Medevac: Doing the 'right' thing

Think of the bleakest, remotest place you've ever visited. You may be smiling as you recall the beauty of the landscape or the solitude and peace of its very remoteness. If you're an adventurer, then the smile may be widened at the thought of skiing in beautiful alpine scenery with soft powder snow beneath your feet and equipped with the very latest Gucci downhill gear that money can buy. Or you might simply be remembering that walking or trekking holiday, perhaps in in the foothills of the Himalaya mountains, or maybe a diving adventure in the beautiful coral seas around the Maldives. Pause…

Think again. What if you fall on the ski slope, maybe develop altitude sickness in the mountains, or the bends from an over-enthusiastic dive? The smile fades and is replaced by a frown and the inevitable questions about accessing emergency medical care when you need it most, about 'medevac' and getting home. Maybe you'll be thinking 'will I be safe?' or 'will I survive?' Worse still for the family of patients who have been rendered unconscious or incapable of making their own decisions.

None of these scenarios is rare, and all of them have happened within the past year. How does an air ambulance company like Capital deal with these problems? How do we medevac somebody back from the foothills of the Himalaya mountains or from the remotest rain forest in South America? Naturally, every patient is an individual, each with unique needs and each with a set of risks, complications and health problems that need solutions – and fast!

Medevac (medical evacuation) is the popular name for what we call aeromedical transport. Some people think that we take off in to the rising sun at the drop of a hat and, like an airborne cavalry, our flying angels scoop down, snatch up the wounded and the ill, wafting them quickly away to the nearest hospital, or maybe even bringing them all the way home. Nice story, but it's a lot more complicated than that.

Every medevac we undertake first requires the very best and most detailed medical report that we can acquire from the team that is currently managing the patient overseas. We don't want to discover about instability that makes a long-range medevac impossible, only after we send an aircraft and crew all the way to that remote location in the most inaccessible place imaginable. Sometimes we're lucky and we acquire excellent reports written in perfect English and filled to the brim with useful information. But that doesn't happen very often. Most times, we have to piece together a story from a doctor 'on call' who doesn't really know the patient or who doesn't speak English or any other language we easily have at hand. Sometimes we get information from a nurse, traveling companions, family member, and even, of course from the patient him or herself. But information is key! Comprehensive medical details allow us to analyse and manage clinical and logistic risks, and the process itself helps us formulate the most appropriate transfer plan for each individual patient and encourages us to contemplate the 'what ifs' and the 'if we'.

Contingency planning is essential. It demands detail. It helps us choose the right medical team with the right skills, right experience and right equipment. It helps us clarify the right mode and vehicle of transport, the right route, the right destination and the right cabin conditions en route. All this 'right'… what could possibly go wrong?

A good medevac team (flight doctor, nurse and/or paramedic) always anticipates the unexpected. We carry enough equipment, medications and related paraphernalia to stock a small intensive care unit. And we practice, train, simulate, test and practice again, always keeping skills and knowledge as sharp as the scalpel. These skills are backed-up and supported by logistics experts - planners, the people who put the mechanics of the journey together, who make the flight work in a safe, timely legal and responsible way.

…And this is all happening before the rescue flight even leaves base. I'll follow this story in the next blog and build up a picture of what it takes to medevac a very ill or injured patient who is hundreds or thousands of miles from home.