iPMI Magazine Air Ambulance Owner Operator Broker Round Table by iPMI Magazine Health and Medical Insurance Assistance News Magazine

iPMIM

FLEET CAPABILITIES | TECHNOLOGY | GLOBAL ACCREDITATION

MEDICATION | PAYOR - PROVIDER RELATIONS

iNTERNATIONAL AIR AMBULANCE ROUND TABLE EXCLUSIVE C-SUITE EXECUTIVE COMMENTARY FROM FAI, JET EXECUTIVE, MEDCARE PROFESSIONAL AND TYROL

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BROAD STATS SHOULD MEAN BROAD COVERAGE

JOIN US TO EXPAND YOUR COVERAGE TODAY

FACT

NO.

438

The top three reasons for expatriate relocation are as follows: 01 Education 02 Employment 03 Relationship

Keeping You Well, While You’re Away.®

WellAway®

Keeping You Well, While You’re Away.®

 +1 441 296 0651  info@wellaway.com  www.wellaway.com

WellAway is a managing general underwriter specialized in worldwide expatriate healthcare. WellAway is proud to underwrite the only ACA compliant expat solution offered in the international market.

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FACT

NO.

533

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FACT

NO.

327

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FACT

NO.

770

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FACT

NO.

807

There are approximately 40 million high-income expats across the globe

The expected number of expatriates by 2017 is 56.8 Million (0.77% of the world)

The average person lives as an expatriate between three and five years

The country with the highest percentage of top-income expatraties is Nigeria

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FACT

NO.

681

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FACT

NO.

445

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FACT

NO.

257

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FACT

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398

WellAway offers multi-lingual, 24/7 concierge care services and e-Consultations

WellAway provides French nationals seamless ACA & CFE integration

WellAway provides access to medical providers worldwide with direct billing capabilities

WellAway has comprehensive programs covering all facets of expat life

24 hour contact for inquiries: express@air-alliance.de +49 2736 44 28 45

Brand new:

Challenger 604 3 stretcher Max. Range: 7,400 km Altitude: 41,000 ft Max. Speed: 870 km/ h Oxygen: 16,000 liters

MEDFLIGHT

WE FLY FOR YOUR LIFE.

from October 2015

• Air Alliance Group founded in 1993 • Fleet of 11 aircraft under own AOC • AC located in Cologne, Siegerland and Vienna • 780 worldwide missions per year

Air Alliance Medflight is a company of Air Alliance Group. Since 1993, we have been successfully acting on the market as experts for all matters in aviation. At present, 11 dedicated air ambulance aircraft for long, middle and short hauls are at your disposal under AOC D-266. They are meticulously taken care of in our own maintainance organization (EASA Part 145) and Modification and Development organisation (EASA Part 21).

WE FLY FOR YOUR LIFE. • Experienced- also in crisis regions • Modern and innovative aircraft technology • Top qualified medical staff and equipment

More at: www.medflight.de and www.air-alliance.de

‘‘Each new situation requires a new architecture.’’ Jean Nouvel - Architect

AntaĂŠ

Architect of international mobility solutions

International companies & organisations

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of iPMIM

“THE INTERNATIONAL PRIVATE MEDICAL INSURANCE MAGAZINE HAVE GREAT MARKET KNOWLEDGE AND EXPERIENCE IN THE IPMI SECTOR AND THEY PRODUCE EXCELLENT MARKET UPDATES. WE ARE DELIGHTED TO BE ASSOCIATED WITH CHRISTOPHER KNIGHT.” CHRISTOPHER PERCIVAL BOARD DIRECTOR HEALTHCARE INTERNATIONAL

22//AUGUST//2015

WELCOME

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ARRIVALS

WELCOME TO THE MOST RECENT INTERNATIONAL PRIVATE MEDICAL INSURANCE MAGAZINE EXCLUSIVE AIR AMBULANCE MEDICAL TRANSPORTATION ROUND TABLE BUSINESS FORUM. My name is Irena Dimitrijevic and I have been Head of Sales and Marketing at Jet Executive International since 2010. In this exclusive debate we talk about the international medical transportation sector of the business. With a focus on fleet capabilities, on-board technology, medication and payor-provider relations the round table takes a closer look at the global providers assisting iPMI insurers and insureds.

I hope you enjoy reading this feature as much as we did and we look forward to seeing you at future iPMIM round table events. With Best Regards

Irena Di mit rijevic

Marketing & Sales Manager Jet Executive International Charter

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READY TO FLY: ARIAL VIEW OF PART OF THE AIR ALLIANCE FLEET

Roundtable

QUESTIONS

A STAR FOR LONGRANGE TRANSPORTS WITHIN THE TAA FLEET: GULFSTREAM 100

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QUESTIONS? 33 | Q1

PLEASE INTRODUCE YOURSELF AND BACKGROUND IN THE AMBULANCE INDUSTRY:

35 | Q2

EXPLAIN WHY INTERNATIONAL INSURANCE AND ASSISTANCE PROVIDERS SHOULD USE YOUR AMBULANCE SERVICE:

HOW CAN WE DEFINE YOUR BUSINESS. ARE YOU AN OWNER, OPERATOR OR BROKER?

36 | Q4

WHAT ARE THE ADVANTAGES OF YOUR BUSINESS?

