Air Ambulance Charter: Health Care Up High

Charter aviation (at least for human passengers) is usually associated with two endeavors – work, and play. The smaller jets popularized by corporate clients and the airports specializing in them are widely described as comprising “business” aviation; however, no few customers hire them instead for leisure travel – sporting events, extreme adventures, family getaways and more.

But, while jobs and vacations combined drive a lot of private jet travel, there is another growing category boosting demand – air ambulance charter. Whether the patients involved are seeking to return to their home countries for necessary procedures, needing to travel comfortably before or after surgery or looking to reach highly specialized medical care, the sky is increasingly the best way to reach their destinations.

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While many may dream of skipping commercial airports for charter ease when business or leisure are involved, no one seeks to require charter air options as a patient. However, the need for air ambulance services continues to exist nonetheless – and is only expected to grow. If you’d like to know more about how air ambulance charter might benefit you, read on.

Wartime to Peace

Aviation as part of health care dates back to World War I. In 1917, a wounded British soldier in Turkey was flown to a hospital in less than an hour – much faster than a trip could be made on the ground. Military records indicated significant survival gains for injured who could be flown to hospitals from the front. World War II only accelerated the trend toward aviation in battlefield medicine, with the U.S. transporting casualties from jungles in the Pacific theater to medical facilities in safer locations.

In between the two World Wars, Australia developed what would grow into its Royal Flying Doctor Service to allow residents of rural areas to reach lifesaving medical care. After WWII, Canada introduced similar services for its own remote locations. In the Vietnam War, the U.S. increasingly used helicopters to evacuate those from the battlefield who needed health care, with this new option eventually adopted by civilian entities back home, in Canada and in Europe.

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As worldwide health care became more interventionalist and sophisticated in the 20th century, the need for speed in treatment drove demand for rapid response even in peacetime. Today, the first hour after a traumatic injury is known as the “golden hour” in which prompt treatment can boost survival and lower the risk of long-term complications. Donated organs intended for transport can only last a short while outside of the body. Increasingly, flight isn’t just a welcome extra – it’s integral to the functioning of a modern medical system. Globally, the air ambulance market is estimated at around $20 billion – and is expected to more than double in size in the next decade.

COVID and Beyond

While militaries often have their own dedicated medical transports and health-care systems operate life flights and flying doctor services, sometimes, other options are needed. Those traveling for leisure or work can turn to scheduled service airlines; however, typically those traveling due to medical needs require a more bespoke solution.

Some medical charter customers are travelers looking to return home more quickly than expected after developing unexpected complications while traveling abroad. Expats happy to live in cheaper developing countries on a regular basis may prefer repatriation to their countries of origin when health problems strike. Still others are patients seeking access to “centers of excellence” such as Houston’s MD Anderson for cancer or the Cleveland Clinic for heart and vascular care.

“The majority of our cases involve cardiac conditions, with an average patient age of 67 years old,” says Brent Gateman, aeromedical manager at Sunwest Aviation Ltd. “Most of our work is repatriation and interfacility transfer, moving patients to the right level of care or closer to home.”

As scheduled service air travel has become increasingly complex and time-consuming, the advantages of charter air travel in the medical field have become even more evident. “Unlike commercial aviation, private charter eliminates the extended ground times associated with security processes, boarding procedures and potential delays that could prove critical in medical situations,” according to medical transport provider Paraflight. “Medical missions have become a significant driver of charter demand.”

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When the COVID-19 pandemic hit in 2020, medical transport services were called upon to assist. “When COVID was at its peak, the majority of requests we received were related to the pandemic,” says Musa Gürçay, managing director of Medjet Medical Assistance Ltd. “However, over time, the number of pandemic-related requests gradually decreased. Today, we rarely receive COVID cases.”

The increased capacity and additional measures added at the height of the pandemic did not vanish when COVID receded as a major concern. Once introduced, practices such as enhanced safety protocols and specialized infection containment have remained in use, along with incorporation of telehealth for assessments and consultations en route.

“COVID raised the bar on process,” says Sunwest’s Gateman. “Clients expect faster answers, clearer fit-to-fly decisions and documented infection control.”

Size Matters

While tiny private jets may work for corporate tours and tourist jaunts, medical transport is a different matter. Air ambulances need a lot of equipment – oxygen machines, ventilators, IVs and stretchers all take up room. While helicopters can serve for short-distance trips for, say, a victim of a car crash headed to a nearby ER, a true air ambulance requires going bigger.

 “Aircraft with a wide fuselage are ideally suited for air ambulance missions,” says Medjet’s Gürçay, who mentions the Challenger 600-605 and Citation Sovereign models as examples. “These aircraft offer the possibility of transporting two patients at once, allowing both medical personnel and companions of patients to be carried.”

