MedAire Grows into Global Medical and Security Company

In summer 1983, Joan Sullivan Garrett, then a critical-care flight nurse and chief medical officer, was aboard a helicopter evacuation flight, responding to a rural traffic accident in the San Tan Mountains in Arizona. She, her paramedic and the pilot were advised a car had rolled over and a child was thrown from the vehicle.

Upon landing, the paramedic assessed occupants of the car and Garrett headed for the child, an eight-year-old boy who was lying on the front seat of a pickup truck. Garrett told him she was going to take him on a helicopter ride. "As I prepared the IV, the boy said, 'I'm brave, I'm not afraid.' He reached up and grabbed the lapel of my flight suit and said, 'I love you.' Then he lost consciousness; his heart stopped, he stopped breathing."

She and her paramedic pulled out all stops to save the boy, who she calls “Tommy,” and were able to get him to the hospital. Although Tommy died more than 33 years ago, Garrett said, "It's as real today as it was then."

When asked if she still thinks about this tragedy, Garrett replied it never leaves her. "I still smell jet-A, feel the heat, smell the dust in the road and see the car where the accident happened," she said. "It's an important event that has shaped and designed the kind of services that MedAire provides today. That whole event was the impetus that got me to look way beyond my day-to-day job; it was the driving force of founding MedAire in 1985.”

Joan Sullivan Garrett revisits the agonizing medical event and loss of life that changed her life and became the catalyst for creating her dream company, MedAire.

Promising to be a scorching day in summer of 1983, Garrett, a critical-care flight nurse and chief medical officer was aboard a helicopter evacuation flight, responding to a rural traffic accident in the San Tan Mountains in Arizona, a remote area quite far south of Phoenix. She, her paramedic and the pilot were advised a car had rolled over and a child was thrown from the vehicle, and multiple injuries awaited the crew.

"We were roughly 10 minutes into the flight, when we were suddenly cancelled," she said. "We argued and used our dispatch to tell the EMTs (emergency medical technicians) that the child could only compensate for a short period of time." By protocol, by law, Garrett explained, first responders controlled the scene.

Upon returning to the hospital, no sooner did the skids hit the ground when Garrett and her crew were scrambled back to the scene. Sadly, 30 precious minutes were lost.

Upon landing, the paramedic assessed all occupants of the car and Garrett headed for the child, an 8-year-old boy who was lying on the front seat of a pickup truck that happened unto the scene.  "When I got into the truck, my first thought was this little boy isn't any older or bigger than my sons," says a tearful Garrett.

Garrett told him she was going to take him on a helicopter ride but first she had to start an IV and it would hurt a little bit.  "As I prepared the IV, the boy said, 'I'm brave, I'm not afraid.'" "Then, he reached up and grabbed the lapel of my flight suit, pulling me down in front of his face, and said, 'I love you.' Then he lost consciousness; in the medical world we call that coded—his heart stopped, he stopped breathing."

She described his voice as extremely high pitched and said she could "see and feel the air from under his skin in his chest." The boy's main airway to the lungs was severely damaged.

Garrett and her paramedic pulled out all stops to save the boy and were able to get him to the hospital.  "I stayed. I watched. I prayed. His injury was mortal, lethal, she said."

Garrett to this day affectionately calls the boy "Tommy." "I continue to protect the little boy's identity because that day, a mother lost her son," she explains.

Although Tommy died more than 33 years ago, Garrett says, "It's as real today as it was then." "I cannot tell this story without being there—hearing his words, looking into his eyes and knowing his life was in my hands, but yet out of my hands. I cannot image having lost my own children, but when I went home that night, I couldn't hold them enough. It was days of anguish; it was emotionally draining. I knew I had to find Tommy's mother and give her his message. He saw his mother in me; he was talking to her not me."

Three days had passed since Tommy's death and Garrett returned to the hospital to locate his mother's number and called her.

"I let her know I was the nurse who took care of her son," she said. "I wanted her to know he wasn't alone and he didn't suffer. I wanted her to know exactly what he said: that he was tough, he wasn't hurting, he was brave and that he gave me a message for her—that he loved her. We were both sobbing. If I'd been a mother receiving a message like that, I think, it would help me."

When asked if she still thinks about this tragedy, Garrett replied it never leaves her.

"I still smell Jet A fuel, feel the heat, smell the dust in the road and see the car where the accident happened," she said. "I relive it a lot, partly because I don't want to block it out of my mind. I think it's an important event that has shaped and designed the kind of services that MedAire provides today. That whole event was the impetus that got me to look way beyond my day-to-day job; it was the driving force of founding MedAire in 1985.

