Medical evacuation repatriation strategies 2016

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INTERNATIONAL MEDICAL EVACUATION AND REPATRIATION STRATEGIES 2016 In this exclusive round table executive business forum, iPMI Magazine speaks with all sectors of the global industry and focuses on the complexities the international private medical insurance industry face when an insured member falls sick, or has an accident overseas, and requires repatriation or

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evacuation services home or to the nearest medical facility or centre of excellence.

Educational and informative the round tables delivers pertinent business intelligence directly from global medical evacuation and repatriation specialists.

ON THE FRONT COVER: Air and ground ambulance companies and assistance providers remain on call 24/7 365 days per year, working closely with medical insurance payors to ensure the safety, protection and duty of care of tourists, business travellers and expatriates globally.

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IN FOCUS

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A R E PAT R I AT I O N INVOLVES MUCH MORE THAN A JOURNEY T

here has been a 30% year-on-year rise in demand for privately-funded medical repatriations, according to global medical assistance and claims providers, CEGA.

Heart problems, long term illnesses and complex fractures are among the most common medical ailments at the source of private repatriations, according to CEGA, with demand spanning areas as diverse as southern Asia, the Caribbean and mainland Europe. Among those requesting the repatriations are uninsured individuals; business travellers; government organisations and even royalty.

"An individual injured or taken ill abroad should expect it to come hand-in-hand with, among other things, travel arrangements made for relatives, translation services and expert medical supervision from start to finish."

"The demand for medical repatriations is greatest from Europe" says Cecilia Geofilo-Pearson, CEGA's Business Development Manager.

"The welfare of the patient can be put at risk if providers don't take the time to fully assess a patient's needs, to organise exactly the right transport and care to meet those needs and to support them throughout the journey."

"But we are getting requests from all over the world - ranging from straightforward road journeys and scheduled flights with medical escorts, to intensive care air ambulance transfers that necessitate full medical management, complex travel arrangements and hospital admission."

"A repatriation involves much more than a journey," adds Ms Geofilo-Pearson.

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Ms Geofilo-Pearson warns against using inexperienced repatriation providers that lack the backing of a multi-skilled team.

She cites a recent case involving a young man with a spinal injury whose attempted repatriation from the other side of the world was hampered by a provider who tried to organise transport that would have worsened his injury and whose doctor deserted him at the airport. CEGA was later asked to (successfully) take on the repatriation.

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EVA KLUGE AIR ALLIANCE MEDFLIGHT Eva Kluge is the Director of Sales and Business Development at Air Alliance Medflight GmbH in Germany.

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IRENA DIMITRIJEVIC JET EXECUTIVE INTERNATIONAL CHARTER Irena Dimitrijevic is the Sales & Marketing Manager at Jet Executive International Charter in Germany.

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MAYDAY ASSISTANCE SPECALISE IN PROVIDING A TRULY BESPOKE SERVICE TO OUR UNDERWRITERS AND YOUR CUSTOMER. WORKING WITHIN DIVERSE MARKETS SUCH AS PRIVATE HEALTH, TOURISM AND BUSINESS TRAVEL. WE ARE PARTICULARLY EXPERIENCED AT MANAGING TRAVELERS WITH PRE-EXISTING MEDICAL CONDITIONS. Our operations office is UK based, providing frontline multi-lingual staff who speak most European languages whilst delivering emergency assistance and advice to your customer. Our language capability enables us to manage your customer's emergency as efficiently and effectively as possible, whilst ensuring that customer is provided with a decision on cover as soon as possible. Thus relieving any unnecessary anxiety caused whilst being unwell or injured in a foreign country. Our operational staff are unscripted as to ensure that each customer is dealt with on a case by case bias.

Mayday Assistance provides escorted and non-escorted medical repatriations worldwide on behalf of our Underwriters. We also undertake private

international repatriations on behalf on individuals, private companies and public sector. With our inhouse Medical team and Operational staff working closely together, we provide the safest and most costeffective return for your customer.

Using our global network we are able to source doctor, nurse and paramedic escorts, arrange ambulance and taxi transfers, ticketing and provide any other ancillary needs. With a truly global reach, Mayday Assistance has agreements with a network of global cost containers who provide medical audits and negotiate discounts with providers to ensure that policy terms and limits are enforced.

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ADAM BOOTH MAYDAY ASSISTANCE Adam Booth is the Clinical Operations Manager at Mayday Assistance in the United Kingdom.

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PHILIPP SCHNEIDER QUICK AIR JET CHARTER GMBH Philipp Schneider is a Key-Account-Manager at Quick Air Jet Charter GmbH in Germany.

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FIONA GREENWOOD ROWLAND BROTHERS INTERNATIONAL Fiona Greenwood is the Operations Manager at Rowland Brothers International in the United Kingdom.

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CLAUDIA SCHMIEDHUBER TYROL AIR AMBULANCE. Claudia Schmiedhuber is the Head of Sales Development & Global Client Accounts at Tyrol Air Ambulance GmbH in Austria.

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ROWLAND BROTHERS INTERNATIONAL

Rowland Brothers International has pioneered international repatriation for over 45 years organising repatriation for families, insurance and assistance companies, corporations, government departments, airlines and funeral directors.

Their international repatriation service transports the deceased all over the world from any destination to any destination. Rowland Brothers International’s multi-lingual team are fluent in Spanish, French, German, Portuguese, English, Italian, Polish and Russian. They can help you with any queries you have regarding the repatriation service, with no obligation.

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IN AN EVER RISKIER WORLD, EMERGENCY MEDICAL EVACUATION AND REPATRIATION INSURANCE COVERAGE IS ESSENTIAL, FOR OFFSHORE WORKERS, EXPATRIATES, BUSINESS TRAVELLERS AND TOURISTS. WHY?

National and international travel for work or pleasure is an accepted part of normal life in the twenty first century. With this increase in people moving around the world, there is a higher incidence of exposure to risk and untimely or unexpected deaths occurring. This is why it is recommended that independent travellers and businesses ensure that their employees are adequately protected with the right insurance policy to cover every eventuality.

According to Saga, 9 out of 10 people who pass away overseas are brought back for funerals near home. What are the main complexities in providing repatriation of mortal remains services?

As an experienced company, we understand that it can be a distressing and difficult time for family and friends who are dealing with the repatriation of a loved one. There are many complexities in the repatriation process, such as understanding the role of coroners, consuls and local authorities.

All of this can be a daunting experience, especially whilst a family is mourning. RBI ensures our experienced team understand our client’s needs, whilst managing the intricacies of the repatriation process on their behalf.

You have a respected track record as an international funeral director. What is most important when providing these services?

RBI has high standards which we aim to deliver on at all times, working with our business or personal clients. We pride ourselves on all the services that we deliver and ensure that standards are maintained in all aspects of our work. We

ensure that our national and international partners have adopted our protocols, so we meet our business and customer service standards at all times.

Some insurance policies have apparently introduced limits on how much they will pay for repatriation. What do you think?

Where limits are placed on cover, or if cover is declined, our expertise in the industry will allow us to quickly research what works best, financially, culturally and emotionally for the family.

Cover for overseas burials can be low. Does such an option prove a common alternative to repatriation?

We have found that overseas burials are usually requested because the deceased’s family either want to bury their loved one in their country of birth, perhaps in or near an existing family plot.

If cost is an issue, our experienced staff will discuss other alternatives, which could include local cremation and then repatriation of the ashes.

Rowland Brothers International will discuss all options based on the circumstances of the deceased and the request of the family. If required, the option of a local burial can be arranged, but in our experience it’s not very common.

The success of an insurance policy may be proven when one makes a claim, but in a world of pre-existing conditions, exclusions, extreme sports, badly worded policies and an aging population, how well does insurance perform in protecting members against such risks?

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INTERVIEW

We do not get involved in the policy assessment, but we are always available to assist families by discussing their situation to find a solution.

According to Saga, the average repatriation claim is ÂŁ3,800 - although a spokesman said claims could be higher from more remote locations. How much does it really cost?

International repatriation costs vary depending on the point of origin within a country, and the final destination sought. Other factors are taken into account, such as preparation of the deceased, the type of coffin or casket used, fees for documentation, flights, clearances, and airport transfers. Carriage of personal effects adds cost as they are packed and carried separately. Our familiarity with these protocols, and our loyal providers network, means we can cost contain due to the number of repatriations we manage worldwide.

What documentation is required for customs clearance when a deceased is repatriated?

Documentation varies between countries.

