LifeFlight of Maine is nearly fully staffed for the first time in nine years after adding a longer training academy, equal pay for paramedics and flight nurses, and an in-house mental health counselor. The nonprofit air ambulance service’s gains come as demand for air medical transport rises in one of the nation’s most rural states and across the country, where hospital and ambulance closures are widening gaps in emergency care.
At LifeFlight’s headquarters at Bangor International Airport, pilot Will Bradbury stood near a helicopter with a clipboard and reviewed emergency landing procedures with flight nurse Denise Saucier and paramedic Brian Merklin. If smoke or fire forces a quick exit, he told them, watch the terrain so they do not walk uphill into the rotors. The crew then prepared a stretcher and equipment for takeoff; Saucier folded herself into the compact aircraft.
Saucier has worked for the air ambulance service for seven years and still calls it a dream job. But the life of a flight clinician is hard, and the strains in rural health care are making it harder. Since 2015, demand for medical flights in Maine has doubled. LifeFlight crews flew 3,031 flights in 2025, more than one every three hours. Demand is up another 10% this year.
Nationwide, air medical services are filling gaps left by rural hospitals that close, convert to outpatient-only rural emergency hospitals or stop offering unprofitable services such as labor and delivery. Medicaid cuts estimated by the Congressional Budget Office at $911 billion over 10 years are taking effect, and hundreds more rural hospitals or maternity departments are at immediate risk of closing. With every closure, care moves farther away. Ground ambulance stations, many struggling to stay open, increasingly cannot meet the need.
“We’re seeing this across the board. The need for air medical services is increasing year over year,” said Nicholas George, who runs the ETHOS Database, a national tracking system for air medical programs. When the rural health care system breaks, emergency medical services on the ground and, increasingly, in the air become the backstop.
The backstop role
Every week or two, Saucier flies to one of Maine’s thousands of islands. Crews occasionally land in the state’s forests and mountains and use snowmobiles to reach patients. Scene calls to roadside or trailside accidents account for less than 10% of LifeFlight’s transports; the share is higher in urban areas. Most flights are interfacility transfers: clinicians stabilize a patient at a small local hospital and fly the person to a larger hospital with more resources.
Saucier watches the landscape for hazards and for reminders of the organization’s role. “You go so long of a distance without seeing any houses, any roads,” she said. “It really hits home how rural Maine is and how necessary EMS is in the state.”
The pressure is growing as ground services in Maine strain. The system is so fragmented that patients can fall through the cracks. Last year, a woman in a small northern Maine town died while the county dispatch center called 10 ambulance services; none responded.
Staffing a difficult job
Retaining clinicians who can treat heart attacks, injuries and fragile newborns has been difficult, especially since the COVID-19 pandemic. The job requires medical expertise and the ability to withstand a demanding schedule without burning out. Almost a quarter of ground-based EMS workers leave the field every year. There is no comprehensive staffing data for air medical services, but flight clinicians face a distinct set of stresses: dangerous conditions, long shifts and unpredictable hours, rising training and certification requirements, significant mental health burdens and low pay across emergency medical services.
For years, LifeFlight retained only 60% to 70% of its workers, said CEO Joe Kellner, a paramedic himself. “This is a really hard job,” he said. “By their job description, they are seeing people on their worst day, over and over again.”
The rural health crisis is also cutting into obstetric care. By the end of the year, Maine will have lost 12 labor and delivery departments, creating a statewide shortage of birthing centers. LifeFlight works in partnership with Northern Light, one of Maine’s large hospital systems, and operates a specialty ambulance designed to transport newborns who need critical care.
A longer path into the cockpit
This year, for the first time in nine years, LifeFlight is nearly fully staffed. One of a handful of independent nonprofit air medical companies in the country, it has taken an approach that combines better training, higher pay and in-house mental health support.
Mike Abernethy, an EMS expert and retired emergency medicine professor at the University of Wisconsin, considers LifeFlight one of a handful of model programs for the industry. LifeFlight is a nonprofit, while much of the industry is for-profit and has drawn criticism for high prices. “There’s just absolutely no comparison in the aviation and medical quality of these programs” versus an average for-profit air medical business, Abernethy argued.
When Kellner became CEO in 2023, he began addressing recruitment and retention. LifeFlight’s Critical Care Academy, a six- to eight-month orientation program, is intended to address both issues. Emergency critical care advances quickly, so most clinicians need regular education both to remain successful on the job and to be hired in the first place.
At headquarters, four instructors sit in a claustrophobic control room. Through a window into what looks like a hospital room, paramedics Daniel Horne and Brad Alleger undergo an annual skills assessment, a simulation of a medical crisis. Dr. Dave Saquet turns on a microphone and coughs. “It’s hard to breathe,” he whispers urgently. “It hurts everywhere.” The voice seems to come from the patient, a breathing, bleeding mannequin on a hospital bed.
“What happened to you?” Horne asks. “My house was on fire,” Saquet chokes out. A wall monitor displays vital signs that Saquet manipulates on a laptop. Medics and nurses perform simulations often, both to pass the academy and to stay current on occasional but critical events such as emergency births, newborn resuscitation and burns. Before the assessment ends, the paramedics try and fail to intubate the patient. After that failure, they perform an emergency procedure to enable breathing, switching from the mannequin to a pig trachea.
Because recruits qualified for the rigorous training are hard to find, LifeFlight also started a mentorship program for people considering applying. Some attend the academy and gain skills even if they never work for the company. Success comes slowly: LifeFlight recently hired one of last year’s mentees.
Equal pay and mental health support
Kellner instituted another unusual change: LifeFlight raised paramedics’ pay to match flight nurses’ compensation. Industrywide, paramedics make less, which keeps costs down and makes pay equity rare. Kellner said the change has helped recruitment and has support from nurses as well.
The company also hired a full-time mental health counselor. EMS workers’ rates of post-traumatic stress injury, anxiety and depression are more than five times higher than the average American’s. “That has led people to leave this profession,” Kellner said.
That was true for Merklin, who was working for a different service in Nevada during the pandemic. “We got hit really hard,” he said. “The crews were just flying nonstop. We did four-day shifts, so for 96 hours we were just going, going, going.” About a third of the staff quit, he said. “They were getting air medical service plus COVID, right in the teeth.” Merklin eventually needed a break. He left the profession for a few years, then felt the urge to fly again and found LifeFlight.
A transport and a peer team
On a recent flight, the helicopter took off from Bangor and landed on a community hospital’s rooftop helipad. Merklin and Saucier hurried to the patient’s side. Most LifeFlight patients are unconscious or too ill to consent to share their stories, so the details are private. The injuries were shocking. If the patient did not reach a trauma center quickly, the person might die. Merklin and Saucier were unfazed.
It is that kind of incessant trauma exposure that makes mental health support for first responders so valuable. Merklin serves on a peer support team. “There’s a lot of lip service paid … to the cost to your mental health in this profession. But this is the only place I have ever worked that actually provided support,” he said. “I would love to see it take hold in other areas.”
If counseling keeps two or three people from leaving, Kellner argues, it is a wise investment. “The cost of training somebody new into our organization is about $100,000,” he said.
As air and ground EMS become more essential, the task is to recruit and keep more people like Merklin and Saucier. If hundreds more hospitals close, highly trained EMS workers may be the only people standing between patients dying and getting the care they need.