Patient first. Always

Some missions test equipment. Some test protocols. This one tested everything – and proved, once again, why the aeromedical industry’s fiercest competitors are, when it matters most, allies.

The patient

A 78-year-old British national, several months into a long-awaited, postretirement journey around the world, fell critically ill while staying in Busan, South Korea. Admission to a local hospital and coronary angiography revealed severe, three-vessel coronary artery disease. While still in the catheter suite, the patient’s heart gave out – cardiopulmonary resuscitation was required, and the patient was placed on veno-arterial extracorporeal life support (VA-ECMO), the most advanced form of life support available.

Over the following weeks, repeated attempts to wean the patient off VA-ECMO failed. One trial period without support triggered dangerous cardiac arrhythmias and a precariously low cardiac output, forcing the team to re-establish VA-ECMO. A switch to a mechanical cardiac assist device was considered but ultimately ruled out given the patient’s advanced age. After careful deliberation, the insurer and the patient’s family reached a decision: the patient’s best chance lay in repatriation to the UK, to Leicester, for definitive management – a transport that would need to be completed while sustaining life support across 10 time zones.

A mission only two teams could deliver

Unicair was contracted to move the patient – still on VA-ECMO – from Busan to Leicester. This was never going to be a routine flight. As per Unicair’s standard protocol for missions of this complexity, a full clinical case conference was convened: the ECMO specialist team led by Prof. Onnen Moerer of University Hospital Göttingen, Germany; the admitting team in Leicester; the assistance company; Unicair Operations; and the treating physicians in Busan.

Although the Korean team was unable to join the call, the conference gave every other stakeholder a shared, unified understanding of the risks and the plan – the foundation every highacuity ECMO transport is built on.

Unicair turned to FAI – and FAI didn’t hesitate

Then came the first real obstacle: both of Unicair’s long-range CL604 aircraft were grounded for maintenance, exactly when a mission of this magnitude demanded one. Unicair turned to FAI – and FAI didn’t hesitate. An aircraft was made available immediately, transforming a potential mission-stopping setback into a seamless handover between two organisations that, in this moment, operated as one.

The crew that assembled around this patient reflected that same spirit of shared expertise: two ECMO physicians, a Unicair critical care ECMO nurse, and an FAI paramedic – a multinational, multi-company team united by a single objective.

Flight planning presented its own layer of complexity. Gimhae International

Airport in Busan does not permit overnight aircraft stays and restricts ground time to a strict three-hour window. But the patient required recannulation onto the transport team’s Cardiohelp device before departure – a procedure that simply could not be rushed into a three-hour turnaround. The solution was a masterclass in logistics. The final routing sent the aircraft from Nuremberg, Germany to Almaty, Kazakhstan on day one for an overnight stay, then on to Busan on day two, where the medical team and equipment disembarked while the aircraft repositioned to Seoul.

The crew, after well-earned rest in the UK, returned the aircraft to base in Nuremberg on day five

On the ground in Busan, the medical crew joined the local hospital team to carefully cannulate the patient onto the Cardiohelp device – a critical, hands-on collaboration between visiting and local clinicians. The next morning, day three, brought another challenge: the patient was found to be hypokalaemic and anaemic, requiring a red blood cell transfusion. Once packed red cell concentrates were sourced from the regional blood bank, the aircraft was called back from Seoul to Busan, and the patient was transferred by ground ambulance to meet it.

Twenty hours, one patient, zero room for error

With the patient loaded and secured, the crew began the long flight home – technical fuel stops in Almaty and Budapest bookending a transport that would ultimately span roughly 20 hours in the air.

Throughout, the medical team worked without pause: inflight echocardiography to track volume status and cardiac contractility, repeated blood gas analyses to monitor ECMO function and electrolyte balance, serial activated clotting time (ACT) measurements to fine-tune anticoagulation in a patient additionally complicated by heparininduced thrombocytopenia (HIT), and near-constant titration of inotropes and volume support.

Two experienced, highly motivated teams of aeromedical professionals can achieve results significantly greater than the sum of their individual expertise

In the early hours of mission day four, the aircraft touched down at East Midlands Airport. A brief, uneventful 35-minute ground transport followed, and the patient was handed over to the awaiting team in Leicester – stable and successfully connected to the UK hospital’s ECMO system. The crew, after well-earned rest in the UK, returned the aircraft to base in Nuremberg on day five, closing out a five-day mission that had spanned three continents and pushed the boundaries of what critical care transport can achieve.

Why this mission matters

Missions like this one don’t succeed because of a single aircraft, a single device, or a single team. They succeed because of the depth of clinical expertise to manage a patient on ECMO through 20 hours of flight, the depth of operational planning to route around airport restrictions and grounded aircraft, and the depth of relationships that let two companies act instantly and instinctively as partners rather than competitors. In this industry, Unicair and FAI compete – and compete fiercely. Fleet capability, response times, clinical protocols: these are the metrics companies are measured on every day, and rightly so.

Missions like this one don’t succeed because of a single aircraft, a single device, or a single team

But when a human life hangs in the balance, that competition simply disappears. What remains is a united team of professionals, driven by one shared mission and one common goal. Two experienced, highly motivated teams of aeromedical professionals can achieve results significantly greater than the sum of their individual expertise. This mission – and many others like it – is proof.

A fitting toast

The leadership teams of Unicair and FAI recently celebrated this collaboration, and others like it, over dinner in Singapore during the ITIC APAC conference. As the evening wound down, one fortune cookie on the table offered an unexpectedly perfect line: “Do not be afraid of competition.” We’re not. The combined excellence of Unicair and FAI enabled the flawless execution of one of the most complex air ambulance missions either company has undertaken – and stands as a reminder of what’s possible when two industry leaders put one thing above all else. Patient first. Always.