You’ve been working in the industry for more than 15 years. How has it changed in that time?
There have been many changes, some really positive. If I compare the medical equipment we used in an air ambulance jet 10 years ago with today´s standard equipment, it’s much better quality. Medical crews are more experienced in critical care and emergency medicine but, at the same time, patients flown by air ambulances today tend to be more seriously ill. This trend of needing to transfer much more complex cases has also been recognised by assistance companies, who are regularly demanding specialised ICU medical teams for the transfer of their patients. There is also gradually more recognition that, for certain missions, larger air ambulance aircraft are needed.
What are you doing to keep your flight and medical crews safe?
I am certified in tropical disease management and did additional training in hygiene before the pandemic. Our cleaning and disinfection procedures haven’t changed a lot – the thorough disinfection of the cabin after each transfer has stayed the same. But while we used to fog the aircraft once per week, or after having flown a patient with a multi-drug resistant germ, we now use the H2O2-nebuliser after every flight.
Do you have isolation units to carry Covid-19 patients?
Yes, we purchased our first patient isolation unit (PIU) in May 2020 and added a second one in early 2021. We use the Epishuttle from Epiguard as it’s perfect for a larger aircraft with a three-crew medical team. Additionally, many countries did not give landing permissions for fuel stops when having a Covid-19 patient aboard, even when using a PIU, which is an additional reason to use a larger aircraft with longer range. We also have a smaller PIU (Isovac Capsuls) for patients with milder symptoms, which we use for shorter flights.
Can you tell me about a recent mission that was particularly complex?
We have never had as many complex cases as in 2020. My most complex flight was when we carried a Covid-19 patient in Kabul, Afghanistan, who was on seven litres of oxygen per minute according to the medical report, with oxygen saturation of around 90 per cent. Our conclusion was that the patient would need intubation and mechanical ventilation, but when we landed in Kabul we had to wait for the ambulance because it ran out of oxygen. Having done pre-hospital emergency medical treatment since 1990, I know most ground ambulances carry one 10 litre bottle, meaning 2,000 litres of oxygen when full. With seven litres per minute, the bottle would have lasted for more than four and a half hours. It meant that the bottle was not full when departing hospital, or the patient was on more than seven litres per minute, or both. I guessed the last option was probably the most realistic.
What happened next?
When the ambulance arrived two hours later, we checked the IV access and the oxygen flow – it was 15 litres per minute! We started rapid sequence induction and our medical pilot handed the hose inside and started the ventilator. Minutes after the ground ambulance arrived, the patient was inside the Learjet with stable vital signs. They remained stable throughout the flight to Europe.
Are you starting to see business pick up again from your insurance clients?
Luckily, things are beginning to normalise again slowly. After about 120 Covid-19 flights, it is a pleasure taking care of other illnesses and trauma. We expect things to develop in a ‘hybrid’ way: while tourism will gradually pick up again, we believe there will be a continued need to transport Covid-19 patients in the wake of local outbreaks.
Have you invested in larger planes so that you don’t need to stop as much to refuel?
We already owned two dedicated Challenger 604 aircraft, and these two airplanes have been flying more than ever during the pandemic. The Learjet 35 fleet will be gradually exchanged for other aircraft within the next couple of years. It is still a real reliable ‘work horse’ with a very good range. I have been flying the Learjet 35 as a flight physician for the last 21 years and I still like it! Some patients also have advantages of the 30- to 45-minute fuel stops inbetween the lower cabin pressure periods during flight. But fewer stops means less chance of any technical issue with the aircraft.
Has Covid-19 changed the expat market for good?
I don’t think so. Where oil, gas and minerals are found, there will be always be international companies onsite with employees. Bear in mind that many of these locations have few treatment options, so we expect the number of expatriates to be unchanged. The same is true for retired people whose pension may have a much better buying capacity in other countries. The only group that will travel less, in my opinion, are business travellers, because although face-to-face meetings stopped, contracts were still signed. However, this makes up a very small minority of our clientele.