Aeromedical Services: An Evaluative Study - Assignment Example

?Aeromedical Services: An Evaluative Study Introduction The aeromedical services would be shared by different ICUs such as the Pediatric ICU and the cardiothoracic ICU. Hence it would be prudent to look for options that can satisfy the critical requirements of both units. We structure the study in this manner. First we identify the options available in terms of the type of aircrafts, the feasibility for a range of 800 km and the kind of additional skilled personnel that would be required. For this, we explore the existing aeromedical services across different countries. This will give us a better viewpoint when we assess the choices available. Secondly, we look at the likely prices and estimate the funding requirements; in parallel, we also assess the financing options available. In the final stage, we also assess the various equipment that are needed to be procured for effective medical services in-flight. Aligning the choices with the potential costs against each, we can arrive at the best possible option. 2. Survey of International Aeromedical Services In the United States, one of the popular aeromedical services is operated by U.S Air Ambulance (U.S Air Ambulance, USAirambulance.net). The service has signed up around 600 hospital clients. There could be various levels of critical emergency care. Air ambulance is the fastest method of transporting critically ill patients. Other methods could involve commercial air escort, where the patient is not in need of critical care or medical escort via rail, where the patient’s condition is stable and he / she can travel by train especially if distances less than 300 miles are involved. Other methods include transporting patients by road in specialized vehicles fitted with advanced medical equipment. A much larger international organization operating in this domain is Medi-Aviation (International Air Ambulance, mediaviation.com). The service operates out of London and caters to patients across the globe. There is provision for Intensive care during air travel. This service also assists tourists with a medical condition. It provides trained medical assistance round the clock in coordination with commercial airline services. Hence tourists who face medical condition of any kind need not hesitate to travel to other countries. We briefly look at prominent aeromedical services in Australia and New Zealand. In Australia, the Royal Flying Doctor Service (flyingdoctor.org.au) through the services of its own aircraft and chartered flights covered a distance of nearly 24 million kilometers in 2009. This company has 21 aircraft operating bases. It has 178 pilots, 60 engineering professionals and 15 operational coordinators to support the doctors and paramedical staff. RFDS (Royal Flying Doctor Service) operates the following types of aircraft: King Air B200, the PC-12 Pilatus, the Cessna Grand Caravan C208 and Hawker 800XP2 in Australia. Aeromedical services in New Zealand are operated by a trust known as Canterbury West Coast Air Rescue Trust (airrescue.co.nz). The service caters to three different requirements: Westpac rescue helicopter, Solid Energy Rescue Helicopter and New Zealand Flying Doctor Service. In light of the earthquakes that occurred in 2009, New Zealand has air services that focus more on search and rescue operations. In this regard, Garden City Air Centre (helicopters.net.nz) also provides air rescue and ambulance services across the three cities of Christchurch, Nelson and Greymouth. In New Zealand, air charter services are also available through Skyline Aviation (skylineaviation.co.nz). This organization operates fixed wing, twin engine aircraft; among them, prop King Air B200C, Cessna 421C and piper Navajo are well accepted by the medical fraternity. Besides, these aircraft are known for their safety standards. Similar to other organizations, Skyline Aviation also offers search and rescue operations in addition to aeromedical services. 3. Key Issues with Aeromedical Services There could be questions regarding the usage of helicopters versus ground transport for aeromedical services. In a survey conducted by a team of doctors (Arfken, Shapiro, Bessey and Littenberg, 789), it was noticed that there was no significant differences for survivors in health status. Moreover, with regard to search and rescue operations (Martchenke, Lynch, Pointer and Rooker, 360), it was clearly evident that aeromedical services formed an integral part of the relief efforts. It is not necessary to assume that the need for these specialist services would continuously rise. For instance, in New South Wales, it was observed that practical, clinical review systems could help health care firms in rural areas to achieve better results through specific focus on patients who could benefit from planned care (Garne, Perkins, Boreland and Lyle, 602). Another critical issue is the need for performance measurement of such sophisticated medical services; in this regard an emergency medical team found that despite the availability of several aeromedical services in Britain, there was no emphasis on understanding the performance aspect of these medical services (Simpson, Bartley, Cornfield and Hearns, Early view). Besides, optimization techniques have been used to reduce the costs and attain maximum coverage for trauma care using a model that considers crash nodes and paths (Erdemir, Batta, Spielman, Rogerson, Blatt and Flanigan, 1106). In a descriptive study of aeromedical services across a span of 12 years, the Royal Flying Doctor Services in Australia noted that trauma was the single most common clinical diagnosis (Margolis and Ypinazar, 365). There were 4259 cases of patients who used these services for critical clinical conditions. The death rate in transport was 1%; this typically was noticed with males who were from locations with minimal basic healthcare facilities. 