JUANA SUMMERS, HOST:
Hundreds of rural hospitals have closed. Hundreds more are at risk of closing. So patients increasingly depend on emergency care by air. But practicing medicine in a helicopter is stressful, and staff burnout is common. An air ambulance service in Maine is trying to address that. Elaine Appleton-Grant reports.
(SOUNDBITE OF HELICOPTER RUNNING)
WILL BRADBURY: Emergency procedures in flight, so I just checked the red iPad in the middle is up on the QRH.
ELAINE APPLETON-GRANT, BYLINE: Pilot Will Bradbury stands next to a green-and-white helicopter outside LifeFlight of Maine's hanger in Bangor. He's running down preflight safety items with his crew, flight nurse Denise Saucier and paramedic Brian Merklin.
DENISE SAUCIER: Yeah.
BRADBURY: But if we need to get out quickly because of smoke or fire, just watch the terrain so that you're not walking uphill into the rotors.
APPLETON-GRANT: We climb into the tiny helicopter.
(SOUNDBITE OF HELICOPTER LIFTING OFF)
APPLETON-GRANT: We're heading to a community hospital to pick up an injured patient. As we take off, the helicopter vibrates underneath our feet. Across from me, Saucier occasionally glances out the window for hazards. She's worked for LifeFlight for seven years. But the view still reminds her of the role they play in this very rural state.
SAUCIER: You go so long of a distance without seeing any houses, any roads. I mean, there's just nothing. It really hits home how rural Maine is and, actually, how necessary EMS is in this state.
APPLETON-GRANT: The calculus is simple. As rural hospitals close, you're more likely to need an ambulance to get care that's now far away. But ground EMS has long been underfunded and short-staffed. And in rural America, volunteer EMTs are aging out. Millions of people live in ambulance deserts, meaning help is dangerously distant. Mike Abernethy is an EMS expert and retired flight physician.
MIKE ABERNETHY: Just getting an ambulance for just anything in some rural areas, it's hard.
APPLETON-GRANT: This is pushing up costs. It means many patients are transported by helicopter - people who could have taken a ground ambulance if one were available. At LifeFlight - one of the nation's handful of independent, nonprofit air medical companies - demand has doubled in a decade. And between the need to travel further and high health costs, more people are delaying care.
SAUCIER: They get sicker and sicker every year, it seems like.
APPLETON-GRANT: The needs and the know-how to treat everything from heart attacks to laboring moms keep ratcheting up, especially at LifeFlight, which is a critical care service. But it's hard to recruit and hang onto the elite clinicians LifeFlight needs. For years, the company retained only 60- to 70% of its workers.
JOE KELLNER: This is a really hard job.
APPLETON-GRANT: That's CEO Joe Kellner. The company is fully staffed for the first time in nine years. It innovated on standard practices like raising paramedics pay to match nurses. It let some potential recruits join training classes and brought mental health support in-house.
KELLNER: By their job description, they are seeing people on their worst day, repeatedly, over and over again.
(SOUNDBITE OF HELICOPTER LANDING)
APPLETON-GRANT: We land on a small hospital's rooftop helipad. Merklin and Saucier hurry to the patient's side. Most LifeFlight patients are unconscious or too ill to give consent to share their stories, so I have to keep the details private. The patient's been badly hurt. I am shocked by their injuries. Calmly, Saucier and Merklin transfer the patient to a stretcher and strap them in. If this patient doesn't get to a Tier II trauma hospital quickly, they might not live. The incident doesn't seem to faze the clinicians, but EMS workers' rates of PTSD and depression are more than five times higher than the average American's. LifeFlight has tackled this problem head-on, Kellner says.
KELLNER: I do think that has led people to leave this profession. We've put in some incredibly robust behavioral health supports.
APPLETON-GRANT: Including a full-time counselor on staff and a peer support team. Paramedic Brian Merklin is on that team. He worked for many companies before joining LifeFlight last year.
BRIAN MERKLIN: There's a lot of lip service paid to the cost to your mental health in this profession, but this is the only place I have ever worked that actually provided support. And I would love to see it kind of take hold in other areas.
APPLETON-GRANT: It's a wise investment, Kellner argues.
KELLNER: Because the cost of training somebody new into our organization is about $100,000. It's about six months of training.
APPLETON-GRANT: Actually, every new hire's job hinges on passing six to eight months of required training. It's called the Critical Care Academy, and LifeFlight can only hire experienced clinicians like Saucier. She worked for years as an oncology ICU and trauma nurse before she felt ready to apply. The training standards are high. Merklin again.
MERKLIN: You want to be able to meet that standard 'cause you recognize the severity of what potentially we might have to do. But the stress, at times, when you're going through it, can feel like, hoo boy, I don't know if I can do this.
APPLETON-GRANT: Merklin had been flying since 2009. Still, it took seven months for him to pass. Some people never do. But as both air and ground EMS become even more essential, the task is to recruit and keep more people like Merklin and Saucier. Because if hundreds more hospitals do close, highly trained EMS workers may be the only people standing between patients dying and getting the care they need.
For NPR, I'm Elaine Appleton-Grant in Belfast, Maine.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.