Repatriation of a patient with a brain injury: waiting for the right moment

Albania has gained recognition in recent years for its natural beauty and unexplored destinations, particularly appealing to adventure travellers due to its diverse landscapes that include mountains and seaside regions in close proximity. However, the rapid growth in tourism has outpaced the development of infrastructure, presenting difficulties in handling emergency situations. Terrain can be rugged, and, in some instances, even animal-assisted or off-road vehicle evacuations are required.

Incident details and medical response

Initially, the patient received first aid at a small local hospital. Subsequently, she was transported by public EMS helicopter to a tertiary hospital in Tirana specialised in traumatology, where she was intubated and admitted to intensive care unit (ICU) for conservative treatment. Upon stabilisation, the treating physicians deemed the patient fit for transport, prompting the organisation of an air ambulance for repatriation.

At this stage, AIS was notified to assist in issuing from the embassy a temporary document as the patient’s passport was held by a relative in Germany. Issuing such a document within 12 hours and during the weekend was a challenge on its own. Upon arrival, the air ambulance crew conducted an evaluation and determined that the patient was unfit for transport as initially referred from the hospital treating doctor. Due to the severity of the brain lesions, the mission was aborted.

Medical clearance and coordination

Following the aborted mission, the AIS medical team was assigned with the medical clearance process. This involved a thorough reporting of the patient’s current condition, vital parameters, laboratory results, imaging studies, and administered treatments on an everyday basis. Continuous verbal and written updates were provided to the assistance company. AIS staff were involved in completing all the necessary documentation for safe transport.

A detailed form was prepared for the medical crew, outlining the patient’s condition, lab results, diagnostics, and the specifics of any intravenous lines and catheters. Eventually, the second air ambulance mission was successful, resulting in well-executed repatriation.

Conclusions

The case underscores the importance of comprehensive reporting and coordination between onsite medical professionals and air ambulance crews during evacuation or repatriation missions. The expertise of a local assistance company like AIS is crucial, particularly in regions with moderately developed healthcare systems such as West Balkans countries.

The medical clearance process aligns the treating physician’s information with insurance requirements, which is essential for coverage of expenses and efficient repatriation. In the West Balkans, where AIS operates, meticulous clearance procedures are vital to meet the growing demand for travel assistance services. AIS’s capability to integrate local medical expertise with international standards demonstrates its effectiveness in managing complex evacuation cases.