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Published on : March 03, 2012

Medical Evacuations: What You Need to Know to Save Your Employees’ Lives

Medical Evacuations: What You Need to Know to Save Your Employees’ Lives

Medical evacuations overseas for those who have become ill or injured are often misunderstood. Often, people have images of “MASH” type helicopters swooping down in the middle of a desert or high atop a snowy mountain peak to rescue those in need. But usually they are nothing like this. The cost of just one evacuation alone can vary quite widely, from $6,000 up to $250,000 or more depending upon the aircraft and what kind of medical expertise and equipment are necessary. Given these high costs and the importance of rescuing your employees, you need to understand all that you can about medical evacuations in your role as a travel manager.

In reality, there are various types of medical rescues (with helicopters frequently being the last transport of choice because they are so unsteady and quite lacking in space). When it comes to your employees traveling internationally, you need the expertise of a physician or medical specialist at the scene. The advice/guidance of a second physician, working for an insurance carrier that provides evacuation coverage and assistance to your company, is highly recommended.

Understanding how these medical evacuations are decided, the costs involved and how to best utilize the various transportation options is of the utmost importance for those responsible for the care and well being of their traveling co-workers. All-encompassing events like the catastrophic earthquake and tsunami in Japan, violent attacks in Libya, and the government overthrow and riots in Egypt can put business travelers in danger of both injury and disease. Even business trips to seemingly less dangerous locations are not without risk/danger.

Each type of evacuation is individually facilitated with the health, comfort, and well-being of your traveling employees being priority. Following these considerations, the availability of a particular type of aircraft, location, terrain, expertise required and cost are also critical factors.

Here are some of the different options:


Medical evacuation by commercial flights is the most common, utilized about 75 percent of the time. This form of transportation is for medically stable, alert and conscious patients. Evacuating one of your employees by commercial carrier usually means buying one seat in business/first class, or possibly even having to purchase one or two extra seats. The extra seats and space will provide more comfort to the patient. For instance, if an employee has a broken extremity, he or she would need extra leg and/or arm room.  Patients considered for commercial evaluation are not on an IV, are easily transferable via wheelchair and are able to breathe on their own or with the use of supplemental oxygen.

A medical evacuation on a commercial airline often involves an escort for the patient. A medical escort— such as a doctor, nurse, or paramedic – is needed to assist with issues like monitoring oxygen and assisting with the dispensing of medications. However, a patient with a less emergent medical issue wouldn’t necessarily require a medical escort, but may utilize a non-medical escort. A non-medical escort could include a family member, friend or co-worker who needs to help the patient with non-medical issues— such as getting up or down from a seat, eating, luggage handling or going to the restroom.


Lufthansa is the only airline in the world that operates an intensive care unit aboard some of its flights. Located on board regularly scheduled flights from Germany to 62 destinations across the Lufthansa network, the separate compartment of the plane provides a ventilator, EKG monitor, blood gas analyzer and other equipment usually found in hospital ICUs. In addition to the patient, two to three medical personnel can be accommodated.

This type of aircraft has more room than a small air ambulance and does not need to be refueled after just 1,500 miles, As a result, the patient also has to be in an area where the ICU flight is offered and there must be availability of the service on a particular flight. Ultimately, everyone has to be in the right place at the right time.

For both this service as well as commercial evacuations, there needs to be sufficient time to locate and transport the appropriate medical personnel to accompany the patient. Again, all these factors should be considered when making individual medical evacuation decisions.


These are private jets that are outfitted as ambulances, as the name suggests. Generally used about 10 percent of the time for medical evacuations, these aircraft are usually a Lear 35 jet or a somewhat larger plane. They can accommodate a patient, two pilots, two to three medical personnel (e.g.—doctors, nurses, paramedics, respiratory therapists), and minimal luggage.

These planes are generally used for patients who are medically unstable.  If you had an employee who has suffered cardiac or respiratory failure, is breathing through a respirator, has suffered a stroke or traumatic injury, is on an intravenous drip, and/or is unconscious, an air ambulance would be considered.

However, each decision must be made on a case-by-case basis. For instance, if an employee is unconscious after suffering a stroke or heart attack and that person is in a top-notch hospital in a place like London or Paris, it may be more medically sound to not move that person and continue the current course of care. In such an instance, an air ambulance transport would not be medically indicated.

There’s the flip side – again, the decision being location-dependent – where you would utilize an air ambulance for a less medically dire situation. For instance, if someone has suffered a broken leg and is in a very remote area with not a lot of commercial flights available, evacuating that individual via air ambulance may be the safest and quickest way to get the care that he or she requires urgently.

In addition, if an employee requires medical evacuation over a great distance, an air ambulance may not be the optimal choice. These aircrafts can only travel about 1,500 miles before they need refueling.  If traveling further, they would need to make multiple stops – which may not always be the best option for the patient.


This form of medical transport is used less than one percent of the time, usually only in remote parts of Africa and Asia. It is only done if a patient is in a location that does not even have a roadway or patch of land which can accommodate a small air ambulance. Usually, a helicopter is chartered from a local pilot and the patient is flown to the nearest airport to board an air ambulance or commercial airplane. The helicopter will only fit the patient, pilot and one medical person.

By understanding the different type of medical evacuations, you will know that your employees who may become ill or injured overseas will be getting the best possible care. In addition, understanding the different options available will also allow you to watch costs and make decisions that are financially sound.

About The Author

William W. Spangler, MD FACEP, is the worldwide medical director of Travel Guard Chartis. He is board certified in emergency medicine, with 27 years of experience in this medical specialty. Dr. Spangler also serves as team physician to the NFL Houston Texans. Travel Guard, a Chartis company and worldwide leader in travel insurance and assistance, provides products and services to millions of travelers around the globe. Travel Guard North America’s Premier Assist is a medical, security and personal assistance program designed for international business travelers, expatriates and students traveling overseas.