Navigating the World of Air Ambulance
What you need to know before you transport your patient
Our Navigating the World of Air Ambulance course will help you as a Case Manager learn and understand more about long-range air ambulance transports for your patients. You will learn about the history of Air Ambulance, the different types of aircraft used and what long-range specifically is. You will understand what kinds of patients can be transported and the equipment utilized to do so safely. Lastly, you will be guided on how to research and find the best Air Ambulance provider for your patient to ensure they are financially protected and properly cared for during their transports.
In today’s modern era of medical transportation, fixed wing aircraft and helicopters frequently serve as air ambulances. Staffed with medically trained flight crews, they help transport patients from remote locations to hospitals or medical facilities for the provision of medical care. The proud history of medical air transportation testifies to the important changes air travel has made in the modern world during a relatively brief span of human history.
“The air ambulance industry has been instrumental in saving the lives of thousands of America’s soldiers, sailors, airmen, and marines throughout every contingency in which our country has engaged since World War I. Additionally aeromedical transports have moved thousands of family members who required medical care beyond that available in their local communities.”
{Gale Academic Onefile, Bruce Green, Winter 2001}
In this industry, there are a lot of questions and confusion around the aircraft used for medical transports, specifically when to use a rotary-wing (helicopter) aircraft versus a fixed-wing aircraft (airplane). Many factors play into determining which aircraft is better suited for the patient’s medical situation and transport needs. Our infographic will guide you through each factor to help make an informed decision. Hover over each informational icon below to learn more about each section.
Overall there are pros and cons for each Air Ambulance aircraft. The aircraft that you use will depend on your patient and their medical needs. When options are more accessible it’s important to look at what would make your patient the most comfortable during transport and allow them to get to their destination faster, so they can move on to their recovery.
A Learjet aircraft that has been medically configured can act as a full airborne Intensive Care Unit. The main components of an Air Ambulance aircraft is a stretcher system (that replaces two passenger seats), secured medical equipment, a two-person medical team, and a two-person pilot team. For additional safety, providers should have a secure loading ramp to safely loading patients into the aircraft while on the stretcher. The Learjet 35 and 36 aircraft offers extra-wide 36-inch cargo doors allowing for a safer, smoother transition when loading and unloading our patients. The Learjet offers comfortable executive-style interior seating and accommodates at least one accompanying family member or friend to fly with the patient during their transport. There is storage space for luggage in the back. The Learjet 60 offers a stand-up cabin and a lavatory for extra comfort. See a tour of a Learjet 60 below.
Utilizing the right kind of equipment in an Air Ambulance is crucial to achieving positive outcomes on every transport flight.
Transporting patients in the air has inherent risks. The Universal Gas Laws are taken into consideration when caring for patients. Read below for how these law’s can affect a patient.
The volume of a gas is inversely proportional to its pressure, subject to temperature. As altitude increases, gas volume expands due to the decrease in barometric pressure. This can indirectly affect a patient with a breathing tube, an IV, or GI/GU assist devices. Flight crews should recognize and monitor gas expansion/contraction during flight.
As altitude increases, gases exert less pressure – this is the law of partial pressure. At higher altitudes, barometric pressure decreases, and oxygenation can become more difficult for patients. Without intervention, hypoxia can occur. During the medical flight, supplemental oxygen can be administered to help the patient.
When the pressure of a gas over a given volume of liquid decreases, the gas in the liquid will also decrease. This law is responsible for decompression sickness, Gases commonly get trapped due to a rapid rate of ascent, excessive body fat, or in geriatric patients. At risk patients can be pretreated with high flow oxygen therapy prior to flight.
Air Ambulance providers should be equipped to transport any patient across all ages and body type spectrums. Alas, not all Air Ambulance providers can, so be sure to do your research and make sure the provider is experienced, properly equipped, and even accredited to safely care for your patient during transport. It is common for providers to be able to transport adult patients.
Patients can be monitored in an Air Ambulance just like they would be in a medical facility or hospital room. Intensive care equipment including patient a monitor, ventilators, infusion pumps, critical care drugs, and necessary supplies are carried on each flight so the medical team can respond to any in-flight emergency situation. Each patient’s heart rate, blood pressure, and oxygenation are continually monitored during flight. These vital signs are the lifeline in assessing the patient’s condition and determining if interventions are needed. Patients requiring ventilator support are placed on a ventilator that can provide intelligent ventilation solutions for critically ill patients, from neonates to adults, and can provide both invasive and noninvasive ventilation capabilities. Many patients require intravenous fluids to maintain homeostasis, and infusion pumps on board can provide continuous or intermittent delivery of fluids and medications to adult, pediatric, or neonatal patients. Pain and pain control can also be a reason that long-range medical air transport is utilized.
