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An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot easily or quickly reach the scene or the patient needs to be repositioned at a distance where air transportation is most practical. Air ambulance crews are supplied with equipment that enables them to provide medical treatment to a critically injured or ill patient. Common equipment for air ambulances includes ventilators, medication, an ECG and monitoring unit, CPR equipment, and stretchers.



  1. Air ambulance service, sometimes called Aeromedical Evacuation or simply Medevac is provided by a variety of different sources, in different places in the world. There are a number of reasonable methods of differentiating types of air ambulance services. These include military/civilian models, government-funded, fee-for-service, donated by a business enterprise, or funded by public donations. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including rotary-wing, fixed-wing, or very large aircraft.

  2. air ambulance pilots are required to have a great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. After a spike in air ambulance crashes in the United States in the 1990s, the US government and the Commission on Air Medical Transportation Systems (CAMTS) have stepped up the accreditation and air ambulance flight requirements, ensuring that all pilots, personnel, and aircraft meet much higher standards.

    While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation in order to be licensed to operate. This is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights.

    The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is done on a continual basis by the accrediting organization. Their accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport with considerable input from all disciplines of the medical profession.

    The medical crew of an air ambulance varies depending on country, area, service provider and by type of air ambulance. In those schemes operating under the Anglo-American model of service delivery, the helicopter is most likely to be used to transport patients, and the crew may consist of Emergency Medical Technicians, Paramedics, flight nurses, or in some cases, a physician.

    Recommended Air Ambulance services
    Lifesavers- Vibha Lifesavers (India)
    Hi Flying aviation group (India)
    St John Ambulance Australia
    STARS (Canada)
    SMURD (Romania)
    Mayoral Executive Jet (Spain)

  3. AAMS

    About AAMS
    Established in 1980, the Association of Air Medical Services (AAMS) is an international association which serves providers of air and surface medical transport systems. The association, a voluntary non-profit organization, encourages and supports its members in maintaining a standard of performance reflecting safe operations and efficient, high quality patient care.

    AAMS is built on the idea that representation from a variety of medical transport services and businesses can be brought together to share information, collectively resolve problems and provide leadership in the medical transport community.

    AAMS Mission
    To assure that every person has access to quality air medical and critical care transport.

    AAMS Vision
    AAMS represents a unified voice for the entire air medical and critical care medical transport community. Through common effort, we will improve the health outcomes of the populations we serve.

    AAMS Core Value Statements
    1. AAMS is committed to continually improving the standards of operational and clinical practice through research, education, and the application of new technologies.

    2. AAMS is committed to continually improving clinical and operational safety practices for both patients and crew members through research, education, and rigorous commitment to quality improvement.

    3. AAMS is committed to the responsible stewardship of scarce health care resources through improving systems of care and measuring the benefits of transport medicine.

    4. AAMS is committed to supporting its members through regulatory and policy advocacy at the federal, state, and international levels.

    5. AAMS is committed to supporting its members through public education about the benefits to patients and society offered by competent air medical and critical care transport systems.

    6. AAMS is committed to developing innovative initiatives and programs that support the financial viability of our members.

  4. Conferences

    Air Medical Transport Conference (AMTC)

    The annual AMTC provides up-to-date information on the latest techniques and innovative approaches to air medical practice from community experts while giving attendees lots of opportunities to earn continuing education credits. Top-notch keynoters and expanded educational offerings (including mechanics technical briefings, special information exchanges, new clinical sessions, scientific abstracts and poster sessions) make this the air and critical care ground medical transport event not to miss! The conference exhibit hall gives attendees the chance to learn about the newest technology and meet with service providers in the largest trade show for the air and ground medical community. Best of all of, the AMTC is the best place for medical transport professionals to network and learn from each other.

    2008 – Minneapolis, Minnesota – October 20-22

  5. Air Ambulance Spring conference

    Spring Conference
    March 2009
    March 11-13
    The Melrose Hotel Washington DC

    This conference is held each spring in the Washington, D.C. area. The focus is on legislative, regulatory and reimbursement issues. Members are encouraged to participate in our grassroots efforts and visit their Congressional representatives on behalf of the community. In addition to the grassroots lobbying, we also offer the highest quality educational content that consistently receives rave reviews! Attendees learn about what regulations are affecting them, how to speak out locally on issues affecting them, billing and reimbursement insights, leadership and management issues, and much more!


  6. Medical Transport Leadership Institute (MTLI)
    AAMS works closely with the Medical Transport Leadership Institute (MTLI) at Oglebay Resort to provide an intensive continuing education experience and certification for individuals currently managing medical transportation services, those seeking management positions, and others with direct and indirect involvement who desire greater understanding of this dynamic profession. The Institute operates with a rigorous approach to competency-based education, utilizing formal classroom hours, mandatory participation, written testing and oral presentations. Graduates of the two-year program will receive certification as a Certified Medical Transport Executive (CMTE). Each year, the MTLI also offers a graduate program through which a minimum of 12 Management Education Units (MEU’s) can be earned toward the CMTE re-certification.

    Future Dates
    2009 – April 26 – May 1
    2010 – April 25 – 30
    2011 – May 1 – 6
    2012 – April 22 – 27

  7. Regional or Topic Specific Conferences

    Friday, July 25 – 1000 – 1600h
    Dallas, Texas

    Many thanks to all the participants at the recent Safety Summit held in Dallas. Please see links to two presentations from the summit provided below:

    IHST Safety Presentation
    Submitted by Roy Fox, International Helicopter Safety Team (IHST)

    AAMS Safety Legislation Presentation
    Submitted by Christopher Eastlee, AAMS Government Relations Manager

  8. Clinical analysis Management.

    Critical Care Transport Certification Review Course
    November 22-23, 2008
    Courtyard Fort Worth Downtown/Blackstone Hotel
    Fort Worth, TX


  9. Children Transport.

    4th Annual Neonatal/Pediatric Transport Conference
    March 18, 2009
    Akron Children’s Hospital

  10. Air Transport Minimum Data Set.

    The Air Transport Minimum Data Set (ATMDS) was developed with the purpose of describing time points and intervals relevant to transport of patients by air. At this time, the data set is specific to rotor wing. This set of data elements is not necessarily the complete set of items that an individual program will collect. Rather this is a “minimum” set that can be used to compare programs on essential elements.

    The ATMDS was developed during 2 research studies. The first study identified possible terms from a set of patient transport records (Thompson & Schaffer, 2002**). These terms were evaluated by a panel of transport experts for inclusion in a minimum data set. The panel also provided definitions for each of the selected terms. The second study, an international survey of flight professionals, was used to validate the content of the data set (Thompson & Schaffer, 2003***).

    This data set is copyrighted. However, transport programs may use the data elements and their definitions freely. Research publications should reference the data set appropriately.

    Time of Incident* Time the injury or medical event occured.
    Time of Call Time requiest/inquiry received.
    Time of Alert* Time crew is notified of pending flight.
    May be same time as Dispatch if no delays encountered.
    Time of Dispatch Time crew notified flight is a “go” post pilot ok’s flight.
    Time Depart Base Time of lift off for mission from base or other site.
    Time Arrive Location Time helicopter arrives at landing zone or helipad.
    May be same time as arrive bedside for scene call.
    Time Arrive Bedside* Time crew arrives at patient (bedside or scene).
    Time Depart Bedside* Time crew leaves scene or patient bedside.
    Time Arrive Destination Time patient transferred to receiving clinical team.
    In unusual circumstances, this time may not be at
    a healthcare facility.
    Time Depart Destination Time left patient destination.
    Will be recorded for flights not ending at base.
    Time Arrive Base Time arrive base after call completed.
    Time Aborted Time authorized flight aborted/cancelled after dispatch.
    Delay Length of delay in departure (specify cause).
    Response Time Time interval between Time of Dispatch
    and Time Arrive Location.
    Ground Time Time interval between Time Arrive Location
    and Time Depart Location.
    Transport Time Time from Time Depart Location and Time Arrive Destination
    Total Mission Time Time interval between Time of Dispatch and Time Arrive Base.

  11. Vibha Lifesavers (Hi Flying group).

    VIBHA LIFESAVERS was established as a comprehensive medical transport system by Dr Nitin Yende in 1996 when he realized that patient transportation needs was not adequately met by the existing ambulance service.

    Dr Nitin Yende had a vision of a ‘complete medical transport system’- a service of very high quality – a service of compassionate patient care- a service that would transport ‘any patient’, ‘any time’, ‘any where’ in India and abroad and he strived hard to establish, develop and motivate others to give.

    Air Ambulances

    We provide 24 hours a day, 7 days a week services of highly trained group of qualifed doctors and paramedics for emergency transfer of patients by commercial airline, chartered planes or helicopters through out the world.

    Our services extend from medical escorts to commercial airline stretcher services to evacuation of critically ill patients on ventilators by chartered flights to any destination in India and abroad.

    Our doctors are available 24 hours a day on our medical HOTLINE to respond to your request and propose the most suitable and economical solution for your transport.

    Our Mission
    To provide and assure the highest level of Emergency Medical Services in an effective, caring, and professional manner.

    To demonstrate empathy and compassion to one and all.

    To treat all with understanding, dignity, and respect.

    To work as a team to give our best to our patients.

    We promote individual, family and community well being.

    We take pride in our achievements and accomplishments.

    Our Motto
    Care Of The Patient
    Respect To Doctors
    Strive For Excellence

    We provide 24 hours a day, 7 days a week services of highly trained group of qualified doctors and paramedics for emergency transfer of patients by commercial airline, chartered planes or helicopters through out the world.

    Our services extend from medical escorts to commercial airline stretcher services to evacuation of critically ill patients on ventilators by chartered flights to any destination in India and abroad.

    Our doctors are available 24 hours a day on our medical HOTLINE to respond to your request and propose the most suitable and economical solution for your transport.

    Medical Escort Services are great and economical for patients who have recovered from a serious illness and are stable and do not require critical care management on flights. Usually a qualified doctor, a trained nurse or a paramedic accompany the patient who receive basic monitoring of vital parameters, bathroom and travel assistance and administration of medications.

    We take care of all formalities associated with the transport which includes:
    Booking of tickets for patient and relatives;
    Priority boarding and seating of the patient;
    Ground transportation at origin and final destination and all Documentation procedures.
    This service works out to be very economical for the right patie

    Air stretcher services is ideal for patients who are stable for transportation in Commercial Airline and eligible for our economical Air stretcher services.

