ECMO or extracorporeal membrane oxygenation machine is a device that takes over some of the functions of the heart and lungs, thus providing the much-needed rest for both these vital organs. It has been seen that a malfunction of lungs is a major cause of COVID-19 fatalities. At times, patients have needed a lung transplant to stay alive. A South Korean woman aged 56 years was in a similar situation recently and was fighting for her life in Mexico. She had developed pulmonary fibrosis due to the underlying COVID-19 infection. The only way to survive was a lung transplant.
Air Ambulance to the Patient’s Rescue
Lung transplant is a major medical procedure, and naturally, the Korean woman and her family wanted to get it done in their own country. South Korea enjoys a robust healthcare system just like the United States. Moreover, it is always better to undergo a major procedure surrounded by people that one is familiar with. However, there was one problem. The woman had to be flow in this critical condition for an extended period. This is when the ECMO machine came into the picture. The air ambulance used was literally an ICU with this equipment.
The Air Ambulance Creates a Record in the Process
The US-based air ambulance Jet Rescue was tasked with this challenge. After extensive consultation with medical experts, it was deemed that the risk was worth taking to save the woman’s life. A Learjet-36 was chosen for the task. The journey was chalked out by scheduling periodic stops for oxygen and fuel refills. The air ambulance finally took off and successfully transported the patient to South Korea. During the process, the air ambulance company made a record. It now holds the distinction of being the longest medical flight with an ECMO machine onboard. The feat is quite an encouragement as this equipment can prove life-saving for patients with COVID-19 infection.
Medical flight professionals play an important role in offering life-saving services that range from triaging to offering emergency medical care on the spot and during transit. However, it must be observed that they perform these tasks in enclosed spaces with limited resources, both in terms of equipment and personnel. Rapid decisions and medical interventions are all a part of their daily routine. There is a constant need to keep in touch with medical experts on the ground. That’s not the end of it, the crew is expected to maintain a clear record of what has been done so that the transfer of care is smooth and seamless.
Best Practices for Medical Flight Professionals
The foremost thing to do is inform the receiving hospital about the status of the patient. If he or she is suspected of COVID-19 infection that must be made apparent. Even in the absence of a clear test report, if the patient is exhibiting symptoms of COVID-19, it is best to keep the receiving hospital informed. This is especially important as the protocol to receive a COVID-19 patient varies when compared to other health conditions. The practice can save several valuable minutes and appropriate care can be quickly provided upon landing.
Personal Care is Important
It is not possible to drastically modify most if the medical flight choppers to accommodate COVID-19 patients. Being in an enclosed space without a clear separation between the crew and the patient increases the risk of infection. However, PPE (personal protective equipment) offers an effective shield in this situation. It is reported that the PPE can be uncomfortable when worn for long periods of time, but it should not be a reason to compromise safety. Also, all mandated sanitization protocols laid down by the CDC and other government health agencies must be strictly adhered to.
Medical flight crews are at the frontline of the COVID-19 battle. While these brave men and women are tirelessly working for the good of patients, the fact remains that it is taking an immense toll on their mental health. The working conditions have drastically changed – sanitization and donning of PPE are necessary at every step. Not just that, there is the constant fear of contracting the infection and eventually passing it on to the loved ones. Torn between the sense of responsibility towards the society and to their families, medical flight crews are under tremendous pressure today. However, help is not far for such individuals.
Medical Flight Companies Recognize the Need to Help
Medical flight companies around the world are formulating policies that offer help when the crew members need it the most. Offering counseling and professional mental health on particularly tough days is one such effort. Also, companies are keeping an open line so that the frontline workers can seek help when they need it. Some of them are even going to the extent of preparing questionnaires to assess the mental status of the healthcare workers who constantly take to skies in tough situations.
William and Kate’s Foundation is Leading the Way
The two royals have been regularly advocating for the medical flight industry in the United Kingdom. Their efforts have been targeted at the mental health of frontline workers too. Now, they have set up a fund of British Pounds 1.8 million that will help this cause. The idea is to include the frontline workers as well as those affected heavily by the COVID-19 pandemic. Their organization will lend a helping hand to 10 chosen charitable entities. Access to peer-to-peer support and mental health resources is among them. The effort will surely help when the anxiety level among medical flight crews is perhaps at its highest.
Disinfecting the air ambulance has become one of the topmost concerns for the industry today. The problems that the COVID-19 pandemic has brought forth are unprecedented. It is, therefore, no surprise that air ambulance companies are grappling to find an effective protocol that can be followed. When one refers to safety, it’s all-inclusive today – from the crew members to the patients. Here are some steps that are highly recommended.
Follow a Consistent Air Ambulance Disinfection Protocol
The Centers for Disease Control in the United States recommends that air ambulance companies follow a consistent protocol. The basic rule is to ensure adequate ventilation during the cleaning process, especially when using chemical disinfectants. The aircraft doors should remain open during this process.
