Extending a LifeLine

Trietsch had been searching for drainage tile beneath a front lawn outside Arcadia late last month when the hole he was in collapsed, according to Baker, fire chief in northern Hamilton County's Jackson Township.

Rescue workers called for a LifeLine helicopter and started digging. It took three

The helicopter took seven or eight minutes to reach Methodist Hospital's trauma center in downtown Indianapolis, Baker said, while an ambulance ride could last

45 minutes.

"We couldn't survive out here without LifeLine; that's the bottom line," Baker said.

Methodist Hospital leaders had exactly this sort of situation in mind 25 years ago when they started Indiana's first hospital-based helicopter program to bring advanced trauma care to more people.

LifeLine lifted off July 16, 1979, thanks to the efforts of Dr. Henry Bock and others. More than 25,000 accident-free flights later, hospital officials see a stillgrowing need for helicopter rescue, and they hope to add more aircraft by next year.

LifeLine uses two helicopters working primarily from three pads at Methodist and one at Riley Hospital for Children to reach throughout Indiana.

The pilots and medical teams stay on call around the clock and can be airborne within 10 minutes of receiving a call, according to Kathy Hendershot, director of clinical operations, emergency medicine and the trauma center at Methodist.

They can reach every surrounding state. Their normal range is within a 150-mile radius of Indianapolis, but most calls fall within 75 miles of the city. That extends roughly across the state, up to Logansport and down to Bedford.

Zionsville firefighter Trevor Hanshew calls the program "a flying ER," but its case list extends beyond trauma care.

About half its calls are trauma-related, said Kathy Beretta, LifeLine's chief flight nurse. The other half involve medical cases like strokes or heart attacks, or flying patients to Indianapolis for specialized care.

Traveling about 150 mph, they move from Point A to Point B at a much quicker clip than an ambulance. An hour-long drive from Nineveh to downtown Indianapolis, for instance, takes 15 minutes in the chopper.

These aircraft do much more than provide fast delivery, according to Hendershot.

"We're not just flying [patients] up to Indianapolis; we're giving them a skill level," she said. "You're not just getting a fancy aircraft with colors and blades that will get you to the city quick."

That skill level includes a doctor/nurse or nurse/paramedic team that handles each call.

They see tough cases on a regular basis and they bring that experience to remote accident scenes that might otherwise have only a basic life support crew, said Hanshew, Zionsville's deputy chief of operations.

Baker has watched a LifeLine doctor cut a hole in a patient's throat to establish an airway. Other firefighters have seen doctors start directing amputations.

The experience extends beyond medical personnel. Hanshew said he's seen LifeLine pilots "set those helicopters in places you wouldn't park a car."

This experience arrives well-equipped. Helicopters can carry units of blood, unlike ambulances. They also carry cardiac monitors, ventilators and defibrillators.

LifeLine is one of several hospital-based helicopter programs in the state. Others fly out of South Bend, Evansville and Fort Wayne, Beretta said.

One private helicopter company covers the southwest part of the state, and Hendershot said another wants to start somewhere in state.

A pricey alternative

This high-tech help doesn't come cheap.

Hendershot declined to provide budget figures for the Lifeline program, which is owned by Clarian Health Partners. But she said the industry average for flights is $3,500 or more. That's three or four times more than an ambulance ride.

That, of course, depends on variables like where the helicopter flies, the complexity of the case, and the size or model of aircraft.

Manpower for each flight can run $450, Hendershot said. Buying and equipping a new helicopter costs anywhere from $1.6 million to $2 million.

Clarian leases its helicopters from a Texas company. The leasing agreement covers the pilots and mechanics, according to Hendershot.

Add to all those costs the fact that Clarian writes off about 30 percent of its flights. That normally happens because a patient's insurance declines coverage or the person has no insurance. Hendershot said the range for reimbursement falls "all over the place."

"At the end of the year, when everything's said and done with the expenses, we run it to break even," she said. "The aircraft is not a business; it was brought in to serve our trauma and our emergency medicine."

She said the program usually does manage to generate a slight profit, though.

It also creates residual benefits. Depending on a patient's insurance, the helicopters can bring in what's known as downstream revenue, people who need surgeries or extensive rehabilitation after arrival.

The helicopter program a] so attracts the "best of the best" in flight nurses and medics, Hendershot said. Plus, second- or third-year medical residents go on flights.

"It's been a great recruiting tool for our hospital, for Clarian, for the [IU] School of Medicine," she said,

Is it worth it?

Less than 10 years ago, four medical helicopters covered Phoenix, Ariz., according to Hendershot. Today, about 20 do.

Helicopter rescue programs started developing and multiplying across the United States in the late 1970s and early 1980s, according to Dr. Dan Hanfling, a Virginia-based physician with the American College of Emergency Physicians. The military refined helicopter rescue in Vietnam and the civilian world followed its lead after the war.

As medical technology continues to evolve, time-sensitive care will become more and more important. Hendershot thinks that means the need for helicopters will increase.

"I think that it's probably going to explode," she said.

Hendershot hopes to add more helicopters by next year to provide better coverage within 150 miles of Indianapolis. She said she wants to add more than one but declined to specify how many. Nothing has been approved yet, she added.

While the need may grow, helicopters will never replace the ambulance, Hanfling said. Weather and mechanical issues can always ground aircraft.

"While they are useful, by no means are they comprehensive," he said.

Still, the choppers get rave reviews from their ground-based rescue personnel.

"Every time the tones go out, you know in the back of your mind you've got LifeLine if you need them," Baker said. "It's a good feeling."