39 | Q5

PLEASE WALK US THROUGH YOUR FLEET:

41 | Q6

WHAT MEDICAL EQUIPMENT AND TECHNOLOGY DO YOU HAVE ONBOARD?

Questions

36 |

Roundtable

QUESTIONS

DIVERSE FLEET: THE RIGHT PLANE FOR ANY KIND OF MISSION

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43 | Q7

WHAT ADVANTAGES DOES YOUR FLEET PROVIDE?

45 | Q8

WHAT MEDICATION DO YOU HAVE ON-BOARD?

47 | Q9

HOW FEASIBLE IS 1 WORLDWIDE VOLUNTARY AMBULANCE ACCREDITATION STANDARD?

Q10

WHAT POLICIES AND PROCEDURES MAY BE IMPROVED BETWEEN INSURERS, ASSISTANCE PROVIDERS AND AMBULANCE SERVICES?

51 | Q11

HOW CAN YOU MANAGE THE QUALITY OF A PARTNER PROVIDING EMPTY LEGS?

53 | Q12

WHAT DOES THE NEXT 5 YEARS HOLD FOR THE AMBULANCE INDUSTRY?

Questions

49 |

EXPANSION: ADDITION OF CHALLENGER 604 FOR THE AIR ALLIANCE FLEET. RANGE OF 7,000 KM WITHOUT STOP

Round table

24 hour contact for inquiries: express@air-alliance.de +49 2736 44 28 45

WE F LY FOR YOUR LIFE. • Air Alliance Group founded in 1993

• 780 worldwide missions per year

• Fleet of 11 aircraft under own AOC

• Experienced- also in crisis regions

• Brand new: Challenger 604

• Modern and innovative aircraft technology

• AC located in Cologne, Siegerland and Vienna

MEDFLIGHT

WE FLY FOR YOUR LIFE.

• Top qualified medical staff and equipment

More at: www.medflight.de and www.air-alliance.de

NEWS

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News

EVA KLUGE AIR ALLIANCE

Introducing Eva Kluge, new Director of Sales and Business Development at Air Alliance As of 1 August 2015 Eva Kluge has joined Air Alliance Medflight as the new Director of Sales and Business Development. Eva has been in the industry for more than 20 years. Her professional career includes 7 years at Europ Assistance, Munich, in various roles as well as 10 years at Munich Re/ ERGO Group as Head of International Medical Provider Network and Key Account Manager

ÂŠ

Medical Assistance/ Healthcare for international insurers. Prior to joining Air Alliance she spent 2 years in Austria as Head of Sales and Marketing for a renowned Air Ambulance company. Eva has studied Healthcare Management and speaks fluently five languages, among them Arabic.

Global coverage, reliablity and service. Seeking out new life and new civilisations. No matter how undiscovered and

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the Munich Health brand, Munich Re pools its primary insurance and reinsurance operations, as well as expatriate staff as well as individuals and their families flexible underwriting solutions, high-level products

related services in international healthcare business.

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Munich Re as a group stands for exceptional solution-based expertise, consistent risk management, globe. Plus the advantage of covering pre-existing diseases in the insurance policy. Trust in our expertise.

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Outstanding care for outstanding people. DKV Globality is the international

With Globality CoGenio® and Globality YouGenio® we offer international companies and their expatriate health insurer with a special focus on expatriates. As a member of Munich Health with more than 5,000

staff and individuals and their families, flexible underwriting solutions, high-level products with

experts at 26 locations worldwide we offer innovative healthcare solutions for clients and partners all over

comprehensive outpatient, inpatient and dental cover and market leading services around the globe. the world. As an integral part of the Munich Re Group, we give you the financial strength and security of one of the world’s leading insurers and reinsurers.

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A Market Leader in Patient Transport by Ambulance Jet

•

„Special Care“ certified by EURAMI

•

A fleet of dedicated medical aircraft

•

All cabin sizes ranging from small to midsize and to wide body jets equipped with up to 2 Intensive Care Units

•

Lear 35, 55 & 60 series, Challenger 604 and a unique CRJ 200 equipped for the transport of 6 stretcher patients

•

Worldwide operation including hostile areas with no restrictions

We are only a phone call away and ready 24/7 to take off for your medical transfer Contact: Telephone: +49 911 36009 0 Telefax: +49 911 36009 59 Email: ops@fai.ag www.flightambulance.com

Fast - Safe - Reliable

EXECUTIVES

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Executives

VOLKER LEMKE FAI

Volker Lemke is the Director Sales & Marketing (CSO) at FAI Air Ambulance. After learning about the basics of aviation and emergency medical care in a long career as a road and helicopter ambulance paramedic, Volker built on this experience to become a trainer and teacher and then a sales manager. In 2004 Volker brought his talent and enthusiasm, as well as his extensive market knowledge to FAI. He has since helped build the team as a member of the Board of Directors

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and was a key element in making FAI one of the leading air ambulance providers in the world. On the international travel insurance scene his in depth familiarity with the complexities of the business, coupled with his still intact enthusiasm, have made his peers recognise him as one of the best experts in the industry today.

