On June 10, just after midnight, 33-year-old Mike Holtham of Chilmark told his wife he was headed to the Martha’s Vineyard Hospital (MVH) emergency room. For several days he’d experienced nausea and stomachaches that he assumed stemmed from heartburn. That night those symptoms became unbearable, and he vomited. Mr. Holtham wanted a prescription antacid, which at that hour, only the ER staff could provide.
When he arrived at the hospital he told the ER staff what he believed was ailing him and what he wanted for it. Instead of giving him antacid, they connected him to an EKG, and were soon swarming all around him.
“You don’t have heartburn; you have heart failure,” he recalled being told.
Mr. Holtham said his heart rate dropped to 36 beats per minute.
“It got very real very quickly,” he said.
The physicians on duty placed a call to Boston MedFlight (BMF). Before long, a medflight crew in blue flight suits stood over his bed, prepping him for helicopter transport. Mr. Holtham, a volunteer firefighter for Chilmark, tried to joke with them and find some common ground in the midst of an emergency he was the center of, but he didn’t make much headway:
“They were no play and all business.”
Mr. Holtham was rushed out to the helipad behind the hospital and secured inside the waiting helicopter. He recalled the intensity of his vital signs being relayed over the radio in contrast with the serenity of the moon as they ascended over Vineyard Sound. Rather than heading to a Boston hospital, he was flown to Cape Cod Hospital, where a heart catherization expert was standing by. The BMF helicopter touched down at Barnstable Airport. Less than 10 minutes later he was in the hands of the medical team that would preserve his heart and save his life.
Critical moments
Carol Bardwell, Martha’s Vineyard Hospital chief nurse executive, remembers the days when a medical transfer of the sort that saved Mr. Holtham was rare, because Boston MedFlight did not yet exist. “It made such a difference when they came on board,” she said.
BMF first took to the air in 1985. The charity air ambulance service is headquartered at Hanscom Field in Bedford.
BMF chief operating officer Andy Farkas said the air ambulance completed a record 366 transports in the month of June. Many of those were from small regional hospitals, similar to Martha’s Vineyard Hospital, that opted to send a patient to a larger institution where more specialized care would be available.
The 25-bed Vineyard hospital has limited ability to handle heart attack, stroke, and trauma patients. If a patient’s medical condition is stable enough, he or she may be transported by ambulance. But if time is of the essence, if there’s an “imminent threat to life or limb,” as Oak Bluffs Fire and EMS Chief John Rose puts it, a call goes out to Boston MedFlight.
Last year BMF airlifted 196 patients off the Vineyard, according to Chief Rose.
Because the hospital is located in Oak Bluffs and because it fields the largest ambulance fleet on the Island, Oak Bluffs EMS handles the majority of transfers between the hospital and waiting medflight aircraft when they touch down at the airport. As a result, Oak Bluffs EMS has received critical-care training from BMF to help them stabilize preflight patients.
In addition to the pilot, a critical care nurse and a critical care paramedical make up the aircraft crew. Their medical skills are a step above those of typical ground ambulance teams. They can handle critical neonatal patients, a range of intensive care situations, and complex traumas — essentially keeping the “sickest of the sick,” as Mr. Farkas puts it, stable in transit.
“It’s just such a high-caliber level of training,” Ms. Bardwell said
Flying ICUs
“Our aircraft are specifically configured for medical transport — basically mobile intensive care unit[s],” said Rick Kenin, GM of aviation operations for Boston MedFlight.
BMF’s fleet of custom aircraft includes two twin-engine Airbus EC-145 helicopters, a Sikorsky S76 twin-engine helicopter, and a King Air 200B twin-engine turboprop airplane. Mr. Kenin said that twin engines are an important safety feature of BMF aircraft. Should one engine fail, the pilot can rely on the other.
He added that twin-engine aircraft are much more expensive to maintain. He said air rescue companies, particularly out West, often rely on single-engine helicopters for cost savings, but pay for it when a mechanical emergency arises. BMF helicopters are strategically placed at airports in Lawrence, Plymouth, and Bedford. The airplane is on standby in Bedford. Like the onboard medical crews, BMF pilots are exceptionally skilled.
