CARIBOU, Maine — The Cary Medical Center-based air ambulance service known as Fresh Air LLC has recently graduated four new recruits to their life-saving crew. Bill Belanger, owner and manager of the private company, began operating in 2000, and renewed their contract with the city of Caribou, for the second time, in 2012, in order to keep the air ambulance service operating out of Cary.
The air ambulance service provides the Aroostook County area with two separate air ambulance planes — one based in Presque Isle and the other in Caribou.
The Caribou-based air ambulance team recently welcomed critical care paramedic Chris Zappone and critical care flight nurses Michelle Bernard, Lara Boudreau and Amanda Daigle to Fresh Air’s flight crew.
Despite the Fresh Air ambulance service’s operating base being located in Caribou, the courageous critical care nurses and paramedics transport a wide-array of critical care patients everywhere from Aroostook County to Boston, said Ann King, who has been a registered flight nurse since 1988.
Thanks to the expansive training process completed by critical care nurses and paramedics, the two planes and now three pilots, Fresh Air ambulance service is able to makes flights all across the East Coast, 24 hours a day, seven days a week, and all year-round.
The company has agreements with Crown Ambulance in Presque Isle and the Caribou Fire and Ambulance Department, while also providing service to all other Aroostook County hospitals from their own airports.
The city of Caribou licenses Fresh Air LLC and provides paramedics with specialized training in critical care transport. Cary provides nursing support, and the critical care nurses and paramedics have all taken the University of Maryland, Baltimore County Transport Course, which provides certification in critical care air transport, and according to King, the Maryland-based training course has been and continues to act as the gold standard when it comes to air ambulance training.
“It’s a pretty intensive class we have to take,” said King “It’s provided by the University of Maryland and Baltimore County Transport. It’s also known as the CCEMPT course. The nurses and the paramedics are both required to take the same course. The certification lasts for three years. Then, we have to participate in ongoing education to keep our certification. The training has also become more demanding over the years, which is really good.”
Dr. Beth Collamore, who is an emergency department physician at Cary and also the medical control agent for the air flight service, coordinated the training which was done at the Northern Maine Community College. Professional staff from the University of Maryland came to the school to conduct the 80-hour course.
Dr. Collamore completed her formal residency training in emergency medicine at the University of Massachusetts Medical Center. During her training, she served on the Life Flight UMASS helicopter ambulance unit. When she came to Cary in 2000, she was committed to bringing an air ambulance service to patients at Cary. Through a remarkable collaborative effort involving both public and private entities, especially from Belanger and his team, her dream has been realized.
From a humble beginning of offering five flights a year, the air ambulance service has now grown to include two Cessna single-engine airplanes, and the number of flights has increased dramatically, with the service having made 39 trips over the last year.
King explained that a great deal has changed since she began her career 30-plus years ago, and it has all been for the better.
“It’s really nice to have dedicated planes that are specifically designed for this type of service. Before, we pretty much had to make do with what we had, so we had to go looking for planes,” said King. “I’ve flown with infants in the back of bombers from the Loring Air Force base when it was still active. Also, it’s nice to have dedicated pilots who are actually trained in air flights, because there is a big difference when taking off with cargo, as opposed to a patient, so the pilots have to have medical training as well. Plus, we make significantly more flights now, so we’re continuing to get better at it.”
When asked to describe a typical flight, King’s response was more or less that there is no such thing as typical in the air ambulance service.
“It’s like an intensive care room, except it’s in the back of a plane,” she said. “The equipment is laid out differently, so we have to be able to think quick and sometimes even improvise. It’s also very humbling because we have patients here whose families are trusting us to transport the sickest patients out of the building and to their destination with just a flight nurse and a paramedic in the plane. To do this job you really have to love it.”
Chief of the Caribou Fire and Ambulance Department, Scott Susi, explained that it takes a very competent person to be able to perform such a high-stress job, whether it be the flight nurses or the paramedics, the latter of which he personally hand-picks.
“You have to remember that when you’re in a plane, the competency of the crew has to be very high. I don’t just send any paramedics to take the training course, and the hospital doesn’t just send any nurse,” said Susi. “I can have a paramedic who works absolutely fabulous in the back of an ambulance on the ground, but when you put them in a plane, you’ve now lost all your lifelines. You are your own bosses and you are making your own decisions and the outcome of the patient depends on the team’s competency. There’s no hospital to stop at and it can be hard to get questions answered. We do, of course, have a satellite phone, but if you’ve ever used one you know that it can be unreliable in certain spots, and a phone number consists of 39 numbers, so you have to remember that whoever goes in that plane is completely dependent on that team that’s in the plane at the time,” said Susi. “It used to be that there was constant communication between the in-flight team and their colleagues on the ground, but now it’s just not needed to that same extent anymore. Paramedics don’t call for orders anymore. They make their own decisions and accept the responsibility of getting that patient to their destination alive and stable,” he added.
When asked what he looks for in a paramedic when making the decision on who can work in the air ambulance service, Susi reiterated that competency and the ability to work well under pressure are both imperative.
“I look for somebody who can make competent decisions on the ground, as well as somebody who won’t need to rely on someone on the ground to answer questions all the time, but rather somebody who can make competent decisions on the fly,” said Susi. “It’s not something I can necessarily put my finger on, but it’s more of a feeling I get from constantly watching my paramedics when they’re working under pressure. I also read every run-form that comes across my desk, and from those I can get a pretty accurate idea of who is doing their job to the best of their potential.”
