Building partnerships for wing-to-wing transfers
Oliver Cuenca talks to air ambulance industry experts about how they build strong relationships with partners around the world to support wing-to-wing transfers
Wing-to-wing transfers – where a patient is flown to a location, then transferred to another operator for the remainder of their journey – are complex operations, relying on a high level of skill and planning. Consequently, it pays for air ambulance operators to ensure that the partners they work with to conduct them are as capable and reputable as they are.
Not the preferred option – but sometimes a necessity
Seeking out partners for wing-to-wing transfers may not be the first choice of any assistance provider, but it can become a necessity, especially in regions where longer-distance aircraft are not available.
Dr Fraser Lamond, Group Medical Director at Air Rescue Group, began by explaining that “medically speaking”, Air Rescue Group “try to avoid wing-to-wing transfers, as the complexity in itself leads to increased patient transfer risk, particularly … linked to multi-leg, loads and offloads, the transfer of medical equipment, and changes in personnel”.
Consequently, his company prefers to use an air ambulance with greater logistical reach to avoid such situations.
This attitude was echoed by Volker Lemke, Managing Director and Director of Sales and Marketing at FAI rent-a-jet, who said his company’s approach was similarly guided by a lack of enthusiasm for wing-to-wing transfers. He explained that FAI is “generally very cautious” when it comes to such transfers, “as the issue of medical responsibility is considered critical”. Instead, he said, “we always prefer, if operationally possible, to carry out the transport alone, without involving a partner operator”.
We prioritise partners who have achieved long-range intercontinental accreditation
However, Lemke added: “Should a wing-to-wing transfer nevertheless be necessary, we generally look for a recognised partner.” FAI, he explained, maintains a pool of preferred providers, some of which have relationships with FAI that have been “established over many years”. Consequently, FAI does not maintain regular contact with a select set of operators for the purposes of delivering wing-to-wing transfers.
For Tyson Smith, General Manager of Commercial Partnerships at LifeFlight, this shared reluctance to conduct wing-to-wing transfers manifests in the company’s approach to assessing partners: “We prioritise partners who have achieved long-range intercontinental accreditation.”
Evaluating potential partners
For Irena Dimitrijevic, Head of Sales and Business Development at Jet Executive International Charter, shared corporate values and goals are a priority when seeking out potential wing-to-wing partners.
“Identifying these shared values can be achieved through video calls or in-person meetings,” she explained. “For Jet Executive, aligning on medical suitability is particularly important, [and] can be confirmed through direct exchanges between the medical directors of both organisations.”
She added that once a partner had completed their first few missions, it is “crucial” to provide “honest feedback”. Industry events, including conferences “such as ITIC and EURAMI”, provide a vital platform for companies to “present their services and foster personal connections … Establishing these relationships early on helps in understanding each partner’s offerings and compatibility,” she said.
Clear communication of these timings is crucial to avoid any miscoordination
Vinod Nair, Chief Operating Officer – Air Ambulance at Bluedot Assist, agreed, adding that when assessing potential wing-to-wing partners, his company’s medical and flight teams will jointly evaluate them to ensure they meet Bluedot’s standards.
Areas they will particularly focus on include “experience managing operations; fleet capacity; aircraft maintenance reports for airworthiness; patient loading systems equipment maintenance; and the expertise and licensure of medical staff trained in advanced cardiovascular life support (ACLS) and paediatric advanced life support (PALS).”
Finally, Nair added that Bluedot places a great deal of importance on a company’s reputation. “Feedback from healthcare providers and institutions that have partnered with the provider [will be] solicited,” he noted.
Shaun Andrews, Business Development and Relationship Manager at Avcair, agreed, adding that his company “prioritises partners who align with our commitment to aviation excellence, ensuring safety, efficiency, and patient care. This entails assessing their operational standards, fleet capabilities, crew expertise, insurance, and adherence to regulatory requirements.”
He added that when looking to facilitate transfers, Avcair prioritises companies that maintain “clear protocols”, particularly for “communication, patient handover procedures, equipment compatibility requirements, and contingency plans for unforeseen circumstances”.
Smith concluded by saying that his company will typically use its own experience with aircraft and the aeromedical configurations for them in order to assess potential partners’ capabilities. “We choose wing-to-wing partners based on their ability to provide the most efficient transfer possible, minimising fuel stops and ground time to ensure the patient reaches their destination swiftly and safely,” he explained.
Accreditation
Dimitrijevic argued that accreditations were also critical to identifying the suitability of potential partners: “Adherence to high quality standards is essential,” she said, adding that membership of an accreditation organisation “provides a level of credibility, as all members are publicly listed and accessible”, particularly during annual meetings and conferences.
Lamond agreed, adding that for Air Rescue Group, accreditations provide an important “insight into the culture of the air ambulance organisation and [its] recognition of standards”. Ultimately, however, there is no substitute for “direct … understanding [of] the partner’s clinical governance approach, and the clinical standards that are applied”.