Understanding this complex process is where our expertise comes into play. We obtain the correct combination of documents to meet national and international requirements, including permits to leave one country for a funeral in another, and co-ordinate flights and clearances to make the repatriation a seamless operation.

Each case is different, and progressed individually by our expert team.

A call comes in from an insurer that you assist.

One of their members has been involved in a serious accident in a remote area of Thailand and the unthinkable has happened. Case details are sketchy however it is clear the member has passed away and the insurer wishes to repatriate their mortal remains to their home country. What would happen next?

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This is not uncommon, and we deal with this type of real life scenario daily. Our starting point would be to gather as much detail as possible, especially with regards to the deceased and contact details of the next of kin from the Insurer.

We would aim to contact the designated person immediately, so we can understand their requirements and guide them through the process of repatriation. We would also provide a daily update to the Assistance Company, who can obtain regular updates via our business portal.

Our aim would be to simplify the process for the family during their time of mourning, ensuring that they are receiving a professional, courteous and sympathetic service at all times.

The recent earthquake in Italy reminds us just how powerful Mother Nature is and that mass casualty situations are a risk faced by all. What capabilities do you have to assist in mass-casualty situations?

RBI is Mass Casualty Specialist with a network of experienced agents across the globe whom we work with on a daily basis. We have been called upon previously to utilise our experienced network of agents when a major disaster has occurred.

New technology, low oil prices, civil unrest and BREXIT can all affect travel, tourism and expatriation. How will the industry develop in the coming years?

Geopolitical changes can affect repatriation. RBI has adapted over the last forty five years, developing worldwide repatriation strategies from popular holiday resorts, remote and high risk areas. Tragedies which happen away from home are often unexpected and unpredictable, but with a sound process and experienced global network, we will continue to offer successful repatriation solutions for our clients.

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ROUND TABLE

Q1

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IN AN EVER RISKIER WORLD, EMERGENCY MEDICAL EVACUATION AND REPATRIATION INSURANCE COVERAGE IS ESSENTIAL, FOR OFFSHORE WORKERS, EXPATRIATES, BUSINESS TRAVELLERS AND TOURISTS. WHY?

PHILIPP SCHNEIDER: On the one hand no one is certain about his personal health. We see every day that healthy people fall sick or get injured in an accident and need medical repatriation.

On the other hand also terrorism or the outbreak of an epidemic leads to unforeseeable situations.

In these cases not only the financial suffer is covered by insurance. Also the whole organisation round the treatments and possible repatriation is covered. Medical contacts checking the correct treatment and progress of disease as well as status controls observing the best medical outcome for the insured person are the benefits of an insurance coverage.

ANDREW APPS: Emergency medical evacuation insurance is essential when sending employees to work in remote, underdeveloped or high-risk regions of the world.

From oil and gas workers located thousands of miles from the nearest medical facility, to administrators working in less developed countries, decent emergency evacuation insurance can literally mean the difference between life and death.

Local services can in these areas be lacking at the best of times and every employer has a duty of care to make sure that if the unexpected happens and it becomes necessary to get medical care for an employee, the support and expertise is in place to ‘make things happen’, quickly, efficiently and with the safety of the patient at the top of the list.

Of course, not all emergency evacuations are the same nor are the companies that provide this service. Some will have better helicopter support in certain regions. Some own their own high quality private hospital facilities, so have

better control over the treatment provided from the very beginning.

Some, we know from experience, are less willing to authorise repatriation than others.

Some will pay for dependents to travel with your affected employees. Others may not.

Our job is to help ensure the right emergency evacuation support is provided for our clients no matter where in the world their employees are located. From war zones and active terrorist areas, to offshore oil and gas facilities, we look to ensure that quality medical assistance, fully paid for, will never be far away.

EVA KLUGE: Medical infrastructure around the world is getting better, but at a different pace in different locations. Whereas an expat or corporate traveller is pretty safe in places like Singapore or the United States, an offshore worker in Algeria, Western Africa or Afghanistan will be in serious trouble if he/ she suffers from a serious illness or accident and has neither proper coverage nor access to good assistance services. Few individuals, including tourists, will be able to organize medevacs on their own because this situation will be mostly a “once in a lifetime” experience.

They are not prepared for it and they usually do not have the means to pay a larger amount out of their pocket. For expats, it is essential that their employer will offer them a comprehensive coverage prior to their mission abroad. This should not only include coverage of costs, but also preventive advice and access to high level clinical and aeromedical services.

In infant and emerging insurance markets, we observe rather conservative underwriting and lower coverage. This can make a repatriation very difficult once the patient has been in a

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hospital for a longer period and his coverage limit is “exhausted”. These policies, fortunately, are slowly changing though, to more comprehensive health plans with several options to choose from.

If an individual is properly covered, his/ her insurer will also partner with a reputable assistance company who is capable of organizing professionally evacuations and repatriations around the world.

“Professionally” does not only mean excellent service when something happens, but also a serious vetting process for all their network providers in advance.

For an air ambulance company, the vetting process should include, among others: • preference to air operators who have full control of their own aircraft • adequate liability insurance for aircraft and medical teams • qualified medical team and state-ofthe-art medical equipment • ability to evacuate from remote and crisis regions • aeromedical accreditation • certified maintenance of aircraft and top technical support IRENA DIMITRIJEVIC: In my opinion a decent medical travel insurance plan for tourists and business travellers has always been of high importance.

Especially young people love to travel far away and are very carefree and don’t think about any possible incidents that might happen. Before I started working in the industry I was the same.

But when you read all these medical reports from patients we repatriate all over the world you are more aware of how quickly life can turn into a different direction.

Expatriates who live in metropolis will most likely have a very good local medical care. The local hospitals and medical facilities in South East Asia such as in Singapore and Bangkok for example, have very high quality standards; there is no real medical need for repatriations back to

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Europe or the USA. But these treatments are highly expensive for foreigners; therefore the own insurance coverage should be checked carefully. Medical expenses are incredibly cost intensive as everyone knows. People shouldn’t expect to get an all inclusive package if they buy a “20-EUR-insurance.” Unfortunately we expect in our modern world everything to be cheap and good at the same time.

In summary I wouldn’t necessarily say that today’s global risks are solved by insurance packages. Frequent travellers have to start evaluating their individual risk of certain geographical areas, either due to political issues or due to medical threats such as the current ZIKA warnings. Unfortunately the global media tends to dramatize global issues because they need headlines. Nevertheless people should use their own common sense. If you are pregnant don’t travel to the Amazon.

ADAM BOOTH: Coverage is essential as people are travelling further afield and becoming more adventurous, but with adventure comes higher risk, remote locations and reduced levels of healthcare. There appears to be an ignorance at times to the environment that they may be heading to, this can cause many complications with pre-existing medical conditions. Having a contact who is aware of the local policies and procedures is vital when a client is unwell or has an accident abroad, this is very reassuring at a highly stressful time.

High cost areas in the world such as USA, Canada and Asia require early intervention and management from an Assistance Company to ensure that the patient is getting the required treatment, but at the same time they are not getting unnecessary procedures which could increase the costs involved for them, but also the underwriters.

CLAUDIA SCHMIEDHUBER: As we move towards a more globalized world, it becomes increasingly important for any individual to make sure that

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“..In countries like Austria, people tend to be over-insured due to the fact that most of our credit cards include a worldwide medical expense and repatriation insurance.

CLAUDIA SCHMIEDHUBER TAA

appropriate insurance coverage will be provided at any point during his/her absence from his/her home country. Factors such as companies’ expansion into even the remotest areas, an increasing pool of exchange student programs, as well as a growing backpacking population has increased the demand for global insurance and assistance services. Although in recent decades the issue of “worldwide coverage” was not as significant as it has become in the last couple of years, I believe that we have now entered a time of complete global mobility which allows the insurance industry to strengthen its international travel insurance products and for the client to profit from the seamless service and worldwide care this development brings with it.

I believe that it is part of every company’s duty of care to ensure the wellbeing and safety of their employees by supplying a tailor-made

LEARN

insurance package for their global workers. In addition, it should be on every family’s mind to purchase a suitable travel insurance package for their loved ones when they go on vacation – the same goes for the individual backpacker or the adventurers who want to conquer the Grand Canyon.

In countries like Austria, people tend to be over-insured due to the fact that most of our credit cards include a worldwide medical expense and repatriation insurance. In addition, most Austrians are also insured through our membership of a specific club – for example the “Alpine Club” or certain “Sport and Leisure Clubs”. Finally, on top of these “included” travel insurance options, Austrians can also purchase top-up packages with their flight tickets or go directly to one of the big health insurance providers.

