The use of expensive air charters to evacuate critically ill patients is increasing.
A couple of weeks ago there was nothing more precious than time for 44-year-old Rajendran Muthu, an aeronautical engineer who had suffered serious head injuries after a fall. While walking down the hill on his way back from Vaishnodevi temple, Muthu fell down a hard stone staircase and sustained injuries. After he was rushed to a hospital in Jammu, the doctors gave their prognosis: they did not have the facilities to stabilise him. As his wife started running out of ideas, a friend suggested that Muthu be airlifted to Delhi. That idea saved Muthu’s life.
Today, Muthu is back on his feet and has been discharged from Delhi’s Apollo Hospital. Both his doctor and Muthu credit his recovery to the airlift, which ensured the blood clots in his brain could be treated rapidly. The bill for airlifting Muthu from Jammu to Delhi in an aircraft chartered by Apollo Hospital was Rs 3.5 lakh. Since Muthu hails from a middle class family, the cost was borne by relatives. But his wife Padmini states, “All we could think then was to get him the best treatment. There were no other option for us. Money can be earned later.”
Dr Priya Singh, who heads the emergency medicine department at Apollo Hospital, says it took them less than two hours to get mobilised once they got a call from Muthu’s family. Singh quickly assembled a team of two doctors and a paramedic to fly in a chartered aircraft to bring him back. “Once we are briefed by the patient’s relatives and the local doctors treating them, we give them further advice on treatment. Then our team flies to the location and brings the patient back, all the while treating him and monitoring him on the aircraft. We carry along with us all the necessary life-saving equipment and medicines,” says Singh.
Today, a host of hospitals around the country, and individual doctors who have formed medical and private air charter companies, are providing medical evacuation. According to Dr Nitin Yende of Vibha Care, a Mumbai-based company that offers medical charters, the service is today broadly divided into the following categories:
“The first is a medical escort where a patient who is conscious is transported in a commercial airline with a doctor and a nurse in attendance. Then, there is the stretcher service where a row of seats are removed in an aircraft and the patient travels with medical attendants. Finally, you have the exclusive charter of an aircraft or an helicopter to ferry a patient,” says Yende.
The option to use a commercial flight is exercised only when care for the patient is not timebound. On receiving a call, a hospital or a medi-charter agency will, in turn, place a call to a private air operator to book an aircraft. Since time on a private aircraft is not always guaranteed, these agencies usually have slots booked in advance that can be activated on a priority basis. A significant majority of the cases — 60 per cent — are road traffic accidents, followed by cardio-vascular complications.
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“When we receive a call from a customer needing a medical charter, it takes us less than an hour to respond. We always have crew on stand-by. We strip seats to make room for a stretcher and equipment,” says Captain R Puri of Air Charters India, a division of Stic Travel Group. The company also entertains requests for medical charters, but the bill for doctors and equipment is charged extra. The Bangalore-based Deccan Aviation offers a similar service.
The aircraft typically used for transfers is the twin engine aircraft, which is also favoured by corporates. The charter rates for medical transfers are the same as a normal charter, and the same flying rules apply. On long distance international transfers, the patient is usually brought on a commercial airline. Helicopters are used for short range transfers which is also the international norm, but in India it hasn’t proved to be very popular. “It is very expensive to keep a chopper and a crew on standby for medical emergencies. Abroad, it works because there are institutions that pick up the bill,” says Wing Commander U Pillai, chief test pilot, Hindustan Aeronautics Limited (HAL).
HAL, a few years ago, had tried to keep a couple of its own choppers on standby at its premises in Bangalore and offered them at heavily subsidised rates, but Pillai says they discontinued it because of weak demand. Another factor that makes the helicopter option unpopular is that in India the rules require a flight plan to be filed, making it time-consuming. Also, flying a helicopter in the night is considered hazardous even though sophisticated instruments are available. Today, only Deccan Aviation and Mumbai’s Asian Heart Institute offer helicopter services.
Though the patient has the option of accessing medical facilities via the airlift option, the challenge of providing critical care still remains with the medical team that first attends to a patient, says Singh. She adds that she communicates in detail with local doctors. While helicopters, she says, are an ideal option, one needs to make best use of what’s on offer. Thus, one can be sure Muthu’s rescue will be repeated more often as long as critical trauma care in tier II and III towns continue to languish.