Technology and expertise

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1 Global Corporate Solutions AUGUST 2012 Edito Dear Reader, We are glad to provide you with the 5 th issue of Inside out, focusing on the backstage of medical evacuations organization. Assistance companies image is usually associated with repatriation, evacuation, and the women and men ready to repatriate an injured or ill person not able to pursue his/her trip or mission. In the past 50 years, the assistance business has widely opened up to new services, other than repatriation and evacuation. Nevertheless, these traditional services still get the most requests and remain the first service offering embedded to any corporate travel policy: ensuring that business travelers and expatriates, in case of any major issue, will be repatriated according to international medical safety standards. In this letter, we asked experts to tell us what is behind the decision and the organization of an evacuation. Our core activity is Human-related; each evacuation is a challenge making the decision difficult to take. It is not only a question of requesting an aircraft, a pilot and a medical doctor to go get the patient and fly him/her to a safe destination. Volumes, technology, expertise and people having the knowledge, know-how and experience are key elements to Europ Assistance s success stories in organizing medical evacuations. Volumes Still, in order to efficiently manage the high annual volume of cases, international assistance companies must set-up solutions to standardize their procedures. The objectives are multiple: To ensure maximum safety to our patients, through the choice of solutions and the rigorous selection of our providers To open-up the number of available choices of transportation means at the time of the decision To be prepared to any type of situation, whatever the patient s origin, culture, localization and evac-destination. To choose not to evacuate if it is not necessary. Investing in a quality medical network is also a key point, even more for resident employees or expatriates To optimize evacuation costs - a stretcher on a commercial airline requires to book 6 to 9 seats in addition to the medical escort s seat, and the cost of an air ambulance rapidly reaches amounts up to several tens of thousands of Euros. Technology and expertise Europ Assistance employs more than 400 health professionals dedicated to assistance in addition to Europ Assistance - GCS medical staff dispatched on sites. Europ Assistance - GCS ensures that its experts have access to the most professional tools in order to take the decision to evacuate in the best conditions. These dedicated tools, fully developed and owned by Europ Assistance, combine expertise, technology and knowledge of the travel industry. They are strengthened by nearly 50 years of statistics and experience. While their use is mainly operational, our global purchasing team also uses them to negotiate with carriers, whether commercial airline companies or specialized air ambulance providers. Medical coordination at the heart of the plan The common denominator to each evacuation is the medical clearance physician who, supported by collected reliable information (medical reports, localization, local logistical relays, etc.), takes the decision. Rarely alone, his/her first quality is his/her ability to dialog and exchange within the medical team, with operational teams receiving the first call and managing the case, with local providers as well with the client company s general management and/or the client company s medical department when existing for which an employee, a contractor or a guest must be evacuated or repatriated. Crisis management capacity With the largest medical equipment and oxygen reserves, amounting to 200,000 liters, in the assistance market, Europ Assistance has the capacity to evacuate up to 70 individuals incubated and ventilated simultaneously at any one time via our Europ Assistance Crisis procedure which can be activated from our nerve center in Paris within 2 hours from the start of a crisis. The management of high volumes of cases by Europ Assistance - GCS is the guaranty for our clients that we master our trade as well as the quality delivered for each case we handle. It is also the guaranty that during a major event crisis, natural catastrophe, and industrial accident all these actions and procedures, repeated on a daily basis, are already mastered in order to give teams plenty of room to concentrate on the event s exceptional aspect. With more than 300 million covered members, Europ Assistance has been implicated in all major events since its creation in Our clients feedback on our interventions professionalism, reactivity and responsibility is the proof of the quality of the choices made by men and women working with us and the logistical means that support their decision to evacuate or not. Whatever your situation or need, Europ Assistance - GCS is here to help you develop the best solution. We hope you enjoy reading this issue and we look forward to your comments for future improvements. Kind regards, Florence Jean Chief Commercial Officer Europ Assistance - Global Corporate Solutions 01

