Telemedicine means there’s always a doctor on board

 - October 9, 2007, 1:00 PM
In the last 10 years, the odds of facing an in-flight medical emergency haven’t changed much, but thanks to the development of aviation telemedicine, the odds of surviving such an event have gone up considerably.

Briefly defined, telemedicine is the remote practice of medicine, including diagnosis and treatment, by means of modern communication systems. In the aviation community, it establishes an air/ground link to permit the same type of relationship. It allows medical experts on the ground to understand the nature of an in-flight medical emergency, make a diagnosis and recommend treatment or a course of action to be taken by the patient or others aboard the airplane.

At its most basic, aviation telemedicine is not new. It was being practiced by NASA in the 1960s as a means of transmitting biomedical or physiological data from space to a ground site where medical experts could interpret the data and determine the health and well-being of astronauts.

It took much longer for the idea to take hold in the civil aviation community. Even in the 1980s the FAA had begun to take note of the growing numbers of in-flight medical emergencies aboard airliners–from cardiac arrests to births–and was discussing a requirement for emergency medical kits to be carried on all aircraft. But the Internet would not take root outside academia for another decade, and air/ground telemedicine in commercial aviation remained at best a matter of patching through radio link with a doctor on the ground and hoping for the best.

In the mid-1980s MedAire, now the world’s largest provider of telemedicine service for commercial and general aviation, was already in the business of providing in-flight emergency medical kits and crew training. Joan Sullivan Garrett, who founded the Phoenix-based company in 1985, said it was shortly after opening for business in 1986 that she became aware that despite the training, flight crews remained unsure of their ability to deal with in-flight medical emergencies that might require a higher level of medical expertise.

This prompted Garrett, a former flight nurse with Phoenix-based Samaritan AirEvac, to begin looking into the idea of an air/ground telemedicine hotline. MedLink was the result, and it fielded its first call in 1987 from a yacht owner. That same year, MedLink had its first experience with an airborne medical emergency when John O’Brien on an American TransAir flight suffered a heart attack. MedLink was contacted and O’Brien survived. “That day we proved it worked,” said Garrett.
Today, MedLink has more than 800 corporate aviation subscribers and its services account for about 45 percent of the company’s total annual revenue. A total of 20 staff members man the 24/7 operation.

Lucrative Market
The success of MedLink is not the only illustration of the growth of telemedicine in the business aviation community. AirCare International launched its own version called Access in 1997, exclusively targeting the business aviation market. Today the Olympia, Wash. company has 125 subscribers. And AirCare has since launched Pilot-Access, which was designed to “meet the specific needs of pilot-only, light-jet operations.”

AirCare uses as its ground-based medical resource the emergency medical unit at George Washington University. According to AirCare president Douglas Mykol, “The university’s medical department has been in the business of remote medical services for 20 years and has been incredibly successful.”

MedLink is hospital-based at the Good Samaritan Regional Medical Center in Phoenix, where a total of 20 emergency physicians staff the hospital’s level-one trauma center. MedLink handles more than 12,000 emergency calls annually, about 20 percent of them from business aircraft subscribers, not all of which actually involve in-flight emergencies. “We get calls from crews on the ground from all over the world,” said Garrett.

Both companies offer similar aviation telemedical services, which include:
• 24/7 air-to-ground telemedical links with board-certified physicians.

• Physician-directed telemedical assistance.

• Coordination of ground-based medical resources.

• Global aviation-specific medical resource database.

• Poison center resource.

• Liability insurance covering subscribing individuals and companies when medical assistance is provided under direction of an AirCare or MedAire physician, respectively.

With more than 40 commercial carrier subscribers, airlines dominate the MedLink program in terms of actual emergency calls, but the business aviation segment is growing rapidly. Gulfstream Aerospace has long been a client and includes a MedLink subscription with each new business jet it sells. In May (retroactive to April 1), the company announced that, through MedAire, its new GVs and GIV-SPs will also come equipped with an Agilent Heartstream FR2 automated external defibrillator (AED).

Gulfstream competitor Bombardier Aerospace has also provided MedLink as standard on its Global Express and Challenger 604 business jets. And at the Paris Air Show in June the Montreal-based company announced that it will provide the same service to buyers of its Learjets.

Virtually Unlimited Potential
According to Garrett, the potential of aviation telemedicine is “unbelievable; especially as applied to business aviation.”

The key, she said, is in the rapid advance of technology, from new high-speed air-to-ground Internet access systems to highly sophisticated telemedical monitoring and diagnostic equipment.

MedAire has recently reached agreements to represent the makers of two revolutionary pieces of equipment that will allow the transmission of everything from 12-lead electrocardiogram readouts to video pictures.

