On a June morning in 2020, 51-year-old Navy veteran, freelance writer and massage instructor Bettina Freese had just turned on the coffeemaker when she felt a sharp pain at the base of her skull. At first, she suspected a pinched nerve, but then the pain exploded in intensity.
“I’ve had children, and it was more pain than I’d ever even imagined,” she recalls.
Freese’s son initially drove her to the Charles George VA Medical Center, and a CT scan revealed that she had a brain aneurysm. The VA transferred Freese to Mission Health, where doctors attempted to perform an endovascular coiling procedure, in which a minuscule coil is inserted into the aneurysm to seal it off from the blood vessel. Not finding success, Mission Health located neurosurgeon Dr. Edward Yap at the UNC School of Medicine in Chapel Hill, an aneurysm specialist who agreed to do the procedure.
More than 12 hours since her pain started, Freese required immediate care. In stepped the helicopter and crew of Mountain Area Medical Airlift, Mission Health’s critical air transport service. As midnight approached, it immediately flew her to Dr. Yap, who performed an aneurysm clip that stopped the bleeding.
Freese feels lucky to be alive and believes her MAMA flight played a crucial role in saving her life. “I was doing research on what happens to people clinically after something like this,” she says. “There really isn’t a lot of research on it, because a lot of people don’t survive.”
Answering the call
Mission Health has two MAMA helicopters and crew ready 24/7 to lift off from either its Asheville hospital or Angel Medical Center in Franklin. It also keeps a backup helicopter in a hangar at Asheville Regional Airport.
Since its first flight from Transylvania Regional Hospital in September 1986, MAMA has served over 26,000 patients across 18 counties of Western North Carolina, as well as northern South Carolina, northeast Georgia and eastern Tennessee.
MAMA and other hospital or government-owned air ambulances are operationalized only by emergency and medical personnel. But WNC residents can also hire private companies that provide fully outfitted medical planes for less critical situations.
The technology available on air ambulances, and the treatment they can provide, has changed dramatically over the years — as has the cost.
What hasn’t changed, according to MAMA director Dick Whipple, is the type of person best suited to flight medicine. “They like the uncontrolled environment, the variability, the opportunity to make important decisions,” he says. “That challenge brings a certain type of person that is unafraid.”
MAMA operates an average of 90 flights per month (two to three per day) transporting patients. In 2021, 29 percent of MAMA’s trips responded to trauma-related incidents, 22% for cardiovascular emergencies like heart attacks, 16% for neurological situations like strokes, and 15% for all other medical issues, according to Whipple.
Helicopter ambulances are often called flying ICUs, because they are designed to provide intensive and critical care in life-or-death situations. While equipment can vary, all ambulances carry Federal Aviation Administration-approved stretchers with safety harnesses, means of delivering oxygen to a patient, defibrillators, emergency medications and equipment like pulse oximeters that measure vital signs. MAMA flight crews include a pilot, a flight medic and a flight nurse.
Multiple factors determine whether a patient travels via ground ambulance or medical airlift, especially in the mountains. Sometimes, ground transport can reach terrain that may be inaccessible to helicopters or when conditions are unsafe for flight. However, when time is of the essence, flight can’t be beat: It takes a ground ambulance about an hour and 20 minutes to drive between Angel Medical Center and Mission Health, while MAMA can make the trip in 25 minutes.
Since debuting in 1986, MAMA lays claim to some firsts for civilian air ambulance services. In 1999, the FAA-approved the service as the first air ambulance to use night vision goggles during flights. More recently, it became the first medical airlift service to carry a blood thinner reversal medication. Both of these improvements are now industry standards.
On March 1, MAMA added another tool to its arsenal: an intra-aortic balloon pump, which is used to pump blood when the heart cannot. This equipment allows the crew to fly patients with these pumps from outlying hospitals to Mission Health for further care.
According to Mission Health spokesperson Nancy Lindell, the new Airbus BK117 C2e helicopter MAMA purchased in December 2020 has almost one-third more room in the patient area than the older helicopters and a longer fuel range. Having three helicopters available proved particularly useful during the pandemic, when MAMA transported many COVID-19 patients from hospitals that were at capacity to other facilities.
In the early days of the pandemic, private air ambulance companies also flew many COVID-19-positive clients.
“When [the pandemic] first started, we bought a couple of pods to put the patient in,” says Larry Bercu, the founder and CEO of Miami-based Air Ambulance Central. “It was sort of like AIDS: Everybody was afraid.”
Like helicopter-based air ambulance services, private air ambulance companies carry intensive care- or critical care-level medical equipment. Each flight also carries a flight medic and nurse. However, private services typically don’t transport patients in life-or-death situations. Instead, they deploy small jets, called fixed-wing aircraft, to transport patients in non-emergencies over longer distances.
Private air ambulances are frequently used when a patient becomes ill away from home and wants to return safely and comfortably after receiving stabilizing treatment at a medical facility. Cancer and stroke are the two most common reasons his company is hired, Bercu says.
In 2002, federal law increased the Medicare reimbursement for air ambulance transport, especially from rural hospitals. The cost of air ambulances has risen significantly since then, according to NPR’s podcast “Planet Money.”
Costs vary widely based on a patient’s insurance status and the services provided. A 2021 white paper by FAIR Health, a nonprofit focused on transparency in health care costs nationwide, found that the price tag for a private medical helicopter flight rose 22.2% from $24,924 in 2017 to $30,446 in 2020. Fixed-wing flight costs rose 27.6%, from $19,210 to $24,507, during that time.
Mountain Xpress reached out to five private air transport companies with a hypothetical scenario of an elderly woman needing transport back to Asheville after suffering a broken leg while vacationing in central Florida. Quotes ranged from $15,460 to $18,200.
Patients in life-or-death situations, unfortunately, have no opportunity to comparison shop. Freese’s bill for her MAMA flight was $80,000. However, her VA insurance plan covered the entire cost of her nonelective procedure.
Freese now takes blood thinners daily. She has a CT scan at the VA every six months and a cerebral arteriogram at UNC annually. This preventive care revealed another aneurysm in December, which Dr. Yap treated before it became another life-threatening emergency.
“I look at my children so differently now,” Freese says. “I’m so glad [they] still have a mother.”
Editor’s note: The article was updated on March 25, to accurately reflect the type of procedure Dr. Yap performed, as well as the month of Freese’s second aneurysm.