PEER 2 PEER INSURERS ARE COMING TO GET YOU

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A CALL COMES IN FROM ONE OF YOUR INSURED MEMBER’S FRIEND. THE INSURED HAS BEEN INVOLVED IN AN ACCIDENT IN A REMOTE AREA OF THAILAND, AND HAS SUFFERED SIGNIFICANT INJURIES. CASE DETAILS ARE SKETCHY. WHAT HAPPENS NEXT?

ADAM BOOTH: We would open a case and coordinate the management from the UK. This would mean contacting one of our local agents to assist in gathering the required information and making contact with the client. If they are taken to a local hospital where the facilities are poor and require further intervention, we can facilitate their transfer to a hospital with a higher level of care.

PHILIPP SCHNEIDER: Our medical department will ask the insurer for the hospital contact details to organize a doctor to doctor call to gather more detailed information as soon as possible. Also possible co-travellers contact details would be requested to get a secondary way of contact to the remote area. Simultaneously airport capabilities and a possible flight routing would be prepared by our ground operations to ensure a prompt response.

CLAUDIA SCHMIEDHUBER: As TAA not only has its own fleet of air ambulance jets but also a full 24/7 Medical Assistance Operations Centre, this would be a standard case to be managed by our experts. TAA’s MA staff and Medical Assessment team immediately evaluate the current situation and determine the next steps.

While the medical assessment of the patient takes place, a health and safety check is also carried out and our local agent is contacted to assist with quick and efficient arrangements. TAA has access to over 3,000 healthcare providers and assistance partners worldwide and will work closely with our local correspondent in Thailand to evacuate the patient to the nearest suitable healthcare facility – whether via sea, land or air – depending on the patients’ condition and medical recommendation.

TAA’s MA OPS will also contact the insurance company to confirm coverage and benefits for this patient and inform them about the expected costs and further steps.

TAA’s MA OPS will monitor the evacuation to the nearest healthcare facility and immediately contact the treating doctor to re-evaluate the situation once the patient has arrived and been assessed at the hospital in TAA’s network.

As TAA also has access to psychological support for any relatives or travel companions involved in the case. Our MA staff and Medical Assessment doctors will also check on all involved parties, in order to determine whether any further help or support is necessary – after all, we at TAA believe that there is always more than one patient in such situations.

TAA’s first priority is to make sure that the patient feels safe and in good hands. We continue to monitor the case closely, working with the local agent and insurance to keep every party involved up-to-date, through smooth and unbureaucratic case management.

ANDREW APPS: Hopefully when these events happen, the member or whoever is with them, places the first call to their insurance company’s 24/7 emergency assistance centre, but on occasions because of the close relationship that we have with our clients, we do find ourselves handling the initial enquiry.

In such circumstances, we try to extract as much information as possible about what has happen, calm the situation down (remember this is a very stressful time for everyone concerned) and advise the caller what the next steps will be (and why) and what they need to do.

We will also contact the insurer immediately to let them know what has happened so that

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“..We would open a case and coordinate the management from the UK..”

ADAM BOOTH MAYDAY ASSISTANCE

their professionals can take over.

EVA KLUGE: Thailand is a place with generally quite good medical care around the country.

Very serious cases should be taken to a centre of excellence in Bangkok. The first call will come to the alarm centre of the patient’s assistance company. In most cases, the patient is already admitted to a hospital or a clinic. The standard procedure is to assess all facts and data (location, valid coverage, travel data, companions, hospital, name and phone number treating doctor, languages spoken). If no medical report can be obtained directly from the hospital, the assistance company will work with a local network correspondent who is familiar with the region.

The assistance company will provide a GOP (guarantee of payment) to the hospital. Their medical desk staff will start a medical risk assessment and will decide if the patient shall undergo e.g. a surgery at his present location, stay for treatment or, if, how and when he/ she needs to be repatriated.

As soon as the medical assessment indicates that the local medical care is not adequate, the patient will be either transferred within the region or repatriated back home. There are several options for a repatriation: ground ambulance (for shorter distances), commercial flight with medical escort (sitting or commercial stretcher) or air ambulance (for serious cases or lack of available commercial stretchers).

Economic considerations are also important without compromising in quality.

For example, on certain occasions, an air

ambulance flight back home (where statutory or other insurance will pay for treatment) can be a lot more cost efficient for an insurer than having a patient for several weeks in an expensive hospital abroad. At the same time the client will be happier to go home in most cases.

IRENA DIMITRIJEVIC: Our clients usually have local agents all over the world or at least partner assistance companies that can provide services such as a local visit to the hospital in order to check on the real patient’s status. At least they can discuss the current treatment with the doctors and nurses on duty in their local language.

We usually set up a telephone conference call between the treating doctor, the medical director of the insurance company and our medical team.

Based on the provided details they have to decide on further steps; to wait until the patient is more stable or to proceed with the repatriation.

Sometimes the medical reports are completely deviating from the real status – either because the hospitals want to get rid of the patient or because they would like to keep them. The final decision rests with the insurance company as the “payer” and not with the providers.

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Q3

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IN 2016 DUTY OF CARE IS A LEGAL AND MORAL OBLIGATION. HOW DO YOU HELP GLOBAL EMPLOYERS FULFIL THEIR DUTY OF CARE OBLIGATIONS?

CLAUDIA SCHMIEDHUBER: I can sum this up in one sentence: “By being there when someone needs us the most”.

As we provide a 24/7 emergency call centre, we are always available and reachable for our insurance and other clients and most importantly for the patients who suffer a medical emergency abroad. Our team is multilingual and has unrestricted access to medical assessment doctors and a network of healthcare providers when a member needs immediate information or support anytime, anywhere in the world. TAA also has the privilege of operating its own fleet of air ambulance jets, providing a “one-stop-solution” for our clients.

In addition, we are always happy to “educate” our clients as we believe that sharing our knowledge is the best way to optimize our collaboration and improve the level of care for our mutual patients.

TAA regularly visits to clients to provide “behindthe-scenes” knowledge and present important updates concerning the company and our industry.

PHILIPP SCHNEIDER: We as an air ambulance operator can assist global employers with our services to guarantee an immediate evacuation in case of a medical emergency situation for their abroad employees. We are able to make sure that employees working in remote areas with limited access to medical treatment get fast help, on-board treatment and a transport solution to the next appropriate medical facility.

ANDREW APPS: Most businesses insure their vehicles and their office contents but often fail to put in place adequate protection should an employee be injured or fall ill particularly whilst on assignment. This can be due to one or more reasons, with cost-savings often topping the list.

Some believe they have the cover when they haven’t. And then there’s those who convince themselves (often due to the cost-saving) that they have the cover when, in fact, they haven’t.

Claims can and do happen. Defending a claim can be both time consuming and costly, often eating up reserves and denting profits.

Most employers are likely to have a responsibility (duty of care) whether as employees or contractors and it doesn’t matter if it’s for a year, a month, a day or even an hour. Just imagine should a high earner not be able to work again and you are found at fault – we are talking millions.

ADAM BOOTH: Assisting global employers with their duty of care obligations is currently not a role we undertake or have been asked to facilitate.

IRENA DIMITRIJEVIC: The aviation business is a highly controlled market with many regulations, audits and requirements. It gets tougher and tougher every year. Every step done by a pilot, mechanic or dispatcher is legally documented.

Pilots from the old days often joke that in these days they spend more time on bureaucracy than in the cockpit.

The same rules apply for the medical teams.

Therefore the Duty of Care in our industry is indispensable.

In addition we regularly organize training courses especially for new team members but also for senior employees to discuss old cases and issues that occurred during a transport to prevent the same mistakes in the future.

EVA KLUGE: As an air ambulance company, we have clearly responded to the global employment situation of the last years with people living and moving around the planet.

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“..Our fleet of 12 dedicated air ambulance aircraft (Learjet 35 and its larger sister Learjet 55, Challenger 604) caters to all distances and medical needs. We started operating the longrange Challenger 604 in 2015..”

EVA KLUGE AIR ALLIANCE

EVA KLUGE: (continued from page 51) Employers want to be sure that you will be able to evacuate/ repatriate their employees from any place around the globe at any time. There is an increased demand for long range air ambulance flights, often with critically ill/ ventilated patients.

Nowadays, we still many of classical European “holidaymakers” back home, but we also set out regularly from Europe to the US, the Middle East, Africa and Asia. Missions like Mauritania to Lebanon, Mexico to Shanghai and Ecuador to the UK are nowadays not that exotic anymore.

