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ESCANABA - A visit to his hometown Escanaba late last fall took an unexpected twist for Mike Greis of downstate Livonia. A medical emergency landed him at OSF St. Francis Hospital for initial treatment and diagnosis and from there an air ambulance flight took him to a hospital near Ann Arbor.

Events started about 10 p.m. on his 77th birthday when Greis began experiencing severe abdominal pain. That continued for several hours until he was taken to the OSF Emergency Department. After a number of tests it was determined Greis had a bowel obstruction and would need surgery. He opted to return to lower Michigan for surgery so he could be closer to home during his recovery. Thus began the process of arranging transportation. Because ambulance services are limited to 250 miles round trip, transfer by air was necessary.

"The people at St. Francis took care of everything. The nurse (Barbara Seibert) arranged my transportation and hospital needs and Dr. Jeanblanc (the surgeon who consulted on Greis' condition at OSF) did the preparation work with my downstate doctors," Greis said.

By 6 p.m. Greis and his wife, Annette, were on a plane staffed by two medical personnel and the pilot. One hour and 20 minutes later they landed at the airport near Ann Arbor and were transferred to St. Joseph Mercy Hospital, where surgeons agreed with the diagnosis and requirement for surgery that had been determined by OSF. Surgery was completed later that same evening and after a seven-day recovery period, Greis said he is home and feeling fine.

"OSF did everything to make the transfer a smooth one. We were happy to transfer closer to our home; it was much more convenient for my wife," a grateful Greis said.

An air ambulance transfer involves the coordination of several patient related resources, explained Seibert. The process starts with the patient's attending physician, who determines a transfer is in best interest of the patient and provides details to the accepting physician of the receiving hospital. The nursing supervisor is responsible for the coordination of patient care services and coordinating transportation. For this transfer, Seibert contacted North Flight EMS a fixed-wing air service out of Traverse City. Coordination of the local ambulance service is also involved to transport the patient from the hospital to the airport - or, in some instances, to transport the flight crew from the airport to the hospital for an evaluation prior to transporting the patient.

"Throughout this process, it is not uncommon to meet with the patient and family many times so they have a full understanding of what they can expect. This helps them make informed decisions and plan accordingly."

Seibert said if a family member wants to accompany the patient on the air transport, arrangements can typically be made, but noted the air ambulance transport team makes the final decision based on aircraft space, equipment needs and crew size. OSF social workers may assist that individual by providing lodging information and options available near the receiving facility. Another task during the flight planning is to discuss cost issues with the patient. The air flight service is independent of the hospital and requires this step.

Many insurances cover all or part of the cost if the patient is going to the nearest facility with a higher level of care that meets the patient's medical needs. If the patient does not meet that requirement the air ambulance requires payment up front, typically between $10,000 and $14,000. The patient and/or representative will be informed of the options. If the patient is critically ill and needs to get to a trauma center, air flight will typically just bill the insurance, Seibert noted.

In addition to fixed-wing aircraft, helicopter service is also available for transfers to hospitals in Green Bay and other nearby locations. While appropriate in some situations, Seibert said helicopters are slower and not practical for longer distance trips like Gries required. Northwoods Air Lifeline, a fixed wing air service out of Iron Mountain, is also available. There is no cost to patients, as it is paid for by donations, but there are some restrictions. Patients must be ambulatory and able to walk across the tarmac, and must not require supplemental oxygen, ventilation or advanced cardiac life support.

While fixed-wing flights can take a patient anywhere in the nation, Seibert said transfers from OSF are most commonly made to the University of Michigan in Ann Arbor; Mayo Clinic in Rochester, Minn.; St. Joseph Mercy Hospital; Milwaukee Children's Hospital; and Marshfield Clinic in Wisconsin.

"Air ambulance transportation is a complex process, but when our patients need it, it's an option that works very well," said Seibert.

"There is a good deal of work up front by the transporting and receiving facilities doctors, nurses and coordinators, as well as the ground and air ambulance specialized workforce. ..."