EXECUTIVES

EXPERIENCED PILOTS FOR ALL MISSIONS, EVEN IN CRITICAL TERRAIN

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Executives

IRENA DIMITRIJEVIC JET EXECUTIVE

Irena Dimitrijevic is the Marketing & Sales Manager at Jet Executive International Charter. Jet Executive International Charter is the legal successor of company Taunus air. The company is dealing under actual ownership since 1999. The fleet consists of three Learjets 35A, one Learjet 55 and one Beechcraft King Air 200. JET EXECUTIVE is performing worldwide ambulance- and cargo flights. Since summer 2006 JET EXECUTIVE has

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successfully established a second home base at Munich airport. One Learjet 35A and one Beechcraft King Air 200 were purchased from Munich-based operators, which ceased their flight operations. In consequence JET EXECUTIVE is developing its services towards charter & operational management of third party owned aircraft.

Wherever your patient is, we´ll get him out !

MedCareProfessional is an internationally operating air ambulance provider, as well as one providing ICU and ambulance ground transportation. We pride ourselves on highly trained medical staff and experienced flight crews, thus being able to guarantee superior quality patient care, both

M E D C A R E P R O F E S S I O N A L K E R K E N B U S C H 1 5 4 5 5 2 9 H A T T I N G E N , G E R M A N Y T E L : + 4 9 . 2 3 2 4 . 9 1 9 9 8 0

EXECUTIVES

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Dr Joachim Friese is the CEO and Medical Director at Medcare Professional. Dr. Joachim Friese is a medical doctor and was born in Germany in 1964. He is the Medical Director for MedCare Professionals. After finishing Medical School in Frankfurt Dr. Joachim Friese worked as a trauma surgeon and intensivist in University and teaching hospitals at Hattingen, Bochum and Koblenz. Whilst attending Medical School Dr. Joachim Friese discovered a passion for Emergency

Medicine and Intensive Care. After years of doing ER in the streets, Dr. Joachim Friese was finally airborne in 1995 and gained extensive experience in Medical Missions on fixed wing and rotor wing air crafts, in repatriations and evacuations.

Executives

JOACHIM FRIESE MEDCARE PROFESSIONAL

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. e m o h e m e k a

24-HoUR EMERGEnCy SERv ICE

+43 512 22422-100 taa@taa.at More than medical care and ambulance services:

www.taa.at

• 3000 patients returned home every year • Cost-effective double and multiple transport facilities • Worldwide operations - experts in long-haul flights • Shuttles with shared capacities from popular tourist regions around the Mediterranean Sea on a weekly basis with guaranteed departures • Online tracking of free capacities at www.taa.at • own fleet of five aircraft

Platinum Safety of Flight Award 2013 | ERA member | EHAC member | EURAMI certified | IAG Core Partner

EXECUTIVES

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Claudia Schmiedhuber is the Sales Development Officer for Tyrol Air Ambulance. Tyrol Air Ambulance is the winner of ITIJ Industry Award 2013 as the world’s best Air Ambulance Provider. Claudia has extensive knowledge and experience in the medical assistance, repatriation, healthcare and cost containment market and has gained work experience worldwide. Her past work includes working for one of the biggest Medical Assistance

companies in Toronto, Canada. Claudia has also gained practical industry knowledge by working as an Emergency Flight Paramedic for her company’s medical repatriations. She also holds a Bachelor’s Degree in Romance Languages and is able to communicate in six different languages.

Executives

CLAUDIA SCHMIEDHUBER TYROL AIR AMBULANCE

ROUND TABLE

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PLEASE INTRODUCE YOURSELF AND BACKGROUND IN THE MEDICAL TRANSPORT AMBULANCE INDUSTRY: and travelling is a passion so therefore it was a great opportunity for me. JOACHIM FRIESE: My name is Dr. Joachim Friese. I was born in 1964 and after school have studied Medicine in Frankfurt. After these studies, I worked as a Trauma Surgeon and as an Intensive care Physician in academic teaching hospitals and university clinics in Hattingen, Bochum and Koblenz. During these studies, I developed a passion for intensive care medicine and accident and rescue medicine. After many years in rescue medicine, I finally developed my passion for air medevac missions in 1995. With this, I could collect experience for different companies and organisations in rescue and repatriation flights both with fixed wing and rotor wing air crafts. In 2007, with my partner, Michael Weber, we established the organisation MedCareProfessional in which I am employed as the CEO and Medical Director. Furthermore, since 2014, I have lead as the senior consultant in the Surgical Emergency Department in Hattingen Hospital. CLAUDIA SCHMIEDHUBER: My name is Claudia Schmiedhuber and I am the Sales Development Officer at Tyrol Air Ambulance. I started my career in the medical assistance field at the age of 22 when looking for a summer job. At the time, I was studying romance languages and working as a volunteer emergency paramedic for the Red Cross in Vienna. This job combined both of my main interests â&#x20AC;&#x201C; medicine & languages. Shortly after starting to work for Europ Assistance in Vienna as a Case Manager, I

