Maine Air Ambulance Service Pays Paramedics and Nurses the Same

Rural hospitals in the United States are closing at an accelerating rate, leaving air medical services to fill the gap for patients who require specialized care. This shift places new pressure on flight clinicians who must transport patients across vast distances with fewer ground-based options available.

In 2015, demand for medical flights in Maine was half of what it is now. By 2025, LifeFlight of Maine crews completed 3,031 flights, averaging more than one every three hours. Current projections indicate demand will rise by another 10 percent this year. Nicholas George, who runs the ETHOS Database for air medical programs, confirms that the need for these services is increasing annually as ground ambulance stations struggle to meet capacity.

The workforce strain has been severe. Ground-based EMS workers leave the field at a rate of nearly 25 percent per year. Flight clinicians face additional stressors, including dangerous landing conditions, unpredictable shifts, and the psychological burden of repeated exposure to trauma. Historically, LifeFlight retained only 60 to 70 percent of its employees. CEO Joe Kellner, who took the role in 2023, attributed this turnover to the intense nature of the work, where staff see patients on their worst days repeatedly.

To address these issues, LifeFlight implemented a six- to eight-month orientation program called the Critical Care Academy. The company also introduced a mentorship program to help candidates gain necessary skills. A major policy change involved raising paramedic pay to match that of flight nurses, a move that is rare in an industry where paramedics typically earn less. LifeFlight also hired a full-time mental health counselor to support staff dealing with post-traumatic stress injury and anxiety.

These changes have begun to yield results. For the first time in nine years, LifeFlight is nearly fully staffed. Brian Merklin, a paramedic who previously worked in Nevada during the pandemic, joined LifeFlight after taking a break from the profession. He credits the organization's peer support team with making a difference in his retention. Merklin notes that while many services talk about mental health, LifeFlight provides actual support. If counseling prevents just two or three employees from leaving, Kellner argues, it saves the company approximately $100,000 in training costs for new hires.

The service operates primarily as interfacility transports, moving patients from smaller local hospitals to larger trauma centers. In a fragmented system, patients can sometimes fall through the cracks, as seen last year when a woman in northern Maine died after dispatch called ten ambulance services that did not respond. With Medicaid cuts estimated by the Congressional Budget Office at $911 billion over ten years, hundreds of rural hospitals or maternity departments face immediate risk of closure. This trend pushes more care into the hands of highly trained EMS workers who must bridge the distance between patients and critical treatment.