Long-distance ambulance

American MedFlight Human Resources Manager Dena Wiggins jokingly estimates the Reno-based air ambulance company has transported nearly 90 percent of Elko County residents to major metropolitan hospitals.

Founded in Reno nearly 20 years ago, American MedFlight began its fixed-wing air ambulance operations in Elko in 1995. The company transferred its second base of operations to Ely two years ago but still has strong ties to the Elko community, Wiggins says.

"Our roots run very, very deep in Elko," she says.

Fixed-wing air ambulances work well in Nevada as opposed to rotary air ambulatory service providers because the state has such long distances between its population centers, and because hospitals and health clinics in rural areas don't provide critical care services. Helicopters typically are used for shorter distances since they fly about 120 to 170 miles per hour, whereas American MedFlight's four Piper Cheyenne planes cruise at 300 mph.

Generally, the air ambulances aren't first responders; rather, they transport people already at a hospital or care center to a metropolitan hospital where they can get a higher level of care, say for a heart attack or stroke, for instance.

About 40 to 50 percent of flights consist of transporting heart attack victims, Vice President and Chief Pilot John Burruel says. American MedFlight usually transports victims to Reno, Las Vegas or Salt Lake City, depending on their location.

"If they are in Winnemucca, they are probably going to come back to Reno," Burruel says. "Everything from Hawthorne comes to Reno unless it is a burn victim, and that goes to Sacramento. Anything Battle Mountain, Eureka, Ely, the majority of that stuff is going to Salt Lake or Las Vegas."

American MedFlight employs more than 30 people between its pilots and medical and administrative staff. There are about 15 pilots, three full-time nurses, three part-time nurses, four full-time and eight part-time paramedics.

The company also is poised for growth, founder Jack Dawson says. Its growth plan calls for adding another base of operations within the next two years. Dawson credits the dedication of American MedFlight's personnel with the company's longevity.

"What we provide is the fastest service available," Dawson says, "and that is what is needed in the outlying areas: Speed. Time is of the essence, and the faster we can pick up that patient and get them to the next level of care they require, the better the chance for a positive outcome for the patient. That is what we do better than anyone else."

American MedFlight maintains four craft so that several planes are available at all times. Having multiple bases of operations also allows it to service more than one call at a time.

Crews typically are on call and have a 20-minute response time to arrive at the airport ready to depart. Crews consist of a pilot, a critical care flight nurse, and a critical care flight paramedic. Nurses at the company have an average of seven to 10 years of trauma care experience, says Wiggins.

"They really need to have the higher-level trauma, ER, ICU, that type of (nursing) work," she says. "We really like combat medics and combat nurses, anyone coming in from the trauma areas. The nurse has to independently think, and have enough skill and ability to know what to do."

The team at Ely consists of a day and night pilot, and a flight nurse and medic so that someone is on duty 24 hours. Medical staff remain on duty 24 hours a day for 14 days. If the crew is on rest, another team from Reno can be flown out, says Chief Flight Nurse George McCraven.

The biggest challenge for pilots, Burruel says, is flying into rural airports that lack instrument landing system equipment and proper weather reporting apparatus. When flying into these smaller airports, pilots must be able to see to land, and sometimes the inclement weather in northern Nevada makes landing or taking off impossible or a tense, white-knuckle affair for the pilots.

"Unless we legally can't do so and the weather has to be really bad we can fly in almost everything," Burruel says. "We are up when Southwest and everyone else is grounded."

Pilots typically land using pre-established flight routes and altitudes. But without instrument approach, they have to rely on their eyes and faith in their skills.

"That is the hardest thing for a pilot to deal with," Burruel says. "It is a toss-up if we may or may not get in there, and you know you have somebody that needs your help."

American MedFlight operates on a flat-rate fee per flight, as well as a per-mile charge. Part of the education, Wiggins says, is getting doctors to understand the fee structure between fixed-wing and helicopter medical services.

"Our rates are extremely competitive with other fixed wings, and rotary wings are very expensive," Wiggins says. "We try to educate doctors to use rotor wings only when necessary because the cost is twice what it would cost to fly in our aircraft.

Rising fuel costs are chipping away at the company's bottom line. Fuel is the company's single biggest expense, but Dawson has stayed away from boosting his fee structure or tacking on surcharges. Most of the company's aircraft are paid for, Dawson notes, so it doesn't have to factor in amortization.

"Medicare really controls our billing," Dawson says. "Whatever we bill Medicare, we have to bill everyone else the same; that is the law. But they don't recognize fuel surcharges. The costs are just eating into profitability."