November 10, 2026

Your Evacuation Coverage Comes With a Carrier You've Never Met

Air ambulance jet on the tarmac

Dr. Abraham Medina Jr., DMSc, PA-C, Founder, Global Executive Medicine

On October 3, an air ambulance flying from Bermuda to Boston went down off Nantucket. The Gulfstream G100, operated by Ontario-based Latitude Air Ambulance as Heartbeat 104, carried two pilots, two medical crew, a patient and a family member traveling with the patient. The crew had flown to Bermuda specifically to bring the patient home. The Coast Guard suspended its search after finding debris, and all six people are presumed dead. The cause has not been determined, and the NTSB and the Transportation Safety Board of Canada are investigating.

I want to be careful with this one. Nothing I have seen says anything about this operator’s standards, and I am not going to guess at what went wrong. What the loss made me think about is a question I rarely hear a family office ask: who is actually flying our people?

The carrier you never chose

Most families buy medical evacuation protection through a travel medical assistance company, an air ambulance membership or an insurance policy. When something happens abroad, someone calls the number on the card, and the assistance company arranges the flight.

The aircraft that shows up can belong to a different company entirely: a third-party operator the assistance provider brings in. Accreditors treat this as a recognized practice. EURAMI defines it as a mission conducted by a third party but operated under the provider’s brand, and it requires written client approval before such a mission is dispatched. Industry reporting describes this layer as opaque, with the real operator sometimes unknown until the flight is arranged. That is not wrong in itself. Networks exist for good reasons, including coverage, aircraft positioning and speed. But it means the family’s trust sits with the brand on the card, while the crew, the aircraft and the procedures that matter belong to someone else. The principal, the relative riding along and the chief of staff coordinating from home usually know nothing about that operator until it lands, if then.

Why this matters for families and principals

Evacuation happens at the worst possible moment: a sick or injured family member, often at night, often far from home, with a relative who wants a seat on that plane. That is not the time to start asking about accreditation, crew configuration or weather policy. If nobody asked before, nobody will ask then.

There are independent benchmarks to ask about. CAMTS, an independent nonprofit, audits air and ground medical transport services against published standards. Its accreditation is voluntary, runs three years, and some U.S. states require it for licensing. EURAMI accredits fixed-wing and rotary-wing air ambulance providers and re-audits them every three years. Neither is a guarantee. Both give you something concrete to verify instead of something to assume.

Who owns this, and when

In most family offices, nobody owns it. The insurance broker placed the policy. Security plans the trip. The concierge physician manages the medicine. The evacuation carrier falls in the gap between them. Three steps close it:

  1. Give it an owner. The chief of staff or COO is usually the right person, with input from the family’s physician or medical advisor and the security lead. One person should be accountable for knowing how evacuation actually works for each family member, and that person should not be learning it on the night it is needed.
  2. Ask your provider before you need it. At purchase and at every renewal, ask the assistance company or insurer how it selects carriers, whether it requires CAMTS or EURAMI accreditation, how often it reviews them, whether it will tell you which operator is coming before the aircraft launches, and whether it can hand a mission to a third party without your written approval. Get the answers in writing and keep them with the policy.
  3. Add a pre-trip check for the trips that matter. Long overwater legs, remote destinations, outbreak regions, a family member with a chronic condition. For those itineraries, find out ahead of time which operators serve the region. Know the questions you would ask on activation: accreditation, aircraft type and age, two-pilot crew, medical crew credentials, night and weather policy, and whether a family member can fly along. And decide in advance who in the office has the authority to accept a carrier or push back.

Closing

None of this replaces the coverage. It turns the coverage into something you understand. Helping families and their teams work through these questions before travel is part of what we do at GEM, and I would like to hear how others handle it. Does anyone in your office know who would actually fly your principal home?

Sources

← All Medical Governance Insights