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SALT LAKE CITY — Five-year-old Ezra Partridge's heart and lungs were not able to oxygenate or pump blood because his blood vessels connecting the organs were blocked. Doctors realized he needed more specialized care than was available at Primary Children's Hospital, and he needed a unique treatment provided by a specialized doctor in Texas.
A Bombardier Challenger 604 jet — recently acquired by Intermountain Healthcare — was instrumental in saving Ezra's life. He was flown on the jet, along with an ECMO machine that was performing as his heart and lungs, keeping him alive, to Texas Children's Hospital in Houston where a doctor was able to help him.
The aircraft has a range of 4,600 miles, so it can go to places throughout the world with a normal cruising speed of Mach .80, which is over 600 mph, to transport patients and organs quickly during medical emergencies.
Lauri Merrick, a pediatric flight nurse, was on the flight with Ezra to Texas and back to Utah. She explained that he had severe super systemic pulmonary hypertension, and was on an ECMO, extracorporeal membrane oxygenation machine, for 17 days at Primary Children's Hospital while they tried to help him get off the organ bypass.
She said they began reaching out to other facilities about his condition, and were thinking he may need a heart and lung transplant. One cardiologist in Houston thought he may be able to help and Ezra was transported to Texas on March 19 for the treatment.
Typically when transporting children there are two nurses, but when someone is on an ECMO machine they want more help, Merrick said. There were five nurses who accompanied Ezra in the Challenger.
"There's only a handful of centers here in the Intermountain West that provide ECMO for children. There's even a smaller number of transport teams that are able to transport children on ECMO," Merrick said. "It's so exciting to see our program start to develop."
She said being up in the sky makes it seem like one person is insignificant, but the one cardiologist in Houston was able to make a big difference for Ezra.
"I think the power that this aircraft will make in our program and the things that we can provide to people will be amazing. I'm excited to see what the future of Life Flight looks like," Merrick said.
Zane Partridge, Ezra's dad, said that Ezra started saying he was tired soon after his little sister was born in February. They took him to their pediatrician who noticed a murmur and recommended they go to a cardiologist.
During an appointment, the cardiologist discovered that Ezra was in right-sided heart failure, but his oxygen was good. He was taken to Primary Children's Hospital by an ambulance. Partridge said on the ride, Ezra was joking and they were having a good time. The two were watching Pokemon in his hospital bed when he stopped breathing.
Partridge said Ezra was doing well enough that he would have been at school if they hadn't had the appointment that morning with the cardiologist. He is glad they were in a place with people who knew what was wrong and who were able to put him on an ECMO machine.
"If we didn't have that appointment, he could have died in his classroom," Partridge said.
The father explained that three of the four vessels that should take oxygenated blood between Ezra's lungs and heart were destroyed, and the fourth was only partially open. Going to Texas was the best shot to keep Ezra alive, he said.
A day after the surgery to open some of those veins, Partridge said Ezra was able to stop using the ECMO machine. He returned to Utah on April 20 for more recovery at Primary Children's Hospital. Ezra is now 6, and is home continuing his recovery.
"We're grateful to Intermountain Life Flight, to Primary Children's, to Houston Children's, for saving our son's life. This is an important tool for very special cases," Partridge said.
Providing the best care in the air
Intermountain Healthcare already had one jet, a Citation CJ4. The new jet, however, provides additional capabilities. It allows for large machinery like the ECMO machine Ezra used; it can fly longer distances allowing for more direct routes without stopping to refuel; can allow medical workers to be on both sides of the patient's bed; and, can allow additional medical equipment to come along.
Essentially, it is a mobile intensive care unit. Dr. Bill Beninati, Intermountain Life Flight medical director, said all of their aircraft essentially are mobile ICUs, but this one is the most capable.
"Life Flight exists for one reason and one reason only, and that's to take care of the people in our community. And this aircraft allows us to take that to a higher level than what we've ever been able to accomplish," he said.
It can also make high-altitude landings, a feature that Beninati said he initially didn't know would be needed. But it was needed on the jet's very first medical flight, which was to Peru.
