Hospital Step by Step and Case Study

“The Air Ambulance Alternative”

Step-by-Step Plan

1. We speak with the care management and social services team along with the
attending physician at the facility to determine if the patient is
hemodynamically stable and fit to fly on a commercial airline.

2. We provide two options:

• Option #1: If the patient is fit to fly on a commercial airline, and able to
sit up during take-off and landing, we arrange a business or first-class seat
for the comfort and safety of the patient.

• Option #2: If the patient is not able to sit up during take-off and landing,
we would arrange a stretcher service with the airline. Stretcher service is
only offered on international flights and requires two medical escorts.
Depending on the medical condition of the patient, we have physicians,
registered nurses, paramedics and respiratory therapists.

3. We confirm that the patient has the appropriate documents needed to
travel. If the patient does not have the appropriate documents, then Sky
Nurses can assist in obtaining the necessary documents for travel. Please
note it can take up to two weeks to complete the process with the consulate
or authority having jurisdiction.

4. Once our Medical Management and Logistics Coordinators/Travel Agents
have determined the appropriate plan of care and transportation, we will
prepare a detailed quote for your review and consideration. The quote will
consist of:
• Cost for the Healthcare Professionals including meals and expenses
• Cost for Medical Equipment (if applicable)

• Cost of Air Transportation for the medical escort, patient, and any
companions

• Cost of Stretcher Service (if applicable)
• Hotel accommodations
• Ground Transportation
• Administrative and Medical Management Fee

Case Management includes the review of medical documents, complete
telephonic assessment, bed placement/admissions and medical clearances
with airlines (if applicable).

5. Once the quote is approved and a contract awarded, our Medical
Management and Logistics Coordinators/Travel Agents will begin to execute
the plan of care and make all arrangements for the transport. This can take
up to 3 to 5 days depending upon the situation and complexity of the case.

6. Also, note that Sky Nurses will prepare the required travel documents that
will be signed by all parties involved.

7. Should the facility fund this transport, Sky Nurses will prepare an agreement
which will state the payment terms (typically Invoice Net 30) and a
Guarantee of Payment.

8. Sky Nurses will be in constant communication with the Healthcare Facility
and the Guardian (if applicable) throughout the transport with updates and
the progress of the mission.

9. The mission is completed upon the discharge of the patient to another
facility and transfer of the medical records.

CASE STUDY:

The Patient in his 30’s and in a Boston, MA hospital had a history of diabetes and
ETOH abuse. He had been in the hospital for a long period of time and was stable.
Since the patient was unable to sit up during takeoff and landing, a commercial
stretcher service was required.

Once the mission was awarded to Sky Nurses, we immediately spoke with the
family who informed us that they wanted their son/husband back home. We began
working with the Embassy/Consulate to obtain the appropriate travel documents.
The family was very cooperative in obtaining the necessary documents from the
patient's home country for the consulate to proceed.

Sky Nurses worked with the hospital's legal team for the courts to assign a legal
guardian to assist us through this process. We continued our communication with
the Consulate, social workers/discharge planner and the patient's family to make
sure that nothing was changing, especially the patient's medical condition.

Our team coordinated with the Airline to make the travel arrangements and obtain
medical clearance. Due to our reputation and the airlines positive experiences with
Sky Nurses, they respond very quickly to our requests. The documents were issued
within a week and we were able to transport this patient on a stretcher to Ghana
within 10 days.

The total cost of this mission was $47,839.00 which included all the necessary
medical equipment, to include a portable oxygen concentrator (POC), cardiac
monitor, stretcher equipment, suction machine and IV Pump. The guardian had
also instructed us to obtain the cost of an air ambulance if Sky Nurses was unable
to transport this patient on commercial air. The cost of the Air Ambulance was over
$125,000.00.

Under the direction of the hospital, we coordinated the bed placement with the
best University Hospital located approximately two hours from the patient's
hometown. Since the family had no funds to continue his medical treatment at this
facility, we coordinated with the Boston Hospital to make payment to the facility
for the patient to be treated for approximately 30 days. When the clinicians arrived

at the facility, the attending physician in the ER checked the patient and, in a few
hours, he was admitted to his room.

Throughout this transport, Sky Nurses communicated in real-time with the facility
in Boston and the family in Ghana with progress updates until the patient was safely
discharged and medical records released to the accepting medical facility.