Air Ambulance Flights – Everything you need to know about these life-saving missions

PT 4 M minute read
Air Ambulance Flights – Part 1: General Considerations & Lead Times

In the business aviation industry, we often talk about critical missions. Nothing embodies the required sense of urgency more than an international air ambulance flight when success or failure could literally mean life or death. Here’s what business aviation operators need to know about these life-saving flights and the special planning considerations to be considered to launch missions as quickly and efficiently as possible.

1. Private non-revenue or charter

While most air ambulance flights are operated as charter (non-scheduled commercial) some are private non-revenue, although this is somewhat rare. Within the international operating environment, charter operations face additional permit challenges and lead time requirements.

2. General requirements

Lead time to set up air ambulance flights and permits varies significantly across the world. On average it’s best to plan on 12-24 hours to secure required permits. At many destinations in Europe permit processing may take 36-48 hours, but in countries such as Mexico, permits are usually processed within a couple of hours, as long as all required documentation is ready and available. Be mindful of specific country regulations such as visa requirements. In some cases, visa requirements may be waived. However, in other cases, visas must be obtained and your ground handler may be able to assist in expediting this. Note that there may also be special equipment mandates to consider, such as TCAS II. Without proper mandated equipment you may not be permitted within certain airspace, resulting in potential delays and routing deviations.

3. Lead time considerations

Air ambulance flights are usually planned and dispatched very quickly. Typical advance notice is about 36 hours, but many air ambulance launches are put together within just a few hours. Many operators have a two hour launch time to get a trip going. To manage short notice launches pre-preparation is key. It’s important to have all required documents on file as well as aircraft/crew information ready, with the only unknown being patient information and schedule. Without having all required documentation/information assembled and ready, there may be operational delays.

4. Unique considerations

Apart from short notice lead time considerations, there are often special requirements involved, including coordinating with local hospitals and ambulances. This may involve securing additional permissions, to get hospital vehicles and personnel access airside. In many cases, customs, immigration and quarantine (CIQ) clearance may be possible onboard the aircraft but in other cases, you may need to go through the main terminal with the patient. For example, Heathrow (EGLL) typically does not permit onboard clearance of air ambulance flights while some other airports within the EU may not allow ground ambulance access to the ramp.

5. Setting up ground handling

It’s best to give ground handlers as much prior notice as possible to set up local arrangements, although you’ll often be working with very short lead times. Provide your handler with itinerary, crew and passenger details, ambulance information and hospital details. Ambulance information is always required by ground handlers in order to set up airside access to the ramp. Provide as much lead time as possible for any special services, such as wheelchairs.

6. Special services

If your air ambulance operation requires special ground support equipment (GSE), such as medical oxygen or a GPU, this should be specified as early as possible. Note that if you wish to request fire and rescue services on the ramp this needs to be clearly communicated and could involve additional charges. You may also wish to request a power in/power out parking spot, close to the FBO or general aviation terminal (GAT).

7. Permit considerations

Depending on where you’re operating required permits may be processed on an expedited basis, or they may not. Likewise, visa exemptions may be permitted for certain operations. Additionally, over flight requirements and lead times may be more flexible.

For the most part, overflight and landing permits are required for air ambulance operations but lead times may be greatly reduced. Some countries, including Ireland, waive permit requirements for air ambulance flights. On the other hand, certain countries, including China and Brazil are more stringent in terms of air ambulance approvals.

8. Permit requirements

Permits for air ambulance flights are often expedited by the relevant Civil Aviation Authority (CAA). For example, Jamaica waives permit requirements for air ambulance operations and the UK has the ability to process these permits after hours with shorter than normal lead times. Germany will make special exceptions for these sorts of flights and facilitate processing of short notice permits. Permits for international air ambulance tech stops are usually easier to obtain due to the urgent nature of the missions. In the event CAA is closed, air traffic control (ATC) may be able to approve short notice landing permits.

9. Blanket permits

If your air ambulance operations will frequent certain countries, blanket permits, when available, are the best way to go. Countries such as Bermuda, France and Mexico offer blanket permits for air ambulance operations and this not only decreases lead time but alleviates delays. The same is applicable for overflight permits, depending upon the region you’re operating in. For example, Cuba offers monthly overflight permit options.

10. Needed documentation/information

Communication with an appropriate airport and CAA authorities can be one of the more challenging hurdles in terms of setting up short notice permits and operational authorities. If an airport is closed, due to a curfew, it may be possible to extend airport hours on a case-by-case basis. However, such exceptions are always at the discretion of local authorities and not guaranteed.

11. Hurdles to consider

Key information needed to set up a short notice air ambulance operation includes:

  • Aircraft documentation, including certificates of registration, airworthiness and worldwide insurance. Be aware of special insurance requirements enforced in some locations, including Mexico, Hong Kong and Turkey.
  • Full crew documentation, licenses and medicals
  • Country-specific requirements, such as engine serial numbers for Colombia, a color photo of the aircraft for the Philippines and, in some cases, maintenance logs.
  • For charter operations to the EU you’ll need an approved Third Country Operator (TCO) certificate
  • Provide an estimated time of arrival (ETA) that’s as accurate as possible
  • Full crew and passenger information as well as local hospital contact details. For countries that require a business contact for permits, local hospital information, and the discharging doctor will likely be accepted.


When dealing with air ambulance flights it’s critical to provide all the information required for your flight and permits as soon as it’s known. Be as prepared as possible with any required documentation – including special insurance requirements and TCOs for the EU – to better facilitate short notice operations.

There are cases where you may not have certain required information available until close to last minute, such as complete patient details, local hospital information and special service needs. The moment this outstanding information is known it should be forwarded to your local ground handler, to avoid delays with services such as CIQ or permits. However, many agencies will likely provide reduced processing time due to the urgency of the flight.

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