    Air stretcher services includes:
    Obtaining clearance from airline medical department;
    Co ordinating ground transportation at the origin and the final destination;
    Arranging for lifesaving medication, oxygen and emergency lifesaving equipments which include cardiac monitors, pulseoximeters, pacemakers, nebulisers and ventilators.
    The patient is accompanied by an intensive care doctor and trained nurse and necessary medical management is done throughout the transport process

    This services are for the critically ill who do not qualify for the above services. We have our own set of Transport airplanes which are safe and ideal for transportation of critical patients to any destination in India and abroad.

    The equipments includes all lifesaving apparatus including cardiac monitor, pulseoximeter, multi parameter monitors, pacemakers, ventilators, nebulisers, defibmonitors, suction machines which are suitable for air transport.

    The doctors are qualified and experienced to carry out air evacuation operation and selected carefully depending on the requirement of the patients. The doctors are intensive care and emergency physicians, anesthesiologists, pediatricians, cardiologists, neurologists, registered nurses who have minimum 5 years experience in the field of emergency medicine. They are capable of carrying out all lifesaving emergency medical procedures and international in flight repatriation.

    The doctors have the working experience in most of the hospitals in India , UK and USA and well tuned to the working of the hospital procedures and management of patients in their medical system.

    Most of the doctors have their visa status eligible to transport patients in most of countries of the world including Asian, European, American, Australian countries.

    We provide medical cover for major events like party meetings, company seminars, cultural and sport events, official receptions and large marriages, stunt shootings and major entertainment shows.

    Medical cover is in the form of standby well equipped ambulances, team of doctors and paramedics and essential medications. We also install medical cubicles and stalls to look after the common needs of people who attend to these events. Emergency evacuation of serious patients to the nearest medical center including admission formalities can be arranged.

    This is an exclusive medical security service for your prominent guests and VIPs traveling anywhere in India and abroad.

    This service is essential from the view of fatigue, stress associated with travel, jetlag, business stress, individual medical problem both acute and chronic.

    This services are important during travel in countries with poor medical infrastructure.

    Distance and Time for transfer,

    Clinical condition of the patient

    Medical equipments required for transfer.

    Medical and paramedical staff accompanying the patient

    Type of aircraft used for transfer.

    Ground transfer required for transport.

    Medicines and oxygen used for the transfer.

    Vibha Lifesavers

    Head office

    Nitin Yende MD

    Vibha Lifesavers
    Vibha care home, A 101, Mangal arambh, Kora Kendra,
    Near Macdonalds, Borivli west, Mumbai 400092.

    Telefax (24/7)- 91 22 28999991/28333331.
    Best Contact – 919821150889

  12. Vibha Lifesavers

    Head office

    Nitin Yende MD

    Vibha Lifesavers
    Vibha care home, A 101, Mangal arambh, Kora Kendra,
    Near Macdonalds, Borivli west, Mumbai 400092.

    Telefax (24/7)- 91 22 28999991/28333331.
    Best Contact – 919821150889.

  13. Guidelines for Air Medical Crew Education (formerly the DOT Curriculum)
    Available in both traditional textbook and CD format, these Guidelines set forth a template for the initial training of advanced life support (ALS) level air medical crew members to extend their knowledge and skills beyond existing EMT-P, RN, and respiratory care training curricula. This publication covers the knowledge and competencies required for air medical programs to provide appropriate patient care at altitude and in the transport environment. It includes information, bibliographies, and suggestions for skills development in the following broad areas:

    Background and history of air medical transport
    Safety considerations
    Community, public relations, cultural competency, and legal issues
    Patient assessment and packaging
    The physiology of transport in the air medical environment
    Assessment and care of patients with a wide range of diseases and traumatic injuries
    Knowledge and competencies required by air medical programs that transport specialized and high-risk patient groups


  14. Travel Assist Network offers the following comprehensive services at per-trip rates starting as low as US$75 Services include:

    • 24-hour emergency medical hotline
    • Worldwide medical evacuation
    • Medical monitoring/consultation
    • Transport service to specialty hospital
    • Emergency message relay
    • Visa, passport and immunization requirements
    • Loss or theft of baggage, documents recovery and compensation
    • Emergency cash for medical or dental expenses
    • Lost prescription replacement/shipping
    • Guarantee of hospital admission
    • Language translation


    These are unprecedented and difficult times for the global economy. The world’s financial market conditions are severely strained, and risks to the global growth are significant. The largest advanced economies are feeling this most acutely. In the United States, our financial markets are experiencing unprecedented challenges, and this is adding even greater pressure to our already slowing economy.

    These developments are affecting the entire globe. Emerging market countries in recent years, including those in Asia, have made impressive strides in strengthening their fundamentals, accelerating their economic growth and cushioning themselves against external shocks. Nevertheless, as the events of the past several weeks have shown, emerging markets like China are not immune from the global financial stress. Even financial markets with little direct exposure to mortgage-related assets risk becoming destabilized by diminishing market confidence and slowing export growth. Because we are all affected by this crisis, we must work together to address this instability and restore the health of the world economy.

    Over the past two weeks, we have witnessed an unprecedented international response to this financial turmoil. The Group of Seven industrialized countries have announced and are implementing a coordinated action plan to stabilize financial markets and restore the flow of credit. Others around the world, from Hong Kong to Denmark, have adopted similar approaches. Together these countries are taking steps to provide liquidity to markets, strengthen financial institutions, prevent failures that pose systemic risk, protect depositors, and enhance confidence in financial institutions. While financial markets have responded positively in some ways to these unprecedented efforts, much work remains.

    Today, I would like to share my views on how we arrived at this place, what the United States is doing to address the turmoil and suggest some possible early lessons for both the United States and China.

    Root Causes of the Market Turmoil

    How did we get to this point? The story begins with a decade of benign economic conditions marked by low interest rates, low inflation, and less volatile asset markets, leading many to ignore the “risk” half of the risk-reward equation at the heart of financial markets. Investors around the world, who in preceding years had enjoyed above-historical returns on most assets, continued reaching for ever-higher gains. In response, the financial-services industry created a variety of complicated new financial products to meet this demand, and regulators and investors alike showed a growing complacency toward risk. These factors, blended together, created underlying conditions ripe for instability.

    The imbalance between risk and reward was most evident in the U.S. housing market, where lenders significantly loosened credit standards, particularly for a new generation of adjustable-rate mortgages. Last summer, these vulnerabilities in our financial system became clear, as looser credit standards in the housing market combined with an end to rapid home-price appreciation led to a significant rise in delinquent mortgages. This in turn contributed to immediate and unexpected losses for investors and a reconsideration of the risk-reward relationship–first in housing, and soon after, across all asset classes. Shaken investor confidence in housing assets had a domino effect throughout world markets, ratcheting up demand for cash and liquidity, and curtailing the pace of the new lending and investment necessary for continued growth.

    Actions to Mitigate Risk and Stabilize Markets

    Recognizing the risk of the housing downturn to the U.S. economy, the Bush Administration and Congress have taken a number of steps, including a $150 billion stimulus package, to help mitigate the impact on the real economy. Progress in the financial markets has been uneven, and additional challenges clearly lie ahead.

    In formulating a response, we initially acted on a case-by-case basis to address deteriorating financial conditions in a number of financial institutions. In March, the Federal Reserve took unprecedented action to ensure an orderly resolution for Bear Stearns, and in September, authorities around the world took steps to mitigate the impact of the bankruptcy of Lehman Brothers, America’s fourth largest investment bank. That same week, the Federal Reserve provided funding to American International Group (AIG) to address the systemic risk that would have resulted from a sudden collapse of the firm. Several weeks later, the FDIC facilitated JPMorgan Chase’s acquisition of the banking operations of Washington Mutual, one of America’s largest retail banks.

    In each of these cases, policymakers attempted to strike a careful balance of promoting market discipline while mitigating systemic risk, holding investors and management teams accountable while protecting blameless consumers from collateral damage.

    We have sought to achieve a similar balance in the cases of Fannie Mae and Freddie Mac, which are of particular interest to investors around the world, including here in China. These Government Sponsored Enterprises (GSEs) are the largest sources of mortgage finance in the United States, affecting roughly 70 percent of mortgages originated. Not surprisingly, the prolonged housing correction weakened their financial condition, and both institutions faced a loss of investor confidence. Fannie Mae and Freddie Mac are so large and interwoven in our financial system that the failure of either would have far reaching effects on the U.S. and global economies.

    This past summer, investors began to express growing concerns over the stability of Fannie and Freddie and the ambiguity over the scope and certainty of government support for these institutions. In response, Secretary Paulson asked Congress for certain authorities regarding Fannie Mae and Freddie Mac in order to help stabilize and support our financial and housing markets. Congressional leaders acted promptly and decisively with the needed legislation. In the days and weeks that followed, the FHFA, the government regulator responsible for overseeing these institutions – placed both of Fannie and Freddie under temporary government control to allow for needed changes at both institutions.

    In a complementary step, Treasury established contractual Preferred Stock Purchase Agreements with both institutions, committing up to $100 billion per institution to ensure that each GSE maintains a positive net worth, thereby protecting debt holders. These Preferred Stock Purchase Agreements are intended to address the underlying ambiguities surrounding the GSEs by explicitly demonstrating to the holders of Fannie Mae and Freddie Mac debt that the U.S. government will stand behind and protect their investments.

    A Comprehensive Policy Response

    Despite the hardening of the government’s support for Fannie Mae and Freddie Mac, and the decisive resolutions of Bear Stearns, Lehman Brothers, AIG, Washington Mutual, and Wachovia, investors have become increasingly concerned over the possibility of other failing financial institutions. This has made them increasingly reluctant to extend credit and has resulted in the further tightening of our credit markets.

    Sharp increases in the cost of credit for financial and non-financial companies, in the United States and globally, have increased the risk that corporations will be unable to roll over maturing debt. Given this fragile environment, U.S. authorities decided there was a need to act decisively and comprehensively to stabilize the markets and address the underlying sources of uncertainty. The four part plan rolled out by earlier this month seeks to achieve these goals.

