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In the Bush, receiving even the most basic care sometimes means being moved hundreds of miles just to reach the nearest x-ray machine Noun 1. X-ray machine - an apparatus that provides a source of X rays
apparatus, setup - equipment designed to serve a specific function

fluoroscope, roentgenoscope - an X-ray machine that combines an X-ray source and a fluorescent screen to enable direct
. On the Kuskokwim and Yukon rivers Arctic Watershed
  • *Mackenzie River Watershed
  • Upper Liard River
  • Rancheria River
  • Frances River
  • Hyland River
, many of the 56 villages are sprinkled up and down the shores, connected only by boat in summer, ice road in winter, or by airplane in good weather. Time and distance can be deadly in this roadless subarctic sub·arc·tic  
Of or resembling regions just south of the Arctic Circle.


Relating to the geographic area just south of the Arctic Circle.
 region, which rivals the state of Washington in size. Enter Aeromed.

In the past six months, flight paramedic par·a·med·ic
A person who is trained to give emergency medical treatment or assist medical professionals.

 David Harbour has landed on an air strip lit by the headlamps of snow machines. He has tended to patients stretched out in the bed of a wooden sled. He has rushed to someone's aid aboard the village ambulance, a 1972 Suburban.

Harbour works for Aeromed International, a new medevac med·e·vac
1. Air transport of persons to a place where they can receive medical or surgical care; medical evacuation.

2. A helicopter or other aircraft used for such transport.

 service dedicated primarily to the Yukon-Kuskokwim Delta The Yukon-Kuskokwim Delta is one of the biggest river deltas in the world, roughly the size of Oregon. It is located where the Yukon and Kuskokwim rivers empty into the Bering Sea on the west coast of the U.S. state of Alaska.  and its 22,000 Native residents. Getting an ill or injured person from a remote spot to a hospital may be his job, but his efforts are shaped by the rigors of the land and the resources of the locals. As paramedic and acting operations manager See datacenter manager.  for Aeromed, Harbour is far afoot from his paramedic days in urban Texas.

Recently, when he helped transport a girl with appendicitis Appendicitis Definition

Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased.
 from the Bush to Anchorage, the girl's grandmother gave him a big hug and invited him to hunt moose on their land. "The moose is food for their table," Harbour said. "That really touches you. Makes it worthwhile after a long day."

Aeromed has been operating as a critical care air ambulance air ambulance Emergency medicine A helicopter or, less commonly, a fixed wing aircraft, used to evacuate a person who requires immediate medical attention that cannot be provided at his/her current location  provider since January, an extension of the Yukon-Kuskokwim Regional Hospital in Bethel Bethel, in the Bible
Bethel (bĕth`əl) [Heb.,=house of God].

1 Ancient city of central Palestine, the modern Baytin, the West Bank, N of Jerusalem.
. It is the first critical care air ambulance run by a not-for-profit Native health organization in the country, let alone the state, said Ed Hansen Ed Hansen (born in 1937 - died Dec. 16, 2005) was an American writer, director and editor. He was born in Minnesota, and started his entertainment career in advertising, winning several international awards. , corporate vice president for hospital services at Yukon-Kuskokwim Health Corporation.

As of April, more than 350 patients were flown out of a village either to the Bethel hospital or one of three hospitals in Anchorage, among them a man with a gunshot wound in Aniak, a snow machiner with a fractured leg in St. Marys, and a heart-attack victim in Kwigillingok.

On a busy day as many as five medevacs flights can be sent to rural Alaska. On a slow day, none. "It's feast or famine," said Harbour. "Whenever the weather is the worst is when everybody wants you."

The wheels of the medevac are set in motion by a village community health aid who reports the injury or illness to Bethel. The emergency room physician there decides whether the patient should be moved, and if so, when and where. When movement is necessary, the patient is medevaced to Bethel or Anchorage. Surgery is primarily done in Anchorage, while the hospital in Bethel provides primary care.

Aeromed isn't the first medevac to service the Delta. Previously, Alaska Regional Hospital's LIFEFlight and Providence Alaska Medical Center's LifeGuard flew to the region as part of the Indian Health Service The Indian Health Service (IHS) is an Operating Division (OPDIV) within the U.S. Department of Health and Human Services responsible for providing federal health services to American Indians and Alaska Natives.  contract.

