HI Flying Air Ambulance shares insights and experience

Please introduce yourself and your background in the Medical Transport industry:

Dr. Nitin Yende :

I have been in the field of Medical Transport since 1991, starting our first ICU Mobile Ambulance in Mumbai India and had been a pioneer of Air Ambulance services with domestic operations within India and starting International patient transportation in 1996.

It has been an exciting journey with the changing scenario in the field of Medical transport.

I am personally involved in all aspects of Air Ambulance and Medical escort transports right from the start, and it is a passion for me to give my best for our patients.

Dr. Sachin Yende : ##

I have been a strategic advisor, guide, and mentor to my brother in his endeavour in this field of Air Ambulance. 

We both graduated from King Edward Memorial Hospital, University of Mumbai, and I moved to the United States.

My Medical training included a residency in internal medicine at Methodist University Hospital in Memphis, Tennessee. I completed a pulmonary critical care fellowship at the University of Tennessee. I have been actively managing the Critical Care Units at Memphis and Pittsburgh for the last 25 years. I also had a keen interest in research related to topics in the field of Critical care. He has published over 20 medical papers related to Emergency medicine and aspects of Pulmonary care medicine.

At present, I am a Professor in Pulmonary Critical care medicine and work as a Deputy Chief of Staff at a Pittsburgh Healthcare System (VAPHS).

Recently, it has been a challenge to manage the Coronavirus unit at the Hospital in Pittsburgh.
 

Talking about HI Flying; what are your core services?

Our core business includes Medical Transport on Air Ambulance Charter flights and Medical escorts on Commercial flights.

We provide worldwide services from our bases in India, Singapore, the Philippines, and the UAE.

Transporting select critical patients on Commercial flight stretcher has been our USP.

Providing professional services at an affordable cost makes us stand out from our competitors in Asia and the Middle East.

Over the years, we have developed a family of select loyal clients, which includes hospitals, corporates, Insurance, and assistance companies for whom we work 24/7/365 days to provide our professional services at the most affordable costs.

We have excellent systems and policies in place developed over the last many years, which are updated and sharpened with experience to make every patient transport process a safe journey at all times.

We transport patients out of USA Military bases regularly.

As a USA company with an operation center in Asia, we combine the professional working of a USA company and the personal, humane touche of an Asian operation.

Cost containment has always been uppermost in our minds as we deliver the best values to our clients.

And what is the profile for clients you work with?

Our clients are individuals referred by families who have utilised us in the past, corporates with multinational offices, hospitals who receive patients as part of their medical tourism endeavour, and of course, Insurance and Assistance companies who love to use both our medical escort and medical flight services.

We have developed excellent relationships over the years with few select loyal clients for whom we work, and we always look forward to new clients to work with for more unique experiences.

Do you think your focus on medical expertise is what makes you different from your competitors?

I think a lot of our competitors are either an Air Ambulance company or a Medical escort company.

Over the years, Assistance and Insurance companies are looking at an affordable solution.

The patient clinical status is a dynamic thing - a critical patient will need an Air Ambulance today, but as he improves, he may be more suitable to fly a Commercial flight stretcher, which would be a more affordable cost-saving option for our client.

We are a team of experienced doctors, nurses, and paramedics who are experienced in handling patients in all clinical settings and can offer solutions to our clients in both Commercial and Charter flight travel.

It is a one-stop service for them.

It is a constantly evolving process of pre-travel assessment, evaluation, planning, and proposing the right option at the right time.

I think transporting the patient at the right time plays the most crucial role in patient safety - which is of paramount importance.

We are part of the International Assistance group (IAG - Accredited Service provider) for India, Singapore and UAE, which helps in networking.

With close to 4000 medical transfers on Commercial and Charter flights on domestic and international sectors - experience does matter!

Do you think the market places a value on the services you deliver?

Yes, we have the biggest pool of highly trained and ICU experienced Doctors and Nurses who are located in over 18 different countries equipped with BLS ad ALS - visa ready to fly at short notice.

These Medical escorts undergo a thorough vetting process, which includes background screening and etiquette training, undergo a minimum of 80 hours of CME training besides the basic requirements of ICU experience with BLS and ALS certification.
 

We follow American Heart Association guidelines.

Patient feedbacks play an essential role in improving our services.
 

We have regular meetings - online to improve quality score and overcome shortcomings as we have grown over the years.

We have our protocols in place for the Management of Complex patients, Arrhythmias, Acute Coronary syndromes, Hypotension and Shock, Anaphylaxis, Neurological emergencies, Psychiatric and Combative patients, and most Adult and Pediatric cases.

 So we believe that we give a better value for money than many of our competitors.

 

How do you see COVID at present?

We are still in the middle of the Pandemic.

Coronavirus or COVID 19 is the seventh coronavirus.

SARS and MERS were the ones before.

Sixty percent of outbreaks since 1940 have been zoonotic, which means they originate in animals, then mutate to become transmissible to humans.

This is not the last major outbreak.

This is a result of how we interact with the planet.

