© Alyeska Ski Patrol
© Alyeska Ski Patrol
Even prior to the updates, EMTs in the Last Frontier—many working with medevac teams or on ski patrols—were trained to deal with a broader array of medical issues than entry-level EMTs in the Lower 48, explains Todd McDowell, the Emergency Medical Services (EMS) program manager at the Alaska Department of Health and Social Services.
“Our scope of practice was essentially based on scope of practice from the late 1990s, early 2000s,” McDowell says, noting that to ensure EMTs are trained using the most modern techniques, they need to take additional training courses with an expanded scope. “It was actually the first major revision of the EMS regulations in about seventeen years. So, it’s actually a pretty exciting time right now.”
All of the approximately 3,500 trained EMTs in Alaska were certified by the Alaska EMS program to practice in state, explains McDowell. Even those trained Outside are required to take a short transition class to ensure they’re ready to take on the expanded scope of duties needed to perform here.
The lack of connectivity between communities and hospitals via road systems in Alaska is unparalleled in the Lower 48. Because of this, Alaskans living in rural communities depend primarily on air transportation—especially in the case of a medical emergency.
“So when you look at the type of patients we fly, they’re having to fly because there is no other way for them to travel to where they can get the level of care they need,” Guardian Flight Executive Director Jared Sherman says.
“About twenty years ago, the airline industry said you couldn’t put a passenger with a tank of oxygen or managing IV medications on a commercial aircraft.
“And that’s how, originally, all around Alaska commercial operators operated. So, when the FAA came out and said that you needed to actually operate like a medevac company, it opened up the need for this kind of transport.”
Medevac companies, such as Guardian Flight, LifeMed Alaska, and Medevac Alaska, quickly moved in with trained emergency medical personnel to fill that need.
“These services are critical to the people of the state of Alaska. Much of Alaska is remote and underserviced. Many communities exist without a surgeon or specialist. Alaskans are rugged themselves. It just takes time to get to patients,” says LifeMed Alaska Director of Clinical Services Erik Lewis. “Often when someone gets injured it takes time to activate the right resources and mobilize assets to get to a patient; then we fly to their location and fly them to the resources they need.”
Given the wide variety of terrain and patient needs, medevac companies rely on both fixed-winged aircraft and helicopters. Fixed-wing emergent response is rare in the Lower 48, Sherman says.
“Our helicopters are utilized for short transports and scene work, such as a vehicle crash or injured hiker. When we get called to go over the Chugach or Alaska Range or all the way to Seattle, it is a faster transport to use a fixed-wing platform,” Lewis says.
For medical calls, Guardian Flight operates Beechcraft King Air 200, Learjet 45, and Cessna 208 Caravan aircraft. LifeMed Alaska operates a Bell 407 helicopter, as well as Lear 31/35, Beechcraft King Air 200, and Challenger 601.
LifeMed Alaska and Guardian Flight require emergency medical personnel working on aircraft to complete intense additional training. Both flight nurses and paramedics are trained to deal with how the human body functions differently at altitude and how medical procedures need to be adapted accordingly.
“Our flight orientation takes up to a year to complete. Aside from classroom time and frequent simulation, our teams work along physicians in the ER, adult/pediatric/neonatal intensive care units, and the OB department to gain the skills needed for transport in Alaska,” Lewis says.
The advanced training is essential to providing the high level of medical service needed, Sherman and Lewis agree.
“Practicing medicine in a remote village, a mountain top, or in extreme cold has its challenges. The logistical challenges make most situations unique. Not much is black and white about transport in Alaska,” Lewis says. “Anchorage provides much of what Alaskans need, so when someone is really sick, and they need to fly out, it is a long transport to Seattle or beyond. Our flight team is asked to take patients to Portland, Denver, Dallas, and beyond.
©LifeMed Alaska
©LifeMed Alaska
Alaska is divided into seven emergency medical service districts, three overseen by native health corporations, three set up as nonprofits, and one operated by the North Slope Borough.
Each of the entities assists the state with EMT training, data collection, regional medical direction, and providing technical assistance to EMS agencies, explains McDowell.
The state provides EMT-1, EMT-2, and EMT-3 certifications, as well as training for mobile intensive care paramedics, who are licensed by the Alaska Department of Commerce, Community, and Economic Development. However, the updates in regulations are ushering change in Alaska: a nationally recognized Advanced EMT certification.
Currently, the EMT-2 course prepares responders to initiate intravenous lines, administer IV fluids, and specific medications, while the EMT-3 course prepares them to provide limited advanced cardiac life support and additional medications. However, neither course is nationally recognized; if those who complete the course leave Alaska, they are only allowed to attain an EMT license in the Lower 48.
