to ensure the continued excellence of the program.

MedFlight reaches far beyond eastern Massachusetts and its home operating bases. It belongs also to the Northeast Air Alliance (NEA), a system of air ambulance companies based at many locations throughout New England and in New York State that transport the sickest patients. “No matter where you are, you can get into the system,” said Wedel.

“NEA is an alliance. There are no formal arrangements with members and there’s no competition. We never say no. If we’re not in a position to help, we’ll find someone who can.”

Top skills

Boston MedFlight maintains a level of professionalism that’s remarkable for a nonprofit and that would be the envy of any private enterprise. In addition to a pilot on the helicopter and a pilot and
co-pilot on the fixed wing jet, all flights carry two medical personnel with an average of 12 years experience, a critical care transport nurse and a paramedic.

Generally they have the same skill and ability levels, and all specialize in transport medicine. In addition to needing at least five years experience in their respective fields just to apply to the organization, they continue to receive advanced training and education once they are accepted. Critical care nurse Bill Cyr, a 14-year veteran, feels that these opportunities are better than what most hospitals could provide, and the training shows in their expertise: “Our advanced life support courses are basically designed for physicians,” explained Cyr. “On a flight, we can do almost anything that is done in an emergency room. We provide critical care and advanced life support service as opposed to a typical land-based life support service.”

The only limiting factors for a flight are weight and weather. Basically a patient weighing more than 350 pounds could not physically fit into the stretcher space on the aircraft. And Nantucketers know all about weather. Helicopter pilot John Marden, who has logged over 10,000 hours in his 42-year flying career, considers Nantucket a particular challenge. In his 19 years with Boston MedFlight, he has made approximately 600 flights to the island. After 10 years shuttling between offshore oil rigs in the Gulf of Mexico, Marden was well aware of the kind of problems the Grey Lady could pose: “The weather around the islands is constantly changing. Flying at night, in fog or in haze and all over water, are the most difficult conditions to fly in. You need reference points to see where you are. You have to learn how to do it and you need the hardware and experience to do it. Our ships have all the gizmos and gadgets.”

Safety is the ultimate factor that determines whether a flight can take off or not. Boston MedFlight has an accident-free record, a statistic attributable to a high regard for protocol and common sense. Again, professionalism is key. Communication center manager Ken Panciocco explained that his team members are not just dispatchers, although they all come from dispatching backgrounds. They gather information and communicate to the pilot, who ultimately makes the decision whether to go or not, based on weather, mechanical considerations and crew safety.

“A transport decision has to be based on safety,” Panciocco said. “We might sometimes ask a pilot to leave the communications room when a call is coming in. We purposely don’t mention patient information. Once the flight is okayed, they get the medical information they need to assist in their flying decisions.”

Even if conditions prevent a flight from taking off, Boston MedFlight continues to assist the person in need.

“We make a difference every day. If our phone doesn’t ring, that’s a good thing. But once it does, we provide the caller with the best care available at the time. If Nantucket calls and the weather is down, we still try to assist them to find a way to get the patient off the island. We don’t bail out. We know what’s at stake. For most EMTs, their worst call of the year is our first call of the day.” And people taking advantage of MedFlight’s services, of course, never make reservations ahead of time: “One thing our patients all have in common is that they never think they are going to need us,” said Wedel.

No-nonsense

Perhaps what is most admirable for a group of men and women who are so efficient in their approach is their compassion under fire. Everyday exposure to highway trauma, cardiac failure and neonatal tragedy take a toll on their psyches. Yet,
to a person, Nantucketers who have been recipients of Boston MedFlight services all praise their quiet, calming manner.
Kim Horyn, Community Relations Coordinator at Nantucket Cottage Hospital, remembers how she was treated when her son suffered a compound fracture of his femur several years ago. “I was in shock when I learned he had to be flown to Boston. He was only two-years old. It was scary and dangerous. I was so nervous. But the paramedic was wonderful. He allowed me to fly along with toys in the helicopter. He explained what was happening all the way to the hospital. I was so relieved and confident with his care. He put me at ease.”

Wedel is justly proud of the team at Boston MedFlight. “We’re a family. We support each other. We’ve all seen the tragedies. For the most part, at the end of the day, we don’t sweat the small stuff anymore.” And they don’t lose sight of their purpose. As their tag line proclaims, “Your Life. Our Mission.”