Over the past 5 years AirMed, headquarterd at London Oxford Airport, UK, has undergone significant development which has seen the introduction of new aircraft, medical equipment and new medical disciplines and expertise. This investment has been extremely successful, with the two Learjet 35As now being the workhorses of the company.

“During 2011 the two Learjets flew over 1900 hours and covered over 660,000nm (over 1.2million kms). We had always aimed for them to fly a minimum of 800 hours per year each when we purchased them, but it is always reassuring to find them doing above and beyond what we had predicted”, says Jane Topliss, Director of Business Development. “The assistance industry has also evolved a lot over the past few years and we are seeing increasingly that quality of care for patients really is at the forefront of their decisions. This goes hand in hand with the central belief of our business, that the patient comes first.”

With a much better understanding of patient care requirements within the whole insurance industry and with better control of care provision by Air Ambulance Operators, AirMed believes that there is no longer a requirement for unpressurised piston aircraft to be used for “air taxi” flights. Jane comments that “AirMed started out using unpressurised piston aircraft more than 25 years ago, providing platforms for assistance company medical crews to perform air taxi transfers. However as care provision has
	One of AirMed’s Learjet 35As departing Oxford on an air ambulance mission
developed and AirMed’s ability to provide that has grown, demand for unpressurised piston aircraft has significantly declined to the point where they will be withdrawn from service.”

Our decision to cease providing unpressurised piston aircraft is consistent with the EURAMI minimum aircraft requirements. These requirements stipulate a need for a pressurised aircraft, limits on ambient noise and a suitably environmentally controlled cabin. Whilst piston aircraft have in the past been an excellent solution for some transfers, they just cannot provide a suitable environment that is fully controllable for patient comfort. In fact general observations by AirMed’s medical teams over the past two years have certainly led to the conclusion that patient comfort and care provision is somewhat compromised on a piston aircraft.

“I have received reports from staff who have worked on the unpressurised aircraft that suggest that the lack of comfort for patients leads to increased stress causing pain and nausea which require drug and patient care intervention from nursing staff - interventions which are less likely to be necessary on a pressurised turboprop.” Reports Dr Jon Warwick, AirMed’s Clinical Director. “This relates to personal experience with increased use of antiemetics and analgesia on the unpressurised piston aircraft where turbulence would be regularly avoided in other aircraft able to fly at higher altitudes. Increased use of medications to compensate for the aircraft’s iatrogenic artefact leads us to our decison. I must stipulate that AirMed has of course never carried complex patients on their piston aircraft, however we firmly believe that moving forward they are not suitable for even the most simple of transfers.”

These thoughts and conclusions are also in line with the requirements laid down by the Care Quality Commission in England. It became a legal requirement on 1 April 2011 for all England based air ambulance operators to register with the CQC and within this registration are minimum standards for care provision, treatment, infection control and other areas pertinent to patient transport. “The legally enforceable standards laid down by the CQC have led to our conclusion that unpressurised piston aircraft provide an environment for patients which would not comply with these standards” said David Quayle, AirMed’s Chief Flight Nurse. “Given this, it is difficult to see how any legally compliant English air ambulance operation can operate unpressurised piston aircraft for patient transport."

	To this end, AirMed has already decommissioned G-BMDK one of its Piper Seneca aircraft and has put its remaining Seneca and Piper Chieftain up for sale. Whilst they remain to be sold, the aircraft will only be available for cargo and passenger work.
Piper Seneca, G-BMDK has now been decommissioned

“AirMed is very excited about moving into its next phase of development” confirms Rupert Dent, Managing Director. “We can now pool our resources into the best aircraft for the best patient care and make our product delivery even better and more cost effective to our clients. With over a third of our transfers requiring a critical care capability, we need to concentrate on ensuring the best possible care provision.”