An under-supply in the air ambulance sector has contributed to slow market of this life-saving service, WOLE SHADARE writes Nigeria requires more air ambulances to save lives.
Air ambulance service, though popular in Europe, America and South Africa is still largely unknown in the Nigerian environment.
The role of an ambulance is a really essential tool for medical professionals and it is getting the right patient the right medical facilities within the right time-frame.
When patients need to be airlifted to medical care in an emergency, the first priority is getting them to the right healthcare provider as quickly as possible. Patients are at a disadvantage in this urgent situation because they cannot determine whether air transport is a medical necessity, nor are they equipped to direct, which air ambulance provider should pick them up.
That can lead to surprise expenses when the air ambulance provider turns out not to have a contract with the patient’s health plan, even if the consumer has insurance. The patient may then be billed for the full charge of the flight or the balance left after any payment by the insurer for the out-of-network coverage.
Over the last 10 years, there has been a dramatic change within the air ambulance industry, with a rapid expansion of operators entering the market.
Those market changes have had far reaching effects on the costs patients must pay for services, and have resulted in patients receiving unexpected, exorbitant bills for tens of thousands of dollars for emergency transportation that the patient assumed would be covered by insurance. Air ambulance providers typically operate under one of three business models.
One defined by the entity that owns the aircraft and provides the medical services on-board such as Hospital-based: a hospital controls the business by providing medical services and staff, while generally contracting out for the pilots, mechanics, and aircraft. Independent operations are not controlled or run by a specific medical facility. Independent for-profit or non-profit providers directly employ the medical and flight crews to provide air ambulance services.
The other is government operator: a state or municipal government or military unit owns and operates the air ambulances. Air ambulance services are utilised both to transport patients from the scene of an accident to the hospital, as well as for inter-hospital transfers when a patient requires treatment at a different facility.
Some air ambulance providers have both helicopters and fixed wing airplanes available. Majority of emergency medical transports take place in a helicopter, just as most air ambulances come with medically trained personnel and some degree of medical equipment.
As a result of the increase, for profit operators were able to expand their presence in the air ambulance industry greatly. While there were virtually no for-profit air ambulance operators in 2002, more than half of the industry is now controlled by four for-profit operators.
Since the reimbursement increase went into effect, for-profit operators have added hundreds of new air ambulance bases and vehicles nationwide: in 2003, there were 545 helicopters flying out of 472 air bases in the United States; by 2015, those numbers had nearly doubled, with 1,045 helicopters at 864 bases. Although air ambulance transports made up less than one per cent of total ambulance claims in 2011, they represented eight per cent of the total medicare spending on ambulance services because of their high price tag.
Founder and Managing Director, Flying Doctors Nigeria, Dr. Ola Orekunrin, narrated one incident to New Telegraph and how the patient was immediately evacuated by air ambulance for treatment.
She said that the patient would have died if help was not forthcoming. According to her, “for instance last week, there was a patient that we moved from Benin to Lagos.
Her situation was that a building fell on her and her hip was so shattered that it could only be done at Igbobi General Hospital in Lagos. With her condition, it would have been difficult to move her by road because of the state of the roads as the hip has to stay completely together. So, we were able to move her successfully from Benin to Lagos.”
The essence of air ambulance she said it’s just about moving people to the place where they can receive treatment in a shortest amount of time. She said that one of “our common trips is actually from Maiduguri to Lagos and before you are trying to move complex orthopaedic from Maiduguri to Lagos by road, the journey can even take seven days, but with our service, it can be done within an hour; the state of the road and the condition of the patient matters in moving patient across long distances.”
“So, if a patient is on oxygen, for instance, imagine from Maiduguri to Lagos by road, how many cylinders of oxygen will you need to pack inside that ambulance to get the patient safe because one cylinder probably lasts for one hour and you know how expensive a cylinder is?
“You will need about 20 cylinders to even get the patient down to Lagos and you will require about two ambulances too; one for the oxygen and the other for the patient. If that car breaks down in an area where there is no hospital, the patient can run out of oxygen quickly, no matter how far ahead you plan,” she added.
Sometimes, one feels sorry for air ambulance operators in Nigeria who are into partnership with commercial airlines because it’s an extremely difficult environment for the airlines to operate, especially when it comes to respect for departing when they are billed to do so.
Orekunrin noted that her experience with Nigerian airlines has been quite good and they seem to be very caring about her patients. “So, whenever there is going to be a delay, we are always the first to know.
They usually tell us to keep the patients in the hospital and contact us immediately the flight will take-off. So, in most cases, we bring the patients to the tarmac as soon as the aircraft is about to go. They put our patients first no matter their classes.
They are always very conscious in ensuring that in any operational issue they may be having at a point in time does not affect our patients.”
As a nation, we have struggled to secure affordable and high quality medical care for all Nigerians. At a minimum, we should ensure that in critical emergency situations, timely, appropriate medical care – including transportation to that care – is available to all.