Air ambulance industry perspective: complex medicine and logistics in a rapidly changing environment

 Dominic Rose 4 Sep 2020

The pandemic has led to a paradigm shift in the co-ordination and delivery of aero medical evacuations and transfers, affecting all clinical staff involved in the service, whether that is as a clinician in an air ambulance company, an assistance company, a medical escort or a discharging or receiving team.

Medical care pathways and assessments have required complete review and revision to ensure that they continue to ensure patient and staff safety and optimal outcome. Procedures and policies are having to be established at pace to ensure best practice and communication and key stakeholder management sees a continual evolution as the impact of the COVID-19 virus shapes change.

Co-ordinating and delivering aero medical services always required significant and complex logistics management and communications. From liaising with overseas medical teams (often with language barriers), to securing an understanding of a patient's condition and needs, to managing a clinical environment in the sky, and ensuring ground transfer solutions are in place and a receiving facility is prepared for the admission. This has gone to another level since the onset of the pandemic.

In March 2020 the extent of the changes that this virus has had on medical evacuations were starting to take effect. Additional permissions and approvals from regulatory and governmental bodies (who were also in the process of learning about the impacts of the disease) added another layer of administration and delays in trying to co-ordinate a mission.

Changes to border controls, being revised sometimes on a daily basis, meant the landscape shifted quickly.

Could the aircraft land and crew stay overnight or permission to land for a fuel stop to extend range be secured? Could bed to bed transfers still be completed? Did the patient have a COVID-19 negative screening or would they have to be considered as suspected positive and therefore require a Portable Isolation Unit? If they did, what additional medical considerations needed to be in place to ensure they could tolerate a safe transfer? Would flight crew have to quarantine on return?

All these changes have meant that the average time to co-ordinate an evacuation increased, in some cases up to five a day. In most countries medical crew had to stay airside and therefore the first time a physical review of a patient could be undertaken would be on the tarmac. This alone has meant a fundamental shift in the nursing and clinical needs of patients, with cases often presenting in a poorer medical condition than expected.

Prior to the pandemic there were few air ambulance companies who owned and operated a Portable Isolation Unit, over time it is now the majority that do. However, there was, and still remains, no universal approved process and standard for when patients require transfer in a PIU, with industry players all operating differently, presenting an inconsistent and sometimes confusing position to customers who require medevac services. Whilst availability and access to tests is improving there remains limitations in the reliability of the results. Applications to Civil Aviation Authorities were submitted for approval for the equipment and again standard operating procedures and equipment assessment was conducted without well established precedents.

Personal protective equipment (PPE) was scarce and yet an absolute essential to ensure the safety of medical and flight crew, especially when travelling for concentrated periods of time in a small confined space.

The world of air transfer for medical missions has changed irrevocably and the dynamics continue to shift regularly, though it is testament to the collaboration of all the teams and organisations involved in the chain that we have been able to respond and continue to adapt.

Dominic Rose

Dominic Rose

RCN Critical Care and Flight Nursing Forum Steering Committee member

Clinical Services Manager, Gama Aviation UK Ltd

Dominic's background is as a Senior Intensive Care Nurse at Bristol's Southmead Hospital before moving into the Chief Flight Nurse role at Capital Air Ambulance in 2013. He now manages the emergency retrieval contract for Gama Aviation UK Limited service for the States of Jersey and Guernsey.

Page last updated - 04/09/2020