German fixed wing air ambulance operator FAI rent-a-jet enjoyed one of its busiest years so far in 2015, and expects to have a turnover of at least €50 million for air ambulance in 2016. “Air ambulance is the majority of our business and will account for 60-65 per cent of the total revenue this year, and is still increasing,” says chairman Siegfried Axtmann.

It has taken him many years to take the business to its present state. “It is very easy, if you have the capital and the new aircraft, to establish a start-up charter operator. That's no problem at all. With air ambulance, it is a totally different situation. Insurance companies, for liability reasons, and also government agencies and oil and gas companies do not work with start-ups. It is just too dangerous for them.

“The second barrier for these operations is that you need a certain volume of enquiries. I used to compare it with a freight forwarder. Freight forwarding only makes sense when you reduce your empty truck mileage to a minimum. In air ambulance it is the same. It can only be established in a profitable way when you have a higher volume of enquiries than you can really handle. If you fly a triangle from your home base to the patient, to the patient's destination and then back to home base, which is what all small operators did 20 years ago, you would lose money. The triangular calculation per hour is much too low to allow any profit, let alone break even.

“However we now have an occupation rate of more than 60 per cent, which is unique in the air ambulance world. Using the triangle method, 60 per cent is quite impossible. In a triangle the transportation of the patient makes up only one third.”

Axtmann has achieved this by using floating bases: “We use hubs like Dubai or Abu Dhabi in the Middle East, where we run the operation for fuelling and crew change, because this is a big area for patient pick up and drop. When we talk about a floating base, we really mean about 24 hours in one location in the best case scenario, and 60 hours at worst. Then the aircraft is back in the air, and therefore we do not need a hangar, we just need parking. The med team might go to the hospital and find out that the patient needs to be stabilised for another 24 hours before lifting, so the aircraft cannot depart. But we have never had parking for one or two days refused at any airport for an ambulance jet.”

For charter ops FAI uses a Global Express, while for air ambulance it deploys four Challengers and six dedicated Learjets. “The Learjet fleet will be increased slowly to seven or eight jets,” he adds. “It is mainly LR60s, whereas we had 35s and 55s before. We still have one 35 which acts as a backup aircraft. We still have two 55s that we will probably replace as they have quite high hours. By the beginning of next year we will most likely have a fleet of just LR60s.”

The business is also alive and well in Africa, where FAI currently performs around two medical evacuations a week. As a result it is now affiliated with AfBAA. “In Africa there are oil and gas companies along with government agencies that need airlift to Europe or to the Middle East,” Axtmann concludes.