Aeromedical Transport in LMIC
The Role of Aeromedical Transport in LMIC Dr. Ryan Wubben Clinical Associate Professor University of Wisconsin
Background Emergency Physician Medical Director, University of Wisconsin Med Flight Program 2008-present Flight Physician: 14 years 1997-2000 2004-present
Aeromedical Transport in LMIC Role and need? History Business models Levels of care Staffing models Future? New Ideas?
Is there a role? Parallels the establishment of Emergency Medicine Kenya 2000 AFEM today Who are the patients? Citizens Ex-pats Tourists
Development of Aeromedical Transport In many ways parallels the development of Emergency Medicine: Right time, place and environment Different evolution in different countries
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
Wilson Airport, Nairobi
Insurance Scheme -Evacuation Insurance -Subscription Service - Maisha Air Ambulance Scheme
AMREF Patient Mix Kenyan military: 5% NGO s: 30% Tourists with evacuation insurance: 25% Self pay individuals: 30% Charity 10%
AMREF Patient Pathology: Poly-trauma after MVC/RTA GSW Malaria MI and CVA Pediatrics Mix of critical care and stable interfacility
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
AMREF Flying Doctor Service
Aeromedical Transport in South Africa
HEMS in South Africa Extensive Aeromedical Retrieval System: Fixed wing HEMS: Red Cross Air Mercy Service Netcare 911 ER24
HEMS in SA Initial trials in 1976-1977 Johannesburg Bell Long Ranger Nursing staff crew from ICU STAR Flight for Life Helivac
Netcare 911
ER24 Discovery Medicopter
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
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 13000 patients 6.5 million kilometers flown
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
Netcare 911 Private entity Pre-hospital risk management and emergency assistance subsidiary of Network Healthcare holdings Started in 2005 after STAR MD RN/paramedic
Netcare 911
Netcare 911 Day vs Night staffing AS Squirrel: daytime 1 pilot EC-135: night 2 pilots Still current staffing model? Still MD/ALS medic?
ER24 Real Help Real Fast ER 24 & Discovery Medicopter Originally started in 2009 2010 with two aircraft Daylight operations (?) Pilot and two paramedics
ER24 Real Help Real Fast Discovery Medicopter
West African Rescue Association
West African Rescue Association Ghana Sierra Leone Private ambulance response & clinical medical service Subscriptions Medical Director: Dr. Isaac Akanko
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
West African Rescue Association Corporate Social Responsibility Blood Drives, Trauma/BLS training Vaccination programs Work with Government of Ghana on Disaster Management
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
Dr. Ola Orekunrin UK trained Lived in Japan Inspiration from personal family history
Flying Doctors Nigeria
Flight Physicians: Senior Anesthetists Critical Care Certificates in Aviation Medicine
Diverse Business Model Air Ambulance Services Medical Repatriation Medical Logistics Inter-Hospital Transfers Infrastructure Services Remote site medical solutions
Flying Doctors Nigeria 500 patients in first three years CNN story April 2013
Haiti Air Ambulance
Ayiti Air Anilans Air Methods aircraft Donations Charity Care Controversial in some circles HEMS in resource poor environments?
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?
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%
Aeromedical Transport in LMIC Alternative models? Cooperative models Ministry of Health Ministry of Defense Many barriers Politics Resource limitations Turf
Thank You Dr. Joseph Lelo Dr. Zina Semenovskaya Achim Teich James Nzau Dr. Seblework Temesgen Dr. Simon Forrington (AMREF blog)
Thank You History of HEMS in South Africa Dagmar Muhlbauer Raveen Naidoo Dr. Timothy Hardcastle Aeromedicine: A Regional Approach Dr. Wayne Smith 2004
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Thank You!