Air Ambulance & NEMT: Multi-Mission Aviation's Heartbeat

Your family member just had a stroke; however, you live in a rural area hundreds of miles from the nearest medical facility. How do you get your loved one quickly to the right medical center? The answer is an Air Ambulance. Here's an overview of what they are and how they function...

One of the most profitable sectors within “Aerial Work” Aviation is Air Ambulance and Non-Emergency Medical Transportation (NEMT) Services. Over the last thirty years, the Air Ambulance and NEMT market have increased substantially. Based on many market surveys published yearly, the general projections regarding global market value is in the billions of dollars.

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Outside of economics and without saying of its importance, Air Ambulance and NEMT services are critical services that mitigate the tyranny of distance and time when it comes to saving lives. Over the years, these services have become faster and more reliable. In some cases, it’s the only option to transport critical medical patients, medicines, or vital transplant organs.

So, what is this sector of Aerial Work aviation? Following, we will explore the answer...

What's the Difference Between Air Ambulance and NEMT?

Overall, the foundation of both is the same, both Air Ambulance and NEMT services are about moving medical patients or critical medical packages via aircraft from distant locations or between healthcare facilities.

In general, the services provided on these flights range from an emergency or urgent care, general assistance, to transporting lifesaving medical items (donor organs, COVID-19 test or vaccine trial data, one-off medicines, etc.).

However, the simple difference between the two services is related to responding to an emergency or non-emergency situation.

Air Ambulance or Medical Evacuation (MEDEVAC) focuses on emergencies. Air Ambulances typically respond to life-threatening events like an auto accident or a heart attack. In many cases, rotary-wing aircraft are used for these types of events.

Non-Emergency Medical Transportation (NEMT) or Medical Air Transportation concentrate on transporting stabilized patients over a long distance to a medical facility or home. The standard aircraft used in NEMT are fixed-wing twin-engine, turboprop, and jet aircraft.

Who Provides These Services?

The providers of Air Ambulance or NEMT services vary from no-fee (Government) to fee (Independent) providers. The main service models are:

Hospital-Based: The Hospital-Based model or Traditional model consists of a hospital controlling the operation and providing medical services and staff while contracting out (usually long-term) with an independent Air Ambulance provider for the flight operations.

Independent: The Independent or Community Based model involves private companies owning and providing services rather than a specific medical facility. Under this model, an Air Ambulance or NEMT provider operates on a fully integrated basis either by directly employing or contracting with other parties to provide aviation, medical, dispatch, communications, and billing and collection services. A large percentage of Air Ambulance providers operate predominately as independent providers.

Government: The Government model or approach includes national or local government or military units owning and operating the Air Ambulances. Most governments provide Air Ambulance services, either directly or via a negotiated contract with an independent service provider. The government will provide guidelines to hospitals and Emergency

Medical Services (EMS) systems to control operating costs and may stipulate operating procedures in some level of detail to limit potential liability.

What Type of Aircraft are Used?

An Air Ambulance or NEMT platform is usually a heavily modified or configured aircraft with specialised medical equipment and kit. The primary aircraft used in this sector are manned rotary-wing and fixed-wing aircraft.

Manned Aircraft Rotary-Wing: Most Air Ambulance or MEDEVAC services operate helicopters. An advantage of a helicopter Air Ambulance is its ability to land in a variety of locations such as streets, parking lots, parks, or fields, in rural areas or confined urban environments.

However, since helicopters have a short flight range, they are mostly dispatched for emergency cases in which a patient who requires critical medical care can be transported as quickly as possible.

The common type of aircraft used for MEDEVAC is the helicopter (e.g., Bell 206, 407, 429; Eurocopter 135, 145; and the AgustaWestland (Leonardo) AW109, AW149).

Fixed-Wing: The predominant user of fixed-wing aircraft is NEMT providers. A significant advantage of a fixed-wing aircraft is the extended flying range and having a larger cabin area that allows for more advanced medical equipment. Additionally, with extra cabin space, fixed-wing aircraft can accommodate additional medical staff and traveling patient companions.

