Your complete guide to Medical Evacuations, Medical Repatriations and Air Ambulance Services Worldwide

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An Introduction to Air Ambulances

An air ambulance is an aircraft specially designed and fitted with medical equipment to facilitate the transfer of sick and injured individuals, as well as to accommodate accompanying medical personnel from one location to another over medium to long distances, often across countries and continents.

air ambulance

What types of medical transport options are available for patient transfer worldwide?

Air Ambulance Planes

Air ambulance planes, also known as fixed-wing air ambulances, are air ambulances that require designated airports and airstrips to take off and land at. They are preferred for medium to long-distance flights nationally, across borders, or across continents since they can cross these over shorter periods of time. Air ambulance planes are equipped to a similar level as intensive care wards (ICU), and, with an experienced doctor on board, they are able to transfer most intensive care patients. 

Air Ambulance Planes are categorized according to their power source:

Jet planes are powered by jet engines. They can cover long distances at high altitudes, and are preferred for long-distance medical flights within a continent, or medical flights across continents due to their ability to fly over longer ranges. 

Turboprop planes are powered by propeller engines, and can generally cover medium to long distances within the borders of a country, or between bordering countries, due to having shorter flight ranges. 

Air Ambulance Helicopters

An ambulance helicopter, also known as a rotary-wing air ambulance, is powered by large rotary blades positioned above the aircraft to provide lift, which gives it the ability to take off and land vertically. In most cases, flying intensive care patients is possible, since they also provide the benefit of direct hospital-to-hospital transport (in some cases, even across countries) eliminating the need for more time-consuming ground transportation upon arrival at the destination. However, it should be noted that they are ideal for short distances only, such as to fly from one destination to another within the same country.

Scheduled Commercial Flights

Scheduled commercial flights are flights on regular commercial airlines whereby the patient is accompanied by a doctor or a paramedic, and can be transported in a business class seat, or lying down on a stretcher depending on their condition. In cases where a stretcher is deemed necessary, it will be specially installed in the cabin for that flight only, for the purpose of transporting the patient in question. A privacy curtain is installed to protect a patient’s privacy. Scheduled commercial flights are the cheapest of air ambulance options. Moreover, relatives may be assigned regular seats close to the patient and can, thus, travel with him/her as accompanying persons.

Ground Ambulances

For shorter distances, typically from one hospital to another, ground ambulances are the preferred choice. They come readily fitted with medical equipment that can be tailored to the patient’s needs, as well as those of accompanying medical personnel on board to facilitate the transfer of the patient. However, ground ambulances are subject to a lot of unforeseen risk factors, such as traffic delays and road accidents, which may put the condition of the patient at risk specifically when traveling across the country.

What medical equipment comes fitted in an ambulance plane?

Medical Air Service’s ambulance jets come fitted with the following equipment to provide maximum safety for you and your loved ones:

  • Intensive care unit with vacuum mattress and patient loading system
  • Central oxygen tank and optional reserve tank
  • Multi-parameter intensive care transport monitor
  • Compact defibrillator/monitor system
  • Intensive care respirator
  • Portable blood gas analyzer
  • Satellite telephone.

The above list is just a selection of the available medical equipment on board. However, each flight is tailored to fit the unique needs of the patients, as we can source extra equipment, depending on the patient's pre-existing medical condition, to maximize their safety and well-being throughout the flight.

icu equipment

Medical Staff on Board

All Medical Air Service ambulance flights come with a qualified, highly experienced medical crew to accompany patients during their medical flight. As such, in the event of a medical emergency, they can intervene immediately.

The Difference between a Medical Evacuation and a Medical Repatriation?

What is Medical Evacuation?

Medical Evacuation or medevac is the organized procedure of transporting a patient who wants to leave their home country or current location to have access to better (sometimes even world-class) medical care and/or to be closer to relatives who have moved to another country.

What is Medical Repatriation?

Medical repatriation is the organized procedure of transporting a patient back to their home country. Patients opt for medical repatriation for a variety of reasons, which include access to better medical care, being closer to their friends or family while receiving treatment, or to avoid any potential language barrier in the country they are currently located.

In both cases, an air ambulance is the ideal form of transport to transfer the patients, for a variety of reasons that we shall cover below. 

Reasons to pick an air ambulance plane for an evacuation or repatriation?

