Cars share the street with snowmobiles and city by-laws cover the use of dog teams, in Iqaluit, the capital of Nunavut,

Beyond Iqaluit, it's an Arctic desert. Tiny communities, some with less than 100 people, cling to traditional ways. It's a hard life, made even harder when you need urgent medical care.

If you have an emergency in most parts of Canada, you're probably only minutes away from a hospital. But what do you do if there's no 911 to call, no ambulance, no roads connecting communities and the nearest hospital is hundreds of kilometres away?

On Baffin Island, the only option is the Medevac program. It's an air ambulance that flies patients from remote communities all over the Baffin Region to the Iqaluit hospital.

Dr. Sandy Macdonald is the medical director of the hospital in Iqaluit, the medical nerve centre for Baffin Island. He sends out Medevacs everyday. Last year, Dr. Macdonald ordered more than 390 because community health centres can only offer basic care.

"The main reasons for Medevacs are usually that the patient is too ill to be looked after in the health centre, which means they need 24-hour nursing, they need an operation, or they require a level of care that just can't be provided there," says Dr. Macdonald.

Depending on distance, each Medevac flight costs between $5,000 and $35,000, financed by the Nunavut Government. When lives are at stake, no expense is spared. Patients needing specialist care, or tests not available at the Iqaluit hospital are flown south to hospitals in Montreal, Ottawa and Toronto.

"Looking on a case-by-case basis, our system is dedicated to providing the best care we can for individual Canadians. If that requires the Medevac to Ottawa from here then we have to do that," says Dr. Macdonald.

Adventure is what appeals to pilots and medics alike. Going to remote areas means being prepared for anything.

John Horsfield has been a paramedic in Victoria B.C. for 25 years. He also does 21-day stints in the north with the Medevac program.

"It's always a challenge but it's always really rewarding to be able to think that you maybe made a difference in someone's life, especially at a time that for them is a crisis."

The arctic weather makes everything more complicated and some unique precautions need to be taken.

"Every piece of equipment that we have, all the drugs that we have, have to be kept above freezing. Obviously the patients have to be kept warm. So that means in moving from clinics to aircraft, we have to keep everything covered and keep everything warm," says John.

About every 12 hours a request for a Medevac comes into the hospital in Iqaluit, the only one for the 14,000 people in the Baffin region.

During W-FIVE's visit in Iqaluit, the latest patient was a 20-month-old baby who has had a seizure in Clyde River, over 750 kilometres away. Time is tight, so the pre-flight briefing takes place on the way to the airport.

On the frozen tarmac, a King Air turbo prop waits to bring John to the sick baby. Aircraft, crews and medics are all supplied by Kenn Borek Air, a private company under contract to the Nunavut government.

The plane revs up, ready to go. But plans in the Arctic don't always work out.
What should have been a routine a two and a half hour flight to Clyde River suddenly gets aborted.

"Apparently the patient's had another seizure, so there may be a change to whether we'll take a doctor along, or somebody else, or change medications...
If you have repeated continuing seizures, that's a life threatening emergency, so you have to control the seizure before you move the patient," says John.

Since the patient is a baby in distress, Dr. MadDonald decides to send Pediatric Resident, Dr. Abha Gupta on the flight.

But it doesn't always go as planned, two hours have passed since the call came in. The medics will now have to fly in the dark and the wind is starting to blow, but they have no choice. The baby may have had another seizure.

As the Medevac heads out for the flight to Clyde River, the hospital staff is kept busy on the ground.

Seven family physicians, one surgeon, one anesthetist and a rotation of trainee physicians from the south handle appointments, walk-ins, and emergencies.

With different needs and fewer resources than a big city hospital, the staff in Iqaluit is constantly challenged. For Nurse Kathryn Schwartz, sometimes that means a lesson in Inuit culture.

"Children and elders tend to use an awful lot of facial expressions. You have to look at your patient, pay attention when you're speaking to them, even through an interpreter. A lot of times as they're speaking Ineptitude, you can look at their face and you know the answer just by the expression on their face."

