With hospitals and healthcare providers overwhelmed by a spike in cases and international travel restrictions closing borders and airspaces, insurers and their support partners have found it increasingly difficult to deal with the crisis as it unfolds.
Their bottom lines have been hit by rising Covid-19-related claims and the general lack of travel and tourism over the last 15 months too. Add to that the financial burden for air ambulances of having to update their equipment in line with the latest national safety guidelines, such as the implementation of onboard Covid testing, isolation chambers, oxygen supplies and ventilators, and the pressure seems immense.
As a result, many providers have drastically scaled back their operations, while others have had to look elsewhere for revenue sources – focusing on private-pay clients rather than insurance payers. However, air ambulances have continued to play a pivotal role in transferring emergency cases and carrying out air evacuations in countries where local healthcare systems have buckled under the strain of Covid-19 cases and admissions.
Pivoting to meet customer needs
“During the pandemic, we have seen noticeable changes to air ambulance provider operations,” said Will McAleer, President of World Travel Protection Canada. “While some have scaled back in the face of reduced volumes, we have seen others pivot to ensure they are able to not only serve the needs of our customers, but also to ensure they protect their employees when dealing with Covid-positive patients. Many air ambulance providers have made the decision to service markets that were considered off limits at the onset of the pandemic.” As borders started to close and there was little known about how Covid was going to impact their operations, investments were made in implementing procedures for protecting their crews from contamination and outfitting their aircraft with isolation pods to facilitate the transfer of Covid-19 patients.
Encouragingly, many providers have also been using this period of inactivity to build up their capabilities for when travel fully returns, according to Anna Gladman, CEO of nib Travel: “All healthcare providers, including air ambulance companies, had to significantly modify the scale of their operations in light of the Covid-19 pandemic. While some changes have been unavoidable due to the downturn in case volumes as a result of varying international travel restrictions and border closures, our providers have used the downtime to improve their processes and structures in preparation for international travel starting again.”
For insurers and healthcare providers, an integral part of being able to deliver their service is having a back-up air ambulance operator in place in the event that their go-to isn’t available, or hasn’t got the capability to perform the task. This is particularly critical in remote regions where choice is often limited, for example in mountainous and high-altitude areas where specialist propeller-powered aircraft have to be used for air evacuation.
Bernadette Breton, CEO of Alliance International Medical Services, outlined the scale of the problem: “In Africa, there aren’t many options when it comes to fail-safes. It’s not like Europe where providers can just piggy-back off each other, so we have to really think outside of the box for an answer.”
One such solution is using air ambulance brokers, who have a comprehensive understanding of the network of air ambulance partners within their specific region. Another option is to pool resources together and collaborate with other providers operating in those areas.
It’s also crucial to draw up a detailed contingency plan, including everything from different evacuation locations to transportation modes and flight routes. Adopting such a flexible approach is paramount as countries introduce new lockdowns and change their travel lists on a continual basis.
“You always have to have a plan B to Z,” said Robin Ingle, CEO of Ingle International. “If you have got ill people stuck on a high mountain that is inaccessible to only the most specialist rescuer with the right equipment and means to reach them, then get them in your network right away.”
The power of accreditation in selecting a quality provider
Industry bodies such as accreditation providers play a vital role in supplying insurers and assistance companies with a list of alternative air medical operators that operate to a similar – high – standard of care and safety. But in some cases, such as in extreme geographical areas, insurers and assistance companies will have to engage an unaccredited provider, in which case they need to closely assess their documentation and seek legal guidance to ensure they provide the required level of service.
“Accreditation services are certainly important to us, and we do look for providers that have accreditation,” said James Page, Chief Administration Officer and Head of Assistance and Claims at AIG Travel. “We have internal standards that we rigorously check with each air ambulance provider, but if they have certification, particularly with a well-regarded accreditation provider, [this] allows us to fast-track our review process, because we know they’re holding to the appropriate standards, and we know what those standards are.”
Companies need to regularly review their connections and decide which ones are the right ones for them
In these kinds of situations, insurers and assistance companies tend to leverage their industry networks. Regardless of whether they stick with their preferred provider or go outside of that, firms have to do their due diligence to make sure the unknown air ambulance operators are fit for purpose.
“Companies need to regularly review their connections and decide which ones are the right ones for them,” said Ingle. “What might have been a good partnership in the 1980s or 1990s may not be now because the provider’s aircraft is outdated, for example.”
Despite the restrictions of Covid, air medical evacuations remained essential in providing much-needed medical treatment for VIPs and other significant groups throughout the pandemic. That meant that air ambulance services had to make themselves readily available to assistance companies for such events, often operating within extremely short timeframes.
“Even when there was high demand in medical evacuations during the peak of Covid-19, air ambulance providers adapted quickly to help the high volumes of travellers return home safely,” said Gladman. “This included providing recommendations for alternative providers, as well as the most up-to-date Covid-19 travel information such as restrictions on air ambulance crew entering another country with a traveller.”
Delays and closed borders impact air ambulance operations
The biggest challenges in terms of access for air evacuations and repatriations have undoubtedly been because of reduced staffing and hours among governments, embassies, consulates and civil aviation authorities, resulting in delays issuing the necessary travel permits, and arranging entry and exit requirements. Added to that, many countries haven’t allowed sick or infected patients in, or given access to those already within their healthcare system, because they have shut down.
“We were not faced with the challenges of availability this past year as much as we were by restrictions imposed by various countries we were seeking to travel to or operate in,” said Page. “Not only did we have to consider if we could physically land in a certain country, we also had to know if the aircraft had the right equipment, if the crew could do onboard testing, and if they could essentially transport a Covid patient in a bubble, so that the staff wouldn’t be at risk of infection.
“If the government of a country was not allowing flights to land, or allowing patients to be moved, then that was that and we had to make other plans, but we didn’t have any trouble finding a provider that could get a flight in the air for us.”
Our approach is to ensure our network remains broad enough to meet the needs of increased volumes, knowing that travel patterns may remain impaired given the disparity of vaccination roll-out programmes
However, as restrictions are lifted in certain parts of the world, vaccination programmes are rolled out to the majority of the population and international travel starts to pick up again, assistance companies are preparing their air ambulance partners for a busy period. To this end, many have been checking to make sure that they have the right resources in place to respond accordingly.
“The return to travel will evolve, and risks of contracting Covid-19 will continue,” said Fabia Eberwein, Operations Manager of World Travel Protection Canada. “Our approach is to ensure our network remains broad enough to meet the needs of increased volumes, knowing that travel patterns may remain impaired given the disparity of vaccination roll-out programmes.” And as governments react to changing infection rates in different countries, agility is key: “Some destinations may remain closed, with others opening up, and as those travel patterns emerge, so too will the footprint of our global providers,” pointed out Eberwein. “Close contact with providers will be important to make sure the air ambulance industry continues to deliver for customers in their time of need.”
The travel insurance and assistance provider industry and its air ambulance affiliates have, like many others, clearly gone through an extremely turbulent time over the last 15 months. Yet, as the world starts to recover from the pandemic, there is now a glimmer of light at the end of the tunnel to indicate that operations are, albeit slowly, returning to some kind of normality.