A memorandum of agreement finalized Feb. 14 among the Coast Guard, Boston MedFlight, Martha's Vineyard Hospital, and Nantucket Cottage Hospital describes the Coast Guard's role in providing medical transfers from the island hospitals to the mainland.

The agreement is designed to improve communication and coordination between Boston MedFlight, a private air ambulance service, the Coast Guard, and the hospitals when medical transfers are needed. It places reliance on the Coast Guard only for the most serious incidents and when there are no other alternative services available.

According to a Coast Guard press release, "The agreement does not change the long-standing practice of the Coast Guard providing this life-saving service to Cape Cod's island residents."

Boston MedFlight transports more than 400 patients a year off the islands. Approximately two-thirds of the transports occur by helicopter, and the remaining by jet, according to the Coast Guard.

Occasionally weather conditions exceed the criteria under which Boston MedFlight may provide services to the islands. However, Federal Aviation Administration regulations are waived for the Coast Guard in emergency cases.

The Medevac agreement states that emergency medical service coordinators may request Coast Guard assistance to transport patients needing emergency medical services from one medical facility to another. "Such requests shall be limited to serious incidents in which Coast Guard facilities appear to be the most feasible means of providing the required assistance," reads the agreement. "Competition with private ambulance services, including air ambulance services, will be avoided."

Both hospitals agree to provide specialized medical equipment and personnel needed for medical care during the transport.

The agreement also provides for annual familiarization visits for all parties.

Andy Farkas, MedFlight chief operations manager, said there is nothing new in the memorandum. He said MedFlight has a very open and cooperative relationship with the Coast Guard.

He said the underlying purpose is to avoid tying up Coast Guard assets needed for search and rescue missions in cases where the patient may be able to wait for a MedFlight once the weather clears.

Dr. Tim Tsai, Martha's Vineyard Hospital director of emergency services, said that Coast Guard transfers, either by jet or helicopter, are few in number. MedFlight is available most of the time, he said.

Advanced life support transfers are possible by ground but are limited by the availability of personnel and transport off the Vineyard. The Coast Guard is the transport service of last resort, said Dr. Tsai.

"They come under the most adverse conditions for the most critically ill patients. However, medical transports are one among a number of missions, including search and rescue. The difficult choice for them and for the emergency department," said Dr. Tsai, "arises simply because the conditions which preclude the arrival of MedFlight and necessitate asking for a transport from the Coast Guard, are the same conditions which would prompt the Coast Guard to put a helicopter on standby for a rescue at sea ... still, the service they provide is without question, vital to us. They come in the most dangerous conditions for the sickest patients."

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