Alaska’s Traveling Patients
Seeking specialized healthcare in the Pacific Northwest
An Airlift Northwest crew delivers a patient to Boeing Field in Seattle, Washington.
Hospitals in urban and rural areas, telemedicine, and rural clinics with modern technology where previously none existed have made 21st century healthcare more accessible for Alaskans than ever before. But Alaskans still may need to travel Outside for specialized treatment, and often those travels lead to the Pacific Northwest.
Why Travel Out of State?
While healthcare facilities would prefer to keep patients close to home, health conditions and sudden emergencies sometime require specialized care.
"We encourage people to stay in-state when receiving care in case complications arise once they return home because follow up care can be provided close to home and patients’ support systems are here at home," says Kjerstin Lastufka, communications director for Alaska Regional Hospital.
Riley Little, business development specialist with Guardian Flight, an emergency air transport for patients, agrees with Lastufka saying that removing patients from their support system is a troubling trend.
“This has a huge impact because you’re taking patients away from their community, support network, etc.,” Little says.
Even so, Little understands there are numerous reasons patients might choose to go elsewhere for treatment.
“The reason we transport people from Alaska to the Pacific Northwest is for medical care and treatment that cannot be [provided] in Alaska,” Little says. “Examples include burns and some neurological and cardiac conditions.”
Margaret Brodie, director of Health Care Services for the Alaska Department of Health and Social Services, concurs with Little.
“Medicaid recipients go to the Pacific Northwest to see specialists that do not exist in Alaska,” Brodie says. “We send them to the closest location of the type of specialist that can meet their needs. Approximately sixty recipients are sent to Seattle, Washington, each month.”
Brodie says there are no specific illnesses that cause Alaskans to go elsewhere for treatment.
“They are for specialists for whatever condition that the individual has. These specialists do not exist in Alaska or certain specialists in the Pacific Northwest may be [a closer] provider than sending the recipient elsewhere within Alaska,” she says.
Brodie says a few examples of conditions that may cause Alaskans to travel out-of-state include transplants, typically heart or kidney; third degree or higher burns; pediatric or complicated neurologic conditions; pediatric or complicated cancers; pediatric and complicated cardiology conditions; internal medicine, or urology.
Susan Gregg, director of media relations for Harborview Medical Center at the University of Washington Medicine (UW Medicine), says patients from Alaska often travel to major centers in Seattle that offer specialized healthcare in neurosurgery, cardiac surgery, plastic surgery, transplantation, neonatology, cancer care, and many other complex medical and surgical interventions.
“Within Alaska, Airlift Northwest [an air ambulance service] primarily transports patients from rural areas or clinics to hospitals in Juneau, Ketchikan, and Sitka,” Gregg says. “The clinics provide initial stabilization and then transfer patients to the larger Alaska hospitals for additional specialty care.”
“Recent examples of patients transferred from Alaska to Seattle include a patient having a heart attack who required a cardiac catheterization, a pregnant woman in premature labor, a patient with a complex hip fracture, and a patient suffering from a life-threatening sepsis infection,” Gregg says.
Getting from Here to There…Quickly
UW Medicine is part of a consortium of Seattle-area hospitals that established Airlift Northwest with a mission to provide high-quality air medical transportation for underserved areas.
The group learned from a painful experience.
Airlift Northwest was founded in 1982 in response to a tragic house fire in Sitka that claimed the lives of three children who were not able to receive timely care for their burns.
Dr. Michael Copass, at the time director of Emergency Services at Harborview Medical Center in Seattle, appealed to area hospitals to join together to prevent such tragedies from happening in the future.
Airlift Northwest opened its Juneau base in 1994 and currently has a fixed-wing Learjet and a Pilatus PC-12 stationed there; two critical care nurses are on board every flight. They not only provide care to airborne patients but also frequently join hospital teams to prepare patients for the return trip.
The nonprofit air ambulance service maintains a communications center to receive service requests and dispatch crews. The two critical care nurses in the flight crew are trained in advanced cardiac, trauma, and pediatric life support; flight nursing; and neonatal resuscitation. The level of medical expertise on Airlift Northwest crews is unique in the air medical industry and comparable to that found in a hospital intensive care unit.