2 Focus on Cost-effectiveness, technology and international standards: key elements to an efficient evacuation During a medical evacuation or repatriation, the patient s pathology, based on the medical doctor s recommendations, will guide the choice of transportation, whether by commercial airline or by air ambulance. The main objective of major assistance companies is to ensure the highest quality of service to patients whilst optimizing costs for corporate clients. We invited 2 members of Europ Assistance Holding to share with us their expertise in their respective fields: Global purchasing for air transport Air ambulance providers relations and management Volumes - Purchasing power and expert negotiations for the benefit of our clients Europ Assistance issued 34,500 air tickets in 2011 representing an amount of 22 million euros. Clotilde Bray, Global Purchasing Manager at Europ Assistance Holding explains which levers are used in our industry and specifically within Europ Assistance to optimize costs for the full benefit of our clients and their members. Four levers are used to enable a purchasing policy to be efficient at a global level. Negotiation with airlines carriers Today, 90% of Europ Assistance s global air expenses are covered by agreements with commercial airlines (70%) and travel agencies (20%). The aim is to enlarge the number of these agreements to companies where the expenses are increasing. Pooling of expert travel agencies The selection of travel agencies as partners, mandatory for the authorization of issuing air tickets (IATA rules), is key in the optimization process. Agencies must not only provide the highest quality of service, but also have a comprehensive understanding of the assistance business. Indeed, they have to manage on a 24/7 basis both complex medical (stretcher and/or oxygen, extra seats, etc.) and classic assistance cases (seats only). And this whilst maintaining competitive rates. Self-booking tool s optimized use (SBT) An SBT is an airline search engine consolidating GDS (Global Distribution Systems such as Amadeus, Sabre) data, low cost carriers and some charter carriers. This tool includes and automatically updates all rates negotiated with airline carriers. Europ Assistance is using the KDS tool, the market leader. It enables our assistance platform to directly book airline tickets for classic assistance cases to ensure 24/7 fast booking, flexibility and competitive rates wherever our clients and patients are. The SBT tool s 50% adoption rate in European countries is considered an optimum rate. It would be difficult to reach a higher use rate of this tool due to complex assistance cases, requiring a perfect coordination between our logistics departments and airline providers (fine-tuning of the stretcher organization, oxygen, etc.). Lodged Credit card All air tickets are paid via a lodged credit card which allows, besides better payment terms for our suppliers (travel agencies, airline carriers), to benefit from an efficient global database. Rates and rebates are fiercely negotiated every year, pooling all Europ Assistance Group expenses all together. Constant monitoring and reporting These levers are efficient only if our purchasing experts analyze at national and global levels all the data that are collected. Based on different reporting sources (lodged credit card and travel agencies), Key Performance Indicators (KPIs) track, with common methodology, our air spending and follow our partners performances. For example, our quarterly reporting highlights top origin/destination, the top carrier, the mix-traffic (domestic, continental, international), the Average Ticket Price (ATP). The objective is to analyze and negotiate with our partners, the best solutions and rates adapted to the needs of our patients and clients. Technology - Improving reactivity and efficiency whilst reducing the costs The question often asked to Europ Assistance - Global Corporate Solutions is: Where is your Air Ambulance fleet located? Our approach and solution are different and have been built by internal experts after the study in 2004 of the over 1,000 international Air Ambulance flights that we organize every year since 1963 (3 per day out of the primary evacuations, representing a total of 6,250 flight hours). Denis Van Cleef, Project Manager at the International Operations Division of Europ Assistance Holding, dedicated to the Air Ambulance projects and development, explains this innovative approach and solution that benefits our clients and their members. For efficient air ambulance services management for medical evacuations worldwide by international assistance companies like Europ Assistance, four key elements must be considered: Time Beside specific demands from clients requesting exclusive air medical transport by air ambulance, the use of an air ambulance solution is linked to the emergency of the medical case of the patient or to the remote location of the event where the accident/ incident occurred. Time control is essential, especially in the organization of the service. Global network Global cover means global capacities, partners, and suppliers. Requesting 1 or 2 air ambulance suppliers or only national suppliers for evacuation has no sense at a time when companies and people are increasingly crossing borders. And the international offer of such a service is to be carefully considered as well: providers in Europe, Americas, Africa, and Asia must be involved in an assistance program as long as they can demonstrate their technical capacity but also quality and compliancy with air international mandatory rules. Standard processes Being able to propose standard processes makes operations much more fluid and flexible between the stakeholders involved in an evacuation. No useless questions, no redundancy in the information, no multiple communications for numerous levels of authorizations. For our corporate clients, specific processes are built with them to comply with emergency plans and travel risk policies. 02

