HOW TO CHOOSE AN AIR AMBULANCE

 QUESTIONS? 
 

You are being asked to arrange for air transportation of a patient…..

Please allow us to guide you!

QUESTIONS AND ANSWERS

The Federal Aviation Administration (FAA) does not certify air ambulance operators.  The FAA regulates aircraft operations, but exercises no control over the medical aspects of the flight.  Several years ago, the FAA did attempt to regulate the medical aspects of air ambulance operations but withdrew the proposed rules because of fierce opposition by hundreds of Air Taxi Operators.  The individual states were left to decide if they should license their air ambulance operators or not.  Some states do, some don’t, and some have minimal requirements.  Florida has the most rigid requirements for Air Ambulance Operators, including aircraft size and capabilities, medical equipment inventory, and personnel qualifications.

If you use an operator that is not licensed, you have no way of knowing if the aircraft or equipment is up to any standards.  You don’t know what qualifications the medical attendant(s) will have.  They MAY be Doctors and Nurses. They MAY have excellent qualifications and certifications.  They MAY be well trained for Air Ambulance Transport, including aeromedical physiology.  ON THE OTHER HAND????  

There is really nothing wrong with obtaining an air ambulance through a broker.  However, if you use a broker, you might find it difficult to obtain information about the actual aircraft operator/air ambulance operator.  Of course, if you contact the air ambulance operator directly, the chances are that you will certainly obtain the service at a much lower price.  Using a brokerage service may result in inconsistency of care when the brokerage service utilizes various air ambulances’ services.  The broker does not own the aircraft, medical equipment or employ aviation medical professionals.  So each air ambulance service that flies for the broker would have different standards of patient care.  Usually, true air ambulance operators (the actual FAA certified operators) have only one or two bases of operations.  You should be suspicious of an air ambulance operator who claims to have offices in many cities.  It is probably just a broker with many phone numbers.  Therefore, your next question should be:   Who is the actual air ambulance operator?  That is, who is the licensed operator of the aircraft?  Then ask whom, if not that aircraft operator, is handling the medical aspects (i.e., who supplies the medical personnel and equipment).

Each patient should be evaluated by the medical director of the air ambulance service prior to transport.  Because many medical conditions are affected by air travel, the Aviation Medical Specialist is trained to determine the proper equipment, personnel and aircraft required for each transport.  Aviation physiology may affect the patient, so particular attention must be given to his/her condition and previous medical history.

All physicians, nurses and respiratory therapists should have extensive experience in critical care medicine.  The doctors and nurses should be certified in Advanced Cardiac Life Support, and be further trained in aviation physiology.

It is imperative that the aviation medical team assume patient responsibility at the discharging facility and relinquish this responsibility only at the patient’s final destination.  Continuity of medical and nursing care is extremely important to the outcome of all patient conditions.  The aviation medical team is the important “link” between the discharging and receiving patient care facility.  The receiving facility should expect to receive all pre-flight medical records as well as verbal and written documentation of in-flight events.

The cost of an air ambulance transport varies depending on type of aircraft used, length of flight, and medical personnel.  Quotation for flight costs should be all inclusive of:

Aircraft Mileage – Flight Crew – Medical Personnel – Aviation Medical Consultations – Medical Equipment – Landing Fees – Ground Ambulance Transportation

Some air ambulance services may quote aircraft mileage only, or might initially quote a low price for an inappropriate aircraft and then later either raise the price “due to add-ons,” or finally decide that you need a different aircraft, which, of course, will cost more than the original quote.  Be sure that the quotation is all inclusive for the right type of aircraft.  Reconfirm the quotation and the aircraft to be utilized. 

The cost of an air ambulance is not inexpensive.  However, NATIONAL AIR AMBULANCE, because of our volume of business and because we own our aircraft and equipment, is able to provide the service at prices which are competitive with comparable operators.  Often times the cost of air ambulance transportation is beyond the reach of the patient or family.  NATIONAL AIR AMBULANCE will try to work with the patient or his/her family in trying to reduce the cost.  In some cases, patient share programs and one-way patient transports are available.  Depending on points of origin and destinations, the cost of the transport could be substantially reduced.  Because NATIONAL AIR AMBULANCE uses only those aircraft licensed and inspected by the State of Florida to be Advance Life Support carriers, you may rest assured we do not call just any Air Taxi Operator.  We will only coordinate trips that use our own aircraft, equipment and personnel, or deal with those operators whose standards are as high as our own.
 
