Care in the air

Superior medevac services have taken wing in the Middle East. Liz Moscrop rounds up what's on offer.

The Middle East has a long history of being leaders in medicine. Indeed, hospitals came into being during the early Islamic era with the advent of establishments called Bimaristan, which is a Persian word meaning ‘house of the sick’.
Today, as many countries in the region establish cutting-edge medical institutions, there are still some conditions that are better treated on other continents. This is where air ambulance services excel.
People can fly out to the world’s foremost specialist medical institutions. In order to do so they need state-of-the-art “flying hospitals” – medevac aircraft.
Typical equipment can include neonatal and adult and paediatric intensive care units, which can be configured in hours from the initial request. Depending on the size of the aircraft, you could find cardiac monitors, defibrillators and pacemakers, ECG machines, IV equipment and fluids, ventilators, stretchers and oxygen tanks, spine and torso immobilisation devices, splints, catheters, dressing materials for wounds and advanced burn care full neonatal resuscitation equipment.
Operators also offer teams of specialist medical practitioners to accompany patients on board, from emergency physicians and anaesthetists through to intensive care specialists and paediatricians.
The key to a successful medevac operation is being able to offer a rapid turnaround from request to take off.
US company Spectrum Aeromed, which is based in Fargo, North Dakota, provides specialist equipment required to transform a cabin into an emergency room. Around 75% of the firm’s customers are outside of the US, so it has designed a modular system that can turn an ordinary aircraft into a state-of-the-art operating theatre if necessary.
The firm’s account representative for Europe, Middle East, Russia and Asia, Thomas Redder, explained: “Next to the certification processes, at Spectrum Aeromed, we have designed our systems in a way that allows operation in accordance with regional standards around the world. We can provide a customised solution globally, including all required certifications.”
This means, for example, that the electrical sockets in its module are identical to the public electrical system used in the aircraft’s country of operation, and gas outlets are identical to gas outlets used in hospitals in the country of operation. He continued: “We pay attention to these details to make the process smoother for the users.”
Although the Middle East is a vast geographical area, it is well served with paved runways and airfields, so many regional and international operators offer medevac services, primarily using large cabin aircraft (or larger rotary aircraft for hostile areas).
Gama Aviation is confident that there is a strong market for such services in the Gulf. Martin Ringrose, the company’s Middle East MD said: “We predict a significant increase in aero medical evacuation services in the UAE. We believe this will be fuelled by economic growth, a growing population, a rise in tourism as Dubai builds towards the 2020 Expo, and the on-going development of the country’s world-leading aviation, financial services and healthcare sectors.”
He added that, since it is developing some of the best hospitals in the world, the UAE would increasingly be a beacon for people in the region needing urgent medical assistance or specialist healthcare.
UK Gama already provides air ambulance services to the Scottish National Health Service and Duncan Daines, the firm’s chief marketing officer, believes this will help it deliver medevac in the Middle East.
He said: “With an expanding population, a large internal road network and all the modern maladies of our 21st century sedentary lifestyle, the use of aeromedical services within the UAE and the wider GCC region is undoubtedly set to expand. Survival rates for heart attacks, road traffic accidents, and other critical incidents are all improved with a combination of fixed and rotary support. It really is a case of when, not if, these services become more widespread within the GCC.”
Gama believes that aircraft movements in the UAE are expected to double between today and 2030, and says that over the past three years there has been a complete overhaul of healthcare provision in the country, with huge investment in the sector seeing lots of speciality hospitals opening, with more on the way.
Ringrose continued: “The UAE is seeing strong economic growth and attracting more business visitors, tourists and expats. All of this will fuel growing demand for aero-medical evacuation services and this is one of the key reasons why we continue to invest in developing suitable aviation infrastructure in the UAE.”
In June, Abu Dhabi-headquartered Royal Jet subsidiary, Royal Med, took home the prize for the ‘medevac service provider of the year – UAE at the 2016 Oil & Gas Awards organised by MEA Markets.
