By Harlan Spector
The Plain Dealer
CLEVELAND — The airplane carrying the middle-age heart patient from New York touched down gently at Burke Lakefront Airport. The man was in bad shape, hooked up to chest tubes, nine or so intravenous lines and compact life-support machinery that did the work of his heart and lungs.
The medical crew moved an inch at a time to shift him from the aircraft into the waiting ground ambulance. This was the type of patient that typically wasn’t moved from one room to another, much less across state lines. If one of the hoses connected to his heart snagged, it would be all over.
The transfer took 30 minutes.
The Cleveland Clinic Critical Care Transport team under the direction of Dr. Damon Kralovic is well-practiced at delicate maneuvers. The service began operations in July 2008.
With two helicopters, two twin-engine aircraft parked at Burke, and access to a larger jet for international flights, it has plucked critically ill patients from Ecuador to Elmira - landing in 11 countries, 31 states and more than 100 hospitals in Ohio. The service also has two ground ambulances, which have transported more than 1,800 patients this year from smaller area hospitals.
“We’ve virtually eliminated geographic boundaries to access the Cleveland Clinic,” said Kralovic.
Air medical services have proliferated nationally since the 1980s, with 840 helicopters and nearly 300 airplanes in service last year, according to an online industry database.
Time-sensitive treatments for heart attack and stroke have fueled some of the growth. Technological advances also have enabled hospitals to deliver battery-powered, intensive care at 40,000 feet, using ventilators and heart-lung machines the size of a small backpack.
The Clinic has a crew of 41 dedicated to the transport program, while it contracts with outside companies for the aircraft and pilots. AirMed International of Birmingham, Ala., provides the jet service.
The program is another spoke in the hospital system’s efforts to expand its reach in the region and the larger world, and it has helped the hospital fill beds in the Miller Family Pavilion, home since last fall of its signature heart center.
It’s a big investment. The Clinic deploys a medical crew of three on most flights. It declined to reveal the operating budget, but a spokesman said a domestic flight can run up to $35,000 - and double that for a trip to Europe.
Insurance pays for the services and subsequent medical care, but the Clinic says it picks up patients regardless of ability to pay. Overall, the air medical industry asserts that the services save health-care dollars by getting patients to specialty care quicker.
For the Clinic, the service is also a brand investment, says Tom Campanella, director of the health-care MBA program at Baldwin-Wallace College.
“You get exposure,” he said. “The broader their market is, the more you have people coming to them for difficult cases from around the world.”
Arnot Ogden Medical Center in Elmira, N.Y., is one hospital that has come to depend on the Clinic service. Seventeen of the 214 jet flights since the service started were to Ogden.
Rodney Bulkley of Campbell, N.Y., was one of those patients. A near-fatal heart attack at work last fall damaged his heart to the point that it could not pump enough blood to keep him alive. The New York hospital declined to attempt coronary bypass surgery to repair three blocked arteries because of his precarious condition. The hospital called the Clinic, which transported Bulkley to Cleveland with a balloon pump, a mechanical device to increase blood flow. The Clinic stabilized Bulkley, 47, and went on to do triple bypass surgery. Bulkley was hospitalized here more than a month.
As air medical services have grown, so, too, have safety concerns. In an April report to Congress, the Government Accountability Office said 2008 was the deadliest year on record for the air ambulance industry. Twenty-nine people were killed in nine accidents. The GAO called for efforts to improve safety.
The Clinic program has not been involved in any accidents, a spokesman said, noting that patient and crew safety are their top concerns.
Copyright 2009 Plain Dealer Publishing Co.