In 2018, Airlift Northwest started carrying blood products at its Juneau base. These blood products are given to urgent-need patients to stabilize and keep them alive while en route to the most appropriate healthcare facility.
“Blood transfusions in flight have been proven to save lives and improve patient outcomes,” says Dr. Richard B. Utarnachitt, medical director, Airlift Northwest. “Within thirty-six hours of implementing our new program in Juneau, we helped stabilize a patient by providing a unit of plasma. This could very well have saved a life.”
Working closely with early responders in Alaska, the company provides seminars and training sessions for emergency first responders.
Airlift Northwest offers AirCare, a membership program that protects residents from the unexpected—and often expensive—cost of air transport during a medical emergency. For an annual fee, membership provides coverage for an entire household in Southeast Alaska. The nonprofit also offers a three-consecutive month membership package for those vacationing in Southeast Alaska who are not residents but want to prepare for the unexpected, such as a medical emergency.
Guardian Flight also has a membership program called Apollo MT that offers annual memberships as well as a three week vacation coverage option.
Another transportation option is Alaska Airlines, which offers Alaska Airlines Club 49 members two tickets at a 30 percent discount annually to use any time with a four-day notice, says Tim Thompson, manager of external affairs for Alaska Airlines. Membership in Alaska Airlines Club 49 is free but limited to Alaskan residents.
Alaska rural health services have advanced over the years. Utqiaġvik’s Samuel Simmonds Memorial Hospital boasts a state-of-the-art CT scanner—a first for the Alaska Arctic.
Specialized Care Options
“Pediatric and adult patients are often transported to Seattle for specialty care,” Gregg says. “Harborview Medical Center, which is part of UW Medicine, is the only Level I pediatric and adult trauma and burn center for the region, and UW Medical Center, which is also part of UW Medicine, is a premier hospital for organ transplants and specialty heart care. Seattle Children's Hospital is often the destination for specialty pediatrics.”
“Physicians across Washington state, Alaska, Wyoming, Idaho, and Montana regularly refer their patients who need inpatient or outpatient specialty care to Virginia Mason,” says Gale Robinette, director of media relations for Virginia Mason Medical Center in Seattle. “The medical center is recognized for quality and safety, and the medical staff is highly regarded for its expertise in diagnosing and treating cancer, heart disorders, neurological problems, orthopedic issues, and myriad other medical conditions.”
It also offers a rather unique specialty service—the Center for Hyperbaric Medicine at Virginia Mason is a multi-state referral center for individuals who are victims of carbon monoxide poisoning, scuba diving accidents, radiation injuries, and some types of diabetic wounds.
“Virginia Mason’s hyperbaric medicine program is the only one in Washington that is accredited by the Undersea and Hyperbaric Medical Society,” says Robinette.
The duration of time patients remain outside Alaska for treatment is up to their physician.
“Patient care is individualized and dependent on the nature of the patient’s medical condition and treatment,” says Gregg. “Some patients may be required to stay in Seattle throughout the course of their treatment while others may have the ability to travel back to their local community. For example, a cancer or organ transplant patient may start inpatient treatment in Seattle and go home for outpatient care.”
Dr. Michael Todd, a bariatric surgeon in Anchorage, says he sometimes sends his patients out-of-state for care, such as a patient who had an unusual hernia.
“I sent them to OHSU [Oregon Health Sciences University],” Todd says. “I’m glad I have a choice. I send difficult bariatric cases, for instance if they have parts of the GI [gastrointestinal tract] missing, down to California—they’re master surgeons.”
But he generally does not like advising patients to travel for healthcare if he can help it, preferring that patients remain in close contact until they are well.
Plus, he says, he sees those clients in the grocery store and his children go to school with their children, making his post-operative care as important as the operation itself. “I like it, it keeps me honest,” he says.
Medical situations are as varied as the clients experiencing them, and for providers knowing the patient’s outcome is welcome news.
“We don’t always see what happens to the patients after we dropped them off, but we always enjoy when they reach back out to us and tell us how they are doing,” says Guardian Flight’s Little.
Dimitra Lavrakas is the former associate editor of Alaska Business Monthly, and former editor of The Arctic Sounder, The Skagway News, and The Dutch Harbor Fisherman.