Despite high costs, requests for airlifting COVID patients from ill-equipped northern States to southern medical hubs has multiplied manifold
Earlier last week, a Beechcraft King Air C 90 air ambulance from Bagdogra lost its right wheel while taking off from Nagpur after refuelling. The aircraft was carrying a COVID-19 patient for treatment in Mumbai. The pilot was alerted but given the critical condition of his passenger, he kept flying to burn fuel before coming in to land. After hovering over Mumbai, he finally made a belly-landing without any casualties.
The incident highlights the multiple risks taken by the crew of air ambulances as demand has surged for the services amid the surge of the virulent second wave of COVID-19 across the country. Families resourceful enough to charter these services do so to cut through the tardiness of the COVID-19 response to reach better care at the earliest.
Transporting critically ill patients is a difficult operation at the best of situations but transporting COVID positive patients needing urgent care raises additional challenges, the most important being isolating the patients and the crew. This in turn has pushed up costs.
Shifting of a COVID-19 patient from Delhi to Chennai would cost not less than ₹20 lakh, according to an operator. A Mumbai-Hyderabad flight can set one back by between ₹6 lakh and ₹25 lakh depending on where the aircraft is and the medical staff and equipment on board.
Despite the costs, however, aggregators and charter plane operators say the demand for air transportation of patients has increased 10-fold and yet many patients are being turned away as only a limited number of these air ambulances are equipped with isolation pods — mandated by the Health Ministry for ferrying COVID-19 patients.
Evacuating patients in an isolation pod, a collapsible personal capsule with oxygen supply, also ensures the safety of the crew.
“Where we used to receive one or two enquiries for medical transportation, we now receive as many as 20 requests per day. A majority of them have to be rejected because availability of aircraft is an issue. Our machines are being overused and there is a waiting period of at least two to three days,” Sachit Wadhwa, co-founder of BookMyCharters, says.
Data with the Directorate General of Civil Aviation show only 18 companies are authorised to operate air ambulances with 26 aircraft cleared for medical transportation. “Those transporting COVID passengers have to abide by the guidelines of Ministry of Health and Family Welfare and of the States of origin and departure,” a DGCA official said.
“There are only six aircraft available in the country with isolation pods, and we have to move them from different locations across the country for our clients. So, if a patient is in Mumbai and our only available aircraft is in Delhi, then the cost of flying in from a different city will have to be borne by the clients,” Mr. Wadhwa says.
Hyderabad followed by Chennai and Mumbai are the most sought after medical hubs for these patients.
On April 19, an air ambulance from Bhopal landed at the Begumpet airport in Hyderabad. The patient was a 37-year-old pulmonologist, Satyendra Mishra, with extensive damage to his lungs, who had attended to multiple COVID-19 patients. The Madhya Pradesh government consulted Yashoda Hospitals in Hyderabad, and the young pulmonologist was airlifted to the southern city. After undergoing treatment, he recovered and was discharged on May 7.
Apart from Dr Mishra, Yashoda Hospitals has treated 31 patients airlifted from other States, including non-COVID patients.
“Three of them underwent lung transplantation,” A. Lingaiah, Director of Medical Services, Yashoda Hospitals Group, says.
At least 86 patients, most of them with COVID-19, have been airlifted to major corporate hospitals in Hyderabad in the past couple of months. The patients were from West Bengal, Bihar, Delhi, Jharkhand, Chhattisgarh, Karnataka, Madhya Pradesh, and Odisha among others.
Corporate hospital representatives say the combination of extracorporeal membrane oxygenation (ECMO) support, lung transplantation facilities and expert doctors is the reason that patients prefers Hyderabad.
The patients include politicians, influential individuals and people with deep pockets — Bollywood Actor Sonu Sood recently helped a young girl from Nagpur airlifting her to Hyderabad.
- Hari Prasad, president of Apollo Group of Hospitals, says that nearly 20 COVID-19 patients in advanced stage of the disease have been airlifted from Bihar, Jharkhand, West Bengal, Uttar Pradesh in the past couple of months. They underwent treatment at the hospital in Jubilee Hills.