Roundtable

VOLKER LEMKE: I am a member of the Executive Board of FAI rent-a-jet AG and the head of the air ambulance division of the company. I started my career as a paramedic in ground based and helicopter emergency services and acquired an experience of thousands of missions from 1983 to 1999. I took over management roles for air ambulance providers in 2000 specialising in the field of cost sensitive assistance services. My capacity to fulfil the requirements of senior managerial positions in the air ambulance industry, as I have done for quite a long time now, is based on those long years of professional activity and also a talent for interpersonal relationships. IRENA DIMITRIJEVIC: My name is Irena Dimitrijevic and I have been Head of Sales and Marketing at Jet Executive International since 2010. Even though Jet Executive has been established in the Air Ambulance business and has been around for a very long time (27 years) I was approached by them to enlarge the former existing client Base. We used to have close relationships with certain clients but the flourishing times for aviation companies changed in 2009 so most providers had to rethink their strategies, widen their clientele and prepare for hard times. I hold a degree in economics and have been working in Business Development, Key Account and Network Management in previous jobs therefore I was selected for the above mentioned role. I love working with people and clients, I speak five languages

ROUND TABLE

REMOTE LOCATIONS (HERE THE AZORES) ARE OUR DAILY BUSINESS

also took on the role of flight paramedic for repatriations on commercial flights. This gave me extensive insight into the practical procedures and obstacles that are faced during repatriation. After concluding my Bachelor’s degree I decided to move to Toronto, to widen my experience and knowledge within the Northern American Healthcare System. I started working as a Travel Assistance Specialist for Europ Assistance GCS Canada. The experience and work within the Northern American health field provided

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me great exposure to sectors such as cost containment as well as governmental and private healthcare policies. Despite my amazing experience with EA GCS I decided to return to Austria after 1.5 years to start working for TAA. It was important for me to get to know the core business, so I began by working in the alarm centre. Having recently taken over the role of Sales Development Officer at TAA I am also continuing my education in this field by doing a Master’s Degree in Sales & Marketing.

EXPLAIN WHY INTERNATIONAL INSURANCE AND ASSISTANCE PROVIDERS SHOULD USE YOUR AMBULANCE SERVICE: facilities and hospitals close by. Plus Frankfurt is a popular hub for many commercial airlines – we can offer for example wing-to-wing with Lufthansa (PTC patients) and fly the patient to his final destination. JOACHIM FRIESE: MedCare Professional offers national and international patient transport, as well as clarification of medicines (Doctor to Doctor calls) for sick and/or injured patients abroad. We offer reliability and economic services together with well-known insurances, hospitals, embassies and different organisations worldwide. For our customers, we work constantly on quality and in improving our services. The medically-trained staff of the company operates the control room 24/7, which lies in the heart of central Nordrhein Westfalen in Ruhrgebiet, Hattingen. Here, all medical emergencies become scheduled for activity, and all the information of different patients and processes run together. CLAUDIA SCHMIEDHUBER: TAA has been

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VOLKER LEMKE: FAI is indeed one of the very few air ambulance providers to be able to operate worldwide and also makes its considerable experience available in the most difficult countries and areas. FAI offers those services with an outstanding pricequality ratio. IRENA DIMITRIJEVIC: Our company is privately owned and managed. We work hard to fulfil our services and always offer the best possible quality. Our clients value that we are reliable and that they receive fast and efficient responses in the daily work life. I think these qualities result from top management if the owner is always involved in the daily business –after all he is the one who has built it from scratch. We operate worldwide and have a fleet that consists of Jets and Turboprops enabling us to offer a different price range. We have two Home Bases - Frankfurt and Munich – both cities offer a huge amount of medical

ROUND TABLE

in the market since 1976 and is a real pioneer in the Air Ambulance industry. Our vast experience in medicine and aviation is outstanding. Our team is used to rough weather conditions and highly sophisticated airport approaches. It is not by accident that we were awarded Air Ambulance Provider of the Year in 2013

HOW CAN WE DEFINE YOUR BUSINESS: ARE YOU AN OWNER, OPERATOR OR BROKER?

VOLKER LEMKE: As one-stop-shopping! FAI owns and operates all its aircraft as well as its own flight dispatch, medical, maintenance and pilot training departments. IRENA DIMITRIJEVIC: Our 5 aircraft are fully company owned. Therefore we can offer competitive market prices without distorting the price structure by adding broker margins. Q4

during the ITIJ Industry Awards and likewise the EBAA Platinum of Safety Award. In Austria, we also act as assistance provider delivering the full range of medical assistance services including medical clearance, medical escorts, payment guarantee, cost containment, hotel bookings and assistance plus ground ambulance services.

CLAUDIA SCHMIEDHUBER: Our fleet currently consists of 5 aircraft. 1 x Cessna Citation 550, 2 x Gulfstream 100 and 2 x Dornier 328. We are not a broker but are instead a fully operating air ambulance company. JOACHIM FRIESE: We work with air ambulance owner Air Alliance MedFlight. (AOC D-266)

WHAT ARE THE ADVANTAGES OF YOUR BUSINESS?

VOLKER LEMKE: FAI relies on the efficient decision pathways and procedures it has developed in-house to plan its service delivery free of any problems. This allows to handle even the most complex requests from our clients rapidly and to offer cost-efficient solutions. IRENA DIMITRIJEVIC: Air Ambulance business is very challenging but always unique. There will never be the same flight again. Working as a pilot, dispatch or medical team member in Air Ambulance means you wonâ&#x20AC;&#x2122;t get rich; therefore most of the people

do it out of passion. We have a lot of employees who have been working for us for a long time and bring a lot of experience and value to the company. JOACHIM FRIESE: MedCareProfessional is an internationally operating ground and airambulance company based in Hattingen, Germany. There is a good connection to all large European airports. On the ground, medical repatriations from foreign countries and gravely ill patients with need for intensive care are transported in a specially equipped intensive-care ambulances.

