The aeromedical sector in the former Soviet Union is in a race to meet a huge gap between supply and soaring demand as Robin Gauldie reports

Business travel to eastern Europe is booming, with air travel to the region up by more than 15 per cent since 2005 – largely driven by the booming oil and gas industries of Russia‘s Siberian ‘wild east‘, the Caucasus and the central Asian republics. Over much of the region, the climate is severe, the terrain inhospitable, the public health infrastructure poor and the level of violent crime and accidents due to human error high. Much of Russia and most, if not all, of the former Soviet republics have inherited rail and road infrastructures that have hardly improved, indeed, have deteriorated in many cases, since the Soviet era. Distances are huge and that makes being able to call on emergency medical evacuation services an essential for business travel insurers. However, has the aeromedical sector in Russia and the CIS risen to the challenge of providing adequate medevac facilities for the fast-growing number of western travellers to the region? The answer is both yes and no.

Ironically, medevac facilities may be better in some of the most remote regions, where the need to service strategically vital and highly lucrative oil and gas installations was evident even in the Soviet era. Russian-built helicopters have earned a strong reputation for reliability and performance in extreme conditions and have benefited in the last decade from being retrofitted with superior Western-made avionics. Their crews, too, have an admirable reputation for risk acceptance in pursuit of the mission. However, there is a worrying shortage of qualified personnel and dedicated medical evacuation crew, according to aeromedical practitioners in the region. “There is a growing need for aeromedical transportation both inside Russia and to and from Russia ,” said Dr Vladimir Budiansky, president of the newly formed National Council for Transport and Aviation Medicine. International business travellers seeking emergency repatriation to the West drive most of the demand and the majority of patients, according to Budiansky, are those working on remote and relatively high-risk oil, gas and construction sites. But the region lacks the equipment to meet demand on its own, he added, and that creates logistical and cost issues for companies providing medical evacuation services for the insurance industry: “At the moment there are no real air ambulance planes in Russia . Russian-made business jets with medical equipment installed are used for medical evacuation inside Russia .” Often, for international repatriations, air ambulances from nearby Finland , Germany or even Switzerland are used, with a mix of Russian and international medical personnel.

Building up an adequate national aeromedical fleet, with dedicated aircraft at key bases across the region may be a simple matter of investment and with Russia ‘s privatised energy industry generating vast revenues, it must surely be only a matter of time before that investment is forthcoming as the country‘s oligarchs spot a gap in the market. However, it may not be as simple as just throwing money at buying new aircraft. The big shortage is in trained personnel. “There are not a lot of professionals in the CIS region,” said Budiansky. “At the moment, in our view, the number of civil aeromedical professionals is limited to 10 to 15 doctors. There are about six pilot crews who have a large experience in medical evacuation.” As a result, thousands of clients who may be better served by dedicated medical evacuation flights are at present being flown home on scheduled commercial carriers. That‘s not an ideal situation for the client or the insurer, with an array of risks attendant on delayed treatment and patient stress, and significant additional costs. “It is difficult to assess the number of air ambulance flights,” Budiansky explained. “Overall, it is about 150 to 200 missions a year, but including those transported on commercial carriers we think the number is closer to 10,000 people a year.” Budiansky believes the number of aeromedical cases is growing at up to 100 per cent annually and expects that growth rate to continue. “Very soon, the number of fixed wing transfers will be comparable with the US ,” he claimed. Whether the region‘s investors will rise to the challenge of developing a local aeromedical sector to meet that demand, or whether the gap between supply and demand will continue to be met by outsiders, remains to be seen. But the local suppliers could have one big advantage: price.

The average flying cost of an air ambulance flight in Russia is between US$1,500 and US$3,000 per flight hour – somewhat cheaper than in the west. The cost of medical crew is significantly cheaper at a miserly US$70 to US$100. If only there were more of them...

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