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A peek into the air ambulance scenario in India

M3 India Newsdesk Apr 26, 2018

Air ambulances act as true lifesavers especially for attending to medical emergencies in remote or hilly areas, making them a real necessity in India.

When a three-year old toddler in Bhutan went into cardiac arrest recently, he was airlifted to a hospital in Kolkata. He recovered completely after a timely surgery. In such a medical scenario, where time is of essence, a critical question to ask is

Air ambulance can be a true lifesaver not only in case of an accident, but also in cases where an organ needs to be transported for a transplant, especially in hilly areas where road connectivity is an issue, and, when there is a need to transport life-saving medicine from one place to another.

‘Flying doctors’ in India

With the lack of last-mile connectivity in India, the need for air ambulance services is fast growing and many new companies are coming up with such services. An air ambulance can transport a patient to the nearest hospital within the golden hour and thereby increase the chance of survival. Almost 23 per cent of all traumas that occur in India is transportation-related, with 1,374 accidents reported every day on Indian roads. Given the topographical diversity of India and the fact that about 80 % of its population lives in the rural area, this type of specialised medical service can save many precious lives,

Recent years have seen an upsurge in interhospital air medical transport in India. A retrospective analysis published by Khurana et al. (Journal of Anaesthesiology, Clinical Pharmacology,2016) highlights the fact that almost all districts in India have access to either a civilian or military airstrip which can be used for air ambulance services on request to competent authorities.

In the same article ,Khurana et al. (Journal of Anaesthesiology, Clinical Pharmacology,2016) mention that on a case basis, the cost of air medical transportation may seem expensive when compared to ground transportation and even in comparison to the actual cost of treatment but one the contrary, studies show it is cost effective due to the decrease in time to treatment, survival benefits, and quality of life years added.

In this retrospective analysis by Khurana et al, the authors highlighted that Cardiovascular diseases remain the most common cause for the need of transfer to a tertiary centre. According to their analysis, the limiting factor in the speedy air transport of critical patients has been the time required for the customisation of the aircraft and shortage of specialised equipment like IABP and extra corporeal membrane oxygenation and trained personnel.

While the most common complications found in their analysis by Khurana et al were disconnections of leads, intravenous tubing, and ventilator circuits, the authors confidently concluded that the air transportation carries no more risk than ground transportation.

Choosing the best air ambulance service based on the requirement

Transfering a patient via Aeromedical transportation calls for careful consideration. Transferring a stable patient may require minimal treatment in the flight but considering the demands of the flight environment that may impose physiological stresses on the patient may have a critical impact on the patient's condition calls for careful observation.   While using air ambulance service for unstable patients the risk is higher. Such patients are moved by air only when they cannot be treated before a flight. Unstable patients, usually, with a life-threatening condition,  demand a full medical team with resuscitation and airway-management skills. 


A Mehra explains the in-flight stresses that a patient will face, in detail in his paper. 

The upper troposphere is a hostile place. As air pressure declines, less oxygen is available for cellular metabolism. Gases trapped within the body cavities also expand with ascent due to changes in barometric pressure. There are other factors like motion sickness, vibration, noise, cold, fatigue, effects of G forces, dehydration and the psychological fear felt by someone who can imagine nothing worse than being locked in metal carriage tube flying at 805 kph (500 mph) at an altitude of 10,670m (35,000 ft.). Most healthy individuals can readily compensate these stresses; however, a sick and injured patient is palaced at risk, depending upon the nature and severity of the medical condition. 

-A Mehra. (Mehra A. Air ambulance services in India. J Postgrad Med 2000).


  • Choose the type of aircraft based on the medical condition. While most cases can be handled with a helicopter, some cases may require an airplane. Use of helicopters in an air ambulance is increasing owing to its convenience in landing and taking-off from a smaller ground area.
  • Licence and accreditation: Air ambulance must be licensed by the Directorate General of Civil Aviation (DGCA), which is the authorising body for airlifting services in India.
  • RSVM (Reduced vertical separation minima) certificate: An aircraft with this certificate need not fly lower or higher than the airspace, or seek special exemption from requirements.
  • Trained staff and technicians: They are well-informed about emergency procedures and in-flight care. The DGCA lays down guidelines regarding air ambulance crew training in India in conjunction with other medical agencies and institutes.
  • Choose operators wisely. There are brokers who arrange for air ambulances and there are operators who actually administer one. It is advisable to opt for an operator that is more aware of the patient’s needs and technicalities.
  • Insurance cover: Air ambulance costs are for obvious reasons more expensive than the ground ambulance service. They are not affordable for the general public at large, but with more players coming into the market, there is hope.
  • Services offered: Usually, the ones providing both emergency and non-emergency services are deemed to be better.
  • Compare before you choose: Compare the costs and services offered by various companies.

The Director-General of Civil Aviation has laid down category indications of the need and urgency for Aeromedical Transport(AMT)

Urgent: Patient for whom AMT is necessary to save life or limb, or to avoid serious permanent disability.

Priority: Patient who requires specialised treatment not available locally and who will suffer pain and disability unless evacuated with the least possible delay.

Routine: Patient whose immediate treatment can be undertaken locally, but who would benefit from further treatment in advanced care.


Service providers

AMB life can help find services based on location and they even provide a comparison between various services. It is a B2B online platform that allows private ambulance service carriers around the globe. Both air ambulances, as well as a ground ambulance, can be booked based on country, state, and city. Read reviews before making a choice.

Apollo Hospitals’ air ambulance network was set up in collaboration with Aviators Air Rescue last year. It is a pioneer in Helicopter Emergency Medical Services (HEMS) in India that currently covers six southern states of Karnataka, Tamil Nadu, Kerala, Pondicherry, Andhra Pradesh and Telangana. A trip could cost around Rs 1.6-Rs 2 lakh.

EMSOS also provides air ambulance and medical evacuation services, both within India as well as between India and other nations.

Some of the emergency air ambulance services available across India

  • Aviators Air Rescue, Bangalore
  • King Air Ambulance Services, Bangalore
  • Air ambulance International, Udupi
  • Air Rescuers, Mumbai
  • Hi Flying aviation, Mumbai
  • Air Ambulance Aviation, New Delhi
  • Aeromed International Rescue Services Pvt. Ltd., New Delhi
  • Air Ambulance Aviation, Goa
  • All India Air Ambulance - Guwahati Flying Doctors India, Assam
  • Panchmukhi Air Ambulance Services, Bhopal
  • Ganga air ambulance, Coimbatore
  • Panchmukhi Air Ambulance Services, Raipur


This article is contributed by Parvathy Jayakrishnan, a Bangalore-based freelance writer and a member of 101Reporters, a pan-India network of grassroots reporters.

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