    First, central banks from around the world have acted together in recent months to provide additional liquidity for financial institutions. The Federal Reserve has established swap lines with a number of central banks to reduce pressures in global short-term U.S. dollar markets. Moreover, to further increase access to funding for businesses in all sectors of our economy, the Federal Reserve launched a Commercial Paper Funding Facility (CPFF), which provides a broad backstop for the commercial paper market by funding purchases of commercial paper of three month maturity from high-quality issuers.

    Additionally, in early October, Treasury implemented a temporary guaranty program for the U.S. money market mutual fund industry, which had experienced funding problems. This temporary $50 billion guaranty program offers government insurance to address concerns about whether these money market investments are safe and accessible.

    Second, we have taken steps to improve market operations and market integrity. For example, the Securities and Exchange Commission took temporary emergency action to prohibit short selling in financial companies to protect the integrity and quality of the securities market and strengthen investor confidence. The SEC’s exceptional actions were joined by regulators in the UK, France, Germany, and other countries who also imposed restrictions on short selling. In addition, the SEC is aggressively pursuing enforcement action against market manipulation that may have occurred in previous months.

    Third, with the support of Treasury and the Federal Reserve, the FDIC has temporarily guaranteed the senior debt of all FDIC insured institutions and their holding companies, as well as deposits in non-interest bearing deposit transaction accounts. These actions are specifically designed to unlock interbank lending by mitigating counterparty risk. Regulators will implement an enhanced supervisory framework to assure appropriate use of this new guarantee. This important action, combined with the increase in the FDIC’s deposit insurance from $100,000 to $250,000, will provide confidence in the banking system and avert destabilizing capital flows between banks in the United States.

    Finally, and perhaps most important, Treasury is acting to provide much-needed capital to address one of the root causes of the current stress in our financial system – the ongoing housing correction and the consequent buildup of illiquid mortgage-related assets. These troubled assets remain frozen on the balance sheets of banks and other financial institutions, constraining the flow of credit that is so vitally important to our economic growth. The failure to address this would mean that every aspect of our financial and funding markets, ranging from consumer credit to money market funds, would remain impaired.

    On October 3, Congress passed and President Bush signed into law the bipartisan Emergency Economic Stabilization Act of 2008. The law gives the Treasury Secretary broad and flexible authority to purchase and insure mortgage assets, as well as equity securities, as needed to stabilize our financial markets. The law empowers Treasury to design and deploy numerous tools to fill the capital hole created by illiquid troubled assets.

    As part of a carefully defined capital injection plan, nine major financial institutions, which comprise more than 50 percent of all U.S. deposits and assets, have already agreed to participate and will receive a combined $125 billion of capital and will grant the U.S. government minority stakes in return. These healthy institutions are taking these steps to strengthen their own positions and to enhance the overall performance of the U.S. economy. By participating in this program, these banks, along with others that will be identified in the future, will have enhanced capacity to perform their vital function of lending to U.S. consumers and businesses and promoting economic growth. These nine banks have also committed to continued aggressive actions to prevent unnecessary foreclosures and preserve homeownership.

    We are also developing plans to add additional capital to reduce market uncertainty and encourage private investors by purchasing mortgage backed securities and whole loans off the balance sheets of U.S.-based financial institutions.

    Together, these four steps significantly strengthen the capital positions and funding ability of U.S. financial institutions, enabling them to perform their role of underpinning overall economic growth. These actions demonstrate to market participants around the world that the United States is committed to taking all necessary steps to unlock our credit markets, minimize the impact of the current instability on the U.S. economy, and restore the health of the global financial system.

    Much of this action is being coordinated internationally. The steps being undertaken in the United States are consistent with the efforts undertaken around the globe by others to provide liquidity, strengthen financial institutions, prevent failures that pose systemic risk, protect savers, and enforce investor protections. We welcome the policy decisions announced by European countries, Japan, Australia, and other nations around the world to stabilize their markets and ensure the health of their institutions.

    Lessons for the Future

    Since we are very much in the eye of the storm, it is difficult and premature to draw definitive lessons. Let me suggest four emerging themes that may be worth considering.

    First, we have undoubtedly learned that our own financial system is in need of reform. To help rebuild the strength and confidence in our markets, the United States has worked to implement the findings of international experts in the Financial Stability Forum (FSF) and U.S. experts in the President’s Working Group on Financial Markets (PWG). These bodies concluded that we must increase transparency, prudential regulation, risk management, and market discipline. Additional reforms of our regulations, regulatory structure, and international institutions will most certainly follow.

    The Financial Stability Forum recommendations are applicable to the financial markets around the world, and my country is committed to implementing them in full. China can and should benefit from the lessons the United States and other countries have learned from the challenges in our financial markets, and we are happy to share them. It would be unfortunate if, as a result of this turmoil, policymakers in China mistakenly abandon their pursuit of financial sector innovation that has been so important to supporting China’s growth in productivity and macroeconomic stability.

    Second, it is clear that the current turmoil has exacerbated macroeconomic policy challenges the United States and China already faced as a result of structural imbalances in both economies. For the United States, this has made efficient management of fiscal policy an even more critical challenge. China’s extraordinary growth has relied on exports and investment to fuel the economy, but this strategy may no longer be tenable in the face of a global economic slowdown.

    As China’s leaders recognize, their current growth model has created growing internal and external imbalances that need to be addressed. Strong domestic demand growth – with robust contributions from consumption and the services sector – provides the surest guarantee of both macroeconomic stability and sustained economic growth in the face of negative external shocks. Achieving strong demand-led growth is no small policy challenge. However, market-based pricing, including for interest rates and exchange rates, must play a central role in the process of allocating resources towards production for the domestic market.

    Third, we have learned that our growth and prosperity is more dependent on one another than at any time in our respective histories. Openness to international trade and investment has been and will continue to be the linchpin of economic growth for the global economy. Policy makers around the world must therefore remain vigilant to guard against the inevitable short-sighted appeals for protectionism during this period of global financial stress. A central task for policymakers in both the United States and Asia is to embrace the aggregate benefits of openness to trade and investment while taking measures to ensure that opportunities to benefit from that openness are widely shared.

    Finally, the recent crisis has highlighted the importance of continued cooperation among major economies through such fora as the G-20, the Financial Stability Forum, and the International Monetary Fund. As recent developments have demonstrated, the market turmoil is a global event. Governments around the world have taken actions to address financial market developments, and international cooperation and coordination has been robust. It is critical for governments to continue to take individual and collective actions to provide much-needed liquidity, strengthen financial institutions, enhance market stability, and develop a comprehensive regulatory response. We must closely coordinate our efforts within a common framework so that the action of one country does not come at the expense of others or the stability of the system as a whole.


    Ladies and gentlemen, the interdependence of our global economy makes our current challenges more complex. It also makes our work with international counterparts to promote growth and financial stability all the more important. We should take faith from the fact that leaders in America and around the world are rising to this pressing challenge. In the United States we have faced and overcome enormous economic challenges like this before. From this crisis, too, I’m confident we will emerge stronger and wiser.



    This Worldwide Caution updates information on the continuing threat of terrorist actions and violence against Americans and interests throughout the world. In some countries, the rise in oil and food prices has caused political and economic instability and social unrest. American citizens are reminded to maintain a high level of vigilance and to take appropriate steps to increase their security awareness. This supersedes the Worldwide Caution dated January 17, 2008.

    The Department of State remains concerned about the continued threat of terrorist attacks, demonstrations and other violent actions against U.S. citizens and interests overseas. Current information suggests that al-Qaida and affiliated organizations continue to plan terrorist attacks against U.S. interests in multiple regions, including Europe, Asia, Africa and the Middle East. These attacks may employ a wide variety of tactics including suicide operations, assassinations, kidnappings, hijackings and bombings.

    Extremists may elect to use conventional or non-conventional weapons, and target both official and private interests. Examples of such targets include high-profile sporting events, residential areas, business offices, hotels, clubs, restaurants, places of worship, schools, public areas and locales where Americans gather in large numbers, including during holidays. A July 9, 2008 terrorist attack on Turkish police guarding the U.S. Consulate General in Istanbul killed three police officers and wounded other police personnel. On March 15, a bomb was detonated at an Italian restaurant in Islamabad, killing two and injuring twelve, including five Americans. Also on March 15, two bombs exploded at the CS Pattani Hotel in southern Thailand killing two and injuring thirteen. In January, a bomb in a disco pub in the Philippines killed one and injured eight.

    Americans are reminded of the potential for terrorists to attack public transportation systems. Recent examples include multiple anti-personnel mine detonations on passenger buses in June 2008 in Sri Lanka, multiple terrorist attacks on trains in India in 2006, the July 2005 London Underground bombings, and the March 2004 train attacks in Madrid. Extremists may also select aviation and maritime services as possible targets, such as the August 2006 plot against aircraft in London, or the December 2006 bomb at Madrid’s Barajas International Airport. In June 2007, a vehicle was driven into the main terminal at Glasgow International Airport and burst into flames, but the bomb failed to detonate.

    The Middle East and North Africa

    Credible information indicates terrorist groups seek to continue attacks against U.S. interests in the Middle East and North Africa. Terrorist actions may include bombings, hijackings, hostage taking, kidnappings, and assassinations. While conventional weapons such as explosive devices are a more immediate threat in many areas, use of non-conventional weapons, including chemical or biological agents, must be considered a possible threat. Terrorists do not distinguish between official and civilian targets. Increased security at official U.S. facilities has led terrorists and their sympathizers to seek softer targets such as public transportation, residential areas, and public areas where people congregate, including restaurants, hotels, clubs, and shopping areas.

    On March 18, 2008, a mortar attack on the U.S. Embassy in Yemen injured several Yemeni citizens in the vicinity. On January 15, a roadside explosion in Beirut, Lebanon damaged a U.S. Embassy vehicle, killing three Lebanese and injuring an American citizen. On December 11, 2007, two vehicle-borne explosive devices were detonated at the UN headquarters in Algiers and the Algerian Constitutional Council. Three suicide bomb attacks in July and September of 2007 in Algeria killed more than 80 people. In July 2007, suspected al-Qaida operatives carried out a vehicle-borne explosive device attack on tourists at the Bilquis Temple in Yemen, killing eight Spanish tourists and their two Yemeni drivers. There was a series of bombings in Morocco in March and April 2007, two of which occurred simultaneously outside the U.S. Consulate General and the private American Language Center in Casablanca. Additionally, an attack took place on the American International School in Gaza in April 2007. These events underscore the intent of terrorist entities to target facilities perceived to cater to Westerners. The September 2006 attack on the U.S. Embassy in Syria and the March 2006 bombing near the U.S. Consulate in Karachi, Pakistan illustrate the continuing desire of extremists to strike American targets.

