While air ambulances remain a popular choice when transporting patients internationally, ground ambulances may be preferable to air transport for a variety of reasons. They are typically cheaper than flying, and may offer a more direct route – providing that the distance to the final destination is relatively short. Additionally, susceptibility to changes in air pressure, or psychological or physiological factors, may mean that certain patients cannot be flown to hospital.
Kimberly Seay, Senior Director of Medical Services at Falck Global Assistance USA, explained: “Patients with certain medical conditions may not be able to withstand some of the impacts of being in the air, so ground ambulances may be the only option. Examples of medical conditions that may prohibit immediate air travel is a patient with a subarachnoid haemorrhage – a brain bleed – or a collapsed lung (traumatic pneumothorax) where the patient’s chest tube has been removed.”
She added that patients with extreme weight or abdominal girth may also need ground-based transportation: “Obese patients with a large abdominal girth may not be able to fit through the air ambulance door. In those situations, a bariatric air ambulance may be required – but availability of those is limited.”
Other medical conditions that may result in a decision to transport the patient by ground ambulance include pulmonary embolisms, and polytrauma, particularly for patients with an abdominal blunt trauma.
Alongside the patient’s physical health, Michael Key, Director of Business Development at One Call Medical Transports (OCMT), noted that psychological factors may also factor into whether a ground ambulance is used: “I can tell you that we have seen many instances where we are notified that the patient or family prefers ground transportation due to a fear of flying,” he explained. Such psychological reasons should not be discounted: fear can raise heart rates, blood pressure, and put patients under severe stress.
Key added that other factors may affect whether a ground vehicle is chosen over an air ambulance, including ‘the proximity of the patient to their ultimate destination, [as well as] inclement weather, geographic location, and the instances when it may make more sense financially for the patient’.
Seay agreed that ‘issues with wind, visibility, or other factors can be an obstacle to timely air travel’, alongside financial factors or the availability of aircraft. She added that the political and bureaucratic challenges of air travel could also mean that a ground ambulance was preferable: “For example, the airport may close and not open until the next morning, or landing permits may take days to secure,” she said, adding: “The political situation in a country is also a consideration. Air ambulance staff may not feel safe to land in a specific area, so for safety reasons we may move the patient by ground to another location where it is safe for our air ambulance to land and pick up the patient.”
Maintaining patient comfort
However, while ground ambulances may have many benefits, they tend to also be less comfortable to travel in on long journeys, compared with their airborne counterparts. To counteract this, many ground operators take measures to improve the comfort of patients.
Patients with extreme weight or abdominal girth may also need ground-based transportation
Key explained that OCMT’s ground ambulance provider network will typically adapt their medical equipment and supplies to accommodate any potential patient discomfort on longer-distance transfers. “This includes supportive stretchers or beds, appropriate cushions or padding, and comfortable safety restraints,” he explained. “They also offer refreshments, and can provide food when requested. Other measures include ergonomic vehicle configuration, enhanced suspension, climate control, entertainment options, and the ability to bring loved ones along.”
Seay echoed Key. She explained that to ensure that patients are as comfortable as possible while in transit, Falck takes a number of measures, including the use of an ‘egg crate mattress pad or cushion’, as well as ensuring that the ‘patient’s pain management is addressed pre- and during transport’. She added that: “Urinary catheters should be considered for immobile patients.”
Additionally, Falck encourages family members to accompany their loved one, when the patient’s condition allows for it.
Dealing with providers
Despite the differences between air and ground ambulances, the fundamentals of arranging a patient transport remain the same. Success is based on building strong relationships with high quality ambulance providers, maintaining good levels of communication during the quoting process and during the operation, and ensuring that the patient is kept at the heart of planning.
Oliver Müller, CEO of Gateway International EMS, explained that, when mediating with providers, ‘Gateway International EMS builds very personal relationships with employees at ambulance companies’, treating them as ‘true partners, not just service providers’.
However, he added, in return providers are expected to adhere to a number of fundamental standards, such as having appropriate business licences, malpractice insurance, and a certificate of liability.
Gateway International EMS also maintains a strict ‘two strikes’ policy when working with ambulance providers: “By that, I mean that if we receive two serious complaints [from clients] or have complaints of our own, we will not use that provider any more. We will also not continue to use a provider that does not respond to a concern or complaint we have,” he added.
Müller also explained that Gateway International EMS does not directly evaluate patients: “When a client requests a transport, they will typically advise us on what level of care the patient needs – such as basic life support (BLS), advanced life support (ALS), or intensive care.
“With that information, we will then search in our provider database, inputting the city and the criteria, and discuss the case with our [ambulance] provider,” he added.
Success is based on building strong relationships with high quality ambulance providers
Good communication is key
Key said that prior to a patient transfer of any kind, via the ground or otherwise, OCMT’s team will ‘communicate with clients and guide them through the process of gathering all pertinent information – to build an accurate quotation’. The company then combines and compares this information with data from all previous transports to ensure that the best provider is chosen for the mission.
Seay agreed, adding that maintaining regular communication between transportation providers and the medical team was a priority, regardless of whether a transport is being conducted by ground or air. She said that typically will take the form of regular updates at ‘key milestones’, such as their arrival at bedside, the completion of a bedside assessment, the commencement of transport, fuel stops or layovers, the touchdown at the final destination, and safe admission at the new hospital.
Seay explained that when arranging a time-sensitive transfer with clients, Falck prefers to obtain three quotes per transport, and then evaluate those quotes with clinical priorities as the foremost consideration, with cost being secondary. The company also vets all of its air and ground providers to ensure that they meet high standards of safety, timeliness and competitive pricing.