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TAA OPERATING OUT FROM THE HEART OF THE ALPS AROUND THE GLOBE

standards and excellent services, but is also constantly developing cost effective and client-orientated solutions for our clients. Located in Innsbruck, right in the heart of the beautiful Austrian Alps, our base provides the perfect platform to service the Alpine region, thanks to its proximity to Italy, Germany and other central European countries. TAA’s passion for flying and medicine, combined with our experienced staff and excellent dispatch center, offers the best solution for a wide variety requests, including single/ double & multiple transfers. It is also worth mentioning our shuttle flights, which we offer in summer from highdemand areas such as Spain, Greece, Turkey and Morocco as well as our well-known “Gipsbomber/plaster flights” which we operate in the winter. TAA constantly strives to develop client-effective solutions and is able to adapt and cater for a variety of requests. We always strive to find the most cost effective solution for our clients, while still ensuring that the best possible care is provided to the patient.

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In this area, MedCare Professional is integrated into the public rescue service of various local municipalities. At Düsseldorf International Airport, MedCareProfessional is also one of a few companies that have permission to admit patients directly on to the plane. The flying ambulance business works exclusively in cooperation with our aircraft provider Air Alliance, running with a fleet of 7 Learjet 35’s and a Learjet 55. All jets are deployed as dedicated air-ambulances. Since 2009 MedCareProfessional is a provider with special care accreditation with the EURAMI (European Aeromedical Institute e.V.). All business parts of the company are ISO 9001 certified. The medical clarification service is managed through numerous doctor colleagues with various foreign language knowledge, and likewise, are available 24/7. CLAUDIA SCHMIEDHUBER: The Air Ambulance business is a highly challenging business these days. Tyrol Air Ambulance has not only managed to maintain our high

ROUND TABLE

DEDICATION IS A MUST FROM ALL CREW & TEAM MEMBERS

THE LEARJET 55 IS A PERFECT DOUBLESTRETCHER AIRCRAFT

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PLEASE WALK US THROUGH YOUR FLEET:

VOLKER LEMKE: FAI operates in total a fleet of 21 aircraft in the air ambulance, VIP and aircraft management sectors. This includes a fleet of 6 aircraft providing special logistics to support the United Nations humanitarian efforts. For air ambulance purposes we have always 4 Lear jets (ranging from the well-known LR 35A to LR55 and LR60) and 2 long-range wide body Challenger 604 in service. IRENA DIMITRIJEVIC: We currently have 5 own aircraft (1 King Air Beech 200, 3 Learjet 35’s and 1 Learjet 55). We used to have a Challenger 600 up to last year but unfortunately the low margins in the industry didn’t justify the high operating costs. JOACHIM FRIESE: Deployed are 7 Learjet 35’s, 1 Learjet 55 and 1 Turboprop PA 42, operated worldwide as dedicated air-

Roundtable

ON THE RUNWAY WITH FAI ambulances. All jets are identically equipped and used as dedicated air-ambulances. Modified tip tanks extend the range of the machine by 250nm. CLAUDIA SCHMIEDHUBER: Our fleet currently consists of 5 aircraft (1 x Cessna Citation 550, 2 x Gulfstream 100 and 2 x Dornier 328). This variety allows us to service all manner of requests, such as long, middle & short haul flights as well as single and double patient transfers. TAA is also able to meet our client’s demand for full charter, evacuation and shuttle flights thanks to our Dornier aircraft, which can be adapted to meet the needs of the client and patient, with up to 75 possible configurations.

ROUND TABLE

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WHAT MEDICAL EQUIPMENT AND TECHNOLOGY DO YOU HAVE ON-BOARD? patients are confronted with MRSA infections. The machine kills every single bacterium in the cabin as all interfacial are vanished where air gets through and normal disinfection by hand is not possible. Our latest purchase is a fabian +nCPAP evolution ventilator for babies. Our medical department has developed a special vacuum mattress together with a local company in Germany. It is made out of special material that adjusts to the contours of the patient’s body and is perfect for long range transports. CLAUDIA SCHMIEDHUBER: TAA’s air ambulance aircraft are fully equipped with the highest quality state-of-the-art medical equipment. Due to the variety of missions flown by TAA, our planes are fully equipped as a designated ICU unit which allows us to treat all kind of patients. Furthermore, we work closely with the University Hospital of Innsbruck to ensure that we meet the latest hygiene and disinfection guidelines. Our equipment is checked regularly and we are constantly training our staff according to the latest international medical guidelines.