    Potential targets are not limited to those companies or establishments with overt U.S. ties. For instance, terrorists may target movie theaters, liquor stores, bars, casinos, or any similar type of establishment, regardless of whether they are owned and operated by host country nationals. Due to varying degrees of security at all such locations, Americans should be particularly vigilant when visiting these establishments.

    The violence in Iraq, clashes between Palestinians and Israelis, and clashes between terrorist extremists and the Lebanese Armed Forces have the potential to produce demonstrations and unrest throughout the region. Americans are reminded that demonstrations and rioting can occur with little or no warning. In addition, the Department of State continues to warn of the possibility for violent actions against U.S. citizens and interests in the region. Anti-American violence could include possible terrorist actions against aviation, ground transportation, and maritime interests, specifically in the Middle East, including the Red Sea, Persian Gulf, the Arabian Peninsula, and North Africa.

    The Department is concerned that extremists may be planning to carry out attacks against Westerners and oil workers on the Arabian Peninsula. Armed attacks targeting foreign nationals in Saudi Arabia that resulted in many deaths and injuries, including U.S. citizens, appear to have been preceded by extensive surveillance. Tourist destinations in Egypt that are frequented by Westerners were attacked in April 2006 resulting in many deaths and injuries, including Americans. Extremists may be surveilling Westerners, particularly at hotels, housing areas, and rental car facilities. Potential targets may include U.S. contractors, particularly those related to military interests. Financial or economic venues of value also could be considered as possible targets; the failed attack on the Abqaiq oil processing facility in Saudi Arabia in late February 2006 and the September 2006 attack on oil facilities in Yemen are examples.

    East Africa

    A number of al-Qaida operatives and other extremists are believed to be operating in and around East Africa. As a result of the conflict in Somalia, some of these individuals may seek to relocate elsewhere in the region. Americans considering travel to the region and those already there should review their plans carefully, remain vigilant with regard to their personal security, and exercise caution. Terrorist actions may include suicide operations, bombings, kidnappings or targeting maritime vessels. Terrorists do not distinguish between official and civilian targets. Increased security at official U.S. facilities has led terrorists to seek softer targets such as hotels, beach resorts, prominent public places, and landmarks. In particular, terrorists and likeminded extremists may target international aid workers, civil aviation and seaports in various locations throughout East Africa, including Somalia. Americans in remote areas or border regions where military or police authority is limited or non-existent could also become targets.

    Americans considering travel by sea near the Horn of Africa or in the southern Red Sea should exercise extreme caution, as there have been several incidents of armed attacks, robberies, and kidnappings for ransom at sea by pirates during the past several years. Merchant vessels continue to be hijacked in Somali territorial waters, while others have been hijacked as far as 300 nautical miles off the coast of Somalia in international waters.

    The U.S. Government maritime authorities advise mariners to avoid the port of Mogadishu, and to remain at least 200 nautical miles off the coast of Somalia. In addition, when transiting around the Horn of Africa or in the Red Sea, it is strongly recommended that vessels travel in convoys, and maintain good communications contact at all times.

    South and Central Asia

    The U.S. Government continues to receive information that terrorist groups in South and Central Asia may be planning attacks in the region, possibly against U.S. Government facilities, American citizens, or American interests. The presence of al-Qaida, Taliban elements, indigenous sectarian groups, and other terror organizations, many of which are on the U.S. Government’s list of foreign terror organizations, poses a potential danger to American citizens in the region. Continuing tensions in the Middle East may also increase the threat of anti-Western or anti-American violence in the region.
    Terrorists and their sympathizers have demonstrated their willingness and capability to attack targets where Americans or Westerners are known to congregate or visit. Their actions may include, but are not limited to, vehicle-born explosives, improvised explosive devices, assassinations, carjackings, rocket attacks, assaults or kidnappings. On June 2, 2008, a large bomb exploded in front of the Danish Embassy in Islamabad, Pakistan killing at least six people and wounding nearly 20. In May 2008, a series of coordinated bombings occurred in market and temple areas of the tourist city of Jaipur in Rajasthan, India. In Afghanistan, kidnappings and terrorist attacks on international organizations, international aid workers, and foreign interests continue. In Sri Lanka, the Liberation Tigers of Tamil Eelam and other groups have conducted suicide bombings at political rallies, government buildings, and major economic targets, and in recent months have increasingly targeted public transportation. Although there is no indication that American citizens were targeted in these attacks, and none were injured, there is a heightened risk of American citizens being victims of violence by being in the wrong place at the wrong time.

    Previous terrorist attacks conducted in Central Asia have involved improvised explosive devices and suicide bombers and have targeted public areas, such as markets, local government facilities, and, in 2004, the U.S. and Israeli Embassies in Uzbekistan. In addition, hostage-takings and skirmishes have occurred near the Uzbek-Tajik-Kyrgyz border areas.

    Before You Go

    U.S. citizens living or traveling abroad are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site at so that they can obtain updated information on travel and security. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

    U.S. citizens are strongly encouraged to maintain a high level of vigilance, be aware of local events, and take the appropriate steps to bolster their personal security. For additional information, please refer to “A Safe Trip Abroad” found at

    U.S. Government facilities worldwide remain at a heightened state of alert. These facilities may temporarily close or periodically suspend public services to assess their security posture. In those instances, U.S. embassies and consulates will make every effort to provide emergency services to U.S. citizens. Americans abroad are urged to monitor the local news and maintain contact with the nearest U.S. Embassy or Consulate.


    Hi Flying aviation

  17. Trauma care in India.

    Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns, and villages coexist with a variety of health care facilities and an almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centers and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has documented significant deficiencies in current trauma systems. Some initiatives on improving prehospital systems have been seen recently. Although injury is a major public-health problem, the government, medical fraternity, and the society are yet to recognize it as a significant public health challenge.


  18. Vibha Lifesavers – Critical-Care Air Transport: Patient Flight Physiology.

    The stresses of flight create new and unique considerations for the inexperienced medical provider during their initial involvement in the air transport of sick and injured patients. Not only must constant attention be paid to the impact of these stresses on a patient’s condition but on proper equipment performance and the ability of the caregivers to deliver the best medical support possible. Anticipation and prevention of potentially serious complications by vigilant patient monitoring and initiation of therapy is the responsibility of the entire medical crew during air transport. Appropriate ground training and familiarization with approved equipment will provide the crew members with the best opportunities for success.


  19. Changes in cardiac output during air ambulance repatriation – Vibha Lifesavers- Hi Flying group.

    To measure, with the use of suprasternal Doppler ultrasound, the hemodynamic changes in patients and volunteers during air ambulance repatriation. Design: Unblinded prospective observational study. Setting: Chartered air ambulances for the international repatriation of patients. Patients and participants: Six medical crew members and seven patients transported back to hospitals in the UK. Interventions: The measurement of non-invasive blood pressure, ECG, heart rate, oxygen saturation and hemodynamic variables with suprasternal Doppler. Measurements and results: There was a drop in systolic and mean arterial blood pressure in the patient’s group once in the air. Oxygen saturation dropped in both groups once at cruising altitude. Heart rate remained unchanged. Stroke distance and minute distance increased significantly in the patient’s group and non-significantly in the volunteers. Peak velocity increased significantly in the patient’s group. There was an overall reduction of systemic vascular resistance during take off and once at cruising altitude. Conclusions: Hemodynamic changes happen during air ambulance transportation in fit and healthy volunteers and patients alike. These may be due to a combination of hypobaric hypoxia and gravitational forces. It is necessary to establish if these changes have short- or long-term effects in the critically ill.

  20. Heart rate and leukocytes after air and ground transportation in artificially ventilated neonates – Vibha Lifesavers – Hi Flying aviation group.

    Objective To evaluate the effect of interhospital air and ground transportation of artificially ventilated neonates on heart rate and peripheral blood leukocyte counts.
    Design Prospective, observational study.
    Setting Level III multidisciplinary Neonatal and Pediatric Intensive Care Unit.
    Patients Fifty-eight near-term artificially ventilated transported neonates between May 2006 and April 2007.
    Interventions Day-helicopter, day- and night-ground transportation.
    Measurements and results Heart rate at retrieval, on admission to the ICU and 1 h later, and peripheral blood leukocyte counts on admission and 1 d later were compared. Fifteen neonates were transported by helicopter during the daytime (D-HEL), 20 by daytime ground and 23 by nighttime ground transportation (D-GROUND, N-GROUND). No differences in delivery mode, birth weight, gestational age, gender, primary diagnoses for transportation, response time and duration of transportation were found between the groups. Similarly, no differences in pH, pCO2, blood pressure and skin temperature at retrieval and on admission to the ICU were found between the three groups. The mean heart rate at retrieval did not differ significantly, while on arrival in the ICU and 1 h later the D-GROUND group of patients showed a significantly higher mean heart rate compared to the D-HEL and N-GROUND groups. Moreover, leukocyte counts on arrival in the ICU showed significantly higher leukocyte counts in the D-GROUND group of patients compared to the D-HEL group of patients.
    Conclusions These results demonstrate that there is an association between daytime ground transportation and higher heart rate and peripheral blood leukocytes.

  21. Local exhaust ventilation and exposure to nitrous oxide in ambulances- Vibha Lifesavers- Hi Flying aviation group.

    Under extreme conditions, ambulance attendants and drivers could be exposed to nitrous oxide administered to transported patients in concentrations causing acute effects. Special arrangements are necessary to prevent such exposure, which is influenced by travelling speed, local exhaust ventilation and the use of an excess gas transfer tube evacuating expired air and overflow gas from the face mask to the outside. The separate eliminative effects of travelling speed and local exhaust varied considerably with the experimental conditions. The excess gas transfer tube reduced the levels of nitrous oxide in the air by 86 to 97% inside the ambulance at different experimental conditions. The combination of excess gas transfer tube and local exhaust resulted in a relatively constant reduction of the airborne nitrous oxide levels by about 98% when the ambulance was at a standstill and 99% when it was running.

  22. Integrated Model For The Dynamic On-Demand Air Transportation Operations- Vibha Lifesavers- Hi Flying aviation group.

