Industry standards in medical assistance
We reached out to industry experts to assess whether there should be an international medical assistance standard. They share their thoughts with Mario Pierobon on standardization within the industry
According to Claudia Schmiedhuber, Managing Director of the European Aero-Medical Institute (EURAMI), there is a great need for a medical assistance standard to which medical assistance providers could be held. “Medical assistance companies could greatly benefit from standardisation and guidance provided by a global association,” she affirmed. “However, much like the challenges faced in aeromedical standardisation, establishing a worldwide ‘gold standard’ is an exceedingly daunting task due to the intricacies of services offered by assistance companies and the variations in culture and local regulations.”
A form of standardisation already exists within larger corporations with multiple regional branches, and, through EURAMI, they have engaged in extensive debates surrounding this question, as it is intimately connected to their core mission of standardising aeromedical transportation, said Schmiedhuber. “These organisations typically operate under a centralised entity that tailors processes and procedures to the specific needs of each local company. This may serve as an initial step in the direction of standardisation,” she said. “EURAMI is more than willing to help and engage in discussions related to aeromedical standardisation as we welcome such conversations at any time.”
CONNEX Assistance would also welcome a medical assistance standard, like the travel risk management one from the International Organization for Standardization (ISO), said Lara Helmi, Managing Director of CONNEX Assistance. “In addition to our direct operational scope as a medical assistance company, there are areas which are critical to sustaining our infrastructure such as information technology (IT) security, client information confidentiality, business continuity planning, and regulatory compliance – all of which we strive to achieve through meticulously developed internal policies and procedures as well as a set of ISO certifications we have integrated into our business processes,” she said.
Combining CONNEX’s operational manuals with a set of ISO standards has proved to be of value to business performance, highlights Helmi. “These ISO standards include the information security management system (ISO 27001:2013), quality management system (ISO 9001:2015), and business continuity (ISO 22301:2012) standards,” she said. “Adhering to these internationally recognised standards, coupled with our procedural manuals and regular training, ensures that we maintain the utmost in operational efficiency, consistency, and security.”
Establishing a worldwide ‘gold standard’
is an exceedingly daunting task
After more than 25 years of servicing international clients across an extensive region, the business process manuals of CONNEX, combined with compliance with ISO standards, provide a strong foundation for delivering services, affirmed Helmi. “Our dedication is underscored by continuously investing in internal training programmes, which educate and empower our personnel to stay abreast of these high standards as well as changing industry requirements and updated regulatory requirements of our clients,” she said. “We do believe that the existing ISO standards offer ample guidance for medical assistance providers to establish policies and procedures that are both effective and ethical. As a result, we encourage all providers in our industry to draw inspiration from these standards to enhance the quality and reliability of their services.”
Eugene Delaune, Senior Medical Consultant at Allianz Partners USA, observed that the business models of the different travel assistance companies vary greatly. “Medical is, of course, only one small component of travel assistance, and the approach to cases can be quite different, depending on whether or not the subscriber is entitled to just evacuation, evac and repatriation, and/or medical costs,” he said. “And then, when medical costs are covered by the travel insurance company only when the patient is out of the home country, there would be different ways to approach cases.”
Best practices
According to Delaune, if it cannot be confirmed that a patient is receiving appropriate care, even if it is because of lack of ability to get information, the medical recommendation must be to evacuate the patient to an appropriate facility where proper care is available and information about this care can easily be obtained by their travel assistance company. “Travel assistance medical staff should be trained in both critical care medicine (intensive care, emergency, medicine, or anaesthesia) as well as have training or experience in aerospace medicine,” he said. “These providers should be currently actively practising medicine, or at least have practised within the last five years and maintained their professional credentials to ensure they are up-to-date and fluent on the appropriate treatments and expected outcomes for a wide variety of conditions.”