The common type aircraft used for air NEMT is fixed-wing aircraft, e.g., Learjet 31, 35,36; King Air 90, 200; Pilatus PC-12, and Piper Cheyenne.

Unmanned Aircraft: Even though unmanned or drone aircraft are not currently used in the mainstream of Air Ambulance and NEMT operations, the potential of using unmanned aircraft in this sector is growing. Currently, there are on-going efforts to develop and deploy drones that deliver quickly one-off emergency equipment or medication to individuals in stress with such items as a defibrillator, poison antidotes, EpiPens, or oxygen.

When it comes to transporting humans, several non-profit organisations and institutions are working on concepts that would deploy a small van-sized drone that could fly to an emergency scene with one paramedic on board. The drone would be controlled autonomously (GPS guided) or by a remote pilot.

Are These Aircraft Equipped the Same as a Ground Ambulance?

Depending on the type of aerial service provided, most Air Ambulance and NEMT aircraft are modified or integrated, like a ground ambulance, with medical equipment vital to stabilizing, treating, and monitoring ill or injured patients. The typical equipment for Air Ambulances include:

• Medications
• Ventilators
• ECGs and monitoring units
• CPR equipment
• Stretchers.

Today, with the COVID-19 crisis, many NEMT service providers are now adding “Isolation Pods” and specialised sanitising procedures to their capabilities regarding transporting infected patients.

If I Were a Patient on One of These Flights, who Would I See?

Overall, you will see a highly qualified group of people handling your every medical and transportation need. Varying on the type of Air Ambulance or NEMT service you're involved with, the primary professionals you will or might encounter and the kind of training they have are:

Flight Crew

Pilots: For both fixed-wing and rotorcraft, Air Ambulance and NEMT Pilots have a Commercial Pilot Certificate and Instrument Rating. Pilots are required to have at least a second-class medical certificate or even a first-class medical certificate. Many Air Ambulance and NEMT service providers require their pilots to have a minimum of 1000 flight hours before participating in any operation.

Flight Physician: Licensed physicians with experience in Emergency Medicine, Internal Medicine, Anesthesiology, or Trauma Surgical care. Sometimes a specialised or personal physician accompanies a patient but does not have the same Air Ambulance training as a Flight Physician.

Flight Nurse: Licensed nurses with experience in Emergency Medicine. They are specially trained to care and transport critically ill patients.

Flight Paramedic: Licensed paramedics with experience in Emergency Medicine. Like a Flight Nurse but with different care given protocols, they are specially trained to care and transport critically ill patients.

Training and Qualifications

Besides the specific professional education of each crewmember (Pilot, Flight Physician, Flight Nurse and Flight Paramedic), many receive additional training that relates to flying and managing the airlift of medical patients. The type of specialised Air Ambulance or NEMT training these crewmembers receive are:

Advanced Certifications

• Basic Life Support (BLS)
• Advanced Cardiac Life Support (ACLS)
• Pediatric Advanced Life Support (PALS)
• Neonatal Resuscitation Program (NRP)
• Pre-Hospital Trauma Life Support (PHTLS)

Air Ambulance Aircrew Training

• Physiological Aspects of Flight
• Crew Member Duties and Responsibilities/CRM
• Aircraft and Ambulance Safety
• Airmanship, Aviation Communications, and EMS Radio Procedures
• International/National Civil Aviation Regulations
• Air Medical Resource Management
• Bloodborne Pathogens
• Hazardous Material Handling
• Health Insurance Portability and Accountability
• Passenger Briefing Procedures
• Survival and Emergency Procedures

In Summary

The Air Ambulance and NEMT service sector is indeed the heartbeat of Aerial Work aviation. Like with so many Aerial Work aviation sectors (Aerial Surveying and Mapping, Aerial Fire Fighting etc.), the Air Ambulance and NEMT service sector has its unique operating system, specialized aircraft, and dedicated crews.

The future of the Air Ambulance and NEMT sector is incredibly positive. Because of COVID-19, improved access to quality treatment, and increasing public awareness of such services, the Air Ambulance and NEMT aviation sector 'Vital Signs' look great!

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