When the EURAMI Board last met in person for the bi-annual Board Meeting at the ITIC Americas in Costa Rica in March 2020, the Covid pandemic was already dominating conversations – however, no one could have expected what impact it would have on the world, the aero-medical industry, and accreditation companies such as EURAMI.

Just a few days later, as the EURAMI Board and participants from ITIC Americas returned to their home countries, things changed rapidly around the globe. EURAMI conducted its last on-site audit in Colombia at the end of March, and had to suspend all on-site audit activity until September 2020 due to the imposed lockdown, travel, and safety restrictions. With aeromedical providers facing a challenge like none ever seen, it became clear that EURAMI had to rethink its approach to accreditation and to develop alternatives to assure the continuation of its auditing.

While daily business operations remained unaffected by imposed restrictions, in line with the remote working culture of the EURAMI Office and Board, it became obvious that EURAMI had to enable similar adaptation by members and to create a new way of auditing.

Enhancements for members introduced

The first enhancement that EURAMI introduced was the EURAMI Forum, which is a members-only communication platform that allows providers to share, discuss and comment on topics pertaining to the aeromedical industry. EURAMI also quickly established a partnership with CAPSCA – the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation – which gave EURAMI members access to the latest updates from renowned organizations such as the WHO, ICAO, IATA and other global stakeholders directly. These updates were shared on the EURAMI Forum, where members could review the latest briefings on entry restrictions, permissions, health safeguards and global impact reports. The EURAMI Forum was welcomed by the membership and was the first step in EURAMI’s innovation quest as a response to the Covid-19 pandemic.

Virtual audits

The biggest challenge that all accreditation companies are facing in a pandemic is the restriction of travel and the health and safety concerns for dedicated volunteers, which made it impossible for EURAMI auditors to travel on-site to providers. As it became clear the pandemic crisis would be a prolonged event, the Board agreed they could not put off the growing number of re-accreditations indefinitely. On top of this, EURAMI has seen a rapidly growing interest in programs seeking primary accreditation, resulting in a substantial waiting list for first audits. To address a potential backlog, the EURAMI leadership developed an alternative auditing method – the EURAMI Virtual Audit. EURAMI has launched a fully digitalized process that ensures staff and auditors are safe whilst preserving the integrity, detail and quality of the audit process. The accreditation steps are thus divided into three phases – application, preparation, and the audit itself. Each step of this process has been digitalized through a dedicated online auditing procedure, which is accessed through the EURAMI Forum interface. This way, EURAMI will ensure that no external parties have access to the files and that the process is fully compliant with data regulation laws.

EURAMI supports the procedure with the necessary external tools, such as document management and secure storage, as well as video conferencing to ensure that all relevant data can be easily reviewed and that face-to-face meetings with key staff during the audit are possible. No individual patient or identifying information will be exchanged or stored. In the final step, all processes – application, preparation, and virtual audit – are interfaced to achieve a seamless audit. Whilst being a high-quality alternative to on-site audits, the EURAMI Board has decided that the Virtual Audit is only applicable for re-accreditations, and cannot be used for primary accreditation, where an on-site audit and personal inspection of the program is required. All applications for the EURAMI Virtual Audit are reviewed and approved by the Board. 

Conserve costs, maintain quality

This rapid adaptation impelled by the Covid crisis has resulted in two unexpected benefits. It will conserve travel-related costs for providers during an economically stressful period. It also, by design, entails far better audit preparation by providers – giving auditors more time to review materials in advance of the audit, and to identify gaps ahead of time. This will shorten the turnaround and remediation time of the audit process, and allow auditors to use their time to focus on aspects that require real-time observations. While EURAMI’s groundbreaking Virtual Audit will not permanently replace on-site visits, the re-vamping will clearly enhance the quality and efficiency of the accreditation process. The first Virtual Audits are set to take place in the next few weeks.

Staff safety

EURAMI’s initiative to expand its corps of qualified auditors will be a critical factor in completing audits during the pandemic. The Board made a conscious decision to prepare auditors with wider geographical distribution. As we now have auditors on almost all continents, EURAMI can perform on-site audits where local and regional travel is permitted, while taking all precautions to apply safety and health measures and minimize exposure of volunteers. Social distancing, masks and strict hygiene protocols will be enforced, along with Covid testing where required. Such on-site audits are only conducted if the auditor is in the same country or authorized travel corridor as the auditee, and safe transportation can be arranged. This strategic positioning of new auditors has enabled EURAMI to perform re-accreditation in Germany, as well as primary accreditation in France, despite international travel restrictions.

Another positive ‘challenge’ EURAMI has faced is the increased number of applications that we have received in the last two years. We thus have a growing waiting list of providers waiting to start the process for their desired accreditation. Whilst this is a great sign that EURAMI accreditation is gaining widespread respect and recognition, the pandemic makes it difficult to maintain the pace of audits for qualified providers. Notwithstanding this challenge, the EURAMI Board unanimously decided that primary accreditation must be done in person to ensure that every aspect of the program is examined in detail for the first time. Although the situation changes daily, EURAMI expects on-site primary accreditation to be continued in 2021 and we look forward to recognizing those new providers who demonstrate their commitment to safety and quality in aeromedical services.

Data gathering invaluable

EURAMI is privileged to have a richly diverse and supportive membership that includes the utmost experts in their field. One thing that became clear in the first months of the pandemic was the dearth of data available on safety and number of transports of Covid-19 patients. EURAMI has thus created membership surveys that are obtaining such data anonymously. The first survey was done in August, and had a good response rate from the membership. Questions included topics such as change in business / missions since March 2020, total missions flown, total Covid-positive patients flown, number of patients transported in isolation units and impact on infection rate of staff after Covid missions. EURAMI is currently conducting a second round of its survey and will be publishing the article amongst the membership by the end of the year.

Webinars enhance industry cohesion

EURAMI embraces the belief that communication is key, which is why we are launching a monthly webinar series for the aeromedical community. Topics will include best practices shared among experts, medical case studies, and other aeromedical related topics. This is another step for EURAMI to promote industry advancement and encourage dialogue and collaboration.

As an advocate for the global aeromedical community, EURAMI was invited to speak at the CAPSCA Annual Meeting to represent the industry amongst peers from WHO, ICAO, IATA, as well as numerous other international associations. EURAMI President Dr Cai Glushak had the opportunity to bring aeromedical activity to the attention of global aviation authorities, and to reinforce the need to support their activities as a special critical segment of the aviation industry. The recognition as a CAPSCA partner, along with the opportunity to engage with global organizations to improve the focus on the interaction with related entities and implementation of aeromedical transport guidelines, was invaluable.

Onwards and upwards

2020 has been an unprecedented year – not only for EURAMI – but for the whole aeromedical industry and the world. Yet EURAMI continues to work on fully digitalizing its procedures and developing tools and programs to support accreditation, research, and education. When best confronted, crisis can lead to innovation and advancement. Faced with this year’s unprecedented challenges, EURAMI has taken the opportunity to re-invent itself in an innovative and state-of-the art fashion, enabling us to not only support members more efficiently but also progressing to a EURAMI 2.0, with a focus on continuing advancement.