How is the Covid-19 pandemic affecting air ambulance operations? For many operators, there has never been a busier time, but for others, meeting their fixed overhead expenses is a struggle. ITIJ spoke to providers the world over to see how the situation is unfolding, looking at how those who have kept flying have managed to do so, new challenges that have presented themselves, how the industry has adapted, and what the future has in store. Lauren Dulin, Chief Operations Officer for US-based Air Ambulance Worldwide, paints a bleak but honest picture of how the medical air service provider’s operations have suffered as a result of Covid-19. “The Covid-19 pandemic has impacted our operations more than any single event in our organisation’s history,” she told ITIJ. “In the span of little over a week, global air travel essentially ceased to exist in any meaningful way and air medical transport slowed to a trickle, restricted by our need to protect patients and crew, overwhelmed medical facilities and new regulations.” Air Ambulance Worldwide is ensuring that its aircraft are operating according to the most stringent infection control protocols by operating air ambulance flights for Covid-19 patients using specially designed isolation pods and disinfecting its cabins with state-of-the art SaniSwiss machines after every flight. Dulin explained more: “Air Ambulance Worldwide quickly brought our isolation pods into service at both our Pennsylvania and Florida bases after ensuring that our infection control protocols were adequate to this new reality. We have disinfected our aircraft after every mission using the SaniSwiss bio disinfection technology for several years, and it remains the best way to ensure that the aircraft is free of infection for the next mission.”
The Covid–19 pandemic has impacted our operations more than any single event in our organisation’s history
For FAI Air Ambulance, based in Germany, the pandemic has led to a drastic shift in operations, as Volker Lemke, CSO/Head of Ambulance Division articulated: “While there were still many typical missions for smaller aircraft such as our Learjet 60 at the beginning of March, we are now almost exclusively busy on our long-haul aircraft. There are many operational restrictions regarding, for example, landing permits and overnight stays for crews, as well as the necessity to transport a Portable Medical Isolation Unit (PMIU), which lead to the increased use of our Challenger and Global Express fleet.” When it comes to transport options for coronavirus patients, FAI has procured the latest version PMIU solid-shell EpiShuttle manufactured in Norway by EpiGuard AS – and additional systems are imminent, as Lemke revealed. “We have owned an IsoArk PMIU for several years,” he told ITIJ, “but, due to the crisis, another EpiShuttle was purchased in February. A second shuttle and a second IsoArk will arrive [soon]. This means that in future we can meet the requirements of the coronavirus crisis with four isolation units on four longhaul aircraft. I assume that many operators will try to buy similar systems in order to establish resources for Covid transports.”
Implications for all
Jet Rescue in Mexico is another air ambulance provider that has been deeply affected by the pandemic. ITIJ spoke to Carlos Salinas, Founder, CEO and COO, to better understand the impact of Covid-19 on his business and the wider industry. “Like everyone else in the business, Jet Rescue has been deeply affected by the suspension of international travel. It would be fair to say that the whole industry is struggling,” he said. “Fortunately, thanks to sound strategic and financial planning, this horrendous crisis finds us basically debt-free, in almost full ownership of our aircraft, and with fleet-wide compliance with Federal Aviation Administration (FAA) 2020 instrumentation rules.” What’s more, Jet Rescue was already equipped to begin transporting Covid-19 patients and so was among the first to do so. “Having invested in bio-hazard isolation transport capability, a stock of PPE gear, and advanced decontamination technology some three years ago, Jet Rescue was among very few air ambulance companies that were able to safely transport patients with confirmed, or suspected, Covid-19 diagnosis from the onset of the crisis in the Western Hemisphere,” he said. “We commenced isolation transport services on 8 March.” In terms of transport capabilities, Jet Rescue’s air ambulance jets have been specially equipped with a USmade portable isolation chamber, allowing the infected patient to be transported as securely as possible.
Due to the travel restrictions and for safety reasons, we have suspended all on-site audits until further notice
While AirLink, also based in Mexico, was likewise as prepared as possible for the pandemic, given the unprecedented nature of the situation, the impact has still been significant. Inez Dijkstra, Commercial Manager, explained more: “By listening to Asia and Europe, we knew what was coming. In that sense, we had the ‘advantage’ of being a step behind Asia and Europe. It allowed us to prepare. However, the magnitude of the impact was, and still is, unpredictable,” she said. “The Covid-19 pandemic has affected our operations. Normally, a large amount of our flight requests come from travel insurance companies and, as there are currently fewer to no travellers, we are receiving fewer medical evacuation/ repatriation requests. Additionally, our transportations are co-ordinated case by case, as many countries have changed their standard procedures in terms of landing permits, overnights and so on. Transportations are coordinated with the local and international health and aviation authorities and we are following their instructions.” AirLink purchased an isolation pod to transport suspected or confirmed patients with Covid-19 and, according to Dijkstra, the provider’s operations are steady. “We have adapted to the requests of the industry and the needs of Mexico and the world in general,” she told ITIJ.