When we burn the Amazon rain forest, when we hunt wild animals in their homes, we are basically insulting and not respecting nature.

The mathematical numbers are high both in the United States and India.

Our team has been following up on this Pandemic right from the time it erupted in Wuhan and started spreading its tentacles across Iran, Italy, Spain, Europe, UK, Asia, and the United States.

We have been watching, observing, preparing, and bracing for the various changes it brought to our personal lives and the functioning of our company.

This virus obeys infectious disease principles.

We need to understand the transmission dynamics of this virus.

The silent nature of this enemy needs a very controlled environment.
We need to have an awareness to know where this bug is transmitting and becoming explosive to be able to put in appropriate control measures.
The silent nature of the bug and even asymptomatic patient transmitting it makes it more dangerous than a typical non-communicable infection.

I think that Environmental segmentation, Testing, and Contact tracing should be the pillars of infection control.

Humans are social animals, and they do not want to isolate themselves.

A more disciplined population can control it better.

People who are addicted to socialising and enjoyment fall prey to it.

It spread faster.

I feel that the number of cases would have been more restricted if the political leaders and the scientific community would be more in sync with decisions and policies taken in the greater interest of the population.

Reopening of business activities should be undertaken in the right manner at the right time. Implementing low-cost easy-to-segregate measures should be taken first, and a more advanced strategy should follow, customised for every business.

I have formed a group of trusted medical colleagues on a private discussion group to kind of update each other or follow up on what's going on, and also provide the support that I think is just becoming more and more important in the present scenario.

This group helps us emotionally and academically to ride these uncertain times.

How is the COVID impact on the organisational workflow?

The disruption is broad.

The processes are impacted.

The most significant aspect is a change is processes as everyone is working remotely.

There has to be strong communication in the team; having a business continuation plan is very important.

We had our team working from home and continuing to provide equally efficient service.

We already had a CRM in place which we upgraded.
Commercial flight transportation came with additional permissions from the embassies for the patient and medical escort to travel and the quarantine time-spent by the medical escort.

Air Ambulance flights needed diplomatic permits to be taken and additional formalities for overflying and landing permits for the flight planning and implementation.

We were pretty busy at the start of the Pandemic spread when patients wanted to go back home, and commercial flights were on, and as the commercial flight transport restrictions were put in place, there was a surge of Air Ambulance Charter flight.
We continue to assess the situation from a company and an individual point of view - the real impact this virus has and the precautions we need to take as we process the information based on news, from medical facilities, from the community including the social media which is playing a powerful role in this Pandemic.

We are in touch with our clients - evermore alert in terms of patient assessment as the safety of the medical escorts would depend on taking the right decision and planning the right barrier precautions one needs to take in such a situation.

There are variables in terms of testing standards in different countries, constantly changing rules and regulations of travel, flight planning alterations based on longer routing and flight duty time limitations, embassy formalities, ground ambulance arrangements, hospital admission confirmations in the constantly changing scenario.
We had to adapt!
 

How is the COVID impact on patient management during transport?

At present, irrespective of the patient's COVID status, we are taking universal care during transportation.
The standard care of using PPE, Masks, gowns, gloves, and face shields for all.

Training of medical escorts for the use of PPE and Hand Hygiene.

A modified and more elaborate pre-travel assessment guidelines to anticipate respiratory complications.

Patient handover protocols are essential since many transports are airport to airport, given all the restrictions of medical escort travel. A modified and more elaborate pre-travel assessment guidelines to anticipate respiratory complications.

In case of respiratory failures, it is wiser to go for endotracheal intubation directly, as non-invasive ventilation like CPAP and BIPAP would mean a higher risk of infection transmission.

Intubated patients should have a HEPA filter inserted between the bag-valve-mask breathing device and the patient.

Patients who are not ventilated should wear a surgical or N 95 mask.

Ensuring an adequate supply of PPE and staff training is important.

We may add powered air-purifying respirators for high-risk patients, especially for Vent and ECMO patients.

We have a post-transport decontamination process in place.

What has been the financial impact of the COVID on HI Flying?

We have enough reserve to tide over the business, including maintaining the services without compromising on the quality and safety of the services.

We are looking at the business's sustainability from decreased no of transfers and higher efforts and longer timelines needed to implement a transfer.

We are using our experience and instincts to continue to provide good services - by making changes in our work processes within our framework, change communication methods - increase our efficiency - to continue taking the right actions on every aspect of our operations.

Dr Sachin Yende: How was it to prepare and manage the Coronavirus cases at your Hospital in Pittsburgh for you? ##

The Pandemic is a long-term dynamic event that will require nearly constant proactive strategy development and problem-solving.
We had new testing machines in place, and organised car park testing facilities, so healthy normal people did not have to visit the hospital. We cannot afford large numbers of persons seeking care at health care facilities and exposing each other as well as uninfected patients. Rapid Testing ensures appropriate sorting of inpatients as is Testing of staff members who are ill, to define safe work practices. We took a lead role in clearly communicating, in which patients need Testing and who can safely stay home to prevent the medical care system from being overwhelmed.

