The repatriation of a patient is a complex process that involves decisions by many different parties in the assistance chain. While we often talk about the air ambulance sector within ITIJ as part of this process, Mandy Langfield explores its ground-based counterpart, the road ambulanceNot all terrains and geographies lend themselves well to ground repatriation services, but others are remarkably well adapted. Where road networks are of a good quality, the ground ambulances that use them are basically rolling intensive care units, and the care provided by the medical personnel onboard is the same as you would expect in an air ambulance. Across the world, ground ambulances are commonly used to repatriate people or move patients between medical facilities, where this is a logistically feasible and cost-effective transport option. ITIJ spoke to Jane Hegeler of Tangiers International about how the company views ground ambulance transports differently in various parts of the world: “There are areas in the Middle East and Africa where flying restrictions, or no fly zones, may result in ground transfers. When air travel is contraindicated by our medical team, but the patient needs to seek treatment at a higher level of care facility, we would opt to use ground transportation. Every case is different, and decisions are made depending on individual circumstances and the origin and final destination. For example, there are some cases in remote areas that do not have a nearby operating air field, where we are left with no choice but to move patients by ground to a destination where they can continue by air.” The decision on whether or not to use a ground ambulance, she said, are both medical and logistical – primarily, it is the medical condition and security aspects of the case that are considered first, and then logistics are worked out on that basis.
The ground ambulances that use road networks are basically rolling intensive care units ”For US-based Gateway EMS, the last few years have seen an increase in the number of insurance and assistance companies seeking its services. Oliver Muller, CEO, said: “We have seen a consistent growth for over seven years now in volume. While we would like to think that a big part of this is due to our excellent customer service, we are also realistic and aware that the economy has been going up sharply in the last [few] years, leading to more business and leisure travellers. In turn, there is a higher percentage of possible travellers falling ill or injuring themselves.” The current economic climate means he is cautious about the future, though: “At the same time, we are watching the economy closely as there is prediction for a slowdown in 2019 which will likely lead to fewer travellers and we need to prepare for this as well.” In certain seasons, there is a spike in the number of insured clients being moved by road ambulance, according to experts who contributed to this article. Muller explained that seasonal holidays have a significant impact on patient volume, and on the type of injuries for which these patients need care: “Whether it is the snowbirds going to Florida, the Caribbean or other islands, or skiers from all over the world going to the Rockies or Canada, the type of illnesses or injuries we see is very cyclical.” Christoph Ullrich, Senior Manager of International Network for ADAC Ambulance Service in Germany, pointed out that the sheer size of his company (20 million members and counting) means that there is a less noticeable shift in terms of assistance cases in different seasons, but that the locations to which the company is called certainly correspond to tourist activity. “Of course,” he explained, “Switzerland, Austria, the French Alps and northern Italy contribute the main volume in winter season, whereas in spring/summer southern France, Italy, Croatia, and so forth, are the main countries.” Christian Nagiller of Austria-based Medi-Car confirmed that for his company, 90 per cent of all transports performed during the winter season are from ski resorts in France, Switzerland, Austria and Italy, with the main injuries being fractures of the lower leg and ruptured ligaments. He added: “During the summer season (from June to the end of September), it changes completely; the pick-up places move to the south of Europe, especially Italy, Croatia, Spain, France and Austria, and the problems are more serious like stroke, heart attack and other internal problems.”
In the US, there has been a real increase in the number of patients being driven, rather than flown, home ”Those providing such services in Europe may not have the same logistical – or security – concerns as those in other areas. As Hegeler of Tangiers International told ITIJ, when it comes to using a ground ambulance in a high-risk area or war zone, risk mitigation measures have to be taken to ensure the safety of the crew and patient. She explained: “We always try to use an experienced ambulance company in the area where the transport is taking place and use the support of our own network of field agents on the ground that can assist with additional logistics, as well as the services of armed escorts and security where necessary.”