As he handed off command of the Coast Guard in Alaska this month, Rear Adm. Nathan Moore said there’s a lot of good things about living in Alaska — including the ability to watch Monday Night Football at a reasonable time.
But as Rear Adm. Megan Dean takes command, Moore said, his service is facing new challenges in the state, and one of the biggest is a growing — and possibly unprecedented — demand for emergency medevac flights.
“It’s just more maritime activity,” Moore said. “This year, we’re seeing the commercial cruise ship industry go back to what is the pre-2019 level.”
“They’re actually going above the before-COVID level in terms of ships and vessels and passengers here. And so what that means is just more risk for us,” he said.
In just the first half of this year’s summer tourist season, from Oct. 1 through June 15, the Coast Guard in Alaska has flown 163 medical flights.
That’s already more than the 150 that the Coast Guard flew in a full federal fiscal year four years ago, the last year before the COVID-19 pandemic.
The largest Coast Guard base in the United States is on Kodiak Island, home to a major port and air station. Sitka also has a Coast Guard air station, and boat crews operate from large and small towns across the southern coast.
Moore said the Coast Guard is keeping up with the demand with people and equipment from those places.
“But is it more of a workload? There’s no question,” he said.
The Coast Guard’s figures include the kind of dramatic helicopter rescues from ships at sea that are properly referred to as medevacs, but they also include what are known as “non-maritime medical transports,” where someone needs to get from a remote onshore location to a hospital urgently.
The number of requests for non-medical transports increased more than 50% from FY19 to FY22, and this year’s number is on pace to surpass last year’s figure.
“The unique challenge of small towns and villages off of the road system with limited medical facilities creates a frequent need for urgent medevacs to hospitals in bigger cities. While there is a robust network of commercial providers such as Guardian, LifeMed, and Airlift NW, (plus North Slope Borough SAR in the Arctic) there are many locations they cannot fly into after dark or in inclement weather. For years, the Coast Guard has helped fill that gap,” said Jennifer Whitcomb, manager of the search and rescue program for the Coast Guard in the state.
The Coast Guard doesn’t fly to every call for help, Whitcomb said. A Coast Guard flight surgeon reviews every case and decides whether the urgency of the request warrants a flight.
If the patient’s condition improves, the weather clears up or a commercial air ambulance becomes available, the Coast Guard might defer.
Even with those qualifications, the number of medevacs is rising, and officials say there’s one primary cause: the rebound of Alaska’s cruise ship tourism industry.
“This is not only our first full cruise ship season in several years, but it is our largest. And so that is driving the majority of those numbers,” said Erin Hardin, director of community relations at Juneau’s Bartlett Regional Hospital.
Southeast Alaska has a population of about 74,000 people spread across a California-sized stretch of islands and deep ocean channels. Bartlett is the biggest hospital in the region, and many Coast Guard medevacs end there.
In 2019, 1.3 million tourists visited Alaska by cruise ship, most of them staying in Southeast Alaska. This year, 1.65 million tourists were expected to arrive by cruise ship, and actual passenger counts have been close to that projection.
During an emergency at sea in Southeast Alaska — whether aboard a cruise ship or not — the Coast Guard is usually the first responder and typically carries the patient to Juneau or Sitka for further treatment or a transfer to a commercial medevac flight that may take them to Seattle or Anchorage for more advanced care.
Commercial firms also carry patients between communities with airstrips, but when the weather is bad, the Coast Guard can fly at times when commercial flights can’t.
Stephen LeMay, director of business development for Airlift Northwest, the nonprofit air ambulance service affiliated with the University of Washington medical center, said his organization has seen the same trend that the Coast Guard is observing.
“We’ve kind of nicknamed it ‘revenge travel’ after COVID,” said Stephen LeMay, “Everyone wants to get out of the house and travel. So we have seen a pretty significant uptick in medevacs from the cruise ships, either going north to Anchorage or south to Seattle,” he said.
But some officials say tourism isn’t solely to blame.
Close to 8% of Alaska’s population is at least 71 years old, the highest proportion on record, with the number of Alaskans over 65 doubling from 2010 to 2021. That upward trend is expected to continue through at least 2035, state economists have said.
Most of those elderly Alaskans aren’t newcomers: They’re people who arrived in Alaska during the oil boom and have stayed in the state even as they aged.
The SouthEast Alaska Regional Health Consortium has been expanding its presence in Southeast Alaska to meet the region’s needs, and Dr. Cate Buley, its medical director of primary care clinics, said that better health care has reduced an incentive to move away as residents age.
“So I think there’s more people with more severe chronic diseases living in very remote areas than there have been in the past,” she said.
In Southeast Alaska, more than one in six residents is now at least 65 years old.
Telemedicine offerings have gotten better and clinicians are now able to help people in remote places with chronic conditions, “but then you’re also in a very rural spot when something goes wrong. You can get sick, really pretty sick, really fast,” she said.
That, coupled with changes in procedures that have reduced the availability of some commercial medevac companies, has increased the burden on the Coast Guard, she said.
LeMay, at Airlift Northwest, said that group hasn’t seen a significant change in its year-round business, which would be expected if Alaska’s aging population were contributing to the demand for flights.
“The regular — what we call our meat and potatoes stuff, year-round — has been pretty consistent. We have not seen any large uptick or any downfall on that whatsoever,” he said. “So our growth has been seen through the tourism this year.”
For the past two years, Buley said, SEARHC has been meeting quarterly with the Coast Guard, commercial medevac services and representatives from the cruise tourism industry to talk about demand and take steps to reduce the burden on the Coast Guard.
Those have included instructions to shipboard doctors, letting them know about the availability of clinics in different ports and the commercial medevac services that operate in Alaska.
“If somebody breaks their hip, or it’s something that’s not life-threatening, they can be transported out that way,” Hardin said, referring to commercial services.
She said the hospital has been participating in conversations about medevac services as well, because as demand rises, so does the risk that the Coast Guard can’t respond in a true emergency.
“It’s important for folks to know when it’s appropriate to call the Coast Guard and when it’s not,” she said.
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