3 Monitored expenses The choice of an air ambulance solution vs. the use of airline companies makes it mandatory, towards our clients and insurance partners who are the final payers, to demonstrate our capacity and our procedures for cost-containment. The consolidation of data related to any air ambulance flight enables the monitoring of expenses and capacity to explain any over-charge that may appear on an invoice. At any time, Europ Assistance is able to inform its clients about all the flights organized for them with multiple criteria researches. Auction tool for each air ambulance request In 2006, the Europ Assistance Group decided to review its global strategy with regards to the management of air ambulances for medical evacuations. Our International Medical Committee strongly recommended improving Europ Assistance s position towards the 4 key elements described above. A dedicated team of experts proposed a very innovative approach, still unequaled to this day: the development of a unique seamless medical assistance booking system, 3AT, Europ Assistance s proprietary Air Ambulance Auction Tool. The principles of 3AT are as follows: Prior audit of providers capacity and organization Compliancy of providers with regulations (licenses and proper insurance for the company, the aircrafts, the pilot, the medical escorts, among others) Written contracts with approved providers Acceptation of the tool s business rules Negotiated rates Large and multiple technical/cost effective choices per air ambulance request Unbeatable costs reduction. With one message sent to the entire network once a request for an air ambulance is uploaded by Europ Assistance, each provider responds within a 45 minutes timeframe with a price, quote and availability. Europ Assistance can then choose the most suitable provider to carry out the service. This frees up valuable staff time to focus even more on the patient, as previously medical staff had to fax each supplier and physically chase for a response. The launch of this unique tool in the assistance industry was also beneficial to air ambulance providers. Volker Lemke, Director of Sales & Marketing at Flight Ambulance International (FAI), comments: The 3AT tool developed by Europ Assistance constitutes an ideal platform to handle all the information inputs related to the management of quotations for air ambulance flights. Clearly organized information regarding essential operational variables (for instance degree of emergency of the planned evacuation, date desired for the flight, destinations, capacity to take accompanying persons on board, need for a sea level flight etc.... ) can be accessed easily, and the direct linking through this tool of the price calculation and the quote has been extremely simplified. Calculation errors and missing information can be excluded through the use of this communication methodology. This system even allows including essential additional information pieces such as schedule proposals including planned technical stopovers through dedicated fields in the quotation process. FAI, with over 12,000 requests for air ambulance quotations a year has to deal with exceptionally high volumes, but no other client offers the capacity to deal with those with such a creative, user-friendly tool. Therefore 3AT is a unique communication tool and we foresee its further development very positively. 3AT MAIN BENEFITS Allow air ambulance providers to instantly provide a standardized and comprehensive offer upon receiving a request for a quote. Allow each Europ Assistance office to benefit from having the choice of the best price for the best quality among several providers around the world Contract with more than 112 air ambulance providers including a standardization of the accreditation and audit process as well as improve commitment and special rates Expertise - Flying safe: the accreditation of air ambulance companies by independent organizations Much of our work at Europ Assistance as Medical Clearance Physicians involves making sure that we treat and transport our patients in a safe & timely manner explains Dr. Laurent Taymans, Medical Clearance Physician at Europ Assistance Belgium, guest expert of this #5 Inside-Out Newsletter. One of the more expensive and also high profile modes of transport we have is the air ambulance. Many, if not the majority, of the patients that we transport are in need of a high level of quality of care and often in difficult circumstances. But how do we ensure that the air ambulance provider will give us this level of care that we need? What do we need to look for in a highly professional air ambulance service? There are several independent organizations that audit fixed wing and/or rotor wing operators. The two most known are the Commission on Accreditation of Medical Transport Systems (CAMTS) and the European Aero-Medical Institute (EURAMI). CAMTS has more impact in the USA where it audits the vast majority of the rotor & fixed wing providers. Note that CAMTS certification is often a requirement on the state level to be able to operate with a hospital or EMS. EURAMI has a more