Exceeding expectations: APAC air ambulance provision
Air ambulance provision in the Asia-Pacific (APAC) region is experiencing positive growth and outperforming pre-pandemic levels. Mario Pierobon speaks to industry experts about market growth, dedicated operational arrangements, and industry challenges
Market growth
The market for specialised air ambulance services is experiencing sustained growth, especially in the APAC region, where what can be observed is a constant demand for high-acuity transfers, said Tyson Smith, General Manager of Commercial Partnerships at LifeFlight. “In the past six months, we have conducted key operations, including medical transfers from New Caledonia during civil unrest, dual patient uplifts from Tonga and French Polynesia, and medical evacuations from Japan during Golden Week – all while continuing our regular flights within Australia,” he said. “Demand has not only rebounded to pre-pandemic levels, but has exceeded them.”
LifeFlight offers long-distance, multi-patient air ambulance solutions, and it currently comprises a fleet of four medically configured aircraft in APAC, affirmed Smith. “Last year, our fleet transported 520 patients and logged over 1,400 flying hours. Our jets were dispatched to various locations, including the Middle East, India, North and southern Asia, the Pacific Islands, and the US mainland,” he said. “Our fixed-wing fleet is the only service of its kind in Australia to be officially recognised by the European Aero-Medical Institute (EURAMI) and one of only three to gain accreditation in the Asia-Pacific region.”
This growth of market is driven by increasing demand for high-quality healthcare and medical transport services in the most remote regions
According to Claudia Schmiedhuber, EURAMI’s former Managing Director, there is a steady increase in interest from providers looking to get EURAMI accredited, reflecting a recognition of the importance of meeting high standards in air medical services. “This growth of market is driven by increasing demand for high-quality healthcare and medical transport services in the most remote regions,” she said. “Many countries in APAC have developed into tourism hotspots, often for backpacking or longer holiday trips, which has also led to an increase in missions for aero-medical providers. We do see a lot of traffic from/to Europe with longer-range jets, as well as the occasional wing-to-wing transport. As EURAMI, we do support companies in the APAC region by providing resources and guidance on how to become accredited.”
The APAC region attracts attention as a constantly growing market, and the traffic in this region varies heavily depending on the season, as APAC is a popular tourist destination for European travellers between October and May, said Ozan Alemdaroğlu, Deputy General Manager at Redstar Aviation. “Within the scope of our global air ambulance operations we have heavily expanded our operational network in the APAC region, especially with our four long-range Challenger 605 aircraft which [have been] newly added to our fleet of 14 aircraft,” he said. “With the awareness of people travelling after the pandemic, an increase was observed in the number of people travelling and purchasing insurance. This situation is especially observed in India, where Indian citizens living or travelling abroad started to have travel health insurance, and this has had a positive impact on the number of Indian patients we carry.”
Operational arrangements
According to Smith, air ambulance arrangements in the APAC region are rapidly evolving, propelled by increasing healthcare demands and advancements in medical and flight operations technology. “Given the broad geographical coverage, agility is crucial to effectively monitor and manage the impact of political instability in certain areas, which poses significant risks to operational safety and certainty,” he said. “To tackle these challenges, we engage in ongoing dialogue with local aviation and clinical authorities across diverse cultural landscapes, invest in continuous training for ourteams, and commit substantial resources to technology. This strategic approach enables us to navigate these complexities successfully and deliver the highest standard of care consistently to our patients and their families.”
Schmiedhuber observed that the development of air ambulance fares in the APAC region varies widely depending on the country, and specific circumstances, factors such as geographical challenges, regulatory environments, and the availability of trained medical personnel can influence costs. “While there is a positive trend in the development and accessibility of air ambulance services, providers may sometimes struggle with meeting the high standards necessary for accreditation. Additionally, issues such as limited infrastructure and logistical complexities can pose significant challenges,” she said. “One thing that should be noted is that we see effort from APAC providers to set up bases in larger hubs such as Singapore or Bangkok to ensure better connectivity to Europe and the US.”
