While this may be an appealing idea which has been up in the air, as it were, for many years, it still has not become a reality. "Pealtnägija" delved a little more into the reasons why.

At a time when the Health Insurance Fund (Haigekassa) is raising alarms over its funding model, which the authority says is unsustainable, and new patient insurance policies have put ambulance services under great strain LINK, a cadre of experienced helicopter pilots aim to introduce a private air ambulance service to the Estonian market.

Proposal from experienced pilots

Martin Noorsalu, a former commander of the Estonian Air Force's (Õhuvägi) helicopter squadron, said: "We've heard it before—some guys without even a helicopter between them wanting to do something."

"No, that's not our goal. We want to improve the system. I'm a taxpayer too, and if an accident happens, I worry about how I'll get to the hospital too," he went on.

The group's proposal stems from the need for a faster, more efficient response to medical emergencies in Estonia.

Ivar Värk, another key figure behind the initiative and who served in military and civilian roles, including evacuations in Afghanistan, agreed with the assessment.

"Currently, I wouldn't for example venture to move too far from a city or a place which had a hospital system," he said.

"Knowing that this system won't save me in a critical situation."

"I've personally been in a situation where I had to perform artificial respiration for 40 minutes straight, just to save a life," he went on.

"We had to wait that long for an ambulance. Fortunately, the person survived," said Värk and Noorsalu as noted are both battle-hardened pilots with extensive experience in both military and civilian aviation.

Värk has flown over 500 medical missions in the U.K., saving nearly all the patients he ferried to hospital.

Both pilots however believe that Estonia's current system is inadequate, particularly when it comes to remote areas.

The limitations of the current system

Currently, emergency flights in Estonia are handled by the state via the Police and Border Guard Board (PPA), which operates a fleet of three helicopters, two planes, and has around 20 pilots on its books.

However, medical flights only make up 20-30 percent of their workload, while they are often delayed by the PPA's broader responsibilities, which also include sea rescues and search missions.

According to PPA aviation unit head Rain Jõeveer, "If we're talking in terms of internal security, that person is also in critical condition or needs rescue. Our medical flights account for … around 250 flight hours annually."

This means that PPA helicopters can't always respond to medical emergencies quickly.

Värk said: "A thing that tries to do everything does not do anything well.

"A rescue helicopter is intended for rescue operations. If it has to take on another role, it would simply not be cost-effective."

Also, PPA helicopters are large (they use AgustaWestland AW139s, pictured) and so require more space for landing, while their crews are not always available to scramble at immediate notice.

In rural areas, where roads are poor or sometimes even inaccessible, this way of doing things becomes particularly problematic.

In addition, many of Estonia's islands are inhabited and while the larger ones like Saaremaa or Hiiumaa have hospitals, the smaller ones do not.

For example, in case of an emergency, a rural patient may first be taken to a local hospital for triaging before being airlifted to a larger facility, all of which wastes valuable time.

"At present, it might be that the nearest ambulance crew arrives, takes them to the nearest county hospital, where they then assess that there's nothing they can do, so then have to call the helicopter anyway," Noorsalu said.

Private air ambulances: A more efficient solution?

The solution proposed by Noorsalu and Värk is to introduce smaller, more agile helicopters, dedicated solely to air ambulance roles.

These could provide a faster and more efficient response, especially in the more outlying areas.

"The medical system could respond directly to the scene. If Aunt Maali has a stroke down on the farm in Rapla County, the helicopter could take off from Tallinn, pick her up, land right next to the farm, take her aboard, and fly her straight to the hospital," Noorsalu explained.

This approach would eliminate unnecessary delays and improve response times, something crucial for saving lives in critical situations.

"Having lived in the U.K. and seen how beneficial this service is, I believe we in Estonia are worse off," Värk added.

Financial and legal challenges

However, the introduction of private air ambulances faces both financial and regulatory hurdles.

The Health Insurance Fund, which finances medical flights, has estimated that maintaining a national air ambulance service would cost around two million euros per year.

Nikita Panjuškin, head of the Ministry of Social Affairs' health services department, argued that this money would be better spent on improving ground ambulance services.

"These people do not need an air ambulance that arrives from Tallinn a few minutes faster than the hour; they need an ambulance that reaches them within five or at most ten minutes, to save lives," Panjuškin said.

Despite this, Noorsalu said he believes that a dedicated air ambulance service could be more cost-effective in the long run.

"I can state that the cost per flight hour of a rescue helicopter has risen to such a level where, for the same money, it would be viable to operate a specialized air ambulance helicopter," he said.

Moving forward with the project

Despite these challenges, Noorsalu and Värk are committed to moving the project ahead.

They plan to launch the service as early as next year, partnering with a Western European medical flight service provider.

The helicopter would be based in either Pärnu or in Tallinn, with a medical team on site, ready to respond immediately to emergencies.

"I've done this and have seen the benefits it brings. The question is how people might support it. Will they be on board and help make it succeed, or will they work against it to ensure it doesn't work out?" Värk inquired.

For now, the key issue remains whether private air ambulances will be permitted to operate in Estonia.

Noorsalu and his team remain hopeful of seeing a more open and competitive air ambulance market, where private operators can help address the country's urgent medical needs.

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