Introduction

How do we move a bedridden patient long distances for emergency medical care?

This is the question we grappled with when we had to move my mother from a small town in Jharkhand (Bokaro Steel City) to Hyderabad Apollo for surgery of her spine in August 2023.

She was bedridden given her injury and deterioration of her bone and pressure on her spine had caused her to partly lose control of one of her legs. The doctor in Hyderabad Apollo had recommended bringing her so that they could open her up and see what was wrong and do what was required for her spine and the bone there. This was a complex and risky surgery and the time was running out.

When we realized we had to move her, the first reaction was: it is not possible! Thankfully, better sense prevailed and a few calls and google searches later, I had a rough idea of what needed to be done: we could move her through commercial aircraft if lots of things could be lined up. Unfortunately, the information was scarce, conflicting, and mostly irrelevant. Fortunately, we were able to successfully move her to Hyderabad, go through the surgery, and declare it a success!

This post is to help anyone who has to go through this process with details of the process as well as specific things to focus on, so that they don’t get hassled. Emergency medical care is a stressful situation and hopefully this post takes away that stress a bit.

Summary

There are a few options available: 

1. Air ambulance services are available. Many large hospital chains will have their tie-ups with such services. 
2. There are service providers like RED Health who will assist in procuring such ambulance services – air ambulance with chartered plane, air ambulance with commercial craft (which is what this note describes in detail), road service, or even train service. In all of this, RED Health will provide medical professionals with the patient and any other support required like oxygen or other care. 
3. Indigo (the only one I know of, but maybe Air India does it too) is approved to provide commercial craft to use for carrying stretchers. The advantage is that you get the reach of Indigo – most airports (but not all) and most flights (where they have A320 planes) are covered. 

This article provides details on option 3 – it is probably the most cost-effective if urgent transfer is required – road and train will take much more time. Our experience was with Indigo and hence we talked about it. There may be another airline that might offer this, do check them out if Indigo does not work for you.

How is it done?

Indigo folds 9 seats to create space and then fits a stretcher in the area. The patient is strapped into this bed (it is not very comfortable!), covered using curtains (probably to avoid discomfort to the rest of the passengers), and strapped properly so that take-off and landing are smooth for them. One attendant is compulsory to travel with the patient. See the picture below. 

They are equipped to move the patient manually from the ambulance to this stretcher (Bringing the ambulance near the aircraft requires another approval, which is not mentioned in their initial form). Many airports also provide mechanical lifts (ambulift) that can do this much more efficiently (you have to pay for them). Ambulifts typically seem to be available at larger airports. For instance, when I took my mother from Ranchi to Hyderabad, ambulift was available at Hyderabad airport but at Ranchi it was manual.  At the destination, the hospital provided their own ambulance and nursing services which received the patient and moved her from the stretcher to their ambulance. So ask your healthcare service provider if they do this. Otherwise, you will again have to arrange for an ambulance service.

What is the cost?

Indigo claims that they will charge you for the 9 seats (the attendant is an additional seat) which sounds very cost-effective (compared to air ambulance). However, at least in our case, they charged much more but couldn’t explain why. After going through it, I realized that it might have been higher because those 9 seats stayed folded for much more than one trip. 

For example, if the craft starts from A and goes to B, C, and D where it has a long layover, while you need the craft to carry the stretcher between B and C, they probably fit the stretcher at A, and take it off at D, so you will be charged for 3 trips, 9 seats each! I haven’t got the confirmation from Indigo, so I am not sure if this is the correct explanation, but we were charged 3-4 times more than the 9-seat charge. This will be the most significant charge. To be on the safe side, assume 4 trips, so 36 seats’ price. At an average of 6K per seat, this comes out to about 2.15 Lac INR. 

