EMA Finland: Professional Air Ambulance Services for Critical Patients

When a serious illness occurs while you’re abroad, transferring the patient to their home country for treatment can often be the best option. Reasons for such transfers include inadequate medical resources at the destination, prolonged treatment in an unfamiliar cultural and linguistic environment, and the psychological stress these factors can cause for the patient.

EMA Finland Ltd has been managing air ambulance services in Finland for 35 years, primarily facilitating the transfer of critically ill patients. These services are also utilized within the country for patients requiring specialized medical care such as ECMO, burn treatment, pediatric cardiac care, hyperbaric oxygen therapy, and transplant surgeries.

The Challenges of Air Transport

Air Pressure and Altitude:

As altitude increases, air pressure decreases. At typical jet cruising altitudes (around 12 kilometers), the atmospheric pressure is only about one-fifth of that at sea level. Modern aircraft are pressurized to simulate an altitude of approximately 2,500 meters, where air pressure is about 25% lower than on the ground. This can cause healthy individuals’ oxygen saturation to drop to around 90%, increasing breathing effort and oxygen consumption by the heart. For patients, especially those with certain medical conditions, this reduced pressure can lead to complications. If a patient’s condition requires cabin pressure equivalent to sea level, the aircraft must fly at a lower altitude, significantly increasing travel time and fuel consumption. This is known as a “sea-level flight.”

Acceleration and Deceleration:

During takeoff, the blood in a lying patient tends to shift depending on the body’s position, requiring careful management to prevent blood pressure fluctuations. For neurosurgical patients, positioning the head in the direction of travel helps prevent increases in brain pressure.

Turbulence:

Air turbulence caused by weather phenomena, jet streams, wake vortices, and clear air turbulence can cause sudden and severe vertical accelerations. Securing the patient and medical supplies is crucial to prevent movement during turbulence.

Noise, Vibration, and Movement:

Aircraft noise and vibrations can cause discomfort, fatigue, nausea, shallow breathing, and muscle tension. These factors complicate patient monitoring and treatment, necessitating efficient communication and careful planning.

Spatial Constraints:

The limited space in air ambulances requires careful positioning of the patient to ensure easy access to vascular connections, catheters, and drains. Basic treatment must be adapted to the confined environment, and infusions often need to be administered via pumps due to limited cabin height.

Implementing Patient Transfers

Patient transfer operations begin with thorough preparation, including obtaining the patient’s background information, current status, and ensuring all logistics are in place. This involves securing overflight and landing permits, visas, and customs formalities. Coordination with the receiving hospital is essential to prepare the patient for transfer.

The aircraft is modified for medical use by removing seats to accommodate 1-2 beds equipped with pressurized oxygen. Medical equipment and medications are provided by EMA Finland’s medical crew, which typically includes an anesthesiologist, an intensive care nurse, and other specialists as needed.

During the transfer, patient monitoring and treatment are conducted as in a hospital, with portable blood gas analyzers and other necessary equipment. After landing, the patient is transferred via ground ambulance to the receiving hospital.

Financial Considerations

Air ambulance flights are a significant financial investment. European flights can cost tens of thousands of euros, while intercontinental flights can exceed one hundred thousand euros. Most transfers are funded by insurance companies or healthcare districts, with private payers accounting for only about 5% of transfers. Despite the costs, the value of saving a human life justifies these substantial investments.

Alternative Transport Options

When a patient’s condition allows, they can be accompanied on a commercial flight. This requires the patient to sit upright during takeoff and landing and not disturb other passengers. Additional seats or business class seating may be used, and medical escorts are often required if the patient needs medical monitoring, medication or e.g. supplemental oxygen, which is usually supplied by the airline for an additional fee.

EMA Finland’s air ambulance services play a critical role in ensuring that patients receive the best possible care. Our commitment to excellence, thorough preparation, and specialized medical teams ensure that every patient transfer is conducted safely and efficiently. As we continue to provide these essential services, we remain dedicated to meeting the evolving needs of our patients with professionalism and compassion.

Source (In Finnish): Laine A., Haapsaari P.: Sairaanhoitoa Ilmassa. Finnanest 2018, 51(4) (https://say.fi/files/laine_sairaanhoitoa.pdf)