    On-demand air transportation is progressively obtaining the popularity with its flexibility, convenience, and guaranteed availability. However, its unique dynamic characteristics, such as short-noticed new demands and disruptive unscheduled maintenance, challenge the efficient operations, since they will significantly affect the priori algorithmic solutions. An integrated optimization model is presented to tackle the dynamic nature of the on-demand air transportation operations. A dynamic planning method together with a rolling-horizon approach is used to accommodate new demand. A realistic solution to recover from unscheduled maintenance events is also provided and demonstrated to be effective based on real world scenarios.

  23. Pulmonary Thromboembolism Associated with Air Travel- Vibha Lifesavers-Air Ambulance – worldwide- Hi Flying aviation group.

    The duration of flight appears as a major contributing risk factor for severe pulmonary embolism associated with travel. Given the risk of air travel of long duration, behavioral, mechanical, and pharmacological prophylactic measures should be considered. Behavioral and mechanical prophylactic measures are easy to perform and include abundant consumption of nonalcoholic beverages, refraining from smoking, avoidance of tight clothing that may limit blood flow, use of elastic support stockings, avoidance of legcrossing, frequent changes of position while seated, and minor physical activity, such as walking, or at least moving the limbs. These measures and, perhaps, pharmacological measures, are insufficiently documented to suggest precise indications.

  24. Informing Collaborative Information Visualisation Through an Ethnography of Ambulance Control – Vibha Lifesavers- Air ambulance services- Hi Flyng aviation group.

    An ethnographic analysis of an ambulance control centre is presented, specifically investigating the design of information displays and their practical use in this setting. The spatial distribution of the displays around the control room is described and its consequences for cooperative work drawn out. From these analyses, we make several suggestions for information visualisations in virtual environments, including a design concept of multiple displays coexisting within a 3D environment as an alternative to the notion of ‘immersive’ information visualisation more commonly encountered. The paper closes with a reflection on the relationship between ethnographic analysis and system developmentthat our work here exemplifies.

  25. Air Evacuation of the Neurosurgical Patient – A review- Vibha Lifesavers- Hi Flying aviation group- Worldwide air ambulance services.

    Patients with brain and spinal cord injuries can be air evacuated safely and effectively acutely and after definitive neurosurgical care. An accurate evaluation of the patient’s neurological condition, acute stabilization, and intransport medical management during AE can help improve patient outcomes and reduce secondary brain and spinal cord injury.

  26. Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance asia.

    prehospital emergency care – ambulance – emergency transport – emergency department – field emergency care.

    Importance of prehospital emergency care cannot be underestimated in the present scenario.


    Lifesavers India.

  27. prehospital emergency care – ambulance – emergency transport – emergency department – field emergency care

  28. Management of Severe Head Injury – Vibha Lifesavers- Hi Flying aviation group.

    The objectives embedded in the management of traumatic brain injury (TBI) include limiting the primary damage and controlling secondary insults, which are thrust upon the brain immediately after an accident. Applying the recommendations of evidencebased guidelines approved by the American Association of Neurological Surgeons attains these objectives. At the scene of accident, airway support, ventilation and oxygenation are strongly recommended in trying to keep the systolic blood pressure (SBP) of the patient at around 100 mmHg [1]. Upon stabilization of the hemodynamic and pulmonary function, the victim is transferred rapidly by surface or air into the closest trauma center. In the emergency department (ED), one must maintain an SBP of at least 90 mmHg with adequate SPO2 before any other diagnostic procedure is performed, including CT of the head. When faced with multiple trauma, surgical prioritization depends on stability of vital signs, clinical evidence of herniation, findings on CT and intracranial pressure. A rapidly deteriorating patient should have infusion of mannitol and short-term hyperventilation en route to the CT suite. To prevent secondary brain insults, especially ischemia and brain swelling, the victim of TBI needs 3–4 weeks of vigilant supportive care in the intensive care unit (ICU), including ICP control and perfusion pressure management, adequate ventilation, infection control, nutritional support, physical and occupational therapy. Physical, mental and occupational rehabilitation in a well equipped center prepares the patient for ultimate social integration.

  29. Aircraft Considerations for Aeromedical Evacuation – Vibha Lifesavers- Hi Flying aviation group- Air ambulance asia.

    the USAF possesses a wide variety of aircraft with a proven capability of moving large numbers of patients. Each aircraft used in the AE role has specific strengths and weaknesses as described. While the civil air ambulance industry is highly capable of moving small numbers of patients, their experience with large numbers is limited. Therefore, in the event of a sudden disaster requiring AE of large numbers of patients, the expertise and capability of the USAF (through US Transportation Command) will be required.

  30. Indications and Considerations for Emergent Evacuation of the Peacetime Casualty – Vibha Lifesavers- Hi Flying aviation group- Air ambulance asia.

    The sickest of patients can be transported by AE under the right circumstances with the right crew capabilities. The civilian aeromedical industry has a wide variety of aircraft, medical configurations, pilot configurations, and capabilities. It is important, both from a medicolegal and patient care standpoint, for any who wish to transport a patient by air to know what transport capabilities are available in the local area. It is also important to know the limitations and contractual agreements of both the sending and receiving medical facilities. Prior to transport, the physician must be aware of the preflight preparation based on the patient’s condition and disease process, especially in light of the potential impact that barometric pressure changes and exposure to the elements can have on the patient. Safe patient transportation by air depends on careful planning and a reasonable understanding of the process of AE.

  31. Ultrasound Image Transmission via Camera Phones – Vibha Lifesavers- Hi Flying aviation group- Air ambulance asia.

    Ultrasound is a modern imaging technique, which delivers no radiation and does not require injection of any chemicals to enhance visualization. Unlike other imaging modalities, it can reach locations that are inaccessible to plain X-rays, computed tomography, and magnetic resonance imaging. Ultrasound image transmission through camera phones can be useful in scenarios like remote locations, disaster scenes, battlefields, cruise ships, ground and air ambulances, and expeditions. The most important requirement for transmitting ultrasound images and video via camera phones is access to a network on which the camera phone can transmit data.

  32. Air Ambulance – The Medical World is Flat Too – Vibha lifesavers- Hi Flying aviation group.

    Tom Friedman, in his book,“The World is Flat,” makes a very persuasive argument that our current economic policy transcends national boundaries. Friedman describes various processes that prove his point. These include workflow software, open sourcing, outsourcing, off-shoring, supply chaining, in-sourcing, and informing. The United States already outsources surgery. In this article, I give the retail surgical rates and discount rates of the US, and compare them to that of the same surgery in India, Thailand, and Singapore. Supply chaining is another example that applies to the field of medicine, particularly pharmaceuticals. Most pharmaceutical firms are located in developed countries, but 80% of the pharmaceuticals are manufactured in developing countries. A phenomenon that may be unique to the United States is that we off-shore some of our diagnostic capabilities, primarily during out nighttime hours. Under the rubric of “Nighthawk,” X-rays, including CT scans, are digitized and sent to Australia, Spain, and other countries during our nighttime hours. A diagnosis is made and sent back to the referring hospital in the US, usually within 30 minutes. I think an argument can be made that almost all of the issues that Friedman talks about in his book, apply to the field of medicine. Trauma care is a microcosm of medicine and uses most of the resources shared by other specialties. The trauma patient has to be identified and ambulances called, usually by 911 or similar numeric systems in other countries. The patient is transported to an emergency room, and if the injury is severe, admitted for acute care, which often requires surgery, intensive care, and ward care. When possible, the patient is discharged home, but is often sent to a rehabilitation facility or a nursing home. To improve trauma care and outcome, surgeons have turned to the organization and system approach that has been so successful in military situations.
    Materials and methods An extensive review of the surgical and public health papers relating to trauma was carried out. This article is an inventory of how trauma systems are progressing in different countries and whether they are effective. Some of the pitfalls that globalization may bring are also discussed.
    Results and conclusions For the last 100 years, there has been gradual improvement in care of the civilian patients, as a system approach similar to the military care of injured patients has been introduced and matured. These systems include prehospital care, acute care, rehabilitation; ideally, using a public health approach, preventive components are also utilized. Research is another component that is key in improving patient outcomes.
    This article is the synthesis of two lectures presented at the meeting of the International Society for Surgery in Montreal, August 28 and 29, 2007. The first lecture was the American College of Surgeons’ Lecture entitled “The Medical World is Flat Too.” The second lecture was The Donald D. Trunkey Lecture entitled “Improving Trauma Care in Developing Countries.”

  33. Long-distance transportation of patients with a paracorporeal left ventricular assist system – Vibha lifesavers- Hi Flying aviation group.

    a patient must be transferred to these hospitals for extended treatment, regardless of the distance. Trans-portation of the patient with a paracorporeal left ventricular assist system (Toyobo LVAS) is difficult because of its extremely large consumption of electric power. We planned to transfer a patient with a Toyobo LVAS for 600 km, but the patient was not transferred because he had a stroke. In order to find the best transportation method, various possi-bilities are evaluated; special ambulance car, Shinkansen (Super express train), fiexed-wing aircraft, medium-sized helicopter (belonging to private company or public aviation corps), and large helicopter (belonging to the Self-Defense Force). The special ambulance car the medium-sized helicopter may not be able to provide a stable electric power supply. There is a connecting traffic problem with the Shinkansen and the aircraft, depsite their sufficient electric power supply. The large Self-Defense Force helicopter seems to be the best option for us.

  34. The Management of Mass Burn Casualties and Fire Disasters – Vibha lifesavers- Hi Flying aviation group.

    The Executive Board of the WHO has defined disasters as situations where there are unforeseen, serious, and immediate threats to public health. Every year about 150 disasters of different kinds occur in peacetime all over the world, each with more than 20 deaths at the scene and an immediate cost of more than US$ 8 million. Thirty per cent of these disasters are caused by earthquakes, environmental pollution, floods, etc.; 70% are classified as severe fires and explosions due to train crashes, air accidents and underground disasters.

