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Wednesday, August 16, 2017

Air Ambulance Case Study: Combination with commercial flight

LJ45 double-stretcher interior

European Air Ambulance Case Study Beirut-Sydney

Combination of Air Ambulance from Beirut to Frankfurt with Commercial flight from Frankfurt to Sydney

While visiting Beirut an Australian woman suffered a stroke and was admitted to a local hospital. Medical staff conducted tests and a tomography scan with a conclusion that the patient had suffered a blockage to the middle cerebral artery, which had resulted in loss of oxygen supply to the left side of the brain and the consequent reduction in consciousness and a paralysis of the right side of her body.

The patient needed to be flown home to Australia for therapy, which required a stopover in Frankfurt so that her condition could be stabilised. Indeed, it was vital that the patient was in a stable enough condition to endure the long-haul flight back to her native country.

On 30 August medical staff decided that although she was still suffering loss of consciousness and partial paralysis, the patient’s condition was such that she could undertake the first leg of the journey. Her vital signs, such as heartbeat, breathing rate and blood pressure were all within normal ranges and, in addition, there were no signs of sources of infection or other criteria that could have endangered an air ambulance transport.

A flight was arranged via a European Air Ambulance dedicated air ambulance aircraft from Beirut to Frankfurt. Emergency physician Dr.Thomas Stute, who was on board the EAA flight, explains that the biggest problem with a patient in this condition is ensuring that the airways are protected. “These patients often display problems with swallowing,” he says.

As is the norm on EAA air ambulance flights, a paramedic, Simon Schreiber, as well as two pilots, Miles Bennet and co-pilot Jens Stein accompanied Stute. Schreiber describes the care criteria that must be taken into account when transporting a patient in this condition. “The position of the patient, the avoidance of Decubitus ulcers (pressure sores) and the state of catheters all have to be monitored as the patient cannot move due to partial paralysis.” The state-of-the-art equipment aboard all EAA air ambulances includes monitors, defibrillators, ventilators and infusion systems, which allows the operator to transport all manner of seriously ill or badly injured patients.

Before taking off for Beirut, the crew and flight planners also had to factor in a number of criteria, such as whether the patient would be transferred to EAA care at the airport or at the admitting hospital and what sort of ground transport would be provided. They had to assess the security situation in the country and ensure the patient possessed a valid passport. The flight plan was meticulously examined to check whether any external influences, adverse weather or flying over countries with air space restrictions, could affect the journey.

The day of the mission the EAA air ambulance took off for Beirut at 11.15 CET. Three hours and 30 minutes later the aircraft landed in Beirut. An ambulance was waiting at the airport with the patient on board. While the flight crew oversaw refuelling and technical preparations for the return flight, the medical crew undertook an examination of the patient and prepped her for the four-hour air ambulance transport.  They maintained a constant watch over the patient during the return flight and administered medication.

Landing in Frankfurt at 19.45 CET, the patient was immediately transported to the University clinic by a waiting ambulance. The plan was to stabilise the patient’s condition so that she was capable of undertaking the long flight to Sydney a few days later. Considering the distance, this would be undertaken on a commercial airliner. But EAA was still in charge of the transportation and so had to coordinate logistics and medical care with the airline.

An EAA medical team consisting of an emergency doctor and a paramedic would accompany the patient, who would be secured on a stretcher in a curtained off area of the passenger cabin at the rear of the plane. The crew had to prepare a special “commercial flight bag” which contains basic equipment and medication, but is then customised for each specific case.

The EAA planning team was again called in to action, this time to coordinate with the airline and airport authorities to ensure the patient and crew could check in and had valid visas and other travel documents, that ground transport would be waiting for patient transfer in Sydney and that the medical crew accompanying the patient had sleeping arrangements in Australia and that return flights had been booked.

The flight was booked as soon as possible, leaving Frankfurt at 11.50 CET and landing in Sydney at 18.10 local time the following day. The medical team of Dr. Günter Anti and paramedic Raimund Kosa factored in plenty of time to allow for transport to Frankfurt airport from the clinic as well as for security checks and for the patient to board the plane ahead of the other passengers.

The total flight time of close to 23 hours also required the transfer of the patient to a Sydney bound plane at Abu Dhabi. During the flight the medical team took turns to watch over the patient, check vital signs and prevent pressure sores. The flight passed without further incident and upon landing in Sydney on schedule, the medical team accompanied the patient on the ambulance for the short ride to the hospital. There they handed her over to the admissions unit.

Two days later the medial team flew back to Frankfurt and, after completing and handing in their report, the mission was finally deemed accomplished.

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