Providers should be currently actively practising medicine, or at least have practised within the last five years and maintained their professional credentials to ensure they are up-to-date and fluent on the appropriate treatments and expected outcomes for a wide variety of conditions
In the absence of an international standard, the current internal standardisation efforts of larger corporations with multiple entities worldwide, where the same software is employed and similar or identical products are serviced, might be somewhat more manageable to standardise in comparison with achieving genuine global standardisation for assistance companies, pointed out Schmiedhuber. “However, considering aeromedical standardisation is already successfully established, there is both significant value and demand for such guidance within our industry. This would contribute to enhanced patient care and elevate the overall customer experience,” she said. “Platforms where best practices can be shared, cases can be thoroughly discussed, and meaningful dialogues can take place, are beneficial to addressing challenges on a global scale and a first step towards developing a common ground.”
All medical evacuations follow a certain set of procedures and require escorts with very specific qualifications, affirmed Helmi. “A medical escort has to be a doctor, nurse or a paramedic who has had training and qualifications for advanced life support (ALS) and basic medical knowledge and practice. We prefer to assign the medical escort according to the specialty of the case surgeon: orthopaedic, paediatric, cardiology and neurology,” she said. “Standard practice is to receive detailed medical reports on the repatriated subject, along with fitness to fly; this will dictate the mode of transport, stretcher, ambulance or air ambulance. In addition, this will make our medical team decide on what type of escort to assign to the patient: paramedic, nurse, doctor etc.”
The medical escort evaluates the patient prior to evacuation to specify the methods and requirements of repatriation, along with making sure that the patient’s situation described in the medical report is in line with the examination of the patient and condition, explained Helmi. “This process is already standardised within our operations procedures and includes set checklists for equipment required for the medical escort, and equipment specifically required for intensive care patients and for intubated patients, which may differ,” she said.
The health and safety of the patient is the primary consideration and supersedes any financial ramifications
According to Delaune, only medically sound input should be provided by travel assistance doctors and acted upon by the travel assistance companies. “The health and safety of the patient is the primary consideration and supersedes any financial ramifications, regardless of covered benefits or patients’ willingness to pay out of pocket for uncovered benefits,” he said. “Neither the medical team, nor the medical nor the operational arms of the travel assistance company, should take any action that may harm the patient in any way.”
Medical input on cases must always be independent and free of any pressure, said Delaune: “While it is fine for travel assistance doctors to be aware of the benefits included in a travel assistance policy to help present treatment and travel options which may be covered by the payer (which decreases the chance that the patient will end up with out-of-pocket costs), these doctors should never feel pressured to give input that places financial interests over the wellbeing of the patient.”
Industry standardisation
EURAMI, as a global aeromedical accreditation association, has committed to the mission of standardising medical care in aviation, ranging from fixed-wing and rotary-wing air ambulance to commercial airline medical escorts, said Schmiedhuber. “With over three decades of experience and a diverse membership spanning the globe, we have been providing guidance to companies involved in safe patient transportation since our inception,” she said. “Recently, we have introduced an updated version of our Fixed Wing Standards, and we are presently in the process of preparing the publication of EURAMI Commercial Airline Medical Escort Standards 2.0. This revised standard will encompass even more specific requirements for transporting patients on commercial carriers.”
It is crucial that any standard covers all aspects that ensure the diligent, responsible and safe transportation of patients
It is crucial that any standard, whether originating from EURAMI or fellow accreditation organisations, comprehensively covers all aspects that ensure the diligent, responsible and safe transportation of patients, from the moment of pick-up to the handover at the hospital, pointed out Schmiedhuber. “This is a rather intricate concept, particularly when dealing with global standards. However, our most recent standards publications address all current issues and concerns, thereby contributing significantly to the improvement of aeromedical transportation worldwide,” she said.
“Based on the positive responses we receive from assistance and insurance companies regarding their choice of aeromedical providers and the increasing demand from providers seeking accreditation, it is evident that standardisation has become an even more vital issue in today’s insurance landscape.”