Patients the priority for Boston MedFlight staff
BEDFORD — It only took an instant to disrupt the quiet sunny morning at Hanscom Air Force Base.
“We have a call,” said critical-care nurse Christine Muszalski, her eyes darting to the civilian helicopter parked inside the hangar. “It’s in Norfolk. We don’t know what it’s for.”
So began another mission for Boston MedFlight, a nonprofit company that works with seven hospitals to transport patients in dire emergencies.
Twelve minutes later, Muszalski and paramedic Scott McKinnon were scurrying across a ball field at a Norfolk elementary school, rushing to a fire department ambulance where a 34-year-old man thrashed in pain after a 10-foot fall from a ladder.
Blood streamed from his left ear, a large knot had swollen on his skull, and he had severe pain in his lower back.
Muszalski and McKinnon sedated him, bound him to a backboard, and helped rush him to the helicopter on a stretcher.
In 10 minutes, they touched down on the helipad atop Brigham and Women’s Hospital, where they were met by a large trauma team. Mission accomplished.
Norfolk Fire Chief Coleman Bushnell, who watched the helicopter arrive at the ball field, appreciated the speedy response.
“Everybody says this, but sometimes it really is the difference between life and death,” Bushnell said.
“The sooner you provide care, the better they do,” said Dr. Jason Cohen, Boston MedFlight’s chief medical officer.
Boston MedFlight transported just over 4,000 patients in the last fiscal year, almost evenly divided between air and ground on its four helicopters, one fixed-wing aircraft, and six critical-care ambulances at Hanscom, in Plymouth, and in Lawrence, company officials said.
That’s an average of 11 patients a day, and it’s the highest total among the five medical aviation services in New England.
Babies and children account for 30 percent of the transports, according to chief executive officer Maura Hughes. That number has been increasing, which helps hospitals keep their staff on site instead of dispatching them to neonatal and pediatric emergencies, Boston MedFlight officials said.
“We’ve taken that over basically. It’s a huge source of pride for us,” Cohen said. The company has recently received approval for a $17 million project to build a new hangar and offices on the civilian side of the Hanscom airfield.
The five medical aviation services in New England cooperate on many levels, including air-traffic control and backup for calls that other companies cannot field, said Elizabeth Conley, a former fire lieutenant who monitors a bank of screens in Boston MedFlight’s communications center.
From her post, Conley directs pilots to one of 3,000 designated landing zones in New England, scans those sites for obstacles, and checks where every medical helicopter in the region is located at any time.
The pilots and crews do not know the specifics of an emergency when they are dispatched, but they receive some patient information during the flight. When weather is a concern, Conley said, these “blind assignments” help remove emotion from the pilot’s decision on whether or not to fly.
“There are days when we leave here, you could use a week to decompress,” said John Duggan, who also works in communications. “But you have to be back the next day,”
Boston MedFlight, which has operated since 1985, sprung from a decision by Boston hospitals to concentrate medical aviation in one company, rather than have several hospitals with air wings.
Boston MedFlight provides care regardless of a patient’s ability to pay, Hughes said. In the last fiscal year, its Medicare and Medicaid reimbursements were $8 million less than the cost of providing those services.
Deficits are subsidized by the seven hospitals that back Boston MedFlight: Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Boston Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, Lahey Hospital and Medical Center, and Tufts Medical Center.
“We take care of everything from babies to someone over 100 years old,” Muszalski said. “You never know what you’re going to get. Five minutes from now, you could be standing in the middle of the highway.”
On this day, Muszalski and McKinnon left Brigham and Women’s and flew immediately to Barnstable Municipal Airport in Hyannis, where emergency workers waited with a 54-year-old Harwich man who had impaled his right hand on a spinning wire wheel. The flight took 25 minutes.
“This is why they send them to Boston, where they have the best,” said Hyannis Fire Lieutenant Jeff Huska.
The injured man sat in the back of a Harwich ambulance as the pair hurried from the helicopter. In 13 minutes, they were back in the air. The patient pursed his lips and glanced out the window as the helicopter flew over Plymouth Harbor, a heavy bandage wrapped around the hand that still held part of the wire wheel.
Antibiotics seeped into his body from a suspended intravenous bag, and Muszalski whispered encouragement during the half-hour flight to Tufts Medical Center.
She and McKinnon appeared to work seamlessly together — taking notes, checking monitors, and talking frequently through headsets attached to their helmets. Every movement seemed essential and reflexive, without a trace of panic.
“Somebody has to stay in control,” McKinnon said after the flight to Tufts. “If we don’t stay in control, the job isn’t going to get done.”
McKinnon spoke just off the Tufts helipad, where a spectacular view of downtown Boston served as an open-air backdrop. He and Muszalski work under intense pressure to save lives, but they are human beings, too.
Case in point: “I don’t like heights,” Muszalski said.