Could you share a little about your background and what inspired you to pursue a career in the medical aviation industry?

I was first exposed to aeromedical repatriation when I worked as a paramedic to support tuition and cost of living during my time at medical school. In fact, I flew my first mission on a Citation II Jet in 1993. Then, in 1999, I founded Medcall together with my friend and colleague Michael Diefenbach. This company evolved to become Jetcall and, since 2021, Unicair. 

I trained in paediatrics, neonatology and paediatric cardiology. Currently, I hold an Associate Professor position at Monash University in Melbourne, Australia, and I am the Medical Director of Unicair and the Department of Paediatrics at the Helios HSK Hospital in Wiesbaden, Germany. 

The drive towards quality and perfection in medicine and aviation continues to fascinate me – two areas in which the famous Apollo 13 quote “failure is not an option” become (almost) a reality.  

What do you find to be the most challenging and rewarding aspects of your role as Medical Director of Unicair?

I do believe that we are incredibly privileged to have a product that makes it so easy to rally teams behind a common goal – who wouldn’t want to be part of a team that brings people stranded in dire circumstances abroad back home to safety and comfort, and save a few lives on the way? I firmly believe that we need to communicate this unique aspect of our work throughout the organisations we work in, so that every team member – even those remote from the patient, such as aircraft mechanics and support services such as IT and HR – understand and feel that they are contributing crucial components of something great!

Who wouldn’t want to be part of a team that brings people stranded in dire circumstances abroad back home to safety and comfort, and save a few lives on the way?

At the same time, we work in challenging environments that ask a lot of each individual team member. We sometimes task our teams with long and exhausting missions, and staff in our operations centre need to triage multiple complex tasks with little to no tolerance for errors.  As leaders, we have to support our teams with suitable infrastructure, training and learning opportunities, and create a quality-focused, humble culture that encourages people to openly discuss avoidable errors, champion corrective actions, and reward and cherish innovation. 

How do you approach training medical staff to handle critical care scenarios in the unique and high-pressure environment of an aircraft?

High-fidelity simulation is an integral component of aviation training and became commonplace in medical training in the past decade. We do teach the well-established American Heart Association Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) curricula in classroom sessions and in specifically adapted courses in the aircraft itself. We also offer the quite extensive interhospital critical care transport training programme of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI).

The second important component is a strict no-blame culture that must be ingrained in each level of the organisation. At Unicair, we use an electronic risk management system that allows for named and anonymous reporting of all adverse events, serious and non-serious.

Each reported event is reviewed by the medical director and discussed at quarterly quality improvement meetings that can be attended by all medical staff. We communicate corrective action plans using an electronic document management system that provides tracking of the read/unread status of team communications and newsletters for each individual medical crewmember.

Can you tell us about the fleet at Unicair? What unique features or capabilities set it apart from others in the industry?

The backbone of Unicair’s fleet is seven Learjet 45s and three Challenger 604s. These aircraft are supplemented by two Learjet 35s. All Unicair aircraft are exclusively used for air ambulance and carry an identical set of equipment.

Unicair can capitalise on size and on its set-up as a fully integrated service provider. Since all medical teams and flight crews are employed on a fixed contract, we can minimise ferry sectors, CO2 emissions and crew duty times by not returning to home base after each flight but proceeding directly to the next mission after patient handover.

This floating base concept allows for competitive pricing without compromising on quality. Our set-up as a fully integrated service provider with a strong and patient-focused in-house medical department, its own maintenance facility and multiple other in-house support services allows us full control over every minute aspect of the final product: a safe and comfortable patient journey with a quality of care that matches or even surpasses a stationary hospital critical care unit. 

The drive towards quality and perfection in medicine and aviation continues to fascinate me

What role does systematic research play in improving patient safety, and how can industry professionals collaborate to drive meaningful advancements in this area? 

We are increasingly documenting large amounts of advanced physiologic data in aeromedical repatriations. While in the days of paper-based transport protocol, we documented spot observations biased by the filter of the team member who noted down variables such as heart rate, blood pressure and oxygen saturation every 30 minutes or so, modern electronic transport protocols capture an almost continuous data stream from our critical care monitors, ventilators and newer devices such as brain function monitors and regional tissue perfusion measurements. 

By systematically analysing such data within or across organisations, we can better understand what additional risks are incurred by the transport of critically ill or injured patients. In a second step, such information should be correlated with (ideally long-term) outcome data – at the moment we pretty much lose track of what happens to a patient after handover. 

In what ways do geopolitical tensions or evolving regulations influence your ability to operate across borders, and how do you address these challenges?

The fast-changing geopolitical environment is a challenge for the aeromedical industry as a whole – no-fly zones pop up with little to no notice periods and countries that might have been impossible to operate in just a week ago (for example Syria) might become  an option for an aeromedical operation today or tomorrow. War risk insurance quotes carry an expiration date of 24–48 hours.

This ever-changing landscape calls for highly professional operation centres that can explore every potential evacuation opportunity for a patient in need – and, at the same time, a healthy and candid provider/client relationship in which alternative routings and changing financial implications are met with trust and consideration. 

Air ambulance missions are such a complex endeavour – to get every little detail right in every single mission and repeating this 1,000 times each year is a monumental task!

How is inflation impacting the air ambulance industry, and what steps are being taken to manage rising costs while ensuring quality patient care?

The cost increase in the aviation sector, particularly in aircraft maintenance, by far exceeds the general inflation rate. Prices for Learjet parts have seen a price increase of 300% and beyond over the past five years. 

Obviously, such an increase in costs cannot be compensated in the slim margins that are realised by air ambulance companies; therefore, prices will have to go up. Strict cost control measures, particularly in the maintenance department, will become crucial for the commercial viability of an operator. In comparison to aircraft maintenance, costs for medical staff and equipment are marginal in an air ambulance operation – therefore, maintaining aviation safety is likely the most important focus in a cost-sensitive environment. 

Thankfully, the aviation industry is heavily regulated and controlled so that cost pressure should not impact the safety of aircraft operations in most developed countries. However, in times of skyrocketing maintenance costs, customers may want to be extra careful with operators of questionable origin or reputation. 

Could you share a story about a particularly challenging mission you’ve carried out recently and how your team overcame the obstacles involved?

We carry out a lot of challenging missions every day – adding up to a total of around 1,000 international patient movements per year. Some of these stay in mind for a long time – the spectacular extracorporeal membrane oxygenation (ECMO) mission, with cannulation of the patient at takeover point; the smallest preterm baby (875g) on the longest transport (from Tokyo to Helsinki); the difficult airway in a patient that had to be intubated by our team prior to a long transatlantic flight… but what is impressing me the most is the continuous and relentless pursuit of perfection that is evident in our teams in each and every mission – even the non-spectacular standard transport of an elderly lady with a broken hip back from the Canary Islands to her home in the UK. 

Air ambulance missions are such a complex endeavour – to get every little detail right in every single mission and repeating this 1,000 times each year is a monumental task! At the end of the day, our performance is not measured by a one-off spectacular stunt, even though these missions do make a great story on Instagram and LinkedIn.

Our true and reliable quality level is reflected in the consistent average performance – or even the weakest performance – over a 12-month period. While I appreciate spectacular missions like anyone, at Unicair, we prioritise maintaining high standards just as much as achieving peak performance.