It was October 2005, and the Bermuda Air Medivac (BAM) air ambulance flight hadn’t even left the runway when the patient on board went into his third cardiac arrest.BAM vice president Eloise Bell stopped the flight and the team began to frantically resuscitate the patient using defibrillators and medication.They got him back, and Ms Bell telephoned his cardiologist and asked what he wanted them to do. The answer came back, ‘If you bring him back to King Edward VII Memorial Hospital (KEMH), he’ll die. It’s your call’.Ms Bell’s choice was to fly on to the United States where the patient could receive specialised care. Several weeks later, Ms Bell was driving along the North Shore and saw the patient well and walking along the roadside. He lived for several more years, thanks in part, to the actions of BAM.If her patient had waited on the runway any longer, he’d have surely died.Luckily, he needed the service in 2005. If he’d had the same situation in 2011, there is a high probability he might have had to wait hours while BAM went through a bidding process with other air ambulance companies in the United States.If a foreign company had underbid the Bermuda company, he may have waited hours for the air ambulance to fly to Bermuda.It’s a behind-the-scenes situation that most patients awaiting transport to hospitals overseas know nothing about, and have little control over unless they can pay the air ambulance bill themselves, out-of-pocket.Ms Bell, 64, believes she is largely unsupported by Bermuda’s medical establishment because she is black, female and Bermudian.“People often express surprise when they see that a woman is running things,” she said. “I think that is why we have problems with the insurance companies.“They object to a female, a black female, and a Bermudian. People think, categorically, that a Bermudian can’t do anything.“When I went to start up the business people said, ‘You will never get that off the ground’. But I never had any moments of self-doubt.“My father, Arnold Minors Sr, told me ‘God made two ends, one end you think with and the other end that you sit on. If you want to succeed you have to decide which end you are going to use. Heads you win, tails you lose.’”The president of the company is Sheldon Smith, a Bermudian pilot. They started the company in 2004.The late David Barber donated the air ambulance, and they made their first trip on June 22, 2005.They have three pilots, two to fly and one on standby if a pilot is sick or on vacation. Since that time they have run about 500 trips.“I am a nurse, and I saw the need,” said Ms Bell. “People were waiting ten to 12 days to go out of Bermuda, because they had to wait for an air ambulance to come in from the United States. Bermuda was not a priority.“One of my friend’s sons needed an air ambulance and after a whole lot of negotiations and whatever, finally one came out. That was when I decided Bermuda is such an affluent place we should have our own.”One of the arguments against them is that they do not have international certification from the Commission on Accreditation of Medical Transport Services (CAMTS). BF&M and Colonial Insurance refuse to utilise BAM for this reason.BAM is accredited by an independent company recommended to them by the Canadian Medical Network (CMN), the company Argus Insurance is now using to run the bidding war between BAM and American air ambulance companies.“In order to get the CAMTS certification, these ambulance have to satisfy requirements for mountain travel, desert travel and over water travel and snake bites,” she said. “We never do that. We tried to have a modified accreditation with them, but they would not allow it.“That is why we had to go with an independent company who would look at us for what we do. CMN set up our accreditation, and sent someone down here to do it, but BF&M and Colonial refused to accept that accreditation.”They are used by The Argus Group, Government Employee Health Insurance (GEHI), patients on FutureCare, and patients who are paid for by the Lady Cubitt Compassionate Association (LCCA).The bidding process was started two years ago, and it works like this. When a patient needs to be transported, Ms Bell receives an e-mail.As a result she sleeps with her BlackBerry, because she only has a half-hour to respond to the e-mail. She makes a bid for the job, and if she is not overcut by an American ambulance company, she gets the job and is ready to go within about three hours.“The foreign companies do frequently undercut us and they tell little falsehoods,” said Ms Bell. “They say they will be here a certain time and they are never on time.“Ninety nine percent of the time, they are not on time. They are two, four, or six hours late. I know it is detrimental to the patient’s care, but each time it happens, they say it won’t happen again. Until something dangerous happens, then no one will do anything.”She believed that sometimes the American air ambulances were giving prices that were detrimental to themselves.“You can’t couldn’t operate at that much of a loss and maintain your aeroplanes,” she said.This seemed proven recently when an American company undercut BAM.After the patient was transferred to them, their aircraft broke down, and the patient was sent back to the hospital.When the patient returned to the aircraft, it broke down again, requiring the patient to be returned to the hospital for a second time. Finally, BAM was called in to handle the patient.Ms Bell grew up around the airline industry, as her father worked for Pan American Airlines and American Airlines. She also worked part-time for American Airlines at one point.She studied nursing in England in the 1960s and returned to Bermuda to work in 1969, only intending to be back for a short time. After 18 months at KEMH she became bored.“I didn’t enjoy it there because I had come from a hospital in England where they were doing heart transplants,” she said. “On Cooper Ward, we were looking after people who had just had their appendix out.“That was the major surgery and it was not very challenging. I moved to the Emergency Department. It was a whole new experience because the nurses went on the ground ambulances, which wasn’t done anywhere else that I had worked. In England, they had St John Ambulance or private ambulances that did the trip.”Ms Bell moved to the emergency ward as a nurse, where she was second-in-command for 12 years.She left, but now works as a regular nurse in the Emergency Department on weekends.What she would like is greater support from the local insurance industry. She would like to be the main carrier used to transport patients from Bermuda.Before the bidding system was introduced BAM handled about 75 percent of cases going out of Bermuda. Now they are down to about half.“We don’t want all the work,” she said. “If we are here and someone needs to go, we would like to be the one.“Our record has spoken for itself. We have never had a problem. As a nurse, I know that if you get care, sooner, rather than later, the outcome is generally better.“If you are President Clinton in New York, you can get to a major hospital and get a stent in within two hours. Why do we have to wait eight hours in Bermuda because they choose to give their air ambulance flight to someone else?“I am giving you the avenue to get that good service, and you are being denied it because an insurance company needs to have a bidding process, or a company says you are not accredited by us.“That is BF&M and Colonial. How can an insurance company accredit an air ambulance? If the doctor insists that the patient goes right away, the companies will use us.“So you can use us when it is a serious case, and not use us when it is not serious.”