Every medical transfer mission presents unique challenges that requires rapid and spontaneous interventions to help ensure the desired outcome for patients and all stakeholders involved. This case in question was not different as it featured unique developments at intervals that tested our clinical expertise, logistical and coordinative abilities.
We were faced with clinical challenges such that the patient suddenly developed Hyperkalaemia which is a life-threatening condition that could cause a heart attack just a few hours to the scheduled departure. This posed a crucial threat owing to the pre-existing medical condition of the patient and duration of the flight, but our medical team was able to effectively manage the condition inflight with the administration of calcium gluconate 10mls over 10mins and insulin – glucose regimen via portable syringe driver.
In addition to this, we experienced a lot of external logistical setbacks particularly with the airline that appeared to have maintained an undue interest to disrupt the mission taken into consideration the incessant and extensive delays in their responses to our application for a medical clearance, conflicting information provided per time on the requirements and unrealistic justifications for the delays and initial rejection issued.
Our team was however able to address the entire situation by extensively leveraging on our relationship resources within the different airlines (the flight was operated by two airlines) and embassies to fast-track activities that ensured the patient was evacuated timely and safely.
BACKGROUND
It was a sunny Saturday afternoon, when our alarm centre received a call requesting for our availability to assist with a medical escort to accompany a foreign national (Mr. Maxwell) from Nigeria to Malaysia at the soonest possible. Mr. Maxwell, a 48-year-old male was an expatriate who was deployed to work for a marine company in Port Harcourt, Nigeria, had unexpectedly come under one of the most difficult moments of his life just one month into his stay in Nigeria.
He was onsite when he suddenly developed severe swelling and pain in the abdominal part and legs with some febrile symptoms. The pain persisted for a couple of days and the symptoms worsened after which he was rushed to a nearby hospital for urgent medical attention.
Tragedy struck following the result of the laboratory investigations that was conducted as Mr. Maxwell was diagnosed of a chronic liver disease with malignancy and was immediately placed on treatment while further investigation was ongoing.
Consequently, Mr. Maxwell developed anxiety and repeatedly requested to be repatriated home immediately and it was at this point that Flying Doctors Nigeria was then contacted by the management of his company to assist with a commercial medical escort (CME) transfer.
Pre-flight Activities
Following confirmation received, our team immediately swung into action and activated all the relevant components (airline, hospital at both ends, medical escort and ground ambulance) in view of a prospective travel date. Our team was also in constant communication with the facility where patient was admitted to in Port Harcourt to ensure his condition remained stable for a commercial transfer. It was during these engagements we got to find out about the patient’s displeasure with the level of care being administered at the admitting hospital in Port Harcourt. This significantly heightened his anxieties and necessitated a quick intervention requiring moving him to another tertiary facility, possibly in Lagos for continued management as he would be exiting the country through Lagos. This was thankfully approved by his financiers and led to the first phase of the transfer.
Medical Transfer – 1st Leg
The confirmation to transfer Mr. Maxwell was gotten midday and the available window was later that evening which happens to be a peak period with limited flight options, but our team utilized available resources and contacts within our network to quickly sort out flight ticket and medical clearance for the CME transfer from Port Harcourt to Lagos. We secured a 17h30 flight and were able to swiftly dispatch our ground ambulance for patient pick up at the hospital. Transfer from the hospital to the airport was uneventful and arrival was in time for the scheduled departure.
There however was a delay from the airline which began to increase Mr. Maxwell’s anxiety but our personnel was able to manage the situation and reassure him. Mr. Maxwell was subsequently able to board the flight at about 19h30 in the company of our medical escort. The one-hour flight to Lagos was also uneventful and on arrival in Lagos, we already had our ground ambulance team positioned at the airport to receive the patient for transfer to the hospital we have also helped with and placed our guarantee of payment (GOP). Patient remained at the facility for another 48hours owing to the extensive delays experienced with the airline in issuing medical clearance for patient to board flight from Lagos to Kuala Lumpur. During his time at the new hospital, Mr. Maxwell’s countenance greatly improved, and he became a lot more settled environment and was able to speak with his family back at home. He appreciated the new environment and the quality of care made available to him inflight and at the new facility.
Medical Transfer – 2nd Leg
After over 24hours of intensive back and forth with the airlines to get medical clearance for the Lagos to Kuala Lumpur leg, we were able to again leverage our relationships to facilitate the eventual issuance of the clearance. The delay was due to communication breakdown between the two airlines involved – we initially opened communications with the booking airline for the flight which is to be operated by two airlines and this delay prompted us to communicate directly with the complimenting airline which in turn resolved all issues and we got the go ahead.
On the faithful day of the transfer, the entire team was mission ready, and our ground ambulance team was positioned at the hospital in Lagos to pick the patient for onward transport to the international airport. There was yet another setback as we were made aware that Mr. Maxwell developed hyperkalaemia (6.0 mEq/L) which is a condition that could lead to complications if not effectively managed during the transfer.
The new development in Mr. Maxwell’s condition necessitated an immediate engagement between our Medical Director and that of the hospital. Outcomes from this was a specially developed management plan to ensure Mr. Maxwell is safely transferred to Malaysia. Our team also had to make adequate provision for additional portable devices and consumables to enable an effective management of the patient inflight. Following this, Mr. Maxwell was handed over to our ground ambulance team for transfer to the Lagos International Airport.
On arrival at the airport, check in and boarding was seamless for both the patient and our medical escort. The aircraft departed Lagos and just about two hours into the flight, Mr. Maxwell developed diarrhoea with an open bowel of about 4times, however, he was constantly rehydrated. However, his overall vitals during the flight were stable.
There was another hitch during layover due to security checks that resulted in a delay that made them miss the connecting flight to Malaysia. Our team had to quickly make arrangement for him to be admitted to the holding bay at the airport. An alternative arrangement was also made for him to be admitted to a hospital with proximity to the airport in case there is that need but eventually, both passengers were cleared and got on the next available flight. He was uneventfully transferred to the aircraft; vital signs remain stable, although supplemental Oxygen was administered throughout the flight and as he was restless with multiple episodes of desaturation and severe abdominal pain. He however was handed over successfully to the ground ambulance team and his family in Malaysia.
Learn more about our Commercial Medical Escort (CME) service here.
For enquiries, Call: (+234) 0703 509 7761 OR Email: emergency@flyingdoctorsnigeria.com
