Medevac in the Northeast

The northeast of India boasts of an uneven terrain which certainly makes it a top destination for nature lovers and hikers. But due to its topography and inaccessibility to most areas, transportation of critical patients becomes a herculean task. The air ambulance is a relatively new concept in the context of transferring patients from their home to the designated hospital in India. Often termed as Medevac, it's a plane/helicopter that is equipped with all the necessary life-saving equipment, approved flight stretcher, and medication to treat a critical patient. Also included is a team of medical staff specifically trained to address the needs of a patient while transportation. Fast and efficient, an air ambulance can evacuate seriously injured patients from the scene of the accident to receiving sophisticated medical facilities on board.

Service in North East

Northeast India becomes a prime place for air ambulance service due to unavailability of high-end medical infrastructure in the region. In most cases, critical and normal patients choose to get treated in metro cities like Delhi, Chennai, and Mumbai rather than continuing with their treatment in the region. In such cases, air ambulance plays an important role in transferring patients bed to bed. However, unavailability of concrete airstrip or proper helipads makes it difficult to introduce this service in the other states of the region. Right now, the northeastern region has 11 airports spread in all the eight states.  Assam has five namely in Guwahati, Tezpur, Jorhat, Dibrugarh and Silchar and one each in Manipur, Nagaland, Meghalaya, Mizoram, and Tripura.  Though the standard of healthcare infrastructure has greatly increased compared to past decades especially in Guwahati with the emergence of private role players in healthcare section.  Hospitals like GNRC, International Hospital, Hayat Hospital and even the state-owned, Gauhati Medical College and Hospital has played a great role in providing excellent medical care facilities at a fraction of the cost compared to medical facilities outside the state. Guwahati being the gateway to the Northeast plays a key role in bringing the international standard of hospital care under one roof. Having said that, it becomes impossible to evacuate a patient who lives far away from an operational airstrip or airport.  In such cases, use of helicopters comes into play. However, the only helicopter service provider in the Northeast, Pawan Hans, a state-owned PSU is right now facing a bleak future with a track record flagged with accidents and dismal maintenance of its fleet.

‘’We still have an ongoing partnership with Pawan Hans for air ambulance service but right now it’s in a dormant state due to their poor service. For now, we only run airport-pickup ambulance service in Guwahati’’ said Mr. Mrinal Hazarika, Public Relation officer, GNRC.

Cost Effective

 Air ambulance service generally opts for transferring patients from the area of accident or residential place to the nearest or best possible healthcare facility. However, in some cases, the service is also used by patients for a transfer to an outside country where he feels the diagnosis and treatment will be better or a necessity is required. Air ambulance service can be broadly defined into two main categories. One is hiring a private chartered plane through a specific aviation agent or through a Hospital which provides that service. Second is a commercial stretcher. In here, specific booking is done before hand in any commercial airliner. The airline will go through the case summary of the patient and will only allow if the patient is deemed eligible to fly without many worries. A required number of seats are then removed and the commercial stretcher is fitted in there with all the required medical facilities and a team of medical experts. The former is an expensive affair with a cost that can go up to as high as 7lacs-9lacs one way depending on the type of airplane and the city from where it will be flown down.  The latter is a most commonly used service by patients with a cost that can be around 1.5lacs to 4lacs depending on the distance that will be required to cover. ‘’We have two aircraft in our fleet positioned at Chennai and Delhi but we only receive 10-12 cases annually where we require the service of the planes. Mostly, patients ask for the commercial stretcher since it suits their budget and saves time equally’’ said Mr. S.N Farid, Apollo Hospitals Information Centre .

The budget and service requirement of a medevac depends on many factors- 1. Distance and Time required for transfer, 2. Clinical condition of the patient 3. Medical equipment’s required for transfer, 4. Medical and paramedical staff accompanying the patient, 5. Type of aircraft used for transfer, 6. Ground transfer required for transport, 7. Medicines and oxygen used for the transfer.

Type of aircraft for the service also plays an important role in deciding the total cost of the service.  At present, twin PT-6 turboprop fitted engine KING AIR B 200 and single turboprop fitted Pilatus PC 12 is used by most operators. They're operation although, is dependent on the prevailing weather conditions. The twin PW545C turbofans fitted engines of Cessna Citation XL is an excellent aircraft with no adverse effects of weather in their operation. It’s endurance and speed calls for shelling out more money than the previous two aircraft.  The cost effectiveness of such a service comes with the fact that most of the operators are based out of the Northeast. So in general, for an immediate basis availability of an air ambulance will easily take around 5-6hrs depending on the weather conditions, availability of aircraft, the city from where it will fly from. This is an absurd amount of time in context to a critical patient. In the mainland, it takes around 1.5-2hrs for arranging a medevac. Mr. Raju Ranjan Gogoi, a Guwahati-based aviation entrepreneur and founder of Radiant NE Aviation & Travel Support said ‘’ We provide a package of medical transfer by commercial airlines wherein it include bed to bed transfers, ground handling, and ambulance, escort team of one doctor and one nurse, one relative attendant on board in economy class’’. He further said that commercial stretcher saves a patient of about 70% of the total cost compared to an air ambulance which involves a private chartered plane. ‘’A transfer from Guwahati to Delhi will cost around 3lacs with the package’’ he added.

Roadmap

Air Ambulance’s introduction in the landlocked region of northeastern India surely means a step towards global healthcare. But availing such an expensive service in a region whose per capita income hovers below the nation’s average is a matter of concern. A step towards making it more accessible for poor and middle-class demography will definitely catapult its need. In addition to that, the region needs to have more airstrip and concrete helipads in order to spread the service beyond the gateways. Having said that, private players and operators shifting base in Northeast is equally important as this will cut time and money by a huge amount. Northeast India currently doesn’t have any operators with an all go ready medevac. In the coming years, Northeast will hopefully play an important role and key site for the emergence of healthcare infrastructure.

Prabir Kumar Talukdar

( Prabir Kumar Talukdar is a freelance journalist. He travels around the country to capture stories. He is a recipient of  2015 Trust Women Photo Award by Thomson Reuters Foundation and Microsoft.  He can be reached at [email protected]. His mobile no is  73995-02650 )