“When you get into the larger aircraft it becomes like a hotel, with dozens of staff supporting the plane based in a galley area down below. You have very comprehensive cooking facilities, and on larger aircraft we have looked at theatres, with spiral staircases and a Steinway grand piano. The limitations for what you can put inside a plane are pretty much the limits of physics, and even money cannot always overcome that. Even so, people are still always trying to push [the limits]. ”
Getting Home Sick
You fly aboard a business jet. Could you have any better insurance policy than that if you need medical care while traveling or must return home due to injury or illness?
Actually, yes, say companies that provide aeromedical insurance plans. “Just because you fly privately doesn’t mean you can get back safely where you want to go in case of an emergency,” said Roy Berger, CEO of MedjetAssist, an international medevac plan provider based in Birmingham, Ala.
Plan purveyors and medevac experts cite a host of reasons why a business jet is unsuited for air-ambulance duty, including improper cabin layout and the lack of medical equipment and an aeromedical team. A stretcher can’t even be loaded horizontally aboard most business jets, and standard divans aren’t certified for use by a prone passenger during taxiing, takeoff or landing. Depending on the patient’s condition, a ventilator, a heart-lung machine or sufficient headroom for a physician to perform aggressive CPR might be necessary. Additional considerations include biohazards and decontamination, transferring medical records and handling special visa requirements for transporting medical patients.
“You look at all these issues and your realize transporting people back home to medical care encompasses much more than just the aircraft and the airframe,” said Patrick Deroose, a group general manager at MedAire, a Tempe, Ariz.-based provider of traveler medical services with offices on five continents.
While the emphasis is on aeromedical evacuation, many plans offer ancillary services such as in-flight consultation with medical experts. But most basic medevac plans simply provide transportation from one medical facility to another one of your choosing–a hospital near your home or a renowned treatment center, for example–once your condition has stabilized. You might require such transportation due to a stroke, heart attack, contagious disease, fracture or–the most common reason–an accident involving ground transportation.
An increasing number of providers are taking steps to help members minimize their need for medevac services. “We’re also focused on taking care of travelers on the ground,” said Mark Roban, a vice president at MedEx Global Solutions, which covers medevac as well as evacuation from political turmoil and natural disasters. “Where the industry is really trending is to better prepare travelers so they’re less likely to have a medical emergency.”
Medevac plans differ in coverage areas, the aircraft they use, ancillary benefits and program policies. Some companies require annual membership while others sell plans for specific time periods. Some plans simply arrange greater reimbursement for medevac services from your current medical insurer. Costs for medevac plans are typically a few hundred dollars per year for international coverage, a sum that will likely seem a bargain to anyone who needs an air ambulance.
“We just did a non-member evacuation out of Egypt. That was $160,000,” said Jeff Tolbert, CEO of AirMed International, which specializes in long-haul medevac flights and is headquartered, like MedjetAssist, in Birmingham. As for the cost of an uncovered evacuation within the U.S., “Los Angeles to New York, you’re going to get hit with $30,000,” Tolbert said.
Comparison-shopping among coverage plans is challenging because the offerings are so varied–not only do the ancillary services differ, but so do the aircraft fleets and medical personnel, which are key considerations. To pick a plan, start by defining your coverage needs by evaluating your travel patterns, health status and the activities you engage in. If you don’t need ongoing coverage, choose a company that offers fixed-period policies. If you travel to remote areas, opt for a provider that has experience in the parts of the world you visit. And make sure the program offers transportation to a facility of your choice, rather than simply to the closest appropriate medical center.
Before signing up for a policy, ask the company for proof of aviation insurance and professional medical liability. Get tail numbers of the aircraft the service uses and identify the ownership. Determine from an independent auditor such as Argus or Wyvern that the aircraft meet safety-audit standards. Find out, too, about the provider’s ability to quickly locate and dispatch aircraft, and where the air ambulances are based.
You should also ask whether the company has a medical director, and ascertain his or her aeromedical qualifications, as well as those of physicians, paramedics and pilots. Inquire about onboard medical equipment and its age. Check references from previous medevac patients. If you have a medical condition that might require a specialist, ask whether such a specialist is on staff. Consider a plan provider’s unwillingness or inability to answer your questions as a red flag.
Due diligence is critical for several reasons: Your health is at stake, and the time to learn any unpleasant surprises about a plan’s coverage is before you sign up, not when an emergency occurs. Also, aeromedical services are largely unregulated. The FAA considers air ambulance companies to be Part 135 charter operators. The more stringent standards applied to helicopter medevac flights do not extend to long-distance fixed-wing operations. Required operational specifications mainly focus on ensuring that stretchers are secured aboard the aircraft by certified methods. (The Department of Transportation regulates medical equipment installed on air ambulances.) Two accreditation bodies, CAMTS (Commission on Accreditation of Medical Transport Systems) and Eurami (European Air Medical Institute), offer voluntary quality-control audits for aeromedical services, but their audits are not widely used.
