ITIC Global: Air Ambulance Educational Forum
Panelists discuss lessons learned from the Covid-19 pandemic, and future challenges for Air Ambulance crews
Dr Terry Martin, Phoenix Aviation Ltd
Learning lessons from Covid-19
Dr Terry Martin opened the afternoon session pondering what we have learned from the transportation of Covid-19 patients. After covering the history of the outbreak, Martin then turned his attention to the issues this presented for the medevac world.
It was certainly a time where leadership was needed, but proved to be tricky, with it coming from accreditation bodies such as CAMTS and EURAMI.
Martin moved on to cabin configuration and the effect when dealing with a highly contagious disease, and the knowledge that transporting Ebola patients had equipped them with in the early days of the pandemic. “Given that Covid-19 was spreading so rapidly, we had to make the assumption that everyone was a carrier,” he confirmed. “There was a lot of self-doubt, but that led to early lessons.” This paved the way for considerations and what-ifs to be addressed by both the medical and aviation communities, not only surrounding the virus, but also crew safety, workload and the use of Personal Protection Equipment (PPE).
Evolution of policy development, procedures and protocol elaboration have been all about the data and having a logical approach. “We challenge the traditional, work on the innovative and the novel. We relate current methods to outcomes, audit it, test it, change it if it doesn’t work,” concluded Martin.
Surrounding the question of PPE, Terry invited Sean Bryan from Reva to comment as to how this affects the management of patients onboard aircraft? “Masks work,” was the clear response.
We challenge the traditional, work on the innovative and the novel. We relate current methods to outcomes, audit it, test it, change it if it doesn’t work
Bryan continued: “My biggest takeaway is that PPE did indeed work, but for some reason we just doubted it. Moving forward, Covid-19 patients are not the only infectious patients that we transport, but we have learned a lot in the sense we are more methodical in the way we prepare for a flight and mitigate risks…so, policies, procedures, sharing data - we are all in this together.”
Cai Glushak MD FACEP
Long range jets – assistance and medical transportation
Glushak’s presentation worked on the premise that ‘this is not simply about pandemics, but also how war is changing our industry as we speak’.
We have entered an era of rapid adaptation, not only logistically for our clients, but also how we drive services
“Our industry … we’ve learned to see a lot of red flags,” he began, underlining that data collection and analysis takes time. He pointed out that the air medical transport sector doesn’t always have the luxury to wait for the CDC, government agencies or the WHO to create rules, as bureaucracy and medicine move at very different speeds. They key is apparently to ‘look for the early warning signs’.
Medical assistance provision was severely impacted by the drastic drop in travel that resulted from the Covid-19 shutdown. A shift of activity was seen, with assistance cancellation, rebooking and quarantine costs to also be factored in. “We saw a reduction in, and redeployment of, aircraft availability and the same with air ambulance too to an extent.” Coupled with a turnover in personnel, this led to a change in the level of expertise available to assistance companies and air medical providers.
Is the customer always right?
In the midst of talk surrounding logistics and practicalities, Glushak addressed client industry demands, some of which are not realistic. The ‘I have enough coverage, why can’t you do it?’ mentality is one that created a teaching opportunity in order to reset the expectations of clients, as Glushak confirmed: “We have entered an era of rapid adaptation; not only logistically for our clients, but also how we drive services.”
Air ambulances were relied on as the only way to bring patients home during the pandemic, who would normally have been repatriated via commercial flight, solely as a ‘cost-saving measure’ – it was more cost-effective to evacuate, than treat them in situ, especially from certain locations where healthcare was either not available or not of sufficient quality.
With fewer aircraft and crews, the increased cost of fuel, inflation and restriction of flight zones all posing challenges for the industry, this has further emphasised the move by the air ambulance industry to invest in long-range aircraft. Equipment requirements, limited chances to refuel and restrictions that carrying Covid-19 patients presented has no doubt accelerated this, concluded Glushak.
Sean Bryan, Director of Medical Operations REVA
Staffing challenges in the air medical industry
Bryan boldly addressed delegates by stating: “Staffing challenges is probably the most important topic in our industry right now.” Going through the already long list of pre-pandemic staffing concerns ranging from exhaustion, PTSD and depression, Bryan wanted there to be an that medical staff were already under pressure before Covid hit.
In the air medical sector, add this a lack of regulation for medical crew duty times and there is little to no protection for medical staff. This is in stark contrast strict duty times for pilots, begging the question: is this safe?
During the pandemic, the stakes were undoubtably raised, with 66 per cent of nurses considering leaving the profession altogether. “Post pandemic, we have an issue with PTSD, we have an issue with burnout, we have and issue with exhaustion, lack of protection, the hospital systems are inundated, and the next problem is coming.”
What Bryan is alluding to is money. With lucrative private nursing contracts leaving both hospitals and the air medevac industry short staffed, it doesn’t seem to be a problem disappearing anytime soon. “The travel industry is coming back, and I can’t guarantee that I can meet the daily volumes … I simply do not have the staff available,” he warned the assistance companies and insurers in the audience.
This decreased crew availability in medical personnel and pilots has the potential to present a post pandemic perfect storm that we simply were not anticipating.