The Air Alliance Group was founded in 1993 in Germany by Wolfgang Krombach, a pilot, technician and skydiver, who was passionate about all things aviation. The company started as an aircraft maintenance organization, but quickly expanded its strategic business units to include aircraft sales, a flight school and charter flights.

In 2001, the first air ambulance flights were introduced. Since then, the company has grown from being a small hangar operation to a general and business aviation service provider. It is an authorized dealer for Pilatus and Gulfstream aircraft, and an approved organization for maintenance and for aircraft design and modification. Since 2017, Air Alliance has also run its own government-approved aeromedical training academy.

Keeping the customer at the heart of the operation

Eva Kluge, Chief Commercial Officer at Air Alliance, explained to AirMed&Rescue that customer centricity is the key to all the company’s activities, and the basis of its development. She added: “Our wide range of business units makes us a ‘one-stop-shop’ for all needs around aviation and aeromedical matters. Due to our longstanding experience in aviation, we are very flexible in adjusting and expanding our fleet – at present we have 12 aircraft.

“As an air ambulance company, we are quite unique by having a setup with regional hubs in Germany, Austria and the UK. This helps, on the one hand, to shorten flight routings and to be competitive in core markets, but, on the other hand, is also is a great way to blend different cultures.”

The ability to draw upon multi-national expertise in aeromedical repatriation and evacuation was born out of an initiative launched in 2017 – ‘Medicine without Borders’. Led by Group Medical Director Dr Gert Muurling, the core aims were to increase the pool of Air Alliance medics across Europe and integrate differing skills into a collective group standard. This allows a flexible fleet of dedicated air ambulance teams to deploy quickly from bases in Germany and the UK. Air Alliance has three medical directors in the different hubs, all affiliated with university hospitals.

Air Alliance transports patients of all ages (including neonates and children) at all levels of care, starting from a relatively ‘simple’ femoral neck fracture, to ICU patients on ventilation. The company operates in critical and remote areas worldwide.

The ability to draw upon multi-national expertise in aeromedical repatriation and evacuation was born out of an initiative launched in 2017

Kluge shared a recent case about an obese, hypertensive, diabetic patient in severe hypoxemic respiratory failure with Covid-19 pneumonitis. He was hospitalized in Bamako, Mali. His employer agreed on a transfer to an ICU in Paris for a higher level of medical treatment. Air Alliance rapidly assembled an international medical team consisting of UK Medical Director Dr Neil Crooks, and two experienced ICU nurses from Germany and the Netherlands.

“As the patient was already receiving 15 liters per minute of oxygen, a request was made to the treating hospital for the patient to be intubated and ventilated in preparation for transfer,” said Kluge. “Unfortunately, he was transferred to the airport on more than 15 liters per minute of oxygen. Furthermore, the ground ambulance did not have a sufficient oxygen supply and we had to provide oxygen from our aircraft.

“Our medical team intubated the patient in the ground ambulance, before carefully moving him to the safety of the portable medical isolation unit (PMIU). Gusting winds, sandstorms and looming thunder increased the challenge and sense of urgency. Before initiating the aircraft’s departure, the pilot carefully plotted a course to avoid entering into the teeth of the storm, zig-zagging to reach more stable weather conditions for the safety of both crew and patient.”

Covid-19 solutions

For Covid-19 patients with mild or unclear symptoms and on shorter distances, Air Alliance sought out other solutions. In collaboration with a university hospital in Austria, the company is working on a mobile PCR test (amplification of DNA) for aeromedical transportation. The goal is to have reliable and fast Covid-19 testing en route if this is not available at the patient’s location. It is also looking into PMIU solutions for smaller aircraft to meet market demands.

At present, about 15 to 20 per cent of all patients are infected with Covid-19. To meet the new demand for isolated patient transports, the company invested in an EpiShuttle for Covid-19 patients, which requires intensive training for the aeromedical crewmembers, and is perfectly suited for longer trips. All EpiShuttle flights are done on the company’s Challenger aircraft.

Kluge added: “On top of our existing strict infection protocol, we have taken serious measures to protect our crews and our staff. For example, we do Covid-19 tests in our office and obtain the lab results within a few hours. Our crews have to measure their temperature regularly and to report any flu-like symptoms immediately.

As an air ambulance company, we are relatively lucky as medevacs are considered humanitarian and we still can land on most airports. However, flight and logistical planning have become a big challenge and are often very time-consuming.”

Looking ahead

With digitization as a core driver of all economic developments, Air Alliance introduced a new case management and ticketing system in May 2020, and is analyzing its processes with regards to the entire value chain. Advantages of integrated digital processes are faster response times, as well as streamlined and more individual communication with clients. The company also started to digitize medical documentation and its medical inventory management system. A new comprehensive data center will be launched later this year.

And is there hope for the future? Of course, because as long as there are challenges, the air medical community will work to overcome them and find new ways of working that allows patients to access the treatment they need. Kluge commented: “We expect to explore new markets in terms of clients and geographies. Last but not least, digital transformation will be an important aspect to remain innovative and competitive.”