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The patient-centric approach to air medical care

What drew you to air medical specialism in the first place?

The need to fly patients in the safest way!

As an emergency doctor I flew many patients via chopper. Then through medical assistance I also transported patients via commercial flight as well as air ambulance. The ability to understand the specific environment of an aircraft is critical to secure best practices for patients’ safety. As always it is a very patient-centric approach considering my job environment and the willingness to deliver the utmost appropriate care.

How has aeromedical repatriation changed as an industry since you first got involved in it? What has been the most significant development for you in terms of the care you are able to offer onboard?

Our industry has changed in many ways: digitalization, constantly changing aviation authorities regulation, professional standardization via bodies like the Commission on Accreditation of Medical Transport Systems (CAMTS) or EURAMI, performance of medical equipment, additional medical capabilities like ultrasound, extracorporeal membrane oxygenation (ECMO) or dialysis in-flight, carbon footprint exposure, clients’ budget sensitivity, lack of medical team, lack of pilots, spare parts challenges, maintenance costs on the rise, mixed challenges between security, operations and medical, the capacity to fly contagious patients via portable medical isolation unit, etc…

The most significant step forward in my humble opinion is air ambulance ECMO capability allowing lifesaving flights, especially during Covid times, but also for critically ill patients in remote locations.

If you could choose just two pieces of medical equipment to always carry onboard air ambulance flights, what would they be?

Oxygen cylinders and medical bag – specifically, a stethoscope!

What trends are you seeing in the global medical assistance and repatriation sector? Are you transferring more complex cases now, or are more patients being treated in their temporary location and are you therefore waiting until they are more stable before performing a repatriation?

The quality of medical care has positively evolved worldwide, also because of business perspectives with significant financial profits coming from such an activity. A lot of capital cities like Nairobi, Abidjan, Kuala Lumpur, Bogota, San José, Hanoi etc, which can be considered as a ‘center of medical adequacy’, have made great progress in that field. As a result, patients have more and more the opportunity to be treated locally before flying back to their home country with less en route medical requirements.

Are you doing more commercial transfers than air ambulance transfers compared with pre-Covid? What are the primary challenges when performing a long-distance commercial transport?

Definitely yes. Commercial airline routes are now fully back to normal and our usual partner for medical flights, Air France, remains a solid asset we can rely on. Air France is always keen to provide to patients safe and reliable solutions. Let’s also keep in mind the financial challenges of repatriation where our commitment to our clients is to provide a cost-effective solution while never downgrading the medical care for patient’s best benefit.

Long-distance commercial transport challenges are multiple: flight schedule matching with receiving care constraints at final destination, availability of seats (many flights are fully booked), direct flights versus connecting flights, the drawbacks of long waiting times during transit, patients’ mobility limitations, power and oxygen onboard, portable oxygen concentrator batteries, Medical Information Form (MEDIF) approval not possible during weekends, medical team visa hurdles.

What has been the most challenging air medical mission you have been part of? Why this particular flight was troublesome, and what you did to overcome the obstacles?

My most challenging one was my first mission with a 19-year-old patient who was under ECMO. A first ECMO air ambulance flight for me as Medical Director as well as the first ECMO mission for the air ambulance company.

The quality of the medical reports required close relation with the client and attention to detail. Preparation of the mission with the air medical team required many phone calls and briefings. Communication with the client was key through many alignment calls. Communication with the treating medical team was instrumental, also requiring many alignment calls.

The air medical team was expected to focus on medical matters during the mission, so another physician was added to the mission just to deal with external contacts/relationships, allowing the medical team to focus on the patient.

Considering the huge volume of medical equipment, one extra ground ambulance was booked for each ground transfer on both ends.

Engine or technical failure had to be anticipated, so a plan B for the air ambulance route was a must-have (we had identified specific cities to divert to should anything happen during the flight) and for the medical equipment (spare).

What are your hopes and visions for the future of air medicine?

I hope that we will continue to have pilots to fly, we will continue to have medical teams to care, that a human approach and patient centricity will always drive our actions, that patient safety and aircraft security will remain paramount, and money will not be an alibi for downgrading medical care. Also, that ethics and values will remain, carbon footprints can be reduced, standardization and harmonization will prevail via CAMTS/EURAMI (and others), and competition will bring out the best and not the worst in the industry. I hope that compliance with legal standards will not be too complex a hurdle to deal with; our industry will continue to have passionate and caring people, and trust among all stakeholders will be preciously protected.

My vision is that people will continue to travel far away from their home country. Our job will remain deeply patient-centric. Carbon footprints will be more and more considered – sustainable aviation fuel (SAF) needs to be looked at quickly.

Prices will keep on being on the rise (aircraft, medical team, medical equipment, maintenance etc), clients will intensify their price sensitivity, and small air ambulance companies may struggle more and more. The quality of the service to the client and patient can still make the difference in clients’ minds. Standards and accreditation/certification are a must-have.


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