Amid Covid crisis in cities, air ambulances put far-flung hospitals within reach for many
New Delhi/Mumbai: As a Beechcraft Super King Air B-200 air ambulance touched down in Sahnewal, 7.5 miles southeast of Ludhiana, after a 50-minute flight from Delhi, paramedics hurriedly shifted a Covid patient out of the plane to an ambulance and rushed him to a hospital where his family members reserved a bed for him.
With the oxygen saturation of the patient dropping precariously, and no beds available in any Delhi-NCR hospital, the family started exploring options in cities in Uttar Pradesh and Punjab. As soon as they managed a bed with oxygen support in Ludhiana, they booked an air ambulance and took the patient there.
The fourth Covid wave completely overwhelmed the healthcare system in the national capital with hospitals first running out of beds and then oxygen supply. For a couple of weeks there were no beds available in any hospital, especially in the ICUs.
With health care resources stretched to their limits, desperate families did whatever they could to arrange hospital care for their relatives.
According to Lakshay Rescue air ambulance services based in New Delhi, when the cases of infection surged many folds recently, at least 70% of the flights they operated were between Delhi and cities such as Ludhiana, Patiala, Jalandhar, Lucknow and Varanasi.
“We operated almost one flight every day. The situation was so bad that we even had patients who consumed 5-6 oxygen cylinders in an hour-long flight. Usually, we travel only with one or two oxygen cylinders. Because of the shortage, we had customers wanting to take their patients to tier-2 and tier-3 cities, mainly in Punjab and Uttar Pradesh as they are closer to Delhi. People were ready to take their patients wherever they could arrange an oxygen bed or ventilator,” said Birendra Kumar Mishra, marketing head at Lakshay Rescue.
Shaju Kumar, the chief executive officer of air ambulance service AEROMED International Rescue Services Ltd, said when Delhi was reeling under severe oxygen shortage and hospitals were running full, his company operated many fights to cities that would not be people’s first choice when it comes to availing medical facilities.
Such a trend was, however, not only limited to Delhi.
Accretion Aviation that is based out of Mumbai and Indore witnessed a similar trend. Rahul Mucchal, owner of the firm, said due to the extreme stress on the medical infrastructure and non-availability of hospital beds in metro cities, many families shifted their Covid patients to smaller or less developed cities, wherever they managed to book a bed or medical care, as required.
“We transported patients from bigger cities to cities like Indore and Ranchi. Some of these are migrants while others have friends or family members running hospitals in these tier 2 and tier 3 cities. The booking volume too, this year, has been unprecedented,” he said.
At the time, Mucchal’s Accretion Aviation was completely booked and was committing to bookings only 24 to 28 hours ahead of the departure. “We get 30-35 enquiries per day, sometimes even 50. Of these, only four to five are converted to bookings. The demand is ever increasing April onwards. We operate Covid air ambulances which are bed to bed; implying that we provide an ICCU ambulance to the airport, then isolation pods in the aircraft, along with medical teams and ICCU equipment on board and then ground ambulance at the destination,” he said.
AEROMED’s Shaju Kumar said his firm had witnessed a 100% hike in demand. “When there was severe oxygen crisis in Delhi and other places, we were flying three flights a day. Usually we used to fly one flight every day. This is a three-fold rise. All are Covid patients and we have three pods available. Covid patients are only kept in pods which helps us contain the spread when there are others (staff and paramedics) travelling along in the same plane,” he said.
At the same time, Lakhsya Rescue also had a tough time dealing with the steep surge in the number of enquiries and calls per day. “From 25 to 30 calls, our daily enquiries had gone up to roughly about 100-120 queries a day. People, most commonly, ask about the charges, facilities included, availability of flights and most importantly safety and precautions taken onboard,” the firm said.
However, on the contrary, in the current situation, it has also been observed that bookings of air ambulances for non-Covid patients have drastically fallen.
According to Amit Kumar, the founder of Flaps Aviation that runs Book Air Ambulance fleet of aircraft, they receive about 50 enquiries for air lifting only Covid patients daily, whereas the calls for air lifting non-Covid patients have gone down.
“The overall demand for air ambulances even in tier II and III cities has gone up for Covid patients, as the relatives of the patients want to shift them to hospitals in other cities for better treatment and as per the bed availability,” he said.
With increased demand, the cost of hiring air ambulances has also gone up. Operators said factors that have led to a rise in cost are expensive charges of medical team that takes the risk of travelling along a Covid patient, arrangements of pods – in which a Covid patient is kept to contain the spread of the virus and availability – as service providers often pay extra to arrange for an aircraft at a shot notice.
Prices also vary depending upon what kind of aircraft is being used, how much crew is needed onboard and how many family members will travel along.
According to Accretion Aviation, for a Goa to Mumbai flight, a patient might need to shell out as much as Rs. 1.8 lakh for a twin engine turboprop C 90, whereas a flight from Delhi to Chhattisgarh will cost around ₹8.5 lakh on a Pilatus PC-12 aircraft. Similarly, charges from Indore to Delhi will be aroun dRs 10-12 lakh and between Indore and Mumbai, may go up to Rs. 13.5 lakh for a Super King Air B-200 plane.
The isolation pods, which are mandatory to carry Covid patients, also affect the pricing. Shaju Kumar of AEROMED, which has three isolation pods available, said the cost of renting a pod has gone up due to a major spike in demand. “While an air ambulance between Delhi and Mumbai would cost around ₹9 lakh earlier, it is now ₹14-15 lakh. Isolation pods which used to cost ₹50,000 earlier, will cost upwards of ₹1.5 lakh,” he said.
Even as families may be willing to pay the sky-high rentals, the availability of air ambulances is another challenge amid the rise in demand. Among the reasons cited for shortage include mandatory protocols that need to be followed while ferrying a Covid patient. Besides, industry veterans also point out rostering of crew to be one of the challenges, as they are bound to undergo mandatory quarantine after flying an infected passenger.
According to veterans, the country has around a dozen air ambulance operators. “India has 12 to 15 air ambulance operators, and it is important to note that not all air ambulance operators are flying Covid patients due to logistical issues,” said a member of Business Aircraft Operators Association (BAOA).
Highlighting the difficulties, he added, “Strict protocols are to be followed while flying a Covid infected person. Currently, the demand is much more. An aircraft needs to be thoroughly sanitised every time after a Covid patient is flown, not allowing more than five operations per day. Moreover, the shortage of isolation pods that is mandatory for carrying Covid patients is also a major drawback.”
Accretion Aviation’s Rahul Mucchal said apart from the aircraft, many a times, ground ambulances aren’t available. “Because of the shortage, we try to accommodate the most critical first. We have now started to tie up with various ground ambulance providers, which we use for distances up to 400-500 km to increase our service and ensure availability,” he said.
AEROMED also said that the availability is an issue even now. “It depends on aircraft providers. We only provide for medical services and equipment. Whoever needs to book an air ambulance needs to make booking in advance as planes are not available at short notice. Once the booking is made, we arrange for everything and this may take up to a day or two,” said Shaju Kumar, the CEO.