international approach, and although it is not a requirement for local EMS in Europe or the USA, it has grown significantly since All of these organizations have a structured auditing approach that integrates a pre-audit written self-assessment, a site visit with an auditor s report, and finally the validation and voting of the report by an executive body. The audit structure is often based on ISO or EFQM principles, as well as evidence based medicine. This article aims to give an overview of what a quality air ambulance service is built on and which agencies you can count on to certify them. The list is quite extensive but auditors look at the following basic elements of a company The company, its image and ethics The medical personnel (physicians, nurses, paramedics, respiratory technicians) The medical material brought along on the flights The aircraft and their management The operations center Leadership & Management Quality Control The company High service quality companies have a clear and understandable vision & mission statement. They communicate clearly on how and when to call them. As they perform regular and frequent transports, they know what pathologies they are familiar and unfamiliar with, and they define their operational and medical limits. The medical personnel A-players attract A-players, and B-players hire C-players. sums up what this is all about. Not only is the level of skill of the medical personnel evaluated, but also their continued training and hiring practices. The medical director and nurse director are essential as leadership in the air ambulance setting is essential to implementing best practice in the field. One of the key indicators that are looked at is the turnover of the personnel as well as the mean years of experience. A highly experienced, well respected and active member of the local medical community is a great asset for any air ambulance company. There should also be a clear procedure and minimum requirements for external medical crews that do not belong to the ambulance company to come onboard. Remember, many countries stipulate that the air ambulance operator is legally responsible for any incidents onboard (medical or other), so it is only normal 03

4 that they avoid litigation by defining in advance their standard operating procedures in regards to third party medical crews & equipment. Medical equipment High quality companies invest in the work environment which includes the aircraft interior, as well as the medical material brought on board. High quality & robust monitors and ventilators are essential to be able to transport more critically ill patients. All medical equipment must be tested or certified for aviation or at the very least pre-hospital medicine to guarantee that it won t become a safety hazard to the user. The stretcher system and internal layout is also a telltale of the level of investment and importance that a company gives to the quality level of care. Aircraft and management As probably the most visible aspect of company, what are evaluated are the company s safety record and any incidents in regards to their Air Operators Certificate. Note that all air ambulance companies must operate under commercial flight operations rules, so there are already regular and stringent checks and audits by the local civil aviation administration. Safety is everyone s concern and maintenance as well, therefore standard operating procedures must be impeccable. Black listing a company for maintenance or safety reasons is taken seriously and prompts a thorough review as well as an immediate discussion. EURAMI as well as CAMTS remove blacklisted providers from the list of certified companies or downgrades them until all questions are answered satisfactorily. Agencies will also request, upon application and sporadically, the proof of insurance, valid AOC (air operator s certificate) as well as any FAA or EASA STCs for material brought on board. Operations Center This is where all information is centralized. An efficient and well managed operations center is essential for the health of the company, as well as its internal communications. We also look at the management of patient records and sensitive medical information to ensure that privacy is respected. Leadership & Management An air ambulance company may have great planes and wonderful personnel, but without a good leader and a clear management structure it cannot thrive. Great companies have a clear line of authority and also C level leaders with charisma and vision. Quality management & control Often the least developed aspect of a company at the initial evaluation, this is an ongoing, dynamic internal process. What is looked at is the collection and measurement of key performance indicators. Quality management implements an upward spiral of improvement through experience in a no blame environment. All of the accredited providers can be found online on the organizations websites, or In conclusion, quality air ambulance companies are essential to our high profile, complex medical cases. Quality has an initial up-front cost making certified companies more expensive than their non-certified competitors. However, this cost is nothing in comparison to the liability and negative publicity of an extreme adverse event such as death or mismanagement with a non-certified company. For more information on Europ Assistance - GCS medical evacuation and repatriation capacities, contact sales@ea-gcs.com