Aeromedical Transport in LMIC

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Aubrie McKenzie
10 years ago
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1 Aeromedical Transport in LMIC

2 The Role of Aeromedical Transport in LMIC Dr. Ryan Wubben Clinical Associate Professor University of Wisconsin

3 Background Emergency Physician Medical Director, University of Wisconsin Med Flight Program 2008-present Flight Physician: 14 years present

4 Aeromedical Transport in LMIC Role and need? History Business models Levels of care Staffing models Future? New Ideas?

5 Is there a role? Parallels the establishment of Emergency Medicine Kenya 2000 AFEM today Who are the patients? Citizens Ex-pats Tourists

6 Development of Aeromedical Transport In many ways parallels the development of Emergency Medicine: Right time, place and environment Different evolution in different countries

8 AMREF Flying Doctors Established in Kenya 1957 Sir Michael Wood and two others Fixed wing Regional and international Cessna Caravan, King Air, Citations Insurance Subscription service Evacuation Insurance

9 Wilson Airport, Nairobi

10 Insurance Scheme -Evacuation Insurance -Subscription Service - Maisha Air Ambulance Scheme

11 AMREF Patient Mix Kenyan military: 5% NGO s: 30% Tourists with evacuation insurance: 25% Self pay individuals: 30% Charity 10%

12 AMREF Patient Pathology: Poly-trauma after MVC/RTA GSW Malaria MI and CVA Pediatrics Mix of critical care and stable interfacility

13 AMREF Staffing Model Depends on situation Doctor-Nurse Nurse-Nurse Doctor-Two Nurses Nurse only Do not use paramedics or clinical officers Volunteer Physicians: 4 weeks

14 AMREF Flying Doctor Service

15 Aeromedical Transport in South Africa

16 HEMS in South Africa Extensive Aeromedical Retrieval System: Fixed wing HEMS: Red Cross Air Mercy Service Netcare 911 ER24

17 HEMS in SA Initial trials in Johannesburg Bell Long Ranger Nursing staff crew from ICU STAR Flight for Life Helivac

18 Netcare 911

19 ER24 Discovery Medicopter

20 Air Mercy Service (AMS) First established in 1966 Single Cessna 205 Red Cross Red Crescent movement Philosophy: The most appropriate resource for the particular requirement Non-profit

21 Air Mercy Service (AMS) Mixed fleet: 8 bases PC-12 AS350, EC130, AW 119K, AW 109 Grand First HEMS in 2000 BO105 Daylight Physician and ALS/ILS paramedic Approx patients 6.5 million kilometers flown

22 Air Mercy Service (AMS) Formed into Trust in 1994 Services directed at disadvantaged & isolated communities Also render service to private paying and insured patients Operational costs: Dept of Health, medical aid societies, & organizations that use service Donations

23 Netcare 911 Private entity Pre-hospital risk management and emergency assistance subsidiary of Network Healthcare holdings Started in 2005 after STAR MD RN/paramedic

24 Netcare 911

25 Netcare 911 Day vs Night staffing AS Squirrel: daytime 1 pilot EC-135: night 2 pilots Still current staffing model? Still MD/ALS medic?

26 ER24 Real Help Real Fast ER 24 & Discovery Medicopter Originally started in with two aircraft Daylight operations (?) Pilot and two paramedics

27 ER24 Real Help Real Fast Discovery Medicopter

28 West African Rescue Association

29 West African Rescue Association Ghana Sierra Leone Private ambulance response & clinical medical service Subscriptions Medical Director: Dr. Isaac Akanko

30 West African Rescue Association Staffing Model -Physicians (18) -Nurses (16) -Medics (17) Vision: To provide first world health care support to our clients in the developing world

31 West African Rescue Association Corporate Social Responsibility Blood Drives, Trauma/BLS training Vaccination programs Work with Government of Ghana on Disaster Management

33 Nigeria Flying Doctors Nigeria Founded by Dr. Ola Orekunrin Mission: To get the right patient to the right facility within the right time frame Vision: To revolutionize the provision of emergency healthcare across Africa

34 Dr. Ola Orekunrin UK trained Lived in Japan Inspiration from personal family history

35 Flying Doctors Nigeria

36 Flight Physicians: Senior Anesthetists Critical Care Certificates in Aviation Medicine

37 Diverse Business Model Air Ambulance Services Medical Repatriation Medical Logistics Inter-Hospital Transfers Infrastructure Services Remote site medical solutions

38 Flying Doctors Nigeria 500 patients in first three years CNN story April 2013

39 Haiti Air Ambulance

40 Ayiti Air Anilans Air Methods aircraft Donations Charity Care Controversial in some circles HEMS in resource poor environments?

41 Aeromedical Transport in LMIC As with Emergency Medicine Develops at different times and at different paces in different places Appropriate in resource limited environment? Significant issues: Business model and funding? Patient population?

42 Aeromedical Transport in LMIC Business models that work Diversity and flexibility Provision of charity care Need? UK Hangar 8 service: Est 15,000 aeromedical evacuations/year Collectively costing 300 million pounds Africa accounts for 40%

43 Aeromedical Transport in LMIC Alternative models? Cooperative models Ministry of Health Ministry of Defense Many barriers Politics Resource limitations Turf

44 Thank You Dr. Joseph Lelo Dr. Zina Semenovskaya Achim Teich James Nzau Dr. Seblework Temesgen Dr. Simon Forrington (AMREF blog)

45 Thank You History of HEMS in South Africa Dagmar Muhlbauer Raveen Naidoo Dr. Timothy Hardcastle Aeromedicine: A Regional Approach Dr. Wayne Smith 2004

46 Twitter! #FOAMed #SMACC Chicago US in June 2015 Registration this

47 Thank You!

HISTORY OF HELICOPTER EMERGENCY MEDICAL SERVICES IN SOUTH AFRICA

HISTORY OF HELICOPTER EMERGENCY MEDICAL SERVICES IN SOUTH AFRICA Mrs Dagmar Muhlbauer Chief Flight Paramedic Netcare 911 Mr Raveen Naidoo Dr Timothy Hardcastle The day it all began. Started operations