Five hours later the Medevac arrives back in Iqaluit. The baby is safe and on his way to the hospital. For Pediatric Resident, Dr. Gupta, it was an eye opening experience.

"I was asking what happened before the Medivac system was there. It's true, there was nothing that could be done for those patients."

As if to underline how crucial the Medevacs are, the baby have another seizure at the hospital in Iqaluit.

The Medevac Program on Baffin Island brings patients to the hospital in Iqaluit, but when they need intensive care they also send them out.

In Pascal MacLellan's case, a routine appendix operation has turned critical. He has a possible infection and a blocked bowel.

Pascal hasn't eaten for 10 days and he's getting weaker by the hour. He needs a CAT Scan to find the source of the blockage, but the hospital in Iqaluit doesn't have the equipment. Pascal understands why he has to be flown to Ottawa.

"I've been here for ten days and I've shown no improvement. I have gas built up in my stomach. So, they're going to send me there to see if they can do anything."

Nurse Elizabeth Crosland and respiratory specialist Jacob Krygier prepare Pascal for the three-hour flight. He's a critical case, so they have to take extra care.

"Once you're in the air, what you have is what you have. You can't get anything else. So you have to be prepared, which is why we spend a little time doing things before we get off the ground," says Elizabeth.

It's dangerous to move a patient this ill, but if Pascal has any chance of recovery it's a risk that has to be taken.

At the airport, the temperature is -39 C. A Learjet will fly Pascal to Ottawa. It's one of five operated by Skyservice Lifeguard, a company that specializes in medical evacuations. As Pascal heads south, another jet prepares to fly north.

Nurse Dianne Busby is leaving Toronto to make more than 2,400 kilometre trip to Iqaluit to pick up five-year old, Curtis Willie. He's showing signs of acute liver failure and needs to go to Toronto for some specialized tests, which couldn't be done in Iqaluit.

"You only have one liver. Once it's destroyed, there isn't any cure for it. So you have to have it treated," says Dianne.

But Skyservice does more than just provide transportation. Their planes for Medevac are really a flying intensive care units.

We handle fresh MI's or heart attacks, stroke victims, multiple traumas, respiratory distress," says Dianne.

Dianne expects the flight to be routine. But as darkness falls, the pilot has some bad news.

"It is blowing snow, temperature -31C. It's very windy... Not the prettiest day in Iqaluit," he tells Dianne.

The turbulent arrival in Iqaluit confirms the bad weather, but those tests the patient needs can't be delayed.

At the airport, the wind chill is now below -50 C, the transfer will have to be fast. The Learjet may be a flying intensive care unit, but for passengers, it's strictly no frills.

"We have stuff to drink, but nothing to eat right now unfortunately. There are no bathrooms," says Dianne to Curtis' mother.

Despite the cold weather, they make it off the ground in Iqaluit. Dianne make Curtis as comfortable as possible.

"We have to monitor his oxygen saturation because sometimes when you get up to altitude, it will be lower... so you monitor that. If it gets to a certain point, then we'll start giving him some oxygen," says Dianne.

However, the long journey to Toronto was worth it for Curtis. Doctors feared that he might have liver damage from a medication he was taking. Tests done by specialists at the Hospital for Sick Children in Toronto would show that his liver will recover and won't require a transplant.

As for Pascal MacLelland, he is recovering well in Ottawa and enjoying his first meal. He's still in a bit of pain, but a CAT Scan found the source of his infection and he's had some surgery to clean it up.

Back in Iqaluit, another Medevac heads into the wilderness, linking modern medicine to a traditional world.

"Efficiency in the Arctic is a hard thing to achieve because of the distances and the weather... But actually, I think that the system we have works quite well and we get a very good service from the people who provide the Medevac service from here to Ottawa. I would say it's a system that works quite well," says Dr. Macdonald.