Resilience in the face of challenges
For accreditation organisation European Aero-Medical Institute (EURAMI), daily business has not been as significantly affected by the pandemic, but the Institute has had to make some important decisions that affect some air ambulance providers. Claudia Schmiedhuber, Managing Director, explains more. “EURAMI is set up in a way that allows for its staff , board members and auditors to work remotely from anywhere in the world. Obviously, we are all following the national guidelines and imposed isolation regulations,” she told ITIJ. “Having said this, the biggest impact Covid-19 has had on our daily operation is that, due to the travel restrictions and for safety reasons, we have suspended all on-site audits until further notice. These reaccreditation audits will be conducted once the situation allows us to do so. For the same reason, we have also postponed any new registrations for accreditation and have created a waiting list for these providers. Fortunately, EURAMI is in a very stable position, which allows us to completely focus on our membership and how we can best support them.” Schmiedhuber notes that the reaction of EURAMI’s accredited providers to the changing situation has been impressive: “From the very beginning, EURAMI providers started to purchase isolation chambers/isolation units in order to assure the safe transportation of infected Covid-19 patients, which has allowed for them to conduct these flights from the early stages onwards.” For LIFESUPPORT Air Medical Services, Inc., a Canada-based international air medical transport firm, the impact on operations is multifaceted, as CEO Graham Williamson highlights. “The largest and greatest impact has been the sharp and sudden drop in transport volumes, as tourists and travellers returned home,” he told ITIJ. “Each case has become logistically more intense, requiring a great deal more planning and preparation. Things that we would normally have taken for granted now take additional time, effort and cost to plan and prepare for.” And for Airlec Ambulance, in France, while things have never been busier, challenges are abundant. “We have never flown as much, but have never had so many difficulties (landing permits and so on) to perform our missions,” said Paul Tiba, the organisation’s Managing Director. Fortunately, the company is well-equipped: “We have been fully ready to transport highly infectious patients for several years. For example, we fly haemorrhagic fever patients out of Africa every year. What has been particularly challenging is determining whether patients were Covid-19 negative or not at the beginning of the crisis. We have never refused a Covid patient, even critical intubated-ventilated ones.”
What happens next
As the air ambulance community has proven time and time again, it is resilient, hardworking and determined. And, perhaps most importantly of all, adaptable. Looking ahead, the providers ITIJ spoke to have plans in place to ensure their future success and ability to continue meeting demands and saving lives. For example, FAI wishes to continue to expand its Covid-19 transport capabilities, but pointed out that this is a balancing act with the need to maintain financial stability. Similarly, for Jet Rescue, the focus is on maintaining service to its clients throughout the crisis. “Currently, we utilise the downtime to re-train staff and to perform fleet-wide scheduled maintenance,” said Salinas. He believes that the pandemic will have a long-term impact on the air ambulance industry: “We see a probable paring down of the number of operators, an increase in the number of brokers, some consolidation of brands, and a possible increase in prices paid for medevac.” Dulin told ITIJ that the pandemic has forced Air Ambulance Worldwide to adapt. “The slowdown in non-Covid flights and the trials presented by countries closing airspace has necessitated that we re-invent ourselves on a daily basis,” she said, “adapting to meet the new transport requirements for Covid patients, working remotely and ensuring that nothing is overlooked when organising air medical transport flights in a new and ever-changing landscape during this pandemic.”
Each case has become logistically more intense, requiring a great deal more planning and preparation
But she is confident that the industry will recover: “The air ambulance industry is one that was born of necessity and thus will evolve based on necessity: we will come out of this with a renewed sense of purpose – as air travel resumes after the pandemic, so will a more resilient and adaptable air ambulance industry.”
Adapt and flourish
Schmiedhuber also sees adaptation as key to overcoming challenges presented by the pandemic. “It is, and will be for sure, a very challenging time and I believe that we will see impactful changes in our industry, such as mergers, as well as some providers going out of business,” she stated. “I do hope that our industry will bounce back completely, and that travel activity will resume to its full capacity over the next two years. However, for now it will be a challenge for all providers to ensure that resources are planned carefully and that a solid long-term strategy is in place. I firmly believe that it will be the companies who are able to adapt to the changing situation that will emerge stronger and with new skills and capacities.”
It is undeniable that the Covid-19 pandemic has introduced unprecedented challenges in the form of travel restrictions and new rules and regulations, but the air ambulance industry continues to prioritise, above all, serving its clients to the highest standard, and is determined to adapt and persist. As is the case for many other industries, the true scale of the long-term impact of the pandemic is difficult to predict, but with hard work, determination and resilience, the air ambulance industry can continue to serve those who need it and grow, flourish and innovate, despite the uncertainties of an ever-changing world.