Wearing Personal Protective Equipment is Necessary
Donning personal protective equipment or PPE is very important. Keep in mind that the Coronavirus can remain on surfaces for hours. You do not want to contract the infection by coming in direct contact with it during the cleaning process. Discard the PPE right after the cleaning process is complete.
Adequate Ventilation is Very Important
It is hard to provide ventilation when an air ambulance has taken off. However, an adequate inlet of light is helpful. When the air ambulance is not in use, care must be taken to allow adequate airflow too. This is particularly helpful in getting rid of airborne infections like the COVID-19.
Using Appropriate Disinfectants is Absolutely Vital
Bleach is very widely used as a disinfectant but can give rise to noxious fumes. A detergent-based disinfectant is most effective. This is because the Coronavirus is covered by a layer of fat and soaps are known to dissolve fat instantly. The process instantly kills COVID-19.
Disposal of Soiled Linens
It is highly recommended that the soiled linen is not shaken in any way and is disposed of in a careful manner so that any infection-causing virus is not transferred to the surrounding surface.
It is imperative that the guidelines laid down by agencies like the CDC are followed meticulously. There is no substitute for these life-saving guidelines.
The Lincolnshire and Nottinghamshire Medical Air Services recently revealed that they are witnessing a whopping 40% increase in demand for their services. On the other hand, the COVID-19 pandemic has seen a sharp fall in the finances.
As the nations around the world have eased lockdowns, more and more people are out on the streets. This has increased the chances of injuries related to accidents and crime. The medical air services are seeing a proportionate increase in demand due to these factors.
In regions where the lockdowns have not been eased, the rise in domestic violence and anxiety-related ailments are on a sharp rise. However, the medical flight companies are in a bind.
Health Risk Faced by Medical Air Services Crews
The crews of medical air services are highly exposed to the risk of contracting deadly Coronavirus. When you look at the world scenario, there have been several reports of frontline workers being infected. This puts added pressure on the remaining staff. Added to this problem is the inability to act fast due to the stringent disinfection process being put in place for the safety of the crew as well as the patients.
Air Ambulance Organizations Dependent on Charities are Struggling to Raise Money
It is a known fact that people around the world are losing jobs and consequently their income. In a situation like this, raising money for causes like that of medical air services is an uphill task. For countries like the United Kingdom where air ambulance organizations depend heavily on charity, this is a big blow. Besides, it is tough for individuals to initiate fund-raising activities. All these factors have rendered the industry a heavy blow. Countries like the United States where air ambulance companies are already reeling under losses, shutting down seems like a real threat.
People around the world are wary of getting out of the confines of the home due to the COVID-19 pandemic. The result has been a reduction in emergency calls for the air ambulance industry. The change has come into play due to the reduced crime rates and accidents as fewer people have ventured out lately. While this is a good sign in general, there is a negative commercial aspect to it that can affect this commercial emergency service profoundly. It must be understood that reduced calls affect the revenue of the air ambulance industry in general where most players are heavily indebted.
The Expenses have Increased
Responding to emergencies is no longer the same as it used to be. The COVID-19 pandemic has changed things deeply. Today, the paramedics must sport personal protective equipment (PPE) before they venture out into helping anyone on the ground. This is essential to protect the crew’s health and also that of the person who is facing the emergency. This results in a further uptick in the cost as these PPEs cannot be reused. Also, there are protocols in place for sanitization after each evacuation, which further adds to the cost.
The Air Ambulance Industry is Seeking Financial Aid
It is not that there has been no financial aid coming towards the air ambulance industry; however, it is yet to be seen how effective the distribution has been. It must be noted in this context that several small players in the industry cater to rural communities. These critical services are the only line of defense for these communities where local hospitals have shut down in large numbers. If these organizations are not helped financially, they might eventually shut down. It is therefore vital that a close watch is kept on the industry’s requirements.
The lockdowns around the world are easing, down and people are slowly gaining the confidence back to venture out and involve in matters that are pressing for a society to function normally. One of such activities is medical flight charity. Countries like the United Kingdom depend heavily on public contributions to keep the air ambulance services running. Here are a few developments that stand evidence to the fact that they are inching towards normalcy.
A Kid from Reading Raising Money for Medical Flight Services
Alfie, an 8-year-old boy, has made news for his efforts to raise money for Children’s Air Ambulance. This enterprising child organized a sponsored run and has been selling bird feeders to raise money. It is believed that he has already raised a few hundred pounds through his relentless efforts. Alfie is a part of #TheCrew, a children’s club, involved in raising money for the worthy cause.