MedAire: from a rough start to a global company

"Each day that I struggled to build this business, frankly, no one I talked to could comprehend what I was trying to offer," Garrett said. "It was difficult: metaphorically, doors were slammed in my face. Nevertheless, I was passionate about what I was bringing. I knew there was a need and it was difficult to get me to go away. In fact, people said I was relentless."

The first thing Garrett did was design an advanced medical kit, because at the time as flight attendants and pilots had nothing to work with in the event of an emergency. "Even if flight attendants or pilots wanted to do CPR, they didn't have any protective equipment; all they had were bandages," she said. "I knew we could add some basic things to these kits that would protect them if blood or body fluids were involved, and they would be less reluctant to help someone."

She also developed MedAire's training program, Management of In-flight Illness and Injury. "Unlike a lot of other training programs, ours could be taken home," she said.  

As well, she provided training on how to properly use an AED (automated external defibrillator).

"Then feedback started coming in: someone saved their father from choking; another saved someone from drowning, etc.," she said. "EThings that we trained them to do they thought they'd never remember. More and more lives were being saved, and every step of the way there was positive reinforcement, a reason to keep going. Tommy was my fundamental driving force to never give up."

Completely Ddevoted to her life-saving training program, it wasn't unusual for Garrett worked to work two or three jobs to support herself and her children while launching MedAire, a process that took 10 years. Without investment capital, she continued to work like a dog for the next 10 years.

"No one believed in what I was doing," she said.  "Venture capitalists liked the idea but they didn't want to put money on the table. Or if they did, they wanted to own the company. I decided to go it alone, knowing it would take a lot longer to get a foothold in the industry."

Today, MedAire provides services and remote medical care programs for business aviation, air charter companies, the world's most prominent aircraft manufacturers and 75 percent of Fortune 100 companies. In fact, it was Gulfstream Aerospace that first contracted with MedAire in the 1990snineties to provide its customers with MedLink, AEDs, first aid kits and medical training. It wasn't long before other aircraft OEMs also took notice of MedAire's services. Additionally, the company provides its services to 150 airlines, half of the world's supper yachts and the commercial shipping sector.Today, MedAire provides services and remote medical care programs for business aviation, air charter companies, the world's most prominent aircraft manufacturers and 75 percent of Fortune 100 companies. Additionally, the company provides its services to 150 airlines, half of the world's supper yachts and the commercial shipping sector.

Be it from air, sea or land, MedAire has taken more than one million calls. When asked how many lives MedAire has saved, Paulo M. Alves, MD, MSC, MedAire's global medical director/aviation health, replied, "You can't count things you avoided." "In other words, because of our medical tools and training, illness in many cases is detected quickly and remedied. Although, there have been a few cases where we have sent a physician or nurse to accompany a client."

A Global Enterprise

Amongst Garrett's creation of MedAire in itself was brilliant: envisaging and constructing a global, ground-based telemedical assistance program in real-time was sheer genius. The MedLink Global Response Center, a ground-based telemedical assistance program, is is located in the emergency department of Banner-University Medical Center Phoenix, which has the designation of a Level I trauma center.

"When I started MedAire, with my first aid kit in tow, I'd knock on hangar doors and visit small and large flight departments," Garrett said. "I'd talk about my aviation training program, but didn't mention MedAire—it was a non-starter. No one could conceive the thought that flight attendants or pilots could talk to a doctor in real -time."

One of the ways in which MedLink physicians are able to provide advise medical diagnosis and treatment in real -time, is through due to Remote Diagnostic Technologies' Tempus IC, a real-time vital signs monitoring system that transmits data, voice and video. Garrett, who is recognized as establishing Tthe first global emergency response center dedicated to delivering instant medical assistance to people in remote locations, is staffed by board certified emergency physicians and registered nurses.

As more people are flying on private jets, Dr. Alves said he sees different medical risks in business aviation today that weren't present a few years ago. "What we see are threats of epidemic infectious diseases, such as bird flu. We had the MERS [(Middle East respiratory syndrome]) virus. This is important because in certain countries, like Saudi Arabia for example, no one is immune to this airborne virus. The Ebola virus in Africa, another example, heightened concern for business aviation."

He said MedAire is on top of medical threats around the world and keeps its clients updated.

