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What Are The Main Complexities Of Conducting International Evacuation And Repatriation Missions?

What Are The Main Complexities Of Conducting International Evacuation And Repatriation Missions?

According to global medical assistance and claims providers CEGA, there has been a 30% year-on-year rise in demand for privately-funded medical repatriations.

Heart problems, long term illnesses and complex fractures are among the most common medical ailments at the source of private repatriations, according to CEGA, with demand spanning areas as diverse as southern Asia, the Caribbean and mainland Europe.

"The demand for medical repatriations is greatest from Europe" says Cecilia Geofilo-Pearson, CEGA's Business Development Manager.

"But we are getting requests from all over the world - ranging from straight forward road journeys and scheduled flights with medical escorts, to intensive care air ambulance transfers that necessitate full medical management, complex travel arrangements and hospital admission."

But what are the main complexities when conducting global medical evacuations and repatriations?

Healthcare used to be a local service for local people in a local area serviced by a local GP, maybe a friend of the family. What happens when an expatriate falls sick or has a major accident - What then? Shopping in a foreign country can be hard enough, but what about access to healthcare and medical services?

In this article we hear about the main complexities of international medical evacuation and repatriation missions and how air ambulance and assistance companies prepare for such emergency situations 365 days a year.

Irena Dimitrijevic, Jet Executive: On a daily basis the flight operation and the dispatchers have to overview all the requirements, limitations and challenges of each country and airport. Every single airport is different therefore it is hardly impossible to foresee all relevant costs and changes. The clients on the other hand often require an all inclusive price.

Example: We had a flight confirmation for Tromsø, Norway. When we started to prepare the flight we were told by the local authorities that all of a sudden the airlines require an additional certificate to operate into the northern parts of Norway in the winter season. We have done many operations in winter to this region before but now the restrictions by the government came along and these kinds of changes are daily business. 

In the long term the biggest challenge is to maintain in the highly competitive market with the constantly rising costs in aviation but at the same time keeping the flight prices for the clients as unfortunately the service is mainly price driven. 

Adam Booth, Mayday Assistance: The main complexities include having to communicate with not only the patient/ family to reassure them, but also the treating hospital, local ambulance companies and any other organisations involved on a particular case. This is all before we even commence the planning of the Repatriation which will require completion of a Medical Information form for the airline (or multiple airlines), ensuring that they grant clearance for the flight, organising Medical staff to fly out to the client and that they are well rested prior to the return flight, especially with long-haul flights.

Then the arrangements back in the UK, whether it be transporting the patient home or organising a bed in their local hospital.

Philipp Schneider, Quick Air: One of the main complexities is the “just in time” organisation of a medical evacuation. All steps of the patient transport for example take over in the hospital; ground transportations etc. have to be carefully planned.

Furthermore flight crew duty and rest times as well as local time zones have to be observed regarding a safe and sound transport of the patient. Also unplanned delays have to be calculated concerning oxygen reserve and the stock of medication.

Another complexity is the valuation of the integrity of medical details provided especially when patients stay in remote areas. A detailed query by an experienced medical department is essential for the mission success.         

Claudia Schmiedhuber, Tyrol Air Ambulance: From my point of view – every mission is different and comes with different challenges and complexities. I think the first factor that has to be taken into consideration is the mode of repatriation. There is a significant difference between repatriation via air ambulance jet when compared to repatriation via commercial flight.

Secondly, we have to differentiate the kind of mission – whether this is a repatriation back to the home country to continue treatment or therapy, or a flight to a foreign country to start a new therapy or improve the current status or whether this is an emergent evacuation to safe the patients’ life.

Thirdly, the patient’s personal situation, as well as any external factors, have to be taken into consideration, carefully assessed and acted upon. TAA has performed thousands of missions over the course of more than 40 years in business and I, myself, have concluded numerous repatriations. No two cases are the same, no two patients conditions are the same, and every country has its own challenges and obstacles to overcome – whether that be a foreign language, cultural differences or indeed a completely different healthcare system. The key for a successful provider, in my opinion, is to be sensitive to all of these aspects and to ensure that everything is taken into account to ensure a safe and comfortable mission.

