CASE STUDY: Out of the ordinary
After decades of experience in aeromedical transports, one might think they have seen it all – however, sometimes there is a case so extraordinary that even the most experienced flight physicians must go beyond their limits to make sure a patient is able to return home safely.
This was the case for Malteser Aeromedical in late August, when a call was received in the operations centre stating that a German citizen in Denmark was desperate to get back to Germany.
A 46-year-old woman with a family with two toddlers and a demanding position in a leading corporation in Munich had contracted Covid-19 in early 2022 and subsequently developed grave symptoms of a myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
ME/CFS is a widely complex, debilitating, long-term medical condition which – to this date – has limited research and treatment options. Patients affected by ME/CFS might experience symptoms such as dizziness, feeling extremely tired and exhausted all the time, and having trouble sleeping, concentrating and performing the simplest tasks, which leads to many being unable to function in their lives.
Following her acute onset of symptoms and being restricted to bed rest as well as being incapable of performing even the lightest daily tasks, the patient was admitted into an ME/CFS study group at a renowned German hospital with access to the very rare treatment with apheresis. Fortunately, when additionally stabilised with pacing, the patient’s condition improved and she was able to return to a somewhat normal life.
Convinced that a stressful daily routine wouldn’t be beneficial to her health, the patient decided to spend some time in a vacation home in Denmark to avoid any triggering situations and recover better – a self-imposed ‘rehabilitation’.
Whilst the first few days seemed to confirm her intentions of bettering her overall health, the patient suddenly fell gravely ill again, once again being bedridden, having difficulty swallowing, and developing severe hypersensitivity to light and noise. Despite the daily care of relatives, the patient’s condition worsened by the hour, and, with no ability to receive any medical support from local doctors and hospitals beyond treating acute symptoms, the patient desperately reached out to her insurance company for support to return to Germany. Subsequently, Malteser Aeromedical was contacted and tasked to perform this highly complex mission.
It became clear that anything involving a normal medical repatriation by air ambulance – starting with loud noises due to turbines, transportation in a ground ambulance, light exposure, communicating with the medical staff, as well as moving the patient into the aircraft – would cause almost unbearable pain for the patient. So, how to transport such a patient thousands of kilometres back to her home?
For the team from Malteser Aeromedical, the most challenging part was going to be to limit any exposure that might exacerbate the patient’s condition. Due to the very limited literature and experience worldwide with ME/CFS, adequate treatment and procedures had not yet been established, which added another layer of complexity to this case. Long briefings with the flight crew as well as the ground transportation companies on both sides on how to minimise any noise and movement, as well as thorough planning of the handovers and pre-transport visits, were conducted.
Malteser’s medical team prepared itself for a potential deterioration of the patient’s condition – with an imminent risk of the patient not being able to bear the transport – which consequently would mean full sedation and intubation. Adding more complexity to this scenario was the patient’s extremely limited capability to concentrate, which made it impossible to thoroughly explain any potential risks and consequences to her in case only a fully sedated transport were possible. In lieu of the patient not being able to fully comprehend the situation and being able to move forward with the transport, her closest relatives were informed by the medical team, and both patient and relatives agreed to the same.
Upon departure with aircraft partner Quick Air’s Learjet 45XR, the team arrived in Copenhagen the day before the transport and evaluated the patient in her holiday home. Upon confirming the final details, it was arranged for the medical team to arrive at the patient’s home in early morning to avoid additional light exposure. The next day, the patient was prepared with a sleeping mask and hearing protection as well as sedation with midazolam. Following the ground transport to the airport, the patient was carefully loaded into the waiting aircraft and was flown back to Munich, where another ground ambulance already awaited her arrival. Accompanied by Malteser’s medical crew, the patient was transported to her treating hospital, where she was once again admitted to the ME/CFS study group and put on a treatment plan with apheresis. Unfortunately, to this day, the patient continues to suffer from severe symptoms and is unable to return to her daily life.
This case definitely stood out for the team at Malteser Aeromedical and was a true challenge to everyone involved. From starting the turbines as late as possible to not talking in the aircraft and avoiding any use of fragrances, such as perfumes or disinfection, all the way to minimising any light during the flight – hundreds of factors had to be considered to make the transport bearable for the patient. Thankfully, the team worked seamlessly and, together with our ground ambulance partners and our aviation partner Quick Air, we were able to successfully support a patient in an unimaginable situation.