Air ambulance services facing burnout and staff and aircraft shortages as Covid sparks ICU bed crisis

Air ambulance services are facing aircraft and staff shortages across the United States as the latest Covid surge fuels an ICU bed crisis, The Independent can reveal.

Covid and natural disasters, combined with responders’ regular workloads, are contributing to more and more patients needing to be transported further and further across the country – and the highly specialised air services are strapped.

“Nobody talks about the helicopters until they need one,” Cameron Curtis, president and CEO of the Washington, DC-based Association of Air Medical Services (AAMS), told The Independent.

“There are shortages for various reasons,” Ms Curtis continued – just hours after she finished a call about the increasing problem.

“Some people are first responders and going to work at hospitals ... transporting patients is a very difficult job anyhow in terms of dealing with seeing some of the worst things that we can barely even imagine. They’re already dealing with a job that’s very stressful – and then, on top of that, adding the Covid exposure risk, the higher workloads, the uncomfortable environment...

“If you imagine someone is in the back of a helicopter – which is not a huge space – it’s essentially a flying ICU to get patients where they need to be as quickly as possible. And now they’re wearing a lot more when it comes to PPE ... It’s become even more difficult than it already was.”

Air ambulance services in the US are divided between rotor and fixed-wing aircraft – basically helicopters and planes outfitted as flying ICUs, experts explain. AAMS counts about 1,000 rotor aircraft among its members which make 360,000 trips a year during non-pandemic times. The specially outfitted fixed-wing aircraft are equipped to make longer journeys, while choppers tend to be utilised in more emergency-response, shorter jaunt situations.

The vast majority of air services across the United States are privatised. In addition to a pilot, most air ambulance flights have on board a nurse, a paramedic and sometimes a physician or specialist, depending on the level of care a patient requires.

Andrew Bess is the Arizona-based CEO of Angel MedFlight, which, along with its brands, comprises the largest fixed-wing air medical provider in the country.

“We’ve had to acquire more airplanes in the last six months than we’ve ever had to before,” he told The Independent. “Covid played into that.”

The situation is something of a perfect storm for air ambulances. They’re usually called in to transport patients for specialised treatment at trauma centres or centres of excellence in different states – or to respond to an accident or disaster zone.

That’s what the services are equipped to handle – but “this is atypical,” Mr Bess said.

“We don’t have a playbook for the pandemic.”

It’s not unique to transport patients huge distances for complicated or specialised treatment, AAMS’s Chris Eastlee told The Independent – but “what is unique to this situation is the frequency with which that is occurring, the distances with which that is occurring ... [and] the levels to which you have to protect yourself during that flight.”

And the situation has been getting exponentially worse as the pandemic has progressed, industry insiders said.

At the beginning of the lockdown, for example, air ambulances were slightly freed up in various locations because “people weren’t moving around – they weren’t getting injured,” Mr Eastlee told The Independent.

Others were afraid to call emergency services for fear of getting Covid and were delaying specialised treatments that would have necessitated transport to far-away centres of excellence.

Now, however, as vaccination rates rise, people are travelling more and life is returning to some semblance of normality in many areas – while natural disasters hit and continuing Covid surges contribute to ICU bed shortages.

The knock-on effect for air ambulances has been overwhelming – as has the subsequent lack of resources to meet demand.

“It’s been happening slowly, but I think it’s really starting to ramp up,” Ms Curtis told The Independent of staffing shortages to man flights. “People are leaving to go work for other healthcare systems. Perhaps you were an EMT and you left to go work for a hospital because they needed people and were offering a better deal ... it’s like everybody’s scrambling to get healthcare providers.

“The shortage is only going to get worse, because people see now it’s a very difficult line of work and they’re reluctant to go into something like that.”

Mr Bess told The Independent that air ambulance crews tend to be a “certain breed” – altruistic, A-type personalities, often former military.

“We have to, more than ever before, remind our folks what we signed up for in the first place,” he said, adding: “The industry as a whole across fixed-wing and rotor are answering the call – but everyone’s burnt out. Everyone’s exhausted, and everyone is waiting to gasp for that next breath of: When will this be over?’”

He said: “EMS as a whole have always been the unsung heroes of emergency response missions. Nobody in EMS asks for credit; it’s not in their DNA.”

His own company, he said, has no lack of volunteers, particularly for flights in emergency situations and disaster areas. Covid, however, has certainly added a new layer of hesitancy for air ambulance services across the country, Mr Eastlee said.

The industry, he told The Independent, is definitely “seeing a growth in recruitment efforts – we’re not necessarily seeing a good growth in recruitment in terms of actual employees.”

The constraints placed by Covid, however, he hopes will alert the average person to the importance of air ambulance services, particularly in rural areas.

“We need to be very, very cognisant,” he said. “It’s not something you think about until you’re in desperate need of it – and then [what if] Oh my God, it’s no longer there? That’s the problem in this country that we’re going to see more of – it’s not just necessarily air ambulances, it’s also ground ambulances at rural hospitals.

“We do tend to be the tip of the spear in terms of these crises.”