We have strongly invested in additional aircraft with the latest technology, in modern equipment, highly qualified staff and training. Our fleet of 12 dedicated air ambulance aircraft (Learjet 35 and its larger sister Learjet 55, Challenger 604) caters to all distances and medical needs. We started operating the long-range Challenger 604 in 2015. This is a perfect option for the premium air ambulance segment. Our superior aircraft insurance coverage enables us to fly to remote and critical areas right away instead of having

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to ask the insurance company for war risk coverage beforehand. In May 2016, we opened an office in Birmingham UK with 2 Learjets and excellent British medical teams. As the UK, especially the London area, is a haven for corporates and expats, this is an additional asset.

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Q4

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WHAT ARE THE MAIN COMPLEXITIES OF CONDUCTING INTERNATIONAL EVACUATION AND REPATRIATION MISSIONS?

IRENA DIMITRIJEVIC: On a daily basis the flight operation and the dispatchers have to overview all the requirements, limitations and challenges of each country and airport. Every single airport is different therefore it is hardly impossible to foresee all relevant costs and changes. The clients on the other hand often require an all inclusive price.

Example: We had a flight confirmation for Tromsø, Norway. When we started to prepare the flight we were told by the local authorities that all of a sudden the airlines require an additional certificate to operate into the northern parts of Norway in the winter season. We have done many operations in winter to this region before but now the restrictions by the government came along and these kinds of changes are daily business.

In the long term the biggest challenge is to maintain in the highly competitive market with the constantly rising costs in aviation but at the same time keeping the flight prices for the clients as unfortunately the service is mainly price driven.

ADAM BOOTH: The main complexities include having to communicate with not only the patient/ family to reassure them, but also the treating hospital, local ambulance companies and any other organisations involved on a particular case.

This is all before we even commence the planning of the Repatriation which will require completion of a Medical Information form for the airline (or multiple airlines), ensuring that they grant clearance for the flight, organising Medical staff to fly out to the client and that they are well rested prior to the return flight, especially with long-haul flights.

Then the arrangements back in the UK, whether it be transporting the patient home or organising

a bed in their local hospital.

PHILIPP SCHNEIDER: One of the main complexities is the “just in time” organisation of a medical evacuation. All steps of the patient transport for example take over in the hospital; ground transportations etc. have to be carefully planned.

Furthermore flight crew duty and rest times as well as local time zones have to be observed regarding a safe and sound transport of the patient. Also unplanned delays have to be calculated concerning oxygen reserve and the stock of medication.

Another complexity is the valuation of the integrity of medical details provided especially when patients stay in remote areas. A detailed query by an experienced medical department is essential for the mission success.

CLAUDIA SCHMIEDHUBER: From my point of view – every mission is different and comes with different challenges and complexities. I think the first factor that has to be taken into consideration is the mode of repatriation. There is a significant difference between repatriation via air ambulance jet when compared to repatriation via commercial flight.

Secondly, we have to differentiate the kind of mission – whether this is a repatriation back to the home country to continue treatment or therapy, or a flight to a foreign country to start a new therapy or improve the current status or whether this is an emergent evacuation to safe the patients’ life.

Thirdly, the patient’s personal situation, as well as any external factors, have to be taken into consideration, carefully assessed and acted upon.

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ROUND TABLE

TAA has performed thousands of missions over the course of more than 40 years in business and I, myself, have concluded numerous repatriations. No two cases are the same, no two patients conditions are the same, and every country has its own challenges and obstacles to overcome – whether that be a foreign language, cultural differences or indeed a completely different healthcare system. The key for a successful provider, in my opinion, is to be sensitive to all of these aspects and to ensure that everything is taken into account to ensure a safe and comfortable mission.

It is critical for TAA’s Operation Centre to ensure that we possess all necessary overflight and landings permits, to confirm that the crew visas are valid and do not cause any delays, to check if there are any accompanying people on board or to see if there are any weather restrictions at the airport of choice. Furthermore, it is necessary for a well-functioning operations centre to be prepared for any unforeseen events that can and do occur during such missions, ranging from any change in the patients’ health status through to weather changes or security alerts.

All of these factors mentioned above contribute to the organization and successful completion of a repatriation mission – whether by air, ground or sea.

EVA KLUGE: There is a multitude of complexities.

It would be too long to describe all of them. From an air ambulance’s point of view, here are some: PROVISION OF AEROMEDICAL INFRASTRUCTURE Air Ambulance flights need to happen fast and it is unpredictable where on this planet you will head next and which patient you will fly. The provision of an ad-hoc aeromedical infrastructure and perfectly maintained, safe aircraft requires a very high, continuous investment and a sustainable business model.

It also means that your entire organization needs to be very well organized and stocked:

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have your aircraft, medical equipment and teams ready, including all licences, insurances, pilots’ type ratings, trainings, aircraft maintenance, visa, vaccinations etc. Only then you will be able to set out immediately when your client needs your services.

MEDICAL CHALLENGES As mentioned above: your next patient could be 150 kg, elderly person with several by-passes, a 1,5 kg prematurely born baby or just a “normal” adult. For each patient, a careful pre-flight medical assessment is essential. Normally, our client will already have pre-assessed the patient’s condition and will share this information with us. Nonetheless we are obliged to double-check on the patient’s condition before the mission and when picking him/her up. Once our doctor accepts a patient on board he/she is – from a legal point of view – medically responsible. In most cases, the preflight patient information given to us is helpful, but occasionally, we detect e.g. missing diagnostics, unclear information, unknown pre-existing conditions or clinical assessments which would be ok on the ground but not in the air. It may have a dramatic impact if, prior to a flight, our medical team would not ask the right questions.

It is also quite important to see the patient in the clinic before departure, speak to the treating doctor, check if his/her condition corresponds to what you have been told beforehand and, after arriving at the final destination, to take the patient to the hospital (“bed-to-bed”) for a smooth and safe handover.

LOGISTICS, PLANNING AND TIMELINES Landing and overflight permits need to be obtained and fuel needs to be ordered. Heeding the duty times of staff within the legal confines is an essential part of planning.

The medical equipment and medical kit on board need to be regularly maintained and stocked up. They need to be adjusted to the

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“..Air Ambulance flights need to happen fast and it is unpredictable where on this planet you will head next and which patient you will fly. The provision of an ad-hoc aeromedical infrastructure and perfectly maintained, safe aircraft requires a very high, continuous investment and a sustainable business model..”

EVA KLUGE AIR ALLIANCE

EVA KLUGE: (continued from page 61) patient’s needs during the entire journey (e.g. medication, amount of oxygen). Our medical teams all are very experienced and prepared to react to any change of the patient’s condition on board.

Especially when flying long range, we come across a variety of wind and weather conditions.

Just remember hurricane Matthew in the US some weeks ago.

Any change or delay may also result in higher costs. We have a very good record in punctuality, fortunately. In smaller airports it is sometimes

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easier to obtain a landing slot, but they usually do not operate around the clock, so you need to land and fly out on time. It is also a bit unpleasant to arrive in a hospital abroad and to learn that there is an unsettled hospital bill – the hospital may refuse to discharge the patient while your aircraft is waiting. It rarely happens, but it does.

We review our missions on a regular basis, internally and together with our clients. The goal is to learn from experience and become even better.

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Q5

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THERE ARE MANY LOCATIONS IN THE WORLD WHERE A FIXED-WING AIR AMBULANCE SOLUTION WILL NOT WORK. WHAT SUPPORT AND SERVICES MAY YOU OFFER VIA HELICOPTER?

EVA KLUGE: As a fixed wing air ambulance company, we do not offer any helicopter services.

We can support an assistance company to find a helicopter, but from our experience, they will deal with this on their own as part of their network management.

CLAUDIA SCHMIEDHUBER: As mentioned earlier – TAA is privileged to have access to over 3,000 healthcare professionals worldwide, allowing us to work with quality local providers on a global scale. With the help of our local agents, it is possible to arrange evacuation and repatriation services in even the remotest areas in the world.

In addition to our network, we also have direct working relationships with helicopter providers in Austria (governmental and private helicopter firms) as well as helicopter companies in Nepal, Africa and Switzerland.

PHILIPP SCHNEIDER: We have a global network of medical transport suppliers which we are

working with for years. If our client asks us for the organisation of a helicopter transport we will try everything to make this happen. Of course we will look for accreditation and insurance coverage of the possible supplier.

IRENA DIMITRIJEVIC: We don’t have any helicopters in our fleet and don’t particularly offer these services. If it is an evacuation in Germany, Austria or Switzerland we have local partners we can rely on and with whom we have worked in the past.