Though the details for the Advanced EMT certification are still being worked out, being able to provide another nationally recognized certification—the EMT-1 certification is already recognized throughout the United States—is a huge boon to the state, says McDowell.
For areas where there is a large enough tax base, boroughs and cities provided temgergency medical services” to read: the funding for paid emergency medical services—often in conjunction with volunteer staff.
“Most small communities rely on volunteer staff entirely,” McDowell says, noting that some of the services provided by volunteers can be billed to insurance companies to help cover the costs of operating a volunteer emergency medical service.
To better support those providing emergency medical servicesin rural communities, Alaska launched the Code Blue Project in 1999. The project, which has been hailed as a success by the state, was designed to prioritize and seek funding for essential equipment for rural emergency medical services in the state.
“The Code Blue program grew over the years. It provided seed money or match money for ambulances, cardiac monitors, defibrillators, communication equipment, training equipment, and patient care equipment,” McDowell says.
Coordination between those trained to provide even the most basic medical services in rural communities, first responders, and the Coast Guard is often required to ensure continuity-of-care.
“We do a lot of joint training with the local EMS. These are the teams on the ground that call us for assistance when there are multiple patients or someone who is hard to get to,” Lewis says. “Often we coordinate with the Coast Guard or Air National Guard for transport. There are times they can get to the patient first and we will rendezvous with them to provide our critical care the rest of the way.”
Last year, LifeMed Alaska managed 3,500 flights and nearly 6,000 ground transports, according to Lewis. Within the state somewhere between 6,000 and 7,000 medevac trips are completed annually, Sherman says.
“So during the summer months, especially with the tourism, the cruise ships, and just the general increase in population across Alaska, the number of cars on the road, all of that really swell in the summer months,” Sherman says, reflecting on Guardian Flight’s busiest season.
Guardian Flight
Foister says Alaska Regional Hospital hires EMT-1s, EMT-2s, EMT-3s, and paramedics. When employed by the hospital, they are considered ER techs and must follow the guidelines established in their job description. However, as one of the three high-level care facilities in Alaska, the hospital is often where medics bring patients.
“There are no contracts, or obligations, to bring patients to Alaska Regional. In the confines of Chugiak, Anchorage, and Girdwood, it is a patient’s choice as to where they would like to be treated,” Foister says. “There is always medic discretion for patients that are unable to make the decision. This comes down to proximity and capability of the receiving facility.”
“Patrollers have quite a few duties assigned to us. We are trained to provide medical care, technical rescue, rule enforcement, and risk management, to name a few. For example, on the mountain, you can think of us as the ambulance, fire truck, police, and DOT,” Alyeska Ski Patrol Director Ben Habecker says. “As first responders in a wilderness environment, our primary medical training is called Outdoor Emergency Care. It typically takes approximately 120 hours to complete—though many of our patrollers also carry EMT certificates and a few are paramedics.”
The team is made up of about 120 patrollers, 55 professionals, and the rest volunteers. Of the 55, about 25 are trained EMTs, says Habecker.
The Alyeska Ski Patrol team, which sees about 650 patients a year, offers basic and advanced life support services, dealing with everything from injuries that need a simple bandage to broken bones.
“As we all know, Alaska is home to some extreme weather. I think even compared to other ski areas in the Lower 48, we have some unique challenges from the weather,” Habecker says. “Our mountain terrain and daylight hours pose some unique challenges to working and operating a ski area.”
Helping out the Alyeska Ski Patrol team are Yuki, Kilo, and LZ—the resort’s rescue dogs. Another dog, Vega, is in training. The Alyeska Avalanche Rescue Dogs are trained to detect the scent of a person trapped below layers of snow, significantly decreasing the amount of time it can take a team to search an area.
“A smaller number of transports are paid by commercial insurance,” Sherman says.
Sherman points out that there are membership options for people who pursue activities that might put them more at risk or for those who live in remote communities where such services are the only form of transportation to a medical facility.
Annual memberships cover the cost of any copay and deductible associated with the medevac trip.
Though the numbers for LifeMed Alaska were slightly up in 2018, Lewis points out that advancements in video teleconferencing in some rural clinics are making a real difference with regard to medical treatment in those communities. But for many rural communities, there aren’t even clinics.
“In some villages, the chaplains serve as both the Community Health Aid and the local EMS—something that is unique to Alaska,” McDowell says.
The key to better serve these communities really comes down to education, says McDowell. The distance and logistics of bringing EMT training to those based in remote communities creates additional challenges for the industry.
“A lot of the regions are working on distance training, and how do we overcome these challenges,” McDowell says, noting that the new regulation package will make a difference in the EMS industry and to Alaskans throughout the state. 
