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Air Medical/Ambulance Services: An emerging trend needed in Ghana's health care system

Author: Kwadwo Owusu Nyarko, B.Sc., MHCM, MBA
Kwadwo Owusu Nyarko, B.Sc., MHCM, MBA, The writer is a Senior Health Care Practitioner & President for Congress of Amansie Young Professionals Group (COAYPG), Bekwai Municipality, Ashanti Region.
Kwadwo Owusu Nyarko, B.Sc., MHCM, MBA, The writer is a Senior Health Care Practitioner & President for Congress of Amansie Young Professionals Group (COAYPG), Bekwai Municipality, Ashanti Region.

An air medical service is a comprehensive term covering the use of air transportation: air plane or helicopter, to move patients to and from healthcare facilities and accident scenes. Its personnel provide comprehensive pre-hospital, emergency and critical care to all types of patients during aeromedical evacuation or rescue operations aboard helicopter or propeller aircraft or jet aircraft. The advantages of medical transport by helicopter may include providing a higher level of care at the scene of trauma and improving access to trauma centres. Helicopter - based emergency medical service (EMS) also provides critical care capabilities during interfacility transport from community hospitals to trauma centres and specialized hospitals.

Brief History of Air Ambulance

Air Ambulance is a complex service in which acute care meets air and land transport. Using aircraft to transport the injured has its origins in the military and is almost as old as powered flight itself. In 1870, during the Siege of Paris, 160 wounded French soldiers were transported back to France by hot - air balloon. In the Korean War in the early 1950s the U.S. had specially equipped helicopters dedicated for medical transport and by 1969, in the Vietnam War; specially trained medical corpsmen were providing in - flight care. Subsequent to this, a group of researchers concluded that service men wounded in battle had better rates of survival than motorists since they were air lifted to nearest health facilities with specially designed helicopters with emergency technicians, doctors and paramedics.

Air Ambulance in Africa

AMREF Flying Doctors is a company limited by guarantee wholly owned by Amref Health Africa, which is the leading international health development non - governmental organization based in Africa and headquartered in Nairobi. They started the pioneering role of air medical services in Africa, thus especially east Africa. AMREF Flying Doctors was established in 1957 by three surgeons: Sir Michael Wood, Archibald McIndoe, Thomas Rees and has since been involved in a number of health care projects in East Africa. Spurred by what they had seen of the combined effects of poverty, tropical diseases and lack of adequate health services in East Africa, their collective vision was born in the foothills of Mt Kilimanjaro. At that time, there was one doctor to every 30,000 people in East Africa while in Britain it was 1:1,000.

NB : After AMREF paving the way for Africa, especially eastern Africa, few countries like Ethiopia, south Africa and Nigeria have drafted policies and implemented same on air medical services and now most lives within catchment areas of operations in these countries are saved from preventable emergencies like sudden cardiac arrests, heart attacks, strokes,Aneurysms, head and spinal injuries, intestinal perforations, exacerbating gastric and duodenal ulcers, ectopic pregnancies, hypovolemic/cardiac shocks, comas etc.


Perceptions on Air Safety

Some have questioned the safety of air medical services, while the number of crashes may be increasing; the number of programs and use of services has also increased. Factors associated with fatal crashes of medical transport helicopters include flying at night and during bad weather and post - crash fires. Crew and patient safety is the single most important factor to be considered when deciding whether to transport a patient by helicopter. Weather, air traffic patterns, and distances (e.g, from trauma scene to closest level one trauma center) must also be considered.

Air Ambulance as a whole

An air ambulance is a special helicopter that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. These and related operations are called aeromedical. In some circumstances, the same aircraft may be used to search for missing or wanted people. Like any well - equipped ground ambulance, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment and stretchers. A medically staffed and equipped air ambulance provides medical care in flight while a non - medically equipped and staffed aircraft simply transports patients without care in flight.

AIR AMBULANCE AND INSURANCE COVERAGE

What Is Air Ambulance Coverage

Air ambulance coverage may come in handy if you are injured while traveling or if you require medical care due to an emergency or a medical condition that requires specialized care that is not available in your local hospital or health - care services center. It may be used during an emergency or to obtain specialized services. Air Ambulance coverage may be included in health insurance or travel insurance policies. Air ambulance services and air medical transport is not something we usually think about when we are healthy. It's important to review your travel insurance or healthcare insurance coverage in advance to choose a policy that offers air ambulance coverage with lower out-of-pocket expenses, reasonable deductibles and the co-insurance that works best for you. Air ambulances are largely used in emergency medical situations or situations where timing is of the essence in helping a patient receive treatment.

Air Ambulance Transfers Are Useful

1. When you are injured during a trip and would like to be transported home to receive care near home that is for patients suffering from the (my-life-is-safer-only-in-the-hands-of-my-family/personal-dr/physician syndrome)

2. If you need to be transported to a rehabilitation center to receive specialized care with immediate effect from unmotorable routes.

3. If being transported by ground is impossible or will provide a risk to your health and that rapid transportation is essential and necessary

How Much Does Air Ambulance Cost

According to the National Association of Insurance Commissioners (NAIC) an average cost for one air ambulance flight is between $12,000 and $25,000.

When Can Air Ambulance Be Covered by Health Insurance or Travel Insurance

1. When the attending physician at an emergency recommends an air ambulance due to the fact that it is medically necessary

2. When a patient receives a letter of medical necessity. Medically necessary refers to the medical care required to prevent, diagnose, or treat an illness, injury, condition, or disease according to current medical standards. Medically necessary health care may refer to either services or supplies and must be deemed medically necessary by a medical doctor.