"We give our clients pre-travel and post-travel advice, which is a major difference in how we prepare service for business jets or commercial airlines, as airlines have many anonymous fliers," Dr. Alves explained. "Because business aviation is more flexible, it's easier to prevent situations from happening."

As for in-flight emergencies, Dr. Alves said cardiac arrest is by far the most challenging situation to deal with. There is no time for guesswork; having an AED is critical. The FAA announced in April 2001 its final ruling that required U.S. airlines to have AEDs and enhanced emergency medical kits, a precaution Garrett advocated. "We see roughly five to six percent of cardiovascular events," he said. "They may not be the most frequent events, but they are the most serious. Sometimes, a heart attack starts with symptoms of feeling nauseated or faint. So, it's very important to pay close attention to a person having these symptoms."

Most of the medical issues MedAire deals with are simpler in nature. Some include gastrointestinal intestinal issues, allergies, nausea, fainting and anxiety.

For various reasons, passengers of private aviation will fly commercial airlines. Due to Garrett's persuasive testimony before Congress, the FAA announced in April 2001 its final ruling that required U.S. airlines to have AEDs and enhanced emergency medical kits. 

Garrett recalls earlier times when it seemed impossible to get commercial airlines interested in her products. "There was a starving student survey by Arizona State University for students' masters programs, which targeted company flight departments," she said. "The survey showed I had a 33 percent response rate with business aviation. Those results told me there was a need in the business aviation industry. However, I was a complete failure in the commercial airline industry. I had started my efforts in the commercial airline sector because I knew they had nothing up there; flight attendants hadn't been trained in CPR."  

MedAire Today

Although MedAire is based in Phoenix, Ariz., it has offices in London, Singapore and Dubai. In addition to real-time medical assistance it the medical side of MedAire, it works with clients around the globe—around the clock—providesing real-time travel security briefings/ solutions, air space assessments, logistics and overall security to mitigate risk.  

"MedAire is something that could've only been driven by passion, driven by knowing you're making a difference," says Garrett, looking back at her history-making company. "To start a company in 1985 that would become global from day one, I think, was a bit daunting. In many ways, I wish I'd been like Galileo Galilei or back in the Christopher Columbus days—when they thought Earth ended at California—as I would not have worried about knowing everything about culture, customs and the medical capabilities on a global scale all at once."

MedAire today

With a workforce of 350 people worldwide, including clusive of more than 50 MedLink physicians, MedAire has grown leaps and bounds. MedAire, an International SOS company, which has 11,000 employees, makes its 26 assistance centers available to MedAire as well.

"MedAire is growing at a phenomenal rate," said MedAire CEO Bill Dolny. "We're now up to 600 calls a day, for all of our services. That gives us the ability to have such a large infrastructure. When I say this, I mean when calls come in we're ready. Within 45 seconds, a MedLink physician is on the phone."

Dolny said due to evolving technology, MedAire is now able to provide customers teleconsultations with a physician, who can prescribe medication without and without a physical examination, medication can be prescribed. Currently, this program is available in 13 cities spread out through the U.S., UK and Australia.  Within an hour, aA customer's medication is delivered within an hour, which saves a customer a ton of money and time. 

"We mainly focus on the aviation and yacht sectors," he said. "Business aviation today is operating in challenging places and new places," said Dolny.; "Iit's not the same aviation of 15 or 20 years ago when it was the U.S. and Europe. Because business aviation operators are going to all sorts of new places, we now see that some of the safest places have become some of the most unsafe places in the world. Our mission is to help our customers stay safe wherever they're operating aircraft, and to deal with any risk they may encounter."

MedAire has offices in London, Singapore and Dubai. In addition to real-time medical assistance, it provides real-time travel security briefings/solutions, airspace assessments, logistics and overall security to mitigate risk. He said whether it's medical or security, MedAire is 100 percent there for its clients. And when a customer is traveling to a new location but isn't sure about that location, the company provides in-depth safety information.  

"Many companies can provide security information on a city, but what MedAire provides is aviation-specific security information," Dolny said. "It's the airport, where they park, how safe is the parking area and hotel routes from the airport, etc. We're talking about the asset, flight crew and the executives."

Security and mitigating risk is so intense that MedAire tells its customers whether armed transportation is required. 

"Six years ago MedAire developed the Aviation Travel Security Brief, which is used by most flight departments use when they fly to high risk areas," he said. "We take roughly five security-related calls a day and the same for medical."

Dolny said one of his challenges as CEO is to ensure that MedAire keeps that personal touch with customers as the company continues rapid growth.