However, as those medevacs also service the entire state, they were not always available when YKHC YKHC Yukon-Kuskokwim Health Corporation (Bethel, Alaska)  wanted them, as under the IHS IHS

(I.H.S.) first three letters of Greek spelling of Jesus; also taken as acronym of Iesus Hominum Salvator ‘Jesus, Savior of Mankind.’ [Christian Symbolism: Brewer Dictionary, 480]

See : Christ

 contract something called stacking took place.

"If two medevacs are needed at the same time, our folks might have to wait," said Hansen. "Nobody was doing anything wrong. The air ambulance was making a professional judgment."

Hansen said the 20 elected board members of YKHC wanted to have a service primarily devoted to their region, in part, to avoid delays. The startup operation is also part of a larger trend among Native organizations across the country to directly control and administer all services delivered to constituents.

Under the Indian health care delivery system, YKHC is authorized to provide health services health services Managed care The benefits covered under a health contract  to Native residents in place of the federal government. About 60 percent of the operating budget Noun 1. operating budget - a budget for current expenses as distinct from financial transactions or permanent improvements
budget items, operating cost, operating expense, overhead - the expense of maintaining property (e.g.
 for YKHC comes from the Indian Health Service contract. The other 40 percent comes from third party reimbursement, mostly Medicaid.

Hansen said, in running the air ambulance service themselves, YKHC could cut down on duplication of services. The health center pays for the service either through the IHS contract or by paying companies directly to transport, yet they also had their own staff and a billing system committed, he said.

"It was easier for us to manage the process overall than to have pieces of it done by an outside operation," Hansen said. "In the best-case scenario, we see ourselves eventually breaking even," he said.

To create revenue that will allow the service to expand, Aeromed's secondary mission is to serve other Native groups in Alaska, as well as Alaska residents in general, then lastly to fly international contracts. Aeromed recently flew a Lear jet to Korea and returned a patient to the Lower 48, its first international medevac.

Aeromed leases aircraft from F.S. Air Service, the Anchorage company that formerly owned Aeromed International.

FS Air's Lear jet 35, which can maneuver a gravel strip landing, and a 19-passenger Metroliner are ready to pull up their wheels in 45 minutes. A Merlin and a Piper Navajo are also on call at the hangar office at the Anchorage International Airport.

In June, YKHC added to the aircraft on hand by putting a contract out to bid for local aircraft based in Bethel, Hansen said.

Flights range from as far north as Kotlik, south to Platinum, west to the island of Mekoryuk and east to Lime Village on the Kuskokwim. The size of the runway determines what plane can land. In Eek, for example, on its 1,400 foot runway only the Navajo will set down. While in Emmonak with 4,400 feet of runway, the Lear jet can land in good visibility.

"The fastest thing we can get into the field, we'll send," Harbour said.

"They (Delta residents) believe they are being picked up faster and the quality is better because it is their ambulance service," Hansen said. "That's not my perception, that's their feedback."

The Competitive World of Medevac

Some 17 different organizations run medevac services of various levels across the state, sweeping from the North Slope North Slope, Alaska: see Alaska North Slope.  to Southeast Alaska.

Aeromed (Yukon-Kuskokwim Regional Hospital), LifeGuard (Providence), and LIFEFlight (Alaska Regional) are three of the 10 critical care air ambulances in the state. Aeromed, the new chopper on the block, is getting a fat share of business, taking over the Yukon-Kuskok-wim Delta region.

"It's a huge area," said Dean Dow, coordinator of LIFEFlight's emergency room outreach. "We lose our service bond to those communities because Aeromed is now the dominant or primary provider."

"Anytime one more service is available it always makes an impact on the business," said Margaret Auble, program director of LifeGuard at Providence "As far as anybody being put out of business, I don't think that's the case," she added.

Aeromed has been in operation since January, LifeGuard since 1983 (1975 for its charter services), and LIFEFlight since 1985. LifeGuard and LIFEFlight still provide back-up service to the Delta region.
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Title Annotation:includes related article on medical evacuation services; air ambulance services
Author:Sullivan, Patty
Publication:Alaska Business Monthly
Date:Aug 1, 1998
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