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Challenges Involved in Starting an Air Ambulance Business

Air ambulance service, as a business, is not short of challenges, budget being the first concern but not the least of it. A good business plan that lays out the path to profitability can easily attract investors. However, there are other challenges that are seldom looked into by most entrepreneurs. Here, we discuss some of those road blocks in some detail.

Understanding the Legislations Across the World

The air ambulance industry in the US, as most experts opine, is pretty saturated. It is, therefore, recommended that entrepreneurs target the global market. This necessitates looking into legislations that govern the land. While the norms in most developed, capitalistic countries are similar, they can vary a lot when it comes to developing countries and socialistic policies too can pose some government roadblocks. It is wise to employ an array of consultants to overcome this hurdle.

Provision of Round the Clock Air Ambulance Services

Failure to respond to emergencies can leave your organization with negative public perception problem. To ensure that air ambulance services are always available throughout the year, it is necessary to make arrangements to be available throughout all weather conditions. Also, medical staff needs to be on standby at all times, even though this means additional overheads. Most air ambulance companies overcome this problem by transferring this overhead costs to the end consumer. However, the wisest thing to do is introduce memberships for nominal fees. Efforts must be made to remain ‘in coverage’ of insurance networks so that reimbursements are seamless.

Acquiring Air Ambulance Fleet and Keeping the Staff Well Trained

Air ambulance industry demands seasoned, qualified professionals and it’s hard to find people who fit this criterion. Plus, there is the issue of ongoing training to the staff. Accredited training organizations must be looped in to meet this challenge. Lack of ongoing training can impact the quality of services immensely.

How Important is Accreditation for Air Ambulance Service Providers?

The Commission on Accreditation of Medical Transport Systems and the European Aero-Medical Institute are perhaps the two most well-known organizations that offer accreditation to air ambulance service providers. While the former is primarily for the United States, the latter caters to the European continent. There are several air ambulance companies that certify their quality services through these accreditations. Then, there are those companies that are equally quality oriented but are not accredited. These medical flight companies are usually smaller in size and cannot afford accreditations. This raises the question: are accreditations really needed or is it just another additional cost?

The Benefits of Air Ambulance Service Accreditations are Several

For one, insurance companies are more willing to take an air ambulance service provider in their network coverage when they are accredited by a well known organization. It is an assurance of high quality standards and safety. Many private players who tie up with air ambulance companies too prefer such certifications before tying up for their services. For medical flight service providers, therefore, it makes sense to spend money on such accreditations. Even hospitals and customers veer towards those organizations that have recognized accreditations.

The Constantly Evolving World of Air Ambulance Accreditations

The rules that govern the air ambulance industry constantly evolve. Bodies like Federal Aviation Administration of the United States up the standards that govern air ambulance companies constantly. When this happens, the organizations that offer accreditation automatically are forced to change their standards. For air ambulance service providers, this means upgrading their certifications on a regular basis to stay current. Moreover, these accreditations must follow not just the norms of their own countries since air ambulance services are increasingly going global. An accreditation organization that only caters to a single country risks being ignored as there is a chance of the service providers preferring other more global options.

Medical Flights and Physician Training

Being a physician in fixed-wing medical flights is no small task. Being responsible for a patient in an intensive care unit setting, hundreds of feet above the ground while he battles for life can be quite daunting. What compound the gravity of the situation are the limited resources at the disposal of physicians manning the medical flights. It’s only the world- class training and a cool, professional head on the shoulders that comes to aid in situations like this, day in and day out. Here, we describe some of the training requirements that are typically needed.

Initial Training for Medical Flights

Well, the training starts even before one applies for the job. The training is a little different from the one that you receive in hospitals. You need to be adept in working with limited resources. Also, it is important to understand that problems that one can face up in high altitudes. Gas pockets within the body and limited oxygen are just some of those. Training is optional in some regions but in others, they are absolutely mandatory. The documentation of such training might needed to be vetted by organizations like National Accreditation Alliance for Medical Transport Applications. The training, however, can be obtained through organizations like European Aero-Medical Institute or Commission on Accreditation of Medical Transport Systems.

