Different countries have different rules for the international movement of patients – which can be difficult and time consuming for the air medical and assistance companies at the sharp end of operations planning patient transport across borders. For this reason, staying on top of innovation and streamlining operations where possible are keys to effective repatriations. Even domestic transports can sometimes throw up unexpected challenges.
That is one of the reasons France-based Airlec Ambulance has been focusing on digitising its operations as much as possible. Flight planning, permission requests, pricing and medical reports are already fully virtual at Airlec. However, there are certain limits to digitising the complete process as the complexity and quick reaction involving repatriation of patients via air ambulance always benefit from the human touch.
“We do, however, believe that certain aspects of our work can be automated at this point to perform more efficiently and cost effectively,” said Paul Tiba, Managing Director at Airlec. “When it comes to making patient transports easier, I would say that digitising our medical reports and flight planning has had the biggest impact for our staff, especially improving the work efficiency of our mission planning and monitoring patients during the mission. This has made hospital handovers much more convenient for both sides, our crews, and the hospital staff.”
The pandemic changed the way air ambulances could operate
But how does the pandemic come into play? At this point in time – and with the pandemic still ongoing and new variants emerging all the time – the situation changes almost daily. Countries open and close again, go into lockdown and come out of it. New testing regulations are being established and within a day everything can be different once again.
Flight planning has become especially important during the pandemic, when getting a patient from A to B involved a lot of paperwork and staying on top of travel restrictions. Italian medical escort company DTMedicalService24 has been dealing with medical transport by ground and air ambulance, and medical escorts on scheduled flights and ships for years. But Covid-19 has changed how they operate in ways they could have never predicted.
Davide Toso, Business Development Manager at the company, recalled: “Never have we felt a crisis on this type of work as [we did] in 2020. Covid has drastically stopped us. But we can say, perhaps, that we were the only ones to carry out international repatriations of Covid patients in the lockdown by ambulances and medical flights with biocontainment capsules, from Albany to Italy, from Kazakhstan to Italy, from Norway to Italy, from Spain to Italy, and from Italy to France.
“In this period, what was normal for us, from the arrival of the request to the departure of the vehicle, was that everything was complicated. It takes several hours – if not days – to obtain transit permits at customs or to see if the person needs a Covid-negative buffer; in short, a lot of bureaucracy to carry out medical transport to help the neediest. Everything can be overcome, but we hope to return to normal soon.”
Local knowledge is key during Covid
The availability of Covid test kits, as well as the validity of these for the receiving destination, is a key factor that must be carefully planned for, not to mention the variable response times for receiving test results, which determined how soon a mission could be started.
local knowledge and direct relationships and experience with these ports and their specific requirements and procedures is essential to ensuring that cross-border missions run smoothly
James Halsted, Managing Director at ACE Air & Ambulance in Zimbabwe, explained: “We have set up and continue to monitor and update our own database of regional ports, roads and airstrips, detailing current conditions and risks. This is updated and informed by our own pilots and local contacts set up for this purpose. In this way we avoid planning mistakes by avoiding unsuitable routings, and we understand the local conditions before allocating vehicles to a mission. With regards to Covid-19, the measures discussed above also ensure that additional safety equipment and protocols are in place to ensure safe and effective missions, as well as staff education and communications to ensure staff are comfortable and confident to perform their duties.”
When crossing borders and entering foreign countries, it is essential to have local knowledge. Halsted added: “Once again, direct relationships and experience with these ports and their specific requirements and procedures is essential to ensuring that cross-border missions run smoothly. Obviously, the necessity for putting Covid protocols in place has extended the duration of medical mission planning significantly, especially the requirement for patients procuring negative Covid-19 test results for repatriation in most cases.”
Additionally, since there is no common ground for any Covid-related requirements to enter or leave a country, it has become very time consuming and sometimes even challenging to organise missions from one country to another.
“I would say that while there are some countries that have made it a bit more difficult to transport patients to and from (for example Morocco), it is the rapidly changing situation on a daily basis that is the biggest challenge at this point,” said Tiba. “At this point, I understand that there is also no common guideline or regulation, thus I remain hopeful that soon organisations such as the European Aero-Medical Institute (EURAMI), International Civil Aviation Organisation (ICO), and the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) and others, will provide us with such guidelines to support a mutual approach and harmonise the requirements to safely transport patients on a global scale.”
