Have you ever experienced a heart attack in central Africa? You had better not! Do you want to call the EMS service? Perhaps you are looking for pain relief, or want to find a hospital with good diagnostics, maybe one that performs a cardiac catheterisation or a thrombolysis. Unfortunately, the truth is that you will rarely find one.

In these instances, your first call should be to your assistance company. You can talk to the doctor on call to help get you out of here as fast as possible. The doctor’s decision will be based on three major factors: The medical issues, the legal side and of course on the costs.

The medical decision will be based on the question of whether the risk of leaving the patient will be higher than the risk of transportation. The medical infrastructure at the patient’s location cannot be altered, but the risk of transportation is dependent on the quality of the provider. The doctor will ask the following questions:

– Are the pilots trained to fly into remote areas and is the aeroplane well-maintained and an adequate transport means for this location?

– Does the cockpit provide supporting technology to help the pilots and is the EMS equipment state-of-the-art and able to serve as a flying ICU?

– Does the aircraft provide all necessary medical functionality to cope with complications during a long flight?

– Finally, the question arises of how well trained the medical crew is.

If the doctor finds a high quality air rescue provider with all the questions being answered in a positive sense, and they decide that the risk of keeping the patient at their current location is high, then the decision will be made to transport the patient to the nearest centre of excellence.

The easiest way to find out how well the aeromedical company is performing the service is by auditing the provider through an independent organisation. This certification process has been in action for several years in America with CAMTS (Commission on Accreditation of Medical Transport Systems). At the beginning of this year, EURAMI (European Aeromedical Institute) started the European accreditation process for air rescue. Providers like LAR (Luxembourg air rescue), DRF (German air rescue) and REGA (Swiss air rescue) are already certified.

Coming back to that legal decision, unbiased proof of the service of the provider allows not just our doctor, but also a court judge, for example, to evaluate the medical capabilities of the provider in case of a legal dispute. In some US states, air rescue can only be performed with a CAMTS certificate. In Europe we have already seen that transatlantic clients want to see a quality certificate of the European operator to reduce their legal risk.

Finally, the costs in the medevac industry will drop for the insurers, because the provider will be able to evacuate or repatriate the patient at an early stage, reducing local hospital costs and overall medical costs. Some of the insurers have already realised that providers with a high quantity of medical services and experience are the best choice.

The answer to the question, “Does the quality of medical services affect the medevac business?” is yes, and it will certainly continue to be a positive effect. The risk for the patients will be lowered, increasing the number of transportable patients. And, of course, more elderly people will travel, leading to an increase in overall medevac. This steady increase in medevac activity has already been experienced by the major air rescue providers in Europe.

Michael Weinlich MD is medical director of International SOS GmbH and writes here in his capacity as president of EURAMI.