Organization and Mission

Boston MedFlight (BMF) is a 501(c)(3) non-profit organization based in Bedford, Massachusetts, whose mission is to extend the tertiary care services of the major Boston hospitals to the citizens of Massachusetts and New England. The service is available 24 hours a day and seven days a week. BMF was formed by a consortium of Boston area hospitals to provide emergency medical critical care transport services. The consortium includes Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital, Children’s Hospital, Massachusetts General Hospital, Tufts New England Medical Center. BMF provides transport to the hospital deemed best able to meet the patient’s needs, regardless of whether that hospital is a member of the consortium. BMF currently operates three helicopters, two ground ambulances and one fixed-wing air ambulance. Additional information is available at www.bostonmedflight.org.

Systems Integration
BMF has created a system of critical care transport with the goal of getting the sickest patients to the best care as fast as possible. BMF derives its strength and cost-effectiveness by functioning as a regional provider. The existence of BMF spares the members of the consortium the expense of operating separate critical care transport services. Earned revenue covers 92 percent of BMF expenses are covered by earned revenue; the hospital consortium funds the remainder. Although BMF strives to be efficient, it has no financial incentive to generate additional business volumes just to cover expenses.

As a regional provider, BMF achieves a volume of utilization of approximately 2,700 transports annually, a volume that would not be possible for an independent operator. The high volume means that BMF teams encounter even unusual cases frequently enough to keep skills at high levels of proficiency and its affiliation with the consortium of hospitals facilitates development and coordination of treatment and transportation protocols that strengthen the system and improve the quality of care. Having the choice of ground or air vehicles means that BMF can choose the most appropriate and effective mode of transport for that patient under the specific circumstances.

BMF has historically incorporated the quality assurance process into its operation. Every transport team member is responsible for a quality assurance project. Structured training time is built into the operating budget and schedule; team members are required to maintain their skills and certifications through extensive hands-on clinical training opportunities at all the member hospitals.

Implementation Strategy
BMF celebrated its 20th anniversary in June 2005. The system has evolved over that period of time. The genesis of BMF was a core group of surgeons and hospital executives who saw the need for helicopter transportation in the Boston area. Massachusetts regulates the establishment of new health services through its Determination of Need program and State health regulators expressed concern about the potential for the proliferation of competing and inefficient services. Hospital representatives also recognized that multiple providers meant less efficient operations, possibly encouraging the transfer of less acute patients just to make operations financially feasible. Hence, the six-hospital consortium formed BMF.

BMF has used its quality assurance process as a change agent to continually improve the quality of service it provides and as a tool to identify additional services that were needed. One example of that is the evolving recognition of critical care transport as a specialization separate from prehospital emergency medical services. Quality assurance has also helped BMF operate efficiently.

BMF has found that it needs to drive the development and acceptance of critical care transport protocols. Consortium hospitals have willing and effective partners in developing those protocols. Standardization of procedures has helped make the transport process achieve optimal clinical results while smoothing other operational issues.

Evaluation and Results
BMF conducts structured quality assurance activities to monitor the appropriateness and effectiveness of its services on an on-going basis. BMF’s high degree of appropriate utilization indicates that the regionalization of the service effectively reduces the inappropriate utilization that is sometimes attributed to the existence of redundant and competing providers. Boston MedFlight with support from the sponsoring consortium hospitals has fostered an environment for research based practice. Since the inception of the program, there have been changes in clinical standards and current clinical research which has helped shape the BMF Standards of Care as well as its patient care policies and procedures. The BMF research program has been one of the components that make BMF a leader in the transport community. It has resulted in numerous publications and presentations at national and regional conferences.

Education and Replication
Boston MedFlight has worked with a number of organizations since its inception. Particularly in cases where BMF and another provider serve contiguous or overlapping areas, reliance on similar protocols is seen as a means of strengthening the system as a whole, as well as improving care on a case-by-case basis. The New England rotor-wing programs have formed the New England Air Alliance, which is a unique regional infrastructure designed to encourage collaboration instead of competition for critical care transport.

BMF personnel have published a variety of articles relevant to interhospital transfer. A partial bibliography can be found at www.bostonmedflight.org/research.html.