The lack of industry standards can cause problems, say aeromedical experts. While a medical oxygen system is a necessity aboard an air ambulance, for example, no stipulations exist regarding minimum amounts of oxygen they must provide. And some air ambulances require external power on the ground, which can compromise patient care during a fuel stop. These may not be large issues for domestic travelers, but can be a factor in international medevac flights.
“Traditional air ambulance services use a Lear 35 or Lear 36 for transoceanic transport, and a Lear 36 doesn’t have an APU [auxiliary power unit],” said Tolbert of AirMed International, which is the only medevac-plan provider that owns its air ambulance fleet. “If you’re making a refueling stop, it can be cold in Newfoundland and hot in Brazil. Not being able to maintain a proper cabin environment is a big consideration.”
Tolbert also noted that a standup cabin such as the ones in the Hawker 800s that AirMed International operates on long flights can be a lifesaver. “In extreme cases, if a patient goes into full cardiac arrest, the doctor can’t perform chest compressions [aboard a smaller aircraft], because there’s not enough height in the cabin.“
Among the most important benefits these programs provide is peace of mind. The majority of medical evacuations involve sending patients home aboard a commercial aircraft accompanied by a medical escort. But these plans are all about covering yourself for worst-case situations.
“Business travelers nowadays go to remote areas, and it’s not getting easier to get appropriate health care,” said Deroose of MedAire. “Accidents and illnesses happen, and the better prepared you are with an assistance program, the better the chance of recovering and being productive again in the shortest possible time.”
Getting Out Of Harm's Way
If you use your jet primarily for domestic travel and rely on airlines internationally, you may be interested to know that some companies can help with evacuations in the event of political instability or natural disasters.
“We’re finding right now a tremendous need for our security or political evacuation product,” said Mike Roban, a vice president at MedEx Global Solutions. “Times are turbulent,” he added, citing recent unrest in Egypt, Libya and the Ivory Coast.
The company’s plans are available worldwide for situations involving both political turmoil and natural disasters, such as “in a location hit by an earthquake–we provide evacuation services in that situation,” Roban said.
Air Charter International, based in Dubai (aircharter-international.com), offers plans that cover emergency evacuation out of the Middle East, Africa and Asia. Flights may be provided through arranged priority seating on scheduled commercial service, or on chartered aircraft ranging from two-seaters to large-body airliners. The company offers emergency evacuation services for individuals and businesses operating in Afghanistan, Iraq, Kuwait and Sudan and has recently performed evacuations from Bahrain and Yemen. Levels of service range from simple security advisories to placing evacuation aircraft on standby for accelerated response.
Here's a listing of some leading medevac service providers, along with their plan highlights and contact information:
AirMed International. Specialists in international long-haul medevac flights. Only provider that has its own air ambulance fleet. Recently opened Hong Kong base. Provides fixed-wing airlift for the Mayo Clinic. Individual, family and group memberships available through annual and fixed-period plans. (877) 633-5387, airmed.com
Assist America Inc. Global emergency medical services, including medical referrals and critical-care monitoring in addition to evacuations. Coverage available solely through employee benefit plans. (800) 304-4585, assistamerica.com
AXA Assistance USA. U.S. arm of international insurer offers travel insurance plans, including medevac services. Provides assistance in more than 200 countries. Plans are geared to corporate customers. (800) 575-3195, axa-assistance.com
GlobalCare. Arranges for members to receive in-network rates for emergency treatment when traveling outside their insurance-coverage areas. Corporate plans only. International program costs $750 per employee annually or $250 per hour for work arranging medical services. Medevac fees are based on percentage of money Global Care saves members over their insurance company's standard deductibles. (800) 860-1111, globalcare.net
MedAire. Annual membership provides access to fee-for-service plan options such as MedLink Global Response Center for 24/7 access to medical care worldwide. Medevac flights provided through preferred air ambulance services, whose costs members pay. Individuals, corporate and flight-department memberships available. (480) 333-3700, medaire.com
MedEx Global Solutions. Global medical and travel services, including risk assessment, ground transportation, evacuation from political turmoil and natural disasters. Coverage available via annual, monthly and short-term individual, family and corporate memberships. (800) 537-2029, medexassist.com
MedjetAssist. Medevac provided via chartered air ambulance. Geared to corporate and leisure travelers. Program covers U.S., Mexico, Caribbean, Europe and Asia. Individual memberships, $250 per year; family memberships, $385 per year. Short-term coverage starts at $95. (800) 963-3538, medjetassist.com