We were also training of our staff and work safety in place.

We had to establish COVID 19 dedicated ICU and standard beds and efficient staff in place, including myself working in the COVID wards.

Everything was done on a war footing.

How do you see your role as a Guide mentor and Advisor to HI Flying? ##

What my brother started was unique in that part of the world way back in the 1990s. 

He had the good opportunity of being in the United States in those days seeing and experiencing the Medical Transport services - both ground and air transport done here.

He was full of ideas which he could adapt and implement them back in India.

With success in India, he could replicate the model and make it work efficiently in other hubs that he created going forward.

Yes, I feel that Medical Transport is a challenging field.

Unlike a hospital, it requires the medical personnel to manage the patients in the limited resources of a flight in a hostile high altitude environment.

It needs quick decisions to be taken by an experienced and trained individual with I understand working in an ICU setup; the limitations and stress placed on an individual when flying a critical patient.

I think vetting and choosing the right medical escort for a transfer is the most crucial part of the Medical transport process.

We understand this aspect, and much importance is provided on choosing and matching the right medical escort with a particular patient.

We are looking for passionate individuals who are highly motivated to add more productivity and creativity to our team. They need to love traveling and be caring.

We have sharpened our policies and protocols during these pandemic times, where the transport volumes decreased significantly, and we had more time to improvise and introspect. 
We have pretty good protocols and procedures in place for both Commercial flight and Charter flight transportation.
Over the last many years, with the rise in the number of transport cases, we have invested in making software CRM with Standard operating procedures and Quality management systems, which has helped make the process of transfer very efficient and cost-effective.
The HI Flying CRM Software system has been upgraded recently to support remote working and exchanging information across our team in a secure manner.
We place a lot of emphasis on personalised care & human touch and not make a transport just another number - that has proved to be a winning edge for HI Flying. 
Patient confidentiality is an important aspect of our work process.
With my experience in managing patients in a Critical care setting for the last 25 years - it was my pleasure and privilege to guide the HI Flying team at essential steps of their journey in the last many years.

With the advent of the Coronavirus pandemic, how do you see the future of the Hospital and Medical transport business changing?

The present Pandemic is a rapidly changing entity, and things will change as we move ahead into the future.

I immediately see the social distancing and masking to continue for some time until a definitive cure or vaccine is in place.

I also would want to take care of the possibility of a second wave to happen and the necessary precautions to be made for the same.

In Medical Transport, we are looking at PPE use for all Medical personnel and the use of Isolation units in Air Ambulance flights.

We are looking to build a more customised unit, which will be less claustrophobic for the patient with built-in sealing windows with membranes for cables and wires for medical equipments. It will have clear patient access for critical patients on a ventilator or ECMO to make patient monitoring and treatment most accessible and comfortable for our medical team.

We are looking for the use of N 95 masks for all our patients and medical escorts in Commercial flights.

We are looking at pre-travel COVID 19 testing with two negative reports within seven days of patient transport given the false-negative tests, which is a part of the PCR RT testing process.

This is especially important for Commercial flight patient flying, which puts the medical escort/s and other passengers at risk.

We also respect our Medical escorts' opinions who would want to travel on Business class with and without patients to be less exposed to the general passengers in an airline flight.

We will have periodic COVID 19 testing of all our medical personnel and office staff and have a vetted list of ground ambulance providers who take similar precautions.
The standard for molecular diagnostics has been and remains qPCR. Most of the tests being done every day, all around the world are RT-qPCR, and those are excellent. They tend to work very well, are very sensitive, but they require sophisticated instrumentation.

The SARS-CoV-2 Rapid Colorimetric LAMP Assay Kit utilises Loop-Mediated Isothermal Amplification (LAMP) to detect SARS-CoV-2 nucleic acid is a promising and faster way to process the sample for COVID.

It is a 30-minute isothermal protocol with no sophisticated lab equipment required.

Colorimetric and visual detection – ease of use and simple-to-read results make it an ideal way of testing our patient before every transfer once it finds success in the commercial market.

There should be a home testing kit that could detect this virus, and actions can be faster and more effective in the future.

It is a challenging situation as we move forward!

Last but not least, if you could live anywhere in the world, on land or sea, where would it be? ##

(Sachin) First of all, I love living in Pittsburgh; due to its low cost of living, lower crime rate, cultural opportunities, outdoor activities, and low risk of natural disasters. I am close to nature. It is safe and enjoyable.

(Nitin) I spend my time in Mumbai, India, which is home but love spending time between Singapore, Manila, and Dubai.

I have been staying in the Family home; Mumbai has its pros and cons. 

Mumbai and Manila are very similar with its traffic and pollution, but both are excellent hubs for doing business. 

The Philippines has one of the best beaches in the world and would be an excellent place to retire.

Singapore is safe and secure; everything works like clockwork; the unpredictability of Mumbai and Manila makes it a more spicy place.

Dubai is neat and clean, and many opportunities for professionals and entrepreneurs like me.