Research in Aeromedical Transport

Despite decades of terrorism attacks on aircraft from ‘skyjacking’ to the atrocities of ‘9-11’, and to the more recent global pandemic, there has been a phenomenal rise in global travel in the past 80 years. With millions of passengers travelling the entire planet every year, it is small wonder that, like any other population, many will travel sick, and many others will become ill or injured whilst away from home. It follows that the need for aeromedical transportation has grown exponentially, driven by the travel insurance industry and related support organisations, including medical assistance companies, emergency solutions services and cost containment organisations, which have also flourished.

The term ‘aeromedical transportation’ covers a wide variety of situations from short duration ‘hops’ in a primary retrieval helicopter system, to long haul repatriations on commercial airliners, with a large assortment of other systems and organisations in between. In the past 50 years the world has also experienced massive growth in trauma care, mostly led by military medevac experiences, and it is now not unusual to see emergency helicopter air ambulances in major cities all around the world.

There are hundreds of insurance companies which have data from thousands, if not millions, of travellers who have been injured or taken ill abroad and who have required assistance.

Where does all this information go? Most stays just where it is collected and stored – in the computers and files of the companies concerned. The usual rationale is commercially driven, to protect business-sensitive data which may benefit competitors for the same revenue segment.

The same has been said about airlines who, traditionally, don’t like to give information about the number of passengers who fall ill in-flight. This sort of information may be perceived to ‘send the wrong message’ about the airline from an industry perspective.

For many decades the Faculty of Founding Members of ICARUS have highlighted that good quality research is needed for the development of high-quality medical care in the air. Some will argue that aeromedical transportation has come a long way in all those decades, but the ‘new age’ has brought new challenges.

The aeromedical transport industry worldwide faces a number of significant challenges: increasing fuel costs, loss of airline stretcher capability, larger aircraft carrying large numbers of passengers to increasingly remote travel destinations, plus the growing prevalence of highly contagious and lethal diseases. In addition, advances in medical technology, with regionalisation of super-specialist medical care including critical care, places higher demands on the need for higher standards of care in flight, including training, documentation and compliance with ever-increasing legislation.

All of these challenges need to be met with planning and improvement of efficiencies without detraction from patient safety or operational capability.

Sharing information amongst aeromedical transport and repatriation services across the globe and building a true global database can only improve the management of current demands and planning for the future.

Our industry has been described as the ‘new kid on the block’ in terms of its research foundation. Perusing the scientific literature shows only too clearly that there is a huge amount of published material, but much of it is anecdotal, ‘me-too’ studies, or poorly designed paradigms that offer little useful additional information to improve the scientific foundation of our specialty.

There are many reasons for this, not least the difficulties in raising research funding, the ethics of ‘to transport or not to transport’ as a challenge for true randomised double-blind trials, and the low subject numbers for inclusion in studies and trials to generate meaningful and valid outcomes.

One potential solution would be to match similar organisations around the world so that subsets of data can be collected and pooled. The information should be freely shared and made freely available to global health planners, be they from commercial or public health/governmental organisations.

At a recent meeting of global air ambulance operators, a consensus agreed that pooled data would benefit the whole industry. The will is there, the time is right, and the academic means are available.

The greatest challenge remains that of funding. Without the huge numbers of patients that are seen in traditional therapeutic and interventional trials, traditional funders such as pharmaceutical companies are not incentivized to spend money on researching outcomes which benefit relatively small numbers of patients eg: victims of major trauma being transported by emergency service helicopters within a single service or system.

However, the corollary is that, with co-operation from within our own global industry and at relatively low cost, a low budget project could arguably see the creation of a global database within a year. With the added support of academia, this topic might fire the imagination of prospective postgraduate students who would be well placed as PhD and MSc students to assemble such a database whilst earning their postgraduate degrees.

With such a database, there will be countless research questions that can be answered. The Faculty of Founding Members at ICARUS is already focused on searching for the questions that most need to be answered, and some interesting projects have already been proposed.

It is intended that ICARUS not only encourages good quality research, but that it also asks the questions, helps to set-up the projects, and matches students with the opportunities that present themselves by our growing network of interested parties.

ICARUS will also form networks with aeromedical providers, educational establishments, equipment manufacturers, government departments, regulatory bodies, and other interested third parties in the search for funding and support.

Finally, research must be shared to be of widest possible value to the entire aeromedical community. Publication in traditional journals is paramount, but more contemporary means of promulgation will include social media, in-house and external conferences, webinars and specialist working parties.

The Faculty of Founding Members at ICARUS have the combined experience and enthusiasm to drive this project forward as we lead our industry into a new era of scientific achievements.

Dr T E Martin
MSc DAvMed DipRTMed FIMC FCARCSI FRCS FRCA FFICM FRAeS Consultant in Anaesthesia & Intensive Care Medicine

Lead: Aeromedical Research and Education