Our network of hospitals, head physicians and transport providers in Europe is very large and a complete solution can be offered to our clients.

In remote areas of Africa and Asia we would rely on the expertise of others and in my opinion global assistance companies have the appropriate network. Nevertheless we like challenges and can always offer our help.

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Q6

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A SOUTH AFRICAN NATIONAL BUSINESS TRAVELLER FALLS SICK WITH PNEUMONIA WHILST TRAVELLING FROM NEW YORK TO MAURITIUS. HE IS CURRENTLY AT DUBAI AIRPORT AWAITING A CONNECTING FLIGHT. UNFORTUNATELY HE CANNOT CONTINUE. THE INSURER WANTS TO REPATRIATE THEM HOME TO SOUTH AFRICA. HOW MUCH WILL IT COST?

ADAM BOOTH: The primary concern would be is the patient going to be stable enough for any further travel at the present moment. We would require a full medical report from a medical facility in Dubai before any decision would be made on moving a patient. This will always be our first priority, also they would need to get medical clearance before any further flight which could take a few days to come back, so in this time the condition of the patient may have improved.

PHILIPP SCHNEIDER: The requested prices depend on the aircraft availability and type of aircraft in the mentioned region. A one way ambulance flight without positioning costs from Dubai to Cologne/Germany would cost approximately €20.000. A flight to Johannesburg/South Africa approximately €25.000.

EVA KLUGE: It depends entirely on the patient’s medical condition and in which mode he will be able to travel: commercial flight with or without medical escort or via air ambulance. Therefore, to be serious, I would rather refrain from a precise indication about the cost/ price.

On an air ambulance it could be anything (very roughly) between EUR 40,000 and EUR 100,000.

Different aircraft will have different ranges, costs and prices. The price depends on where your aircraft sets out and to which airport you will fly (airports have different landing charges and fuel prices). Sea level transports are more expensive due to higher fuel consumption at a lower altitude.

Empty legs can be a good option to cut costs, but the ones available do not always match with the demand of the client.

IRENA DIMITRIJEVIC: We would advise the

insurance company to ask another provider in case the patient will be repatriated to South Africa. There are local providers in Dubai and Johannesburg and therefore my colleagues in the industry are more suitable for this repatriation compared to us coming all the way from Germany.

In case of a repatriation to Germany please call our 24/7 hotline and my team will send you a quote.

CLAUDIA SCHMIEDHUBER: As this question contains very limited information regarding the patient’s health status, as well any requirements he may have to continue travelling, it is difficult to provide a definite cost estimation for his repatriation. If his insurer wants to move him to South Africa, a medical assessment must first be performed to determine his current status as well as to evaluate the possibilities to move him to the desired destination.

If medically cleared for a flight either via AA or commercial flight with medical escort, TAA will make all the necessary arrangements to move the patient to his desired destination. Furthermore, we will identify a suitable hospital and provide the insurance client with a cost estimate for the entire mission, including an estimation for the hospital stay in either Dubai or South Africa.

Additionally, all necessary arrangements will be made with regards to the cancellation of his current ticket in order to avoid any further loss for the insurance company. Further savings will be achieved by working with one of the hospitals in our network which provides TAA with an exclusive discount for all of our patients.

We will always provide the insurer with the most cost-effective yet patient friendly option, helping our insurer save costs while always ensuring the best care for the patient.

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Q7

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THE RECENT EARTHQUAKE IN ITALY REMINDS US JUST HOW POWERFUL MOTHER NATURE CAN BE AND THAT MASS CASUALTY SITUATIONS ARE A RISK FACED BY ALL. WHAT CAPABILITIES DO YOU HAVE TO ASSIST IN SUCH NATURAL DISASTERS?

PHILIPP SCHNEIDER: We are experienced in fast response to mass evacuation requests. The major part of our aircraft is set up in a double stretcher configuration.

Our total fleet transport capacity for a mass evacuation is a maximum of 16 patients. Depending on the destination we would be able to fly repeatedly day and night.

ADAM BOOTH: Like all companies our resources are limited. Our current plan in such a situation would be to send key Medical and Operational personnel out to the location along with local language speakers to liaise with Emergency services and a competent third party.

EVA KLUGE: With a large fleet, excellent availability and top medical teams, we are very well prepared for mass casualties and medevacs, even in remote and crisis regions. Our spacious Challenger 604 can carry up to three stretchers and travel up to 7000 km nonstop.

With our large fleet of 12 air ambulance jets, many casualties can be carried at the same time on several flights. Not to forget our long standing experience, even with culturally challenging mass medevacs: in 2012, we evacuated some 200 Libyan war wounded from Libya and Tunisia to Germany within record time.

As long as the runways are still working and we are allowed to fly in, we will set out on behalf of our clients to get the victims into a safe environment.

IRENA DIMITRIJEVIC: We are not specialized in mass evacuations; the Learjets in our fleet are only made for one or two patients. First Aid evacuations are usually done by helicopters; the Air Ambulance Jets usually take over after the

patients are stabilized in the hospitals. I assume that in Italy most people that have been injured and affected by the earthquake were locals and they would have been treated in the surrounding hospitals in their own country.

Nevertheless we have evacuated wounded civilians and war victims out from Libya and neighbouring countries during the civil war for a couple of months. During that mass evacuation we have flown out patients almost every day with several aircrafts.

CLAUDIA SCHMIEDHUBER: As previously mentioned, TAA has a 24/7 multilingual emergency call centre where we can also coordinate mass casualty situations.

TAA does have sexperience in this field as we were actively involved in the repatriation of Austrian citizens during the Tsunami in Thailand, the evacuation of war-wounded from Libya and, more recently, the repatriation of injured and traumatized patients from an Alpine avalanche catastrophe.

One feature that makes TAA quite unique is our ability to transport multiple patients at once with our Dornier 328 aircraft. These aircraft can hold up to 6 stretcher patients in addition to multiple seated patients, making it a quick and efficient way to respond to such mass casualty situations.

Additionally, TAA has can call on experienced aviation and disaster psychological expertise to support all parties involved and provide additional guidance for our trained staff. We are proud to have assisted several victims in such tragic situations and continually strive to strengthen the support system for all our clients and partners by steadily developing and improving our services.

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Q8

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YOU HAVE A TRACK RECORD OF CARRYING OUT INTERNATIONAL MEDICAL REPATRIATIONS AND EVACUATIONS FOR GLOBAL INSURERS AND ASSISTANCE NETWORKS. WHAT IS MOST IMPORTANT WHEN PROVIDING THESE SERVICES?

EVA KLUGE: Excellent service, availability, reliability, high quality in medicine and aviation, transparency, and, not always, but many times, competitive pricing, are the most important assets for a client.

IRENA DIMITRIJEVIC: Maintaining a close relationship with clients in order to receive constant feedback. Positive feedback assures us that we can continue our procedures in place; negative feedback enables us to rethink our processes. People are the key factor in our industry; the nature of the business doesn’t allow us to be very creative with the product. The planes and medical equipment of the providers are more or less very similar (within geographical regions: Europe, US, Africa). What makes the difference are the people behind it: The management, the doctors, pilots, paramedics, dispatchers.

CLAUDIA SCHMIEDHUBER: TAA has been in business for more than 40 years, focusing on the

safe repatriation of patients from around the world as well as the management of medical emergencies abroad through our 24/7 Medical Assistance Case Management centre. With our vast experience in this area, as well as our inhouse expertise in risk-assessment, dispatch, Medical Assessment doctors and medical flight staff, TAA has a proven track record of thousands of successful missions. We at TAA pride ourselves on delivering excellent quality and the highest standards in medicine – a reputation we are keen to keep as we strive to improve ourselves every day.

PHILIPP SCHNEIDER: A trustful relationship and working together is essential. Written and harmonised procedures are the base of a successful performance. The most important thing is that the patient’s outcome is always focused and the mission priority has to be the safe patient transport.

As we are able to look back on 25 years of business and partnership with our clients our success speaks for itself.

“..People are the key factor in our industry; the nature of the business doesn’t allow us to be very creative with the product. The planes and medical equipment of the providers are more or less very similar IRENA DIMITRIJEVIC JET EXECUTIVE

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Q9

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CAN INSURERS AND MEDICAL EVACUATION AND REPATRIATION SERVICE PROVIDERS WORK MORE EFFICIENTLY TOGETHER, AND IF SO HOW?

ADAM BOOTH: Insurance and Assistance are two completely different roles, it is more beneficial for the client to specialise in one field and concentrate on the service provided instead of a combination, especially when there is a risk of financial concerns overriding those of a professional assistance service with high clinical standards.