The firm also sponsored a healthcare convention in Abu Dhabi in May. Chaired by HE Sheikh Hamdan bin Mubarak Al Nahyan, the company has delivered more than 1,000 medical evacuation flights. It employs 15 paramedics and intensive care nurses, as well as 10 doctors and consultants, and can turn its aircraft into intensive care units.
Another local player is Dubai-headquartered RMSI, an international rapid deployment medical and rescue service, specialising in 24/7 complex and high-risk missions. Primarily operating in unstable war or conflict-affected territories and areas of extreme natural or man-made hazards, it offers a dedicated fleet of medevac rotary and fixed-wing aircraft that support both civilian and military personnel. Deployed with intensive care medical staff and equipment, they can be dispatched within minutes and safely transport patients to the nearest appropriate medical facility.
The firm set up shop in 2008 and was the first licensed air ambulance operator in Dubai. It offers remote on-site medical staffing and clinical facilities, topside medical support through the Dubai-based 24-hour mission response centre, and both ground and air ambulance services.
CEO Rob Lamb said: “Geographically, Dubai is the centre of the world and, from both a logistical and commercial aspect, the only place I would consider anchoring RMSI’s operations. Being based in Dubai allows for quick, efficient and smooth deployment of RMSI’s air ambulances to our clients across the region, with world-class medical care in Dubai enabling us to bring patients here for emergency treatment. The healthy business environment in the city, coupled with innovative vision of its leaders, makes it an attractive place to call home.”
The firm’s high-speed intensive care jets (operated by Empire Aviation) are deployed within minutes of receiving flight clearance. Every stage of the journey is monitored with high-tech satellite tracking, and communication is maintained between the air ambulance and the mission response centre.
FAI Rent a Jet is one of the world’s leading air ambulance suppliers and averages two intercontinental medical evacuations per day.
Last December, the German operator added a fifth Challenger 604 to its fleet of air ambulances, which are used for medevac missions worldwide, and often hired for private use in the Middle East.
Chairman Siegfried Axtmann said: “We took the decision to add a fifth Challenger as the model fulfils the unique requirements of long-range patient transport. With its spacious cabin, capacity for multiple missions and long-range capability, it is a valuable addition to the mix and supports our growing air ambulance activity.”
Hiring the right crew is essential. All FAI’s pilots and medical personnel have to be willing to fly into areas of conflict if necessary, although the firm stresses that it adheres to guidelines and will not operate in no-fly zones and areas deemed completely unsafe by the international aviation community.
According to Axtmann, the number of medevac flights to and from the Middle East has remained stable for the last year, “neither growing nor decreasing”. Other than medical repatriation for insurance companies, clients fly to and from the region for specialist medical care that is not yet available in the Gulf.
Meanwhile, Turkey’s Redstar Aviation has introduced a Learjet 45 to its medevac fleet, which it has converted into a two-stretcher air ambulance, replacing its older
Jetstream 32.
This March, it received European Aviation Safety Agency (EASA) third-country operator (TCO) authorisation to conduct commercial air transport operations into, within or out of, any EU member country, as well as EU overseas territories and four European Free Trade Association states. The TCO will be mandatory for air carriers from November 2016.
While medevac operators require highly specialised skills and equipment, so, too, do brokers who source such flights.
Experienced brokers understand that it is crucial to obtain a medical report or a contact number for the doctor treating the patient. Without this, the air ambulance operator cannot determine the best solution for the patient, or whether they are stable enough to fly.
Trust is vital, alongside due diligence. Medical flights involve sick and dying people and come with understandably emotional family members.
British broker PrivateFly includes air ambulance flights in its offering. CEO Adam Twidell said: “We do arrange some medevac flights to and from areas in the Middle East, such as Dubai and Abu Dhabi. Typically, these are clients needing repatriation or specialist treatment in the Europe and the US.”
The equipment may have changed exponentially, but ancient Islamic values and practices still hold true when dealing with sick people in the aeromedical field. Bimaristans were secular. They served all people regardless of their race, religion, citizenship, or gender. The ultimate goal of all physicians and hospital staff was to work together to help the well-being of their patients.