In some cases, air ambulance services will be provided by government, either directly or by means of a negotiated contract with a commercial service provider, such as an aircraft charter company. Such services may focus on the transfer of critical care patients, may support ground-based EMS on scenes, or may perform a combination of these roles. In almost all cases, the government will provide guidelines for use to both hospitals and EMS systems, in order to keep operating costs under control, and may specify operating procedures in some level of detail in order to limit potential liability, but almost always takes a ‘hands-off’ approach to the actual running of the system, relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario’s ORNGE program and the Polish LPR are examples of this type of operating system. The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently, there is no independent HEMS operator in Poland. In North East Ohio, including Cleveland, the Cuyahoga County-owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro’s level I trauma and burn unit. There are 5 helicopters for North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft.
In the United Kingdom, the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. These represent the UK’s only government-funded air ambulance service.
In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. In southern Queensland, Australia, the helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the Queensland Ambulance Service or New South Wales Ambulance Service providing paramedics, as required. In some cases, the flight paramedic will be provided to the aircraft operator by local EMS on an as-needed basis. In other cases, the paramedic will staff the aircraft full time, but will have a dual function. In the case of the Maryland State Police, for example, the flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies.
In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. This is not, however, universally true. The cost of providing air ambulance services is considerable, and many such services, including government-run ones, charge for service. There are certain groups which, in particular, charge for service. These tend to be privately owned companies, such as aircraft charter companies, hospitals, and some private-for-profit EMS systems. Within the European Union, almost all air ambulance service is on a fee-for-service basis, except for those systems which operate by private subscription. Many jurisdictions have a mix of operation types. Fee-for-service operators are generally responsible for their own organization, but may have to meet government licensing requirements. Rega of Switzerland is an example of such a service.
Donated by business
In some cases, a local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Examples of this are common in the European Union, where in London the Virgin Corporation funds the Helicopter Emergency Medical Service, and in Germany and the Netherlands a large number of the ‘Christoph’ air ambulance operations are actually funded by ADAC, Germany’s largest automobile club. In Australia and New Zealand, many air ambulance helicopter operations are sponsored by the Westpac Bank. In these cases, the operation may vary, but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor. In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a ‘hands off’ approach to daily operations, relying instead on subject matter specialists.
In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as the U.K., use a mix of such systems. In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered, although the service to London receives most of its funding through the National Health Service.
Great strides were made in the UK between 2005 – 2008 when the independent charities formed themselves into the national association of air ambulance charities (AAAC) This organization is widely credited for having created the political climate which resulted in the helicopter industry and National Health Service recognising the enormous contribution that charities made to trauma care in the United Kingdom. In 2008, NHS partners joined the association and it was re-named the Association of Air Ambulances.
In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities buying expensive clinical governance services from independent “for profit” companies. The industry is currently divided over whether it is ethically acceptable that income derived through philanthropy and altruism should be spent on buying this essential governance from profit-driven entrepreneurs. Research has been commissioned (March 2010) and it is expected that in future, clinical governance will be provided either free or on a not-for-profit basis.