Founded in 1982, Airlift Northwest – an air medical program operated by UW Medicine in Seattle, Washington – has grown substantially in the past four decades, with the service now flying approximately 4,000 patients per year across its operating area.

The program provides air medical coverage to southeast Alaska, Washington, parts of Idaho, and Montana, confirmed Jeff Richey, its Executive Director.

He added that Airlift has had “a slow, thoughtful growth plan”, but has always aimed to “meet the needs of the communities we serve”.

A mixed air fleet

The provider currently flies a mixed fleet of seven Airbus H135 helicopters, as well as four Pilatus PC-12 NG turboprops and two Learjet 45XR jet aircraft. While its jets are based exclusively out of its base in Juneau, Alaska, Airlift’s rotary-wing and turboprop fleets are spread across eight bases in Washington state.

These eight bases are located in the towns of Arlington, Bellingham, Bremerton, Davenport, Olympia, Pasco, Wenatchee, and Yakima.

Steve LeMay, Director of Strategy at Airlift Northwest, explained that all the aircraft are leased from the organization’s aviation partners – Air Methods provides and operates the helicopters and turboprops, and Aero Air does the same for the jets.

“All aircraft are leased from our Part 135 vendors,” he explained. “We utilize one backup of each [aircraft].”

The Part 135 vendors also provide all maintenance services, operating out of Airlift’s “maintenance bases at Boeing Field in Seattle, Washington; McAllister Field in Yakima, Washington; and our hangar in Juneau”, LeMay said.

Operations

While Airlift Northwest provides air medical operations in both Washington and Alaska, the services it provides in each state differ substantially, said Kyle Danielson, the program’s Director of Operations.

A benefit of this mixed fleet is flexibility, he noted, where one of Airlift’s H135 helicopters can conduct a wing-to-wing transfer to one of the program’s fixed-wing aircraft for the journey over the mountains to a higher level of care

“With our Alaska operations, we are 100% fixed-wing-based. Our Juneau, Alaska-based team is highly adept at transporting critically ill patients over vast distances to advanced specialty care,” he said. Additionally, he added, the Alaska team are experts in “initiating and elevating the level of care to patients in resource-poor settings or austere environments”.

Danielson added that Airlift’s team in Alaska also offers “tailored education and training” to hospitals, clinics, emergency medical services (EMS), and first responders throughout the state as part of its “commitment to education”.

By contrast, Airlift’s Washington-based operations involve a mix of fixed-wing and rotary aircraft, in part necessitated by “environmental factors such as icing over the Cascade mountains”, explained Danielson.

A benefit of this mixed fleet is flexibility, he noted, where one of Airlift’s H135 helicopters can conduct a wing-to-wing transfer to one of the program’s fixed-wing aircraft “for the journey over the mountains to a higher level of care”.

“This approach,” Danielson said, “drastically reduces out-of-hospital time for patients who would otherwise require ground transport, which could take hours.”

Typical missions

Danielson explained that Airlift conducts both interfacility transfers and emergency callouts, at a ratio of approximately 70% interfacility to 30% scene response.

When it comes to emergency response, the service will face a range of medical incidents. These include:

• Trauma
• Neurocritical care – hemorrhagic or ischemic strokes, seizures
• Cardiac intensive care – cardiac arrests, heart failure, heart attack
• Medical intensive care – sepsis, acute respiratory distress syndrome (ARDS), multi-organ failure.

A common theme for the type of missions Airlift responds to – due to the low population density of the Pacific Northwest region – is that “patients are either remote or at facilities that require them to be transferred to a higher levels of care”.

“While Airlift Northwest flies patients to or from any hospital or scene location, Harborview Medical Center [in Seattle] is a common destination for patients throughout the region,” said Danielson, noting that the facility is “the only designated Level I pediatric and adult trauma and burn center in the state of Washington”.

Medical crew training

Airlift Northwest provides its medical crew with regular training opportunities to remain “current”, including annual sessions on airway management, ventilation, and cardiac devices, said Brenda Nelson, Airlift’s Chief Flight Nurse.

Airlift Northwest provides its medical crew with regular training opportunities to remain current

Crew undergo regular simulation testing for competency in the management of trauma, respiratory illness, obstetrics, sepsis, and cardiac, for both pediatric and adult critical care.

Nelson added that “as we fly with a single pilot in our rotary-wing aircraft, our nurses are [also] trained to use night vision goggles (NVG) on outbound flights”.

She noted: “We have a robust education department that evaluates and trains the needs of the crews to successfully care for our patient population,” adding that  Airlift Northwest is also “lucky to be part of UW Medicine to assist our education needs when we tackle new areas”.

Additionally, “our own medical directors and staff are involved with research, both locally and nationally, to ensure that we stay current on the latest treatment modalities”.

Equipment

Nelson and Danielson explained that all of Airlift Northwest’s aircraft carry a varied but “identical” range of medical equipment. This includes “Hamilton-T1 ventilators; LP 15 monitors; Spectrum IV pumps; Braun syringe pumps; Crēdo coolers for blood products; QinFlow for fluid/blood warming; and all necessary ICU-level drugs”.

We have recently developed an extracorporeal membrane oxygenation (ECMO) transport team, in collaboration with our colleagues at UW Medicine

They added that “we have point-of-care ultrasound (POCUS); i-STAT point-of-care lab testing; Aerogen for aerosolization; and a Hamilton-H900 for high-flow humidification” onboard.

Danielson also noted: “We have recently developed an extracorporeal membrane oxygenation (ECMO) transport team, in collaboration with our colleagues at UW Medicine, for primary and secondary retrieval.”

Consequently, the provider can now “rapidly respond to an outside hospital and initiate cannulation for patients who need this level of cardiac and respiratory support”.

Airlift Northwest’s standard selection of onboard equipment is extensive, but the program continuously reviews what it needs to be equipped with for any medical situation that may arise. “We continue to evaluate the need for owning our own cardiac devices, depending on the demand of our referring and receiving hospitals,” they said. “We’ve also recently added intra-aortic balloon pumps to our rotary-wing fleet – they have been used on fixed wings for years.”