Keeping the Skills Current for Medical Flights is Vital

Some skills are more important than others, like the ability to intubate a patient quickly. Yearly ALS refresher courses are expected to be in place by most medical flight companies. Since, hospitals often see critical patients, experience handling them in emergency settings is considered an added advantage by most air ambulance companies.

Ongoing Training for Full-Time Professionals on Medical Flights

Most of the reputed air ambulance companies offer their medical staff ongoing training. While some of this training is conducted in-house, others  may be outsourced to external agencies that are accredited. In all, these efforts and checks are put in place for the safety of both the medical flight professionals and the patients under their care.

 

The Cost Factors Behind Medical Flight Services

When faced with an emergency situation concerning the life of a loved one, cost is the last thing that you want to worry about. However, it is always wise to have an idea of the costs involved in emergency situations and medical flight services are one of those. With the cost having doubled over the past decade, you must know what to expect if you’re opting for a medical flight. While most of the costs will be covered by your health insurance, you would still want to keep the costs low as you might be forced to pay the unapproved balance amount as it so often is seen happening.

The Cost of Ground Transportation

One cannot completely discount the fact that a ground ambulance may be required to transport the patient. It becomes an absolute necessity when it’s a fixed-wing medical flight, which can only take off from an airport. Even choppers can, at times, not reach the patients owing to the terrain and ground ambulance services may be needed.

The Destination of the Medical Flight

This is an obvious factor. The longer the medical flight, greater the cost. The nearest appropriate treating facility might be quite far and sometimes across borders – all this ultimately translates into higher cost.

Medical Flight Landing Fees

The landing fees depend on the duration that a medical flight uses the landing facility. This becomes a part of the final bill.

Type of Medical Flight and Number of Medical Staff

Long flights typically demand fixed-wing air ambulances. These can be more expensive than choppers. They are generally better equipped and considered more comfortable. The number of medical staff is also a criterion. Certain medical conditions demand that professionals in more than one field of medicine be present in the air ambulance and this can push the costs up.

While there may be other cost factors too, the ones discussed above are the major ones.

REVA Leads Air Ambulance Companies in ‘Just Culture’

It might seem that the aviation and air ambulance companies have little in common. While one deals in the mechanics of aviation machines, the other primarily deals with biology and chemistry of the human body. However, when one looks closely, it is easy to spot several similarities between the two. It is these similarities that the air ambulance companies must be aware of and must work on, to improve the safety of medical flights. The risks involved in both industries are very similar to each other. This is why REVA, which is an international fixed-wing air ambulance company, has published a white paper on ‘Just Culture’

What is ‘Just Culture’ and How Does it Apply to Air Ambulance Companies?

This is a highly relevant question. Although one rarely gets to hear about fatal crashes and safety flaws concerning air ambulance companies, such incidents are not unheard of. Apart from this, there are obviously going to be some near misses. The logic behind the ‘Just Culture’ is to treat mistakes as learning opportunities to avoid them completely in the future. REVA released a white paper on the topic recently.

According to Emma Roberts who is the company’s Safety Director, the white paper meant for air ambulance companies, lays down the steps involved in implementation of just culture and explains how this culture increases the degree of safety.

‘Just Culture’ Fosters Transparency in the Way Air Ambulance Companies Function

‘Just Culture’ makes reporting easier for staff who constantly put their lives on the line to protect and serve the needy patients. The culture ensures that these front-line warriors are not punished for the mishaps but are rather encouraged to report them so that apt solutions can be found. The result is improved safety of medical flights and better compliance with medical as well as aviation norms.

A Guide to Air Blocks on Medical Flights

The study of aviation physiology is quite extensive. On diving deep into this subject, it becomes apparent that air blocks are major factors that bring about physiological changes in relation to altitude. To say that principles of aviation physiology hold good for medical flights too is stating the obvious. In this guide, we highlight some of the very common air blocks. These must be considered every time a person opts for a flight, pressurize or unpressurized.

