You may not need to call for an air ambulance if you get sick while traveling.

Most people know that if they fall ill while traveling – and their insurance covers it – an air ambulance can come to their rescue and repatriate them back to their home country. But not everyone knows that a patient can also jump on a previously scheduled commercial flight to return home, and it might save them thousands of dollars.

Medical repatriations are for patients who are “medically fit” to return to their home country after becoming sick during travel, according to Medical Air Service, a global air ambulance company. On top of that, sometimes patients will be repatriated because the country they have traveled to may not have specific facilities. While not all travel insurance covers repatriation, getting one that does will likely be far cheaper for the patient, because while the flight price may be costly, expenses for foreign medical bills are generally higher.

However, repatriation should not be confused with emergency medical evacuation. Also dubbed medevac, a patient (usually in critical condition) is transported to a specialist medical facility that may not be locally found. It doesn’t necessarily mean the patient will relocate to another country, but to the closest place with suitable facilities.

There are several ways for patients to return home after falling ill or suffering from an accident. Air ambulances or private business jets are what most patients opt for in more extreme circumstances and can be deployed quickly. But hitching a ride on a scheduled commercial flight is often more convenient for those in less severe situations. Managing director at the European Aero-Medical Institute (EURAMI), Claudia Schmiedhuber, told AeroTime that,

“Usually, most of the commercial airlines allow for commercial medical repatriations to take place on their aircraft. However, there are limits in route network and the patient’s conditions which might cause repatriation to be denied.”

On a commercial flight, there are three ways for medical repatriation to work: on a seat with a medical escort such as a nurse; on a stretcher; or in a Patient Transport Compartment (PTC). A seat with an escort is generally the cheapest and easiest way to transport a patient with a minor illness back to their home country or one with sufficient facilities.

This might mean that the patient sits in the front seats of an aircraft that offer more legroom or even a business class seat that enables them to lie down. The benefits of this are that there will be minimal disruption to the airline, it will be cheaper for the patient, and it is typically far more comfortable for the patient, especially as family and friends can be by their side.

However, a stretcher is required for the patient in more serious circumstances. This can take up to several days to install but is an efficient option and can be used for medium and long-haul flights - a far more attractive alternative to air ambulances where multiple stops may be made due to fuel refills and other reasons. The patient on a commercial flight will also be separated from other passengers with a sheet, which gives them more privacy.

The last option is a PTC, which is a separately installed unit with intensive care equipment, usually left for patients with severe illnesses. According to Medical Repatriation UK, a PTC usually has a scoop stretcher with a vacuum mattress and patient warming system, a biphasic defibrillator, at least 2,400 liters of oxygen, infection protection kits, special equipment for the care of babies and children, and more. It is essentially a small flying hospital room.

While a PTC is beneficial for extreme situations, most airlines do not accommodate them. In fact, Germany’s Lufthansa was one of the few known international carriers to provide intensive-care transportation on scheduled long-haul flights, but in June 2020, the company ceased the program. The PTC was installed in its Boeing 747s as well as its Airbus A330, A340, and A380 intercontinental fleets. A Lufthansa spokesperson told Simple Flying the airline decided to suspend its PTC services amid the rising use of long-range ambulance aircraft.

While preparing to repatriate an ill traveler is time-consuming, its cost benefits sometimes outweigh the lengthy process. Air ambulances can cost well into the tens of thousands, but a commercial transfer can be below $10,000.

Repatriations are costly and have become even more difficult amid the COVID-19 pandemic. Schmiedhuber said that on top of the extra time needed for transferring a medical patient:

“[With] the recent ever-changing COVID-19 related restrictions it has become complicated to assure smooth journey. Organizing transportation very much depends on the patient’s location, destination as well as the patient’s condition".

The patient’s attending physician must also fill out a Medical Information Form for Air Travel (MEDIF) and get clearance from the airline before commercial repatriation can be arranged, which can take time. The repatriation process on a commercial flight also means the carrier gets the final say, giving the physician less control over how their patient is transported.

Typically, the escort assisting the patient during the transfer will fill an airline’s MEDIF, but the carrier will make the final call on how it gets done. Dr. Thomas Buchsein, a medical director at German air ambulance company FAI, told AirMed&Rescue magazine that one patient with a pelvic fracture who used UK-based AXA Assistance to fly on an unnamed German airline was told a doctor was to accompany them instead of a nurse. He said the airline expected the doctor would be able to deal with a higher level of pain compared to the nurse, ultimately showing the carrier has the final say.

The airline must also be mindful of other passengers, such as ensuring the patient’s condition won’t affect others. If there is a potential for that, the airline has the choice to reject a patient transfer, especially if a PTC is not installed.

The pandemic threw a spanner into the works of medical repatriation and essentially shut down all measures of using commercial flights for the task. It made air ambulance’s far more valuable but almost impossible due to border closures and strict health measures. While this is true, many made do, such as adding larger aircraft that could accommodate ten patients simultaneously to mitigate the demand.

However, now that most of the world is open again, aside from some nations that have reigned tight closures, medical repatriation on a commercial flight is an option once again. While this is a positive sign, it’s important to note that since Lufthansa suspended its PTC services in 2020, the option for severe cases to be repatriated on a commercial flight is much slimmer, especially for long-haul travel.

However, Schmiedhuber said she believes more people will opt for this option in the future when it’s possible.

“One aspect in favor of commercial carriers is that we see more and more routes being developed which will help to transfer patients with less connections necessary,” she said. “I think that we will see more commercial medical repatriations being performed in the future and more carriers adapting their fleet and service offerings.”

Source: Aerotime, AirMed&Rescue