Coast Guard provides Vineyard medical air link of last resort

When weather conditions are at their worst and MedFlight is unavailable, Martha’s Vineyard Hospital calls on Air Station Cape Cod.

A Coast MH-60 Jayhawk helicopter lands at Massachusetts General Hospital Tuesday, Feb. 16, 2016. The helicopter crew transported a patient from Martha’s Vineyard Hospital. — U.S. Coast Guard District 1

Under most circumstances, when a patient requires a level of care not available on the Island, Martha’s Vineyard Hospital relies on Boston MedFlight, or the Oak Bluffs ambulance service, to transport that individual to a more advanced mainland medical facility. However, when those options are not available, when weather conditions are harrowing, the Coast Guard becomes the lifeline of last resort.

Coast Guard aircraft conducted six medical evacuations (medevac) off Martha’s Vineyard in the past 12 months. “Boston MedFlight is the primary medevac service for patients from the Islands; when the weather inhibits their aircraft from flying, the Coast Guard is called,” Lieutenant Michelle Simmons, a pilot at Air Station Cape Cod, said in an email to The Times.

The Coast Guard relies on its fleet of Sikorsky MH 60T Jayhawk helicopters and AirBus HC 144a Ocean Sentry planes.

Lieut. Simmons said advanced electronics and instrumentation make the difference. “The 60 and 144 pilots are able to fly ILS [instrument landing system] approaches into Martha’s Vineyard Airport,” she said. “This allows the crew the best chance of making a safe landing in bad weather.”

Coast Guard aircraft do have limits. “The minimum weather to complete an instrument approach into Martha’s Vineyard for the 144 would be cloud ceilings of 200 feet above ground and half-mile visibility, and for the 60 it would be 200 feet above ground and quarter-mile visibility.”

Air Station Cape Cod’s coverage area extends from the top of New Jersey up the Atlantic to the Canadian border. According to Lieut. Simmons, the station executed 28 medevacs overall in the past 12 months. In addition to the Vineyard, these were “from other local islands and vessels underway.”

Unlike commercial services, the Coast Guard “does not charge patients for transport to a medical center for care,” Lieut. Simmons said.

Bare bones

Rick Kenin, general manager of aviation operations for Boston MedFlight (BMF) and a former Coast Guard aviator, said the capabilities of Coast Guard aircraft set them apart from MedFlight aircraft. He noted that deicing is a particular advantage.

“They can fly in icy conditions where we can’t,” he said. “Their aircraft have a lot more endurance. Because their aircraft are made for long offshore searches, their helicopters can carry a lot more fuel than ours can. So in bad weather conditions, they have the ability to hold somewhere and wait for the weather to clear potentially. And so their decision to come out to Martha’s Vineyard and pick up a patient will be very different from our decision.”

Mr. Kenin said the interiors of the Jayhawk and Ocean Sentry are markedly different from MedFlight aircraft, which are essentially flying ambulances. Mr. Kenin, who logged many hours in Jayhawks, said the contrast is especially pronounced in the helicopters.

“The Coast Guard’s helicopter is austere,” he said. “It has nothing on the inside for medical care. So if you’re transporting a patient in a Coast Guard helicopter, much depends on the medical personnel who are there to take care of them.”

Boston MedFlight crews include a critical care nurse and a critical care paramedic. The Coast Guard relies on Vineyard paramedics to accompany an ill patient, and in some instances a doctor.

The Oak Bluffs connection

The Oak Bluffs Critical Care Team is a special paramedic unit within Oak Bluffs EMS. The unit has received advanced critical care training from BMF personnel. Because Coast Guard aircraft aren’t crewed with medical personnel — only pilots and a rescue swimmer — members of the Critical Care Team accompany any patient airlifted by the Coast Guard off the Vineyard.

“Medical teams are a key component when conducting medevacs,” Lieut. Simmons said; “their knowledge and preparation significantly enhance the ability to safely and successfully transport patients to proper medical care.”

On a snowy evening in April of this year, after a full day shift, Lieutenant Matt Bradley of the Oak Bluffs EMS Critical Care Team participated in back-to-back evacuations.

A little after midnight, Lieut. Bradley, along with paramedic supervisor Kevin Kilduff, boarded a Coast Guard Jayhawk with a patient who’d been in an auto accident. The patient was secured on a backboard and nested in a Stokes basket. As the helicopter approached Tufts Medical Center in Boston, a tethered Coast Guard crew member opened the side door and began relaying visual observations of the building below to the pilots.

As Lieut. Bradley recalled, the main rotor churned up the snowy rooftops, obscuring the helipad. Nevertheless, the Coast Guard aviators touched the helicopter down smoothly.

“These guys are so good you barely know you’ve landed,” Lieut. Bradley said.

On that night, the helicopter crew did not have another mission, and was able to fly Lieut. Bradley and Mr. Kilduff back to Air Station Cape Cod. There have been occasions when that was not possible, and tired paramedics had to hop into a cab for the long ride back to Woods Hole.

The two men got a lift to the gate, and took a cab to Falmouth to meet the daybreak Patriot ferry. Oak Bluffs EMS picked up the two men in Vineyard Haven as soon as they arrived, and hurried them to the hospital, where a cardiac patient was poised for another evacuation.

From there they rushed in an ambulance to the airport, where a Coast Guard Ocean Sentry readied for takeoff to Barnstable Airport. “The airfields at MVY and at Cape Cod were just literally a sheet of ice,” Lieut. Bradley said. Yet the Coast Guard crew took off and landed cleanly. The patient was safely transported to Cape Cod Hospital via ambulance. Lieut. Bradley and Supervisor Kilduff got ambulance rides too — courtesy of Cape Cod Ambulance — back to the Steamship Authority in Woods Hole.

On one rare occasion, the Coast Guard could not fly, but a medical evacuation was deemed critical. The Coast Guard, as it has so often in its history, came through. Oak Bluffs Fire and EMS Chief John Rose recalled the experience: “It was a bad motor vehicle crash — we had a young teenager who was in danger of losing her life,” he said. “The fog was so thick even the Coast Guard helicopter couldn’t land on the Vineyard. The ceiling height was almost zero.”

After conferring with the chief, the Coast Guard sent a motor lifeboat, and took the patient to Woods Hole and a waiting ambulance.