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Coronavirus Disease 2019: The Impact of Coronavirus Disease 2019 on the Use of Air Ambulances for International Medical Assistance

      Dear Editors:
      In a recent letter to the editor published in this journal, we considered the impact of coronavirus disease 2019 (COVID-19) on when and how we repatriate patients—a core activity for International Medical Assistance. The 3 main changes we considered were a potentially more local/regional-based approach to care with extended hospital stays and a decrease in the feasibility of sending medical escorts on commercial aircraft resulting in a greater use of air ambulances compared with commercial airliners.
      • Duchateau FX
      • Ramin G
      • Castro MT
      • Lepetit A
      COVID-19: from the short term crisis mode to a long term maintainance mode, International Medical Assistance to reinvent?.
      This last assumption was considered because we expected the availability of scheduled commercial flight options to decrease dramatically, travel restrictions for both patients and escorts to become more restrictive with commercial airlines, and exemptions for cross border movements to be easier for specialized fixed wing air ambulances. The objective of this study was to evaluate whether specialized air ambulances were used more frequently during the COVID-19 pandemic.
      As previously described, with a presence in 25 countries, Allianz Partners has 5 large-capacity, high-expertise coordination centers worldwide staffed with approximately 80 critical care physicians (the majority of whom are actively practicing emergency medicine) and critical care nurses. Additionally, Allianz Partners has internal medical teams for evacuations and repatriations. These teams are mostly made up of emergency physicians and critical care registered nurses as well.
      • Duchateau FX
      • Verner L
      • Cha O
      • Corder B
      Decision criteria of immediate aeromedical evacuation.
      ,
      • Duchateau FX
      • Ramin G
      • Lepetit A
      Covid-19: response plan for International Medical Assistance companies.
      The majority of repatriations with medical escorts on scheduled, commercial aircraft are performed by these internal teams. Although we do staff some of our air ambulance missions on chartered aircraft using our internal medical teams, the majority of these missions are contracted to external air ambulance providers.
      For the purpose of this study, we considered both commercial and dedicated air ambulance transports conducted by 4 of our major centers: North American (Canada), Asia Pacific (Australia), Belgium, and France (the last 2 representing Europe). We compared the transport activity from these centers for the period of March 16, 2020, through August 31, 2020, with the activity for the same period in 2019. Data are expressed as percentages and compared using a chi-square test. P values < .05 were considered significant.
      During the study period, we transported 215 patients. Forty-three percent (92 patients) were transported by specialized fixed wing air ambulances compared with 32% (363 patients) who were transported by specialized fixed wing air ambulances during the same period in 2019 (P = .0036). Detailed data are shown in Table 1.
      Table 1The Number of Transports in 2019 and 2020
      20202019P Value
      Air AmbulanceOtherAir AmbulanceOther
      Canada2715161207
      Australia635488
      Belgium211655164
      France388993295
      Total92123363754.0036
      Our data demonstrates the volume of transports decreased dramatically in 2020 (by a factor of 5) compared with the same period in 2019 and, as expected, the proportion of specialized air ambulances was significantly higher. However, considering the low overall volume of medical transports, there is no significant risk of the demand for air ambulance transports exceeding the availability of aircraft in the market. As travel restrictions are gradually eased and the availability of commercial flights increases, we will need to deliberate on a gradual shift back to the pre–COVID-19 model of considering commercial flight options over dedicated air ambulance so that the profound increase in the percentage of air ambulance transports linked with COVID-19 does not become permanent.

      References

        • Duchateau FX
        • Ramin G
        • Castro MT
        • Lepetit A
        COVID-19: from the short term crisis mode to a long term maintainance mode, International Medical Assistance to reinvent?.
        Air Med J. 2020; 39: 310
        • Duchateau FX
        • Verner L
        • Cha O
        • Corder B
        Decision criteria of immediate aeromedical evacuation.
        J Travel Med. 2009; 16: 391-394
        • Duchateau FX
        • Ramin G
        • Lepetit A
        Covid-19: response plan for International Medical Assistance companies.
        Eur J Emerg Med. 2020; 27: 158-160