In the past six months, flight paramedic 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 service dedicated primarily to the Yukon-Kuskokwim Delta 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 for Aeromed, Harbour is far afoot from his paramedic days in urban Texas.
Recently, when he helped transport a girl with appendicitis 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 provider since January, an extension of the Yukon-Kuskokwim Regional Hospital in Bethel. 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, 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 contract.
However, as those medevacs also service the entire state, they were not always available when YKHC wanted them, as under the IHS 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 to Native residents in place of the federal government. About 60 percent of the operating budget 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 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.