  35. Development of a Cooling Unit for the Emergency Treatment of Head Injury – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    In the emergency medicine, icing has been used as first aid treatment to the patient of head injury. By reducing cerebral temperature, prevent the generation of secondary brain damage such as discharge of neurotransmitter, and the reaction of free radical. The average boarding time is 15 minutes in an ambulance, however by icing treatment quantitative temperature control is very difficult as it always occur insufficient cooling or excessive cooling. Icing for 30 minutes or more has the danger of frostbite. As an other problem homeostasis, which happens when icing is stopped is suggested. Therefore, the issue is how and quickly cools an injured head without generating any secondary damage. In this study, we have developed a cooling unit using Peltier device. A Peltier is a thermo-electric semiconductor device that generates heat surface on one side and cool surface on the other, when passes electrical current. By adjusting passing current, heat controlling can be made easily. Other advantages are small size, light weight, vibration and noise free. A Peltier device is also harmless to the environment as it does not use any material like Freon. We have fabricated a helmet type unit that can cool a head from the surface. As a fundamental evaluation we have investigated electrical properties as well as cooling ability, and response time. The result of our investigation showed a uniform electrical properties without getting any interference of ambient temperature while use water as heat radiation coolant. An 80 watt device (39.6mm X 39.6mm X 3.94mm) is found sufficient to cool a helmet around 15 degree C. Only 30 second is necessary to reach the expected temperature when direct-current stabilization power supply of 11V-15V was used.

  36. Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

  37. Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

  38. Disaster Management Response – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    Increasing numbers of natural disasters and man-made disasters, such as earthquakes, tsunamis, floods, air crashes, etc., have posed a challenge to the public and demonstrated the importance of disaster management. The success of disaster management, amongst all, largely depends on finding and successfully integrating related information to make decisions during the response phase. This information ranges from existing data to operational data. Most of this information is geographically related and therefore when discussing integration of information for disaster management response, we often refer to the integration of geo-information. Current efforts to integrate geo-information have been restricted to keyword-basedmatching Spatial Information Infrastructure (SII, may also known as Spatial Data Infrastructure). However, the semantic interoperability challenge is still underestimated. One possible way to deal with the problem is the use of ontology to reveal the implicit and hidden knowledge. This paper presents an approach for ontology development and ontology architecture, which can be used for emergency response.

  39. Cardiopulmonary Resuscitation Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    A patient with out-of-hospital cardiac arrest (CA) stands little chance for survival without prior organization and preparations for immediate resuscitation. Fortunately, many communities have achieved relative success with resuscitation since the 1970s. In the 1970s, cities such as Seattle and Milwaukee achieved overall survival-to-hospital discharge rates for the subgroup of patients with out-of-hospital ventricular fibrillation (VF) that exceeded 20 to 30% (1,2). Both of these communities used a classic deployment system for out-of-hospital CA that sent a three- to four-member firefighter crew as a neighborhood “first-responder” (FR) followed by a two- (or more) member paramedic ambulance crew. In cases of witnessed collapse in which the patient received immediate basic cardiopulmonary resuscitation (BCPR) by bystanders and presented to paramedics with VF, survival rates in these systems exceeded 40%. This finding was duplicated in several other communities, including the City of Houston Emergency Medical Services (EMS) system after a major restructuring in the 1980s.

  40. Aeromedical Evacuation Prehospital care – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    Orthopedic casualties present specific challenges to both the civilian and military AE system. While usually not critically ill from their orthopedic injuries, these patients frequently represent a difficult nursing and transport challenge due to lack of mobility and potentially bulky and heavy splintage and traction devices. While orthopedic emergencies that threaten life or limb are rare during AE, there is relatively little the aeromedical crew can do to treat them in-flight. For this reason, the cornerstone of the safe AE of orthopedic casualties is adequate preparation and stabilization, together with delaying AE until 72 hours after injury or surgery if possible.

  41. Interhospital Transportation of Mass Burn Casualties – – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance Asia.

    The transported patients had a lower pH the first day after transportation, but condition during the second day as well as ventilation day and mortality did not differ between the transported and the non-transported group. Therefore, transportation during the unstable phase, the first day post-burn, seemed not to have had a negative impact on patient outcome.

  42. Air Ambulance Guidelines- Vibha Lifesavers- Hi Flying aviation group

    Estimated Time of Arrival (ETA)
    Air Ambulance Communications Centers or Routing Centers (communications facilities that coordinate requests for EMS resources) will include an inherent Estimated Time of Enroute (ETE), to all prehospital flight requests, when providing an Air Ambulance Estimated Time of Arrival (ETA). The ETA will be provided to the requesting organization once the Air Ambulance Service accepts a prehospital flight request.
    Air Ambulance Services, once air borne, will provide the requesting Public Safety Answering Point (PSAP) with an updated Estimated Time of Arrival (ETA). This information should then be relayed to the requesting ground EMS units who may use the information to determine the ultimate mode of patient transportation.
    Air Ambulance overall ETAs are defined as the combined times of the ETE (pre-flight) and flight time that occurs until the aircraft is overhead at the scene of the identified landing zone (LZ).
    Air Ambulance Services shall communicate with the PSAP any unexpected delays, diversions or other situations which will alter the initial ETA. Changes in an Air Ambulance ETA shall be communicated by the PSAP to ground EMS units who may use the information to determine the ultimate mode of patient transportation
    Air Ambulances agencies should incorporate Quality Assurance measurement programs into their respective flight programs which strive for a 90% target goal of arriving on scene within Five (5) minutes of the initial reported Estimated Time of Arrival.
    June 23, 2008
    Declination of Flight Due to Weather
    Declination due to inclement weather: In cases in which a Public Safety Answer Point (PSAP) contacts an Air Ambulance Communications Center or a Routing Center (a communications facility that coordinates requests for EMS resources), the Routing Center /Air Ambulance Communications Center will identify the Air Ambulance resource based upon the base of operation and availability. Should the requested Air Ambulance Service decline a request due to inclement weather the Routing Center / PSAP shall:
    • Document the declination of flight and maintain agency specific records.
    Proceed to the next due Air Ambulance resource based upon closest base of operation. Advise the second due resource that the first due resource declined the request due to inclement weather conditions.
    • In cases in which Air Ambulance agencies have declined the same flight due to weather conditions, the Routing Center / PSAP will follow state approved regional procedures to determine the depth of resource polling, at which point the PSAP / Routing Center will advise the ground EMS unit of the situation. Ground transport should use this information to determine the most appropriate method of transport to a facility using State Approved Regional Trauma Triage Protocols.
    • Routing Centers shall maintain and make available to Regional EMS Councils, the Department of Health and participating Air Ambulance Services, agency specific records.
    • In cases of Inter-Facility patient transfers, it is strongly recommended that the transfer center, hospitals or other agencies coordinating Air Ambulance transportation logistics, relay flight declinations due to weather to the respective flight programs as they work to secure air transportation.
    June 23, 2008

  43. Joint Position Statement of the American College of Emergency Physicians, the National Association of EMS Physicians®, the Air Medical Physician Association, the Association of Air Medical Services, and the National Association of State EMS Officials

    The American College of Emergency Physicians (ACEP), the National Association of EMS Physicians® (NAEMSP®), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.

    Every state should develop regulations or statutes regulating the advertising and/or marketing of air ambulance medical transport services.
    These regulations or statutes should only allow an entity to advertise and/or market as an air ambulance medical transport service if the entity possesses a valid air ambulance medical transport license.
    These regulations or statutes should require the air ambulance medical transport service to inform the client at the time transport is arranged if another licensed air ambulance medical transport service will complete the transport, including providing the name, contact information, and licensure information of that service.
    Active physician medical direction, oversight, and ongoing performance improvement through quality assessment and review shall be a component of state air ambulance medical transport licensure.


  44. Air Ambulance – EMS guidelines. Vibha Lifesavers- Hi Flying aviation group.

    The American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) believe that patient care and safety are the priorities for all emergency medical services (EMS) systems. All calls requesting EMS response should be managed according to these priorities. EMS systems may encounter patients who do not need advanced life support (ALS) level care or evaluation at an emergency department. In these circumstances, transportation by alternate means or to an alternate destination may be appropriate. EMS systems that choose to implement such options, either in the dispatch phase or following on-scene evaluation by field personnel, should develop a formal program to address these alternatives. Alternate transportation and destination decisions may affect the EMS system’s liability.

    Key elements of such alternate transportation and destination programs should include:

    EMS physician medical director oversight for all components of the EMS system from dispatch centers and first responders to basic life support and ALS services.

    EMS physician medical director-led development, implementation, continuous quality improvement of policies and procedures, and research designed to ensure patient safety and appropriateness of any alternate transportation or destination decisions.

    Education programs for EMS personnel, physicians, and the community.

    Compliance with established emergency medical dispatch criteria.

    Opposition to patient incentive programs that circumvent the established 9-1-1 (or equivalent) public safety answering point as the initial call for a perceived medical emergency.

    Assurance that alternate transportation and destination decisions are consistent with medical necessity and with consideration for patient preference when the patient’s condition allows.

    Support of appropriate compensation for EMS systems based on patient evaluation and treatment as well as on transport.


  45. Discontinuing Resuscitation in the Out-of-Hospital Setting – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians believes that under certain well-defined circumstances, resuscitative efforts may be discontinued in the out-of-hospital setting for pulseless patients who do not respond to an adequate trial of resuscitation therapy. The literature demonstrates that these are situations in which resuscitative efforts would be unlikely to provide medical benefit to the patient.

    Patients for whom resuscitative efforts may be discontinued in the out-of-hospital setting include patients who are asystolic or are in a wide-complex pulseless bradycardic rhythm with a rate less than 60, are normothermic, and fail an adequate trial of resuscitation therapy. Adequate resuscitation therapy may include airway management, CPR, medications, defibrillation, and pacing.

    When a process for field termination is established, a psychosocial support system should be available to help family members and friends. Local EMS systems must work together with appropriate local agencies to develop effective policies for field termination of resuscitation, to include appropriate involvement of medical control.


  46. Do Not Attempt Resuscitation (DNAR) in the Out-of-Hospital Setting.
    Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    As an adjunct to this policy statement, ACEP’s Ethics Committee developed a Policy Resource Education Paper (PREP), ‘Do Not Attempt Resuscitation’ Orders in the Out-of-Hospital Setting.

    All emergency medical services (EMS) system(s) should have a well-defined, comprehensive policy addressing their response to ‘Do Not Attempt Resuscitation’ (DNAR) orders and other directives of similar nature. Public and patient education information regarding this policy must be widely disseminated at the community level, and among EMS providers and other health care workers serving the out-of-hospital -hospital interface.