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 Outside of TV hospital dramas, medical aviation typically involves more (human) maintenance than active diagnosis or complicated treatments. “Anything that needs imaging, lab work or definitive treatment waits until the receiving facility,” Gateman points out. “Our focus is a safe transfer, maintaining or improving vitals and comfort in support of a clean handoff.”

 Safety First

Unsurprisingly, safety is a preeminent concern in the medical aviation field. While outright accidents are not unheard of – such as the January 2025 crash in a Philadelphia neighborhood of a Learjet 55 serving as a medical transport – the more frequent concern revolves around illness and infection.

“Infection control protocols involve cabin and equipment cleaning between every patient and a complete fogging for sanitization after infectious patient transports,” says Gateman. “There’s a defined turnaround process, and speed never replaces compliance.”

 Multiple industry groups offer accreditation in the medical aviation sector for the various parties looking for reassurance. The Commission on Accreditation of Medical Transport Systems (CAMTS), representing multiple medical and aviation organizations in North America and Europe, first offered accreditation in 1991 following several accidents involving medical transport helicopters. In the U.S., many government jurisdictions require CAMTS accreditation for companies wishing to provide medical transportation.

 However, CAMTS only offers accreditation to companies operating for at least a year. For U.S. medical aviation providers operational for at least six months, another alternative is the National Accreditation Alliance of Medical Transport Applications (NAAMTA).

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 For medical air transport companies based on Europe, the European Aero-Medical Institute (EURAMI) offers accreditation to fixed-wing air ambulances, rotary-wing air ambulances and commercial airline medical escorts that meet its mandates. Providers who have operated for at least two years with a minimum of 250 medical flights can apply for accreditation.

 All three organizations assess policies, procedures and training programs to ensure they meet certain standards for accreditation. Typically, the assessment process involves on-site visits by evaluators seeking to ensure that the equipment, aircraft and personnel involved in air ambulance services are reliable.

 Miles Are Money

Having been reassured about safety, many potential air ambulance customers turn to questions about pricing. In air ambulance charter, distance and flight duration represent the main cost drivers. Aircraft requirements also influence the final price tag – stable patients may be okay with basic life support, while very sick patients requiring measures such as Extracorporeal Membrane Oxygenation (ECMO) machines to keep them alive need both specialized equipment and highly trained medical personnel.

Paraflight estimates that domestic air ambulance charter flights under 1,000 miles in the U.S. will typically cost somewhere in the range of $40,000 to $75,000, while international medical repatriation starts around $100,000 and goes up from there. Urgent or emergency transport requires an additional premium, as does specialized ground transport.

For those looking to balance cost with effectiveness, providers may be able to suggest various options. Medjet offers smaller planes such as Citation Bravos or Hawker 400s for single patient transfers, for example, as well as escorting customers flying on commercial or other non-specialized aircraft who do not need a full air ambulance, but still require health oversight by a professional. “We aim to be competitive in our pricing,” says Gürçay.

Moving Forward

Medical aviation companies often have to get comfortable with navigating infrastructures in multiple countries. In addition to the specific practices and resources involved in each nation’s health-care system, broader mandates such as border controls, permitting and laws can make things really complicated really quickly.

Gateman recalls a patient who wished to return to their home country in Eurasia from North America at the end of their life, with a Do Not Resuscitate (DNR) order in place. However, while DNRs are recognized in Canada, where the patient was traveling from, they are not in the patient’s home country.

“During the ground ambulance transfer upon arrival, the patient’s condition deteriorated,” Gateman recalls. “This created an immediate conflict, as the Canadian medical team was obligated to honor the DNR, while the air ambulance crew was legally required to intervene. The situation was further complicated by a language barrier between the teams.”

Those in the industry only expect more complexity in the future. In developed countries, health-care costs are rising as new treatments are being introduced and the average age of the population increases. General inflation is pushing up costs further. As health care gets more and more complicated and more in demand, air ambulance charter is expected to follow suit.

“For now, the constant increase in costs is one of the biggest challenges we face,” says Medjet’s Gürçay. “We predict significant technological advancements in the aviation sector in the days to come, such as drone ambulances and other innovative services and products.”

Both in the present day and in years ahead, collaboration and focus will stay vital for air ambulance charter providers and their customers. “Over time, we expect more standardization in quality and clinical governance, more demand for transparency in protocols and tighter integration with insurers and case managers,” says Sunwest’s Gateman. “Operators that can be innovative problem solvers, efficient, consistent and strong team players with insurers and assistance companies will lead.”