Interview: David Fox, Fox Flight
ITIJ spoke to David Fox, founder and President of air ambulance Fox Flight, about how the business has developed over the past 25 years, and what its plans are as the company moves forward
You have been in your current role for 25 years now. How has it changed since you started?
Of course, my role has changed as the company has grown, from a nurse escort service in the beginning to an international air ambulance provider today. The biggest change has been going from just myself and four nurses in the first year, to now almost 60 staff members, including nurses, physicians, respiratory therapists, pilots, maintenance staff and office staff. And we own four aircraft now, which is something I never dreamed I would do as a nurse, so there is the whole finance aspect of the business that I oversee as well. So, I started out in the business as a nurse looking after patients and now I’m an administrator involved in every aspect of the business – although I still play a part in looking after patients occasionally.
I can imagine your role can be quite rewarding sometimes. What do you love most about your job?
I love the fact that it changes every day. No two flights are exactly the same – the patients are different, the destinations are different, the circumstances are different, the medical and logistical challenges are different. If you’re a person who thrives on coming into work and being presented with a new challenge every day - and most people with medical backgrounds are that way or they wouldn’t do it - then it makes for an interesting and enjoyable career.
It’s never dull, that’s for sure, and you get to interact with a lot of different people. It’s also really rewarding to help people get home quickly and safely when they find themselves in a bad situation abroad. Getting sick or injured far from home can be a really stressful experience: the healthcare in some foreign countries sometimes is not the best, there might be a language barrier, and that just adds to the stress of being sick or injured. It’s rewarding to be able to step in and remove a patient from a bad situation and get them to a better one. You can see how much it means to the patient and the family on their faces.
Did the pandemic change how you view your role?
The pandemic presented our company with the biggest challenge we’ve ever had in our 25 years in business. The Delta wave in Canada put enormous stress on the healthcare system and the intensive care units (ICUs) were at the breaking point in several provinces. The government asked us to come in on an emergency basis - first in Ontario, then in Manitoba, and finally in Saskatchewan - and move fully vented, Covid-positive ICU patients out of province to help alleviate the pressure on the hospitals. We only had about 48 hours to put new Covid transport protocols in place and get all the stuff we needed - full-body PPE, breathing apparatus, et cetera – to jump in and start moving patients.
In the case of Manitoba and Saskatchewan, we actually had to set up remote bases in those provinces to co-ordinate flights and supply our crews, who had to remain on site for several weeks at a time working 15-hour days. There are not many companies in Canada, or in the world, that have the personnel, equipment and experience required to carry out a mission like that. We ended up moving about 160 ICU patients over the course of about 16 months. There is no question that if we were not there to step in and help, the ICU crisis in Canada would have been even worse and more lives would have been lost to Covid and other illnesses.
As a family-run business, what sets your company apart from others?
We started out as a small, family-run business and we function pretty much the same 25 years on, although we are slightly larger today. Being relatively small gives us the flexibility to adapt and adjust to changes and shocks in the market faster and more easily than larger organizations with more planes, bigger staffs and more complex ownership and management structures.
Unlike a lot of companies, we control every aspect of our business - we own our own planes, the medical staff is ours, the maintenance staff is ours. This allows us to maintain a certain standard of care and service on every mission from start to finish. Plus, being a smaller provider allows us to tailor our services for each individual client, because each client has different needs and preferences, and bring a more personal feel to the care we provide for our patients. And from the feedback we get from our clients, which are some of the biggest travel health insurance providers in the world, we know that our approach works for the patients and their families.
How has the pandemic influenced the way you work?
Well, it has certainly been different. It has changed things from an operational perspective, where it takes longer to set up trips. We have to spend a lot more time managing the logistics of each mission now, because of Covid travel restrictions and testing requirements. But the actual processes that are involved with moving patients are the same; we haven’t had to change much in terms of medical, aviation and maintenance procedures, at least for non-Covid patients.
As for Covid-positive patients, of course, the protocols are much more involved. But we already had an infection-control screening tool in place that we use for every patient, and we have had strict infection-control protocols since the SARS epidemic, which hit Toronto quite hard. So, when the Covid pandemic began, we had a pretty good idea of what to expect. Plus, we are very fortunate to have our medical director, Dr Raymond Kao, who worked in Toronto during SARS and worked in West Africa during the Ebola epidemic with the Canadian military. He has a really good infectious disease background and understands the epidemiology, so that put us in a better position to deal with it.
How has air medical transport as a whole changed since the pandemic?
Obviously, there are a lot more rules and regulations surrounding where you can go and can’t go, what the requirements are to travel to certain places, whether or not the crews can overnight in a particular country or even leave the airport in some cases. And those rules and regulations are changing all the time. That has made planning and executing missions far more challenging and put more stress on everyone involved – aircrew, medical crew, operations, even patients and their companions.
We found during the pandemic that people all over the world are just more stressed, and when people are stressed they tend to put up barriers. Trips just take a bit longer now because there are more hoops to jump through, but it’s something we all have to deal with. I don’t know if things will ever get fully back to the way they were before the pandemic, but I hope so.
What has your company planned for the future? How are you adapting to this new world?
If we’ve learned anything from the pandemic, it should be that you never know what’s coming around the corner. In the first quarter of 2020, we were on track for the best year in our company’s history, then the global travel industry basically ground to a halt. Luckily, as a relatively small operation, we were able to respond quickly and adapt to the sudden change in the market. Companies that couldn’t do that didn’t survive the pandemic.
Now, as the global travel industry gradually comes back, we can expand our operation to respond to the growing demand from our core travel insurance clients as their business comes back. Plus, through our work for the provincial governments in Canada during the ICU crisis, we were able to demonstrate our capabilities and establish new relationships that should lead to more government-focused work in the future. That diversifies our client base and that’s a good thing. So how are we adapting to this new world? By diversifying and staying flexible. If we do that, we’ll be well positioned for whatever comes along.