Leading Private Medical Insurance and Assistance Magazine iPMIM speaks with Mr. Rupert Dent. Mr. Rupert Dent is the Managing Director and Accountable Manager of AirMed. After 20 years in the Investment Banking industry, 12 of which were with what is now known as UBS Investment Bank, Rupert joined AirMed in 2003 as a Director and shareholder. His experience in corporate finance has helped in the development of AirMed over the last nine years. In particular the adaptation of the aircraft fleet to include jets and the significant expansion of the medical capabilities of the company, have proved key aspects in being able to grow sales from £1.4 mio per annum to the current £7.2 mio per annum.
Please introduce yourself and your air ambulance company:
My name is Rupert Dent and I am the Managing Director and Accountable Manager of Air Medical Ltd “AirMed”. AirMed has been in business since 1985 and is the UK’s premier fixed wing Air Ambulance operator. It operates 6 aircraft for air ambulance work and is one of only two integrated service providers fully registered with the Care Quality Commission “CQC” for intensive care transfers, available within the UK.
AirMed owns, operates and maintains its own fleet and has a full-time medical department which is capable of providing the highest standard of patient care from neonates through to adult intensive care. In the past 3 years alone AirMed has carried out 1700 air ambulance missions and has clinically staffed 1400 of these. Many of these flights were undertaken within Europe, however a significant number were from destinations as far West as San Diego, as far East as Brunei and as far South as Ascension Island.
During the past 3 years AirMed has made significant investments in medical equipment, including the purchase of two incubator systems and all of the associated specialist pumps and monitors. We have gained extensive experience in doing specialist and intensive care transfers and on average just over a third of our trips through the year are now critical care transfers. AirMed’s close relationship with the Oxford University Hospitals Trust (OUHT), means that we not only have access to specialist medical personnel, but we also have excellent access to hospital beds for the admission of private patients.
What are the advantages of being an air ambulance owner/operator?
The advantages of being an Air Ambulance owner / operator are very straightforward: you have complete control over the content and quality of the service you provide. AirMed believes the best way to ensure that the quality of the service provided to clients is of high standard, is to have a totally integrated approach to managing as many aspects that make up the service offered, as possible. Specifically, combining in house patient care capability, with ownership of aircraft, aircraft operations and engineering, using a management team that work together with the same objectives, is the best way of ensuring the outcome of each evacuation is as good as it possibly can be.
What type of clients do you serve?
AirMed has a wide range of clients, though the majority of them are from the insurance/assistance industry. We have global agreements in place with many of the leading insurers and assistance companies. In addition to this insurance driven repatriation work, we also undertake a number of internal secondary transfers within the UK for step-up care on behalf of the UK NHS. This follows the decision by the Government to set up regional specialist health facilities. The majority of these transfers are neonatal and paediatric, but also include some ECMO patients.
Working in conjunction with the OUHT, AirMed provides the UK MOD with paediatric, neonatal and obstetric aeromedical support for all military personnel and their families stationed around the world. AirMed also provides evacuation support to the Canadian Government.
How much notice do you need to arrange an air ambulance transfer?
The answer to this partly depends on the patient’s needs and also where the patient is located. If the patient is in an area where visas and landing permits are difficult to source quickly, then there may be a lead-in time required of more than 12 hours. However in the vast majority of cases, AirMed can react to a go-now situation and depart with an intensive care medical team, 1hr30mins from receipt of confirmation.
What are the orders of service priority – quality, price or reliability?
The order of service priority is: quality, reliability and price. Whilst remaining as cost competitive as possible, AirMed believes that providing a high quality and reliable service is what matters to its risk and liability conscious client base.
How important is the accreditation process for air ambulance companies?
The requirement for accreditation differs depending on the legal framework in place wherever the company is registered. In England, there is a requirement for air ambulances to be registered with the care quality commission (CQC) for the regulated (medical) activities they carry out. Failure to comply is a criminal offence. In the main however, accreditation is a voluntary process which draws attention to the quality of the service provided. There are two organisations involved in accrediting excellence in the air ambulance world; the European Aeromedical Institute (EURAMI) and the Commission on Accreditation of Medical Transport Systems (CAMTS).