Roundtable

VOLKER LEMKE: The complete set of medical and technical equipment on board FAI air ambulances meets the highest international standards. In order to fulfil the requirements of intensive care transports FAI has continuously expanded the scope and quality of its medical equipment and kept up with technological advances through equipment replacements. Our latest equipment acquisition for instance has been eight Hamilton T1 intensive care respirators. JOACHIM FRIESE: The medical facilities of the planes incorporate fully comprehensive intensive-care medicines, and medical equipment, making monitoring redundant, as we use alternative instruments for assistedbreathing management including fibre optic bronchoscopes. Within the framework of our cooperation with the university hospital Bergmannsheil, Bochum, it is possible to transport patients with a CardioHelp ECMO system. IRENA DIMITRIJEVIC: We have 2 spectrum stretchers for each aircraft. The complete set of required medical equipment with high international standards (such as Siemens Monitor, Dräger Oxylog 300, Braun Perfusor Compact Weinmann Accuvac) is available at our home bases plus one responsible paramedic who manages the equipment container and the mandatory regular maintenance. We have a bio sanitizer machine from Switzerland – the latest technology for disinfecting our aircraft as more and more

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ROUND TABLE

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WHAT ADVANTAGES DOES YOUR FLEET PROVIDE?

VOLKER LEMKE: We offer the whole range of options, from the cost-efficient “workhorse” Lear 35, to the more comfortable cabin arrangements of the Lear 55 and 60’s, and on to the long range capability of the Challenger 604 to suit any mission requirements anywhere in the world. IRENA DIMITRIJEVIC: We have the King Air for short runways and short distance flights especially within Central Europe for cost efficiency. Our Learjet fleet is separated in two home bases which result in different price calculations and the cheaper price is offered to the client. CLAUDIA SCHMIEDHUBER: As mentioned earlier – we are capable of meeting our clients’ various requests thanks to the diversity and flexibility of our fleet. Our Cessna Citation 550 is an excellent aircraft to perform short

Roundtable

FAI’S FLEET OF DEDICATED AIR AMBULANCES and middle haul flights. It is cost effective and convenient to operate. Our Gulfstream 100’s are perfect for long haul flights and double patient transfers. We strive to combine missions for two reasons, to provide a cost-efficient solution to our clients but also to help fly more patients in a shorter time frame. Our Dornier 328’s are a unique aspect of TAA’s business. We operate these aircraft for our shuttle flights in summer from Spain, Greece, Turkey, etc. to Benelux and UK as well as for the famous “Gipsbomber / plaster flights” in winter. The big advantage of these flights is that we can configure them to meet our clients’ needs more efficiently (up to 6 stretchers, and up to 75 configurations including leg rests and sitting patients are possible).

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ROUND TABLE

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WHAT MEDICATION DO YOU HAVE ON-BOARD?

AIR ALLIANCE TEAM DURING A NEONATAL TRANSPORT FROM RIJEKA TO AMSTERDAM

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VOLKER LEMKE: Since FAI provides intensive care air ambulance services to the whole scope of pathologies, from medical emergencies to complex trauma victims, and caters to the whole age range, from premature newborns to the elderly, it has a very large spectrum of drugs available and can also provide for special pharmacological requirements, including as far as blood products are concerned. IRENA DIMITRIJEVIC: We have everything in place for all ICU and emergency treatments. A list is available and can be provided to all clients. Special requests such as blood units can be sourced from our partner hospitals upon request. All necessary medication for the flight is analysed prior to departure by our medical director. JOACHIM FRIESE: We have all necessary

medications for treating severely ill and/or injured patients. Carrying red blood cells is possible on request. The medical facilities of the planes incorporate fully comprehensive intensive-care medicines, and medical equipment, making monitoring redundant, as we use alternative instruments for assistedbreathing management including fibre optic bronchoscopes. CLAUDIA SCHMIEDHUBER: We are fully equipped with state-of-the-art medication for all common injuries and sicknesses. TAA follows the standard international medical guidelines and regulations. Should a patient require additional or specific medication, this will be discussed with every party involved and our aircraft will be equipped accordingly.

OUT NOW

iPOLICY

CIGNA APPOINTS ARJAN TOOR AS NEW GLOBAL IPMI MANAGING DIRECTOR

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HOW FEASIBLE IS 1 WORLDWIDE VOLUNTARY AMBULANCE ACCREDITATION STANDARD?

this one organization there is continuous improvement in regards to the accreditation procedures which proves how difficult the whole topic is. CLAUDIA SCHMIEDHUBER: This would really make sense but it is difficult to realise due to different legal requirements in various countries, financial situations etc. We are EURAMI accredited. EURAMI aims to have a common (minimum) standard worldwide. JOACHIM FRIESE: Basically there are many different standards in the field of air medical transports world-wide. Due to different healthcare systems, the requirements in the air ambulance business are diverse. Currently EURAMI and CAMTS have succeeded world-wide as certifications in recent years. For customers in the ambulance flight business, one of these certifications shall serve as a basis to put faith in the quality of the provider and be a precondition for placing an order.