4. Assessment of Funding Requirements We consider various aircraft for their operational capabilities and prices. Then, we look at identifying the best possible mode of financing: purchase, lease or charter. We look at a comparison of the aircraft that have been used by the Royal Flying Doctor Service (flyingdoctor.org.au) Aircraft Type PC-12 Pilatus King Air B200 Hawker 800 XP2 Engine Single, Pratt & Whitney Twin, Pratt & Whitney Twin, Pratt & Whitney Patient Capacity 2 2 3 Total Capacity 5 5 5 Cockpit Capacity 1 2 2 Remarks Has state of the art ground proximity warnings Has provision for extra battery to power medical equipment. Also pilots can communicate with cabin staff Can handle specialized equipment for neonatal care also Suggested Price $2,000,000 $3,400,000 $5,000,000 [Source: flyingdoctor.org.au] At first glance, the prices are definitely beyond the reach of an ordinary hospital. Besides, the suggested prices as obtained are for used aircraft. New aircraft could cost as much as double the suggested prices. As we can see, based on the number of engines and the number of stretcher patients, the prices are fixed. If we go for direct purchase from the market, then the financing requirements are on the higher side. Plus, we do not know the number of cases where such air-lift operations may be required. Hence direct purchase would be a last resort. Moving on to the second option, we can look at leasing the aircraft. This would involve paying annual lease charges which could be in the range of $500,000 which is probably 25% of the cost of a PC-12 pilatus aircraft. This is a reasonable expense and it does away with the hassle of ownership. The third option is chartering a service. If there is a service in our own state, then we can consider this mode also. With chartered flights, ownership, running and maintenance do not feature in our considerations. It is similar to paying for a taxi service. Considering all the factors discussed above, we would recommend chartered flights as our first option. After using the third party aeromedical services for a year, we can observe the number of cases when we have utilized it; based on these statistics, we can assess the possibility of leasing. Leasing, as an option would arise if chartered flights are unable to cater to our needs at short notice. If we find more such non-availability issues, then we can consider the leasing option. 5. Planning for Additional Equipment The aeromedical services domain involves a complete understanding of the aircraft requirements as well as the other medical equipment and services that need to be on-board throughout the flight operations. We have identified some of the important equipment as listed in the table below Medical Kit 1 Medical Kit 2 Oxygen Treatment S-Scort Suction Unit Oxygen D Size Orthopedic Mattress Monitor (NIBP) (SPO2) (ECG) Neb Mask Absorbent Pads Life Pac 12 defib Nasal Cannula Slide Sheets Transport Ventilator Airway Set   [Source: mediaviation.com] Medical services personnel can easily identify with the table above. The list is not exhaustive, yet it covers the bare minimum equipment that needs to be on-board. The monitor ensures that all critical parameters of the patient can be assessed throughout the journey by air. The transport ventilator would be handy in the event of respiratory problems. Additionally, neo natal equipment could also be factored in for procurement. The oxygen therapy which is a part of basic equipment attempts to simulate the hospital environment where 100% pure oxygen is available on tap. In the event of severe bone damage or fractures, the orthopedic mattress would serve its purpose. Besides, it would help in transporting patients from their as-is condition to the nearest medical facility without disturbing their postures. 6. Concluding Discussion In our report, we have assessed the nature of aeromedical organizations around the world. We have briefly touched upon the different types of services they offer. We have studied their reach and attempted to understand some of the critical issues that are faced by personnel working in this domain. This has been learnt by way of a thorough reading of the medical literature pertaining to the field. Considering the operational decision, we have discussed the various types of aircraft: we have looked at the prices, their specifications and capabilities. In terms of the funding requirements, we have discussed all the three possible options, namely, purchase, lease or charter. In the end, our recommendation is that we begin aeromedical services by chartering flights. Observing the progress after a year, we review and move ahead to the leasing option based on the pattern of demand for aero services and the efficiency of charter operations. As a last option, we consider direct purchase. Direct purchase means that we need to invest not only in aircraft, but also on crew, maintenance and performance evaluation. With regard to additional equipment, we have listed out some of the essential requirements. These would form a part of our initial procurement. At a later stage, we could move onto more sophisticated, specialized equipment. Works Cited Arfken, Cynthia L. Shapiro, Marc J. Bessey, Palmer Q. and Littenberg, Benjamin. “Effectiveness of Helicopter versus Ground Ambulance Services for Interfacility Transport.” Journal of Trauma-Injury, Infection & Critical Care. 45.4 (1998): 785-790. Print. Canterbury West Coast Air Rescue Trust. 11 Aug. 2011. < http://www.airrescue.co.nz/ > Erdemir ET, Batta R, Spielman S, Rogerson, PA, Blatt A and Flanigan M.. Optimization of Aeromedical base locations in New Mexico using a model that considers crash nodes and paths. Accident, Analysis and Prevention. 40.3 (2008): 1105-1114. Print. Garden City Air Centre. 11 Aug. 2011. < http://www.helicopters.net.nz/ > Garne DL, Perkins DA, Boreland FT and Lyle DM. “Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study.” The Medical Journal of Australia. 191.6 (2009): 602-604. Print. Margolis SA and Ypinazar VA.. “Aeromedical retrieval for critical clinical conditions: 12 years of experience with the Royal Flying Doctor Service, Queensland, Australia.” The Journal of Emergency Medicine. 36.4 (2009): 363-368. Print. Martchenke, J. Lynch T., Pointer J and Rooker, N. “Aeromedical helicopter use following the 1989 Loma Prieta Earthquake.” Aviation, Space and Environmental Medicine. 66.4 (1995): 359-63. Print. Medi-Aviation. 11 Aug. 2011. < http://www.mediaviation.com/airrambulancefrancetouk.html > Royal Flying Doctor Service. 11 Aug. 2011. < http://www.flyingdoctor.org.au/ > Simpson N., Bartley B., Cornfield AR and Hearns S. Performance Measurement in British Helicopter Emergency Medical Services and Australian Air Medical Services. Emergency Medicine Journal. 2011. EPub Ahead of Print. Web. Skyline Aviation. 11 Aug. 2011. < http://www.skylineaviation.co.nz/aeromedical/ > U.S Air Ambulance. 11 Aug. 2011. < http://www.usairambulance.net/air-ambulance-service.php > Read More