Many congratulations on Life Link III winning the BCEN National Certification Champion – Healthcare System award; what does this achievement mean to the organization?

One of our core values at Life Link III is excellence. This award affirms that we are demonstrating excellence when it comes to supporting certification and the professional development of our nurses and offering a high-level clinical program.

For our patients and communities, our ability to deliver critical care through specialized certification and be recognized with this honor is an assurance that if they or their loved ones are ever in need of air medical transport, they know that the highest level of patient care is going to be delivered by highly trained and skilled certified RNs.

How has Life Link III adapted to the challenging environment that 2020 has brought?

There is no doubt that 2020 presented challenges to our organization and communities. When presented with this challenge, Life Link III took a comprehensive and deliberate response to this new opportunity through innovation and collaboration. 

At the onset of the Covid-19 pandemic, we quickly identified that the safety of our employees had the potential to be jeopardized. Life Link III takes great pride in caring for our own, just as we care for the patients we transport. Personal Protective Equipment (PPE) was an item that was quickly becoming as scarce as toilet paper early in in the pandemic. We knew that we had to be able to provide the front-line staff with the appropriate PPE. We began with the basics by securing additional inventory of PPE, as well as simulation training, with the objective being safe donning and doffing. Our clinical education team was very innovative in their approach and strategy to reinforce the proper donning and doffing technique to reduce contamination. This was made visible through the use of particles simulating aerosol that was visible under a black light.

Through collaborating with others facing a PPE shortage, we learned of a P100 respirator that was equipped with a microphone would allow our clinical staff and pilots to effectively communicate through the helicopter and airplane’s existing intercom and radio system. This provided us with a sustainable solution for airway protection without sacrificing our crewmember’s safety. Each pilot and clinician were issued their own personal P100 Tiger Mask. Prior to receiving the Tiger Masks, our crews, like healthcare providers throughout the country, were expected to reuse N95 masks for multiple days in response to the nationwide shortage.

The management of our patients early on in Covid-19 consisted of early intubation as a means of protecting our pilots and clinicians in a confined spaced. By having our patients on a ventilator for the transport, we were able to adequately filter the air with a viral / bacterial filter. We often assumed that these patients would require a ventilator based on the information we were receiving from other parts of the world and the country. As time moved on, we learned that patients did not necessarily require mechanical ventilation, however, there were limited means of protecting our staff if they were not on a ventilator.

Watching the CBS Nightly News in late March, I learned of the Sea-Long Helmet. Devices such as these were being used in Italy in response to a shortage of ventilators in the management of patients effected by Covid-19. I brought this information to our team of medical directors and it was determined that this would provide an increased level of safety for our crew members.

Life Link III is a non-profit consortium made up of healthcare member-owner organizations; could you explain a bit about how this works in practice in terms of when decisions have to be taken about opening a new base, or expanding in-network coverage with a health insurer, for instance?

Life Link III is a consortium model comprised of 10 health systems who are member-owners. Life Link III is governed by a board of directors and each health system provides a board member from their organization. The executive leadership team at Life Link III, in conjunction with the Life Link III board of directors, are responsible for the development and execution of the Life Link III strategic plan.

Which aircraft does Life Link III operate now, and are there plans to upgrade the aircraft or these avionics at some point soon? Budgetary considerations must be concerning at the moment!

Life Link III currently operates 10 Leonardo AW119Kx aircraft and is expecting to take delivery of the first civilian single pilot IFR equipped AW119 in 2021. Life Link III also operates a Pilatus PC-12 fixed wing aircraft.

Speaking of budgets and payments, what are your thoughts on the Air Ambulance and Patient Billing Advisory Committee and its actions?

To address the balance billing issue, providers and insurance companies should be incentivised to establish in-network contracts, so that the provider knows what they will be paid, the payer knows what benefit will be provided their subscriber, and the patient knows what benefit will be provided by their insurance company. To advocate for our patients, Life Link III assists the patient and their families in navigating insurance claims and appeals processes when necessary. Our finance team works with the payers to negotiate in-network participating provider contracts. Ultimately, the focus is for Life Link III to provide high-quality care while holding the payers responsible. 

In April this year, Life Link III gained its own Part 135 Air Carrier Certificate; what positive changes has this brought for the company?

There have been several. The largest being far greater ability to fully influence our culture of safety and quality. As a single team, we now share the same mission, vison and values which will contributes to our success. Operating 11 total aircraft, we now have control over our aviation and maintenance expenses. While we are still early in this new paradigm, we have already experienced some significant financial benefit.

Could you share a bit of background about your career to date? How did you reach your current position with Life Link III?

I knew I had wanted to be a flight nurse since I had relied heavily on air medical transport teams coming to bail me out since I was a first responder in rural northeast Iowa. I had several individuals that I looked up to and I followed their advice all along my journey. I became a paramedic while attending nursing school which afforded the ability to work 911 ground transport as well as a paramedic tech in the ICU. Following graduation with my BSN, I worked in the emergency department, neonatal and pediatric intensive care unit. Three years into my nursing career, I had landed a flight nurse position at Gundersen Lutheran MedLink AIR (now Gundersen Air). During my time with MedLink AIR, I progressed to leadership roles, which included being the nurse educator and then chief flight nurse. In 2013, I had the opportunity to become the Vice-President of Clinical Services at Life Link III. This was a giant step for a young leader to take on a then five-base rotor wing operation overseeing five managers, 55 clinicians and an education department. From my start at Life Link III, I have had the luxury of a board of directors who prioritize safety, employee engagement, and delivering the high-quality patient care with the best equipped aircraft.

As an active member of ASTNA, what are your primary concerns about the challenges for today’s medical transport nurses?

Many transport nurses are in the same situation as me, in which we are all navigating our first pandemic and adjusting to a new normal in our personal and professional lives. The challenges will be to find innovative solutions to new ways of caring for our patients as well as protecting our staff members from becoming ill.

Quality must drive reimbursement. Nurses have forever been known to serve as advocates for our patients. In the transport industry, the advocacy must continue after the transport. We must be able to demonstrate evidence-based medicine and track quality metrics to illustrate the benefit of critical care transport to the payor.

Nurses in the critical care transport industry must stay current and relevant through ongoing professional development. Having the opportunity to learn from peers locally and nationally through networking opportunities is priceless. The pandemic has eliminated any chance of networking in person, but like anything, nurses improvise and find ways to move on. Many of our trade conferences have gone virtual with impressive engagement from the community.