In March 2020, as the world came to terms with the fact that coronavirus was going to impact everyone’s lives, and borders started to close, aircraft operators were incredibly busy. Travellers scrambling to reach their home nation before flights stopped meant that fixed-wing air medical providers were kept very busy trying to repatriate all the patients that had been on holiday and had fallen ill. While normally, they might have been able to stay in their host nation and recuperate, now the pressure was on to get patients into their own healthcare system.

Staff levels had to change

“It came in waves,” explained Patrick Schomaker, Sales and Marketing Director of European Air Ambulance. “People needed to get home at first, but then demand for all kinds of travel dropped significantly.” So, how does a company that relies on international travel deal with a sudden drop in demand? Thankfully, EAA is based in Luxembourg, where the government has played a significant role in helping companies adapt. Schomaker told AirMed&Rescue that the firm has been able to stay flexible and respond to changes in demand as a result of a scheme that allows companies to give their employees part-time leave, and bring them back into work at short notice. For flight crews that may not have a flight for a week, but then be called on an air ambulance mission in less than a day, this is ideal. “The help from the state enables us to be incredibly flexible,” said Schomaker. “All the aircraft are maintained and ready to go at a moment’s notice, and the crews can be called on to activate and perform a mission when needed.”

Investment opportunity for training and fleet

An unexpected benefit of the global lockdown was that everybody at EAA had more time, and this meant that items like training, which can be difficult to fit in around a tight air ambulance missions schedule, could be brought to the forefront. “It was a good time to invest in staff training,” Schomaker pointed out. “This is not something that we would ever stop doing, but it was more difficult to manage when we were doing many more flights.”

with no stopovers, and more space for the medical team to work in, we can enhance the patient experience and ensure safe and efficient transports over longer distances

Even before Covid hit, EAA was evaluating client and patient demands, and looking at whether or not its fleet of six Learjet 45XRs could be adapted or enhanced to better meet the needs of its customer base. The sudden drop in demand, though, hastened the decision to sell off two of the Learjets, and the company is considering how best to adapt its fleet to the current situation.

“The medical aspect of any flight is always our main focus, and every so often, the limits imposed on us by the Learjet 45XRs would mean that we couldn’t do a transport in the most efficient way. For instance, we might have to make a fuel stop where a longer-range aircraft wouldn’t, which would increase the length of the flight for the patient. With no stopovers, and more space for the medical team to work in, we can enhance the patient experience and ensure safe and efficient transports over longer distances.”

Space is a critical issue. Coronavirus may eventually disappear, said Schomaker, but the next infectious disease will hit, and when that happens, air medical providers need to be prepared to transport potentially infectious patients, and this means patient isolation units – which take up a lot of room on an aircraft.

While for international fixed-wing air medical providers which rely on insurance and private pay patients to fund their activities, this year has been tough, for the charitable sector, it has been much worse. In the UK, HEMS are run by charities, not the government, and the economic cliff off which the UK has fallen has resulted in job losses, meaning a significant drop in funding.

Emma Gray, Fundraising and Marketing Director for the UK’s Midlands Air Ambulance Charity, told AirMed&Rescue: “During the initial lockdown period, all four charity shops temporarily closed their doors; the charity’s annual calendar of events were either cancelled or made virtual; and face-to-face fundraising with supporters and volunteers could not take place.”

A reforecast by the charity’s senior leadership team and board of trustees predicted a reduction of up to 48 per cent in fundraising income for this fiscal year. Focus was quickly placed on boosting media engagement and online activity in a bid to reduce the financial impact brought about by the pandemic and resulting adverse trading conditions.

The RACQ LifeFlight Rescue helicopter network is part-funded by the Queensland Government, sponsorship and profit-for-purpose social enterprises, but the service relies on the community to make up nearly 30 per cent of funding required to deliver the medical rescue and retrieval service to Queensland communities each year.

Unlike international air ambulance services, HEMS never stopped functioning as a result of Covid-19

LifeFlight CEO Ashley van de Velde told AirMed&Rescue: “Covid-19 restrictions meant many community and business fundraising events, which we rely on, had to be cancelled or postponed. This included two annual gala balls and dozens of third-party events, organized by passionate community members. The Foundation team was quick to innovate and find solutions, including developing and organizing ‘Run to Rescue’, our first mass participation fundraiser on a Queensland-wide scale. More than 300 Queenslanders signed up to run, walk or ride a combined 33,349 kilometers, to raise funds for the RACQ LifeFlight Rescue helicopter service.”

Unlike international air ambulance services, HEMS never stopped functioning as a result of Covid-19 – indeed, many were busier than ever as they were seconded to transfer patients from hard-hit parts of the country to other areas, where there was still capacity in hospitals. With demand continuing to rise, plans to invest in the future could not be put on hold, and the planned decision to buy a rapid response car to bolster the air ambulance fleet was carried out.

Other planned investments that will still be done include the development of an advanced clinical simulation suite, echoing what Schomaker said about staff investment never stopping. Emma Gray of Midlands Air Ambulance Charity told AirMed&Rescue: “Providing a suitable space to re-enact real-life examples of incidents, the clinicians will have sufficient facilities to practise the lifesaving skills needed to meet the requirements of a helicopter emergency medical service (HEMS) team, including:

• Advanced analgesia and procedural sedation,
• Pre-hospital anaesthesia,
• Resuscitative thoracostomy,
• Finger and tube thoracostomy,
• Surgical cricothyroidotomy,
• Limb amputation,
• Major incident command and control, and
• Advanced extrication support and management.

