MUMBAI: A Kolkata family that flew their 10-year-old son to Mumbai for an emergency brain tumour surgery, a middle-aged man from Raipur who flew home after a bypass surgery in Mumbai, a seriously ill elderly woman with liver and kidney ailments who had exhausted her treatment options at a Hyderabad hospital and so left for her home in Indore. These are some of the patients who took the nearly two dozen air ambulance flights operated over the past four weeks as domestic flights and trains were suspended across India due to the lockdown.Air ambulance operators say despite calls for medical evacuation soaring during the lockdown, the tougher norms have badly hit families who need to fly down patients to different cities.On March 23, the ministry of civil aviation banned all airline flights, but medical evacuation flights by charter operators were permitted. On April 15, the ministry issued a clarification stating medical evacuation flights “should not be permitted without the explicit permission of the government”.“During normal times, all that was needed to operate a medical flight was a hospital discharge summary and clearance from the aviation regulator. Now, we need permission from collectors or district magistrates of both arrival and departure cities, letters from the doctor and hospital giving patient’s details, an NOC from the state health department, which is needed for both the origin and destination states, and then medical certificates for the patient’s attendants saying they are not Covid-positive and neither have come in contact with any Covid-positive person in the last 15 days,” said Rahul Muchhal , founder, Accretion Aviation, an aggregator. He said only a few companies offer air ambulance services now due to these restrictions.Mucchal says they do bed-to-bed transfers. An ICCU ambulance along with a doctor and a technician picks up the patient from the hospital and takes him/her right up to the aircraft in the apron and the process is repeated after landing. “So if a patient has to be taken to Bhilai, then you land at Raipur airport and for the nearly 30-km journey on ground, you need clearances to show the cops. If the journey is from one district to another, then written permission from each magistrate is needed,” he added.He says almost every single patient’s family called to thank them for the service, with some even breaking down over the phone because they had exhausted most of the options to transport the patient. “That is something that never happens in a customer service business where customers are always complaining about something or the other,” he said. His company has operated about 10 flights during the lockdown, including eight departures, arrivals from/into Mumbai.“A 10-year-old boy from Kolkata was flown into Mumbai for an emergency brain tumour surgery. A patient who underwent a bypass surgery had to be moved to Raipur. Then, there are cancer patients who don’t want to miss the chemo cycle. After we receive the call, we ask the patient to get the permission from the state authorities as they need to show the medical papers, our team gets permissions from the hospital, the aviation regulator…the entire process takes about two to three days,” says Mucchal.Mandar Bharde, managing director, MAB Aviation Pvt Ltd, a DGCA-licenced aircraft charter company said inquiries for air ambulances have gone up post lockdown. “We used to get about 10 inquiries a day, but after the lockdown, the number has gone up to 30-35,” Bharde said, adding his company has operated about 10 flights during the lockdown. “In most cases, it’s those with elderly parents who need to be flown back home. A lot of them don’t have the money for the air ambulance flight, but approach us as last resort,” said Bharde. “Never in the past 10 years of charter business have I come across such emotional requests. I got a call from a couple in South India who wanted to take possession of their baby, born to a surrogate in another city. They wanted to get the baby back home. But now it’s not possible as it is not deemed an emergency,” Bharde added. He said that it is getting increasingly difficult to operate these flights. “Now, some airports have also begun taking advice from the airport doctor on whether to accept the patient or not. Apart from the documents we supply, they have begun taking their own doctor’s opinion,” said Bharde.India has about five to eight major air ambulance operators, with about eight aircraft between them. There is a huge demand in India for air ambulances, says Bharde. An air ambulance is an aircraft fitted with a stretcher and ICU equipment like BP, pulse monitor, ECG machine, ventilator and other items as demanded by the passenger’s condition. A doctor has to be on board to accompany the patient.“Mumbai is a big centre for cancer treatment. We operate about 60-80 air ambulance flights a year in and out of Mumbai. Most of the patients with heart ailments go to Delhi, those with liver problems go to Hyderabad,” said Mucchal. “We largely operate a Cessna C90 aircraft and charge a subsidised Rs 90,000 per flying hour for air ambulance. For normal charter, it is Rs 95,000 per hour, but then for normal flights we have conditions like minimum cost would be for two hours of flying time per day etc. For air ambulances, we have don’t have such conditions,’’ he said. TOI tried to contact patient’s families, but none of them wanted to be quoted or written about.