Medical Air is an international air ambulance and patient transfer service based out of Jandakot Airport in Western Australia. Formed in 2013 as a joint venture by CEO Shane Gifford and business partner Doug Brooks, Chief Pilot Zach Froneman, and Medical Director Dr Rob Liddell, Medical Air is one of three independent businesses operating under the umbrella of Formula Aviation and alongside Formula Air Services, a charter company and Formula Aircraft, an aircraft maintenance and leasing organization. The driving focus of the company was the facilitation of patient repatriation to rural facilities closer to home for rehabilitation and continued care following their treatment in the metropolitan area. Whilst health data clearly demonstrates that patient repatriation is important in managing patient flow the service faces numerous challenges primarily due to the apparent lack of regional administrative infrastructure within Western Australia. “The Eastern states have clearly demonstrated the benefits of an efficient Non – Emergency Patient Transport (NEPT) service and have developed a specifically delineated service model where the RFDS, Air Ambulance and HEMS’ transfer all high acuity patients to tertiary facilities, whilst other approved transport operators, such as ourselves, provide the transport for medium and low acuity patients and also undertake repatriations,” says Mr Froneman. “This service model is clearly well established and functions far more effectively than the Western Australian model. We believe that change is coming, and I strongly believe the benefit of the services we can offer will be recognised through the weight of the already available evidence.”
As a private company, Medical Air is also well placed to undertake interstate patient transfers. While initially using King Air aircraft, Medical Air soon began leasing small jets from external companies for faster interstate travel. To accommodate increasing demand, for patient transfers the company’s services grew to include international patient repatriation, particularly from Indonesia, and commercial medical escorts for patients well enough to travel on a commercial airline but still requiring in-flight medical support. Perth has proven to be an ideal base for Medical Air’s operations due to the availability of excellent tertiary and quaternary health facilities which deliver the majority of medical disciplines.
With the growing use of small jet aircraft, the company saw the necessity to acquire its own jet and was granted approval in May 2015 to operate our Learjet both internationally and within Australia. One of the first missions for the Medical Air jet was transporting a newborn baby from Perth to Melbourne for emergency cardiac surgery.
Medical Air’s aircraft are fully equipped and staffed as airborne intensive care units. “Apart from ICU patients we mainly go into Indonesia for chronically ill patients or older people who fall and break a leg or hip and have received initial care at a local hospital,” Zach explains. “We fly there, collect them, and transfer them back to hospitals anywhere in Australia. That’s really how we’ve grown to what we are now; an international retrieval company with our own ICU air ambulance jet operation.”
While Medical Air’s primary service is the repatriation of any patient that require air ambulance evacuation, the company also provides domestic and international commercial escorts, both for seated and stretcher patients. Additionally, Medical Air has worked alongside the local Westpac Rescue Helicopter Service, providing medical staff for local events such as the V8 Supercar races. “When they come here, Westpac provides the helicopter, and we provide the medical crew.” Medical Air can also staff primary care medical facilities with medical equipment, registered nurses and paramedics if required. Through Dr. Rob Liddell, the Medical director for Medical Air, the larger affiliate Health Service Network currently provides poisons permits for 12 mining sites and Medical Air provides patient evacuation if required.
As a relatively young business, Medical Air has found Australia’s medical care environment to be highly insular and isolated, operating separately from state to state. In order to circumvent such issues, the company has established strong alliances with service providers in various locations to form a single cohesive unit. To date these partnerships include Dr. Rob Liddell and his Health Services Network, which Medical Air itself forms a part of, a number of ambulance service providers including Wilson Medic One – a ground service ambulance provider, equipment and pharmaceuticals providers, and numerous insurance providers (QBE, Dynamic and Allianz to name a few), and local hospitals. Zach notes that one of the major Work Health and Safety issues facing the resource industry is the delay in transferring injured workers to definitive care.
The current WA Country Health Service model focuses on a single medical aviation service provider . Given the size of WA and the everincreasing demand on transport services it is time for a review of this service model with a view to providing an efficient and future oriented service.. “A number of our team have come from the eastern states, Europe and America,” he says, “where these services are much more developed and established. We like to think that we’ve brought the best of that with us.”
Mr Froneman continues. “Through our Health Services Network, we are able to provide care from the point of injury of the worker at the mine site, all the way into the hospital, through rehabilitation, the recovery plan, onto physio, transport between home and any doctor’s appointments, until the entire treatment plan is complete and the patient returns to their onsite duties. We provide a Total Solution that covers the full process with One Point of Contact.”
The fleet of aircraft currently in use by Medical Air feature a variety of world-class modifications and equipment, including the most modern ventilators and patient monitoring systems, in line with the best national and international standards. “Because we own the full package including the aircraft, maintenance facility, and all of the medical equipment, we have direct influence over quality control,” Zach says. “As a small company, we have very short lines of communication and a dynamic team who are highly motivated to ensure excellence in care and service. We are agile because we’re such a small group.”