While there is a positive trend in the development and accessibility of air ambulance services, providers may sometimes struggle with meeting the high standards necessary for accreditation
The APAC region features significant destinations for patients with advanced treatment centres in cities such as Seoul, Tokyo, Bangkok, Singapore, Melbourne, Sydney, and others in India and the Philippines, said Alemdaroğlu. He noted, though, that “foreign air operator certificate (FAOC) processes implemented by Australia, Singapore, and Malaysia have restricted the operations to these countries. However, since Redstar has the required FAOC permission for these countries, we carry out our operations without any issues.”
Concerning the challenges in the region, meteorological conditions such as typhoons, monsoon rains and earthquakes affect the APAC region regularly, thus disrupting flight plans and scheduling, observed Alemdaroğlu. “In the case of the Himalayas, due to the geographical conditions, pilots must receive simulator training to fly to special airports such as Kathmandu and Skardu. We are one of the few air ambulance operators that can operate in this region thanks to the continuous training we provide to our crews,” he affirmed.
Airport restrictions
Airport restrictions, such as limited operating hours and restricted access for medical flights due to incompatible airports, can further complicate air ambulance operations, observed Schmiedhuber. “These restrictions can delay response times and affect the overall efficiency of medical transport services in the region,” she said.
Smith agreed that airport restrictions – particularly those stemming from cultural holidays and shortages of ground handling staff in remote locations – pose significant challenges in the APAC region. “However, thanks to our strong connections with vendors in the region, these challenges are typically overcome relatively quickly. This allows us to maintain reliable scheduling and continue providing high-quality service to our patients and clients,” he said.
Extended-Range Twin-Engine Operations Performance Standards (ETOPS) mandate longer authorisation times for flights to certain islands, noted Alemdaroğlu. “ETOPS authorisation, which is normally 120 minutes, must be 180 minutes to fly to some islands in the APAC region. Redstar Aviation can carry out such flights with the Challenger 605 aircraft,” he said.
Staffing considerations
Staffing is a critical aspect of air ambulance provision in the APAC region, according to Smith. “We have proactively addressed this by implementing a six-month pilot recruitment and training programme, focusing on understanding the motivations of our pilots and ensuring they have a clear understanding of their role,” he said. “Full transparency throughout the recruitment process facilitates a solid onboarding experience and provides a strong foundation. On the clinical side, specialising in aeromedical transport and pre-hospital care requires a unique skill set that is not widely available across the APAC region.”
LifeFlight has a dedicated team consisting of more than 160 medical personnel employed to perform shifts on helicopter and fixed-wing aircraft throughout Australia. “Additionally, operations and engineering teams are in constant demand, with both markets remaining competitive in terms of staff retention,” explained Smith.
Operations and engineering teams are in constant demand, with both markets remaining competitive in terms of staff retention
Staffing in the APAC region is especially challenging for long-haul flights, which require crew changes due to restrictions on duty times, affirmed Alemdaroğlu. “Since flights from this region to Europe or America are long-range, it may be necessary to change the cockpit crew due to duty time restrictions, and a reserve crew is required for this. Thanks to Redstar’s vast pool of staff, such operational changes are not an issue for our company,” he said.
According to Schmiedhuber, staffing can indeed be a significant issue in the provision of air ambulance services in the APAC region, just like everywhere in the world right now. “There is often a shortage of highly trained medical personnel as well as aviation staff for operating air ambulances. We do see providers engaging more international staff in addition to highly qualified local resources; however, availability for regular missions can be challenging in addition to the usual supply chain issues which still linger,” she said. “Furthermore, one must take into account the diverse weather and infrastructure [in APAC], ranging from bustling cities to the remotest places, which might make it difficult to only operate with one aircraft type, creating the need for even more diverse staff.”