It is critical for TAA’s Operation Centre to ensure that we possess all necessary overflight and landings permits, to confirm that the crew visas are valid and do not cause any delays, to check if there are any accompanying people on board or to see if there are any weather restrictions at the airport of choice. Furthermore, it is necessary for a well-functioning operations centre to be prepared for any unforeseen events that can and do occur during such missions, ranging from any change in the patients’ health status through to weather changes or security alerts.

All of these factors mentioned above contribute to the organization and successful completion of a repatriation mission – whether by air, ground or sea.

Eva Kluge, Air Alliance: There is a multitude of complexities. It would be too long to describe all of them. From an air ambulance’s point of view, here are some:

Provision of aeromedical infrastructure

Air Ambulance flights need to happen fast and it is unpredictable where on this planet you will head next and which patient you will fly. The provision of an ad-hoc aeromedical infrastructure and perfectly maintained, safe aircraft requires a very high, continuous investment and a sustainable business model.

It also means that your entire organization needs to be very well organized and stocked: have your aircraft, medical equipment and teams ready, including all licences, insurances, pilots’ type ratings, trainings, aircraft maintenance, visa, vaccinations etc. Only then you will be able to set out immediately when your client needs your services.

Medical challenges

As mentioned above: your next patient could be 150 kg, elderly person with several by-passes, a 1,5 kg prematurely born baby or just a “normal” adult. For each patient, a careful pre-flight medical assessment is essential. Normally, our client will already have pre-assessed the patient’s condition and will share this information with us. Nonetheless we are obliged to double-check on the patient’s condition before the mission and when picking him/her up. Once our doctor accepts a patient on board he/she is – from a legal point of view – medically responsible. In most cases, the pre-flight patient information given to us is helpful, but occasionally, we detect e.g. missing diagnostics, unclear information, unknown pre-existing conditions or clinical assessments which would be ok on the ground but not in the air. It may have a dramatic impact if, prior to a flight, our medical team would not ask the right questions. It is also quite important to see the patient in the clinic before departure, speak to the treating doctor, check if his/her condition corresponds to what you have been told beforehand and, after arriving at the final destination, to take the patient to the hospital (“bed-to-bed”) for a smooth and safe handover.

Logistics, Planning and Timelines

Landing and overflight permits need to be obtained and fuel needs to be ordered. Heeding the duty times of staff within the legal confines is an essential part of planning.

The medical equipment and medical kit on board need to be regularly maintained and stocked up. They need to be adjusted to the patient’s needs during the entire journey (e.g. medication, amount of oxygen). Our medical teams all are very experienced and prepared to react to any change of the patient’s condition on board.Especially when flying long range, we come across a variety of wind and weather conditions. Just remember hurricane Matthew in the US some weeks ago.

Any change or delay may also result in higher costs. We have a very good record in punctuality, fortunately. In smaller airports it is sometimes easier to obtain a landing slot, but they usually do not operate around the clock, so you need to land and fly out on time. It is also a bit unpleasant to arrive in a hospital abroad and to learn that there is an unsettled hospital bill – the hospital may refuse to discharge the patient while your aircraft is waiting. It rarely happens, but it does.

We review our missions on a regular basis, internally and together with our clients. The goal is to learn from experience and become even better.

 

 

 

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Hacks Tax and Expatriates

Hacks Tax and Expatriates

Panama law firm announces major data hack. Resignation of Icelandic PM. Swiss police raid Uefa offices. 20 global leaders alleged to have used tax havens. British PM gives 5 different answers to questions on finance after allegations that his father paid no tax for 30 years then eventually admits he profited from father’s offshore fund. China shuts down the Internet...

08-04-2016 Articles Case Studies

Where There's A Will, There's A Way

Where There's A Will, There's A Way

Aviva‘s latest Family Finances Report highlights very clearly the lack of planning people generally have in place should they die. It also reveals that although families know they should plan ahead for the inevitable, they find it difficult to have those important conversations.  The report suggests that 62% of people feel that death is a taboo subject. These figures are borne out...