    Out-of-hospital orders and directives used by EMS personnel (‘Do Not Resuscitate’ (DNR), Do Not Attempt Resuscitation (DNAR), EMS-DNR), officially document decisions to forgo resuscitation efforts at the end-of-life. These directives anticipate and countermand the routine initiation of resuscitation efforts that, as part of the care continuum, are performed by EMS providers called to serve in out-of-hospital settings.

    EMS personnel should initiate full resuscitative efforts immediately when cardiopulmonary arrest is confirmed or develops subsequent to scene arrival unless:

    Obvious signs of death are present; or

    A valid DNAR order or other directive consistent with local policy, is immediately available; or

    The patient’s personal physician or the EMS control physician directing on-scene efforts assumes official responsibility for withholding resuscitation.

  47. Drug-Assisted Intubation in the Prehospital Setting – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), and the National Association of EMS Physicians (NAEMSP) recognize that expert prehospital airway management by trained, non-physician, EMS providers is of paramount importance in the treatment of critically ill and injured patients. Endotracheal intubation (ETI) may be difficult or impossible, especially if the patient is combative or has intact airway reflexes. The scope of prehospital care may include drug-assisted intubation (DAI) to facilitate ETI.

    DAI is an advanced airway procedure that should not be considered mandatory, nor is it appropriate, for many prehospital EMS systems. DAI should be utilized only by EMS systems that, in the judgment of the EMS medical director(s), have a specific need for the procedure and possess adequate resources to develop and maintain a prehospital DAI protocol. It must be understood that DAI is a powerful technique used to facilitate endotracheal intubation, which can be harmful if not performed properly. Every effort must be made to ensure that EMS providers authorized to perform DAI demonstrate ongoing competence in order to maximize patient safety and quality of care. This position statement is not an advocacy statement for or against the use of DAI.

    EMS providers performing DAI should possess training, knowledge, and experience in the techniques and in the use of pharmacologic agents used to perform DAI. Confirmation of proper endotracheal tube placement is essential.

    ACEP, ACS-COT and NAEMSP recommend that a prehospital DAI program should include, at a minimum, the following elements:

    Medical direction with concurrent and retrospective oversight supervision;
    Proper patient selection; to include training and continuing education designed to demonstrate initial and ongoing competence in the procedure (includes supervised DAI experience);
    Training in airway management of patients who cannot be intubated; as well as the availability, and competence in the use, of backup rescue airway methods in the event of failed DAI;
    Standardized DAI protocols, including the use of sedation and neuromuscular blockade;
    Resources for drug storage and delivery;
    Resources for continuous monitoring and recording of heart rate and rhythm, oxygen saturation, and end-tidal carbon dioxide, before, during, and after DAI;
    Appropriate training and equipment to confirm initial and verify ongoing tube placement;
    Continuing quality assurance, quality control, performance review, and when necessary, supplemental training; and
    Research to clarify the role of DAI on improved patient outcome within EMS systems.


  48. Early Defibrillation Programs – Early Defibrillation Programs – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians (ACEP) believes that the efficacy of early defibrillation with the reliable technology of current automatic external defibrillators (AEDs) is proven and widely accepted within the out-of-hospital provider community. However, before early defibrillation programs can be promoted in a widespread manner, they must be integrated into or coordinated with EMS systems that are designed to maximize the potential for survival in the ventricular fibrillation victim.

    AEDs should be carried on all basic life support ambulances. AEDs should also be available to Medical First Responders such as police and fire personnel and to other designated first responders in highly congested population areas.

    ACEP endorses the widespread availability of AEDs and the implementation of early defibrillation programs coordinated with an EMS delivery system to ensure the following:

    Immediate activation of the EMS system for the ventricular fibrillation victim

    Immediate delivery of CPR

    Early defibrillation by the first designated responder to arrive on the scene

    Timely provision of Advanced Life Support

    Rapid transport to an emergency medical facility

    Medical direction of all components including the AED program.
    All of these factors are critical to ensure that the EMS personnel can optimally treat victims of cardiac arrest. Appropriate monitoring of quality of care and outcomes must occur. Legislation may be necessary in some locations to allow for Medical First Responders to use AEDs.


  49. Emergency Ambulance Destination – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians (ACEP) believes that patients who are transported under the direction of an EMS system should be taken, whenever possible, to a hospital facility that meets the Emergency Department Planning and Resource Guidelines of ACEP.

    If an area does not have a hospital facility that meets the Emergency Care Guidelines, the EMS system physician medical director may designate an alternate medical facility to receive patients by ambulance. ACEP recommends that such alternate medical facilities meet the Emergency Care Guidelines of the College.

    The EMS system physician medical director should have the authority to establish transport protocols that address the needs of both the patient and the local EMS system. These protocols must be closely monitored to ensure optimal and appropriate patient treatment is provided.


  50. Expanded Roles of EMS Personnel – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians (ACEP) acknowledges expanded scope of practice programs are being developed in response to community needs. ACEP recognizes that EMS providers are likely to be used in the workforce for these programs. With proper design and medical oversight, potential benefits may include improved access to health care in underserved areas, improved patient care, and reduced costs.

    The evidence must be clear and compelling that significant patient benefit will result from any such expansion of roles for EMS providers. To expand the scope of practice for EMS personnel, the following principles must be met:

    Close medical oversight by physicians with experience and an understanding of the roles and capabilities of EMS personnel is mandatory.
    Education programs with quality assurance mechanisms to ensure maintenance of standards must be in place before implementing an expanded scope for EMS providers.
    Quality assurance mechanisms for the care provided by EMS personnel operating under expanded roles must be in place at the time of implementation of such programs to ensure appropriate and safe patient care.
    Expanded roles for out-of-hospital providers must adhere to legal requirements. Physician oversight of any such expanded roles for out-of-hospital providers is a necessity.
    The existing emergency response system must not suffer for the sake of an expanded scope program.
    Access to emergency care must not be compromised by efforts to alter the basic emergency response system as a part of medical care integration.
    A community plan and needs assessment with physician input must guide the development of any expanded scope program.
    Attempts to expand the scope of paramedic practice without the support of all involved parties and adequate medical oversight are not in the best interest of good patient care.
    Any current pilot programs for expanded roles of EMS personnel are strongly encouraged to share the results of their programs with ACEP and other EMS organizations.


  51. Health Care System Surge Capacity Recognition, Preparedness, and Response – Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians (ACEP) believes that:

    Surge capacity is a measurable representation of a health care system’s ability to manage a sudden or rapidly progressive influx of patients within the currently available resources at a given point in time.

    Health care systems must develop and maintain surge capacity throughout the system in anticipation of the need to care for patients presenting from infectious disease outbreaks, public health emergencies, and mass casualty incidents.

    Surge capacity is currently limited for a variety of reasons, including the overcrowding of hospitals and emergency departments due to the need to maintain continuity of care for all other patients.

    The health care system must recognize that a sudden or rapidly progressive influx of patients may temporarily eliminate the ability of the system to provide for elective medical and surgical care.

    Emergency departments, as principal portals of entry into health care systems, will always be faced with the challenge to ensure patient safety by managing significant supply/demand mismatches.

    Funding sources should be developed for surge capacity planning, training, equipment, supplies, oversight and process improvement at the local, state and federal levels.

    Legislation should be enacted to mitigate liability issues when surge capacity is exceeded for reasons beyond the control of health care providers.


  52. Implementation of EMS Interventions Vibha Lifesavers- Hi Flying aviation group- Air Ambulance India.

    The American College of Emergency Physicians encourages the continuous development and improvements of emergency medical services (EMS) systems. EMS equipment, medications, and procedures should provide benefit to the patient in the out-of-hospital environment, be safe for the patient and operator, and be cost effective.

    To help ensure quality care, ACEP believes that EMS systems should adopt devices, medications, and procedures only after unbiased research has demonstrated their benefit, safety, and cost effectiveness in the out-of-hospital setting. Further, both out-of-hospital care providers and emergency physicians should participate in the ongoing evaluation of EMS interventions.


  53. Vibha Lifesavers- a Hi Flying aviation group – air ambulance medical rescue escort service specialising in the emergency repatriation of seriously ill or injured patients using air ambulances or commercial aircraft.

    Not all patients need an air ambulance, and considerable savings can be made, even if the patient requires oxygen or a stretcher, using scheduled airplane flights for rescue, instead of air ambulances – except where very extensive life support is required. Aeromedical International specialises in this, and we have helped many – insurance or privately funded – minimise the substantial costs which can be involved in this kind of emergency, particularly where an air ambulance would otherwise be required.

    Patients on a stretcher, needing oxygen, or even some life support, can often be safely moved by commercial airplane with an escorting doctor or nurse, and repatriation itself can avoid huge bills. We have the expertise to make the necessary assessment in liaison with the local medical practitioner. Insurance companies have also used our services to confirm that proposed treatments by the foreign staff are medically correct and reasonably priced. We have achieved substantial savings for both individuals and insurance companies.

    An aircraft or air-ambulance is a unique physiological environment. Medical conditions can change at thirty thousand feet, and experience is necessary. Aeromedical emergency rescue escort staff are all fully trained to handle the situations that may arise on the aeroplane or air-ambulance. Transporting stretcher bound patients, particularly those with particular life support needs, on aircraft or air ambulances is highly specialised, and the nurse or doctor handling the repatriation and escort needs to be fully capable of dealing with anything that may arise on the aeroplane or the air ambulance.

    It is not just the airplane or air-ambulance that presents logistical problems. They also arise on the ground. It is not an easy matter to cope on an aeroplane with a patient, perhaps needing oxygen or life support, and deal with the bureaucratic and official obstacles that can and do come about where aircraft are involved. We are used to this, and any doctor or nurse of ours is highly experienced in dealing with this as well.

    Hi Flying aviation.

  54. Vibha Lifesavers – Hi Flying aviation group has a complete service and can provide both the air ambulance and the medical crew. Just ask us and we will provide quotes which can be inclusive of all charges, including the flight crew.

    Due to our experience in the field we are able to provide competitive quotes utilising the most experienced operators.

    We operate world-wide. We have developed a specialist knowledge of inter-continental flights, and can safely and efficiently transfer patients between any two points on the globe.

    A particular company speciality is the safe, efficient transfer of sick and injured persons across the world in the cabins of commercial aircraft. This can result in immense savings compared to the use of air ambulances.

    We have access to a road ambulance which enables us to offer highly competitive quotes for transfers of suitable patients in and around Northern Europe.

    We have recently enhanced its capabilities for the movement of mentally disordered persons and can provide a world – wide secure service using both commercial flights and dedicated air ambulances.

