CASE STUDY: Providing medical support on the high seas

New Frontier Group regularly manages the proper medication, medical supplies, and proper quantities of patients in coordination with hospital discharge physicians and flight physicians for repatriations. A typical process involves working through the discharge procedure with a planner, matching patient with a pharmacy, and making sure medication is delivered to the patient when and where it is needed, prior to repatriation.

Getting everyone on the same page to ensure the patient receives the specific medication needed is extremely important to achieving successful outcomes, reducing readmissions, and keeping the patient safe and healthy. We have over 20 years of experience preparing international travel patients for discharge, and we have managed to circumvent several potential prescription issues before they happen. Statistically, medication errors occur more frequently when a patient is being transported back to their home country, and we know first-hand how critical proper medication is to the health and safety of our patients. Sometimes, when the discharge hospital gives medication supply orders that would only be appropriate for a local patient returning home – and which is not sufficient for a travelling patient – we have to work to correct these issues before transport.

We also often oversee specialty meds, as well as critical medication packaging and preparation required for patients prior to repatriation. All these things require careful coordination behind the scenes. We have good relationships with specialty pharmacies, and offer customised delivery and packaging systems to ensure proper planning takes place in the time before the patient’s departure. This advanced planning and communication is critical to a patient being repatriated via air ambulance or escorted flights.

A complex case

Our case study – which focuses on a 45-year-old ship captain from the Netherlands – is unique because the patient was actually repatriated on his own ship, rather than by flight. However, it highlights the importance of managing medication when conducting a repatriation by any mode of travel. The ship captain had been navigating along the US Atlantic coast when he fell ill in Miami. He was transported off the ship and subsequently admitted to a local hospital and diagnosed with adult onset of insulin-dependent diabetes.

When he was due to be discharged, New Frontier Group pharmacists became involved to coordinate medication. He stated he needed to return home on his ship vessel, but we realised he had limited training on monitoring his glucose or administering insulin – and only a few days of insulin and supplies had been given. He had been treated as a local patient going home and working with a doctor – which was not his situation.

NFG launch into action

Our pharmacy team could see he was in shock and traumatised by his diagnosis. We immediately took a lead role in stabilising him, both emotionally and physically, and orchestrated his entire newly diagnosed diabetic training sessions with local specialised pharmacists and nurses. Our pharmacist worked with the hospital to obtain more time with an endocrinologist and diabetes trainer to be sure he was able to administer the care before he got back on the ship to return home.

We also procured all of his necessary insulin, blood glucose monitoring machines, and all associated supplies, to ensure he had the necessary medication with some surplus to make his trip. We time-managed his medical needs making sure he didn’t run out of anything while he was at sea, enabling him to comfortably complete the two-month journey back to his home country. Consequently, the captain made it home in a healthy state, and was very thankful to our team for taking the time to get his critical care right during his time of need. However, if he had not been stabilised and trained properly, it is very possible he would not have successfully made the journey, and could been a candidate for either a maritime air medical evacuation or re-hospitalisation.

Lessons learned

One key lesson we learned from this case is to expect the unexpected, and maintain constant lines of communication. In this business, you are only as good as your behind-the-scenes preparation. We always create contingency plans to ensure additional supplies in case of delays, and communicate in detail with hospitals, hospital pharmacies, specialty pharmacies, patients, care coordinators, air ambulance and repatriation vendors.