“Our standards for our new pilots are fairly high, especially in our industry. We require them to have the highest level of FAA certification,” Mr. Kenin said. “That requires a fairly high number of flight hours. We require a minimum of 3,000 flight hours in helicopters to fly with us. It’s very high. A lot of organizations look for the 1,000-hour mark.”
Mr. Kenin said about half of BMF pilots come from military backgrounds.
Island weather
As experienced as they are, the shifting weather on and around the Vineyard often challenges BMF pilots.
“Because of the ocean currents, specifically around Martha’s Vineyard and Nantucket, you can have different weather than you would have on the mainland or really anywhere else,” Mr. Kenin said. “While it may be sunny up here — the weather — the fog can go from nothing to close to zero visibility very quickly.”
According to Mr. Kenin, all BMF pilots are qualified to fly by instrument flight rules (IFR). This enables them to navigate via instruments in clouds, rain, fog, or at night. Mr. Kenin added that BMF pilots and crew are outfitted with night-vision goggles to aid in night flights. He also noted that Martha’s Vineyard Airport offers a high level of instrument capability, which further enhances nighttime and foul-weather airlifts.
In the winter months, BMF helicopters often cannot come to the Island because they have no deicing capability. BMF resorts to its plane in such circumstances, and patients are delivered to Hanscom Field and rushed into Boston by ambulance. Mr. Kenin estimated it takes “about 20 to 22 minutes for a helicopter to go directly from Martha’s Vineyard Hospital up to one of the downtown Boston teaching hospitals.”
Mr Farkas said a plane airlift draws out end-to-end travel time to nearly an hour. Pursuant to FAA regulations, high winds, very low ceilings, and driving snow will keep BMF from traveling to the Vineyard, or flying at all. In these cases, a call is made to the U.S. Coast Guard.
Charity takes flight
Boston MedFlight is a charitable organization — the offspring of six of Boston’s teaching hospitals: Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Boston Medical Center, Tufts Medical Center, Boston Children’s Hospital, and Massachusetts General Hospital — run in consortium fashion at the request of the commonwealth.
According to Mr. Farkas, in the early 1980s a couple of Boston’s teaching hospitals were considering developing their own helicopter programs. However, the state interceded before they got very far. It asked them to form a noncompeting medical airlift system. Mr. Farkas said the ongoing consortium that resulted from that request is fairly unique. He emphasized that in every other aspect, the six founding hospitals, among the best in the world, are dogged competitors for market share and highly insular in research, but “when it comes to MedFlight, they are 100 percent in.”
“In a competitive medical environment, this is the only cooperative venture all six hospitals have done for 30-plus years,” he said.
Mr. Farkas described BMF as a public service as compared with for-profit air rescue services that often dominate Western states and regions with large unincorporated areas.
“We find ourselves a much different type of program. We care for any patient, no matter their ability to pay,” he said. Depending on what insurance they have, we work with them — we don’t take people to collections or anything like that.”
Mr. Farkas said BMF invoices for medical air transport average about $15,000.
Safety is paramount. Mr. Kenin said BMF has not had a crash since it began. He attributes this to the quality of the pilots, the high level of maintenance the aircraft receive, and the acquisition of dual-engine aircraft.
When MedFlight is not available, aircraft from the New England Air Alliance, for example, a Hartford Hospital Life Star helicopter, touch down on the helipad behind MVH. This is a form of mutual aid, or what Mr. Farkas calls part of “a firehouse model.”
“If we’re tied up on a mission and not available,” Mr. Farkas said, “if the patient requires timely transport and the patient can’t wait for our next available asset, we’ll work with our partners here in the Northeast.”
BMF’s $25 million operating budget is derived from a combination of insurance reimbursements, hospital contributions and charitable donations.
For more information on Boston MedFlight, visit bostonmedflight.org.
