MedEvac

One of the most fascinating things about practicing medicine up here is the transportation system and the process for determining who needs a higher level of care. There are some 56 odd villages in the Yukon Kuskoqwim catchment area, of which very few are big enough to justify a provider (mid-level, PA, NP or physician). What the state of Alaska and the Federal government have done is to create a new type of health care provider called a Community Health Aide. This is usually an individual (mostly local women) from the village who undergo several months of fairly intensive training along the lines of an EMT or paramedic. Their scope of practice, however, is quite broad compared to an EMT, and is performed under the leadership of a physician assigned to their village. When a patient comes in to clinic, the CHA consults a large book of algorithms instructing them each step of the way for common complaints such as abdominal pain, shortness of breath, poisonings, etc. They have specific examinations and treatment procedures. Then at some point during the day the do “Radio Call,” during which they present all of the patients to the assigned doc to make sure the right steps have been followed. This can lead to either approval of treatment, requested follow up, or transport from the village to Bethel for more in depth investigation.

The transport is my favorite part. I have been fortunate enough to travel to the villages of Kipnuk, Shageluk, Kasigluk, and Chevak with the Air medic crew. This has given me a bird’s eye view of the Y-K Delta and a chance to take part in the front line of health care. We fly in a Cessna Cargo Van, a big fat bellied plane which can take off and land on a dime. Most of the villages of this part of Alaska have run ways that are narrow and short enough to scare off all but the most adventurous of pilots. Pictures will follow when I get the cord next weekend.