Case Study: Redstar Aviation on a complicated repatriation case from Singapore to Fort Lauderdale

First Contact

It was early July, when the multilingual operations team at Redstar’s headquarters in Turkey received a request for an air ambulance transport for a rather complicated case from Singapore to Fort Lauderdale, Florida.

A 52-year-old female patient with a history of systemic lupus erythematosus, kidney transplantation, asthma, cervix cancer with lung metastasis and multidrug allergy was admitted to a local hospital in Singapore due to nausea, persistent vomiting, and coughing while on vacation.

After extensive evaluation, the patient was diagnosed with severe dehydration, pneumonia, and acute exacerbation of asthma. Despite IV fluids, antiemetics and antibiotic therapy, there was no visible improvement in the patient’s general condition, which had doctors order additional testing. A chest CT scan revealed a large pericardial effusion which was subsequently drained. Following the intervention, arterial blood gas analyses (ABG) showed persistent severe hypoxemia and non-invasive ventilation (NIV) therapy was initiated. During hospitalisation, her kidney functions had deteriorated, and the patient required Continuous Renal Replacement Treatment (CRRT). The following day, inotropes were also added to her treatment due to haemodynamic instability. The patient was in septic multiple organ failure.

Planning

Upon activation through a global assistance company, Redstar’s medical team immediately contacted the doctors onsite for a real-time evaluation of the patient’s fit to fly status. The duration of the journey from bedside to beside was set to be around 34 hours including three technical stops, flown with Redstar’s fully equipped Challenger 605. It was agreed with the treating doctor that pre-flight intubation would be most beneficial for the patient as she required considerable pressure and FiO2 support through NIV. Subsequently, the patient was successfully intubated; however, low platelet and haemoglobin values needed to be supported via transfusions prior to the flight. Thankfully, her renal functions and electrolyte imbalances had improved enough for her to be safely put off CRRT for the duration of the flight. Following clinical assessment and strategising, Redstar’s aircraft was pre-positioned to Singapore the day before to assure that a timely transport without interruption could be conducted. As always, Redstar’s medical team visited the patient upon arrival in Singapore to perform first-hand assessment and face-to-face discussion with the treating doctor and family members. The risk factors of such a long-haul flight with a critical patient and the family’s expectations were discussed in detail to assure everyone involved felt comfortable, and the patient was to be picked up the next morning to return to her home country.

The journey

As planned, Redstar’s medical team was bedside next morning; however, unfortunately there had been some deterioration overnight, with further hypotension despite inotropic support. It was the family’s wish to proceed in this condition to bring her back home despite the increased risk involved. After thorough assessment and confirmation with the treating doctor, the mission commenced as scheduled and continuous respiratory support was provided via Hamilton T1 ventilator and with the advantage of more than 20,000 litres of oxygen onboard the CL605. Fast ground times were achieved in Karachi, Istanbul and Reykjavik for refuelling.

Throughout the flight, inotropes were titrated as required, blood products and medication were administered on time, continuous oxygen was given, and the patient’s position was frequently changed to prevent pressure sores. A cockpit and medical crew change was performed during the technical stop at our Istanbul base with an additional medical crew member.

Patient handover and outcome

The patient remained vitally stable, and no inflight complications nor further deterioration occurred. After a total mission time of just over 34 hours, the patient was successfully handed over to the ICU in Fort Lauderdale.