Barcelona, ​​October 4, 2023

Dr FERNANDO JUAN GERBER

On September 2023, we carried out a secondary transfer of a 45-year-old patient from Senegal to Spain.

Status report

The patient was a patient with a history of pleural tuberculosis in 2016 and COVID-19 lung disease in June 2023.

Currently, the patient was admitted to the intensive care unit in Senegal with a requirement for invasive mechanical ventilation since September 9 with a diagnosis of diffuse lung disease without associated organ failure.

 

Preparation for the transfer

The collection of information was quite difficult, the language barrier, the disparity of pathophysiological concepts for the diagnosis and treatment of the pathology to be treated and the availability of resources at the destination, made it difficult to diagnose the patient’s real situation.

With the information collected, we defined that the patient was a 45-year-old patient with a history of acute lung disease and who was currently experiencing adult respiratory distress syndrome with persistent hypoxemia and hypercapnea, associated with pneumothorax of the right lung field without associated organ failures.

The day before departure, at the Aeromedical and Marine TRI facilities, we held a mission briefing based on the information collected at the time. Transfer decision, modality, requirements, etc. a check of electromedicine and supplies, including verification via checklist of medication and consumables as well as testing of electronic equipment, batteries and connections to an electrical source.

Already at the airport we transfer electromedicine and supplies to the aircraft, we check respirator connections and electrical connectivity to the aircraft stretcher.

 

Crew briefing

Pilots present flight plan, schedules, flight profile, safety measures.

Aeromedical personnel raised the secondary transfer situation, aircraft requirements for the transfer, updating information on the patient’s global situation and the family and hospital environment.

We arrived at the airport in Senegal without incident. The transfer picked us up on time and took us to the hospital where the patient was for an assessment prior to the transfer.

Once there we prepared to enter the intensive care unit, we corroborated the information previously received but the severity of the situation was underestimated by the unit’s treating staff.

This was a 45-year-old patient with a history of acute lung disease who was currently experiencing adult respiratory distress syndrome with refractory hypoxemia and a large bronchopleural fistula.

 

Transfer

On October 23, early in the morning, we met on the tarmac with the ambulance that brought us the patient from the ICU. The patient was in the same condition as the night before. The ambulance doctor told us that the patient spent the entire night awake, struggling with mechanical ventilation and having an oxygenation crisis.

Before boarding the aircraft, we explained to the patient that we would put him to sleep and that we were going to travel by plane to another country to help resolve his condition.

We did a quick briefing of the crew, pilots and aeromedical personnel, we explained to the ambulance and runway personnel the steps to follow for the transfer. We established an action plan.

We performed deep sedation and neuromuscular blockade on the patient, then we transferred electromedicine. We optimized mechanical ventilation and quickly obtained respiratory improvement.

Once on the plane we conditioned all the devices, vascular access, respiratory orotracheal tube and pleural drainage, we replaced fixations, we sanitized the oral cavity that had large pressure ulcers from the oral device. Bladder and nasogastric tube.

During the transfer we reinforced prophylactic anticoagulation and stimulate a diuretic rhythm. We reinforced corticotherapy.

Finally, after 7 hours 50 minutes, requiring a stopover in the Canary Islands to supply fuel and oxygen, we arrived in Madrid. We transferred her to an ambulance that took her to the ICU at her destination without incident.

 

Final diagnosis

1) ARDS with refractory hypoxemia

2) Bronchopleural fistula

 

Dr FERNANDO JUAN GERBER

In each mission the medical escort finds himself far from the comfort and safety offered by the cockpit of the air ambulance.

Although the operational office organizes as many things as possible in advance for a patient transfer abroad, the escort always has to be able to call on his/her human, social, individual and professional resources.

Those powers of persuasion in the field are all the more exacerbated in a context of diplomatic tension. Indeed, the medical escort doesn’t only have to deal with the patient but also with his environment.

All the steps involved in a commercial repatriation are already cumbersome in ordinary circumstances. They become even more so when the transfer is to a destination country in conflict with the zone of origin, i.e. RUSSIA.

 

Under a contract signed with a children’s hospital in Catalogna, the medical escorts of AEROMEDICAL AND MARINE TRI, are in charge of returning terminally ill children back to their country of origin.

In this case, the child was a Russian baby who needed to be brought back home in Russia.

During the whole transfer, the child needed respiratory assistance with oxygen, via the Portable Oxygen Concentrator as well as the aspiration process.

 

The first issue was to find one escort authorized to cross the Russian border. Fortunately, one member of the team was of Argentinian origin, a country still tolerated by the Russian diplomatic services.

All measures had to be taken with the various diplomatic services to guarantee the safety of the patient, his or her relative and of the medical escort.

Besides, each appropriate form also had to meet the requirements of the Russian consular services.

The second issue was to find a carrier willing and accepted to travel to Russia. And there aren’t many of them.

All Russia’s European neighbors have closed their borders with the country. The only country enabling a flight to Russia was Serbia. But transiting through Serbia considerably lengthened the journey and the wait of the baby. Useless to remind that time was a very precious thing for the young little patient. Our escort had to carry on taking care of the little patient, assisting him with respiratory support during 14 hours.

The third issue was to find a GA willing to accept passengers from Europe. Fortunately, in that case, the family already on site decided to fetch the mother and child directly from the airport to home.

 

For obvious reasons we mainly think about the patient’s health, security and well-being first. But don’t we forget the safe return of the escort who has been utterly involved in the patient’s safe flight. Going back home was a journey neither pleasant nor easy. Our escort had to make a stopover in Armenia where the local government had prohibited the medication that we were carrying.

But fortunately, the persuasiveness of our escort convinced the authorities to let him have the medicines.

Generally, the operational desk can organize and forecast many details and issues that might occur during an evacuation. But the escort is far away and alone on the ground. Everything relies on his/her resources to get by in any adversary circumstances, but also on his dedication to his/her patient.

When a child’s life is at stake, no matter what diplomatic conflicts overtake us. We, modest citizens of whatever nationality, will do everything for their patient, and in particular for the right to die with dignity, once at home.

Dr. Monica Fortea. CEO of Aeromedical and Marine TRI, attended the Barcelona club The Wild Bunch that hosted the special reception last Tuesday, an initiative organized by the business club itself, with its owner Oriol Bueno at the helm, and the British consulate in Barcelona with the intention to create a movement to attract contributions from pharmaceutical companies and hospital operators to Ukraine.

Dr. Monica had the opportunity to have a quick introduction with the General Consul of Ukraine in Barcelona, ​​Artem Vorobiov, as well as other of his counterparts in the city representing Switzerland, Belgium and Poland, as well as with representatives of the Hospital Clínic de Barcelona and Cooperación Internacional.

Dr. Fortea, representing Aeromedical and Marine TRI, and HUGC, has been able to understand first-hand the immediate needs of Ukraine and to collaborate with the initiative. The event ended with an emotional recital by the Ukrainian pianist Oksana Pavlova, who performed songs by Chopin, Debussy and Ukrainian composers.