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Extending REACH

Need for air ambulances has helped Santa Rosa company boost revenue by 33% last year, expand into Oregon, Illinois


By NATHAN HALVERSON
THE PRESS DEMOCRAT

Published: Sunday, July 20, 2008 at 4:30 a.m.
Last Modified: Sunday, July 20, 2008 at 7:08 a.m.

Saving lives is a growth business for REACH Air Medical Service, which uses helicopters and airplanes to transport critically injured patients.

Photos by KENT PORTER / The Press Democrat IN FLIG
GIVING INSTRUCTION: REACH uses medical dummies to train nurses and paramedics from as far away as Chicago at its headquarters in Santa Rosa. The service, which employs 260 workers, provides trauma care in remote regions.
ABOUT THE COMPANY
REACH Air
Medical Service
Headquarters:
Santa Rosa
CEO: Jim Adams
Revenues: $40 million
Employees: 260
Fleet: 16 medical helicopters and four planes
Operations: 12 air bases in California, Oregon and Illinois

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The Santa Rosa company's revenue grew to $40 million last year, up 33 percent from 2006.

It has expanded rapidly in the past three years, adding air bases in Oregon, Illinois and remote areas of California.

Demand for air ambulances is strong in Sonoma County and other locales where hospitals with trauma units can be more than an hour's drive away for some residents.

REACH's appeal is easy to understand: In the remote coastal enclave of The Sea Ranch last week, a 79-year-old resident collapsed of an apparent heart attack. His heart was barely beating, about 10 beats per minute. At that point, without treatment, his remaining life could be measured in minutes.

A REACH medical helicopter touched down in The Sea Ranch 15 minutes after his collapse.

Todd Peltier, a registered nurse with REACH, jumped out of the helicopter and rushed to his side.

Peltier and a REACH paramedic loaded the patient into the helicopter and got to work, inserting a breathing tube and applying an external pacemaker, which brought his heart rate back to 70 beats per minute.

The REACH team had the patient at Sutter Hospital within 30 minutes of the heart attack -- a trip that would have taken more than an hour by ambulance.

On Thursday, the man was moved out of the intensive care unit -- a new pacemaker in his chest -- and was expected to make a full recovery.

Lots of people contributed to saving his life: his wife who called 911 and administered CPR; the paramedics who arrived first in an ambulance; and the doctors and nurses at Sutter. But REACH fills a life-saving niche that wasn't around 22 years ago.

"Every day, I know we make a difference. It's great," said Jim Adams, chief executive officer at REACH and a former flight nurse.

Without access to trauma care, people with critical injuries are up to twice as likely to die because of missed diagnoses or treatment delays, according to the Centers for Disease Control and Prevention.

"They are a godsend when it comes to getting patients from point A to point B quickly," said Jan Gritsch, trauma program manager at Memorial Hospital. "The whole premise of the 'golden hour' is that if you can get a patient to a trauma center within an hour, their mortality rate will drop."

REACH, which stands for Redwood Empire Air Care Helicopter, employs 260 people who help manage a fleet of 16 medical helicopters and four planes. It expanded to western Oregon in 2006, and to the Chicago area this year.

The idea of air ambulances came out of the Vietnam War, and then blossomed alongside the growth of hospital trauma units in the 1980s, Adams said.

Sonoma County is primarily served by four emergency helicopter services -- REACH, Sacramento-based CALSTAR, the Sonoma County Sheriff's Department and the California Highway Patrol. Only REACH and CALSTAR are staffed with registered nurses.

"You can consider us a flying intensive care unit," said Darin Huard, a flight nurse for REACH.

Dr. John McDonald started REACH in 1987 while working in Memorial Hospital's emergency room, which he also co-founded in 1971.

McDonald, who died in a plane crash in 2000, wanted to extend the benefits of Memorial Hospital's ER to people living in distant parts of the North Coast. Air ambulances allowed him to do that.

Just over 20 years later, the company is saving lives not only in Sonoma County, but now in other parts of the nation, too.

"Northern California became saturated with air medical services in the last couple of years," Adams said. "In 2005, we realized the way for us to stay ahead was to branch outside the area."

On July 1, REACH opened its newest air base, in Imperial County, in a remote part of southern California on the Mexican border. It just bought a new $5 million helicopter, and expects to take possession of five more by mid-2009 in anticipation of growth. It has 12 air bases now, including one in Oregon and another in Illinois.

"I would not be surprised if we had at least another five air bases by 2010," Adams said.

All of REACH's flights, even those in Chicago and San Diego, are run out of the command center in a business park near the Sonoma County Airport.

About 60 percent of the company's business is flying patients from one hospital to another. The remaining 40 percent is picking up trauma victims from remote locations such as The Sea Ranch and flying them to area hospitals. It expects to transport 5,500 patients this year.

The company charges about $14,000 to pick up a trauma victim in Bodega Bay and fly him or her back to Santa Rosa.

REACH does not screen for insurance. As a result, the company wrote off about $31 million in uncollected payments in 2007.