Investment is key to business continuity
Many companies had to adapt fast to the nature of patients being transported during the pandemic – while the usual patients (tourists) stayed at home, Covid-19 patients needed transport across borders as health systems were stretched to breaking point. Air ambulance companies adapted to the needs of these patients, investing in portable medical isolation units to ensure the safety of crew could be guaranteed when little was known about the true risk of transmission and infection from the virus. Diana Iaquinto, Medical Operations and Provider Relations Manager for Latitude Air Ambulance, told ITIJ: “Latitude Air Ambulance enhanced operations in several ways to meet the challenges of transporting patients during this pandemic. We have purchased three isolation units enabling us to transfer Covid positive patients within a negative pressure enclosed system. Our in-house lab and testing-units (for travel) allowed us to perform timely PCR testing at base for our crews, as well as bedside (while abroad) to ensure patient status. This has allowed for timely and cost saving results for our clients and ultimately quicker repatriations for the patients.”
And it’s not just about investment in equipment – the medical and flight crews who kept working tirelessly throughout the pandemic were, without doubt, the definition of ‘keyworkers’. While some air ambulance operators have reported difficulties in finding the right staff due to hospitals offering significant sums as sign-on bonuses to medical staff, nonetheless, crew are needed. Another adaptation air medical operators are reporting with regularity is investment in aircraft. Fleets are changing, and larger aircraft capable of longer-range flights with fewer fuel stops are becoming a more common sight in the industry. Not only do that change the capabilities of a provider, they can also allow for safer transport of patients in the isolation units and keep the crewmembers socially distanced. Iaquinto commented: “We invested in Beech 1900D aircraft that allow for transfer of Covid positive (isolation unit) and asymptomatic patients while ensuring social distancing and safety. These new additions that are tandem capable, will also assist with Neonatal transports and Bariatric transfers due to the large 57” door and electronic lift.”
Education and digitisation leads to a better future
Aside from better mission planning, educating clients about air ambulance missions could also help make the whole process easier. Airlec is currently launching a virtual online training course, which will help educate clients on the process involving the organisation of an air ambulance mission. Additionally, the company fully digitised its fleet with Virtual Reality (VR) technology, which now allows for clients from all over the world to experience the fleet. This is especially helpful to educate them on the difference in cabin size, door width and other contributing factors that play into deciding on what aircraft to use for missions.
Not only do clients need to be trained, but staff, too, should also always stay on top of the latest innovations. That is why Airlec launched SimAirlec, which is an in-house medical training facility. At SimAirlec, medical staff can train in medical procedures under ‘real life’ conditions – such as in an aircraft, ground ambulance or hospital environment.
“We are working with our innovative Apollo CAE mannequin,” said Tiba, “which is a simulation device that offers a wide range of responses and medical condition simulation. We believe education is key to avoiding misunderstandings and close the knowledge gaps between all parties involved – the air ambulance provider, the assistance company, and the insurance company.”
certain aspects of our work can be automated at this point to perform more efficiently and cost effectively
This is especially important when it comes to complicated missions that cross borders. “I believe that we have seen great developments and an increase in quality due to an increasing number of operators and clients understanding the necessity of accreditation as well as the utilisation of the most suitable aircraft for each mission. Patient safety, comfort and the best care should always be the number one priority, which is why I welcome the current trend of an increasing use of long-range aircraft without a fuel stop for patients with challenging conditions,” explained Tiba.
However, Tiba thinks there is still a lot to be done in training customers and staff in innovative technology to make sure missions go as smoothly as possible. He believes that training and education should be a focus for the future, along with a dedication to further optimise flight planning and medical monitoring during the flight.
“What I would very much like to see is companies coming forward with tailor-made solutions for these areas, customised to the needs of an air ambulance operator,” Tiba concluded. “Unfortunately, so far this has not been the case and off-the-shelf solutions do not work for our niche field. I am excited to see what the future will bring, though, as now we certainly live in a very challenging and everchanging world.”