Asked why Hyderabad is chosen over other cities, Riyaz Khan, CEO of Continental Hospitals in Gachibowli, says the sophisticated infrastructure here is one of the reasons.
“Mumbai, Delhi, Chennai, too have equally good infrastructure. But the number of cases in those cities are high and it has become difficult for people to find advanced medical attention on time,” he says.
KIMS Hospitals in the city received 23 patients who were airlifted in the past two months. Of them, 16 were COVID-19 patients, two with end-stage lung disease.
Coming home to care
Though a large chunk of the demand is for travel from small towns to big cities with better medical infrastructure, there are also enquiries for travel from metros to Tier-2 and -3 cities as availability of beds in big cities has become a problem, says Rajan Mehra, CEO, Club One Air.
When a Coimbatore-based NRI heard of the death of his brother-in-law from COVID-19 in Uttar Pradesh recently, he did not want to leave his sister, who also tested positive, alone there. She was flown to a hospital in Coimbatore on an aircraft equipped with an isolation pod. Her children came later.
Hospitals in Tamil Nadu are witnessing similar instances of COVID-19 patients being brought back from northern parts of the country.
Planet-X Aerospace Services, which operates out of Coimbatore and Madurai, has airlifted COVID-19 patients seven times in just the past two months.
Patients were brought to cities such as Chennai, Coimbatore, Madurai and Tiruchi on isolation pod-equipped aircraft, says Wing Commander A. Satish Kumar (retd), the company’s Director and CEO. “The majority of patients we brought to Tamil Nadu was from northern States. Their families wanted to ensure good medical care and extend emotional support by bringing them home,” he says.
A Bengaluru-based company says there has been a 500% increase in the demand for its air ambulance services.
In 2017, when the International Critical Care Air Transfer Team (ICATT) launched its air ambulance service, it was transferring 15 to 20 critically ill patients a month. With the second wave of COVID-19, ICATT has been transferring 300 patients a month to different parts of India.
Rahul Singh Sardar, who runs the air ambulance service with Shalini Nalwad, says they were involved in the first few transfers of COVID positive patients in the early days of the pandemic, and had procured isolation pods from Germany.
The team currently has three aircraft and said there is a lot of demand for COVID-19 patients to be airlifted from Madhya Pradesh, Gujarat, Uttar Pradesh, Chhattisgarh, Bihar, Jharkhand, Rajasthan, Punjab and Maharashtra. Dr. Sardar says the majority of the critically ill patients who use their air ambulance service want to be taken to Chennai or Hyderabad as they feel that the southern cities have advanced medical facilities. “Most of the patients we have airlifted during the second wave are in their mid-20s to their late-30s,” he says.
In the last one year, Manipal Hospitals has treated 12 COVID-19 patients who were airlifted for treatment, says Sunil Karanth, chairman, head of the department and consultant, critical care medicine, Manipal Hospitals. “Currently, there is one patient airlifted from Bhopal on a non-invasive ventilator and now under observation,” he says.
Dr. Karanth says the number of patients being air-lifted to Bengaluru is low. “As we speak right now, Bangalore numbers have peaked while cases in other districts are on the rise. Hence, the number of patients airlifted in the second wave is low. But numbers are likely to increase with time, as Bengaluru sees a decline in cases.”
The need to airlift patients extends beyond the mainland. The Lakshadweep Administration has a pact with helicopter operator Pavan Hans to transport islanders needing emergency medical care to Kerala. The service was last availed over a month ago to transport a patient to the Cochin International Airport, official sources said.
An air-evacuation pod developed by Naval Aircraft Yard of Southern Naval Command, Kochi, was relied on to isolate the patient during travel as a precaution in the pandemic situation, they added.
The service of Naval helicopters or aircraft have not been sought in recent memory for medical evacuation, a Navy spokesperson said.
A private player, Chipsan Aviation, has three helicopters to enable medical transportation, Sunil Narayanan of the firm says. One of them used for VIP transport can be converted to have stretcher facility in 45 minutes. “We helped evacuate 14 people recently in West Bengal. Two other helicopters can evacuate patients in sitting position,” he adds.