The flight environment creates a multitude of stressors, some of which can have a negative impact on an already medically compromised person. Utilizing holistic methods can help provide a pleasant, restorative experience. Most Air Ambulance providers don’t offer this type of care to their patients, in fact if they do it’s often an extra charge to perform these measures. Look for a provider that includes this as part of their medical care.
In this industry, it is difficult to decipher who the best provider for your patient would be. There are four areas of concern in the Air Ambulance industry you must be aware of and evaluate when choosing an Air Ambulance provider for your patient. Below is a guide to walk you through each area to help you better prepare you when making this decision.
In determining standard of care with an Air Ambulance provider you must check the following:
Ensure you are working with a direct Air Ambulance provider that performs the actual transport service themselves versus a Broker who acts as a middleman and sources the services out.
Make sure the Air Ambulance provider is accredited, meaning they have been recognized as a company qualified to perform the service and meet certain standards to do so.
Confirm the providers’ capabilities including crew employment, training, and aircraft management to ensure they can take on any medical case with positive outcomes.
When searching for an Air Ambulance provider, your search may lead you to an air ambulance broker who portrays themselves as an actual air ambulance operator with websites showing images of aircraft and making promises of providing their “own” aircraft, medical staff, and flight crew, when instead they simply broker these requests while charging hidden additional fees. Be aware that the broker will find the Air Ambulance company with the lowest cost possible (not the highest quality service), then add an additional fee for their services to the cost. Using a broker does not ensure a higher level of quality for the patient. In fact, they have no system to analyze quality control for patient care. Whenever possible, it is wise to deal directly with the air ambulance service company so the patient can receive the best rate for the service. You make the decisions for your patient based on what’s best for them, not the Broker.
The following key points will help you spot a broker:
Doing the legwork and due diligence yourself will enhance your chances of success in choosing an air ambulance provider who owns and operates their own aircraft while employing the necessary medical team with the proper experience to provide safe patient care during transport.
Accreditation is the action or process of certification, officially recognizing a company as being competent and qualified to perform a particular service. An accreditation determines if an air ambulance provider meets or exceeds industry-established criteria for standards of quality and patient care set forth by the accrediting bodies. In the air ambulance industry, accreditation is a voluntary evaluation process.
The accreditation bodies have established standards for high-quality aeromedical transportation, looking specifically at patient care and the safety of the flight environment. Their goal is to ensure air ambulance providers deliver a certain level of care including safety and medical protocols proper training in the field of aeromedical transfers and air-tight operations for management and flight.
When it comes to air ambulance accreditations, there are currently three organizations worldwide that set the industry standards:
The Commission on Accreditation of Medical Transport Systems (CAMTS). CAMTS is a peer review organization dedicated to improving patient care and transport safety by providing a dynamic accreditation process through the development of standards, education, and services.
The European Aeromedical Institute (EURAMI). EURAMI promotes best practices in the fields of medical evacuation, air rescue, and contingency planning. A EURAMI accreditation is an effective means of validating quality air medical transport services.
The National Accreditation Alliance Medical Transport Applications (NAAMTA). Built to be more flexible in order to achieve broader and more manageable adoption rates in the air ambulance industry, NAAMTA offers procedures that include guidelines for developing a quality management system focusing on transport safety, patient care, and continuous improvement.
The process to become accredited, is arduous. An Air Ambulance company seeking accreditation must meet all the standards and requirements of the endorsing organization through a rigorous review process. This process includes an initial application review that takes up to a year to complete followed by an on-site inspection of operations, facilities, aircraft, and personnel where all program deficiencies must be revealed and addressed. Reaccreditations occur every three years. This ensures accredited providers are continually upholding their rigid safety and patient care requirements.
It is important to understand the experience and skills the air ambulance provider has before choosing them for your patient.
It is important to think of safety first when deciding on which air ambulance company to use. You’ll need to research the air ambulance provider thoroughly before making the decision to use their services. Here are some suggestions to help you put safety first in the decision.
Be sure to check the air ambulance company for all these key indicators that show the company’s commitment to safety through quality of care and experience.
It is important to know what to expect when you are working with an Air Ambulance provider to transfer your patient. The provider should walk you through their process when you first engage with them, however, below is a general idea of what you should know.
