How do Air Ambulance Companies Work?

FlyMarines09

FlyMarines09

Well-Known Member
Good Friday Evening to everyone,


I assume that they're all Part 135 operators and work in a similar fashion as any other charter company. How do they get started in the industry and how do they contract their aircraft and services? Do they charge a patient or a hospital or an insurance company? What extra rules and regs do they follow?
 
I was thinking fixed wing. I see a lot of companies out there with like King Air's or Citation's. I'm curious about the ins and outs of the business. I did a brief search on the subject and didn't really find anything. I'm interested in having a Part 135 operation one day and this is just a curious option that I may want to consider.
 
We have a couple Air Ambulance Fixed Wing pilots on here. Hopefully they'll chime in soon.
 
In NM I saw PC-12's and 400 series Cessnas.

My old boss used a KingAir 90 and a few Lear 35's.

Probably just like any sales gig you call 'em up and offer your services. But ya gotta have a plane first.
 
wheelsup said:
In NM I saw PC-12's and 400 series Cessnas.

My old boss used a KingAir 90 and a few Lear 35's.

Probably just like any sales gig you call 'em up and offer your services. But ya gotta have a plane first.
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I believe my instrument CFI flew for Sevenbar in ABQ...Is that your old boss?
 
I believe most companies get started by first marketing the region you want to serve. You want to make sure there is a need your service before you jump through all the hoops. Most people start by finding an aircraft owner who is willing to let you do a leaseback on their aircraft and use that aircraft for 135 ops. I've heard it takes anywhere from 18-24 months to get an aircraft approved to be put on your charter. That's probably a few things you would need to look at in prep for forming the company.
 
The Seneca we bought was used as Air Ambulance under PART135, it has an STC to put the stretcher.

The former owner told US that they could not make a living out of that and that it was a really expensive operation...ESSCO sells a book on how to start an Air Ambulance Service
 
I've seen a lot of the products offered by ESSCO, never bought any though. Their product description on their website is somewhat vague. Has anyone bought their products? If so, how would you rate them. They have an air taxi manual package for $250 and a "How to Start an Air Charter Company" for $6.95... Not sure what to make of the price difference. Anyone have any insight?

Also, thanks for the previous replies.
 
The market is highly saturated/competitive - if you looking at the bidding mechanisms the ride goes out to so many companies and whoever has the lowest big gets the patient. Payment is mostly from the insurance companies/private payers, though you will find hospitals flying people home as it is cheaper to spend $20k and them out of the country, rather than EMTALA keeping them in an ICU bed here in the US. The best way to probably operate would be a hospital based program like SevenBar and Texas Childrens - but on the fixed wing side, how many critical care 300+ mile transfers do hospitals really have and then you would really need to convince the refering doctors to change. If you want to look at Boston a hospital mecca, BMF only has 1 fixed wing. I know from my work in the ICU, we have had 1 patient in 6 months go via fixed wing.
 
When I was working charter in Florida, we did some Air Med stuff. All of our ops in this regard, dealt with organ donor support. We would fly down to Puerto Rico, etc., with doctors, and wait for them to harvest organs. Then, we would fly home with the organs. That was our operation, and there are many ways to skin a cat.

Our company was actually started on med stuff...the owner had a helicopter service, then had some medical stuff show up. He ended up asking if he found a jet if they would use him, and the answer was yes. So, he found a jet, and they used him. When I left in 2008, they had 2 Lear 60's, mostly used for charter but we did some medical flights, 2 Lear 31's, mostly used for medical flights, 2 helicopters for medical, and a Beechjet for charter.

Of course, now they have been through numerous layoffs, and some jets have disappeared due to charter business going away. Look at history. Some get lucky, but over history in aviation, there has been a net loss throughout the history.

I will finish with an old joke, in case you have not heard it...how do you make a small fortune in aviation? Start with a large one...
 
When I did air ambulance, the company I worked for was a 135 op, the air ambulance company was basically our biggest customer and we had two Lear 25s dedicated to them. Don't know how they did the billing for their patients. Basically we had 3 crews that were on call to cover all hours during the week and weekend. During the day we sat at the airport with a pager and were on a 10 min callout time. At night it was a bit better as we had a 30 min callout time.
 
FlyMarines09 said:
I've seen a lot of the products offered by ESSCO, never bought any though. Their product description on their website is somewhat vague. Has anyone bought their products? If so, how would you rate them. They have an air taxi manual package for $250 and a "How to Start an Air Charter Company" for $6.95... Not sure what to make of the price difference. Anyone have any insight?

Also, thanks for the previous replies.
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Just noticed you are based in SC, our Seneca was based out of Myrtle Beach doing Air Ambulance...
 
Our department works regularly with this company...www.nwmedstar.org

They provide interfacility fixed and rotary aircraft in Washington, Oregon, & Idaho. 12 hour schedules; bases I have visited are located on the airport for rapid dispatch to lift off times.

They use flight crews from this company...http://www.metroaviation.com/

2,500 hours required for the PIC
 
The most successful air ambulance I've seen has been Airlift NW. They have A109's and Lear Jets operated by executive jet in Seattle. Being in the pacific northwest, they have large remote areas, serving as there niche. But don't be surprised when you find out that the flight nurses make much more than the pilots!
 
Krieger said:
The most successful air ambulance I've seen has been Airlift NW. They have A109's and Lear Jets operated by executive jet in Seattle. Being in the pacific northwest, they have large remote areas, serving as there niche. But don't be surprised when you find out that the flight nurses make much more than the pilots!
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Airlift NW is a good company.
 
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