Air ambulance.

AIRESCUE MAKES HOUSE CALLS - BY AIRPLANE, FLYING TO REMOTE PLACES FOR EMERGENCY PICKUPS

Five years ago, Dr. Francine Vogler got a frantic phone call from a friend whose wife had fallen and broken her hip while on a trip to Milan, Italy.

Vogler, an emergency room doctor who had been part of the Medstar emergency medical flight service at UCLA Medical Center, went to work lining up an air ambulance to bring the victim back home. But in doing so she quickly became dissatisfied with the services offered.

"For instance, one carrier told me it was no problem to get a patient with a hip fracture on their plane, but she couldn't climb steps, and the only way in and out was steps," Vogler said.

"She would have needed a forklift (to board)," Vogler said.

Vogler decided she could do better. Using her own funds and those of an investment partner, she launched AIRescue International Inc. - a medical air ambulance and evacuation service that picks up critically ill or injured patients for transport back to the United States.

The business, with revenues of more than 52 million last year, has been named a finalist for Ernst & Young's 1997 Entrepreneur of the Year award.

Based at Van Nuys Airport, Vogler and a staff of 20 independent contractors, including physicians, nurses and respiratory therapists. are on-call and available within 45 minutes to one hour of receiving a call to take off.

Her goal was twofold - to use only specially-trained physicians and nurses on every flight and provide them with state-of-the-art on-board medical technology.

"The huge risk that I took was in making the step that goes above and beyond the typical medical transport consisting of paramedics," she said. "When patients are entrusted to our care, we need to be able to deal with any emergency situations that arise during the flight."

Vogler leases five Lear jets which have been outfitted with life-saving medical equipment and duplicates of some of the equipment in the event any piece fails during the flight.

Vogler said her service flies about 25 flights a month, at an average cost of $7,500 to $8,000 a flight - although fees can run much higher for transporting patients from remote locations.

Besides the wealthy, who can afford such service?

AIRescue typically contracts with insurance companies, health maintenance organizations, hospitals and university medical centers, Vogler said.

In cases of serious injury, Vogler said, insurance companies and HMOs will sometimes prefer to pay the one-time expense of flying a patient home than to face weeks or months of bills for keeping a patient in a foreign hospital with which they they have no relationship.

In addition, flying the patient home reduces the insurance companies' exposure for liability claims in the event of medical malpractice overseas, she said.

"When a call comes in, typically from a patient's insurance company, we work up an estimate for the cost of the transport and make contact with the treating physician to determine the patient's condition," she said.

Vogler said she doesn't usually turn down requests if patients initially can't pay for her service. "I will work with them and give them suggestions as to collecting the necessary funds."

Once the medical team lands, they make a determination as to the patient's stability before making arrangements for the trip back to the United States.

"If the patient needs more stabilization or a different type of treatment, we work with the treating physician in that location until we know it's safe to take off," she said.

Vogler said AIRescue teams sometimes do domestic flights but most of their business is overseas. In one case, she said, a team flew to Cairo to pick up an American medical student who received critical head injuries in a car accident and transport him to a Michigan hospital. Another time, there was a flight to Costa Rica to pick up an elderly man who suffered a heart attack aboard a cruise ship.

In 1995, AIRescue flew to Patagonia to fly a critically-injured mountain climber to University Medical Center in Stony Brook, New York. The rescue operation was written up in Newsday, and the $90,000 tab was picked up by the 24-year-old man's insurance company, Choice Care.

While there are other air ambulance services, Vogler said her company distinguishes itself by having a physician on board.

"There is no air-to-ground communication when you're out over the Pacific Ocean and on a flight when a patient's condition changes and you have just a paramedic on board, it could be a potentially deadly situation," she said.

Vogler said the $2 million in revenues are up from $350,000 in the company's first year - and the business is still growing.

"I thought it would take a good year or year and a half for us to turn a profit but we did so within the first six months," Vogler said.

But it's not all for profit. Robert Adler, M.D., the associate chairman in the Department of Pediatrics at Childrens Hospital Los Angeles, works with Vogler in a not-for-profit joint venture with AIRescue for transportation of critically ill children.

"She provides a service that offers comfort not just to the center where we are going to pick up a child, but 'also to the parents," Adler said.

Her expertise as an emergency room physician and highly-specialized training in aeromedicine is what makes her a stand-out in her field, he said.

"It's rare to have someone as knowledgeable as her and her team to be able to offer the level of care that will prevent a child's condition from deteriorating during the transport," Adler added.

Spotlight

AIRescue International Inc.

Year founded: 1992 Core business: Medical air ambulance and air evacuation service Top executive: Francine Vogler, M.D. Revenues in 1993: About $350,000 Revenues in 1996: More than $2 million Employees in 1992: 2 Employees in 1997: 20

Goal: To provide the highest level of medical care for patients while being transported to medical centers.

Driving force: Growing demand for transport of critically ill or injured patients.