Once considered to be an elite service in Indian healthcare delivery system, air-ambulances have come to rescue stranded patients during COVID-19 lockdown period. However, mandatory tests and extra permissions to airlift a patient or operate an air-ambulance amid COVID-19 crisis has made the process tedious, reports Nikunj Sharma.

The recent COVID-19 pandemic has brought the world to standstill and India is no exception. In this unprecedented scenario of overall lockdown, demand for air-ambulance services has risen considerably. More so, because they are still allowed to operate in case of medical evacuation.

It is indeed interesting to note that air-ambulance services have been doing an excellent job in transferring sick patients to the desired destination during the weeks-long COVID-19 lockdown in the country.

In fact, there has been a tremendous increase in the number of medical evacuation cases since March 24, when India entered into the first phase of nationwide lockdown.

With literally no inter-state movement of vehicles allowed and suspension of all domestic and international flights, air-ambulances offered stellar services to patients suffering from chronic diseases and someone who did not have access to the medical facility in the vicinity.

But even though the lockdown exempted chartered medical service flights, on April 15, authorities clarified that even these must fulfil certain conditions to ensure that people use the elite service for urgent medical conditions only.

As a result, there are many impediments such as government policies, infrastructure, tax structure, etc., which need to be overcome for the smooth functioning of air-ambulances.
Notably, the move was made to ensure that the fleets remain available for emergency situations.

While in normal circumstances, operators only needed permission from aviation authority and patients discharge summary for medical evacuation, during COVID-19 lockdown, the government has mandated six add-on clearances to airlift a patient.

The operators now need to have clearance from district magistrates – both from origin and destination cities; letter from the doctor and the hospital describing the emergency; NOC from health ministries of the states of origin and destination; and COVID negative certificate for the patient as well as the attendants travelling with the patient.

“This has made the whole process tedious and lengthy,” said Captain Amit Kumar, founder and CEO, Flaps Aviation Private Ltd, a dedicated air-ambulance service provider in India. The firm operational since 2012, has a fleet of King Air C-90 twin-engine aircraft for the stellar air-ambulance services.

While every state machinery is focusing on the COVID-19 containment strategy at every level, the critical patients in Tier-I and -II cities who need shifting to better healthcare facilities across states are pushing the demand for air- ambulance services.

Dr Vivek Ramkumar, Director Operations, AeroCare India, one of the leading air medical transportation and medical evacuation flights service provider said, “Unfortunately, owing to total lockdown, transfer of a patient in a commercial airline stretcher is not possible which is why the demand for these air ambulance services has gone up.”

“In fact, it is further going to increase in the coming days,” he added.

Healthcare report by India Brand Equity Fund (IBEF), the largest Indian resource centre on Indian Economy too points that more than essential requirements, healthcare providers are offering luxurious services to patients these days. “Pick and drop services for patients by private helicopters and luxurious arrangements for visitors are a few add-ons,” the report reads.

India’s nascent air-ambulance services market

Air ambulance service market in India comprises three basic types of operators – standalone players have entire setup and arrangements of their own, then there are those who fly in partnership with hospitals, and a few operators who offer air-ambulance as an add-on service offered by domestic and international flight operators.

Currently, India has barely seven or eight dedicated air- ambulance operators with major corporate hospitals like Apollo, Max, Medanta and Fortis having their own air ambulance teams within their emergency departments.

In fact, most of the charted plane or helicopter owners operate under a partnership model.
“There are only 4-5 operators and hundreds of brokers all over India supporting the air-ambulance service sector,” informed Captain Kumar.

Shifting of coffins of diseased patients is also being facilitated by the air-ambulance operators in a few selective cases. “International patient transfers by air ambulance are extremely restricted and only handful evacuations have been done till date ever since the lockdown was announced on March 24,” said Dr Veerbhdra Yadav, Co-Founder – Golden Hour Rescue Air Ambulance Services.

He further added, “Though air-ambulance transfers in domestic circuits are being carried out on routine basis, utmost care is being taken regarding PPE and other safety gears for the medical team, attendants and crew members on board.”

Globally, the air-ambulance market is expected to grow at the rate of 6% by 2025 and India is at the nascent stage leaving huge scope for expansion.

For instance, India loses approximately 43,000 precious lives every year due to heart attacks and the number of such patients from Tier-II towns is higher.

Besides, adding more air-ambulances will significantly add to India’s rapid transportation capability and to the healthcare infrastructure. It can save the lives of many who stay in remote locations and small towns.

However, insurance companies need to come forward to cover air-ambulance services so that even a common man can avail their services.

Medical transfers of patients by air have always been considered to be a costly affair, available only to the high-income group. “Based on my experience in the past eight years, I see a promising future for this niche sector,” said Captain Kumar.

So far the company has successfully executed more than 3400 evacuations with continuous growth in demand. And, now to provide air-ambulance services to emergency patients from Tier-II cities, Flaps Aviation Private Ltd. has launched a membership programme called ‘cashless air ambulance’.

As part of the membership offering, individuals from any city or town can access and avail the lifesaving facility for themselves or their family members in a distress situation.
“Our mission is to ‘connect’ every critical patient to the best of super-speciality hospitals across India. By making air ambulance services available in real-time and at affordable costs will mean a lot to the common man,” added Captain Kumar.

Challenges and outlook
One of the prominent challenges that loom over the growth of air-ambulance sector in India is lack of trained pilots, advanced medical support and ground staff, and an unorganised air-ambulance sector.

In addition, the high cost of airlifting, stringent safety norms and inadequate communication between regulatory authorities and operators are also some areas of improvement to push the growth of air ambulance services in the country.

Besides, the state and central governments also need to provide proper infrastructure to support the air-ambulance operations. “Cost is still a deterrent for many people who want to avail air-ambulance, yet the numbers are increasing tremendously due to highly competitive rates, availability of many operators and so on,” said Dr Yadav.

He further added, “The cost of a particular air-ambulance transfer grossly depends upon – flight time, aircraft type available (e.g. a turboprop will cost less and jet will cost more), origin and destination airport, destination airport ground handling charges, etc.”
Based on these factors, airlifting cost ranges between ₹90,000 to ₹18 lakh per patient transfer.

Though COVID-19 and the subsequent lockdown have pushed the demand for air-ambulance carriers for critically-ill patients, the ever-growing canvas of insurance market, with innovative reimbursement plans is also expected to give a significant boost to the air-ambulance sector in developing economies like India.

Some global reports also suggest that Asia Pacific’s air- ambulance sector is projected to register a compound annual growth rate (CAGR) of 9.5% from 2019 to 2026 due to developing healthcare infrastructure across the region, especially in India and China.

Another factor that may drive the air-ambulance services in India is the continuous increase in the number of the market players such as EMSOS, AeroCare India, Air Ambulance World, Falck, Golden Hour Rescue, Saras Ambulance, Accretion Aviation, Wheels India, SpiceCare and Flaps Aviation.

Besides, factors such as a surge in chronic diseases, growing economies, rising individual incomes and expanding medical tourism are pushing the growth of the air-ambulance market in India. But, with lack of government support are the market players ready to tap this vast potential? Only time will tell.