Case Study: A commercial airline transfer from Tehran to Frankfurt

marm assistance’s medical team was informed of a challenging situation involving a patient in Tehran, Iran. The young patient – who had been diagnosed with small cell carcinoma of the lung, metastasis to the central nervous system, including cerebral and spinal meninges and a 1.5 cm space-occupying lesion – had been visiting family in Iran when her condition worsened.

While in Iran, the patient was diagnosed with Eaton Lambert Syndrome as a paraneoplastic syndrome, and was hospitalised in an intensive care unit (ICU) due to significant impairment to the function of her lower extremities and bulbar muscles (muscles in the lower head and neck). The latter had resulted in limited articulation and swallowing, and an increased risk of aspiration.

marm assistance and the patient’s insurance company decided that a final decision regarding the patient’s fitness to fly, as well as the proper means of transfer, could only be made after visiting and evaluating the patient in person. This decision was made after noting the patient’s delicate condition, as well as Iran’s unique circumstances – such as unusual working hours and days, shortages of specific medications and materials, as well as limited access to recent technology and knowledge about retrieval medicine.

A rigorous medical assessment

Consequently, marm’s in-house medical escort team – consisting of a doctor and a paramedic – was deployed to Iran with the necessary medical escort equipment and modules. They evaluated the patient immediately after their arrival in Iran, and found that the patient was conscious and alert (GCS: 15/15).

The patient was also haemo-dynamically stable, demonstrating spontaneous respiration with a need for supplementary nasal oxygen (baseline oxygen saturation: 88–90 per cent ) without any increased intracranial pressure signs, despite the central nervous system metastasis and space occupying lesions.

Significant palsy was found in the lower extremity (Muscular Force 2/5), and there was significant impaired function of the head and neck muscles – the aforementioned bulbar dysfunction.

The medical escort team evaluated that the patient had acceptable to good general condition, did not have increased intracranial pressure (ICP) symptoms, and was on anti-convulsive treatment with no recent convulsions. They also noted that the risk of in-hospital aspiration and in-flight aspiration was the same for the patient, in case of limiting oral intake and intermittent vacuum aspirations.

Fit to fly

Consequently, the patient was found to be fit to fly in business class, escorted by a medical doctor and medical technician, with a 4-litre/minute supplementary oxygen during flight, where she could sit or lay comfortably.

To compensate the potential hypoxia risk posed by high altitude, the supplementary oxygen has benefits in preventing in-flight intracranial haemorrhage in space-occupying cerebral lesion, since patients with intracranial lesions have been reported to have less tolerance to hypoxia.

All the travel arrangements were done by marm’s in-house travel desk, however runway access to transfer the patient from a ground arrangement had its own operational challenges, which were solved by marm’s Persian-speaking in-house staff.