ITIJ 218, Air Ambulance Review, March 2019
BREAKING NEWS: Air ambulance provider X announces formation of partnership agreement with air ambulance provider Y. It’s a regular headline and a feel-good story, but what is the substance behind such announcements? James Paul Wallis reports on how these deals can benefit patients and payers alike
Announcements of partnerships between international air ambulance providers make for good public relations (PR). But it’s not always clear from the statements released by organisations how these partnerships translate to making a practical difference in the way the organisations can work together. Is there a difference in how a provider would organise a wing-to-wing mission with a previously partnered company compared to any other? To find out, ITIJ spoke to a selection of providers about their partnerships to find out what’s behind the headlines.
The main focus for partnership agreements tends to be wing-to-wing missions: where one provider picks up the patient and flies to a mid-point rendezvous with a second provider that completes the journey. There are various reasons why a provider might opt for a wing-to-wing rather than working alone, such as a faster response time – the patient can be picked up quickly by a local company and the journey started while the remote provider is en route to the hand-over point. Reducing the travel time not only makes for a faster pick-up, but on long-range missions can help deal with crew rest time restrictions. David Fox, President of Fox Flight Air Ambulance (Fox Flight), commented: “The bottom line is wing-to-wing transfers speed up the repatriation process for the patient. Because of the long distances that are involved in these kinds of missions, using a wing-to-wing partner eliminates the need to reposition or rest air crews to cover duty times, which can take days off the wait for the patient. Also, some carriers have better relationships in certain countries that make the logistics of long-distance transfers easier. So you get the patient home sooner and the costs are similar.”
There has to be a due diligence process
As well as response time, there may be a benefit to have each provider cover the part of the mission that’s in a region they’re familiar with. Anne Rodenburg is Commercial Director at US and Mexico-based AirLink Ambulance, which is among a number of partners that work for Luxembourg-based European Air Ambulance’s international Air Alliance. She commented: “One of the major benefits of partnerships is making use of specific local knowledge and expertise. It makes sense to maximise partners´ experience.”
Indeed, David Ewing, Executive Vice-President of Global Markets for Skyservice Air Ambulance International, noted that its partners ‘were sought out based on their expertise, reputation and medical treatment capabilities’: “While the concept of wing-to-wing transport is a good one, you can’t just do a wing-to-wing with any provider. The levels of care provided by air ambulance companies is not all the same, there are services who excel in patient care and transport, those were the ones we sought out and who sought out us to enter a formal partnership agreement.”
Frank Condron, PR Officer for Fox Flight, added: “Companies like Fox Flight and Awesome Air, for example, are both capable of transferring a patient from South Africa to the US on their own. But the resources that would have to be committed to complete such a mission in terms of air crew, given the time required and duty-time constraints, would put limits on other missions that could be taken on, likely for days.”
Any air ambulance mission requires planning and co-ordination, but a wing-to-wing mission ups the ante as the hand-over must be carefully organised. Fox Flight of Canada and Awesome Air Evac of South Africa signed an affiliate agreement in February 2018, but first worked together in August 2017 on what was Awesome Air Evac’s first wing-to-wing patient transfer. The 22-hour mission involved flying a ventilated patient from Johannesburg, South Africa to Kansas City, US with a hand-over in Tenerife, Spain. Speaking at the time, Aaron Payne, Director of Communications for Fox Flight, described the mission as ‘especially complicated’ and said: “We had to work closely with Awesome Air Evac to make sure the hand-over in Tenerife was smooth – and both dispatch teams had to arrange landing, customs and refuelling at airports in various jurisdictions at various times around the clock to keep the transfer moving. Due to the patient’s condition, we couldn’t afford to have any delays along the way.”
The agreements also ‘provide guarantees related to insurance and regulatory requirements’
Due to the complexity of these missions, the conscientious provider will want to make sure that the wing-to-wing partner is a reputable firm that’s likely to perform their part of the mission to a good standard.
David Fox, President of Fox Flight, told ITIJ that deals such as the one with Awesome Air Evac are ‘formal agreements that spell out in clear terms the standard of care and professionalism each partner will maintain and what services each partner will provide for each wing-to-wing mission’. The agreements also ‘provide guarantees related to insurance and regulatory requirements’, he said. A key point though, is that before signing such an agreement, it’s important to do your homework.
In a recent example, last November AMREF Flying Doctors of Kenya and UK-based Capital Air Ambulance announced their formation of a ‘wing-to-wing air ambulance alliance’ offering flights between Africa to Europe. In the companies’ statement, they highlighted that ‘medical protocols, equipment and staff have been aligned to operate at the same level to ensure patient care is consistent across the entire repatriation’. What may not have been obvious to the casual reader was the amount of work that went on behind the scenes in the lead-up to the announcement.
When these agreements are reached, we can guarantee quality of patient care and standards of safety
Speaking to providers, it becomes clear that there has to be a due diligence process to make sure that the potential partner is a brand that it’s safe to connect with.
This reveals that the key element to a partnership is the level of trust between the providers. For example, David Fox said of the 2018 agreement: “Having worked with Awesome Air in the past, we know them to be a quality air ambulance operator capable of meeting the standards of care and flight operations our clients have come to expect.”
On this point, Anne Rodenburg commented: “Before formalising the relationship, there is a careful selection of partners and a process of getting to know each other well.
With our partners, we share paperwork, discuss and agree on pricing and logistics, share expertise and discuss important topics such as secure management of patient data, for example. Having important topics pre-arranged and agreed on in a written document contributes to a swift and cost-effective intervention when working together.”
