There are as many air ambulance aircraft types as companies providing air ambulance services. Each patient’s situation is unique as well has their mission requirements. Distance to be covered, patient’s health condition and size, treatment and medical care requirements, airport runaways, etc., are all factors that need to be taken into account when choosing an air ambulance service (and aircraft).
That is why at Euopean Air Ambulance we insist on having the mission details defined before committing. It has happened that the size of the patient was not provided and, as later on found to be oversize, could not be fitted through the aircraft door of a Learjet 35. With consequent mission cancellation and associated costs.
In some case the patient may be undergoing ECMO (Extra Corporeal Membrane Oxygenation) and the associated equipment may leave too little space for the medical crew onboard smaller aircraft. Same for bariatric patients.
Knowing the exact medical conditions in advance also allows to optimize the medical equipment on-board and avoid cramming the aircraft with unnecessary and expensive devices.
Of course, as a general rule, the smaller the aircraft the lower the price of the mission, but also less convenient to some patients.
Some aircraft do not have a pressurized cabin – named PPUnp (Piston-powered unpressurized) - and are suitable for short distances or where patients cannot stand high altitudes, and can take off and land on more difficult terrain, but they are also nosier and more subject to turbulence.
On the contrary, a slightly larger aircraft, such as the Learjets 45XR operated by EAA, offer more comfort and a series of advantages, such as:
- First of foremost the capability to host a double stretcher, thus allowing to carry more than one patient, including incubators, or additional passengers, and up to a full family as demonstrated in this particular case. They are certified for patients up to 200Kg. Separate bathroom facilities are featured as well and a curtain can separate the 2 patients.
- Each of the separate stretcher units are fitted with state of the art medical equipment including vacuum mattress, ventilator, defibrillator, monitoring system, infusion system, blood gas analyser, suction unit and all necessary drugs to safely transport intensive care patients.
- The aircraft also carries 12.000 litres of oxygen, providing a comfortable reserve for patients with an increased oxygen requirement, (i.e. non-invasive ventilation), even for long distance journeys, which are also more comfortable, of course.
- The medical team can be larger, which is important for patients in critical conditions. In the case of EAA the medical crew is multilingual, which is an aspect not to underestimate.
- Ease and safe loading of patients and short refuelling time.
For some emergency evacuations there is not much time to make an adequate mission preparation also due to lack of information and changing conditions. Therefore this kind of missions have to be fulfilled with more flexible aircraft and foresee different type of intervention and plans.
For air ambulance operators it is however difficult to provide a large choice due to the costs of maintaining them, non-common spare parts, training the personnel, etc.. In order to stay competitive they have to restrict the choice and that’s why not all companies are the same, their type of service and market they operate depends on the critical choice of the aircraft. For the client that means a lot of “shop around” to find the best offer. And the best offer does not mean the lowest price, but it is a trade-off among several requirements, with the patient physical condition and medical care needs always at the top.
And finally it needs to be mentioned that the buyer is almost always the insurer company or an assistance company, not the patient herself, which may further restrict the “wishes” of the patient. The insurer also takes the critical role of assessing the patient conditions and passing on accurate and up-to-date information to the air ambulance operator.