Since the start of the coronavirus pandemic in 2020, the aeromedical provider accreditation industry has experienced much of the same turbulence as any other. Changing demands from operators, burgeoning backlogs and fluctuating travel restrictions and social distancing requirements have meant that accreditors have had to adapt rapidly to the evolving situation.
New procedures and virtual auditing techniques
One key trend since the start of the coronavirus pandemic has been the rapid implementation of new virtual auditing procedures to ensure a continuity of accreditation services during a period when normal travel, both domestically and internationally, has been repeatedly disrupted and even suspended.
Eileen Frazer of the Commission on Accreditation of Medical Transport Systems (CAMTS) explained: “CAMTS and CAMTS Global have had the same challenges since 2020 as many other businesses who rely on travel as part of their normal business practices. Our challenge is to do the right thing to protect our site surveyors and services from exposure and illness in an environment of changing Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines as we adjust to Covid and its variants.”
Frazer added that a framework of procedures was developed early in 2020 in response to the coronavirus pandemic and have been continuously revised over the following two years. The framework includes procedures such as:
- Only site surveyors who can provide proof of Covid-19 vaccinations will be scheduled for on-site visits
- Prior to travelling for a site visit, site surveyors shall provide proof of Covid-19 vaccination to the CAMTS office
- In-person interviews and tours will be conducted with vaccinated personnel only, however, virtual interviews can be conducted with key personnel who are not vaccinated
- Masks and social distancing are required throughout the visit by site surveyors and personnel involved in on-site interviews and tours
- Surveys of satellite bases in high-risk areas may be conducted virtually by site surveyors who are performing an on-site visit to the main base of operations
- Travel to and from a client will be closely monitored to avoid airports in states and countries with high Covid-19 rates, and with direct flights favoured where possible
- In the event of severe restrictions, such as states or countries that enter lockdown, surveys may be delayed or conducted virtually. Decisions will be based on real-time conditions, and a virtual visit may be requested as a substitute.
Ultimately, though, Frazer said that adapting to the new reality would not have been possible without the backing of CAMTS’ clients and staff, as well as a degree of good fortune. “We have been extremely fortunate,” she explained. “Since 2020, over one hundred site visits have been either delayed, conducted virtually, or conducted onsite and we have had only one known exposure. In that case, the site surveyor quarantined and did not develop Covid. None of the services with an impending expiration date decided to withdraw applications for accreditation and all have been exceptionally cooperative as we navigate these changes and challenges. We are also fortunate to have dedicated site surveyors and board members who have supported CAMTS and CAMTS Global throughout the pandemic.”
Some accreditors, such as NAAMTA, expanded on existing technologies such as its NEAT application platform to offer clients a greater degree of transparency and interaction in lieu of more traditional face-to-face auditing methods.
“Prior to the pandemic, we developed and introduced the NEAT application platform. The platform provides customers with a dynamic, transparent and complete accreditation audit report reflecting ‘real-time’ feedback and progress from beginning to the final report,” said Amy Arndt, NAAMTA Global Operations Director, and Nancy Purcell, NAAMTA’s Director of Clinical Operations, in a joint statement. “The NEAT incorporates a ‘Self-Assessment’ feature that enables customers to look at their policies and make an assessment of full, partial or non-compliance to each standard.”
In addition, NAAMTA says that it has introduced a range of additional precautions ‘when going onsite to ensure compliance with current CDC recommendations’, including the re-evaluation of interview procedures and the use of remote video conferencing to overcome travel restrictions and minimise employee exposure, as well as the use of pre-site audit photo lists, ‘allowing [NAAMTA] to preview specific areas of interest at the bases, thus allowing us to conduct a more focused base site audit’.
Overcoming travel restrictions and applicant backlogs
The situation was similar elsewhere, with the European Aero-Medical Institute (EURAMI) also working to prevent a potential ‘backlog in re-accreditation as well as new applications who were already on a waitlist,’ according to Claudia Schmiedhuber, Managing Director, and President Dr Cai Glushak.
“EURAMI had to adjust to the pandemic in an ultra-fast timeline, when in March 2020 Covid lockdowns and travel restrictions made physical audits virtually impossible,” they explained. “We gave reasonable extensions for members who were in good standing with no evidence of programme deficits. However, all new accreditations must follow an on-site audit and virtual visits are still considered a back-up rather than routine process.”
The crisis forced EURAMI to create ‘some permanent improvements, forcing us to move to reliance on digitalised documentation that enables ready access and better advance planning for a site visit’. Future audits, the pair said, will thus be much more streamlined.
“The feedback from our members was very positive as – whilst missing the direct physical interaction between auditor and staff – it does present a safe as well as time- and cost-effective alternative,” she explained.
This also included the creation of the EURAMI Virtual Audit – a ‘fully digitalised process of our normal on-site audits, using pre-recorded videos, virtual tours and video calls with the auditor’, which has successfully been used to carry out multiple audits since its implementation in May 2020. Despite this, the creation of a virtual auditing option has not persuaded EURAMI to move entirely away from in-person visits, with the organisation restarting on-site audits in late 2020.
