Bermuda could permanently lose its on-island air ambulance next month unless an investor willing to buy the business for $2 million comes forward.The service stopped operating temporarily at the end of last year as owners Eloise Bell and Sheldon Smith could no longer afford to run it.They hoped to attract outside investment in order to resume operating but that hasn’t happened.Ms Bell told The Royal Gazette it now looked certain Bermuda Air Medivac (BAM) would fold for good in June after seven years and hundreds of flights.“This was a business that I set up for Bermuda,” she said. “But then nobody was interested because it hasn’t affected them.”Ms Bell, vice president and chief flight nurse of BAM, said she’d make a final decision on the ambulance’s future next month, adding that it didn’t look hopeful.She said the Cessna Citation S2 plane was worth $1 million and it would cost another $1 million to start up the service again.The emergency room nurse said she didn’t know if the company could be run successfully as it could not compete with overseas air ambulances offering cheaper flights.At any rate, she said she and Mr Smith no longer wished to be responsible for the business though they would be willing to manage it for a new owner.With no air ambulance stationed in Bermuda, patients in need of overseas emergency treatment must wait for a medical plane to arrive from the US or Canada — unless, as is occasionally the case, one happens to be here.The wait can delay getting a person airborne for several hours — time that can ill be afforded in certain critical situations.It isn’t only emergency patients who are affected. At least one dialysis patient has lost out on receiving a donor kidney this year due to being unable to get to the States for surgery in time (see separate story).“We wanted to offer what was closest to the best that we can have and that’s being here and available,” said Ms Bell.“The people who are really upset are the surgical doctors. If there is something they can’t do here, they need to get the person out soon.”She has approached Government to see if it is willing to help BAM continue operating but said: “I have heard nothing back.”She and Mr Smith stopped operating the air ambulance in November after not getting any flights for three months.Bermuda Hospitals Board (BHB) had called for BAM to gain international certification — a statement Ms Bell claimed had a bad effect on business.She said BAM was declared safe and its medical services competent by an independent auditor.But she said BHB’s statement persuaded the Island’s health insurers to use foreign air ambulances instead, meaning BAM got hardly any work.The overseas companies offered cheaper flights but Ms Bell said it wasn’t viable for BAM to reduce its fees.Argus, Government Employee Health Insurance (GEHI) and FutureCare use Toronto-based CMN Global to manage medical evacuations.Peter Lozier, CMN’s chief network officer, told The Royal Gazette the company probably coordinated more than a hundred flights a year involving Bermuda.He said BAM had passed CMN’s credentialing and authorisation process and was always the first-choice air ambulance when:n time was of the essence;n it could offer the necessary crew and equipment; andn it was available.He said BAM’s main challenge was that it had only one plane. “They could be out on a trip; they weren’t always available. Part of our quality mechanism gives us statistics showing availability.“Often BAM weren’t able to do the flight because they were busy or the plane was being fixed or under routine maintenance. In that circumstance, we then took the next fastest.”Mr Lozier said BAM wasn’t authorised for all medical situations, including those involving very premature babies, when a specialised crew would be needed.In non-emergency situations, he said, quality of care was of utmost importance but cost would be a factor too and flights would go out to tender.“Otherwise, if you don’t, then you could be beholden to a particular carrier,” he said. “There is a cost associated with these things. That’s the industry standard of procurement.”Catherine Kempe, Colonial Medical’s senior clinical administrator, said the insurer had, on average, 20 air ambulance cases a year to and from Bermuda, with the majority involving high-risk pregnancies, premature or high-risk newborn babies and trauma cases.“During 2011, we did not have the opportunity to use BAM’s services,” she said. “We have a stable of accredited vendors that we use.“For each case we use the service provider who is most appropriate — i.e. capable of working with the patient — and most readily available at the time they are needed.“Our main priority is using a company that is best equipped to handle the case presented. Our selection is never determined on price.”John Wight, president and CEO of BF&M, didn’t respond when asked if the insurer used BAM’s services.He wrote in an e-mail: “BF&M’s primary concern when having a customer transported out of Bermuda for emergency medical services is patient safety and medical care.“We utilise accredited air ambulance transport providers. BF&M employs this approach to ensure that our clients receive the highest levels of in-flight safety and medical care.”Argus said in February it began using BAM regularly after hiring an independent consultant to assess if it could offer a safe service.Michelle Jackson, vice president of group insurance, said the insurer took the view that “since the business was owned by Bermudians and based in Bermuda, we should use their services unless there was a compelling reason not to”.Argus declined to comment further last week.This newspaper asked BHB to comment on the likely closure of BAM and whether the lack of an on-island air ambulance could adversely affect patients.A spokeswoman said the board wasn’t in position to comment on that.She added: “We are very supportive of having an internationally certified, local air ambulance service, as there are clear benefits to patients who need to be flown out of Bermuda quickly.”Last night the Ministry of Health issued a statement which said: “The Ministry is concerned that there is no on-island air ambulance service. It’s important to note that air ambulance services are still available, but there is additional time needed, as the plane must come from the US.“We would like to have more than one option, and we would welcome additional investment in the current local service. Again, however, as a private business, it must be financially viable to attract investors.“We must repeat that the BHB has always said that if the local service gets all of the certifications required, it would be named as a preferred provider. For that to happen, legislation is not required, and at this point no legislation is planned.”Burton Butterfield, chairman of Bermuda Medical Association, a professional body for the Island’s doctors, declined to comment.