Eurami has accredited providers worldwide while Camts remains a predominantly North American organisation. Both have exacting standards in such areas as quality, safety, management and training and accredit only the very best services. AirMed is accredited by Eurami as a ‘Special Care’ provider thus demonstrating to clients that we are amongst the very best air ambulance organisations in the world. Increasingly, clients are asking for Eurami or Camts accreditation in order to award contracts especially in cases where the contract is being awarded by a government agency. This suggests that clients are looking at accreditation in terms of their own management of risk, acknowledging that accredited organisations are much better placed to provide safe and secure, low risk solutions for their patients.
Can you talk us through your current air ambulance fleet?
AirMed currently operates 6 aircraft for air ambulance missions. These include 4 Piper Cheyenne turboprops and 2 Learjet 35As.
What geographical area does your air ambulance fleet cover?
The Learjets are operational worldwide and have carried out missions from as far afield as Brunei and Thailand for UK nationals. The turboprop fleet are utilised mainly for continental European missions, though if the patient is stable enough they can go as far as Northern Africa, the Canary Islands, Turkey and Cyprus.
Which medical staff will be assisting the air ambulance transport?
AirMed uses only UK registered healthcare professionals: specifically Registered Medical Practitioners, Registered Nurses and State Registered Paramedics. Beyond this we only recruit professionals with significant post degree training and experience in the care of the critically ill patient so that our staff is capable of caring for even the sickest of patients. The exact makeup of the medical crew will differ depending on the needs of the patient with this being determined by our in-house medical team who review every case before an aircraft is dispatched. Typical crews would consist of Doctor and Nurse, Nurse and Paramedic, or Nurse/ Paramedic only
Which medical equipment will be utilized during the transportation?
AirMeds medical equipment is compliant with the requirements laid down by the Intensive Care Society (UK) guidelines and the British and European Standard BS EN 13718-1:2008. This means that state of the art monitoring, diagnostic equipment and treatment options are available for the use of medical teams in-flight. The exact nature of the items utilised will depend on the patients requirements, however monitoring equipment including cardiac monitoring, oxygen saturations and blood pressure recording will be used in all cases. Equipment available will enable treatment of even very acute deterioration up to and including cardiac arrest.
What other air ambulance services do you offer?
Our services at AirMed have developed with increasing specialisation such as neonatology, high risk obstetrics and fetal medicine and extra corporeal membranous oxygenation (ECMO). As our service has become increasingly complex, the training for our teams has had to develop in line with this. We now offer world class education to our own staff, which includes high fidelity simulation training, and plan to offer this to external medical staff in the near future.
How will the air ambulance industry develop in the next 5 years and what opportunities will exist?
The Air Ambulance industry consists today of two types of operations. Firstly the relatively short distance rotary operations that are often run in close collaboration with a local hospital and then secondly the much longer distance fixed wing transfers, typically provided by standalone commercial operators. The business models that rotary companies use in the Air Ambulance industry vary.
There are however two main models:
1) A membership based subscription is used to fund the necessary infrastructure that manages calls from members requesting help, as well as funding the assets needed to intervene.
2) fixed term contracts are allocated to third party operators, who then agree to provide the service for a predetermined cost.
The second model above is typically used where governmental agencies carry overall responsibility to provide an Air Ambulance service and sub contract to a rotary operator.
In the fixed wing market, operators are more often than not independent commercial entities working on an adhoc basis under terms set out in preferred supplier or service level agreements with key clients. These agreements underpin the service they can provide. Over the next five or more years there will be clear consolidation opportunities in the Air Ambulance market, whether in rotary or fixed wing or indeed across both types of operation.
You can read more about AirMed in the International Private Medical Insurance Magazine Air Ambulance Services Directory, click here.