Travel insurance and medical evacuation

To the Editor: As consultants in intensive care, experienced in transporting critically ill patients within Australia and internationally, we have also received complaints from clients about some travel insurance organisations.1

Poor service appears due partly to economic restrictions and partly to the paucity of experienced staff and specialised aircraft available.

Assistance companies implement travel insurance policies for underwriters, quoting 24-hour emergency call centres. Some companies economise by subcontracting (eg, episodic diversion of calls to another organisation). This can result in coordinators lacking an understanding of regional geography, population and medical services and omission of the early, vital input of senior medical advisers. Information relayed between several people can be lost or distorted. Failure to ask key questions can result in inappropriate clinical planning. Furthermore, time zone differences can result in calls being received late at night, further reducing availability of immediate expert opinion. Only a well-organised (and thus expensive) control centre with a critical care focus can manage all these variables.

Furthermore, it is difficult for a company to permanently employ current, high-grade healthcare staff in adequate numbers. Current critical care retrieval staff in Australia are confined to a few stand-alone aeromedical organisations or public hospitals which run aeromedical services for state governments and other organisations, using their regular anaesthesia, intensive care or emergency medicine staff. Reliable assistance companies tend to contract with these retrieval organisations or their off-duty staff.

In Australia, ambulance aircraft able to travel offshore, with adequate oxygen systems, stretcher attachments, electrical power, and so on, are uncommon and expensive to equip. Portable equipment to care for a critically ill patient represents a capital investment of over $100 000, and some services try to achieve results with inadequate tools or by borrowing.

ISAS (the International Society of Aeromedical Services, Australasian Chapter) promotes standards on staffing and equipment,2 including the Australian and New Zealand College of Anaesthetists/Australian College for Emergency Medicine standard for transporting the critically ill.3 Based on critical care practice, the standards are not legally binding, but one suspects they would be quoted in any litigation.

It behoves all travellers to scrutinise their travel insurance policies closely — many think of them only in terms of lost or stolen baggage. Following serious injury or illness, the policy may dictate what kind of care is offered.