The Latin American air ambulance sector – market examination

“When we receive requests to transport Covid-19 patients to Brazil from other Latin American countries, it requires an extensive process of authorisation, sometimes up to 72 hours for us to gain the necessary landing authorisations to pick-up the patient and bring them to Brazil,” De Souza said. “Due to the fact the Covid-19 virus is time sensitive for the required medical treatment, we find the patient worsens from the time of the request until the time we are able to reach the patient.

ECMO (Extracorporeal Membrane Oxygenation) transports have increased significantly

“Some Latin American air ambulance companies are able to fly to the US, but to Europe it becomes a lot more challenging as per the European regulations,” he continued. “We are authorised by the Brazilian Civil Aviation Authority to operate all over the world. Since Brazil is such a large country and typically the capitals of each state have the required medical treatment for the current pandemic, we keep busy moving patients from less capable medical treatment facilities in the rural areas to the superior ones in the capitals. The highest level of medical treatment in Brazil starts with Sao Paulo and then in no particular order: Rio de Janeiro, Belo Horizonte and Brasilia.”

Last year, Brasil Vida completed more than 2,800 missions, with 90 per cent of these being Covid patients. At the beginning of the pandemic, the company was asked to transport patients from cruise ships stranded in Latin America to North America and Europe, which involved several long-haul flights to help them get back home. 

Covid has also affected the type of patients being transported. “Our ECMO (Extracorporeal Membrane Oxygenation) transports have increased significantly,” De Souza added. “Prior to the pandemic we would receive one to two requests a year for an ECMO transport. Today, we receive two to three requests per day for the same transport due to the Covid-19 variation that affects the patient’s lungs. This type of transport consumes three times more of our air ambulance operation than a non-ECMO transport.”

Increase in applications for air ambulance accreditation

Pandemic aside, the development in the business travel and expatriate market in certain areas of Latin America has led to an increase in applications for accreditation from air ambulance companies. Claudia Schmiedhuber, Managing Director at EURAMI, the European Aero-Medical Institute, which conducts audits for quality, safety and excellence, believes this will continue after Covid-19.

“We can see development in the corporate and expat market, which also leads to more repatriations and evacuations from certain areas in South and Latin America,” Schmiedhuber said. “I believe that this is a trend that will also return after Covid-19, as we see more and more backpack and adventure travellers emerging.

“However, this specific region also comes with its unique challenges – geographical, medical and administrational. From our experience, we often hear providers complain that evacuating patients from a remote and hard-to-access area such as mountain terrains or vast jungles has become increasingly difficult, since travellers tend to become more and more adventurous in their travel destinations and activities.”

EURAMI has seen an increasing number of applications from that region, so there is definitely a will to become accredited in an effort to collaborate with global companies

In addition to these challenges, medical resources are often not as easily accessible in more remote areas. From an administrational standpoint, providers can face difficulties in obtaining adequate insurance coverage for medical malpractice and liability, which are necessary to be compliant with EURAMI standards, for example.

“From the market feedback that EURAMI has received, we have often heard that insurance and assistance companies are very thorough with the vetting of their providers in the Latin and South American region and that this also includes assuring that they hold an accreditation as an extra layer of security and compliance,” said Schmiedhuber.

EURAMI has seen an increasing number of applications from that region, so there is definitely a will to become accredited in an effort to collaborate with global companies.

Accredited providers from the Latin and South American region are generally able to fly into the US and Europe. Some of them have very diverse fleets, which include long-range aircraft such as Challengers that allow them to operate on a global scale, as well as smaller turbo prop planes that are ideal for short hops across borders and using shorter runways. As ever on a continent the size of Latin America, the scope and scale of air medical providers vary hugely, thus there are also accredited providers who are solely focused on regional fixed- and rotary-wing transports, acting as a national source for governments, private patients, as well as global insurance and assistance companies.

“From what we have heard from providers, Covid has affected the Latin American aeromedical market in the same way that it has affected the rest of the world – increasingly prolonged efforts to obtain permits for aeromedical operations, entry restrictions, rigorous testing of staff and patients, usage of isolation pods with specialised PPE for Covid-19 patients, and of course an economic impact on the providers themselves due to the lack of tourism and travel.”

Political tensions affect air medical operations

Inez Dijkstra, Commercial Manager for AirLink Ambulance (at the time of writing) told ITIJ that when the pandemic hit, regulations in some Latin American countries changed every day. And this wasn’t just down to Covid-19. Other factors, like political tension, also played their part.

“Each country has its own regulations for entering with an air ambulance flight, but the procedure for leaving can also be different,” Dijkstra explained. “When the pandemic hit, these regulations changed on a daily basis – we had to be on top of the changes in the entire continent.

“Restrictions can also be geopolitically based. An example is that last year we had to put everything in place to be able to evacuate a Canadian citizen from Venezuela. Because of political tensions between both countries, it was complicated to obtain permits from Venezuela. Thankfully, we had boots on the ground to inform us immediately of a change in local regulations.”

When it comes to obtaining flight permits, having the right contacts and experience is very important, Dijkstra emphasised. “Especially at the start of the pandemic,” she added, “it was very complex to arrange overnights in countries such as Cuba, Peru or Venezuela, so extra care had to be taken regarding logistics. If, like us, you fly there regularly, then you have the contacts and means to organise these permits rapidly.”

Dijkstra also said that there had been fewer repatriations following a drop in tourism and they too have been asked to transport Covid patients – something not all air ambulance companies were prepared for.

one positive to come out of the crisis it is that a much higher percentage of travellers are now accepting that insurance is essential

“AirLink was called for a service in the midst of the pandemic,” she told ITIJ. “A 39-year-old pregnant female ICU patient, Covid-19 positive with severe symptoms, needed medical transportation from Venezuela to Costa Rica to continue medical treatment. A big challenge was the route of flight, which had to be carefully planned from the start. The first complicating factor was the patient’s location at a hospital in a small village in the west of the country, near the Colombian border and hours away from the nearest airport.

“The patient was in a critical but stable condition when our crew picked her up from the hospital. She was on mechanical ventilation, in an isolation pod, on sedative and analgesic medication. Due to the political conditions in Venezuela, the crew had to stop at approximately nine military checkpoints along the way to the airport, but we managed to safely deliver her at the hospital in a stable condition.”

Despite the challenges of the last 18 months, Dijkstra believes the tourism industry is coming back with a vengeance and one positive to come out of the crisis it is that a much higher percentage of travellers are now accepting that insurance is essential. To cater for what she believes will be a significantly higher demand for air ambulance services, the company will be adding more planes to its fleet and expanding its range.

Salvador Belity, CEO at Health Control and Logistics Management company Logimedex, agreed with this sentiment. If one good thing is to come out of Covid-19, it’s that travel insurance is a must-have now more than ever. “Tourism reduced drastically for a while, but at the same time I believe this Covid situation will improve the market in the future,” Belity said. “Travellers are now aware just how important it is to have insurance.” And with the insurance will come the benefit of medical networks, including the ability to call on quality air ambulance operators, should the need arise.