ITIC Berlin: Security of medical transport crews

John Rose
COO – iJET International
Opening the session, Rose posed the question: ‘How do we keep our flight crews safe?’. He said that he has seen medical crews refuse to go into certain areas because the safety is inadequate, and that there are many things to consider when evaluating scenarios. For example, he said, bringing in security raises the cost of the evacuation, adding that once the threat has been identified, the risk can be assessed and mitigated, and this should be a process that is laid out simply.
Important questions to be asked, said Rose, are where are they flying and what conflict zones are they going through? He said that the crew may be going through an area where there are ‘bad actors’ or people on the opposition that may not want them there. He added that when it comes to such areas, the news is ‘100-per-cent useless’ as it states ‘false, crazy things’.
Another important question, according to Rose, is what is the protective zone around the landing area? “You have to understand the threat in the area and assess the risk,” he said. “Is it worth attempting to land?” He then highlighted the fact that time is critical in picking up injured patients, and added that the best intelligence is required. He said that risk can be reduced by hiring security professionals, and reiterated the importance of assessing the situation, as ‘just because they are wearing a medical uniform, it doesn’t mean they are necessarily safe’. 
Rose went on to underline the essential pieces of knowledge, which he stated as being: the intelligence of the area, on the ground, i.e. tactical information coming in from people manning the routes; and who is being transported. “These people are hurt for a reason,” he said. “Perhaps they have been attacked and there are bad actors who still want to eliminate this individual.” Rose said that there is a need to get the individual to a safe location where the medical crew can work, and that real-time intelligence is required by the minute.
Finally, Rose highlighted that real-time intelligence and alerts does not mean news. “It has been analysed and is meaningful and actionable to you,” he said.
Martin Bauer
Regional security manager – MedAire
Bauer began his presentation by asking whether the situation changes if we know we are going into a high-risk environment. “No,” he answered. “The assessment of all of those various risks should be consistent across the board. The risk assessment should not change.” He then went on to highlight some of the threats and hazards encountered in travel security and their risk rating. At the top of the list was crime, followed by social unrest and terrorism. The hazards with the lowest risk rating were cultural issues, internal travel and natural hazards. He said it is important to ascertain whether certain weapons are easily available on the ground and decipher how lethality will affect an aircraft.
Bauer then showed the audience a list of the countries with the most over-flight concerns. Afghanistan was top of the list, followed by Algeria, Armenia and Azerbaijan, Colombia and the DRC. He also spoke of the incident in 2014 when Malaysia Airlines Flight MH17 was shot down over Ukraine.
Next, Bauer highlighted the fact that threats to aviation vary by location and altitude, and that the MedAire team provides airspace assessments to help security departments to make informed decisions about their flight plans. 
He explained that an airspace assessment involves the analysis of the airspace of a country or region to identify overall kinetic risk and individual threats to aviation assets throughout each phase of flight. According to Bauer, these assessments include analysis of airspace restrictions and warnings issued by governing aviation organisations, including the US Federal Aviation Administration, International Civil Aviation Organization  and European Aviation Safety Agency. 
Bauer then went onto say that, at a minimum, each airspace assessment looks at specific weapon availability, portability, lethality, ease of use, documented use and intent (for example, government or military groups). He said that kinetic risks and non-kinetic risks must be assessed at altitude.
Following the presentation, an audience member asked: “What about the ‘normal’ places and how do we deal with the aircrews; particularly the ones who stay overnight?” 
Bauer responded by highlighting the need for consistency in assessing each different site in the same way. “The assessment shouldn’t change just because we don’t think it’s a high-end conflict zone.” However, he added that the risk assessment may change according to how basic the resources are on the ground. For example, he said that some areas may be missing simple things such as radar and aerial communication.
Dr Bettina Vadera
CEO – AMREF Flying Doctors
Bringing an air ambulance provider’s perspective, Vadera began by listing some of the conflict areas AMREF has been asked to visit, citing Somalia, a country in which AMREF performs hundreds of patient evacuations every year,  South Sudan and the DRC, followed by Burundi, the Central African Republic and Mali. Vadera explained that AMREF’s crew doesn’t leave the airport and added that there is a clear agreement that there is security all around them. 
Next, Vadera moved on to talk about the steps AMREF goes through from a practical perspective. These are: pre-departure briefing and clearance; pre-landing preparation; specific approach procedures; on-ground security protocols; emergency shelter for patient and crew; and finally, a debrief after landing back at their base in Nairobi. She described this example as AMREF’s ‘daily/weekly bread’.
Going into detail about each of the six steps, Dr Vadera explained that the pre-departure briefing involves an active security report from UNSOS Air Ops offices in Nairobi and Somalia, insurance briefing and clearances, and flight clearances from the Government of Kenya and the Swedish Committee for Afghanistan, and encompasses security information and a security brief from AMREF Health Africa’s corporate security manager. She highlighted the importance of flight planning, security updates between crews and a quick departure. 
Referring to air ambulance evacuations from Mogadishu, Vadera then revealed that pre-landing preparations involve scouting by boots and/or boats on the ground, which must happen before landing, and that a pre-landing security clearance must be issued by UNSOS Air ops. She added that the ETD and ETA are classified information. 
She explained that the specific approach procedures involve a steep descent and a high-speed approach just above the water, with a sharp turn towards the airport before landing. When it comes to on-ground security protocols, an allocated secure parking bay for the aircraft, security on standby for both the crew and the aircraft, and an armoured vehicle for patient transport are required.
Regarding emergency shelter, standard operating procedures (SOPs) and a pre-flight briefing on locations and use are crucial, Vadera said. Finally, the debrief back at AMREF’s base comprises: a hazard or incident report, a review of the voyage report, a review of protocols and SOPs with the relevant stakeholders, formalisation of the recommended changes and confirmation that these changes have been implemented. She added that all of the changes must be implemented before another mission to that area is launched, and that this is always the guideline that AMREF works through.
Vadera also pointed out that some missions AMREF just cannot do, and this is because there are human lives at stake: not just the lives of the patients, but the lives of the crews.
Watch a full video recording of this session at