The Tempus 2000 from Remote Diagnostic Technologies of London will transmit 12-lead electrocardiogram readouts, pulse telemetry, pulse oxemetry (important in measuring veinous blood oxygen levels in a pressurized cabin), blood pressure and exhaled CO2 levels.

Even more impressive is the ability of the Tempus 2000 to transmit real-time video pictures. This, said Garrett, “will substantially increase the ability of the physician on the ground to diagnose complaints and direct the treatment of the patient by nonmedical crew or passengers. It will also let us focus at a higher resolution on any area of particular concern; skin color, a rash, even the patient’s pupils.”

Also now available through MedAire is the VitalLink 1200. Only slightly less sophisticated, it has most of the same capabilities as the Tempus 2000. However, the VitalLink system, developed by UK-based Telemedics Systems, has a three-lead electrocardiogram readout and the video capability is still in development. “The video should be available by the end of the year,” said Garrett.

The Tempus 2000 is priced at about $55,000 and the VitalLink 1200 in the $26,000 range. The Tempest 2000 has already received FDA and CAA and FAA approval. Telemedics has received FDA approval for its VitalLink 1200 and expects FAA approval by the end of the year.

MedLink has been rapidly expanding its global reach and, according to Garrett, has “just purchased a majority interest in Global Doctors.” The deal adds nine Pacific Rim medical clinics to the MedLink resource pool and includes facilities in the People’s Republic of China, Thailand, Malaysia, Indonesia and Australia.

“These are places to which a growing number of our clients are traveling and they will now have access to these clinics.” The clinic services include physician and specialist and pharmacy access, with the same levels of care found in the Western world. “And there are more to come,” she added, “in eastern Europe and Russia.”

MedLink Releases Emergency Book
Before the end of the year, MedAire expects to release another addition to its MedLink program in the form of an in-flight medical emergency textbook.
The new, loose-leaf, four-color, 144-page booklet, published in partnership with British Airways’ medical department, is designed to be carried in the cabin and as a crew-training manual and “meets and exceeds” FAA and JAA regulations. The loose-leaf format allows individual clients to customize the book to fit their specific needs and established medical protocols. The pages can be inserted into a flight manual in the same manner as Jeppesen charts, said Kathy Sieperman, a registered nurse and v-p of education at MedAire.

AirCare’s Mykol tells of a call from a pilot who allowed as to how he “just wasn’t feeling right.”

He was more correct than he knew, said Mykol. Access found a doctor who diagnosed it as scromboid poisoning, a relatively unusual and serious form of food poisoning brought on by eating contaminated fish. He received prompt treatment and quickly recovered, though he was grounded for 24 hr by AirCare’s FAA-certified medical examiner.

“It’s important to have a qualified physician available to diagnose and determine treatment,” said Mykol, “but it’s also important to have someone who is familiar with aviation medicine and aviation regulations.”

While AirCare and MedAire offer the two largest aviation telemedicine services in the U.S., worldwide they are not the only companies in this field.

Scottish Medicine in Aberdeen offers the FirstCall program with its partner, the Aberdeen Royal Infirmary. The company has provided remote emergency medical services for some 50 years and works primarily with offshore industries and shipping. More recently, it has offered an aviation telemedicine service and has among its subscribers UK-based major charter operators Airtours International and Air 2000.
Others offering aviation telemedicine services include the Mayo Clinic in Rochester, Minn., used by Northwest Airlines, and the University of Pittsburgh, which serves Delta Air Lines. Singapore Airlines is a client of Singapore-based ISOS International/AEA.

A MedAire partner in Norway, Norwegian Air Ambulance, also has a center similar to MedLink in the capital of Oslo, with a primary focus on supporting offshore oil platforms on the Norwegian side of the North Sea.

Subscription rates for aviation telemedicine services vary widely, depending on such factors as the level of service required, aircraft type, crew training requirements and more. But it typically begins with Pilot Access at the basic level of about $1,000 a year for a light jet and may go well above $3,000 for a heavy-iron business jet. Some companies may include initial and/or recurrent crew training and cabin emergency medical kits.

If you’re a passenger on a business aircraft or a member of the aircrew, odds are actually pretty good you’ll never be faced with an in-flight medical emergency. In fact, like most business aviation flight crews and passengers you’re probably betting you won’t. But you’re betting your life, and possibly the lives of others, and that’s a high-stakes game.

Aviation telemedicine makes it a better bet, said MedAire’s Garrett. “More than that, it’s a vital link in the challenge to make flying safer for crews and passengers.”