Medical Note Medical coordination, skills and responsibilities to decide when and where to evacuate When Mr. Smith is injured with a life threatening wound whilst at work on a drilling platform offshore Angola, his rotation is cut short as he must be medically evacuated and then repatriated back home. Such medical evacuation and repatriation cases happen on a daily basis in the assistance industry. But one might wonder what happened between the time of injury and the time Mr. Smith arrived back home? Who intervened, and how? What were the key decisions made to keep Mr. Smith safe from a worsening condition? We look at the factors, skills and responsibilities of the men and women behind the entire process of safely transporting and treating patients after an accident. Medevacs: what are they and what do they entail? By Dr. Eugene Delaune, Medical Director, Europ Assistance USA In general, Medevac is the term applied to the movement of patients who become ill or injured and require movement for short-term or long-term medical needs. When discussing Medevacs, it is helpful to differentiate between medical evacuation and repatriation, as the considerations that go into recommending these two types of patient movement are quite different. Generally, a medical evacuation is performed when a patient is in a location where adequate medical care is not available to treat a patient s condition. In most cases, the patient has medical needs which exceed the medical capabilities of his current location. On rare occasions, a patient may be evacuated from a location that does have adequate medical infrastructure, but there are cultural or security concerns for the patient. This might occur if a patient is in a location where there is civil unrest or after a large scale disaster when the local medical system is stressed by a mass causality situation. There are also cases where a patient s condition offends local cultural sensitivities. Examples would be pregnancyrelated care for a single woman in a country where out-of marriage pregnancy is frowned upon, or HIV related illness in restrictive societies. In a medical evacuation, moving the patient to an alternative location as quickly as possible is the main consideration. The patient may not be completely stable or may not even have a definitive diagnosis, but the EA physician has determined that it is in the patient s best interest to be moved to a location with superior care as soon as possible. In these situations, cost of the transport and convenience of the evac-destination for the patient and his family are distant secondary considerations. Generally, the goal is to move the patient to the closest location with adequate medical care as quickly as possible. Is some cases, the closest location will be bypassed if an alternative location can be reached quicker for logistical or political reasons. Some examples of obstacles that may cause this to occur are problems with visa entry requirements for a closer destination, availability of evacuation aircraft, and landing/over-flight clearance difficulties for the evacuation aircraft. Medical repatriations are recommended when a patient s acute condition has been stabilized, but there is a need for long-term medical care/recovery, or a permanent disability of the patient is likely. In these cases, because the acute condition has been stabilized, factors such as cost of transport and patient/family convenience take priority over the timing of the transport. In most cases, the patient is being moved close to his home for long-term care. Because he is already in a location where he is receiving good care, there is no medical reason to rush patient movement. The EA physician will want to make sure the patient s condition has been stabilized and his condition is optimized for the trip home. Because there is time to make arrangements, Europ Assistance can work with the patient and the patient s medical insurance to set up the most appropriate care for that patient once he arrives in his home city. There is also more time to arrange the 04

5 transport on a commercial airline or look for more economical air ambulance options. There are occasions when a patient s insurance will influence the transport decision. The timing of the medevac might be different depending on whether the medical transportation and the medical care are the responsibility of the same or different payers. If a patient s travel insurance is responsible for medical expenses as long as the patient is away from home, or out of his home country, then the patient may be offered an earlier repatriation, even if this involves a higher cost of transport (e.g. air ambulance instead of commercial air), over what the cost would be if the patient were treated longer at his current location before being moved. Examples would be patients with fractures which require surgical repair, or non-emergent cardiac patients who require invasive testing or treatment. Because the travel insurance will save on medical costs once the patient is home, a higher cost of medical transport can be justified. If the travel insurance is only financially responsible for the actual movement of the patient, and the medical expenses are the responsibility of another payer, the medevac may be delayed until the patient can be moved by an easier and less costly means, assuming he is getting good care at his current location. When determining the means of moving a