Navigating the Challenges of Long-Haul Medical Air Evacuation

When it comes to medical evacuations, each journey presents its own unique set of challenges, demanding meticulous planning, skilled execution, and adaptability from the medical crew. 

We sat down with the crew at Universal Air Evac to unpack the medical challenges that they face at 40,000 feet. We spoke to them about a particular transportation of an elderly patient requiring continuous ICU care from East Africa to the UK that stands as a testament to the complexities inherent in such missions.

During the long-haul repatriation flight, the medical team faced a multitude of obstacles, ranging from the patient's intricate medical needs to environmental and logistical hurdles. At the heart of the operation lay the patient's condition: immobile, necessitating meticulous attention to detail and round-the-clock care. We thought we would find out what those challenges are, and how they overcame them. 

Saving Lives with Restricted Equipment and Supplies

Universal Air Evac's aircraft serve as a mobile extension of the intensive care unit (ICU), equipped with state-of-the-art medical technology tailored to meet the demands of critical care in flight. 

However, even with the most advanced equipment on board, there are inherent limitations to what can be feasibly carried in the sky. Crew members are tasked with the challenging responsibility of keeping the patient stable as they travel extended distances and can find themselves flying from the southern to the northern hemisphere, or vice versa.  These extreme weather changes, from summer to winter,  as well as possible stopovers in hot desert environments, can have a significant impact on the patient. 

During unexpected delays on long-haul flights, careful evaluation of the patient's oxygen usage is imperative to prevent the depletion of onboard oxygen supplies. Strained by stringent gas and weight restrictions, the available oxygen must be judiciously managed, prompting the crew to plan for worst-case scenarios by carrying a maximum safe amount of oxygen on board, even if the patient's current oxygen needs are relatively low. 

Unexpected delays can also have an impact on the equipment itself. All devices requiring power supply are equipped to operate on internal batteries during ground delays, ensuring uninterrupted functionality. Extended ground delays can put a strain on the battery life, and the crew have to be proactive in managing the battery life as well as ensuring that oxygen taken on board is meticulously calculated before every flight. 

Navigating with Limited Crew

One of the most daunting challenges faced by the team at Universal Air Evac is the constraint of a limited crew on each flight. In critical situations requiring resuscitation, the burden falls squarely on the shoulders of just two individuals, who are tasked with these life-saving activities in the confined space of the cabin.

Furthermore, the crew must seamlessly transition between roles that, in traditional hospital settings are carried out by various individuals. Consider the management of identifying and treating life-threatening conditions, turning the patient and feeding tubes as well as the added responsibility of blood tests and ultrasounds, which are traditionally linked to the laboratory and the radiology department, respectively. On these flights, two people have to wear all of the hats at all times during the flight. 

This particular patient's care regimen involves multiple facets to ensure comprehensive support. First and foremost, a strict medication schedule is adhered to, with various medications administered at precise intervals. In addition to pharmacological interventions, meticulous attention is given to drains, ensuring their proper positioning, monitoring, and cleanliness, with regular emptying as needed. 

Wound care is diligently managed, with a focus on cleanliness and comfort to promote healing. As the patient is unable to mobilise independently, the medical team performs regular turning and pressure care to prevent complications. Intravenous feeds are administered to meet nutritional needs, while oxygen supplementation is essential due to the patient's general condition, history of pneumonia, and altitude-related challenges. Furthermore, frequent tracheostomy care and suctioning are vital to maintain airway patency. 

Overcoming Unstable Conditions

The crew will also have to deal with the turbulent nature of the flight itself. Vibration, turbulence, unplanned stops and pressure variations present constant hurdles. Some of the key challenges, especially in this flight, include:

• Vibrations, inherent to the propulsion systems and aerodynamic forces, can interfere with the accuracy of medical devices and complicate procedures requiring steady hands and precise measurements.
• Turbulence, a common occurrence during flight, poses a significant risk to both patients and crew, challenging the stability of medical equipment and necessitating adaptability in the delivery of care.
• As the aircraft ascends to higher altitudes, fluctuations in air pressure can exacerbate existing medical conditions and impose additional strain on both patients and caregivers.
• On this particular flight, technical delays at the alternate airport extended the time on the ground, exacerbated by the scorching afternoon heat of North Africa. Any ground delay prompts a flurry of additional questions: do we possess sufficient Flight Duty Period (FDP) to continue the mission? At current rates of administration, do we still have enough oxygen and medication to sustain proper medical care? Due to challenges like these, our  "planning for the worst" ethos ensures that we always have surplus medication, equipment, and oxygen on board, enabling us to manage patient care seamlessly in the event of delays.
• Refuelling amidst harsh environmental conditions can significantly impact the sick individual's condition. Extreme heat, cold or even rain can affect hydration levels, heart rate, and blood pressure, and potentially necessitate additional medications or treatments.
• Rain can have a further impact on the equipment and crew who are not only trying to manage the patient but keep equipment dry too.
• Moreover, removing the patient from the aircraft isn't a simple solution, as immigration and customs regulations in various countries mandate strict procedures for entry and exit, further complicating the situation.

Adhering to Various Regulations and Legal Restrictions

Extending their life-saving mission beyond domestic borders means navigating a labyrinth of international restrictions and regulations, each presenting its own set of challenges. Nowhere is this more evident than in Africa, where obtaining permission to operate can be a complex and time-consuming endeavour. From securing overflight clearances to obtaining landing permits, every step of the journey is punctuated by bureaucratic hurdles that must be diligently overcome. Moreover, the crew must contend with varying standards of medical practice and aviation safety regulations, necessitating a nuanced understanding of international law and compliance. 

To navigate these intricate landscapes with precision and confidence, accreditation with organisations such as the European Aero-Medical Institute (EURAMI) is paramount. These accreditations not only validate the expertise and professionalism of the team but also serve as a testament to their unwavering commitment to upholding the highest standards of care, regardless of geographical boundaries or regulatory complexities.

The Bottom Line

As emergency medical services continue to evolve, so too must the strategies employed by organisations like Universal Air Evac. By embracing innovation, fostering collaboration, and prioritising patient care above all else, they stand ready to confront whatever challenges lie ahead, ensuring that no matter where in the world a patient may be, help is never far away.