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In August last year, Korean expatriate Ms. A (56), living in Mexico, was diagnosed with irreversible lung damage exceeding 90% as a result of COVID-19 complications. The rapid onset of pulmonary fibrosis, which hardens the lung tissue, left local doctors with no options. Her final hope was an air ambulance—a specialized aircraft for patient transport. She was flown 12,000 kilometers to South Korea, received a lung transplant, and made a full recovery.
Flying ICU: 96 COVID Patients Evacuated
As highly transmissible COVID-19 variants spread globally, infection numbers are again surging. Korean nationals living in countries with poor medical infrastructure are facing heightened risk. Infections have also been reported among short-term business travelers and overseas assignees. As a result, individual and corporate inquiries into air ambulance services have soared.
According to Flying Doctors Korea, which operates air ambulance services, 96 COVID-19 patients were transported to Korea over the past year. In Indonesia alone—where daily confirmed cases recently exceeded 40,000—53 Korean expatriates returned home via air ambulance. Executive Director Choi Young-ho commented, “Some patients couldn't even be admitted to a hospital and had to rely on oxygen tanks at home. Others tragically died before they could board the flight due to a sudden decline in health.”
Emergency Care and Oxygen Are Key in the Air
Since air ambulances are sometimes airborne for over 24 hours without access to ground medical support, emergency preparedness and oxygen supply are paramount. To protect onboard medical staff, patients are transported in portable isolation units (PIUs). Depending on the oxygen capacity of the aircraft, multiple patients can sometimes be transported at once. “For example,” Choi said, “in a recent case, three family members infected with COVID-19 in Tanzania were transported using one air ambulance since two of them were mild cases that didn’t require supplemental oxygen.”
The cost of an air ambulance ranges from 100 million to 300 million KRW (approx. $80,000–$240,000 USD), depending on the distance and aircraft model. Larger aircraft cost more but require fewer refueling stops, reducing total travel time. Additional charges apply when ECMO machines or more medical personnel are needed.
3 Days on Average for Transport, Plus Remote Support
The patient’s condition plays a crucial role in determining air ambulance viability. Some cases have seen planes dispatched, only for patients to deteriorate and become unfit to fly before takeoff. Transport is faster if the aircraft is already near the patient’s location. Flying Doctors Korea operates about 160 aircraft worldwide in cooperation with foreign providers across more than 200 countries. “On average, it takes about three days from booking to departure,” said Choi. “But if conditions align, we can move a patient in just one day.”
In critical cases, Korean medical teams are dispatched overseas or provide remote consultations. “We give guidance to medical staff in less developed countries or advise on oxygen levels based on video footage of patients waiting at home,” Choi explained. “We have about 20 specialists across 13 departments, including emergency medicine, who assist in this process.”
Room for Improvement in the Domestic Transfer System
Even after arriving in Korea, transferring patients to hospitals can be problematic. Ideally, a specialized ambulance carrying an emergency medicine doctor should meet the patient at the runway. However, Incheon International Airport lacks such a vehicle. Currently, Flying Doctors Korea must arrange for a special ambulance from Seoul National University Hospital each time. Choi urged, “The government should work with regional health authorities to improve emergency transport systems urgently.”
Insurance Gaps and Policy Challenges
The high cost of air ambulance services is rarely fully covered by insurance. While travel insurance may provide some reimbursement, typical coverage ranges from 20 million to 50 million KRW—far short of the actual costs. As of 2019, only 12% of Koreans had travel insurance. Many policies also require hospitalization of 14 days or more in a local facility before paying out, disqualifying many who need urgent repatriation.
Last month, the Korean government announced reforms to improve overseas patient transport, acknowledging the insurance and logistical issues. However, no implementation date has been specified.
Flying Doctors Korea plans to introduce its own domestically operated air ambulances soon. Choi said, “Having our own aircraft will make it easier to place Korean medical staff onboard and reduce reliance on foreign operators. That means lower costs for patients.”
Reported by Park Sung-min | DongA Ilbo