When Is an Air Ambulance Medically Necessary

If you have been in a serious accident or you're in a condition where you may not survive an emergency trip in a land ambulance, an air ambulance may be contacted to quickly come directly to you. The air ambulance has medical professionals on board along with a mini-hospital where they can quickly start treating you as you fly to an appropriate medical center.

Is Approval required Before an Air Ambulance is covered by Insurance

Even if the physician in an emergency recommends an air ambulance, it still has to be approved by your health or travel insurance. A doctor working for your insurance company will review the request and situation and decide if it is in fact medically necessary by the current medical standards. Your insurance company must approve the recommendation for the air ambulance or you may not be covered.

Are Air Ambulances Only For Emergencies

According to the Association of Air Medical Services, more than 550,000 people use air medical transports per year in the U.S. An air ambulance is a medical transport used in many circumstances. It is not always for unplanned medical emergency services. Very often a service could be considered medically necessary but may not have the immediate urgency we often think of. Care may be required during transport, but the timing of the transport is not always necessary to be on the spot. Often time hospitals coordinate to transport patients and are able to set a schedule to help lower the costs of the medical transport if the services of the air transport are medically necessary but not urgent.

Example of Non - Urgent Medically Necessary Air Transport

Amma Smart Yeboah and Awo Yaa are being treated following a skiing accident at the South Patasi Hospital, Kumasi. Unfortunately, although AMMA and AWO are temporarily stable, the South Patasi Hospital is an emergency care facility with limited resources, AMMA and AWO need more tests and specialized treatment. The closest qualified hospital is too far for her to travel by ambulance due to her injuries, so the doctor recommends an air transport in order to get them to the closest hospital centre that can provide the additional services without putting their health at further risk. They arrange air transport for the following afternoon since the care is not critically urgent, yet still requires the advanced care that will be available in the air transport; the air ambulance can come the following day.

Advance Beneficiary Notice of Non-coverage (ABN)

If air ambulance services are deemed medically necessary, yet non-urgent and may not be covered, you may receive Advance Beneficiary Notice of Non-coverage (ABN) that will advise you that you will be held responsible for all charges, so you are made aware before taking the service.

Example of Air Ambulance and Coverage, the American style

Under the Affordable Health Care Act if it is medically necessary, then air transport may be covered under essential services. E.g. NANA YAA sustained a serious injury and in order to save her life, her doctor recommended medical transport to a hospital nearby that would be able to offer her the emergency treatment she needed. The air ambulance cost $29,000 she had a $5000 deductible and a 30/70 co - insurance clause. Once the air ambulance services were approved, she did not receive the full $29,000 of expenses for the air ambulance, she received $29,000 less her $5000 deductible, less the 30% co- insurance ($7,200), for a total reimbursement of $16,800. Due to the deductible and co-insurance she paid $12,200 out of pocket.

Does Air Ambulance or Medical Air Transport Cover Transport of a Companion, Dependent or Spouse?

Depending on your health insurance or travel insurance coverage, if the air ambulance is covered, then insurance companies will often include coverage for an accompanying family member or necessary companion in the coverage. Make sure to ask your insurance representative about this.

Air medical ambulance a parallel scenario to Ghana’s health system

Ghana has no, neither general public nor privately owned air medical service, with the exception of the Ghana armed forces that has basic laid down structures and have had helicopter (s)for evacuations and medical emergencies for years. Governments in and out have not put in place any essential measure to study the mode of air ambulance and its essentials as another means of helping to save lives in Ghana. Most of awareness in to public health in Ghana is based on communicable and sedentary lifestyle diseases neglecting emergency preparedness for trauma from road traffic accidents, fire outbreaks, head and spinal injuries from road traffic accidents and the likes.

Ghana has four teaching hospitals, with about 7 regional hospitals and more than 500 district hospitals, many private health centres, mission hospitals and quasi-health organisations. Due to increasing population and sparsely dense settlements, transfers and referrals of emergencies from smaller facilities to either the regional, teaching or specialist hospitals are delayed causing fatal complications to the extent of patients losing their lives before reaching the referral points for treatment. With interventions of air medical services, these lives can be saved since is a convenient way and a faster transport process to keep human life and restore health. These helicopters used have specially trained physicians, nurses, paramedics to resuscitate and keep victims of such circumstances alive to reach referral points. Thousands of lives are lost yearly in Ghana through road traffic accidents, hundreds through fire outbreaks and most they die in the process of transferring them to the health facilities.

Vehicular ambulances have been so helpful and immensely useful. It also has paramedics and nurses who are trained to save lives on the way to transporting patients to health centers but they are pushed to the corners and not able to achieve most of their aim of preserving human lives due to heavy traffic in the cities in Ghana, unmotorable roads in the smaller towns and villages causing deaths on arrival cases.

RECOMMENDATION

The writer is not saying that these 1st class or highly developed countries don’t lose lives when struck by disasters, they do but in minimal and less as compared to Africa especially Ghana. In Africa, Ethiopia, South Africa and Nigeria have taken the greatest of task and risk to implement air ambulance, east Africa had a taste of these service 50 years ago and it has helped transformed their healthcare industry.

The ministry of health Ghana can work hand in hand with donor agencies, civil societies, and non - governmental agencies to help create and allocate a budget to accommodate air ambulance in the health sector. With these pragmatic steps, a time will come that Ghana will enjoy the vital benefits of air medical services in saving precious human lives. If the Economic Community of West African States (ECOWAS) can sit up, take a critical look and draft cross country polices on air ambulance and implement them, then Africa will record improved life expectancies.

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