PHILIPP SCHNEIDER: A more shared information network of empty legs and actual geographic transport capacities would be a great benefit for both the insurers as well as the service providers.

The main task should be to minimize empty flights and unused free capacities.

EVA KLUGE: Yes, absolutely. Aeromedial repatriations are highly sophisticated and complex services, but yet they will only make up a very small percentage of the cases an assistance/ insurance company is handling. For example, there may be a lot of medical knowledge in some assistance companies, but much less expertise with regard to flight physiology and the challenges and complexities of aviation. We believe that constant learning is a great way to understand each other better. So we conduct training programmes for assistance staff and train our staff how an assistance/insurance company works and thinks.

IRENA DIMITRIJEVIC: In my opinion the efficiency between insurers and medical repatriation providers is already quite highly developed. If you have worked with a client for a couple of years you know their working procedures and how quickly you can rely on necessary information.

The flights are usually booked on a very short notice and we need to set up and organize the evacuation very quickly. But medical cases are

very sensitive and in theory everyone knows exactly how to handle a case but in reality you need a lot of experience to keep an overview on all the details; patient’s condition get worse during the night, the hospitals don’t want to release them, the relatives are concerned, passports disappear, the scheduled aircraft has an AOG, the weather in the operating airports is critical (fog during autumn e.g.); many unforeseen events that can create chaos.

Efficiency is well-meant but not always realistic in our daily lives. After all we are not a manufacturer of a product that can be planned in detail years ahead, we are reacting on people’s needs and we have to react very quickly.

CLAUDIA SCHMIEDHUBER: I believe that a close collaboration between insurers and the medical evacuation and repatriation providers is of great essence in regards to the development of our industry. Insurers / Insurance companies are becoming more and more educated – they attend conferences, read industry publications and start to actively get involved in procedures, workflows and operational planning. This not only leads to a closer cooperation and less misunderstandings between the two parties but also to knowledge sharing and fruitful discussions for best practice and improvements.

TAA has taken the approach to not only be completely transparent in regards to our pricing, best practice, etc. but also to involve the insurers and especially new clients in the active planning of their client – based procedures. This leads to a mutual understanding and base and creates trust in between both parties. As we at TAA understand that all client needs are different it also helps us to create tailor made products for our insurance companies.

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WHAT POLICIES AND PROCEDURES MAY BE IMPROVED BETWEEN THE PAYOR AND PROVIDER?

PHILIPP SCHNEIDER: In general it is important to explain the terms of payment which apply between an airline and its suppliers. Payments for fuel, handling, airport fees, etc. have to be paid immediately and without delay. Understanding these contractual terms should make the payer aware that the time of payment can only be lengthened to a certain degree.

IRENA DIMITRIJEVIC: From our point of view we would clearly prefer if the insurers would pay more quickly. If it is a big insurance or a global assistance company it is not that we are concerned they won’t pay but as everyone knows airplanes and flights are quite expensive and we are producing almost all costs before and during the flight but often have to wait up to 3 months until payment. It is a lot of money we credit each day. In any other business you have to pay up front or latest 14 days after your purchase. The clients usually argue with the point that they are waiting for the money from their insurers until they can close the case and pay us. Unfortunately I cannot say the same to my providers such as handling agents, airports, fuelling companies, hotels and crews.

If we have a request from a private person or an unknown broker we only work with credit card safety before flight operation.

EVA KLUGE: A better structuring of exchanged data and real-time information are certainly worth looking at. So is invoicing. Most assistance companies will receive their payment by the insurers and then pay the provider. With almost all clients, this works quite well, with some, unfortunately, there are long delays. Direct and consolidated billing systems or potentially claims floats for assistance companies may be an option.

CLAUDIA SCHMIEDHUBER: As I have mentioned before – a transparent and open communication and mutual decision making when it comes to workflows and procedures will avoid headaches in the future. A pro-active approach and open communication in regards to the expectations and the steps that need to be taken, should be the first priority when a new client comes on board. Clear structures, a pre-determined workflow and designated contact person who is available to answer all questions is of great importance for both parties.

I am also of the opinion that a well-developed complaint management system is essential for the relationship between payor and provider. As misunderstandings and mistakes can happy along the way, it will determine the satisfaction of patient and client how well the complaint is being managed and also what steps are taken to avoid such an issue in the future.

RELATED READING: INTERNATIONAL AIR AMBULANCE ROUNDTABLE

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DO INSURERS PURCHASE MEDICAL ASSISTANCE, TRANSPORTATION AND LOGISTICS SERVICES BASED ON COST OR QUALITY AND WHY?

EVA KLUGE: Most insurers/ assistance companies (not all) will have a due diligence (vetting) process prior to using a provider. This grants a certain quality.

Price and quality depend on when and where the medical transportation shall occur. For example, if we have a stable patient from the Canary Islands with a femur fracture, going to Western Europe, there are quite a few of providers offering this route the same or the next day. So the price plays a dominant role. If we have, e.g. an urgent polytrauma case from Iraq, going to Europe or Asia, aeromedical options for clients are far more limited and price becomes much less important.

IRENA DIMITRIJEVIC: To become a provider in first place (or a preferred provider within large insurance companies) the quality of your services is essential to receive a first chance.

Accreditation, documentation and audits are the first steps of becoming a new provider. After you have passed “the exam”, the price is the key criteria for being selected. Why? Well you need to ask the insurers. I guess because they can!

They can choose between so many Air Ambulance providers; it is one opportunity to keep the costs a bit limited. And we shall also keep in mind that regular travel insurances for tourists in these days are very inexpensive - I am not sure how the medical costs can be covered by the low earnings.

CLAUDIA SCHMIEDHUBER: I believe that historically providers were chosen based on relationships - companies often only worked with 2 or 3 preferred providers. However in the last years, there is definitely an industry trend to get 3-5 quotes from well-established industry providers which will then be compared in regards

to costs and availability as well as suitability for the mission. Unfortunately this technique often leads to frustration on both sides – the provider and the client (Medical Assistance).

Having worked in both fields I know that a lot of Medical Assistance companies have defined procedures in place when it comes to choosing a transport provider. Some place focus on costs, others on the aircraft type or geological location of the provider. Whatever procedure is in place, it is important that both sides understand the complexity of such missions. Unfortunately it is often very hard to understand for Medical Assistance companies why prices can vary, why different missions might be more complex, and why sometimes it is not possible to organise such missions in the required time frame. Topics like permissions, crew visa requirements, weather, landing restrictions all play a role in flight planning.

Such factors are often not taken into consideration when choosing an AA flight.

The approach for all air ambulance providers has to be that we educate our clients, we show them how a quote is being put together, what factors play into such missions – thus we avoid misunderstandings and the client is more aware of the different aspects involved.

For commercial repatriations it is the medical clearance of the airline, availability and getting the medical escort to the desired destination that can prolong such a process and lead to delays and frustration.

In summary the key is to improve the decision making process for clients which leads to more satisfactory results for the providers via better communication, pro-active approaches and educating ourselves and the clients in their area of expertise to create a mutual and understanding knowledge base.

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HOW IMPORTANT IS ACCREDITATION FOR INSURERS WHEN THEY SELECT THIRD PARTY SERVICE PROVIDERS?

EVA KLUGE: Accreditation is very important as it indicates a quality standard and shows that processes and procedures are in place. It is part of the due diligence process.

IRENA DIMITRIJEVIC: It is a cost saving tool for the insurers to be able to choose their providers as they can rely on the work done by renowned accreditation companies to ensure that the AA companies fulfil a minimum standard. We are EURAMI accredited. The audits and requirements everyone has to pass are high maintenance and the standards are improved annually by the managing board. It is especially helpful for smaller assistance companies with limited network and budget. Nevertheless, many global insurers have their own audits in place to ensure their corporate procedures are adopted.

CLAUDIA SCHMIEDHUBER: I believe that accreditation in our industry provides the insurers

with a general selection criteria when it comes to the quality of providers. However, having said that, I do not believe that it should be solely a criteria for selecting their provider as a lot of factors should play into a careful selection.

Medical quality, availability, proven successful track record and transparency are as equally important. Using the accreditation as a base for the selection of providers is, in my opinion, the right way before looking into them in more detail.

However, I do support providers who choose to go through the lengthy process of getting accredited as it does show commitment to the industry as well as transparency and quality.

ADAM BOOTH: Quality management and accreditation are of the upmost importance as we are trusting our reputation with our company name with a third party. Therefore, the process of selecting a service provider is paramount in ensuring our high standards are met.

