Interview: Eva Kluge

To meet the new market demands, we invested in a modern portable medical isolation unit (PMIU) - EpiShuttle - for Covid-19 patients, which is also suitable for intensive care patients on long-range flights. The mandatory training for the device further strengthened the team’s cohesion.

Obviously, strict infection control is paramount on all flights. When using a PMIU device, the big advantage is that your crew will not go into quarantine. After all missions, we fog our aircraft with Saniswiss Bio Sanitizer. We are also carrying fogging machines on longer trips.

Pick-up destinations have also changed. For example, instead of the Canary Islands, Western Africa has become a hotspot these days. The patients we transport are largely expatriates and government officials, not tourists.

After some rather complicated weeks in April, permits are now, with a few exemptions, relatively straightforward. Permits are less of an issue than the restrictive global overnight policy of many airports. We are quite lucky to own two long-range Challenger 604 aircraft, which have greatly helped us to overcome the overnight bottleneck. We also do most transports as tarmac pick-ups only due to immigration rules. Last but not least, air ambulance missions are considered humanitarian in most countries, so we are still more flexible than other operators.

What has been the most difficult part of 2020 for you?

During my life and my career I have experienced a lot of challenges. You can either crack under pressure, or you learn, adapt and innovate. Personally, I prefer the second option. The past few months have not been easy for the air ambulance industry. The tourism market is a big ‘feeder’ and, since late March, this market has practically vanished overnight. 

For me, personally, the most difficult part over the last few months has been to make up for this development and to work more intensely on other target markets. It is also really important to stay in touch with our clients, who are themselves going through a difficult period. So, I became a fan of videoconferencing. One client told me that she liked video chats, because in normal times ‘you would have never been to my living room’.

Health and social care management has been through an incredibly difficult period, do you think that the way in which healthcare distribution is managed will change as a result of Covid-19?

In the wake of the corona crisis, established norms and operational best practices are being revisited. There are new and unprecedented demands. Despite all the difficulties, there are also many great opportunities. There is an accelerated shift towards digital transformation and innovation in the entire healthcare and social management value chain. On the healthcare provider side, these are, for example, medical teleconsulting, ICU hubs or remotely monitored eICU support centres. On the underwriting side, we have seen that several insurers, instead of excluding corona, are already committing to include Covid-19 treatment in their catalogue of insured risks. I also strongly believe that digital transformation will help underwriters to propose even more customisable products and services. So, my answer is yes, Covid-19 is a real game-changer, but not for the worse, at least in a mid-term perspective.

Although medical tourism as an industry has effectively been brought to a standstill as a result of the pandemic, has Air Alliance continued to fly patients in need of higher levels of care to different countries/hospitals? How difficult have patient transfers been to co-ordinate?

While hair transplant or beauty surgery patients may wait for a while to go abroad for treatment, there are still quite a few patients who seek planned treatment abroad for severe conditions: the healthcare system in their own country does not cater to their needs – in some cases even more so during the corona crisis when a lot of clinical capacity is allotted to Covid-19 patients. Typical examples are patients with organ transplants or other major surgeries planned (cancer, trauma etc.). We always co-ordinate closely with our clients, and make sure that all clearances (including diplomatic clearance) are in place. Obviously, all patients need to have a valid visa, an assigned payer and a receiving hospital.

Looking ahead, how do you think the European travel industry, upon which the air ambulance market relies heavily, will recover from the effects of the pandemic? Do you think that the air ambulance marketplace will change as a result of the pandemic?

From a short-term perspective, domestic travel offers a major opportunity for recovery of the European travel industry. There is no doubt that, for 2020, the overall decline in tourism abroad will be between 60 and 80 per cent, depending on many external factors like travel bans, an available vaccine, a second corona wave etc. For 2021, things will hopefully change for the better. For air ambulance operators, all this will have an impact. Air operators with their own aircraft have very high fixed costs, which means in times of lower volume, that they need to find different ways of utilising their aircraft, spread their cost on fewer flight hours, or reduce their own assets.

On the provider side, a gradual shift in the market, client and product portfolios of the operators, plus increased marketing activities to attract more business, is already visible.

Another impact of Covid-19 in the air ambulance marketplace could be a market consolidation via mergers and acquisitions, or increased lateral networking of the individual providers.

You have worked in both the assistance industry and the air ambulance sector; what key points did you bring to your role with Air Alliance from your previous roles with assistance providers that has allowed you to work more effectively to meet clients’ needs in your current role?

Before I switched to the exciting universe of the air ambulance business in 2013, I had been working in the medical assistance business for some 20 years in various roles, including seven years as Head of Medical Provider Procurement. Having created tenders for air ambulance providers and having organised stressful medical transports at assistance companies myself, today, being ‘on the other side’, I believe that I have a deeper understanding of what my clients expect and what they need.  For example, air ambulance transportation is a mix of medical and aviation knowledge and logistics. Very few assistance companies are really into aviation, but their focus is, for obvious reasons, medical. The lack of aviation knowledge may cause misunderstandings and it is paramount that air medical providers are aware of this. I cannot expect an assistance co-ordinator to fully understand a pilot’s rest and duty limits, or the latest Federal Aviation Administration rulings.

Whereas some air ambulance providers tend to believe that they are the ‘centre of the assistance world’, in reality, air ambulance flights make up only two to three per cent of all inpatient cases for an assistance company. Having seen both sides, it really helps me to communicate with my clients and to build a ‘bridge’ between us and our clients by explaining certain things in a manner that they will understand. We invite our clients to in-house trainings and also encourage our staff to train at clients’ premises.

Some years ago, you helped to co-ordinate the evacuation and treatment of over 600 war wounded from North Africa, transferring them to Europe for treatment. How did this come about, and could you share what happened?

This was a unique project, following a tender in 2011/2012, initiated and financed by the international community when Libya was deeply entrenched in its civil war. At that time, I was still working in the assistance business and responsible for the client account. Libya’s entire healthcare sector had broken down, following the bombings and the fighting. A lot of young warriors were severely wounded, many of them amputees, and they could not be treated in Libya or in neighbouring Tunisia. We were asked to airlift some 600 war wounded within three months to Germany and Austria and to arrange their medical case management in a variety of specialist hospitals.

We had agreed upon an internationally supervised contract, defining service levels, controlling, audits, compliance etc. The majority of operations were done from Tunisia to Germany and Austria. We deployed several teams of very experienced field doctors plus Arabic interpreters, screening some 5,000 Libyan patients in hospitals according to the defined patient selection criteria and then developed patient scores.

On the operational side, we teamed up with several air operators, among them Air Alliance, to perform the airlift services and arrange the flights to Germany and Austria several times per day. It was not always easy to cope with the patients’ and their families’ expectations. We launched a 24/7 hotline with Arabic speakers to be able to respond to the families’ requests day and night and had some 10,000 calls within a few weeks. All patients (and their companions) received an extensive briefing prior to landing in Europe, as most of them had never been out of their country or North Africa. It was a very stressful and challenging project, but also quite rewarding. The medical improvement rate of patients after several weeks of treatment abroad was excellent. It was also a huge intercultural learning experience.

One day, we will be able to travel and meet again (hopefully!); what are you most looking forward to when the world goes back to normal?

I definitely hope that this will happen as early as possible – I’m keeping my fingers crossed that I will be able to attend ITIC Global! What I am really looking forward to is to travel without – or at least with fewer – restrictions, and to be able to reunite with people personally. Video chats are really great, but they will never replace a personal conversation and a heartfelt hug. ■