Here are some other charges this trip might incur: 

1. The airlines will levy a handling charge. For us, it was 30K. 
2. Ambulance from your home to the nearest airport. In our case, since we started from a small town (Bokaro), it was almost 3 hours. If you need life support systems, then the cost will go up significantly. Usually, the originating hospital can provide an ambulance unless it is a very small town in which you will have to organize on your own. Assume 15K.
3. Medical lift at the originating airport – to move the patient from the ambulance to the stretcher in the aircraft. In our case, it was not available at the originating airport. This is typically 10-20K. It will take the stretcher of the ambulance and elevate it to the aircraft level, from where the attendants can easily transfer the patient to the stretcher of the aircraft. 
4. Lift at the destination airport – assume 10-20K.
5. Ambulance at the destination. Usually, this will be the hospital where the patient has to go, and they can provide medical assistance as needed. In our case, it was Apollo Hyderabad, and they have a multi-bed hospital set up in the airport basement so this was totally hassle-free and not very pricy. There was one ambulance that brought the patient from the craft to their holding hospital, and another one that took the patient from there to the actual hospital (Jubilee Hills). This total for us was around 15K. 

So in total, you are looking at about 3-3.5 Lac INR. This is still cheaper than air ambulance which will come to around 10 Lac INR, but this requires you to chase down many process elements yourself. RED Health type intermediaries are an option to smoothen this process (they will charge about a lac on top of what Indigo will charge).

What is the process?

You need to be careful about the process, otherwise you can waste precious time, both to get a booking done with airlines, as well as when you are at the airport to board the patient. For us, both of these became problematic and caused lots of frustration. 

Booking the stretcher

Following these steps: 

1. Read their page on ‘customers with stretchers’ first (look for the tab called “Customers Requiring stretchers”, you will have to scroll horizontally through the tabs you see, it starts with the “Disability assistance” tab). I am adding the content below but for the latest update in their services, read their page. 
2. Call Indigo at the number given, they will provide you with the details of the process (summarized below) and the forms you have to fill and the rest of the details. They will also tell you how to request the booking, which will not be done online but through them.  
3. Once you have filled out the forms and sent them to them, you will have to keep following up with them. Keep calling and replying to the mail you sent. It usually takes some chasing if you are in a hurry. 
4. Once the medical form is approved by them, they will make the booking and you can pay. 

Process (Indigo will guide you through)

This is the process from Indigo (2023 Aug):

1. Complete the medical form and send it to the given email address (customer.relations@goindigo.in). The form needs to be signed by the doctor (Medical form link).
2. Indigo will revert in 24-48 hours to ascertain the medical condition, and provide details on booking. 
3. They will mention that 9 seats have to be booked to accommodate the stretcher, but the cost will be much more (see the cost section above)
4. Both patient and attendant need to have an RT-PCR test done within 72 hours before departure (this may not be relevant anymore but best to check with them).
5. The attendant has to meet Indigo one day before the travel day at the origination airport. This can be waived if you call the duty manager and tell them you will come early enough on the day of travel, in case you live far from the airport. 
6. The process should be completed 48 hours before the travel date. 

The fee outline they provided for my trip (Ranchi to Hyderabad)

1. 9 seat charges
2. Handling – 30K
3. ambulift charge (if applicable) – to get the stretcher (and the patient) in the aircraft
4. Any other charges

Final fees will be shared by Indigo once the medical form is sent and approved by them.

Preparing for the travel

There are a few types of forms that need to be filled for the patient and given to Indigo. 

Clearance of ambulance at originating airport

This became the biggest problem for us. It turns out that taking your ambulance to the aircraft requires approval from multiple government agencies at the airport (some names I came to know for the first time). And if this is not done in advance, it can be troublesome. So make sure this is done 1-2 days before the travel. 

Call up the duty manager of the airport for the airlines (usually this is their cargo department, surprisingly!) and ensure this is done. 

Try to see if the airport has its own ambulance in working condition (in our case, it was not). If it is and they confirm that you can use it, then it is easier – your ambulance just transfers the patient to their ambulance (similar to the way it will happen at the destination airport) and doesn’t require any special clearance. However, it may not be available on the designated date, or your patient may not be fit for such transfers easily. So assess the situation beforehand and plan accordingly to get the gate pass created well in advance. 