With such a trusted partner, a provider can confidently publicise that they can handle long-range missions that include wing-to-wing transfers – knowing that the partnered organisation has the capabilities to perform their section of the mission. Of the August 2017 mission, Shane Marais, General Manager of Awesome Air Evac, commented: “In order to complete a complex mission like this, you have to have complete confidence in your wing-to-wing partner.”
David Fox explained it this way: “When we carry out a wing-to-wing mission we have certain expectations when it comes to medical care and logistics. With an agreement in place, both wing-to-wing partners know what the expectations are and there is a comfort level in knowing how the trip is going to be handled from each end.”
The process is easier if the organisations involved are already aligned to a certain degree – with similar documentation, procedures and equipment. For example, the process for Capital Air Ambulance and AMREF Flying Doctors to partner was made easier by the fact that they were both already accredited by the European Aero-Medical Institute (EURAMI).
Explaining why Fox Flight Air Ambulance favours partners that hold EURAMI accreditation, David Fox said: “Because we are EURAMI-certified, we feel that companies with the same third-party verification are going to have the same level of care and professionalism that we expect. We could partner with a company with another air ambulance certification, but EURAMI seems to be more focused on international transfers.”
ER24 Global Assist of South Africa is partnered with air ambulance providers including Luxembourg’s European Air Ambulance and Skyservice Air Ambulance of Canada. Alastair Lithgow, ER24 Global Assist Fixed-wing Co-ordinator, said: “The benefit of having these agreements instead of working on an ad-hoc basis is that we can confidently expand each other’s footprints in various regions around the world. Besides this, when these agreements are reached, we can guarantee quality of patient care and standards of safety. This means we can each offer our clients the highest standards of care and customer satisfaction in all areas that we jointly service while being confident in the financial arrangements that the agreements cover.”
Speed and convenience
Asked whether there is a downside – where having an agreement with one provider makes it harder to work with other, non-partnered providers – David Fox responded: “We haven’t experienced that at all. Wing-to-wing transfers represent an important piece of our business – we do between 30 and 40 a year – and we’ve found it to be a very beneficial for all the companies involved.”
Partnerships can also bring potential benefits in terms of marketing and brand awareness
Remarking on Skyservice Air Ambulance International’s partnerships, which have been very successful for all parties and have been in effect for many years now, Ewing said: “We continue to seek out partnerships in distant parts of the world where we have no existing partners in order to enhance our portfolio and expand our offering to our existing – as well as potential new – clients.”
However, while a company may work with non-partners when appropriate, having already done the homework speeds things up when arranging a wing-to-wing with a trusted partner, which ultimately means the patient can get in the air sooner.
Frank Condron said: “[The partners] can move immediately to talking about the mission at hand instead of taking time to verify qualifications over and over again. So there is clearly a benefit attached to working with a partner you know and trust, and the client benefits from the reduction in turnaround time required for dispatching aircraft and getting the patient home.”
Another aspect is the convenience for the customer of dealing with providers that will take care of co-ordination between themselves, giving the client just one point of contact to deal with. Under Capital Air Ambulance and AMREF Flying Doctors’ wing-to-wing agreement, for example, customers need only deal with one operations centre. Judy Groves, Marketing Director at Capital Air Ambulance parent company Rigby Group Plc, said: “For insurers and assistance companies, arranging a global medical assistance flight is now more convenient, straightforward and reliable – with only one operations centre and set of logistics to deal with.”
Even setting aside wing-to-wing missions, partnerships can also bring potential benefits in terms of marketing and brand awareness. For example, under the agreement between Fox Flight Air Ambulance and Awesome Air, each will recommend the other to clients in need of aeromedical repatriation services in their respective markets.
Furthermore, some partnerships are aimed at extending capabilities rather than dealing with geographical range. Hemma Niederegger, Project Manager, Sales and Marketing at Austria-based Tyrol Air Ambulance (TAA), commented: “TAA has a close partnership with Pediatric Air Ambulance, a specialised provider of intensive care transports for children and babies. The partnership is profitable for both sides: TAA has access to specialist doctors as well as the necessary medical equipment, while Pediatric Air Ambulance has benefits from swift access to Tyrol Air Ambulance aircraft for their missions.” Here, the pre-partnership work included testing relating to power supply and functionality on board, safe and professional stowage of medical equipment and evacuation training for the medical crews.
Judy Groves emphasised that the main benefit of partnering is how closely the companies can work together: “Given that EURAMI-accredited organisations are aligned to EURAMI requirements on protocols, equipment and staff practices, it distils down to working as one team rather than two teams collaborating. The end result is that, from a customer perspective, there is one point of engagement and control from beginning to end. A truly ‘bed to bed’ service with consistent high standards of medical care, optimised logistics, minimised waiting times, and consequently a more cost-effective service proposition.”
As a final note, in case you’re wondering whether these partnership deals are a fire-and-forget solution, it seems these are relationships that must be maintained. David Fox told ITIJ that each of the agreements that Fox Flight has (it’s partnered with not only Awesome Air Evac, but also Germany’s FAI rent-a-jet, Tyrol Air Ambulance of Austria and US-based Air Ambulance Worldwide) is reviewed on an annual basis. Frank Condron specified that as part of an agreement, each party is expected to keep all relevant documentation and certifications current and up-to-date, subject to audit by the other party at any time.