Dedication and community keep equipment humming in the Land of the Midnight Sun.

Nothing is more frustrating than missing a plane and being stuck in an airport without a scheduled flight.

Well, almost nothing.

“The pilot was dropping me off and flying out to his next destination, and he said someone would be along shortly, but after 5 minutes standing in the freezing cold, shortly was a little too long,” recalls John Duer, clinical engineering project coordinator for Alaska Native Tribal Health Consortium/Alaska Clinical Engineering Services (ANTHC/ACES) in Anchorage, Alaska. “I had a piece of rope with me, so I tied it on to my cases and dragged them to the clinic.”

As part of the ANTHC—a nonprofit health organization owned and managed by Alaska Native tribal governments and their regional health organizations—Duer and his teammates take such episodes in stride, and even make light of the memory. “It was only a half mile, but it seemed like a long distance that night,” he laughs.

Working as part of the ACES, Duer, along with four other biomedical equipment technicians (BMETs), provide support to 254 tribal and United States Coast Guard sites throughout Alaska.

Getting the Lay of the Land
Besides grizzly bears and giant salmon, the 49th state is probably best known for its climate. During dark winter months, temperatures in some regions drop to more than 50º below zero, while in the summer they can soar to 90º in the interior areas.

And while one could argue that rural medical facilities throughout the lower 48 states also struggle with the challenges presented by distance, “remote” takes on a whole new meaning in Alaska.

The state covers an area of 586,412 square miles, making it roughly twice the size of Texas. In addition to several sizable cities, small villages extend into the landscape—95% of which are accessible only by air or ferry. These villages can be as close as 10 or more than 100 miles away, with populations ranging from 23 to 5,000 people.

Vastness is not the only challenge to servicing these locations. With weather notorious for turning without notice, making schedules in Alaska is the easy part—keeping them is another thing entirely.

“We hope for the best, but plan for the worst,” explains Brian Wregglesworth, a telehealth systems integration manager with Alaska Federal Health Care Access Network (AFHCAN) Telehealth Systems. “In the summer we can get out pretty regularly, but in winter you may have two site visits planned and you may reach them in a week, or it may take you 3 weeks, depending on what Mother Nature has planned in terms of snow, ice, or wind storms.”

Also based in Anchorage, AFHCAN manages a statewide program providing telemedicine hardware and software to remote villages. This equipment connects regional hubs scattered throughout the state with clinics located in the remote villages.

More often than not, the first medical resource in rural Alaska is community health aides, local villagers who step up to fill a need in their community. Though they are not medical professionals, they receive some clinical training. The aides operate within program guidelines under the medical supervision of physicians, but they are limited in scope as to what they can treat without help.

“Prior to AFHCAN, if they didn’t know what to do, they could call a doctor and try to explain the situation over the phone,” Wregglesworth says. In many cases, physicians were unable to get a clear picture of the patient’s status and opted to transport the patient into the regional care facility. “AFHCAN helps the physician make a much more knowledgeable determination about whether he really needs to see that patient, or if it’s something the health aide can handle.”

According to Wregglesworth, each clinic selects the equipment best suited to their area, but most have the basics: an otoscope, an ECG monitor, a spirometer, an audiometer, a digital camera, a scanner, and a vital signs monitor.

Making contact with the hub facility is a straightforward process, largely guided by the hardware and software systems provided to village clinics. The system helps health aides create a new patient case, select their village’s designated physician, and deliver the case to the physician. The software automatically emails an alert to the physician notifying him of the case awaiting his review. For urgent cases, many health aides follow up with a phone call. Currently, AFHCAN has more than 300 sites that handle a total of about 1,000 cases each month.

Traditional Roles, Remarkable Setting
In addition to supplying telemedicine systems, AFHCAN provides ongoing maintenance.

“The equipment is quite robust, so there are not many items with a high rate of failure,” Wregglesworth says. “But as the equipment grows older, we start seeing computer failures, uninterruptible power-supply failures, that kind of thing.”

In many cases, the fix is just a phone call away, with AFHCAN staff walking health aides through the steps required for minor repairs, such as replacing an otoscope light bulb. More complex issues—a crashed hard drive, for example—often demand a site visit.

Just Say Yes
As with any biomed department, the ANTHC/ACES team works to minimize the amount of time clinics are without equipment. When possible, they will ship a loaner item the same day the clinic mails in the ailing unit.

“Hopefully, they cross in the mail and they have something to hold them over while we repair their equipment,” Duer says. Turnaround times vary based on a number of factors. “If we can repair it here, often we can send it back out the same day. Delays occur if we have to send it out to a repair facility or if we have to wait for parts. Either way, we get it back to them as soon as possible via the mail.”

