Maine Air Ambulance Crews Flew 3,031 Missions in 2025 as Rural Care Shrinks

Maine's air ambulance service flew 3,031 medical missions in 2025 — more than one every three hours — and demand is up another 10% this year. LifeFlight of Maine's crews are the backstop for a rural health system that keeps shrinking, and the labor market for flight clinicians is showing the strain.

Demand for medical flights in Maine has doubled since 2015, according to the nonprofit. Nationally, air medical services are filling gaps left by rural hospitals that close, convert to outpatient-only rural emergency hospitals, or drop unprofitable services like labor and delivery.

The pressure will grow. Medicaid cuts, estimated by the Congressional Budget Office at $911 billion over ten years, put hundreds more rural hospitals and maternity departments at immediate risk of closing.

"We're seeing this across the board. The need for air medical services is increasing year over year," says Nicholas George, who runs the ETHOS Database, a national tracking system for air medical programs.

In Maine, ground ambulances can't fill the gap. The system is so fragmented that last year a woman in a small northern Maine town died while county dispatch called 10 ambulance services, none of which responded.

How hard is the job?

Retention data tells the story. Almost a quarter of ground-based EMS workers leave the field every year. There's no comprehensive staffing data for air medical services, but flight clinicians face dangerous conditions, long unpredictable shifts, rising certification requirements and heavy mental-health burdens — on low EMS pay.

EMS workers' rates of post-traumatic stress injury, anxiety and depression run more than five times the average American's. For years, LifeFlight retained only 60% to 70% of its workers, says CEO Joe Kellner, a paramedic himself who took the top job in 2023.

"This is a really hard job," Kellner says. "By their job description, they are seeing people on their worst day, over and over again."

What changed at LifeFlight?

This year, for the first time in nine years, LifeFlight is nearly fully staffed. One of the nation's few independent nonprofit air medical companies, it attacked retention with three tools:

• A six- to eight-month orientation program, the "Critical Care Academy"
• Pay parity — paramedics now earn the same as flight nurses, rare in an industry where paramedics typically make less
• A full-time, in-house mental-health counselor and a peer support team

Mike Abernethy, an EMS expert and retired emergency medicine professor at the University of Wisconsin, calls LifeFlight one of a handful of model programs. "There's just absolutely no comparison in the aviation and medical quality of these programs" versus an average for-profit air medical business, he argues.

Training is rigorous. Clinicians run simulations — a breathing, bleeding mannequin voiced by a physician — for rare but critical events like emergency births, newborn resuscitation and burns. Annual skills assessments include failed intubations followed by emergency airway procedures practiced on a pig trachea.

The counselor is a business decision as much as a humane one. Paramedic Brian Merklin, who left the profession for a few years after pandemic burnout at a Nevada service, says LifeFlight is the only employer that ever provided real support. If counseling keeps two or three people from leaving, it pays off, Kellner says: "The cost of training somebody new into our organization is about $100,000."

The company also runs a mentorship program for prospective applicants; some attend the academy even if they never join. Recently, LifeFlight hired one of last year's mentees.

If hundreds more hospitals close, highly trained EMS workers may be the only people standing between patients dying and getting care — and LifeFlight's training-and-retention model is likely to draw industry attention.