patient, the Europ Assistance physician considers the patient s medical needs during transport, the comfort of the patient and the aspects of the patient s condition which could be affected by the stresses of transport. When flying a patient, unless sea-level cabin pressure is maintained, trapped gases should be expected to expand by 25%-50% and the partial pressure of oxygen drops, leading to less effective tissue oxygenation absent the administration of supplemental oxygen. Whether traveling on a commercial aircraft or an Air Ambulance, the air is very dry and this can affect secretions. While air ambulances offer flexibility in terms of timing, landing sites and freedom from obtaining pre-flight medical clearance, commercial airlines offer much longer range with less stops, more space for family, medical attendants and luggage, as well as a much more comfortable aircraft cabin environment. Medevacs: remote site particularities By Dr. David Polleau, Director of Medical Operations, Europ Assistance - Global Corporate Solutionss On remote sites, because of the lack of medical resources, the decision to evacuate is taken very often. The aim is to align the patient s health state with the local available medical infrastructure. Medical evacuations may also be specified as primary, secondary or international, and can be considered urgent or not requiring varied transport modes. However, the remote site context induces the more regular use of air ambulances or helicopters than for classic individual assistance. Prior to each evacuation, a set of standard questions is asked to define the need to evacuate: Are the infrastructure s standards of care adapted to the patient s condition? Are diagnosis means sufficient? Are therapeutic means available? If the answer is negative to one of these, the patient must be stabilized and conditioned for an additional medical evacuation. In these conditions, the following questions are raised: which transport mode should be used? Which type of escort? Is the benefits / risk equilibrium favorable to the patient in case of medical evacuation? When an employee based on an offshore platform is injured with a twisted ankle, there is no other option than using a helicopter to carry out a primary medical evacuation. This medical evacuation is not considered as urgent and can therefore wait for the helicopter s daily rotation and does not require a medical escort. On remote sites, it may sometimes be necessary to evacuate a patient in order to perform a cerebral scan, in order to establish the acuteness of a cranial traumatism, and to indicate a craniotomy. This surgical technique requires a secondary medical evacuation to a reliable medical center. A patient may therefore require 2 medical evacuations for himself only. The organization of industrial and human activity, generally on remote sites, implies an anticipated thought, in order to guarantee optimal safety on the ground. The management of medical evacuations in particular, and more globally of medical treatments, is defined through the Medical Emergency Response Plan (MERP). This plan must consider all possible scenarios, and therefore allow for a quicker and more standardized medical decision-making process linked to the medical evacuation. To reduce the number of medical evacuations, whilst maintaining an optimal level of care and guaranteeing safety on remote sites, several levers exists: Anticipating installations on a remote site with a preliminary health risk assessment of the site and the definition of a comprehensive medical evacuation plan (MERP). Medicalization of remote sites (staffing, equipment and drugs), in alignment with local constraints and those linked to the activity Installation and use of telemedicine tools and topside support (medical advice and second opinion) Upstream medical surveillance of employees and other people on the site through pre-employment and annual medical check-ups (fit for work and fit for expatriation). For further information on our occupational health programs, contact sales@ea-gcs.com Products & Innovation Taking the decision to evacuate in the event of a crisis Over the course of our nearly 50-year history, Europ Assistance has been on the front lines of almost every major mass casualty crisis. Our capacity to take timely decisions and efficiently deploy expert medical care directly on crises nerve centers enables us to ensure the safety and well-being of our clients members. But as the number and the probability of crises happening simultaneously rises, how does Europ Assistance ensure and decides to intervene on 2 or more distant locations whilst maintaining a high quality service on all fronts? The answer is planning. Our decades of experience have led to the development of best practices and protocols to respond in these global crises. When a disaster occurs, crisis teams are activated both centrally at 05