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VOLKER LEMKE: This is indeed a very attractive concept, but its implementation would be quite challenging. It has not proven easy to try to bring the various systems found around the world under a single hat, given the large differences between the various professional organizations involved. IRENA DIMITRIJEVIC: Attractive from a client’s point of view as they would not need to get involved in all the different aspects of accreditation standards but it is not really practical and realistic. As a provider you are confronted with more and more audits, ramp checks and accreditations each day. On the one hand it is understandable for safety reasons and to get rid of the “rotten apples” in the market. For us aviation companies it is getting to a point where we are more involved in paper work rather than the real “field work” and it all costs money. Therefore we would of course appreciate one standardized worldwide model but each country is different and especially each continent. We are EURAMI certified and even within

2008 2009 2010 2012 2013

5 QUALITY AWARDS IN 6 YEARS

MEDICAL ASSISTANCE AIR AMBULANCE REPATRIATIONS MEDICAL ESCORTS COST CONTAINMENT CLAIMS HANDLING ROAD ASSISTANCE TRAVEL ASSISTANCE

IN GREECE AND CYPRUS SINCE 1993

www.athensassistance.gr

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Q10

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WHAT POLICIES AND PROCEDURES MAY BE IMPROVED BETWEEN INSURERS, ASSISTANCE PROVIDERS AND AMBULANCE SERVICES? Ambulance aircraft (such as a Learjet 35). But they have to be in order to get a better picture why it is not possible to take 3 relatives and 5 large suitcases along on board with the patient. A private Jet in our business is definitely not luxury flying what many people think. CLAUDIA SCHMIEDHUBER: Having been a client of air ambulance providers and also a key account manager for insurers, I believe that all parties should gain a better understanding of the requirements each party has. Assistance and Air Ambulance companies are increasingly aware that insurers want to save costs and try hard to improve their services, but do not always get the full picture why an insurer wants this or that. On the other hand, insurers often lack a clear understanding of medical and logistical matters as it is not their daily business. We try very much to build bridges between those worlds; communication is really an important issue. Also, we allow insurers and assistance companies to accompany e.g. group shuttle flights (signing a declaration of medical confidentiality) – this physical, haptic experience often causes a major change in thinking.

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VOLKER LEMKE: The area where progress could definitely be made is that of communications. Strict mutually agreed upon protocols to guarantee the prompt, complete, seamless yet confidential transmission of relevant information even all the way to the end client is an area amenable to progress and is in every party’s best interest to relieve occasional tensions caused by insufficient or inadequate information transmission. IRENA DIMITRIJEVIC: The main problem in the industry is the lack of knowledge about each other’s procedures and daily lives. As an Air Ambulance provider we depend on thousands of external factors such as airport staff, ground ambulance staff, opening times, weather, patient’s condition, slots, permissions, and so on. The other area are costs, that can’t always be predicted however clients would always like to have everything guaranteed in advance. When you build up a close and long-term relationship with your client especially with key people in the operation it gets easier. These key people should actually be visiting each other regularly and ensure an “exchange program”. But it is hardly realisable as both sides work with many private data (clients, patients) which needs to be protected. We had many group tours and “open days” at our Home Bases and in my opinion that is where all begins as I often realise that many employees from insurance and assistance companies are not even familiar with the limited and small sizes of a regular Air

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Q11

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HOW CAN YOU MANAGE THE QUALITY OF A PARTNER PROVIDING EMPTY LEGS?

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VOLKER LEMKE: This is a tough question. FAI has established for itself a policy requiring it to use only suitably accredited partners for this purpose in order to meet and control the desired quality standards. Unfortunately there are still regions of the world where such partners have not yet been identified and where local resources must be relied upon by default. This would however be a solution we would consider only after securing the best possible quality guarantees and with the client’s explicit authorization. IRENA DIMITRIJEVIC: I am only familiar with offering Empty Legs for our own company to our own clients. If we work with partner airlines (for example wing-to-wing) we make sure that the client agrees on this case. CLAUDIA SCHMIEDHUBER: TAA approaches this issue in two different ways. As with most

of our fellow air ambulance providers, we generate a paper version for our empty legs which are sent out via email. However TAA also provides an overview of current empty leg opportunities on our homepage www. taa.at. This gives our client the opportunity to look for options in real time as the portal is updated constantly by the TAA’s flight planning department.

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Q12

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FINALLY, WHAT DOES THE NEXT 5 YEARS HOLD FOR THE AMBULANCE INDUSTRY? CLAUDIA SCHMIEDHUBER: The next year will bring with it many new challenges. I believe that we are currently experiencing a shift in how insurance companies operate and how they provide services to their clients. I believe that the relatively new cost containment segment is slowly gaining relevance in the European market. Insurance companies are leaning more towards costeffective solutions and may hesitate in future to transfer patients with non life threatening problems on a single AA jet. In my opinion, insurance companies are now looking for the most cost-effective yet qualitative solution in order to ensure client satisfaction while also keeping costs under control. The key for air ambulance providers will be to provide insurance companies with different alternatives, using a variety of aircraft while ensuring the high levels of quality and service that have come to be expected. This will be very challenging to achieve, however we at TAA always look forward meeting new challenges.