Price cannot be the only Indicator of good value for Air Ambulance services. It is important to get the best value for each transport, and this may not be the cheapest option. In a lot of cases, you get what you pay for in this industry. Additionally, low-price options may not be completely accurate as you will read in the ethics section.
When asking for a quote be specific about details such as needed medical staff and type of aircraft. Learn what specifics are included in the cost of the quote when making the decision to select one air ambulance service company over another. You may realize when evaluating prices, you are in fact comparing apples to oranges. For example, one provider’s low cost is for a turbo prop plane while the provider with a higher cost is offering a jet engine plane. Or sometimes a quote may include ground ambulance transportation while another quote does not.
Finally, in some scenarios the extra cost is worth the faster time and increased speed to get your patient to their destination quicker and in more comfort. With a little research on your end, patients and their families can get the best service at a great value.
Unfortunately, unethical behaviors do occur in the Air Ambulance industry today. Such behaviors include taking advantage of patients’ misfortunes, dishonesty, and overbilling. Some specific things to look out for are as follows:
Know how to protect your patient! It is great when a patient has insurance coverage that can help cover costs for a medical transport, however this doesn’t mean all costs will be covered. It is important to be aware of the common pitfalls around insurance coverage, provider contracts and service costs.
If your patient needs medical assistance to travel but may not require full air ambulance services, some providers also offer commercial medical escort services. This service includes a medical professional that provides medical care and assistance to patients who are able to fly on a commercial airline. This medical escort service is an alternative medical air transportation option that is more cost-effective and affordable for patients with more stable and non-critical medical conditions.
Patients that can fly on a commercial airline have to be in a non-critical condition and meet the following criteria. They are medically cleared by their treating physician to fly with an accompanying medical professional. Their supplemental oxygen therapy does not exceed 5 liters per minute. They are free of contagious diseases. They are free from conditions involving trapped gases (pneumothorax, bowel obstruction, gas embolism, etc.). They can sit secured and upright in aircraft seating during taxi, takeoff, and landing (unless being transported by stretcher). And they are non-combative.
One of the most important things to know about AirCARE1 is that it was founded by a critical care flight nurse who gained unique insights from caring for her patients in the air. She saw how frightened and afraid her patients appeared to be during their transports, so she developed a truly different approach to patient care that could alleviate the stressors of flight and provide patients and family members a comfortable and pleasant experience. This vision led Denise Waye to create AirCARE1 that provides superior medical care with a soothing Holistic approach.
AirCARE1 is a fixed-wing air ambulance provider utilizing Learjet aircraft to fly all patient types throughout the United States, Canada, Mexico, Central and South America. AirCARE1 also provides worldwide operations utilizing our preferred partners. We own and operate critical care airborne intensive equipped Learjet aircraft out of Albuquerque-New Mexico, Deer Valley-Arizona, and Melbourne (Orlando area)-Florida.
Our mission statement is to do what is right for our patients at all times as we transport them with exceptional care equal to or better than the best premier medical facility. We provide care with empathy and compassion to make a difference in the lives of our patients as we advance the healing process. We believe to have a great company that provides great service; you need the “4 rights”. The right people, the right equipment, the right training, and the right attitude!
AirCARE1 has chosen to be accredited by the commission on accreditation of medical transport systems (CAMTS) and the European Medical Institute (EURAMI). This demonstrates our dedication to providing the highest level of care for our patients. AirCARE1 is one of only two air ambulance companies in the entire Western Hemisphere to have dual accreditation from both CAMTS and EURAMI. We boldly state that dual accreditations align our company to the highest standards of care and safety in the industry.
At AirCARE1, we challenge the industry status quo by putting both the emotional and physical comfort of our patients at the forefront. Our unique approach utilizes holistic methods, combining exemplary medical services with the calming influence of music, aromatherapy, and gentle human touch to provide a pleasant, restorative experience for those in our care.
The primary factor ensuring superior care is to provide a safe environment for patients and family members (as well as AirCARE1 employees) by utilizing a Safety Management System. While the United States does not have a mandated Safety Management System, AirCARE1 has chosen to make safety a top priority within our organization by implementing a Safety Management System. Working in conjunction with the Federal Aviation Administration, AirCARE1 has been recognized as an “active participant” in the FAA’s Safety Management System Voluntary Program. Our Safety Management System is not a separate system, but instead is completely integrated within and throughout all company policies and procedures.