Case Study: Providing air medical services in remote locations

Expeditions in remote wilderness locations can be life-changing experiences for intrepid travellers – but when something goes wrong, getting the necessary medical treatment quickly and getting home safely can be incredibly challenging

A 44-year-old and 12-year-old were on a horseback trek in the remote plains of the MongolianManchurian steppe. But on the last day, as they crossed the prairie, the dad’s horse stumbled in one of the many burrows dug out by marmots that cause numerous accidents each year. The horse lost its balance, arched, and flung the 44-year-old at speed – estimated to be around 50kmph – to the solid rock ground. Barely able to move, he was in severe pain, having difficulty breathing, and couldn’t move his left hand. Due to the severity of the fall, he also couldn’t remember the accident happening.

With only a basic health system in place, the nearest hospital far away in the capital Ulaanbaatar, and Mongolian roads and transport systems rudimentary at best, there were real concerns for his wellbeing. A local ground ambulance took him across the 10-hour journey to the hospital. Once at the hospital, it was confirmed that he had fractured several vertebrae in the thoracic spine, but thankfully his spinal cord was not affected.

However, the patient needed a level of care that simply wasn’t available, so a decision was made by his insurers to call in European Air Ambulance (EAA). The EAA Mission Control Centre made contact with the medics in Ulan Bator and an assessment of the patient’s needs carried out. Although the local doctor only spoke Mongolian and some Russian, a German physician team-member at EAA was able to speak with him in Russian.

The medical transport

The flight crew and medical team – comprising pilot, co-pilot, doctor specialising in anaesthesia, resuscitation, emergency medicine and intensive care, and flight nurse also qualified in emergency and intensive care – were already on standby, so were able to prepare at short notice.

They knew that the medication the patient would need was not available in Mongolia, so the aircraft was stocked with additional supplies. Dr Annemay Huppert said: “The medical equipment we carry makes the aircraft in effect a mobile intensive care unit. We have a ventilator, defibrillator, complete haemodynamic and pulmonary monitoring facilities and other equipment for ICU-patients, syringe pumps, a vacuum mattress, ultrasound diagnostics, and all the medication you might need on an ICU transport.”

Taking additional equipment isn’t as simple as loading it onto the plane – it requires planning as well: “The medical team needs to know the weight of the patient and their luggage before taking off from Luxembourg, so that we could estimate how much additional equipment – especially oxygen bottles – we can carry, as it affects the weight balance of the aircraft.”

As well as medical equipment and medication, the mission planners knew everything else that might be needed would have to be taken from Luxembourg – right down to enough local currency to pay for taxis, food and accommodation on the ground.

“Another challenge for us was that the patient’s 12-year-old daughter was with him throughout,” added Dr Huppert. “She had managed to remain with him all the time. In Ulaanbaatar she stayed in a hotel with support from French Embassy staff, spending time at the hospital, and of course she needed to be accommodated on the repatriation flight too. The aircraft was soon in the air, taking the shortest route to Ulaanbaatar by flying over Russia – only possible because all EAA’s flight and medical crew members have the visas required to enter Russian airspace on a permanent basis.

The hospital transfer

On landing, the medical team went straight to the hospital to assess the patient and prepare him for repatriation, while the flight crew rested. Once medically stabilised, comfortable on appropriately strong analgesia, and declared fit to fly, the homeward journey could begin for father and daughter – although without the necessary Russian visas, this involved a longer route over Kazakhstan, Azerbaijan and Turkey and back to Luxembourg.

A ground transfer followed to the receiving hospital in Toulouse, and the recovery process that began with the arrival of EAA’s team in Ulaanbaatar could continue for the family after their ordeal. Dr Huppert said: “The fascination about my job is the teamwork involved in repatriations and rescue work. 

“On the one hand you have our team, including the flight crew, flight nurse and physician – and on the other hand you have the patient with the medical team in the country we go to repatriate him from, and the medical crews of the ambulances we ride with. “One of the most interesting and sometimes challenging parts is to convince the patient that the transport will go smoothly, and that he can put his trust in us as a professional team with the highest medical standards, that will safeguard him on the way back to his home country.”