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VOLKER LEMKE: The consolidation of the air ambulance market is moving forward, and some providers will disappear while others will grow significantly. As volumes in the air ambulance business grow, survival as a provider in this business will not become easier as the rules of the aircraft industry apply all the way to even the small providers. IRENA DIMITRIJEVIC: In terms of medical aspects I think we will have more and more global challenges such as the Ebola crisis. Globalisation means the world gets smaller and smaller. The last years have been driven by costs and efficiency and to me it doesn’t seem to be over in the near future. It is a big issue in the industry as everyone aims for top quality but in daily business the prices are always pushed to the limit. From an economic point of view this doesn’t work for a long time. I wish insurance companies would realise this one day – at the end of the day we are all saving lives and not bargaining on Ebay or a flea market for a piece of cloth. I understand that medical treatments are highly expensive but aviation is as well. JOACHIM FRIESE: From my perspective, a mutual understanding of the needs of all the companies participating in the repatriation flights should exist. Cost pressure and quality standard must be in reasonable proportion. A dumping of prices must on the whole definitely be avoided due to the already low margins of the ambulance flights sector in order not to evade the self-imposed indicators of quality.

“These results show that, despite increased volatility, tourism continues to consolidate the positive performance it has had over the last five years and to provide development and economic opportunities worldwide”

TALEB RIFAI UNWTO SECRETARY-GENERAL

1087 MILLION

TOTAL NUMBER OF TOURIST ARRIVALS 2013

52 MILLION

MORE TOURIST ARRIVALS IN 2013 THAN 2012

50.5 MILLION

TOTAL NUMBER OF EXPATRIATES WORLDWIDE IN 2013

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21 MILLION MORE INTERNATIONAL TOURISTS IN THE FIRST HALF OF 2015 According to the latest UNWTO World Tourism Barometer the number of international tourist arrivals grew by 4% in the first half of 2015. Destinations worldwide received some 538 million international tourists between January and June 2015, an increase of 21 million compared to the same period of 2014. Europe, Asia and the Pacific and the Middle East all recorded 5% growth in international arrivals and the Americas 4%. Limited data available for Africa points to an estimated 6% decrease in the number of international tourists in the region. At the subregional level, the Caribbean and Oceania (both +7%) were the best performers, together with Central and Eastern Europe and Central America (both +6%). In spite of this overall growth, results by destination are rather mixed. Safety and security remain a global concern while the economic scenario is comparatively more volatile with the recovery of advanced economies contrasting with the slowdown of emerging economies. Tourism demand has also been impacted by lower oil prices and currency fluctuations. According to the UNWTO forecast issued at the beginning of 2015, international tourist arrivals are expected to increase by 3% to 4% worldwide for the whole year, in

line with the long-term forecast of an average growth of 3.8% a year set for the period 2010 to 2020. Europe, the most visited region in the world, led growth and increased international arrivals by 5%, benefiting from a weaker currency in the euro area. Growth was driven by the recovery in Central and Eastern Europe (+6%), while Western Europe, Northern Europe and Southern Mediterranean Europe (each +5%) all outgrew the worldwide average. Asia and the Pacific recorded a 5% increase in international arrivals in the first half of 2015, with Oceania (+7%) in the lead. Destinations in North-East Asia and SouthEast Asia (both +5%) reported rather mixed results, led by Japan (+47% through July) and Thailand (+30% through July). South Asia recorded a comparatively modest 4% increase in arrivals after two years of doubledigit growth. International arrivals in the Americas grew by 4% in the first half of 2015, consolidating last yearâ&#x20AC;&#x2122;s strong results. All four subregions recorded positive growth, although with variations across destinations.

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DEPARTURES “As an air ambulance provider we depend on thousands of external factors and providers such as airport staff, ground ambulance staff, opening times, weather, patient’s condition, slots, permissions, and so on.” IRENA DIMITRIJEVIC JET EXECUTIVE

oving forward as the industry consolidates and price remains a key factor, insurers need to better understand the inner-workings of the air and ground ambulance owners and operators that are on call 24/7 serving their insured’s.

Communication is vital whilst remembering the role of air and ground ambulance providers is to do just that: provide emergency 24/7 evacuation, repatriation and medical logistics services. Providing such services is complex, crossing many cultural, political and perceptual borders. Providing qualitydriven medical transportation services costs money.

Providing international air ambulance services is complex, crossing many cultural, political and perceptual borders. Providing quality driven services isn’t simple and costs time and investment. High quality communications between payor and provider can equal far more efficient future relations for your provider relations team to manage and maximise.

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ROUNDTABLE SESSIONS 2014

1087 MILLION

TOTAL NUMBER OF TOURIST ARRIVALS 2013

52 MILLION

MORE TOURIST ARRIVALS IN 2013 THAN 2012

56.8 MILLION

TOTAL NUMBER OF EXPATRIATES WORLDWIDE BY 2017

50.5 MILLION

TOTAL NUMBER OF EXPATRIATES WORLDWIDE IN 2013

46 MILLION

TOTAL NUMBER OF EXPATRIATES WORLDWIDE IN 2009

2013 WAS AN EXCELLENT YEAR FOR INTERNATIONAL TOURISM Taleb Rifai UNWTO Secretary General

DEFINING ASSISTANCE IN 2014 AND BEYOND PART 1 EXCLUSIVE C-SUITE EXECUTIVE COMMENTARY FROM ALLIANZ GLOBAL ASSISTANCE, ATHENS ASSISTANCE, EUROP ASSISTANCE, MEDIC ASSISTANCE INTERNATIONAL, REUTER CONSULTING AND ROWLAND BROTHERS.

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ONE OF AIRMED’S LEARJET 35AS AT GLASGOW AIRPORT

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Photo: Courtesy of Iain MacKenzie