An air ambulance plane is the best option of transport for an evacuation or repatriation for the following reasons:

  • It allows patients to be transferred safely and quickly from one location to another considering their condition, as it has a similar level of equipment as an intensive care ward.
  • It facilitates the transfer of patients who may not have access to specialized treatment in their current location abroad to see specialists.
  • It gives patients the chance to be treated at a hospital of their choice back home, in the event they get injured or they fall ill while being away from their home country, and to be closer to their family and friends.

What are the potential risks of flying on an air ambulance?

When traveling via air ambulances, patients do not have to worry about anything when it comes to safety and comfort. Ahead of the trip, Medical Air Service will already evaluate the patients’ current and pre-existing medical conditions to assess whether they are fit to fly without any risk. 

Moreover, the air ambulances have been equipped with all the necessary tools to offer you the same care as an intensive care unit and medical professionals accompany patients during the trip to assist them. So, all precautions have been taken to ensure a safe and risk-free travel. 

Being as transparent as possible, we wish to point out that there are unforeseen circumstances and incidents which are beyond our control that can affect a patient’s air ambulance journey. These are caused by: 

Misleading Medical Documentations

Before the flight, patients’ medical condition and their fitness to travel are assessed by our physicians. This assessment is based on several factors: medical history and consultations with other doctors. The issue here is that the original documentation may contain misleading and erroneous medical data or essential information may have been withheld or misreported by local doctors. Of course, this would lead to an inaccurate assessment affecting the flight. 

Having your best interest in mind, it might happen that a flight is cancelled following our physician’s examination of the patient at the hospital. If our doctors judge that the patient is not fit for travel, it is not viable to take additional risks for the patient. 

Unexpected Changes in the patient’s condition

There might be some cases when the medical data is accurate, but still complications arise during the transfer, even after a green light from the physician. This occurs when the patient’s health rapidly or suddenly deteriorates. Usually, flights are scheduled as soon as possible, on the same day or the following day, to decrease the risk of the situation worsening. Additionally, in case of deterioration, our physician will assess the patient’s condition before the flight. Nonetheless, some changes may not be detected before take-off, which might lead to complications during the flight. 

The patient’s unwillingness to cooperate

No transfer is scheduled without the approval of patients or their caregivers, in case the patient is unable to make sound decisions. In most cases, patients are willing to be helped and they cooperate completely during the transfer which facilitates the whole process. 

An uncooperative and unaccommodating patient might increase the risk of complications during the flight since he will be obstructive and unwilling to accept the help of our medical team. 

It can also happen that the patient or caregiver wishes to cancel the flight, in which case, the mission is aborted. 

Residual Danger

In this case, the residual risk would be the stress experienced by the patient. Medical Air Service is aware that the situation is quite nerve-wracking for the patient. Hence, we take all the necessary precautions to ensure that the transfer is smooth and the patient is as comfortable as possible. Despite our efforts, the patient might still feel anxious or stressed which may impact on his health. To cater to this problem and to stabilize the patient, if need be, we have doctors and the necessary medical equipment on board. Moreover, a loved one can accompany the patient to calm him down and offer reassurances. 

Sea level flights: When are they needed?

Certain illnesses or medical conditions may require patients to be transported by air at sea level. This is possible since in air ambulance jets, the cabin pressure can be modified to closely correspond to the air pressure at ground level. For a sea-level flight, the plane flies slightly lower than the altitude of a commercial flight. This is a vital measure to prevent certain medical conditions from worsening.   

These conditions where sea level flights are recommended include:

  • air accumulation between lung and chest wall (pneumothorax)
  • air pockets in the eye or skull
  • intestinal obstruction
  • new surgical wounds
  • anemia

Our medical team will consider a patient’s medical records, to determine whether a flight at sea level is advisable. 

Air Ambulances vs Commercial Flights

Air ambulances are private medical flights whereby an ambulance aircraft is chartered for the transfer of the patient. In contrast, a commercial flight is whereby a patient is transported onboard a scheduled planed by a commercial airline accompanied by a medical professional (usually a paramedic). This option is best suited for patients who are in stable condition.

commercial flight

However, there are situations during which a commercial flight is not a viable solution and an air ambulance is the better option. These are: 

When a patient is too sick to fly on a commercial flight

In a lot of cases, the patient is too sick to travel via a commercial flight which would not offer the same level of care and comfort as a private air ambulance. Our air ambulances are fitted with all the equipment needed to provide intensive medical care to seriously-ill patients during the flight. Since it is more spacious, the patient will be able to lie down comfortably and our doctors can operate without being cramped as in a commercial flight. Moreover, the cabin pressure in our air ambulance can be adjusted to cater to the needs of patients with medical conditions like anaemia and pneumothorax. 

