Fox Flight study of 3,905 air ambulance transports finds age, trauma and ventilation linked to in-flight events
Why It MattersEvidence from a cohort this large gives air ambulance providers a data basis for pre-flight risk screening and crew staffing on long-range repatriation flights, where in-flight escalation options are limited.
A retrospective study of international medical repatriation missions flown by Fox Flight Air Ambulance, a Toronto-based medical transport provider, has been published in the Air Medical Journal. Led by Fox Flight Medical Director Dr Raymond Kao, it analyses data from 3,905 individual patient transports conducted between 2009 and 2024. Most patients were over 60 and had conditions including orthopaedic trauma and cardiovascular, neurovascular and infectious diseases.
The retrospective observational cohort study extracted chart data on demographics, diagnoses, transport modality, team composition and medical interventions, with the aim of describing patient demographics, clinical indications, transport characteristics and in-flight events in international fixed-wing air medical repatriations. Dr Kao said there is relatively limited research in this area, particularly involving a cohort of this size.
Subgroup analysis found significant associations between in-flight interventions and mechanical ventilation, team composition and age group. Independent predictors of in-flight events were age, orthopaedic and trauma diagnoses, neoplasm-related diagnoses, oxygen therapy and invasive mechanical ventilation. The findings may help inform risk assessment, team composition and operational planning for repatriation missions.
Dr Kao noted that air ambulance medical teams are limited in what they can do: if a patient's condition changes during a transfer, the team cannot easily access additional diagnostic testing or specialist consultation. That makes careful pre-flight assessment, selection of an experienced team and anticipation of in-flight changes particularly important. The study notes that international travel is projected to reach 1.8 billion trips annually by 2030, with older and medically more complex travellers placing additional demands on air ambulance services. Dr Kao is a Professor of Medicine at Western University, an internist and critical care physician at London Health Sciences Centre, and has been Medical Director of Fox Flight Air Ambulance since its inception.
