LifeFlight Commercial Operations Manager Tyson Smith answered questions about costs and communication, while LifeFlight Chief Medical Officer Allan MacKillop shared his insights into the medical side of the patient transport business.
Are long-distance critical care transports more common now than they used to be?
TS: The number of long-distance critical care transports has remained steady, in the Oceanic region. Although government regulatory requirements around Covid-19 have made these types of missions more complex to plan, private repatriations for lower-acuity patients are actually becoming more common.
Why do you think this is the case?
TS: The increase in international lower acuity transfers can be put down to Covid-19 restrictions. With fewer commercial flights operating, the need to transfer patients on private repatriations has increased.
With fewer flights available, clients have further sharpened their focus on the medical needs of staff stationed in remote areas. They can no longer rely on regular commercial flights to get sick or injured people out, so there is mounting pressure on insurance companies to have alternative repatriation arrangements in place, early on. Being able to get patients home is as crucial as ever, as some hospitals in Oceanic countries aren’t as accepting of foreign patients during the pandemic.
What are the cost implications of more critical patients being flown home instead of being treated in-situ?
TS: The costs of repatriating more patients is significant for clients. We often see patients treated in intensive care units for a while, to give them a chance to stabilise, before rushing to fly them home. But the cost of being in ICU in a foreign country, medium to long term, can outweigh the cost of repatriation.
Communication with insurers and assistance companies is key to ensuring smooth repatriation flights can take place; what has been your experience of dealing with international insurers/assistance companies, and do you think there is anything the industry could do to aid in communication/understanding of the air medical business?
TS: It’s crucial that clear transport expectations are outlined from the very start of a mission. Meticulous planning is necessary to ensure both parties are fully aware of any potential complications and the timelines of each medical repatriation. This is more important than ever while navigating everchanging Covid-19 restrictions.
Most communication is managed via email, but we are advancing with the use of instant messaging platforms, which allows even faster and more reliable communications with Oceanic countries, such as those in the Asia region.
Is each medical team you decide to take onboard based solely on the type of patient and their condition? What other aspects of a transport do you take into account when deciding on the medical team?
AM: RACQ LifeFlight Rescue’s Air Ambulance jet operations are unique, in that we have our own aircraft and dedicated medical teams, ready to rapidly respond 24/7.
Our standard medical teams consist of a Critical Care Flight Nurse and a Critical Care Retrieval Doctor, who is either a senior registrar or consultant. Together, their skillset covers most adult, paediatric and obstetric patients. However, we add subspecialist medical staff for neonatal and ECMO cases. Prolonged international missions may require supplementary medical staff for fatigue management. Furthermore, the medical team will sometimes decide lower acuity jobs can be managed by the critical care flight nurse, without the doctor.
This comprehensive clinical model means we have the ability to upgrade or downsize medical crews, as and when needed.
For neonatal patients, what particular extra precautions do you take to ensure better patient outcomes?
AM: All our jets are capable of transporting neonatal cots. Our aircraft size means we have the ability to fit multiple cots, of multiple designs, with minimal configuration changes. We take subspecialist neonatal critical care medical teams, sourced from regional neonatal critical care units, supplemented by our flight nurse and occasionally our flight doctor.
Our crews accommodate an accompanying parent, whenever possible.
Are TBI transports more feasible now than they used to be? What has changed?
AM: TBI transfers are quite common, and have always been an important part of our service covering regional and remote areas of Queensland. We manage intracranial pressure monitoring, positioning, ventilation and all standard neuroprotective measures during transport. All aircraft can provide sea-level cabin pressure if indicated due to intracranial air. Our aircraft are able to transfer these patients, over long distances, without the need to stop.
When it comes to patient sedation, there is plenty of new research available on the use of drugs such as ketamine; do you think that concerns around patient sedation in-flight are in keeping with current research and results?
AM: We have used ketamine sedation protocols for many years and contributed to research in this area. It has proven to be safe and usually well tolerated. Expert pre-flight assessment of Acute Behavioral Disturbance, and a low threshold for escalation of intervention is essential in the air medical environment.