    ›› The Company Provides

    24 hour world-wide service
    Door to door service
    Appropriate escorts for each flight
    Arrangements for accompanying relatives
    Liaison with treating and receiving doctors
    Repatriation of mortal remains
    Air ambulance flights
    Commercial flight transfers
    Ground services at each end and at transfers
    Organisation of receiving hospitals
    Emergency message transmission
    Emergency evacuations
    All cases are considered by our Senior Medical Officer before they are undertaken, and each is assessed locally by our team before any transfer commences.


  55. Bed-to-bed transport
    Air-Ambulance provides a highly professional bedside-to-bedside medical transport service to and from every country in the world. A detailed preflight medical consultation with the patient’s attending physician guarantees optimal preparation for the flight.

    Each mission is staffed with an experienced medical team consisting of a doctor and an intensive care nurse. If the patient requires more specialised care (e.g. a newborn baby), neonatologists and other specialists are also available.

    Vibha Lifesavers gives assistance to international travellers whose medical problem can be dealt with locally. Twelve years of experience in in-travel emergency management is helpful when it comes to counselling travellers in distress. Addresses of nearby clinics, qualified doctors and air-ambulances can be very useful.

  56. Medical equipments for air ambulance.

    The following is a list of our most essential medical equipment:

    • Cardiac Monitors
    • Defibrillators
    • IV pumps & solutions
    • Infusion pumps
    • Oxygen
    • Oxygen supplies, regulators and gauges
    • Pulse Oximeter
    • Portable suction units
    • Intubation equipment
    • Respirator/Ventilator
    • Oropharyneal airways
    • Hand operated bag-valve
    • mask resuscitators
    • Blood pressure cuffs
    • Drug box
    • FAA approved stretcher

    Vibha Lifesavers
    Hi Flying aviation – group.

  57. Air Ambulance worldwide.

    Many people have suddenly found themselves in a position where an employee, relative or friend is seriously ill or injured in an area where adequate medical treatment is not available. In many cases they are neither able to cope nor able to obtain the necessary medical assistance. Heathrow Air Ambulance Service is a specialist organisation, which can rapidly provide the very best solutions for :

    The Insurance Industry:
    Travel industry:
    International Repatriation Companies:
    Public and Private Companies:
    Hospital Trusts:
    The National Health Service:
    The Private customer.
    Doctors, nurses and paramedics, appropriately qualified for the patient’s condition, available to escort patients by air throughout the world.

    With over 28 years experience in this field, we are able at short notice to effect the safe, competent and comprehensive transfer of patients from any part of the world. Either by scheduled airline or private air ambulance. This service provides:

    Report & Advice
    Medical Clearance
    Transfers to and from airports
    Medical escorts
    All necessary equipment
    Hospital admission and appropriate medical referral
    Continuous liaison and reporting to the client throughout
    Our 24 hour Control Centre provides a comprehensive service:

    Investigation, assessment and advice in cases of accident or sudden illness overseas
    Medical advice by our Company Doctor, with access to specialists in the relevant field of medicine.
    Electing the aircraft appropriate to the patient’s medical needs and the flying time involved.
    Comprehensive aviation medical equipment.
    Medical teams appropriate to the patient’s condition.
    Scheduling medical teams, air ambulances and arranging medical referral at receiving hospital.
    Liaison with client throughout.
    All aspects of the client, care and transportation are properly insured.

    Vibha Lifesavers
    Hi Flying aviation group


    The Federal Aviation Administration (FAA) does not certify air ambulance operators. The FAA regulates aircraft operations, but exercises no control over the medical aspects of the flight. Several years ago, the FAA did attempt to regulate the medical aspects of air ambulance operations but withdrew the proposed rules because of fierce opposition by hundreds of Air Taxi Operators. The individual states were left to decide if they should license their air ambulance operators or not. Some states do, some don’t, and some have minimal requirements. Florida has the most rigid requirements for Air Ambulance Operators, including aircraft size and capabilities, medical equipment inventory, and personnel qualifications.


    There is really nothing wrong with obtaining an air ambulance through a broker. However, if you use a broker, you might find it difficult to obtain information about the actual aircraft operator/air ambulance operator. Of course, if you contact the air ambulance operator directly, the chances are that you will certainly obtain the service at a much lower price. Using a brokerage service may result in inconsistency of care when the brokerage service utilizes various air ambulances’ services. The broker does not own the aircraft, medical equipment or employ aviation medical professionals. So each air ambulance service that flies for the broker would have different standards of patient care. Usually, true air ambulance operators (the actual FAA certified operators) have only one or two bases of operations. You should be suspicious of an air ambulance operator who claims to have offices in many cities. It is probably just a broker with many phone numbers. Therefore, your next question should be: Who is the actual air ambulance operator? That is, who is the licensed operator of the aircraft? Then ask whom, if not that aircraft operator, is handling the medical aspects (i.e., who supplies the medical personnel and equipment).


    Each patient should be evaluated by the medical director of the air ambulance service prior to transport. Because many medical conditions are affected by air travel, the Aviation Medical Specialist is trained to determine the proper equipment, personnel and aircraft required for each transport. Aviation physiology may affect the patient, so particular attention must be given to his/her condition and previous medical history


    All physicians, nurses and respiratory therapists should have extensive experience in critical care medicine. The doctors and nurses should be certified in Advanced Cardiac Life Support, and be further trained in aviation physiology


    It is imperative that the aviation medical team assume patient responsibility at the discharging facility and relinquish this responsibility only at the patient’s final destination. Continuity of medical and nursing care is extremely important to the outcome of all patient conditions. The aviation medical team is the important “link” between the discharging and receiving patient care facility. The receiving facility should expect to receive all pre-flight medical records as well as verbal and written documentation of in-flight events.


    The cost of an air ambulance transport varies depending on type of aircraft used, length of flight, and medical personnel. Quotation for flight costs should be all inclusive of:

    Aircraft Mileage – Flight Crew – Medical Personnel – Aviation Medical Consultations – Medical Equipment – Landing Fees – Ground Ambulance Transportation – Federal Excise Tax

    Some air ambulance services may quote aircraft mileage only, or might initially quote a low price for an inappropriate aircraft and then later either raise the price “due to add-ons,” or finally decide that you need a different aircraft, which, of course, will cost more than the original quote. Be sure that the quotation is all inclusive for the right type of aircraft. Reconfirm the quotation and the aircraft to be utilized.


    The major factor to consider in selecting the type of aircraft is the patient’s condition. For most flights of more than one or two hours duration, jet aircraft is certainly preferable to a propeller aircraft. The patient’s “flight time” is substantially minimized in a jet. A jet’s flight will be above the weather, not bouncing around in it. All jet aircraft are pressurized. There will be fewer fuel stops (or none at all) than with a propeller aircraft. Some propeller aircraft are pressurized, others are not. For short flights, particularly when the patient is very stable, a propeller aircraft (even an unpressurized one) might be utilized for air ambulance flights. However, this is a decision that should only be made after the consultation between the air ambulance service’s Medical Director and the patient’s physician. Airplanes with proper loading capabilities are also necessary. Some aircraft have doorways and internal configurations which cannot accept stretcher entry at all or without tilting the patient.


    Unbelievably, some services do not have stretchers; some simply carry the patients on the floor of the aircraft on mattresses. Make sure that the service you choose will use an FAA approved stretcher securely fastened to the aircraft. The stretcher must have straps to secure the patient. It must be located so that the attendant has good access to the patient’s entire body.


    If you ask this question of several different “air ambulance operators” you will be totally amazed at the answers you get. Some will answer, “What do you want us to carry?”; some will answer, “We can put oxygen on the airplane if it is needed”; some will say, “We carry nothing but the stretcher.” This is a most important consideration. The states that require licensing of air ambulance service do establish at least the bare minimums for required equipment. The truly competent air ambulance service carries much more than any licensing authority requires. And in addition to standard equipment, often additional items are needed to care for particular patients. This should be determined during the preflight consultation with the patient’s attending physician

    A true air ambulance should have the following:

    A. Basic Patient Care Equipment

    1. Oxygen equipment, with proper masks and nasal cannulas

    2. Complete drug kit with general drugs

    3. Stethoscope and blood pressure cuff

    4. IV administration sets and fluids (IV pumps)

    5. Oral airways and manual resuscitation unit

    6. Suction equipment, electrical and oxygen powered

    B. Emergency cardiac drugs

    C. Intubation equipment

    D. Other specified as indicated:

    1. Cardiac Monitor/Defibrillator

    2. Ventilator (Volumetric)

    3. Special splints traction units (cervical orthosis, stryker frame, Hare etc.)


    Make sure that medical oxygen (not aviators breathing oxygen) is provided and make sure that sufficient quantity is provided for the flight.

    NOTE: In many, if not most, cases even if a patient is not receiving oxygen on the ground, he should receive oxygen in flight because of the reduced oxygen available in the normal air as the aircraft ascends.


    Many patients require IV fluids during flights. A competent service will always have these available even if the preliminary information does not indicate that they will be required. Due to low aircraft ceiling and changes in pressurization, an intravenous pump is often required with intravenous therapy.


    Many patients require suctioning when transported by air even if they don’t require suctioning on the ground. Make sure the operator provides suction units with sufficient power to operate them for the entire period of the flight. Make sure these suction units are powered either electrically or by oxygen. Hand or foot operated units are of little value.


    The air ambulance service should provide: clean sheets, pillows, blankets, etc. Catering should be provided with particular attention to the patients required diet. Rain sheets, umbrellas, etc. should be made available for patient transfer in inclement weather. If possible, hangars should be available for patient loading/unloading in extremely bad weather.


    An air ambulance service should control all aspects of the patient transport. A “TOTAL SERVICE” air ambulance will provide bedside to bedside service. It is imperative that ground ambulance arrangements be made, confirmed, updated and reconfirmed to avoid patient waiting. This should be done by the air ambulance service with the all-inclusive price quotation.


    The air ambulance service should have sufficient medical personnel on staff to handle all inquiries as they arise. Of course, emergencies will be given first priority; however, someone should be available to answer specific questions regarding air patient transport

    Vibha Lifesavers
    Hi Flying aviation group

  59. I have read a few good stuff here. Definitely price bookmarking for revisiting. I surprise how a lot effort you put to make any such fantastic informative website.

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