However, unlike many BMETs, the group must be capable of working on any piece of equipment the clinic is using.

“If they have equipment there we work on it, everything from blood pressure cuffs to x-ray machines and dental equipment,” Duer adds.

In cases where a speedy repair is impossible, clinics work together to find interim solutions. Sharing is very common in regions where multiple clinics are within close proximity to one another. If one facility has a piece of equipment out for repair and a neighbor can provide a spare, they do so without hesitation.

“They can also transport the patient to another clinic, if necessary,” says James Neidlinger, a medical equipment repair technician with ANTHC/ACES.

Redefining Teamwork
A sure recipe for disaster in Alaska? Going it alone.

Fortunately for medical techs on the move, the team extends well beyond staff. While being stranded thanks to weather is not uncommon, neither is local hospitality. Everyone faces the same challenges, and working together is the only way to get things done.

“It’s a necessity because things can become so challenging up here, it’s almost impossible to do it all on your own,” Wregglesworth says.

“They travel too, so they know what we go through to get out there and get back,” concurs Bill Noel, a medical equipment repair technician with ANTHC/ACES. “People won’t let you starve; if you get stuck, they’ll take care of you.”

Even with the kindness of strangers, being ready for anything is essential to the survival and success of professionals tasked with traveling to every corner of the Last Frontier.

“You carry all your food with you, especially when visiting some of the villages where they have a store, but they only open up when they have stuff to sell,” Duer explains.

“At times, the villages are isolated for weeks, surviving with subsistence living—by fishing and hunting, along with the veggies and herbs they grow.”

“The mind-set is to go completely self-contained—especially in the winter. Even if we’re just jumping on an airplane for a short trip, we carry food, water, and adequate clothing,” Wregglesworth says. “Taking it lightly can get you killed.”

Isolation is a State of Mind
Two thousand miles may separate Alaska from the lower 48 states, but technology has closed that gap considerably, proving that every corner of the world is benefiting from the information superhighway.

“I’ve been up here for almost 30 years, and it’s a lot different with Internet access,” Noel says. “Being able to look things up when you’re out on-site, communicating with the company, researching equipment and parts—it’s all easier.”

Many manufacturers are also making service manuals available online, lightening the load for traveling biomeds. For Wregglesworth’s crew, online access also translates to cheaper service for AFHCAN’s clients.

“We have the ability to use the Internet for transmitting patient cases from remote sites to the regional centers. Without it, we would have to install and incur the cost of a dedicated circuit,” he says. “As more and more remote locations are coming online, it’s an incredible help.”

Assume Nothing
While assumptions about Alaska’s weather often prove to be true, plenty of misconceptions are still making the rounds.

“It is a fallacy that in Alaska we have old equipment. We have high-tech, state-of-the-art medical equipment for all the patients,” Noel says, noting that many remote locations in the lower 48 states operate with much older systems. “People don’t realize it, but we have really good health care here in Alaska, throughout the whole state.”

Part of that quality comes from diligent research to discover not only the latest technology and equipment, but to avoid out-of-date systems as well.

“Some manufacturers have sent equipment up here that is going obsolete without letting anybody know it, so we try to keep an eye on that,” Duer says. “Because I help locations look for newer equipment, I do a lot of broad-spectrum research and I keep everyone informed about the newer stuff coming out, as well as training opportunities as they become available.”

Another myth ready to be busted? Painfully slow shipping schedules.

“It used to take 6 months to get parts, but now we can get them overnight,” says Duer, who credits a reduction in bureaucracy for the improved turnaround time. While out-of-stock parts and the occasional (what else?) weather delay can play a role, both Federal Express and the United Parcel Service fly out of Anchorage, which also helps speed things up.

Austere and Foreboding? Guess Again
It has been said that there is no reality, only perception; and Alaska just may make the case. While outsiders tend to focus on the frequent and dangerous obstacles standing between medical tech-support teams and their clients, the professionals in the state disagree.

“I came up here for adventure, and I’ve had one,” Duer enthuses. “It’s been great, and I don’t regret a minute of it.”

And while cruises and flights to Alaska are growing in popularity, most tourists never leave the sanctuary of the state’s biggest cities—a fact not lost on Neidlinger.

“I was thrilled to move up here and have a chance to really see Alaska,” he says. “It’s something 99% of the people in the world will never experience.”

Whether they came for adventure or job security, the BMETs agree they found much more.

“As part of our jobs, we’re going to places people pay thousands of dollars to visit,” Noel says. “I can’t imagine living anywhere else. This is home.” 24x7

Dana Hinesly is a contributing writer for 24x7.