Even with medical experience, those seeking employment within Medical Air’s sector face stiff competition and a variety of challenges. “Many people in the aviation industry and health profession would like to do Aero medical work,” says Mr Froneman, explaining that, amongst other things, a thorough understanding of the impact of transporting an ill patient at high altitude is critical. “The body behaves very differently at high cruising altitudes from the way that it does on the ground; all the medical staff need to appreciate how the physiology changes and prepare accordingly.” Due to the nature of Medical Air’s service, many of the patients that the company transports have suffered a trauma of some kind. Trapped air in body cavities is one of the big issues. When the aircraft is up at cruising altitude, the ambient air pressure in the aircraft drops a little,” Zach explains. “At this point, trapped air bubbles expand and start applying pressure on body structures. This can cause extreme pain, breathing problems and even heart problems. ”Such phenomena impact how the patient can be treated, as well as how fast the aircraft can climb, descend, or manoeuvred. “All of this makes it very challenging to get people into the industry and get them trained properly, which is why we only hire staff that have worked in their respective disciplines for an extended period of time and have gained a lot of experience. We then put them through aeromedical training and do on-the-job training with them where they are “buddied” and mentored by experienced staff. The highly selective nature of Medical Air’s hiring process is one of the main reasons why the company has been viewed as a preferred provider for hospital transfers, and is a key factor behind its high success rate to date. “Every Patient we’ve taken on board the aircraft, we’ve handed over the same or healthier than when we’ve received them. While we have potential for rapid growth, our philosophy has typically been to provide a more personalised service. Our main focus is on providing suitable care to our patients and emotional support their families while maintaining the highest level of safety.
The nature of the service provided by Medical Air, especially when coupled with the company’s recent focus on international work, requires a high level coordination with a wide range of service groups and individuals in order that missions are carried out successfully and without unnecessary delays. Those involved in any given mission include the primary referral hospital, the patient, their family with their needs and preferences, the insurance company that facilitates the repatriation and covers the cost of the care, the medical team, the ground ambulance service providers in both the dispatching and receiving cities, and the receiving hospital. In his role as Medical Air’s Operations Manager and Chief Pilot, Mr Froneman is in regular contact with every group that the company works alongside in order to continuously monitor and ensure the quality of all aspects of the operation. “It’s critical for us to get the timings right,” he says. “When we land, the ambulance needs to be there to take our medical staff to the hospital. The medical staff at the hospital needs to be ready to hand the patient over to our medical staff, and when we come to land back in Australia, the ground staff needs to be there. If we don’t coordinate all of this properly, the whole system breaks down.” The highly efficient system that Medical Air has developed stands as evidence of the company’s careful growth over the past 18 months, a progression that Zach feels has been purely due to the personal and professional relationships established between the business and its many partners. With its fleet based out of Jandakot, located 15 kilometres south of the Perth CBD, the movement of Medical Air’s aircraft are not limited by the issues commonly associated with larger airports such as Perth International. Mr Froneman has found that at smaller, general aviation airports, access and customs clearances may be easier and faster, and patients can be moved from the aircraft straight onto the ambulance, which can park on the apron next to the aircraft. “That needs coordination with the airport authorities, so we work very closely with all of these people,” he says. “We’re getting to know each other, and we each understand the pressures that the other is under, so it makes for a more coordinated and cohesive effort.”
In order for the sector to grow and integrate itself more efficiently with other medical services, Zach emphasises the need for both the political will for change, and the infrastructure to support such a change. “The current preferred single service provider model mostly manages the demand of moving patients from primary sites of injury to primary service or medical care facilities. What happens after that is the problem,” he explains. “Because our population is growing, there’s a growing need for beds to be available in the metropolitan areas, but the mechanisms aren’t really in place to quickly move suitable patients out of acute beds efficiently enough to make the best use of the available beds.” Mr Froneman feels that the movement of these patients is inefficiently managed under the current model, reducing hospitals’ capability to effectively manage patient flow and placing extra demand on already stretched resources. While Medical Air is working closely with the Health Department to achieve changes that will eliminate many of the issues that the industry currently faces, Zach laments that such developments will not occur quickly. “It’s always a cost-benefit analysis, andchange is never easy,” he says. “It’s causing a lot of stress in the industry, but I’m sure we’ll get to a point where the service model will catch up with the demands of providing quality health care in WA.”
Trained in the military initially as a navigator, an air-traffic controller soon after, and, finally, as a pilot, Zach Froneman has functioned in both operational and training roles both inside aircraft and on the ground. He spent the previous decade primarily working within the European aeromedical sector carrying out patient repatriation services. “I’m living the dream, really,” he says. “One of my biggest goals was to get to a point where I can help set up an organization such as this, and we’ve done it! Professionally, I’ve achieved what I wanted to; I’m the chief pilot of an operation that does international aeromedical work, and it’s great. That’s really all there is.”