For quick and immediate flights

Commercial flights require one to book a ticket for a scheduled departure time, which may not always be possible in urgent cases as their availability is not guaranteed. Private medical flights, however, are readily available to be dispatched to the destination of choice.

For direct flights to the destination

Commercial flights may sometimes require a stopover and a connecting flight in order to reach a destination. This ends up taking valuable time that a patient may not have. Private medical flights, in contrast, fly directly to the destination without the need for stopovers. When they do have to make stops, it is for very short time periods.

When in need of shorter lead times

In cases where a patient may require to be transported by a stretcher, a commercial airline will take between 1 and 2 days to determine whether it is possible to transport the patient, which is time that the patient may not have. Private medical flights, on the other hand, can be dispatched almost immediately.

If the patient or their caregivers would like privacy

Certain patients prefer to maintain their privacy when unwell, which commercial airline flights will not be able to offer fully. Private medical flights allow patients to fly for treatment in privacy and comfort, with the option of being accompanied by family or friends on board.

The risks when flying a sick or injured person on a commercial flight

When patients are in a stable condition, and the case is not urgent, then the best option for medical repatriation is often via a scheduled flight because of the lower costs. However, there are certain risks involved. These are: 

  • Refusal from the airline to carry a patient: the airline might decline to transport a patient via its commercial flight because of the risks to the company, the crew, or the other passengers. 
  • Lack of proper equipment: a commercial flight does not have the necessary equipment needed to deal with a crisis if a complication occurs. 
  • Lower oxygen levels may not affect healthy patients, but will likely be an issue when transporting a patient with certain pre-existing conditions such as lung disease.
  • Risks of infections: A patient with weak immunity or pre-existing condition sharing limited space with 200 other individuals on board the plane, increases the risk of an infection spreading.
  • Dehydration, as the air circulating inside a cabin tends to be very dry
  • Increased distress for the patient, due to the process of navigating the airport, embarking and disembarking the aeroplane, and using transit flights.

Organ Transport via Air Ambulance, what to know?

Organ transport is a process that requires rapid action, as the viability of the organ is very time-sensitive, Air transport, in combination with a global network with the shortest lead times possible, is, therefore, necessary to make organ transportation a success and to save the patient’s life.

Air ambulances that are dispatched to carry out organ transport come with the latest medical equipment as well as experienced personnel on board. If the destination airport can only be reached by slower ground transport, an ambulance helicopter can be used due to its ability to land directly at the hospital, thereby reducing transit time.

Contrasting Casevac Vs Medevac

Casualty Evacuation, or CASEVAC, is the transportation of badly injured persons from the scene of an accident to a hospital or trauma facility where they may get prompt medical care. In a military setting, it refers to the transportation of badly injured people, whether civilians or troops, from the scene of the accident to a hospital or trauma centre where they may get prompt medical attention. Although the patient can be evacuated by vehicle, by air is the most usual form of CASEVAC. Neither the trucks nor the aircraft used for CASEVAC are purpose-built, and they may have little or no medical equipment on board to offer medical treatment while en route. Because the patient's life is on the line in these cases, time is of the essence. As a result, general-purpose planes and vehicles are selected based on availability, with the objective of ensuring that the patient arrives on time.

Medical evacuation, or 'MEDEVAC,' on the other hand, is the organized practise of moving patients to a medical institution for additional medical assistance, either from the scene of the accident or from one nation to another. Medevac occurs when a patient wishes to leave his native country in order to obtain better (often world-class) medical care and/or to be closer to a family member who has relocated to another nation. Most patients have already received prior medical assistance and are in a stable state at the time of the evacuation. MEDEVAC is performed by air or road, with specialist ambulance planes and ground ambulances providing en route treatment for the patients. During the travel, Medevac patients are accompanied by medical personnel who provide care for the patient mid-air and oversee the correct handover of the patient to the destination medical facility.

Determining your fitness to fly

Before a patient with acute illness, chronic conditions, or during pregnancy takes a medical flight, their condition is thoroughly assessed by a number of specialists in order to give clearance that they are fit to fly.  

Who determines fitness to fly for commercial flights?

A patient's general practitioner, or doctor at the current hospital they are receiving treatment from, is often the first person to determine the patient's fitness to fly. They will fill in an assessment form outlining the patient's current condition, and mention any underlying conditions.

