Intensive Care in the Air: Flight For Life

Flight For Life has come a long way since it "gave a lift" to its first patient in 1984, when the air medical transport program's inaugural helicopter flight brought a woman from Eagle River Memorial Hospital for treatment at what was then known as the Milwaukee County Medical Complex. That year Flight For Life Wisconsin transported 283 patients. In 2005 the number of transports was 1,420.

The program now has two bases, in Milwaukee and in McHenry, Illinois, that have flown more than 23,000 total missions covering a 225-mile radius from Milwaukee and northern Illinois. Each base has its own BK 117 helicopter, which to the casual (and often fascinated) observer may be simply a flying ambulance but in a very real sense is more like an intensive care unit in the air.

Flight For Life doesn't just use the speed of air transport to improve patient outcomes and survival rates. The helicopters have highly trained and experienced medical teams, specialized equipment and supplies simply not available in standard ground transport. Whether transporting patients from one hospital to another or responding to scene calls such as auto accidents, Flight For Life takes the medical specialty directly to the patient instead of taking the patient to the specialty as an ambulance does.

"There are two major categories of calls for Flight For Life," said Steven S. Andrews, MD, EMT-P, Medical College of Wisconsin Assistant Professor of Emergency Medicine and Flight For Life Wisconsin Medical Director. "There are the patients that are already in a hospital that are going to a different hospital, and then there are scene calls.

"For patients going to another hospital, we're generally called by the hospital sending them. They decide that by the physician's assessment of the patient's acuity, the need for speed of transport, and level of care required. For scene calls there is an algorithm about when to call for a helicopter that's put out by the regional trauma committee. That's again based on the patient's acuity and distance from the trauma center."

Staff Includes Nurses and Doctors
Flight For Life is run under the auspices of the Milwaukee Regional Medical Center (MRMC). Sponsoring board members include Froedtert Hospital and Children's Hospital of Wisconsin (that sponsorship is non-monetary as the program is now entirely self-supporting, paid for primarily through patient insurance).

More than 60 people are employed by MRMC to staff Flight For Life. One of the things distinguishing the service is the level of medical care available on scene and in flight. The standard crew flying out of the Milwaukee base includes a pilot, flight nurse and flight physician or flight paramedic. The teams may include specialty medical personnel in pediatrics or transplant, or a perfusionist.

"The pilots are all full-time, the flight nurses are mostly full-time, and for the most part the paramedics and physicians are part-time," said Dr. Andrews. Flight medics have full time jobs with local fire departments and rotate in to Flight For Life.

"While not based on figures from our program, multiple research studies have shown that for every 100 trauma patients transported by an air ambulance, between one and twelve people more survive because of those transports," said Dr. Andrews. "For cardiac patients in particular, the acute myocardial infarction patients that are going to the catheter lab, for every 30 minute delay there's an 8% increase in mortality."

Most Flights are Hospital-to-Hospital
Cardiac patients, or trauma patients flown from car crash sites, industrial accidents and other scenes aren't the only ones who benefit from Flight For Life. In Wisconsin, such scene calls make up only about 15% of the program's transports each year. The rest are facility-to-facility flights for patients for whom air transport has been determined to be the most medically sound option.

In very general terms, some patients just aren't good candidates for long ground ambulance rides, or might need the specialty care of a nurse or physician while out of hospital, or must be rushed for particular reasons like the sudden availability of transplant at the receiving hospital.

"There are a great number of specialties that are only in certain hospitals," said Dr. Andrews. "That's a benefit, because when you specialize in something you do it frequently and your outcomes are better. Our flight destination is often Children's Hospital, with the children's specialists.

"Getting to a facility with a neurosurgeon to handle head injuries is a frequent cause to transport when there's no neurosurgeon at the sending facility. Getting patients with acute heart attack to a place that has a cardiac facility; that's a reason Flight For Life comes to Froedtert on a fairly regular basis."

See the April 1, 2006 issue of HealthLink to read the second section of this two-part article: Medicine Meets Aviation: Flight for Life Staffing.

Dan Ullrich
HealthLInk Contributing Writer

Some information for this article provided by Flight For Life.org.