6 Japan Earthquake (2011) Europ Assistance Group managed over 500 cases. Customers were evacuated from affected zones to safer locations within Japan. Many others were evacuated out of the country via commercial airlines on regularly-scheduled flights. Globally, the Europ Assistance Group coordinated assistance for approximately 700 customers in the region. the Europ Assistance Group level and also locally at each Europ Assistance office. The crisis teams determine the impact of the event on Europ Assistance clients members, coordinate communication across offices and dispatch assistance to offices directly affected by the disaster, to ensure continued operation in affected areas and also to serve as on-the-ground teams to assist Europ Assistance clients members. Depending on the scale of the event, medical teams may be dispatched together with medical equipment and other supplies. The Europ Assistance Group maintains a stock of evacuation equipment which enables us to equip chartered jets and aircraft to quickly respond to crises of a global, mass nature. With the largest medical equipment and oxygen reserves, amounting to 200,000 liters, in the assistance market we have the capacity to evacuate up to 70 individuals incubated and ventilated simultaneously at any one time via our Europ Assistance Crisis procedure which can be activated from our nerve center in Paris within 2 hours from the start of a crisis. In the case of a crisis happening in a remote location lacking essential medical resources, our expert teams roll-out an already set-up Medical Emergency Response Plan (MERP), allowing for rapid provision of assistance on the spot. Our plans provide complete and structured operational procedures for intervention for all types of scenarios whether onshore, offshore or on moving vessels around the world. Recent events have shown the need for a rapid response system to major accidents on sites. In the case of natural disasters or other catastrophes, even locations where medical capabilities lack or are nonexistent can be rapidly equipped, staffed and managed with adequate procedures in order to effectively ensure the medical treatment and protection of the injured and responders. Haiti Earthquake (2010) Europ Assistance deployed a response team, including logistics and medical personnel to the Dominican Republic to provide on-site support. Europ Assistance s logistics team coordinated evacuations, ground and air transportation and provided communications assistance to impacted customers. Several dozen customers including a student group and a team of missionaries were evacuated. Europ Assistance is currently evaluating a new rapid medical response system for large populations to efficiently answer the requirements of dealing with the complexity of a catastrophe in any environment. For more information on Europ Assistance crisis management capabilities, contact sales@ea-gcs.com Projects & Operations Medico Rescue, Europ Assistance - GCS s new air ambulance partner for the African continent Considering the gap between the number of quality Air Ambulance providers based on the African continent and the number of medical evacuations arranged in and out of Africa, Europ Assistance - GCS has recently partnered with Medico Rescue, a new Air Ambulance provider based out of Pointe-Noire, Congo. This unique partnership is another step towards the reinforcement of Europ Assistance - GCS s Air Ambulance Network, now made of 112 accredited Air Ambulance companies. Europ Assistance - GCS is providing medical staff, equipment and medical transport coordination via its Flying Desk for all evacuations with Medico Rescue. For any medical evacuation requests on the African continent, Europ Assistance - GCS Flying Desk has now the possibility to activate Medico Rescue s services to rapidly and efficiently organize a medical evacuation from one African country to another or to Europe and the rest of the world. Medico Rescue reaches the international and required standards to be registered in 3AT, Europ Assistance s proprietary Air Ambulance Auction Tool, guarantee of perfect transparency in the management of this additional resource towards our clients. As any other preferred air ambulance provider, it will have for each transport, to demonstrate its technical capacity and commercial interest. Medico Rescue is an air ambulance service born out of the alliance between the CMC Medico medical center based in Pointe-Noire, Congo, and the IBEX air charter company, based in Beirut, Lebanon. Medico Rescue Air Ambulance Service - Features: Aircraft types: Jet Cessna Citation XLS & Hawker 800 Base: Pointe-Noire Airport, Congo Dedicated Europ Assistance - GCS emergency medical staff Emergency medical equipment & medication kits Complete with a flying intensive care station Bed to bed services Available as from autumn 2012, Medico Rescue will be able to serve the entire African continent with rapid response quality and comprehensive medical evacuation service. For further information on our emergency response planning capabilities, contact sales@ea-gcs.com 06

7 Future OCTOBER 2012 Europ Assistance - GCS to participate to the 2 nd GBTA Oil, Gas and Marine Travel Symposium in Holland. Europ Assistance - GCS will attend to the Global Business Travel Association Oil, Gas and Marine Travel Symposium 2012 in Rotterdam, Holland, on the 24 th and the 25 th of October GBTA, the Global Business Travel Association, created the globe s first business travel forum dedicated to the Oil, Gas & Marine industry in October With fares & rates, industry issues and logistics all specific to travel for this sector, GBTA recognized the need for an event dedicated to this interest group and created the first, independent forum of its kind. Europ Assistance - GCS will attend the event to present its travel risk management solutions dedicated to the Oil & Gas and Marine sectors. For more information on Europ Assistance s travel risk management solutions dedicated to the Oil & Gas and