7.               WILL THE PROPER AIRCRAFT BE UTILIZED?  WILL IT COMFORTABLY ACCOMMODATE THE PATIENT?
 

The major factor to consider in selecting the type of aircraft is the patient’s condition.  For most flights of more than one or two hours duration, jet aircraft is certainly preferable to a propeller aircraft.  The patient’s “flight time” is substantially minimized in a jet.  A jet’s flight will be above the weather, not bouncing around in it.  All jet aircraft are pressurized.  There will be fewer fuel stops (or none at all) than with a propeller aircraft.  Some propeller aircraft are pressurized, others are not.  For short flights, particularly when the patient is very stable, a propeller aircraft (even an unpressurized one) might be utilized for air ambulance flights.  However, this is a decision that should only be made after the consultation between the air ambulance service’s Medical Director and the patient’s physician.  Airplanes with proper loading capabilities are also necessary.  Some aircraft have doorways and internal configurations which cannot accept stretcher entry at all or without tilting the patient.

Unbelievably, some services do not have stretchers; some simply carry the patients on the floor of the aircraft on mattresses.  Make sure that the service you choose will use an FAA approved stretcher securely fastened to the aircraft.  The stretcher must have straps to secure the patient.  It must be located so that the attendant has good access to the patient’s entire body.

If you ask this question of several different “air ambulance operators” you will be totally amazed at the answers you get.  Some will answer, “What do you want us to carry?”; some will answer, “We can put oxygen on the airplane if it is needed”; some will say, “We carry nothing but the stretcher.”  This is a most important consideration.  The states that require licensing of air ambulance service do establish at least the bare minimums for required equipment.  The truly competent air ambulance service carries much more than any licensing authority requires.  And in addition to standard equipment, often additional items are needed to care for particular patients.  This should be determined during the preflight consultation with the patient’s attending physician.

A true air ambulance should have the following:

A.    Basic Patient Care Equipment

1.     Oxygen equipment, with proper masks and nasal cannulas

2.     Complete drug kit with general drugs

3.     Stethoscope and blood pressure cuff

4.     IV administration sets and fluids (IV pumps)

5.     Oral airways and manual resuscitation unit

6.     Suction equipment, electrical and oxygen powered

B.    Emergency cardiac drugs

C.   Intubation equipment

D.   Other specified as indicated:

1.     Cardiac Monitor/Defibrillator

2.     Ventilator (Volumetric)

3.     Special splints traction units (cervical orthosis, stryker frame, Hare etc.)

Make sure that medical oxygen (not aviators breathing oxygen) is provided and make sure that sufficient quantity is provided for the flight. 

NOTE:  In many, if not most, cases even if a patient is not receiving oxygen on the ground, he should receive oxygen in flight because of the reduced oxygen available in the normal air as the aircraft ascends.

Many patients require IV fluids during flights.  A competent service will always have these available even if the preliminary information does not indicate that they will be required.  Due to low aircraft ceiling and changes in pressurization, an intravenous pump is often required with intravenous therapy.

NATIONAL AIR AMBULANCE carries standard and specialized intravenous fluids, IV pumps, and other related equipment on all flights.

Many patients require suctioning when transported by air even if they don’t require suctioning on the ground.  Make sure the operator provides suction units with sufficient power to operate them for the entire period of the flight.  Make sure these suction units are powered either electrically or by oxygen.  Hand or foot operated units are of little value.

The air ambulance service should provide:  clean sheets, pillows, blankets, etc.  Catering should be provided with particular attention to the patients required diet.  Rain sheets, umbrellas, etc. should be made available for patient transfer in inclement weather.  If possible, hangars should be available for patient loading/unloading in extremely bad weather.

An air ambulance service should control all aspects of the patient transport.  A “TOTAL SERVICE” air ambulance will provide bedside to bedside service.  It is imperative that ground ambulance arrangements be made, confirmed, updated and reconfirmed to avoid patient waiting.  This should be done by the air ambulance service with the all-inclusive price quotation.

The air ambulance service should have sufficient medical personnel on staff to handle all inquiries as they arise.  Of course, emergencies will be given first priority; however, someone should be available to answer specific questions regarding air patient transport.

Call NATIONAL AIR AMBULANCE on our toll-free number (800-327-3710), which is also toll free from many Caribbean points as listed below, or collect (954-359-9900) or just send us a fax (954/359-9500).   All numbers are 24 hours a day, 7 days a week.  You will find that our rates are competitive with all of the qualified air ambulance operators.  But, more important, you will find that our operation is professional and competent in every respect.