The jet is 20 years old but it was altered to become a medical jet. It can comfortably fly up to two patients, along with eight medical crew members or family members, anywhere in the United States, and, in theory, many places in the world, as well.
Kent Johnson, director of aviation operations with Intermountain Life Flight, said a few years ago they realized their jet was not able to keep up with increasing need and they were needing to turn down flights frequently.
With this new aircraft, Johnson said they have two primary objectives — to have a "world class environment" for medical personnel to be able to provide care to critical patients, and to provide a welcome and relaxing cabin environment for family members and physicians.
"I think the cabin environment of this rivals any first-class cabin with a major airline. ... This aircraft is going to be a great aircraft to serve the community and the patients that we serve, I have no doubt about that, for many years to come," Johnson said.
He said his favorite feature is an extra-wide stretcher that is adjustable and inflatable to provide as much comfort as possible for the patient.
Life Flight exists for one reason and one reason only, and that's to take care of the people in our community.
–Dr. Bill Beninati, Life Flight medical director
This type of care can be costly. Johnson said there are many factors that affect the cost, including the distance that the plane flies and the medical care needed while on board. He said an average bill for a trip to the East Coast could be around $40,000, which he said is "very reasonable" for the flight and medical care provided.
Beninati said that this cost is most often paid by insurance, although there are rare instances when a patient has paid. Intermountain has an office dedicated to working through insurance issues.
"It's expensive to own and operate these things and so they have to generate income for us to keep doing it," he said.
Retrieving sick travelers
Sometimes travel ends in either injury or illness that needs critical care, Beninati said, adding that it's amazing how many Utahns end up sick in Cancun. This new jet is able to take a much more direct route to Cancun because it can fly over the water instead of around it.
"When a person becomes critically ill or injured over a period of days as that injury develops, their care becomes that much more complex. Organs begin to fail, right? Before recovery, things can sometimes get worse. And so we need to have extra medical capability than what we can provide in the smaller aircraft," Beninati said.
It can often be better for insurance companies to have a patient being cared for in-network, in addition to benefits for the patient's healing when they are being cared for closer to their home and sometimes having access to more advanced medical care in Utah.
"We heal better when we're surrounded by our loved ones and so it's time that Life Flight had the ability to go get people and bring them back so that they can complete that recovery in the more healing environment," he said. "And for that we need to have a long-range jet."
He also said that when traveling, travel insurance can sometimes help pay the cost to fly back on a medical jet, if needed.
For DonorConnect, which helps coordinate transplants for Utah, Idaho and Nevada as part of a national system, having a second jet will allow them to be more able to transport more organs from other states to patients in Utah.
Tracy Schmidt, executive director at DonorConnect, said the national donation system seeks for fairness, which means a team is asked to fly to recover an organ about two or three times each week.
Until three years ago, the jets they used were from a private company, he said, but priority was given to people who had signed up for the jet, not for a medical emergency. This meant Utah patients lost opportunities for life-saving organs. Being part of Intermountain Life Flight's medical model has helped, because there is a team that can be ready to go within two hours.
Schmidt said transporting organs is very time sensitive, because doctors want to get it to the patient as quickly as possible. Hearts and lungs, kept in cold storage, have a limit of two hours that the organ can be outside a body. The Life Flight team allows them to get organs from California, Colorado and other nearby states to patients between an hour-and-a-half, to two hours, Schmidt said.
"It's fast, and it's critical, that time. So this partnership has saved lives," he said.
The technology for transporting organs is improving, and organs are going to soon be transported in a pump where the organ acts like it is still inside a body. Schmidt said this will allow organs to be transported up to three times further, and with this new jet, there is space to accommodate those pumps.
They have used pumps in the previous jet, but more advanced pumps will be larger and need to be accompanied by technicians, which the new jet can accommodate.
Beninati said it's "like ballet" to get transportation on the jet organized, bring patients or organs to the hangar at the airport and then get them transported by ambulance to hospitals, in addition to coordinating with the other hospital.
"Minutes count on organ survival," he said.
DonorConnect helps them coordinate at an even higher level as they work inside the Intermountain Healthcare program and other health systems in the state, Beninati said. When an aircraft is launched, coordination helps shave crucial minutes off of the time the organ is outside of a body.