CAMDEN — It’s one the few good things the Vietnam War brought us. When medics and doctors returned from the conflict, they shared what they had learned—lives could be saved when helicopters transported patients from battlefield to hospital.

Maine, said Tom Judge, executive director of LifeFlight of Maine, was the last of the lower 48 states to form a medical air transport agency. LifeFlight is a non-profit organization run by Eastern Maine Healthcare Systems, based in Bangor, and Central Maine Healthcare Corp., based in Lewiston.

In recent years, though, the helicopters have become much more than transportation. So well equipped are they, Judge said, that they are more like a flying intensive care unit, and often doctors from small hospitals who see the insides of the helicopters express envy.

The dramatic rescues from mountain tops and remote islands make the headlines, but Judge said most transports are from hospital to hospital.

The Working Waterfront sat down with Judge in LifeFlight of Maine’s office above Camden’s Main Street.

WW: I’ve seen the name LifeFlight in various states. Is it a national network?

Judge: There’s a variety of air medical provider organizations around the country. The name LifeFlight is actually trademarked by Memorial Hermann Hospital in Houston. They will license you to use “LifeFlight” as long as you’re non-profit. They don’t charge us anything for it. Every state in the country has at least one or more providers.

In New England, we tend to be more conservative [with use of resources]. It’s very much a medical model, very tied into the health care system. We want to make sure that the intervention is actually producing a benefit. In a time of increasing cost constraints in medicine, we have to make sure that if we’re going to do something—whether it’s surgery, medication, or being put in a helicopter—from our standpoint, it has to be physician prescriptive.

So a physician, either directly or indirectly, needs to make that order on behalf of a patient.

WW: Every time? Let’s say someone on Great Cranberry Island says, “We need to get this person to a hospital.” It has to be a physician?

Judge: The vast majority of what we do is actually hospital to hospital. About 83 percent of the patients we see—and we see patients by air and by ground—are actually already in the hospital but they need to get to a different hospital. They need to go to Boston; they need very specialized care. But most of the patients we see are already in our community hospitals.

Then we have another group of patients who are on an island, or might be in the middle of the North Woods, might be on the side of the road or in the middle of the Interstate. In that case, the EMS providers and the 911 centers, working together through a very strict set of protocols, say, “In this case, we’ve got to fast-forward the patient.” Maybe not to the closest hospital but maybe to the closest trauma hospital or the closest tertiary care hospital.

So in that case, the EMS people are doing that under the guidance of a physician.

We always want to make sure that we’re making the best choice for our patients. They trust us with their lives.

WW: But you’re also balancing resources”¦

Judge: We all trust that you call 911 and someone’s going to show up. And you can be literally anywhere in Maine and you call 911 and someone’s going to show up and they’re going to do it pretty quickly. They’re trained, they’re compassionate, they’ve got skills, they’ve got equipment. And so 263,000 times a year, a 911 operator picks up a medical emergency.

WW: In Maine?

Judge: In Maine. It’s just phenomenal. They begin that sorting process—what is the right resource, where is this patient going to go.

And then the next line is obviously our EMS services—208 EMS services, 5,000 first responders, EMTs and paramedics. And they’re going to work and begin to sort out and deal with whatever the patient [has].

In emergency medicine, it can be any age. It can be from someone who hasn’t been born yet to senior citizens and you can have any type of disease or injury. It’s an incredible mix. And all the people that work on ambulances and emergency departments—certainly the people that work at LifeFlight—they can be faced with anything.

We have this gifted group of people overseen by physicians all across the state.

I work on a volunteer rescue [in St. George] and we sort things out and we take them to the closest hospital, they get treated and in most cases, they go home. Now some of those patients, they’re going to be more complex. They’re going to be admitted to the hospital, they’re going to end up getting transferred to a bigger hospital for more specialized services.

And at the top of the pyramid, you have this relatively small group, about 1,800 patients a year, who are very sick and need something dramatically different. That’s where LifeFlight comes in, either by air or ground. Working with hospitals, working with our EMS colleagues, sometimes working with public safety, you can be so far in the willy-wags that we’re the first responders.

People focus on the helicopters. Helicopters are cool, they’re unique vehicles, sexy, fast. We obviously rely on the helicopters and they are a unique vehicle, and we’ve got this gifted group of mechanics and pilots that make sure that everything happens safely.

But quite literally inside that helicopter is an intensive care unit. It really has the equipment of an intensive care unit—ventilators, pharmacy, blood, invasive monitoring, portable laboratories, we’re in the process of adding ultrasound.

We have a group of nurses and paramedics trained in intensive care units who work more intimately with physicians, we have a lead physician at Eastern Maine, Central Maine and Maine Med, and then we have another group of about 25 physicians—specialists and emergency physicians—from across the state who volunteer.

WW: Do they get on the aircraft?

Judge: Not often. But occasionally we would put a physician on. Because the crews have constant communication with the specialist physicians, we can make decisions.

We see premature infants. We see patients that literally need a new heart, so they have complete external support for running their heart. And sometimes their lungs aren’t functioning either, so we’re pumping their blood out of their body, oxygenating it and pumping it back into their body.

WW: All while in a helicopter.

Judge: All in a helicopter. That’s the most complex cardio-thoracic transport.

WW: For infrastructure, how many helicopters do you have?

Judge: We have two helicopters. We’re in the process of adding a third helicopter. We’re also in the process of looking to add an airplane to do regional transport.

If a patient is in Fort Kent and they need to come back to Eastern Maine Medical Center in Bangor, we have a helipad right at the hospital in Fort Kent, fly to the helipad, pick the patient up, then fly back to Bangor. 

WW: How long would that take?

Judge: It takes about 65 minutes to fly from Bangor to Fort Kent.

WW: I’m shocked that there’s just two helicopters.

Judge: Part of that is resources. These are very expensive pieces of medical technology.

WW: But they’re also fast”¦

Judge: They do about 165 knots. But in a way, it’s like a mobile hospital. So in some ways, you could think of LifeFlight as Maine’s 37th hospital.