Critical thinking leads to lifesaving medical interventions

AirCARE1 was activated for an urgent flight to transport a trauma patient from a town in Mexico to the US. According to the dispatch report, the patient and her husband were travelling in a taxi when they were involved in a head-on collision. Tragically, the husband died at the scene.

Challenges of international medevac

International medical evacuations (medevac) come with a unique set of challenges, including logistical issues, language barriers, and cultural differences. These factors often complicate obtaining a completely accurate report on the patient’s condition.

This situation was no different as the medical team was unable to obtain a report from the bedside physician. They were, however, able to receive a single-page document that showed the patient had her spleen removed during an exploratory laparotomy that also revealed severe internal injuries. While the spleen had been removed, other surgical and diagnostic interventions remained unknown. With the full picture unclear, the team prepared for the worst-case scenario.

AirCARE1’s primary focus is on safely transporting patients to their destinations. During each mission, the medical team utilises an operational risk management (ORM) formula to assess the risk level. The ORM is a cornerstone of our safety management system (SMS), recently recognised by the Federal Aviation Administration (FAA) as an Approved Safety Management System.

Given the serious nature of the accident and the lack of information, the ORM categorised this mission as high-risk, indicating the need for clinical intervention. This risk was mitigated by the team being seasoned critical care specialists with exceptional critical thinking skills. They accepted the mission and were prepared and ready for all possibilities.

Medical assessment and intervention

Upon arrival at the bedside, the AirCARE1 team found the patient intubated on a basic ventilator with inadequate sedation and no analgesia. The patient displayed tachycardia with a heart rate ranging up to 200bpm.

In this unstabilised condition, the medical team immediately began to stabilise and treat the patient. They administered an anti-arrhythmic to slow her heart rate, gave proper sedation and analgesia for comfort, and switched the patient to a more advanced ventilator with appropriate settings for the patient’s condition. The team also discontinued all infusing IVs and replaced them with AirCARE1 medications.

Transport and stabilisation

The medical team determined the patient was in a critical condition and would not survive a five-hour flight. For the best chance of survival, the patient needed immediate transport to the closest Level 1 trauma centre at the nearest point of entry into the US. The team was notified of the decision to change the destination and made arrangements to transport the patient to Texas.

The patient was stabilised, packaged, and transported by local ground ambulance to the Learjet 60 air ambulance. During the flight, the patient was continuously monitored, with necessary interventions taken to maintain stability.

Conclusion

After the patient was transported to the Level 1 trauma centre, a follow-up revealed she had also suffered a non-ST segment elevation myocardial infarction (NSTEMI) and a traumatic aortic dissection. These findings confirmed that if the patient had been transported to the original destination, she would have likely faced a fatal outcome.