For a scheduled commercial flight, the airline may often conduct its own assessment of the patients’ condition by looking at the patient’s medical records to determine their fitness to fly.

Why determine a patient’s fitness to fly?

A patient’s fitness to fly is determined for two reasons: first, the patient’s condition may worsen as a result of the change in air pressure, cabin pressurization or any other unforeseen risk factor that may occur in transit. Secondly, in the case of a scheduled commercial flight, the patient needs to be ascertained that they will not be a risk to the other passengers onboard the flight. It’s for this reason that an airline conducts its own assessment, and has the final say when determining the patient’s fitness to fly.

In some situations, a patient can only fly on a scheduled flight if accompanied by a medical escort, such as a doctor or paramedic. If the passenger’s health condition requires that they travel lying down, a stretcher is installed inside the passenger cabin.

The final decision of whether or not a patient can board a commercial flight lies with the airline company, which will take into consideration the hospital doctor’s recommendation. However, if a hospital doctor says the patient isn't suitable to travel, don't take their word for it; you can get a second opinion to have a better idea of the situation.

Flying after Surgery- What to Consider?

Whether it is safe to fly or not after a surgery greatly depends upon the type of procedure that is performed. Minor surgeries rarely pose risks of post-surgical complications when flying. However, flying soon after a major surgery, specifically commercially,  might be dangerous to the patient's health because of the possibility of infections, deep vein thrombosis, or blood clots.

The changes in cabin air pressure in commercial flights can be particularly dangerous. This is compounded by the lack of medical equipment and proper supervision in the plane, in the event that complications do arise. Therefore, consultation with a doctor is always important to ensure a patient is fit to fly.

surgery patient

Despite obtaining a doctor’s approval, a commercial airline might not agree to have you aboard. Taking this and the fact that commercial flights are not equipped with the facilities needed to properly treat you in case a complication arises into consideration, an air ambulance is often the most suitable option if you need to fly. 

Most Common Injuries and Illnesses to consider for Medical Flights abroad

Cancer & Tumour Diseases 

As a cancer patient’s health starts to deteriorate towards the later stages, travelling can be a challenge for them. What’s more, cancer patients often require medical support while travelling from one destination to another.

Air ambulances come with qualified medical personnel, together with all the necessary medication and medical equipment, and are therefore the best option to fly cancer patients abroad and to safely take them to the specialists that they require to see. In cases where air pressure may cause further complications for cancer or tumour patients, air ambulances that provide sea level flights can be taken.


Coronavirus is a highly infectious disease that can easily spread by air or infected surfaces. Medical flights via commercial airlines are therefore not only inadvisable, but also impossible, as airlines require passengers to have tested negative for COVID-19 beforehand. 

As a result, air ambulances are ideally suited for transporting COVID-19 patients, as they will implement special isolation measures to protect the patient's safety and prevent infection of the medical crew.

Before the patient is flown, our medical team first determines whether the patient is fit to fly. Once this is confirmed, the patient will be transported in isolation, by using a modern isolation device that lets the patient lie down comfortably, while also being ventilated to ensure the patient has a constant supply of oxygen and to prevent the virus from spreading with the used air. The patient is also accompanied by a flight doctor who will be responsible for the medical safety of those on board the air ambulance

Bodily Injuries 

Body injuries and trauma can cause extreme discomfort when flying on a commercial airline, due to the time spent on the flight, as well as while boarding the plane, and connecting flights,  as certain routes might not have direct flights.

Therefore, air ambulances, are the best option for the transport of patients with bodily injuries since they are more spacious and will allow the patients to board/ alight from the flight and travel in the most comfortable and safe way, without any delay.  


When a stroke develops, blood flow to certain areas of the brain is cut off. In the worst-case scenario, some regions of the brain may suffer irreversible damage. It is not recommended for someone who has just suffered from a stroke to fly long distances on commercial flights since the air pressure inside the cabin is lower, which means that less oxygen is carried to your brain. This may increase the risk of strokes or TIA. As such, if you need to travel just after a stroke, an air ambulance is the better option since it offers the benefits of medical equipment and medical staff on board of the plane to ensure patient’s safety. 

Cardiovascular Diseases 

Cardiovascular disease patients have to take additional precautions when flying. Many of these travelers have pacemakers or automated defibrillators implanted or they have undergone surgery which increases the risks of DVT.  As such, traveling via a commercial flight is unsafe since appropriate care cannot be given to them en-route. In contrast, air ambulances are fitted with the necessary equipment, and medical staff needed to care for the patient, even if he is in a serious condition, during the trip. 