Medics in Ireland take up Cycling Challenge to Raise Money
A team of 11, comprising of an engineer, six doctors, and 4 paramedics is all set to take up a cycling challenge that will cover 110 miles. The effort has come in the face of COVID-19 pandemic, which stalled several fund-raising efforts. The endurance challenge is set to take place between the 2nd and 3rd of October. The expectation is that it will raise the much-needed funds to keep the medical flight services going. They are doing this for the Northern Ireland Air Ambulance.
Midlands Air Ambulance Charity goes Virtual
This charity has revealed that their pre-hospital services have shot up by 35% due to the COVID-19 pandemic. The organization has, therefore, decided to give the community that it serves an insight into what typically goes on. It will, of course, be a fund-raising initiative too. The organization has taken the virtual route to ensure the safety of the community amid the pandemic.
The adoption of private equity is not just a predicament for the air ambulance industry but the entire healthcare system in the United States. Several financial institutions in the country have shown a keen interest in healthcare in recent times. There is no doubt that it makes the whole sector highly competitive with ready access to funds. However, what bothers most people is the profit motive of private equities. The healthcare and air ambulance industries being more human-centric, it does not seem right to most people that they are viewed as a source of profit. They opine that healthcare must be a pure welfare activity.
What’s the Air Ambulance Industry Got to Lose?
Many people believe that the high prices charged by air ambulance companies are directly a result of heavy private equity investment in them. Investors simply do not want to make any losses, even though the United States is flooded with several air medical transport companies, so much so that the consumer base is starting to look too small. This is causing more idle time for many companies. As a result, their costs are piling up and are being ultimately transferred to the customer.
Will the COVID-19 Pandemic Transform the Industry?
The COVID-19 pandemic has drastically cut down the demand for air ambulance services. The reason behind this is simple. The industry relies heavily on helicopters, which are not built to handle highly infectious diseases like COVID-19. The pandemic has given no adaption time to the air ambulance service providers. The lack of isolation between the crew and the infected patients, in addition to the sanitization needs, has made air medical transport not the best option, at least locally. However, they are still being utilized for international evacuations, although not large in numbers.
Experts opine that, if the prevailing low-demand situation persists, there are going to be several service providers who will be forced to shut down, creating a balance between the number of players in the market and the size of the market.
In the past, the air ambulance industry has proved that it is an indispensable part of the health emergency services in the United States and beyond. The cost of availing the services has been a concern, but that apart, the utility of the air ambulance industry has never been questioned. Today, it plays an important role in repatriating COVID-19 patients from beyond the borders. It is also continuing to play a huge role in offering quality care to people in the rural parts of the United States. However, because of the COVID-19 situation, there needs to be a change in the way this industry functions.
Definition of Medical Necessity has Changed in the Air Ambulance Industry
Of course, we are not referring to medical necessity in the context of insurance coverage, approvals, etc. That remains the same. However, today, hospitals are encouraging people not to visit them unless it is important. The reason behind this is simple; people who already have a serious health condition must refrain from visiting spots that are hotbeds of COVID-19 infections, hospitals being one among these. The air ambulance industry is not completely prepared to handle this pandemic that is of epic proportions.
Recommending Air Ambulance Services Demands Careful Deliberation Today
Most of the helicopters in the air ambulance industry are not isolated enough to separate the patient from the rest of the crew. This poses a threat both to the healthcare workers and the patients. The problem of isolation does not exist in ground ambulances.
Besides, reaching the hospital early does not translate into immediate admissions today. Depending on the symptoms of the patient, he or she might need to be tested and isolated before being treated. The treatment protocols are still evolving. In essence, the physicians recommending air ambulance services should do so only after careful deliberation.
The COVID-19 pandemic is slowly making inroads into rural America. The higher number of elderly people living in rural communities is especially vulnerable now. Moreover, the infection is known to be fatal to people with diabetes, heart disease, and other ailments that impact natural immunity in human beings. All things considered, people living in rural parts of the country must have access to medical flights. However, this is turning out to be a huge problem for organizations that offer air ambulance services. It has again boiled down to balance billing, insurance denials, and financial burden to patients.
Medical Flights Being Denied Coverage is a Concern
Medical flights are a part of an industry that is highly competitive and which is already struggling to stay afloat. The COVID-19 situation has created an emergency of sorts throughout the nation and medical flights need to play a huge role in offering adequate coverage to rural communities. However, the threat of inadequate coverage is limiting its services. In this context, it must be noted that when coverage is denied by insurance companies, the burden is shifted to the patients. This presents a significant financial burden to the patients that can run into several tens of thousands.
The Percentage of Balance Billing is Small but Significant
About 300,000 air ambulance evacuations are carried out every year; of this, 3% end up in balance bills. This is primarily due to insurance denials. Most of these denials are due to the service provider being out-of-network.
The providers of medical flights too have not been keen on going in-network with insurance companies. The reason for this is the fact that reimbursements rates have remained unchanged. However, there is hope. With states like Florida looking to revise insurance reimbursement rates, the scenario could change soon.