Maritime sectors, contact sales@ea-gcs.com SEPTEMBER 2012 Europ Assistance - GCS to exhibit at SPE/APPEA International Conference in Australia Europ Assistance - GCS will attend the 2012 International Conference on HSE in Perth, Australia from the 11 th to the 13 th of September The event is hosted by Chevron Corporation in association with the Society of Petroleum Engineers (SPE) and Australian Petroleum Production & Exploration Association (APPEA) at the Perth Convention and Exhibition Centre. The 2012 International Conference on HSE marks the first time this event will be held in Australia. The conference theme is Protecting People and the Environment - Evolving Challenges. This event will feature an extensive and comprehensive technical program covering the key topics of health, safety, environment, social responsibility and HSE management, featuring components including plenary, panel, technical and knowledge sharing sessions, which will strike an appropriate balance between emerging industry issues, best practices, and lessons learned. A technical exhibition will be held in conjunction with the conference, allowing professionals to see the latest innovative technologies and processes being utilized by the industry. Europ Assistance - GCS will exhibit its health, safety and security solutions in association with its local Australian partner Dynamiq. As we aim to develop our activities in the region, we will promote our unique capabilities and on-site health solutions from mobile medical units through to support for occupational healthcare, amongst other services. For more information on Europ Assistance s capabilities in Australasia, contact sales@ea-gcs.com Visit us at Booth #17 Past JUNE 2012 Europ Assistance - GCS inaugurates its new medical center in Chad Europ Assistance - GCS has inaugurated its new Europ Assistance IHS Medical Center in N Djamena, Chad on June 6 th. The event gathered more than 200 local and international clients and prospects who visited the new medical center and provided us with their positive feedback. First established in 2006 at the request of a specific client, the Europ Assistance IHS Medical Center has now changed premises in N Djamena, Chad, and enhanced its overall infrastructure with substantial investment. The center has furthermore developed its local preferred providers medical network to match the needs and expectations of recent new beneficiaries. The medical center manages 24/7 healthcare programs for global corporations and their subsidiaries, average and local private companies, as well as international organizations established in Chad. In all, more than 5,000 people currently access the Europ Assistance IHS Medical Center in N Djamena. Available services at the center, provided through differentiated memberships programs (GOLD, SILVER and BRONZE), include: Medical Consultations Healthcare Services Imagery Intensive care Laboratory standard analysis Medical transport and evacuations Other services upon request For more information on the location of our Europ Assistance IHS Medical Centers and our healthcare programs, contact sales@ea-gcs.com 07

8 Past JUNE 2012 Europ Assistance - GCS participates to UN Procurement Seminar in Copenhagen Europ Assistance - GCS attended the UN Procurement Seminar in Copenhagen on the 11 th and 12 th of June, organized by the German American Chambers of Commerce. The UN Procurement Seminar was specifically designed for German companies with a product portfolio relevant for the UN agencies in Copenhagen. UN representatives gave an overview of the agencies in Copenhagen and their procurement systems. They also presented the online registration platform UNGM and provide the participants with hands-on advice regarding the registration procedure. Europ Assistance - GCS participated to one-on-one meetings in order to better understand the characteristics of working with United Nations Agencies such as the UN Office for Project Services (UNOPS), the UN Development Programme (UNDP), the UN Population Fund (UNFPA), and the UN Children`s Fund (UNICEF). For more information on our Europ Assistance - GCS procurement capabilities, contact sales@ea-gcs.com JUNE 2012 Europ Assistance has launched its Travel for Treatment to Turkey service As a leading Assistance company for medical care services in Turkey, Europ Assistance launched a travel for treatment program together with the Dutch Cancer Association with the aim to assist people, especially those who are suffering from chronic diseases, in finding the most appropriate treatment and diagnosing facilities for the corresponding ailment. With the continuous improvement of medical service quality and specialization in the health sector, Turkey has become a very attractive destination for a various kind of treatments. Many patients start to acknowledge the attractiveness of Turkey as a country for treatment, and Turkish nationals residing abroad appreciate being able to be treated in their mother tongue and in a more conversant and familiar environment. The program is initially set-up for people residing in the Netherlands, and it will broadened later to include partner associations in Belgium, and Germany. In a longer outlook, it is a clear goal of Europ Assistance to establish Turkey as an international hub for travel for treatment and health tourism. For further information on Europ Assistance s Travel For Treatment Program in Turkey, contact sales@ea-gcs.com 08