11-03-2016 Articles Case Studies

Insurance Companies And Products As We Know Them Today Will Have To Evolve

Insurance Companies And Products As We Know Them Today Will Have To Evolve

That's according to Griselle Chernys, CEO, at Wellaway, who took an executive seat on a recent iPMI Magazine round table business forum. Although global risks have changed dramatically, medical inflation and the cost of employee benefits continues to cause concern. In the most recent iPMI Magazine Round Table Business Forum we spoke with leading C-Level executives from the world of International Private Medical...

20-12-2015 Articles Case Studies

Self-Insured Funding – Is This The Right Option For Your Company?

Self-Insured Funding – Is This The Right Option For Your Company?

With rising premiums and reduced benefits to employees, many employers are deciding to self-fund their healthcare benefits, in order to avoid costly healthcare reform mandates, taxes, and inflated insurance carrier profit margins.  Nearly 60% of employers in the USA, of all sizes, self-fund their healthcare plans, states the Employee Benefit Research Institute.  The question remains, “Is self-funded the right option...

04-09-2015 Articles Case Studies

The IRS Moves Towards Implementing The Cadillac Tax

The IRS Moves Towards Implementing The Cadillac Tax

Regardless of the opposition of congressmen, brokers, and employers, on July 30th, the United States Internal Revenue Service (IRS) issued another notice on the Cadillac Tax, which will go into effect in early 2018.  Notice 2015-52 Section 49801 – Excise Tax on High Cost Employer-Sponsored Health Coverage addresses additional topics and issues related to the Cadillac Tax, which will seriously impact...

04-09-2015 Articles Case Studies

What Is Important When Designing Maritime And Marine Medical Health Insurance Plans?

What Is Important When Designing Maritime And Marine Medical Health Insurance Plans?

There are more than 1.5 million seafarers in the world. A majority of these seafarers now have a right to be protected through national laws and practices applying the MLC, 2006 to the ships on which they work. Title 4 of the MLC covers Health Protection, Medical Care, Welfare and Social Security Protection. From August 20th 2013 all vessels over...

26-08-2015 Articles Case Studies

Critical Considerations When Designing Individual International Private Medical Insurance Plans

Critical Considerations When Designing Individual International Private Medical Insurance Plans

Introducing a business into new emerging markets is the response from worldwide business owners to the preeminent mega trend that is globalisation. Establishing a global footprint may be of pivotal importance to a wide range of industry, and according to PWC, cross-border assignments are showing no signs of a slowdown. In fact, 59% of CEOs plan to send more staff on...

26-08-2015 Articles Case Studies

What Are The Key Differences Between An iPMI And A Local Insurance Plan?

What Are The Key Differences Between An iPMI And A Local Insurance Plan?

In a recent International Private Medical Insurance Magazine executive round table business forum, we spoke with leading C-Level executives about the major differences between international private medical insurance plans and local insurance plans. As expatriate hot spots around the world continue to mandate insurance cover for expatriate employees, under various visa and employment laws, questions from the business community continue to...

26-08-2015 Articles Case Studies

Shipping Losses Lowest For 10 Years But Mega-Ships And Cyber-Attacks Pose New Threats For Maritime Sector

Shipping Losses Lowest For 10 Years But Mega-Ships And Cyber-Attacks Pose New Threats For Maritime Sector

75 large ships lost worldwide in 2014, down by a third year-on-year. South China and South East Asian waters top loss hotspots. Increasing size of container ships and floating offshore facilities could cause larger losses exceeding $1 billion. Cyber risks a growing concern in shipping sector, particularly around e-navigation. Crewing levels, Arctic shipping, the increase in human trafficking by sea...

26-03-2015 Articles Case Studies

U.S. Employers Expect Health Care Costs to Rise 4% in 2015

U.S. Employers Expect Health Care Costs to Rise 4% in 2015

Companies plan to continue subsidizing and managing benefits while taking aggressive action to keep costs down. U.S. employers expect a 4% increase in 2015 health care costs for active employees after plan design changes, according to global professional services company Towers Watson (NYSE, NASDAQ: TW). If no adjustments are made, employers project a 5.2% growth rate, putting absolute cost per person...