Some of that whopping figure comes from people who were unable to pay, but a significant percentage was from state Medi-Cal payments, which only cover about a third of the costs incurred by REACH.

Fuel costs also have risen sharply in recent years.

"I remember complaining about aviation fuel going over $1 a gallon in 2001," Adams said. "Now, it's more than $5."

Also hurting the company are recent wildfires. The smoke has grounded some flights because of low visibility.

"We experienced something in the last two months that we never had before," Adams said. "We had a big hit in revenue in June because of smoke."

To help offset costs of uninsured or underinsured patients, REACH began an insurance program in 2005 that allows an individual to pay $25 a year for a plan that would cover the cost of a medical flight. It costs $45 for a family.

About 20,000 people are enrolled in the plan, Adams said.

With its 16 helicopters, REACH is still relatively small among national providers. The largest U.S. company, Denver-based Air Methods, operates 322 helicopters.

Growth is strong across the industry, said Blair Beggan, marketing manager for the Association of Air Medical Services. The number of medical aircraft doubled to 800 in less than seven years.

"Companies are opening new bases and spreading out to more rural areas," Beggan said.

Also, as medicine continues to specialize, patients are more frequently flown from one hospital to another that caters to a specific need.

"That is a big reason for the growth too," she said.

You can reach Staff Writer Nathan Halverson at 521-5494 or nathan.halverson@

pressdemocrat.com.


Comments

  1. ride-1 says...
    July 20, 2008 10:37:07 am

    RE: http://www.pressdemocrat.com/article/20080720/NEWS07/807200339

    Just a few comments, The artical said that REACH was in Sea Ranch within fifteen minuts of the guy falling over. I don't think so. It takes REACH fifteen minutes just to walk out to the helicopter uless they were already in the area. The atrical also says that REACH provides better care than CHP and the Sheriff's helo because of thier nurse. Just a little different but basicly the same care. CHP and the Sheriff has paramedics and EMT's on board just like every ambulance in the country which seems to be adaquate care. By the way, CHP and the sheriff is free.Other than that, REACH has some great people working for them. Just remember, they are a business.

  2. pearlrentals says...
    July 20, 2008 10:56:59 am

    ...a business with EXTREEMLY high overhead.

  3. d_dubbya says...
    July 21, 2008 8:09:35 am

    I want to comment about ride-1's reply to the article. First of all, if you think the Sherriff's Dept., Fire Dept., etc. services are "free" you must not be paying any taxes or surcharges on anything in your neck of the woods.
    Second, there is a significant difference in the care of a Flight Nurse and an EMT or Paramedic. If there were no difference, NO services would have flight nurses. EMT/Paramedic care is a lower level of care in EVERY system across the US.
    Last, every service, no matter how altruistic the mission, is a business. Even "not for profit" services have to have income to buy and maintain equipment, to lease and maintain aircraft, and to pay staff. How does that diminish the mission? If your loved one was in need of care, would you take them to an inferior hospital because you liked the idea of "helping the little guy"? I doubt it. I would want my wife or my child to be taken care of by the most skilled and experienced staff in the most advanced setting possible. No matter the cost.
    Does everybody need a helicopter ride to the hospital? No, probably 5% of EMS calls need air medical transport, but those are the ones that make you thankful for programs like REACH.

  4. oniliqua says...
    July 22, 2008 7:10:29 pm

    Very complimentary article. Well-written. Kudos to the aeromedical people out there every day doing the best that they can to aid those in need.

  5. flygirl08 says...
    July 22, 2008 8:33:19 pm

    Hide Post
    I am a flight nurse responding to the reply regarding the implication the care provided by EMTs and Paramedics is the same as an RN. Wow, I was shocked by this statement. While everyone has something to add to the healthcare team, a Registered Nurse operating as a flight nurse does things typically only reserved for physicians. That is why we get certified to operate in an expanded scope of practice. Fron your comments, you don't even realize your ignorance. There are many many live saving technical procedures as well as pharmaco-therapeutic drug interventions ONLY RNS are licensed to do. Additionally, paramedics are driven by county-dictated protocols. For example, if you are licensed in one county you can not go to another county and practice medicine. You cannot. As an RN, we don't have such restrictions. We are licensed by the state and can practice anywhere in our state of licensure. Additionally, flight programs such as Calstar and Reach are accredited by CAMTS. This is a governing body akin to JCAHO. If you aren't aware of the importance of this, I suggest you educate yourself and google it. It is a very high standard to adhere. It also monitors the pilots and aircraft. Ensures safety for all. I can guarentee you CHP and the sheriff's dept are not even eligible to be members. COnsidering 60 percent of air amb usages is for interfacility transfers, meaning taking a patient to a hospital that offers a higher level of care, paramedics and certainly not EMTs are not even allowed to receive care of that type of patient. Do you really think a member of the sheriff's dept can properly transfer an elderly person, polypharmacy (lots of medications), who is paced with an intra-aortic balloon pump? Not an option for you. This takes a highly skilled RN with years of hospital experience. I think I have made my point. I hope I did. You have really spoken out of turn and I suggest you educate yourself before you say such things that hold no merit and have little relevance due to their lack of truth. You are comparing apples to oranges. Plus, the flight medics REACH employs are EXCEPTIONAL. They have a huge learning curve to fly and should be an example to all.
    If you really think paramedics do the 'same' care as nurses, I challenge you to go on a ride a long (REACH or Calstar) so you can really see the difference. You just might learn something.