Ear Blocks on Medical Flights

The symptoms primarily start as a feeling of fullness; however, the symptom may take a slightly painful turn in higher altitudes and ultimately lead to vertigo. The solutions though are pretty simple:  yawning, swallowing and Valsalva are quite effective.

Sinus Blocks on Medical Flights

There can be two types of sinus blocks. The first type is maxillary sinus block. This is characterized by sharp pain beneath the cheekbones as well as upper dentition. The second type is frontal and is characterized by severe pain under the eyebrow as well as eye corners. The best remedy for this is Valsalva maneuver.

Gastrointestinal Tract Blocks on Medical Flights

Our digestive system can hold a lot of trapped gas. When a person travels on a high-altitude medical flight, this collection of gas can lead to physiological changes in the gastrointestinal tract causing discomfort and sometimes, slight pain. Belching and flatus can provide instant relief.

Tooth Blocks on Medical Flights

This is not the most common air block on medical flights; however, these can be quite painful and irritating. Sometimes, the natural gaps within teeth and gaps that occur due to dental procedures can retain air and act like bubbles. These air blocks can cause pain at high altitude. There is no immediate remedy for this condition. It is advised that the patient visit a dentist upon landing.

It must be noted that any discomfort that does not go away even after the above-suggested techniques must be dealt with all seriousness. In extreme cases, descent or landing may be warranted.

Surviving an Air Ambulance Crash in the Middle of Nowhere

Now, that’s a scary situation isn’t it? Imagine that you’re in an air ambulance and it crashes in the wilderness. What would be your first reaction if you know that you’re going to be stranded for at least a couple of days? Search for food, correct? In reality, that’s the worst mistake that you can make. A typical human being can survive up to 3 weeks with no food at all but can only last up to 3 days without any water. We bring you several survival tips in this guide.

Staying Close to the Crashed Air Ambulance Vehicle is Vital

Wandering off in the wilderness in search of help is not wise. The rescue personnel are, obviously, going to look for the crash site and not wandering survivors. If you’ve moved too far away from the crash site, you might not even be found. So, it’s wise to stay close to the air ambulance and wait for help.

Protect Yourself from Harsh Weather Conditions

If the air ambulance is still in a condition where it can provide you shelter, use it. If not, try to erect a simple tent with sticks that can protect you from the sunlight. It must be noted that aircrafts are not the ideal shelters in extreme weather conditions. Seeking other forms of shelter is advised. The survivor, in this case, needs to be innovative.

Lighting a Fire and Hunting for Water is Important for Survival

Fire not only keeps the survivor warm, but also acts as a signal for rescuers. Keep the fire lit at all times as much as possible; however, beware of the dangers that a fire poses. Don’t get it too big. Also, your air ambulance might still have some water reserves left; use it judiciously. If you find a water source nearby, use purifying tablets before consuming it. If you do not have these, simply boil it for about 5 minutes.

Medical Flight Safety – Oxygen System Checks

The advancement in medical flight performance has a lot to do with the development in oxygen equipment in recent times. Typically, medical flights make use of portable oxygen equipment at altitudes less than 10 thousand feet above the sea level and fixed oxygen equipment if attitudes above 10 thousand feet are achieved by the air ambulance on a regular basis. Typically, the oxygen equipment consists of storage system, tubing, gauges, and mask. Traditionally, oxygen has been carried in gaseous form; however, the new advancements in technology have made way to solid stage oxygen which allows for carrying of greater quantities of oxygen.

Equipment Check Before the Medical Flight Takes Off

It must be ensured that all occupants of the medical flight are well aware of how to don and doff oxygen masks and fit the head harness properly. They should also be knowledgeable about checking the pressure gauges and indicators. Of course, it’s also necessary to check them for faults before the flight. The paramedics would do all these checks for the patients aboard the medical flight.