The suite will provide projected scenery, temperature controls, audio visual equipment and lifelike patient mannequins – a stark contrast to and improvement of the current portacabin training rooms available.”

AirMed&Rescue spoke to US-based Metro Aviation, which has a different approach altogether. COO Kenny Morrow told us: “Metro has never set growth or expansion goals or quotas. We value a slow and steady growth. We have continued on with business as usual, trying to help our operations and business customers succeed. We understand that a lot of businesses, especially health centers, are being much more cautious regarding capital expenditures, so we are helping our customers navigate through that with creative solutions.”

RACQ LifeFlight operates both rescue helicopters locally and international fixed-wing air medical services. Van de Velde said that the RACQ LifeFlight Rescue Air Ambulance Jets remained busy throughout the pandemic, despite the downturn in international patient numbers: “The jets have always performed missions in Queensland and Australia, as well as overseas, so the service was able to focus on supporting locals in our own state of Queensland.”

On top of that, the business utilized the drop in international airlifts to explore new development opportunities – LifeFlight engaged with key partners to support global organizations with their Covid management plans, through provision of international aeromedical fixed-wing repatriation services, including the transportation of Covid-positive patients.”

Looking ahead to the next 12 months, while there are plans to invest in new aircraft – which were already afoot anyway – it was difficult for any of the providers we spoke to for this feature to come up with any major challenges they are facing that don’t involve coronavirus in some way, shape or form. The next 12 months are going to hinge upon the global reaction to the pandemic’s infection levels.

“Missions that were once simple, can quickly become very complex as countries react to rising infection levels in their borders,” said Schomaker. “So a mission that was all planned on one day, could be thrown into disarray the following morning as borders are closed, flight or landing permits are rescinded, and layovers to enable crew rest times to be observed can no longer take place.” International fixed-wing medical providers have to be agile and reactive – which in itself is not an issue – that has always been the case, after all – but it’s the fact that things can change at such short notice that makes it all the more complicated. “All the things that we used to take for granted can no longer be guaranteed, and with rules changing day by day, we are faced with major challenges to overcome,” concluded Schomaker.

A key initiative of 2020 is the upgrade to LifeFlight's systems and capabilities in the Communications Co-ordination and Control Centre, to provide enhanced operational oversight of all our aeromedical taskings

LifeFlight actually had a positive year, if you take a step back from the immediate problem of Covid-19. It welcomed three new Challenger 604 jets in February – perfect timing really. 2020, though, was always going to be a year of change for the organization, as van de Velde explained: “A key initiative of 2020 is the upgrade to our systems and capabilities in the Communications Co-ordination and Control Centre, to provide enhanced operational oversight of all our aeromedical taskings.”

This year also saw the commencement of a 10-year contract with a leading Australian law enforcement agency, which involved the delivery – and introduction into service – of three AW139 helicopters. Meanwhile, the LifeFlight Training Academy continued to grow – improving training outcomes for both internal crews and external commercial clients. A virtual reality aircrew simulator was also brought online by LifeFlight, joining the Thales Level D Full Flight Simulator and a Medical Simulator already available.

Speaking in September, Metro’s Kenny Morrow pointed out that in an election year, it could be difficult to predict what the next 12 months will bring for anyone in the US: “Our hopes are for a strong economy, capital dollars loosening up, customers continue doing well in their programs. Top challenges would be that those things don’t happen, and that government allows [the] free market to thrive … it will be interesting to see where we land come January 2021.” Within the US, where coronavirus has taken a firm hold in many states, and the healthcare system is under pressure, the legislative focus of the Air Ambulance And Patient Billing Advisory Committee seems to have slowed. It will also be interesting to see where that is taken in 2021 as hopefully the spread of Covid-19 will slow and allow for other vital activities to take place to ensure the ongoing viability of air ambulance services in the US.

For Midlands Air Ambulance Charity, the challenge is to face the predicted four-per-cent rise in demand for advanced prehospital care. Patient profiles are also going to change, according to Emma Gray: “The complexity of cases also continues to increase. Stabbing incidents have risen by seven per cent over the last three years, and self-harm and suicide attempts have also increased, reflecting societal changes.”

Schomaker also noted that patient profiles would alter, albeit in a different way for the company: “With a significant proportion of those with Covid-19 being asymptomatic, more tests have to be carried out to ensure the safety of the crew and the receiving hospital. Added to which is the fact that patients may have co-morbidities that make them more likely to suffer from related conditions, and seemingly straightforward repatriation flights can quickly escalate into more critical ones.”

With a significant proportion of those with Covid-19 being asymptomatic, more tests have to be carried out to ensure the safety of the crew and the receiving hospital

LifeFlight’s van de Velde summed up the next 12 months for air medical providers succinctly: “Throughout the next 12 months, the industry demands will continue to change and present challenges around global travel. In turn, this will continue to impact our international retrieval service, recruitment and training of flight and medical crews, movement of staff through interstate borders and freight, which can disturb our supply chain. We will remain committed, as always, to saving lives and providing the best possible aeromedical care, through the RACQ LifeFlight Rescue helicopter and Air Ambulance Jet services.”

It is this commitment to medical excellence, and doing the best for patients, whether in a HEMS or fixed-wing setting, that sets the air medical community apart.