Case study: Malteser AeroMedical face challenges in Mombasa

A 60-year-old male patient from Germany – travelling with family in Diani Beach, Kenya – called the emergency number on his insurance card, wanting to know whether costs were being paid and if he could continue to travel as he entered a local hospital for a quick check.

When initially contacting Malteser’s operations agents, the patient stated that he was suffering from breathing difficulties and bilateral oedemas in his lower limbs. However, a local doctor found an oxygen saturation of only 88 per cent and a rapidly declining breathing situation. An X-ray was performed, revealing COPD and a massive pleural effusion in his right lung, in addition to a rather large mass which was diagnosed as a suspected lung tumor. Unaware of his critical situation, the patient initially planned to leave the hospital, but collapsed during his evaluation and was subsequently admitted to ICU.

Aware of the restrictions in the local hospital, the team at Malteser AeroMedical quickly confirmed aircraft availability to ensure that an experienced team was on-site to assist the patient promptly and prepare him for his repatriation home, as additional treatment was imminent. Equipped with a specialised team, Quick Air’s Learjet 45 arrived at Mombasa Airport the next day, with the crew making their way to the local hospital for a first evaluation. Unfortunately, the local team refused entry at 9pm local time, which left the crew with no choice but to reschedule the initial assessment for the next day, which was also the day of the flight.

Upon entering the patient’s room, it became clear that the situation was worse than described, as he was on 8l/min oxygen, with a saturation of only 85–90 per cent. The patient was anxious, struggling to speak, with a looming hypercapnia. While viewing the X-rays, it was revealed that the patient also refused a pleural drainage, which would have significantly drained the fluid in his lungs and improved his condition. Evidently not fit to fly in his current state, the repatriation was pushed back 24 hours to ensure that the patient was stable enough for his flight back home. In addition, a pleural drainage was carried out by the local team.

It was agreed that the medical crew would revisit the patient later that day to confirm that he could be declared fit to fly with the pleural drainage in situ, and his overall condition stable enough for transport back to Germany. Given his severe diagnosis, it was determined that the patient could only be repatriated once intubated and under continuous ventilation, as any other mode of transport would not be sufficient to bring him back safely. Both patient and his relatives agreed to this measure, which was carried out by Malteser’s medical crew the next day, as the patient was picked up for transport.

Under continuous monitoring and medication, the team at Malteser AeroMedical was able to safely depart from Mombasa and keep the patient stable without incident during the flight. Upon landing in his hometown in Germany, the patient was picked up by an ICU ground ambulance and escorted to the specialist hospital by Malteser’s crew, where he was handed over to the treating doctor.

Another successful mission for the Malteser AeroMedical team, with excellent work in the air and on the ground, under tough conditions. The flight crew on site and assessment doctors in the operations centre in Germany evaluated the situation, then implemented the right measures to bring the patient home safely.