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NEW TECHNOLOGY, LOW OIL PRICES, CIVIL UNREST AND BREXIT CAN ALL AFFECT TRAVEL, TOURISM AND EXPATRIATION. HOW WILL THE MEDICAL EVACUATION AND REPATRIATION SECTOR DEVELOP IN THE COMING YEARS?

EVA KLUGE: The tourism sector has already been affected, mostly in North Africa and the Middle East, but people will certainly travel. Very few will give up their annual holiday by the sea, but choose a different destination instead. Spain was this summer’s champ. However, there are plenty of other international markets and target group for an air ambulance company, both, in cash-and insurance-based economies. So we expect quite a decent growth over the next years.

IRENA DIMITRIJEVIC: Good question! If I could foresee the market I would be on the winning side but every business strategy and step comes along with a risk, this is daily business for CEOs and other decision makers. In our inconsistent world and industry it is almost impossible to foresee the future trends.

The most important decision for us as an aviation company is whether you shall invest in a plane or not. Therefore a forecast would be of high importance but not possible. New technology is great, especially in regards to aviation but nobody is willing to pay for it. The current market prices haven’t changed for ages; even a slight increase is resulting in an uncompetitive price.

Low oil prices are positive for all of us but won’t last forever – unfortunately.

The tourist travel destinations are very dynamic and markets are disappearing completely due to civil threats. North Africa used to be a very popular destination; nobody is travelling to Egypt or Tunisia any longer. Look at the Ukraine or Turkey. Would have anybody expected these kind of riots so close to Europe? Istanbul or the black sea used to be a common holiday destination.

I am sure a lot of tourists are even avoiding a holiday in France lately. Before the horrible attacks in Paris nobody would have thought this could

happen in the heart of Europe. If families and individuals will prefer to stay in their own country and spend their holidays locally, the future prediction for the industry is questionable. But let’s stay positive, after all travelling became a must for everyone.

CLAUDIA SCHMIEDHUBER: I believe that our industry is on the edge of changing or rather “updating” itself. Easy access to a global world, geopolitical events, low oil prices and new technology will lead to the need of changing certain procedures, out views and the necessity to look into newer technical methods. The clients and insurers are getting used to having access to their information and customer service 24/7 which will make the provision of the same necessary – in the way the client demands.

Although we already operate on a 24/7 schedule, it will mean that our industry has to look into new ways of providing this information with the help of new technology and methods. The clients are used to using their smartphones as their “little helper” for everything, so one requirement for our industry will be to enable the client to use their devices to do so. Whether that means being able to whatsapp my updated medical status, facetime with my doctor abroad or just click onto my app’s emergency button to get an instant connection with my service provider. I believe the future for our industry will be a digital one – with all the pro and contras this will bring.

Where I see our industry heading is a challenging time – clients demanding the usage of social media and apps as a way of communication – whereas our industry has to make sure that this is going to be possible in a secure and sensitive way.

In regards to the geopolitical events happening

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and especially the BREXIT I believe that only time will tell on what impact that this will have for our industry. What we could see this year was that the terrorist attacks definitely impacted the travel within Europe – leading people to either stay in their home country or travel within their range of driving on their own - so they can go back home whenever something is wrong. I believe that it will take several months without incidents to give people confidence to travel further abroad.

Furthermore I am of the opinion that countries like Croatia, Spain, Bulgaria, Italy, etc will see an increase in tourism as they are still considered as “very safe”. I do not believe that the announcement of the BREXIT has had any direct impact yet, however we will see with this progress proceeding on what it will bring for our industry.

Generally speaking I feel we are in a very challenging yet interesting time. In an industry that has not changed much it is now time for innovation – a call for the pioneers and the doers, a great opportunity for all of us to make our

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industry better, the patient’s repatriations safer and more comfortable and our client experience smoother than ever before.

ADAM BOOTH: I feel the industry will keep expanding, people are always going to travel and with improvements in technology this could reduce travelling time. Given that the population is living longer and healthier I feel that older people will be travelling greater distances with more complex cases worldwide, thus increasing general workload for the assistance companies.

PHILIPP SCHNEIDER: In the age of globalization medical evacuation and repatriation will always be of importance. The global political situation of the last few years shows us not a decrease but rather a shift in business. New expensive technologies especially aircraft technologies will represent a challenge which maybe not all operators will be able to stand.

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INTERNATIONAL AIR AMBULANCE & MEDICAL TRANSPORTATION | AIR ALLIANCE

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To date, Air Alliance runs a fleet of 11 own aircraft (Lear Jet 35, 55 and Challenger 604) They are located in Cologne - Siegerland (near Frankfurt) and Vienna / Austria.

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Every year, some 780 missions around the globe and approximately 6,000 flight hours are accomplished. Air Alliance Medflight is specialized in long range flights and in flying to remote areas. On our flights, we propose the full spectrum of care: from basic to advanced life support and critical care with premium medical equipment.

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INTERNATIONAL AIR AMBULANCE & MEDICAL TRANSPORTATION | JET EXECUTIVE

4 JET EXECUTIVE GEOGRAPHY: GLOBAL

Jet Executive International Charter is the legal successor of company taunus air. The company is dealing under actual ownership since 1999.

HQ: GERMANY SECTOR: AIR AMBULANCE

The actual fleet consists of three Learjets 35A, one Learjet 55 and one Beechcraft King Air 200.

Different than other operators Jet Executive is owning all aircraft, not only operating them for external owners.

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Since summer 2006 Jet Executive has successfully established a second homebase at Munich airport. One Learjet 35A and one Beechcraft King Air 200 were purchased from Munich-based operators, which ceased their flight operations.

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INTERNATIONAL AIR AMBULANCE & MEDICAL TRANSPORTATION | MEDCARE PROFESSIONAL

4 MEDCARE PROFESSIONAL GEOGRAPHY: GLOBAL

Medcare Professional offers international and national patient transport. We cooperate reliably and economically soundly with renowned insurance companies, hospitals and multi corporate enterprises.

HQ: GERMANY SECTOR: AIR AMBULANCE

We guarantee worldwide professional help for injured or sick people with our fleet of ambulance cars, medical intensive care transport engines and with air ambulances or commercial carriers, no matter where you are.

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INTERNATIONAL AIR AMBULANCE & MEDICAL TRANSPORTATION | QUICK AIR

4 QUICK AIR GEOGRAPHY: GLOBAL

Quick Air Jet Charter GmbH was established in 1992 at Cologne Bonn International Airport. The company started its operation with three Turboprop aircraft with main focus on air ambulance flights. The company grew steadily over the years expanding its fleet to Learjets with worldwide operation.

HQ: GERMANY SECTOR: AIR AMBULANCE

Our dedicated air ambulance fleet comprises three Learjet 55s, three Learjet 35s, a Learjet 36 and a Citation 550. We have a team of 7 full time employed, highly skilled operations officers working in shifts to be of service round the clock. Our team members come from various backgrounds; pilots, paramedics, military, VIP charters, international sales.

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ops@quickair.deEST: 2000

Quick Air is part of the Griesemann Aviation Group which is part of the Griesemann Group, an international company specialised in plant engineering and construction. Our parent company employs over 900 people in 9 offices around Europe.

quickair.de Cologne Bonn Airport Germany (EDDK/CGN)

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4 TYROL AIR AMBULANCE GEOGRAPHY: GLOBAL

Celebrating its 40th year in 2016, Tyrol Air Ambulance (TAA) is a trusted partner for global Air Ambulance missions and Medical Assistance Partner for the Alpine region.

HQ: AUSTRIA SECTOR: AIR AMBULANCE

Based in Innsbruck, Austria, TAA operates its own fleet of 6 dedicated air ambulance aircraft with the flexibility to perform short, middle and long-haul missions.

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Furthermore TAA’s Air Ambulance Operations Center controls and organizes over 3500 transports per year.

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A clear departure from ‘standard’ global healthcare services for expats Destination anywhere - tailor our combination of health, travel and security related risk management solutions to support your business needs.

And with genuine transparency on costs, we won’t cost you the earth.

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INTERNATIONAL MEDICAL ASSISTANCE & TPA | HEALIX INTERNATIONAL

4 HEALIX INTERNATIONAL GEOGRAPHY: GLOBAL

Healix has provided healthcare and risk management solutions to clients around the world since 1992 and offers bespoke services to clients wanting control over their health, travel and risk provision.

