Having passed their A-level examinations, 20-year-old Laurenz and his friend set out for a round-the-world trip to celebrate a new chapter of life. Their first destination was the sandy beaches of Koh Tao in the Gulf of Thailand.
While practising an emergency ascent during a diving lesson, Laurenz lost consciousness and repeatedly tilted under water before being pulled back on the boat. Although Laurenz was resuscitated and regained spontaneous circulation, foamy secretions were running from his mouth and nostrils. Laurenz remained unconscious and started showing convulsions. After emergency treatment in Bangkok Samui Hospital, Laurenz was transferred to Bangkok Hospital.
Patient information sent to FAI implied a severe hypoxic encephalopathy, which fulfilled the criteria of likely brain death. The patient’s father, who had left Austria for Thailand immediately, and the young man’s travelmate, who was suffering from massive emotional strain, were due to escort our patient.
Obstacles to overcome
It was evident that this mission would be challenging in various aspects: Laurenz was mechanically ventilated with a high inspiratory fraction of oxygen and had received a thoracic drain for pneumothorax. He was suffering from a systemic infection that required intensive care therapy.
Moreover, FAI realised that the patient’s father and friend had not had a chance to understand the severity of the situation nor processed the subsequent emotional trauma. Our team would be the first to explain the situation to them in their mother tongue, as well as the first caregivers with a western cultural background. Therefore, we decided that Mr Helm, a psychologist with specialisation in crisis intervention and counselling, should join as the third member of our medical team.
Helm joined our team at Munich airport. FAI’s Challenger 604 left for Don Mueang airport and arrived 20 hours before the scheduled departure to Vienna. The medical team completed a bedside assessment and made the necessary arrangements for the flight ahead. Bangkok Hospital is undoubtedly one of the top medical facilities in Southeast Asia, with therapy plans, preparations and reports met with the highest standards. However, open communication with Laurenz’s family and friends had been impeded by linguistic and cultural differences.
Laurenz’s ambulance transfer was uneventful from a critical care point of view, but when we introduced ourselves to the patient’s father and friend, we immediately knew the decision to include Helm was highly beneficial. Laurenz’s father instantly broke out in tears. The young man’s friend had remained quiet since the incident and was drinking constantly. During the 13-hour flight, there was a lot of talking, crying and a trace of relief and amity. When handing over Laurenz to the University Hospital of Vienna in an unchanged medical condition, there was an undeniable bond between everybody involved in this extraordinary repatriation.
Emotional support as essential as medical staff
Professional psychological support proved invaluable in this critical situation. While the management of a demanding intensive care patient is well within the general expertise of our well-trained flight physicians and paramedics, simultaneously providing adequate psychological and emotional support to his family and friend would not have been possible. The professional intervention of a on-board psychologist may have a great impact on the sufferers’ emotional and mental health and, in a comparable setting, we will opt for the same approach.