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Island airlifts can save lives in a crisis but may be costly

When islander Ken Garrison fell in his garden a few months ago, island medics took him by ambulance to Virginia Mason, where doctors examined and released him. But back at home the next day, he began to have trouble speaking. When the medics arrived this time, they thought he might be having a stroke and determined that heading to Seattle in a helicopter gave him the best chance for a full recovery.

His wife Phyllis recalls that day clearly.

“I said, ‘Yes, you must take him,’” she recalled. “It’s just that simple.”

Garrison faced additional health difficulties after that, but the cost of the helicopter ride was not among them, as his health insurance paid for the ride in full.

Not everyone is so lucky.

Islander Andrine Olson was airlifted to Seattle with severe chest pain days after being hospitalized for a major heart attack in 2005. While the airlift was a relief, she said, her bill for it was not. Her insurance did not cover the $8,000 to $9,000 expense, she said, and she paid between $6,000 and $7,000 out of her own pocket nearly a decade ago.

Vashon Island Fire & Rescue (VIFR) receives more than 100 aid calls a month, according to Mark Brownell, the battalion chief for emergency medical services, and most often when hospital care is needed, the island’s emergency responders take people by ambulance. When faster help is needed, however, they call in Airlift Northwest, a medical transport provider that serves Washington and Southeast Alaska.

So far this year, it has flown 27 people off the island, according to Chris Martin, the executive director of the organization. That number has held steady in the past few years, she noted, with 25 people flown off last year and 28 flown off in 2011.

The well-equipped helicopters are staffed with a pilot and two critical care nurses with at least five years of critical care experience.

“Think of it as a flying intensive care unit,” Martin said.

While providing life-saving care, the so-called flying ICUs are costly to operate.

Airlift NW charges a base fee for liftoff, Martin said, and then charges by mile. The cost from Vashon to Seattle is about $18,500 and to Tacoma is approximately $16,600.

Many health insurance plans cover about 80 percent of the cost; Medicare covers 30 percent, Martin said, and some plans only cover a set dollar amount. She encourages people to check their benefits and determine the parameters of their coverage.

Representatives from two of the area’s largest health insurance providers — Group Health Cooperative and Premera — concur.

Emergency transport benefits in Premera plans offered on the state’s health exchange all vary, said Melanie Coon, a Premera spokeswoman.

“Gold, silver, bronze, they are all different,” she said.

“Don’t wait for an emergency,” she added. “Talk to us about your plan, what is covered and what is not, so when you are in an emergency, there are no surprises.”

Rick Henshaw, a spokesman for Group Health Cooperative, said the same is true in the plans Group Health offers. The company’s gold plan covers 90 percent of the overall cost of emergency transport while the bronze plan covers just 60 percent. The Affordable Care Act limits yearly maximum out-of-pocket costs, he said, but patients could still end up with considerable expenses.

Brownell said he sometimes hears from people about the cost of a helicopter flight, usually when he returns to their home on another aid call. When people have a serious health condition that makes it more likely they will need an airlift, he said he recommends they purchase what is often called “helicopter insurance” but is really a membership in Airlift Northwest’s program called AirCare.

The membership, which costs $79 for a year, covers everyone in a household should they need to be flown to a hospital.

Health insurance is required to participate in the AirCare program, Martin said, and when an AirCare member is flown, Airlift Northwest bills the patient’s insurance and the membership covers the co-pay and deductible.

Brownell is not alone in advocating the AirCare program. Islander and former Seattle firefighter Sharon Helmick was flown to Seattle in 2008 when she was experiencing chest pain and pressure. She remembers the ride well and noted that she is a bit claustrophobic.

“It looked to me like some kind of Barbie helicopter,” she said. “My feet were alongside the pilot, and I could not see the nurses, who were at my head, and my head was about a foot from the ceiling. Fortunately, there were a lot of windows.”

Insurance paid nearly $8,300 for her trip, she said, while she paid a $570 copay and $770 for an ambulance ride between Harborview and Swedish - Cherry Hill.

Despite her claustrophobia, she said the air trip was quick, easy and a positive experience overall.

After her bills came in, she became part of the AirCare program and now encourages others to buy the coverage.

“Everybody — small children, elderly people, everybody — on the island should have airlift insurance,” she said. “I swear I have been talking it up. I even have a sticker on my car.”

Nationally, there are guidelines for when a helicopter can be called in for transport, Martin said, but on Vashon, Brownell noted, additional factors come into play.

First and foremost, he said, if treatment for a severe medical condition is time sensitive and the ambulance cannot get a patient to the hospital as quickly as a helicopter could, emergency responders will call for an airlift. An acute heart attack is a common example, he said.

“There is a saying,” he added. “Time is muscle.”

He added that VIFR typically has at least two paramedics and two EMTs on duty, and it will not send both paramedics off the island at the same time.

“We would never deprive the island of the last paramedic,” he said.

If too many serious calls happen simultaneously, he said, an airlift could be called in, though that is not a common occurrence.

While Brownell said he and his colleagues try to give patients as much say as possible in their care and where they go, hospitals in the area have specialties. Virginia Mason, he said, treats Group Health Cooperative members and also has a hyperbaric chamber, which is useful when a scuba diver develops the bends; the University of Washington excels at obstetrics and complicated medical cases; Harborview Medical Center is a trauma center and Swedish - Cherry Hill is the go-to hospital for cardiac care.

Last year, a study published in the Journal of the American Medical Association determined that transportation to a hospital by helicopter for trauma patients is linked to a 1.5 percent increased rate of survival compared to ambulance transports. While this number may seem small, it translates into one life saved for every 65 people transported by helicopter. Martin, with Airlift Northwest, said she is certain the percentage of people saved by  helicopter flights from Vashon would be higher than that study indicates.

“I would tell you if you are on an island, that percent would increase,” she said. “Stroke, heart attack, bleeding — all are time sensitive. The sooner you can get care, the better.”

Medical helicopter flights have a reputation as being unsafe, and data from the National Transportation Safety Board underlines the problem. In 2010, there were 14 accidents among major air carrier aircrafts, none fatal. In that same year, there were 13 medical helicopter accidents, seven of them  fatal. Serving as a crew member on  a medical helicopter is the most dangerous profession in the nation, according to a report from the University of Chicago.

Martin is sensitive to the issue, noting that the agency has not had an accident since 2005, when three crew members on board were killed when a helicopter crashed into the water off Edmonds. The cause of the accident was never determined, Martin said.

The company takes safety very seriously, she said, and flies twin engine helicopters that have every safety system available, including the ability to fly on instruments when visibility is poor and night vision goggles for the pilots.

Craig Beles, another islander who was transported via helicopter with cardiac problems, was apparently not thinking about cost or safety issues on his emergency flight several years ago. At age 52, he had had chest pain on the way home from work in Seattle, got home and took a nap — which his doctor said he was lucky to have woken up from — and then called 911.

“The guys from the island were there in seconds,” he said. “They took me to the airport on Cove Road and put me in a helicopter. It was sunset and a beautiful ride.”

For more information on Airlift Northwest and its AirCare program, see www.airliftnw.org, call 888-835-1599 or stop by the fire station on Bank Road for a brochure.

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