For third-party consultants such as Jessica Peltz, who is based in southern Florida and who supports accreditation preparation, compliance and quality assurance programme development for medical transport agencies, the effects have been more muted.
Peltz worked primarily remotely even before the pandemic, and has been offered comparatively few opportunities to streamline operations.
“From our perspective, Covid has not complicated our process. This is fortunate, and we continue to provide the same responsive and full-service attention our clients are accustomed to,” they explained. “Accreditation preparation and the audit process is labour intensive, time consuming and exhausting, and the entire process encompasses all facets of the medical transport programme and is nearly impossible to streamline.”
Demand for accreditation has grown since the pandemic
Although the new curbs on international travel may have placed substantial restrictions on how audits could be carried out, this has not translated to a fall in demand – indeed, for many, the opposite is true.
According to Schmiedhuber and Glushak, demand for accreditation has increased since the start of the pandemic in March 2020: “When reaching out to these programmes and asking about their motivation, they often state that the pandemic has led to an internal review of strategy, long-term goals and market placement, which involved obtaining EURAMI accreditation as a sign of their dedication to quality and excellence as well as upholding the strictest standards in aeromedical transportation,” they explained.
However, more surprisingly, the pair says that in addition to rising demand from more standard clients, such as providers operating in the travel assistance and insurance industries, there has also been an increase in requests from providers ‘servicing government and NGO programmes, as well as military contracts’.
While in the past, many of these entities would not have required the kind of accreditation EURAMI provides, Schmiedhuber and Glushak said there has been a shift in recognition and demand for accreditation services, due in part to growing requirements for accreditation from official bodies and authorities.
Peltz echoed EURAMI’s sentiments: “We have been receiving steady inquiries for accreditation since the beginning of the pandemic.”
NAAMTA agreed: “We have experienced an increase in interest from new applicants and existing members for guidance and information on how to best navigate operational obstacles of the pandemic and staying the course to maintain compliance."
The pandemic may have given some organisations more opportunities to invest in themselves
The impact of the pandemic on the medical transport industry has been immeasurable. Whether ground or air operators, domestic or international – all have felt the shockwaves of illness, staffing, travel restrictions, and logistical headaches. Everyone has been making adjustments, including accreditation entities.
Arndt and Purcell explained that during the onset of the pandemic, there was an ‘immediate increase in the need for additional information’ regarding subjects such as enhanced infection control measures, PPE safety precautions and training specific to the transport setting when transporting critical Covid patients.
Peltz pointed out that while other industries may have suffered due to the pandemic, medical transport providers benefitted from increased volume and therefore more revenue, giving organisations more opportunities to invest in the services they provide – a phenomenon that Peltz says has been evidenced by providers from many countries.
“This has led to a renewed interest in seeking accreditation as many programmes were able to clinically grow and enhance their scope of practice due to complex Covid cases. We have fielded inquiries from India, China, Italy, Brazil, and of course, the US,” Peltz added.
Schmiedhuber and Glushak also said that she had seen noticeable investment by many providers in new equipment and aircraft: “A very positive development in the last two years has been the growth of fleets of our existing accredited providers, with many operators adding new aircraft to their operations, including long-range aircraft with the potential to transport multiple and more complex patients. This has proven very beneficial for their clients, especially during Covid. EURAMI was also very proactive in promoting enhanced infection control standards amongst members as well as holding industry-wide scientific discussion on best practices to deal with Covid.”
Improved collaboration and effectiveness for operations
According to Arndt and Purcell, the changes made to procedures since the pandemic may have even improved the effectiveness of operations. They explained that the NAAMTA Alliance and NAAMTA’s online tools ‘allowed our operators to collaborate with each other to discuss various pandemic challenges presented and explore solutions while meeting the critical healthcare needs of their patients and families.’
Through these initiatives, the organisation has reportedly seen ‘positive trends because of Covid’ across its Alliance members, including more frequent safety meetings, more regular reviews of infection control policies, and updates to address Covid-specific safety measures, as well as quality management meetings to assess processes regarding:
- Supply chain disruptions and forecasting for PPE supplies
- Health support, precautions, and Covid monitoring/testing to ensure employee physical and mental wellness
- Enhanced transport intake request and dispatch procedures to ensure information is available to appropriately screen for emerging disease/exposure
- Compliance with additional rules and regulations for transporting a Covid patient to/from other states and/or countries.
Schmiedhuber and Glushak echoed the sentiment, saying that providers with whom EURAMI has worked have displayed exceptional drive to adapt despite the challenges of recent years: “One thing that stood out was how quickly our accredited providers adapted to the requirements of transporting Covid positive patients. It was within a matter of weeks that almost every programme was equipped with an isolation pod and procedures to safely transport infectious patients.”
“We have also found that overwhelmingly, audited entities find these exercises extremely useful and are usually prompted to adopt recommended improvements to their organisations. Sometimes these enhancements are adopted before the audit is completed, but we frequently are gratified during our audits that recommendations from previous visits have since been accepted and integrated into the provider’s structure and processes,” she added.