With travel restrictions and quarantine requirements in place all over the world, most assistance and air ambulance companies have not had many opportunities to transport patients across the globe of late. Air ambulance services have had to adapt to a new world of aeromedical procedures and spend a lot of money on new equipment – with few chances to get any profit back.
Dr Joseph Lelo, Medical Director at Kenyan air ambulance service AMREF Flying Doctors, commented on the situation: “It is an opportunity as well as a death blow for many. Air ambulance work is closely linked to the travel industry and if travel stays depressed for a long time, a lot of air ambulance service providers will be in the red. The risk of staff contracting Covid is very real, and this may lead to some operators shutting down to quarantine or isolate their affected staff.”
So, how are air ambulance services planning to ride out the storm? And how will the pandemic affect them in the long-term?
Feeling the effects
Peter Flemmer, Marketing Manager for Ace Air & Ambulance, expects the pandemic to impact his work for years to come. He explained: “We anticipate that this virus will be with us for a number of years and that the restrictions (including screening, testing and PPE requirements) when flying into neighbouring countries will remain in some measure in the future. At present, we are not allowed to transport Covid-19 positive patients, but foresee this will be possible and necessary in the future and we are procuring a negative pressure bubble to facilitate this.”
Due to Covid-19, air ambulance services have had to update their equipment to follow new safety guidelines. Shira Michlin, Office Administrator at AC Global, believes this will prepare air ambulances for the future and might put them in a better position should a similar situation come up. She explained: “We have purchased specialised ISO-Chamber equipment to transport Covid-19 patients. This will expand our ability to transport infectious disease patients in the future.”
The positive side is that our meetings will also in the future be more via digital medias and not in person, this saves time and resources, even though a personal contact might be better in some situations
Markus Kellner, Head of the operations centre at DRF Luftrettung, also sees some positives for the future of air ambulances. However, he doesn’t believe Covid-19 will have too much of a long-lasting impact: “The positive side is that our meetings will also in the future be more via digital medias and not in person, this saves time and resources, even though a personal contact might be better in some situations.
“Since, in our business, we are used to adapting to special situations, like the Iceland Volcanic outbreak where Europe’s whole airspace was locked down for weeks, the Ebola outbreak in Africa or now the Covid-19 pandemic, I don’t think that it will have a continuous impact on our work, just some little changes – but more or less it will go on.”
Generally, air ambulance services across the world seem to be equipped to ride out the storm. As organisations that focus their whole business on responding to emergencies, air ambulance services are used to adapting to difficult situations.
Wolfgang Seeger, Customer Relationship Manager at Swiss air ambulance service Rega, commented: “Rega was already transporting patients with highly contagious diseases before the pandemic. Our crews can perform these transports with both an ambulance jet and a rescue helicopter. In view of the coronavirus crisis, in February, Rega trained its crews specifically for the transport of Covid-19 patients and, where necessary, has also adapted and established specific procedures.
“In response to the Ebola outbreak in Africa in 2014, Rega designed a Patient Isolation Unit to enable it to safely transport highly infectious patients. The processes that we had adapted to meet the specific requirements of the coronavirus pandemic, coupled with the targeted theoretical and practical training of our crews, allowed us to step in when the virus spread around the world. In spring 2020, our learning curve was steep, and in the meantime we have further consolidated our repatriation procedures by carrying two isolation units onboard our aircraft.
the three Rega/Swiss Air-Ambulance medevac jets have clocked up a record number of flight hours within the first seven months of 2020
“Despite fewer emergency repatriations and the virtual collapse of accompanied repatriations conducted by scheduled airlines and charter operators after March 2020, the three Rega/Swiss Air-Ambulance medevac jets have clocked up a record number of flight hours within the first seven months of 2020. This is due to an increase in long-range missions around the globe. The high-standard services provided by Rega/Swiss Air-Ambulance meet a real demand, especially in view of the current pandemic, and to date we have repatriated almost 50 Covid-19 patients either in our Patient Isolation Unit or intubated.”
However, elsewhere, air ambulance services are less optimistic and worry about a lack of tourism. Markus Kellner said: “It’s very difficult to ‘ride out the storm’ in the air ambulance business, even less possible with our smaller Learjet 35, in which no Epi-Shuttle fits – it has a small cabin and it’s not possible to separate the patient from the pilots. There is some special equipment, e.g. special masks for patient and/or crew etc., which gives us the opportunity to transport Covid-19 positive patients for short range transfers.
“But the tourist business and the long-range travel of tourists is, and will be, less than before Covid-19, and therefore there are also less people who need medical transports back to their home countries.”
He added that the pandemic will have a big impact on the air ambulance market generally, saying: “It has and will have an immense impact, because less people will travel, personally, I see an collapse of up to 75 per cent this year and 25 to 50 per cent the next two years until we are back to ‘normal’.”
Wolfgang Seeger agrees. He explained: “The segment of short- and medium-haul flights in the air ambulance market is likely be impacted as long as the current pandemic is active. This is due to government travel restrictions and a possible lack of trust in the airline/charter industry on the part of travellers. While intercontinental air travel looks set to recover only slowly, the demand for long-range repatriations by medevac aircraft could well increase. We see the main reasons for this as being a possible local undersupply of services for critically ill patients and the desire by patients to be treated in a hospital of their choice.”
Fear of a global recession
More generally speaking, the recession that economies globally are facing will also put pressure on the pricing and scale of air ambulance operations. Additionally, insurers have been severely impacted by the pandemic themselves, and will be looking to contain their risk in the short to medium term. This will have a knock-on effect on the demand of air ambulance services.
Peter Flemmer is worried about an economic recession impacting his work. “Many countries (especially in Sub-Saharan Africa) are facing economic recession due to the effects of the pandemic. We foresee stricter protocols in place for countries to contain the spread of disease in future. This may most likely result in stricter protocols for inter-country transport of patients in the air ambulance industry going forwards, affecting costs and mission response times.”
there might be an opportunity for air ambulances to expand during the pandemic and take on new endeavours
He added: “We have furloughed a significant number of staff and those staff still working are on a reduced salary. We have ground ambulance services in Zimbabwe that will continue to service the local market. There may be a need to consolidate the air ambulance fleet if local demand does not make up for the loss in international tourist demand.”
However, there might be an opportunity for air ambulances to expand during the pandemic and take on new endeavours. Dr Lelo has a positive outlook on the future: “I think it will be an opportunity for growth into long-distance transports for many. A lot of transports will require an air ambulance for the speed, safety (from less crowding) and efficiency. This opportunity is also being seen in general aviation. Air ambulance providers with limited range fleet will struggle to stay afloat in the near foreseeable future of limited travel.”
Shira Michlin is also hopeful. She said that seeing as AC Global has a very diverse clientele, it is able to continue doing work without downsizing. “We are fortunate to have domestic contracts that keep us busy. We provide transports for a variety of industries that have been deemed essential and continue operating,” she said. “Covid-19 will have a lasting effect on our field. Fortunately, we have been able to adapt and remain a strong player in the air ambulance industry.”
It seems that most air ambulance services are adapting to the new circumstances and are optimistic about the future of their industry. However, it can’t be denied that they will still face difficulties along the way, especially with travel restrictions still in place.