  6. Jmedic12 says...
    July 23, 2008 4:29:46 pm

    Be careful flygirl08 that you dont generalize either. Reach has flight paramedics and a base in Oregon and in that state paramedics can do everything an RN can do and have an equivalent license including a mandatory degree. It is true that medics and EMT's in California are subjected to a lower scope of practice, but that just isn't the case for most of the country. So the simple fact is that in some states the care is exactly the same (there's even some who would argue that the care is higher with paramedics being that they come out of school already taught skills such as intubation, inserting chest tubes and central lines. Skills that RN's are not normally taught or allowed to perform unless in the prehospital environment.)

  7. mejmcrain says...
    July 23, 2008 4:32:40 pm

    I've been a paramedic for almost 15 years now so I feel qualified to comment. I can't argue against the increased level of care and education a nurse has over a paramedic. However, in a trauma situation there isn't a whole lot a nurse can do that a medic can't. In fact a vast majority of 911 calls in this country are handled by EMT's and paramedics. In my opinion, the main reason nurses became involoved in helicopters is to hadle the very complicated interfacility transports, something the Sheriff and CHP helos don't do. If I or a family member were injured, of course I would want the highest level of care avail. But I think the most definitive treatment for trauma is rapid transport to a traum facility, so if the Sheriff or CHP were closer I would have no reservations letting them transport.

    Just $.02 from a paramedic.

    P.S. where I work we are allowed to function in other counties, as long as we have communications with one of our base station hospitals.

  8. medicmd911-pressdemocrat says...
    July 23, 2008 7:54:46 pm

    I want to respond to ride-1's comments:

    I am a flight medic from IL familiar with CA's EMS systems and disagree with ride-1 because:
    1) REACH provides superior service than the CHP and the Sheriff's helo because REACH has two brains that work accomplish a common task. How awesome is it to have an ICU/ED nurse AND a street medic working on your love ones? I work with a nurse on my bird and get things done with higher efficiency because we approach an issue from different angles.
    2) If the municipalities began to equip and staff their helicopters like REACH does, say bye bye to your next tax refund. Private agencies do a good job of directing the costs of a caring for the needy few from the general public who do not utilize intensive transport care during their lifetime. Welcome to the capitalism.

    Responding to flygirl08's comments:
    You should know that paramedics are limited in California only because of politics. The state does not want to allow its paramedics a higher scope of practice because it would make the street medics look bad. If you look at Oregon and Illinois the flight medic's and flight nurse's job descriptions are identical. Nurses can intubate and medics can start and maintain any IV infusion. It's sad to see how CA laws restrict medics from working along-side with nurses. In IL, the medical directors are responsible for nurses AND medics. If the doc signs off the nurse to run balloon pumps, he/she can also do the same with a medic. If you call flight in IL, I guarantee you that you will get a TEAM of professionals. I can swap my "Flight Paramedic" name tag with my colleague, a "Flight Nurse," and you'd never know the difference.

  9. p.eachus says...
    July 25, 2008 1:09:04 pm

    What about the 17 people killed in one month in air med helicopters? My child was one.Safty first.

  10. flygirl08 says...
    July 26, 2008 9:08:00 pm

    To the parent who lost their child- My heartfelt sympathy. Safety is always everyone's top priority, no matter the discipline.
    To the paramedic referencing medics'scope of pratice nationwide- yes, I know about that. Of course. I was speaking of CA only. I thought I said that- sorry if it wasn't clear.
    To the other medic- quite frankly, intubating, chest tube insertion, and the like are just tasks. While they can be life saving and are very importatnt, they are teachable tasks. I'm sure you agree they are only as useful as the person performing them, whether that be RN or Medic.
    Nurses don't only fly to handle complicated IFTS. There are so many other reasons to do this job, one of which is community education, aimed at prevention of accidents.
    I am not in any way arguing the ability of medics. I have worked with good medics and bad medics. Just as you have worked with good RNs and bad Rns. My point is only to the first person- there are certain things an RN is needed for in the state of CA. In fact, some air amb programs don't even utilize medics. I'm not saying I agree with that, but I think for the medics out there who think they 'do' the same thing as the RNs, I don't think you get the big picture of what an RN actually does (I'm not talking about tasks or skills). With that being said, I think medics do add an essential component to air amb services. I also don't think this is a competition of who-does-more for patients. Medics and RNs have DIFFERENT abilities to add to the mix. We all want the patient to get the best care in the safest manner! Fly safe everyone.