Each oxygen container is designed to withstand altitude up to a certain level. This must be taken into consideration before embarking on the medical journey. The expected duration of breathing and the duration of the flight are other aspects that must be considered.

Types of Oxygen Masks and Regulators

Continuous flow regulator ensures a 100% flow of oxygen. This usually contains a re-breather mask that allows the user to reuse some of the exhaled oxygen.

Demand and pressure demand works by providing oxygen to the user on demand. In other words, the oxygen only becomes available when the user is inhaling. Such oxygen usage is very stable and can be used up to 10 thousand feet above the sea level. This type of oxygen release becomes necessary in fixed wing aircraft where there travel long distances, often across continents.

How is Air Ambulance Cost Calculated?

The last thing that comes to mind during emergencies is money. Staying alive takes priority over everything else and naturally so. It is after the emergency and when you are inadequately covered by insurance that air ambulance cost finally comes into picture. There are several factors on which medical flight costs depend on. In this guide, we briefly discuss the important cost factors.

The Distance that Air Ambulance Needs to Cover

Unlike a cab that usually considers the distance from the point that you occupy it, air ambulance charges go beyond this point. You might be expected to cover the cost from the air ambulance base to your location and also for the journey undertaken by the air ambulance to get back to its base. Opting for the nearest air ambulance might make more sense in situations like these.

The Type of Air Ambulance Vehicle

For longer distances, an air ambulance with a jet engine might be more suited. Of course, this might translate into higher costs. At the same time, helicopters are ideal for emergencies that occur on busy streets. While one cannot exactly choose which vehicle to hire, it must be understood that aircraft type and costs are directly related to each other.

The Extent of Care the Health Condition Demands

There are two components to medical care: personnel and equipment. If the condition demands that the air ambulance be loaded with advanced life support and monitoring systems, the costs will shoot up. Also, there might be a requirement for specialized human care that only highly skilled professionals can provide. And such care usually comes at a premium.

Air Ambulance Landing Fees and Logistical Charges

When an air ambulance lands on an airport or helipad, it is usually charged a fee for it. Also there might be other charges such as visa, hospital booking, ground ambulance charges, etc. Your air ambulance service provider is obviously going to factor all that in while drawing the bill.

Guide to Tackling Hypoxia on Medical Flights at High Altitudes

Hypoxia is almost a certainty at high altitudes unless it is cared for. However, it does not usually occur as medical flights usually have pressurised cabins. This does not mean that we do not pay any heed to this potentially life-threatening condition, which is a real possibility on medical flights, when the altitudes are in excess of 10 thousand feet above the sea level.

The word hypoxia, when literally translated means lack of oxygen. A decrease in supply of oxygen to human body can bring about myriad symptoms and recognizing these, especially when in medical flights, is extremely important, as patients are usually already in a weak health position in air ambulances.

The Signs of Hypoxia on Medical Flights

Paramedics and nurses onboard medical flights must look for signs such as impaired judgement, lethargy, poor physical coordination, bluing of the skin (also known as cyanosis) and rapid breathing. The intensity of each of these signs may vary but these are the most visible signs that the patient is experiencing hypoxia.

The Symptoms of Hypoxia on Medical Flights

Surprisingly, euphoria or extreme happiness can be a symptom of hypoxia. Other symptoms can be a sensation of tingling, impaired visual capacity, cold or hot flashes, dizziness, headache, nausea, fatigue and air hunger. Not all symptoms might be present in one single individual but at least some of these might be present when the patients are hypoxic in medical flights.

The Effects of Hypoxia on Human Beings

It must be noted that about 20% of all oxygen that we take in is used by our brain. So, one of the first organs that is affected by hypoxia is the brain. If the brain is deprived of oxygen, it can lead to severe and permanent brain damage leaving the person with impaired functions for life. In extreme cases, it may even cause death. However, treating hypoxia, fortunately, is easy. All that patients aboard medical flights need is 100% oxygen and the symptoms vanish within a matter of seconds.