The LifeFlight of Maine medical helicopter landed at Maine Medical Center’s new $8 million helipad, positioning itself over the red “H” painted on one of two landing areas.

Medics whisked a medical mannequin – nicknamed “Stan” – from the helicopter to a set of elevators. Dr. Leah Mallory, medical director for the hospital’s simulation department, followed them, stopwatch in hand, as the team made repeated training runs on Wednesday.

During one of the runs, Mallory clocked the time from helicopter to the emergency department below at 1 minute 44 seconds. That’s 98 seconds faster than the trip from the old helipad, which was located on top of the nearby employee parking garage.

Maine Medical Center’s new helipad Staff photo by Shawn Patrick Ouellette Buy this Photo

While saving less than two minutes might not sound like much, for patients experiencing trauma, every second counts.

“When it’s a stroke patient, after a stroke every minute brain cells die, so those saved minutes could mean the difference between living the rest of your life in a nursing home or independently at home,” said Dr. Michael Baumann, chief of emergency medicine at Maine Med.

The new helipad tops a tower that’s part of the hospital’s $534 million renovation and expansion. The parking garage with the old helipad is set to be demolished as part of the multi-year project. This week, the new Coulombe Family Tower cancer wing – two floors directly underneath the new helipad – will open to patients.

The helipad adds a new chapter to the continued growth of medical helicopter transportation in Maine and across the country. All of the state’s major hospital systems have built helipads, among them MaineGeneral Medical Center in Augusta, Northern Light Eastern Maine Medical Center in Bangor and Central Maine Medical Center in Lewiston. The state is now blanketed with dozens of helipads and designated landing areas for the helicopters.

LifeFlight and Maine Maine Medical Center staff conduct a simulation with a mannequin Wednesday Staff photo by Shawn Patrick Ouellette Buy this Photo

LifeFlight of Maine, a nonprofit company that provides nearly all of Maine’s medical helicopter flights, now carries about 2,100 patients a year, compared to 187 in its first year of existence in 1998, according to the company’s annual report. Of those 2,100 patients, about 20 percent are taken to Maine Med. LifeFlight of Maine is now a $14 million operation with 113 employees.

Across the nation, the cost of medical helicopter rides has soared to an average of $36,400 per ride, although in Maine the average cost is much lower, at $15,000.

EVERY SECOND COUNTS

As medical procedures improve, especially for cardiac and stroke patients, more patients can be saved and have a much-improved quality of life if they can be brought to a major trauma center quickly, said Tom Judge, executive director of the LifeFlight of Maine.

LifeFlight helicopters take off from locations in Bangor, Lewiston and Sanford, have a cruising speed of about 172 mph, and can reach most areas of the state within an hour. LifeFlight’s most common reasons to transport patients are acute medical – which includes respiratory failure, multi-organ failure, drug overdoses and other causes – cardiac, trauma and stroke.

Judge said a 90-minute ground ambulance ride from rural Maine to Maine Med would endanger some patients who could benefit from a helicopter transport. More cardiac and stroke patients being transported by helicopters are part of the reason that demand for medical helicopters is increasing, Judge said.

“Time is as much of an enemy for some of these patients as the disease itself,” Judge said.

Smaller hospitals are now more likely to use a medical helicopter to transport severely ill patients to a major center like Maine Med or Northern Light’s Eastern Maine Medical Center in Bangor, Judge said. Also, Maine has an aging population, and older patients are more likely to have suffered from a severe condition that requires a helicopter.

Dr. Jeffrey Holmes, right, of Maine Health gives a debriefing following a simulation at Maine Medical Center on Wednesday. Staff photo by Shawn Patrick Ouellette Buy this Photo

When Maine Med opened its first helipad in 2007, about 300 flights landed there per year. That number has climbed to 450 annual flights in recent years, and the hospital projects that by 2022, there will be 750 medical helicopter landings at Maine Med. Even at 750, helicopter transports will still be used for only the most acute patients.

For comparison, the hospital sees about 30,000 ground ambulance runs each year.

Baumann, the Maine Med emergency medicine chief, said another advantage of the new helipad is that it has two landing spots instead of one. On the rare occasions that two medical helicopters arrive at the same time – currently about twice a month but expected to be more common in the future – the hospital will be able to accept both patients simultaneously.

Before the new helipad, one of the helicopters would have had to wait several minutes for the other to land and unload, either by circling the city or going to Portland International Jetport to wait.

‘STAN’ FLATLINES

The training on Wednesday gave medics and hospital staff different scenarios for patients to prepare them for the new route from helipad to emergency department.

During one of the training runs, “Stan” flatlined in the elevator. LifeFlight flight nurse Veronica Marzonie administered CPR while another medic gave “Stan” an oxygen mask.

After they left the elevator and rolled “Stan” a few feet into the emergency department, the medical team had revived the mannequin.

The training team debriefed and brainstormed after the run, looking for ways to build efficiencies and close loopholes. The discussion, led by Dr. Jeff Holmes, regional director of MaineHealth’s simulation center, went over the minute details of bringing the patient off the helicopter to the emergency department.

Everything was discussed: Sending pages to Maine Med staff; positioning the helicopter on the pad; optimizing how quickly and safely medics can move the patient off the pad; how long to stop at the patient registration desk. One LifeFlight medic noted that the traction on the pad needs to be improved to reduce slips.

Holmes said the goal is to wring inefficiencies out of the system, and having all parties – doctors, nurses, LifeFlight staff, communications employees – in the same room talking about it is the best way to do so.

“There are so many areas to orchestrate with the crew, to make sure we close any holes there are in the system and get patients into the best care as quickly as we can,” Holmes said.

MEDICAL HELICOPTER BILLS

Massive helicopter bills sent to patients are a concern that has raised national attention. But it’s less of a problem in Maine compared to most other states, said Judge, the LifeFlight executive director.

He said LifeFlight can minimize patient costs because it is organized as a nonprofit – many other helicopter companies are for-profit – and because the company has signed agreements with all of the major insurance carriers in the state.

Judge said that means Maine’s medical helicopter bills are among the lowest in the country, at about $15,000 per ride. The average cost of a medical helicopter flight in the United States was $36,400 in 2017, according to a federal Government Accountability Office report.  The report said about 70 percent of all medical helicopter bills are “out-of-network” for insurance carriers, which means patients can be socked with bills of $20,000 or more, depending on their insurance plan.

“Because we’ve signed agreements with all the major insurance companies in Maine, an out-of-network bill is a lot more rare,” Judge said. “We work extremely hard to keep our charges among the lowest in the country.”

Mitchell Stein, a Maine-based independent health policy consultant, said that Maine is “fortunate” compared to most states because of LifeFlight of Maine’s work to get the agreements with insurance carriers. The for-profit medical helicopter companies, depending on where they are located, may not have a financial incentive to sign in-network agreements, Stein said.

In other states, patients can be billed the entire amount, or if the service is out-of-network, the insurance company will pay a portion of the bill, but the rest would be billed to the patient. For example, if the helicopter ride is $30,000 and the insurance company agrees to pay half, the patient would still be billed the balance of $15,000. In many cases, a deductible may not apply for the medical helicopter ride if it’s out-of-network, Stein said.

“In a lot of other states, the medical helicopters are for-profit, often owned by venture capitalists,” Stein said. “In many cases, there’s not an incentive for them to sign network agreements with insurance carriers. Maine is a lot better off.”

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CORRECTION: This story was updated at 5:57 p.m. on Dec. 17, 2019, to correct the speed at which LifeFlight helicopters travel.


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