HQ: UK SECTOR: ASSISTANCE & TPA

We have built our reputation on medical expertise, our understanding of risk and our ability to move with the times, boasting a track record of service excellence and product innovation. Our core values are professionalism and reliability and our investment in staff and system development ensures our clients always receive quality services and excellent value.

+44 (0) 20 8481 7720

enquiries@healix.com

Our combined medical and risk management expertise places us in a unique position to deliver cost-efficient solutions without compromising on high quality support for the end-user and as a result we boast an impressive list of clients across corporate, government, NGO and insurance sectors.

healix-international.com Healix Group of Companies Healix House Esher Green Esher Surrey KT10 8AB United Kingdom

SERVICE FEATURES 4 4 4 4

INTERNATIONAL MEDICAL ASSISTANCE INTERNATIONAL SECURITY ASSISTANCE INTERNATIONAL TRAVEL ASSISTANCE INTERNATIONAL MEDICAL SCREENING

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4 4 4 4

REMOTE SITE MEDICAL SUPPORT INTERNATIONAL COST CONTAINMENT INTERNATIONAL COST CONTAINMENT INTERNATIONAL COST CONTAINMENT

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NEWS

MAYDAY ASSISTANCE SPECALISE IN PROVIDING A TRULY BESPOKE SERVICE TO OUR UNDERWRITERS AND YOUR CUSTOMER. WORKING WITHIN DIVERSE MARKETS SUCH AS PRIVATE HEALTH, TOURISM AND BUSINESS TRAVEL. WE ARE PARTICULARLY EXPERIENCED AT MANAGING TRAVELERS WITH PRE-EXISTING MEDICAL CONDITIONS. Our operations office is UK based, providing frontline multi-lingual staff who speak most European languages whilst delivering emergency assistance and advice to your customer. Our language capability enables us to manage your customer's emergency as efficiently and effectively as possible, whilst ensuring that customer is provided with a decision on cover as soon as possible. Thus relieving any unnecessary anxiety caused whilst being unwell or injured in a foreign country. Our operational staff are unscripted as to ensure that each customer is dealt with on a case by case bias.

Mayday Assistance provides escorted and non-escorted medical repatriations worldwide on behalf of our Underwriters. We also undertake private

international repatriations on behalf on individuals, private companies and public sector. With our inhouse Medical team and Operational staff working closely together, we provide the safest and most costeffective return for your customer.

Using our global network we are able to source doctor, nurse and paramedic escorts, arrange ambulance and taxi transfers, ticketing and provide any other ancillary needs. With a truly global reach, Mayday Assistance has agreements with a network of global cost containers who provide medical audits and negotiate discounts with providers to ensure that policy terms and limits are enforced.

TELEPHONE: +44 (0) 1273 916228

24/7/365 TELEPHONE: +44 (0) 1273 624661

24/7/365 OPERATIONS EMAIL: operations@maydayassistance.om

WEBSITE: maydayassistance.com

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INTERNATIONAL MEDICAL ASSISTANCE & TPA | MAYDAY ASSISTANCE

4 MAYDAY ASSISTANCE GEOGRAPHY: GLOBAL

Mayday Assistance specalise in providing a truly bespoke service to our Underwriters and your customer. Working within diverse markets such as private health, tourism and business travel. We are particularly experienced at managing travelers with pre-existing medical conditions.

HQ: UK SECTOR: ASSISTANCE & TPA

Mayday Assistance provides escorted and non-escorted medical repatriations worldwide on behalf of our Underwriters. We also undertake private international repatriations on behalf on individuals, private companies and public sector. With our in-house Medical team and Operational staff working closely together, we provide the safest and most cost-effective return for your customer.

+44 (0)1273 624661

maydayassistance.comEST:

maydayassistance.com

Using our global network we are able to source doctor, nurse and paramedic escorts, arrange ambulance and taxi transfers, ticketing and provide any other ancillary needs.

United Kingdom

SERVICE FEATURES 4 4 4 4

INTERNATIONAL MEDICAL ASSISTANCE INTERNATIONAL SECURITY ASSISTANCE INTERNATIONAL TRAVEL ASSISTANCE INTERNATIONAL MEDICAL SCREENING

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4 4 4 4

REMOTE SITE MEDICAL SUPPORT INTERNATIONAL COST CONTAINMENT INTERNATIONAL COST CONTAINMENT INTERNATIONAL COST CONTAINMENT

CONTACT US

NEWS

121

INTERNATIONAL MEDICAL ASSISTANCE & TPA | PAYER FUSION

4 PAYER FUSION GEOGRAPHY: GLOBAL

PayerFusion’s innovative TPA services utilize the latest medical claim processing technology coupled with our unique healthcare cost containment methodologies to provide you with the sharpest advantage possible.

HQ: USA SECTOR: TPA

Our rules-driven medical claim administration tools enable you to remain competitive and compliant in an environment of everincreasing costs and regulations.

+1 305 760 8739

Inflated and fraudulent bills result in $250 billion in unrecovered over payments each year. These over payments are calculated after supposed “discounts” have been applied to retail rates on medical provider bills. The results of such practices are needlessly high per claim costs, which are detrimental to the healthcare system as a whole.

info@payerfusion.comT: 2000

payerfusion.com

As regulation in the U.S. increases providers are rapidly becoming less willing to agree to blanket or routine discounts – traditional methods of medical claims processing can no longer deliver acceptable results.

5200 Blue Lagoon Dr #100 Miami FL 33126 USA

SERVICE FEATURES 4 4 4 4

INTERNATIONAL COST CONTAINMENT INTERNATIONAL CLAIMS MANAGEMENT MEDICAL CASE MANAGEMENT PROVIDER NETWORKS

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4 4 4 4

HIPAA COMPLIANT INTERNATIONAL CLAIMS MANAGEMENT COMPLETE HEALTH PLAN ADMINISTRATION INTERNATIONAL CLAIMS MANAGEMENT

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NEWS

There's no substitute for experience

Global Funeral Repatriation Specialist Talk to us, we’re listening

n of Fun ciatio era sso l rs ecto Dir

Nation al A

+44 (0)20 8684 2324

International Travel & Health Insurance Journal

INDUSTRY AWARDS 2016

ANCILLARY ASSISTANCE SERVICE PROVIDER OF THE YEAR

email:info@rowlandbrothersinternational.com

www.rowlandbrothersinternational.com

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INTERNATIONAL MEDICAL ASSISTANCE & TPA | ROWLAND BROTHERS INTERNATIONAL

4 ROWLAND BROTHERS GEOGRAPHY: GLOBAL

Rowland Brothers International has been providing advice and international repatriation services for over 40 years.

Our reputation and expertise are such that they we have been the official helpline for The National Association of Funeral Directors and its members for 15 years.

HQ: UK SECTOR: Ancillary Assistance Services

Rowland Brothers International repatriation service started in 1971. The family funeral business, Rowland Brothers, established in the 1870s , was asked to exhume and repatriate a Countess to France. Then Senior Partner Tony Rowland was asked to set up a repatriation strategy for a popular tour operator, Intasun, which organised package holidays to Spain.

+44 (0) 208 684 2324

info@rowlandbrothersinternational. com 2000 rowlandbrothersinternational.com

Rowland Brothers International developed and has since worked with numerous holiday companies, insurance and assistance companies, and international corporations around the world. As our worldwide network grew, so did our connections with international organisations such as Insurance and Assistance companies, the Foreign and Commonwealth Office, the Red Cross, Missing Abroad and the Metropolitan Police.

299-305 Whitehorse Road Croydon CR0 2HR United Kingdom

SERVICE FEATURES 4 4 4 4

INTERNATIONAL REPATRIATION SERVICE MULTI-LINGUAL TEAM GLOBAL FUNERAL SERVICES PREPARATION OF THE DECEASED

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4 4 4 4

PIONEER IN INTERNATIONAL REPATRIATION 4 OVER 45 YEARS EXPERIENCE TRANSPORTATION & FLIGHT BOOKING DOCUMENTATION & CUSTOM CLEARANCE

CONTACT US

NEWS

Pacific Cross Insurance Inc. Pacific Cross Healthcare Inc.

Pacific Cross Vietnam

Healthy people drive a healthy bottom line

Healthy employees drive productivity, but managing the diverse needs of teams working internationally can be a challenge.

That’s why we’ve designed a new international health plan that flexes around individual needs. And why we provide aroundthe-clock care, whether its access to our vast network of facilities or in-house emergency evacuation services.

So, if your clients have groups of three or more employees, we can offer the protection they need, wherever they are in the world.

To find out more visit www.generali.co.uk/ggh or call +44 (0) 207 265 6444

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