Air Ambulance Costs - What determines medical flight prices?

There are many factors that lead to the final cost of an air ambulance:

  • The distance between the two countries will definitely influence the cost. However, longer distances do not always mean higher prices.  
  • The patient’s condition: Certain medical conditions require more accompanying doctors or equipment to be fitted in a plane. Additionally, sea-level flights imply more time taken to reach the destination. These factors would definitely increase the cost. 
  • Notice of flight: One way to save some money is by booking life flights in advance. However, in an urgent situation, if an air ambulance is not available close to the place of departure, there might be some additional costs. 
  • Accompanying persons: Our air ambulances can usually cater to one additional person, for free of charge, besides the pilot and the medical team. However, if the patient wishes to be accompanied by more people, then a bigger, more expensive aircraft would be needed.  
  • Ground Ambulance: Medical Air Service also offers bed to bed services at an additional charge if the patient wishes to be transported to and from the airport via an ambulance.

Understanding the role of medical insurance

Insurance covers for medical flights often vary from one insurance provider to another. Some insurance plans and providers may cover all air ambulance costs, but many others place limitations on the services they cover. Most insurance companies, on the other hand, would not cover the costs of non-emergency medical evacuations, or what is not deemed to be medically necessary. It is therefore advisable to contact your insurance provider and find out directly which services they’ll cover before booking an air ambulance, in order to determine whether you may need to add coverage. 

Why fly with Medical Air Service?

  • Our team is available 24/7 for a free, no obligation consultation.  A team of our experts, not call centre agents, will assist you directly 
  • We are a worldwide air ambulance firm that can send an air ambulance to any country in the world in a matter of hours, whether you opt for a scheduled flight or an intensive care transfer with an ambulance aircraft. 
  • We have decades of medical aviation experience and decades of experience in arranging transport from hospital to hospital. 
  • Our air ambulances come equipped with the latest medical equipment and with medical experts having decades of experience and specialized knowledge to cater to a wide range of medical emergencies.
  • Not only do we facilitate the transfer of patients, but we also facilitate arrangements for the travel documentation on his behalf</strong>. We use the most appropriate mode of transportation to ensure that journeys are organised in the quickest, safest, and most cost-effective manner possible.
  • Regardless of language barriers, our staff ensures direct, unambiguous communication with patients, relatives, and medical personnel around the world.

What to expect when booking an air ambulance flight

Before The Flight 

Before a patient boards an air ambulance, their current condition is thoroughly assessed in order to determine whether they are fit to fly, and if they need any special medical equipment for the flight besides what the air ambulance comes fitted with, to ensure their safe transport.

During The Flight

The patient will be accompanied by a highly experienced, specialist medical crew alongside intensive care physicians onboard the flight to ensure a safe trip, even for those who require intensive medical care.

After The Flight

Patients who are traveling with us receive excellent care and arrive at their destination as quickly as possible to be handed over to the team on the ground who will be ready to receive the patient. In case you book our bed-to-bed services, our team will be ready to receive the patient and dispatch them to the hospital as quickly and seamlessly as possible.

ambulance jet

Rent an Air Ambulance in 3 easy steps

Renting an Air Ambulance with Medical Air Service is done in 3 easy steps!

Contact us

The first step to booking a flight with us is reaching out.

We are happy to call you back, free of charge, to engage with you and clarify your needs, before providing a free estimated quote and giving you time to consider our offer and get back to us.

You will then receive a written quotation from us upon completing all flight plans, that lists the flight details (e.g., the flight time, the meeting point, the pick-up time, etc.).

Medical assessment by our physicians

The patient’s medical condition and safety is our first priority. We will begin to organise an ambulance flight even though we haven’t received all the documentation needed. 

We require the patient’s travel documents, such as passports and visas, along with their medical assessment from the clinic or hospital they were receiving treatment from. However, this is not necessarily a requirement since our multilingual physicians will study the patient’s notes, or their translation, prior to the medical repatriation. The patient's medical state is thoroughly evaluated before travelling to see if they are fit to travel by air.

Consultation with family members

After the medical assesment, our clients  are consulted before the flight. They will be informed about flight details and about the precautions we are taking to handle any medical crises that may arise while in the air.

Contact us for an air ambulance 

If you are in need of a private air ambulance, wherever you are across the globe, Medical Air Service is here to help you out. We can arrange for a flight for you even in the most remote location.

Get in touch now