Air ambulance companies that serve Jackson Hole are rushing to figure out if, and how, they can transport COVID-19 patients safely.
At least one has chosen not to fly anyone who tests positive or is deemed at high risk to have the virus. That could have ramifications for rural health care systems that typically rely on air transport to get patients the care they need.
Six air ambulance companies fly in and out of Jackson: University of Utah AirMed; Guardian Flight; Omniflight and Air Idaho Rescue (both owned by Air Methods); Intermountain Healthcare Life Flight; and Classic Air Medical.
Not only is hospital capacity already somewhat limited in a place like Jackson, but neighboring Sublette County is the only county in Wyoming without a hospital, according to a report by Montana research group Headwaters Economics and High Country News.
WyoFile reported last week that clinics in Pinedale and Marbleton would rely on hospitals in Rock Springs and Jackson first if people needed intensive care and there was still room. Likewise, Jackson relies on Salt Lake City and eastern Idaho hospitals if there’s room.
After St. John’s Health learned it would no longer be able to rely on its regular transfer partner, the University of Utah Hospital, for most of its patient transfers, another hospital system offered to help. HCA Healthcare, which operates the Eastern Idaho Regional Medical Center and other hospitals in the region, said it would accept St. John’s patients.
HCA’s agreement with St. John’s means eight regional medical centers will now accept Teton County patients.
“We’re not on our own any longer,” St. John’s CEO Paul Beaupre said Saturday.
AirMed staff have worked for months to be able to transport COVID-19 patients. Program director Frankie Toon said an airplane is now designated just for those cases around the region and was up and running by the end of the day last Wednesday.
“I’ve been working on it since January,” she said. “On the medical side everything is outlined, but when you start working with aircraft and the ability to remove or not remove equipment to clean it, it’s getting a little complicated.”
A helicopter is designated for in-state COVID-19 patient transfers too. Both aircraft have the ability to separate the pilot from the crew with, at minimum, a curtain. One reason it’s taken a bit to get coronavirus flights ready is that all pilots needed N-95 masks to be fit to their faces using a machine to ensure effectiveness.
“Our primary responsibility is just to be able to transport patients to the level of care that they need,” Toon said. “Some people will be able to be cared for in their local hospital, go home and be fine, but there are other at-risk populations — the elderly, people with other diseases, we want to be able to provide that for them safely.”
Air Methods said that in the event a Jackson patient with COVID-19 needed to be flown elsewhere, it would help as long as protections for its crews were available.
“The safety of our pilots and clinicians is our top priority,” said Doug Flanders, Air Methods director of communications and government affairs, in an email. “Air Methods is flying, and will continue to fly, positive/suspect COVID-19 patients only when the proper personal protective equipment is available for our crew.”
Intermountain Healthcare Life Flight is also transporting confirmed and suspected COVID-19 patients on a case-by-case basis with safety and cleaning precautions in place.
Guardian Flight wouldn’t respond to specific questions but provided a statement saying it was following Centers for Disease Control and Prevention guidelines regarding personal protective equipment and screening of transports to identify potentially infected patients.
CDC guidelines, which are changing almost daily, don’t specifically tell air ambulances they can or cannot transport COVID-19 patients, so it’s unclear if Guardian is or isn’t.
Meanwhile, Classic Air Medical’s chief administrative officer Wade Patten told staff and community partners that it was “an evolving situation” but that the company won’t be flying positive or high risk patients for the time being.
“We have chosen that stance for the concern for our crews, their families, our communities and the greater good,” said Chad Bowdre, Classic’s director of customer relations.
According to the CDC, high-risk people are those living in the same house, being a partner of or caring for symptomatic, confirmed positive cases without using recommended precautions. Following the precautions puts people in the same situation into the medium-risk category. That definition is broad, also including people who have traveled from countries with sustained widespread or community transmission, cruise ship passengers and those who have had close contact with symptomatic confirmed positive cases.
The low-risk category includes people who have been in the same indoor space as a confirmed positive case for a prolonged period but don’t meet the definition of a close contact: being sneezed or coughed on or being within 6 feet.
Bowdre said Classic’s approach could change if cases surge and avoiding confirmed positive patients is no longer an option. The company, which flies in Arizona, Utah, Colorado, Idaho, New Mexico and Wyoming, is tracking potential exposures. The company has flown only three potential patients so far in Wyoming; all came back negative.
If it’s deemed OK to fly a patient, measures in place across the air ambulance industry include the patient wearing a mask or being intubated, the use of a mechanical air filter, no family being allowed on the transport to minimize exposure, and blankets with disposable inserts being used instead of hospital linens. Everyone on board — including pilots — needs to wear goggles, gloves, a gown and an N-95 mask during all aspects of the transport, including entering into the hospital to pick up the patient.
“This isn’t all out of the norm for us,” Bowdre said. “It’s in our protocols that we’ve had before. If we have a patient with something that’s very contagious, like influenza or TB [tuberculosis], we would do the same type of thing. This is similar precautions but even up a level.”
Extensive cleaning of the aircraft before returning to base is an essential component of operations too. Like other health care providers at the front line of exposure, air ambulance staffers can’t keep working if there’s any chance they might be sick.
“Some of our crew members are awaiting their tests results and are now in isolation,” Bowdre said. “It’s definitely affecting the industry, for sure.”
Jackson Hole Fire/EMS is prepared to transfer COVID-19 cases, either to hospitals in Utah or Idaho if need be or just within the community. One Teton County ambulance that’s a little easier to sanitize than others is already set aside for COVID-19 transports locally, said Mike Moyer, Fire/EMS battalion chief.
Fire/EMS has all the supplies it needs at the moment, plus it has plenty of staff due to spring break trip cancellations. But it’s hard to know what the demand and burn rate will be in the next couple of weeks, he said. (See related story on page 7.)
“We’re in the starting blocks, and we’ve been preparing, and we’ve been getting things ready to go,” Moyer said. “We’ve been in the starting blocks for a little while now. The muscles almost fatigue a little bit, being ready. So we just need to take care of folks and work on the marathon resilience instead of the sprint.”