21-08-2014 Articles Case Studies

How Can Corporations Improve And Manage The Life Cycle Of Their Expatriate Workforce?

How Can Corporations Improve And Manage The Life Cycle Of Their Expatriate Workforce?

It isn't easy living as an expat and a mix of social, economic and personal circumstances can lead to failure and return. This is one of the big hidden costs of expatriation. The expat quits the assignment and wants to return to their country of residence. On return, they may also leave the company forcing downtime, time and economic expense and...

21-08-2014 Articles Case Studies

What Has The Maritime Labour Convention Meant For The Insurance Industry?

What Has The Maritime Labour Convention Meant For The Insurance Industry?

The Maritime Labour Convention 2006 (MLC 2006) was adopted at a Maritime session of the International Labour Conference (ILO) in 2006 and came into force on 20th August 2013. There are more than 1.5 million seafarers in the world and a majority of these seafarers now have the right to be protected through national laws and practices, applying the MLC 2006 to...

21-08-2014 Articles Case Studies

Defining International Assistance In 2014

Defining International Assistance In 2014

International tourist arrivals grew by 5% in 2013, reaching a record 1,087 million arrivals. Despite the current global economic climate, international tourism results were well above expectations, with an additional 52 million international tourists travelling the world in 2013. For 2014 the UNWTO forecasts 4% to 4.5% growth, above the long term projections. Demand for international tourism was strongest for destinations...

20-08-2014 Articles Case Studies

Managing Risk And HR Asset Protection In The Oil And Gas Industry

Managing Risk And HR Asset Protection In The Oil And Gas Industry

The recent Al-Qaida attack on a natural gas facility and subsequent hostage situation in Algeria, represents some of the extreme dangers Oil and Gas workers face 365 days a year. Originally published 29/1/2013. Militants stormed the Tigantourine natural gas facility near In Amenas with dozens of people killed. Tragically when Algerian military forces stormed the facility, more fatalities were caused. This dramatic...

06-03-2014 Articles Case Studies

The Advantages of Telemedical Consultation

Written By Frank Reuter, Reuter Consulting http://www.reuterconsulting.com Telemedical consultation, which may also be referred to as telemedicine or telehealth consultation, focuses on providing patients with the best possible telephonic advice, independent of the location the caller is in. This method of advice is already common in the United Kingdom and Switzerland and is gaining international momentum. The use of telemedical providers plays an...

19-08-2013 Articles Case Studies

International Assistance Group Core Partner AA International Evacuates Shotgun Wounded Tourist

AA International, Core Partner of the worldwide network of assistance companies, International Assistance Group, received a request from a German Assistance company requesting to organise a medical evacuation of an injured German National from Jayapura, Papua to Singapore. AA International immediately organised the appropriate team and its own air ambulance, a Learjet 35A, for the mission. AA International departed with an...

19-08-2012 Articles Case Studies

International Assistance Group Core Partner ihi Bupa Evacuates British Road Crash Victim from Somalia

A 53-year old British ihi Bupa Travel member was recently involved in a serious road accident in Somalia. Once at the ER in a local hospital, the member’s friend contacts ihi Bupa’s 24-hour assistance service team requesting an air ambulance evacuation. Shortly after the member has been evaluated, ihi Bupa’s medical consultant speaks to the treating doctor. This is the...

19-08-2012 Articles Case Studies

Air Medical Transportation Europe

  Düsseldorf 08:00 AM: A call comes in to operations of Jet Executive, JEI: a 30 year old man vacationing on Mallorca, Spain is suffering from a fracture of leg and rip after a motorcycle accident. While speeding on the highway he hit a pole. The girlfriend of the patient was sitting in the back but luckily she didn’t have any...

01-02-2012 Articles Case Studies

Business Trip Security Development Of Company Risk Management Plans

Written By Frank Reuter, Reuter Consulting http://www.reuterconsulting.com Companies are often careless about “Business Trip Security”. Only few purchase adequate travel insurance programs. Efficient risk management for employees and for the company itself is the exception. This is considered negligent as organizations have a general statutory duty of care towards their employees. The “EU Corporate Manslaughter and Homicide Act”, which is planned...

19-11-2011 Articles Case Studies