For Lemke, reliable accreditations are vital to ensuring that potential wing-to-wing transfer partners are suitable.
“FAI only uses EURAMI-accredited companies, and basically relies entirely on the expertise of the Institute,” he said, adding that FAI “do not consider further checks as part of our due diligence to be feasible”, and that “the only additional measure on our part is usually the organisation of a doctor-to-doctor discussion between the medical directors, in order to coordinate work processes and therapeutic approaches in advance”.
By contrast, Nair explained that while his company will seek out “quality accreditations such as Commission on Accreditation of Ambulance Services (CAAS), Joint Commission International (JCI), National Accreditation Alliance of Medical Transport Applications (NAAMTA), EURAMI, and Commission on Accreditation of Medical Transport Systems (CAMTS)”, this is not always possible when dealing with “regional players”. Consequently, on such occasions, Bluedot will discover whether the operator “recognises current best practices, crew certifications, and registrations”.
Communicating clearly
When working with a partner on a wing-to-wing transfer, one of the most crucial elements, said Dimitrijevic, is working out an individual flight agreement, specifying a range of criteria. This criteria includes the composition of medical teams, any specialist equipment that is needed, work to manage any geographical criteria such as time zones, and the range of any vehicles or aircraft being used.
“Given the global nature of wing-to-wing transfers, partners often operate from different corners of the world, spanning various time zones,” explained Dimitrijevic.
This industry is sensitive, and personal rapport can significantly enhance trust and cooperation
“Clear communication of these timings is crucial to avoid any miscoordination. This includes [creating] a detailed flight schedule with exact arrival and departure times for the patient handover.”
Lemke agreed, adding that when looking to ensure that a transfer goes smoothly, FAI will focus on coordinating heavily with partners’ dispatch teams to create a timetable “with regard to flight and meeting times and ground coordination”.
For Smith, arrangements include “the times medical teams move from accommodations or aircraft to hospitals; the timings for ground ambulance movements between the aircraft and hospitals; aircraft movement schedules; and ground times for fuel stops”.
“We place a strong emphasis on using the same ground handling agent, if possible, at the patient transfer location
to ensure the smoothest and quickest transfer can be achieved,” he added. “Utilising a single ground agent allows for more efficient management of both flight schedules and coordination with local authorities.”
While language barriers could be a potential hurdle when seeking partners for wing-to-wing transfers, in practice this is rarely an issue. Lemke said that when conducting such operations, FAI “assume that the aviation language, English, is available for both operational and medical coordination”. Likewise, cultural differences rarely play a role – “any differences in processes can be clarified in advance of a mission”, he added.
Lamond agreed, adding that while “being a multi-lingual medical and operational platform has benefits … our network and partners speak the same language, and fully understand the medical context of multi-leg, wing-to-wing transfers”.
Maintaining relationships in the long term
While finding partners to conduct a wing-to-wing transfer is important, working to sustain the relationships that you have built afterwards is just as important.
For Dimitrijevic, maintaining strong personal connections with individuals at partner companies is vital: “This industry is sensitive, and personal rapport can significantly enhance trust and cooperation,” she said. “Regular personal interactions, even if informal, help keep the relationship strong.
“Occasional video calls can help keep the lines of communication open, ensuring any issues are promptly addressed and that both parties remain aligned on goals and expectations,” concluded Dimitrijevic.
Smith agreed, adding that LifeFlight works to maintain strong, long-term relationships with its partners through “consistent engagement and trust-building”. He said:
“We actively participate in key industry events and ensure regular interactions between our contract and operations managers and clinical teams.”
He added: “Despite the geographical time zone challenges posed by our main operational headquarters [being] in Australia, we prioritise staying connected and responsive through digital meetings. Additionally, we focus on collaborative learning by engaging joint reviews and mission debriefs post-transfer. This approach not only boosts operational effectiveness and clinical learning, but also reinforces our partnerships over the long term.”
Andrews agreed that maintaining long-term partnerships is critical, and that such business relationships “hinge on effective communication, mutual respect, and continuous collaboration”. He argued that open dialogue is an important factor for this, as are “regular performance reviews and feedback mechanisms” to allow operations to be fine-tuned. “Moreover, we actively seek opportunities for joint training and professional development,” he added.
Nair seconded Andrews on the importance of mutual respect and collaboration, stating that it is important to “respect your partner’s expertise and contributions”, and that engaging in collaborative problem-solving and “strategic planning while “consistently fulfilling commitments” was the best way to build a lasting relationship.
Conclusion
While wing-to-wing transfers may be undesirable compared with other options for transfer such as utilising longer-range aircraft, they are often necessary to get patients the care they need. On such occasions, it pays to be meticulous when choosing potential partners for such operations, prioritising operators who have a strong grasp of the latest practices, a good ability to communicate, and, preferably, accreditation from an internationally recognised organisation.
However, while it is important for air ambulance providers to be discerning when choosing partners, it is just as important that they put in the work to build a strong relationship, recognising the need for collaboration and respect.