You will need documents for the gate pass. Some of these include: 

• Ambulance permit
• Driver’s license
• Driver’s Aadhar card

The ambulance driver will be able to provide these.

Boarding at the airport

Once the ambulance is cleared, or you have an airport ambulance lined up, then you will be taken via cargo gates to the aircraft. An attendant is supposed to go with the patient, so if you have carry-on luggage or check-in luggage, it can be tricky. Indigo staff will help, but you will have to make it clear to them what you need. In some cases, two attendants can help – one will go with the patient, and another will go with the luggage through the normal boarding side. 
This is a security hazard for the airport, so they are extra cautious – this can take time, your hand luggage (if you have carried it with you, I think you are allowed some small stuff) may be scrutinized more thoroughly, the driver’s belongings may be checked as well, so plan accordingly.

Conclusion

The fact that commercial airlines can carry stretcher passengers is very good news. I think Indigo is doing a great job and must be applauded for it. However, the process is a bit non-intuitive and information is not easily available. Make sure you call Indigo (or whichever service provider you are using) and keep chasing them for every step – many steps have direct or indirect impacts from government policies, and hence things can get stuck. However, most people do try to help, so calls do help.

Good luck with everything!

Appendix

RED Health option

(RED Health Fleet)

Air ambulance has two options: 

1. Commercial flight: (same as indigo option above) but they will facilitate all this and will have doctors and other facilities onboard. They do bed to bed, so ambulance from home to airport, then onboard stuff, then ambulance from airport to home here. This will cost between 3-4 lac. 
2. Chartered flight: similar to commercial, but they will have specialized craft dedicated to you. About 8 lac

They also do trains or roads where they will enable travel and have accompanying doctors and medical facilities.

Content from the Indigo page for customers with stretchers

(Indigo original page)

• IndiGo accepts request for stretcher for Airbus A320 only. We will not be able to carry stretcher on connecting flights.
• To book a stretcher on an IndiGo flight,
  • Customers are requested to call us at our call centre @ 0124 6173838 at least forty eight (48) hours before the scheduled time of departure.
  • Customers are required to take a print-out of the IndiGo medical form, available on the website. (Click here to download). Please have the medical form filled out by customer’s treating physician.
  • Customers are required to share the travel details, along with the filled medical form on the email id shared by our call centre team member.
  • Our Medical Department gives the clearance for all stretcher cases and the same would be informed to you within twenty four (24) hours of your making such a request.
  • Based on the report shared, we may require an IndiGo medical representative to meet the customer at the airport on the date of travel to determine the customer’s medical fitness. IndiGo may deny boarding to a passenger in its sole discretion if  such passenger is found to be unfit  to travel by IndiGo’s medical representative.
  • IndiGo may require a fresh medical form on the day of travel, for select cases. We will inform you of the same on the confirmation email.
• The stretcher installation on board our airplane requires us to fold (6) seats across three rows for the stretcher to fit securely against the fuselage and rear bulkhead. The other three adjoining aisle seats across the same rows provide access to the stretcher patient, hence the applicable charges will be for (9) seats at the prevailing fare, plus a handling fee as mentioned in Annexure A.
• Our customer service and cabin crew team will provide all the assistance required other than the ones provided by a safety assistant.

Customer Grievance Redressal

At IndiGo we strive to achieve the highest level of customer satisfaction and our teams have been trained to deliver the same. However, in the event you feel dissatisfied about something please do no hesitate to reach out to us so we can make things right if they were not. We are reachable to you in more ways than one.

Call Center: 0124 6173838

Email: Nodal Officer : NodalOfficer@GOINDIGO.IN

Appellate Authority: Amrita Gill Email: AppellateAuthority@GOINDIGO.IN

Contact: Customer.experience@goindigo.in

OR

Our Customer Services Manager at various airports shall be more than happy to help you.