Case Study: Simultaneous repatriaton of two covid patients

Airlec Ambulance explains the careful planning that goes into repatriating two Covid patients simultaneously requires

Transporting a patient in an air ambulance will always have a certain number of difficulties, whatever the pathology and the state of the patient. Those difficulties are multiplied in the context of an appalling largescale pandemic such as Covid-19. And the complexity increases even further when it comes to repatriating two patients simultaneously, and when both those patients have Covid-19.

When lives are at stake, our medical crews never hesitate to take off and embrace responsibility head on.

Patient details and challenges

Dr Solenn Coz took off from Bordeaux in one of our Hawker aircraft with two nurses, Mrs Dubos and Mr Lagassat, heading to Africa, in order to take charge of two patients who had both been suffering from severe Covid-19 for 10 days. Let’s remember that this stage of the disease is the trickiest, and most dangerous for the prognosis of the patients.

Covid patients especially suffer from acute respiratory distress syndrome (ARDS). Therefore, in order to maintain the patient’s state during the mission, our crew always have to anticipate the stumbling block in the flight where the least oxygen is available. Hence our mission was to take charge – at the same time – of two patients, both of whom were in worsening conditions. As the local hospital did not have the means to care for the patients, it was absolutely vital to bring them back to France.

Patient transfer done at the airport so crew don't have to travel to hospital

The first patient was driven directly from the local hospital to the airport tarmac, where our team could immediately provide him the necessary care. The 70-year-old patient was hypertensive, and his condition was critical. His ARDS was jeopardising his vital prognosis. The patient was on his 13th day of disease, and he had been intubated for five days. His medical status was beyond critical when our team took charge on the tarmac. The local hospital’s resources were inadequate to manage patients with Covid-19.

Until our staff took over, the patient’s state of health was continuously deteriorating. Our team had to stabilise and improve his clinical status as fast as possible. He progressively recovered after take-off. He was then stabilised, and his state was much better during the flight. The flight – for this patient – then took its course without any serious events.

Simultaneously, our medical team had to deal with a second patient in his seventies, also with Covid-19. The state of this patient was of particular concern, as he was entering the critical phase of the disease, i.e., the 10th day. And, although the patient was suffering from respiratory failure, he could not be admitted into the local hospital because it was completely full. The patient was, however, medically monitored and supplied with oxygen and antibiotics directly at home. He had been driven from there to the airport by a local ambulance for air evacuation. He wasn’t intubated, but our team immediately put him on non-invasive ventilation to
take him to aircraft stretcher. His ECG was completely normal.

Critical condition worsens during air medical transfer

But unlike the previous patient whose condition was improving, the second patient’s state progressively worsened after the aircraft took off, requiring 100-per-cent oxygen. The patient was suffering from decompensated diabetes, and he was on insulin therapy. This metabolic disorder was actually putting the patient’s condition in jeopardy because of correlated dehydration. The patient suffered a drop in PaO2, and he then could no longer tolerate the change in altitude and started hypoxia. His respiratory pathology, i.e., Covid-19, was becoming extremely serious. The doctor then decided to place him under mechanical ventilation. He was intubated, sedated, and curarised. To haemodynamically support the patient, the staff installed a central intravenous line and an invasive blood pressure monitoring to stabilise him until he got to the destination hospital. The medical staff were reassured to see good progression of both patients, but kept them under
close scrutiny.

When the whole crew landed in the French airport, the local SAMU ambulance took the first patient to the hospital. At the same time, Airlec medical staff drove the second patient to the hospital to ensure an uninterrupted transfer to the intensive care unit (ICU) of the same hospital.

Although our doctor was absolutely used to dealing with two patients at the same time, she and the staff had to face two very critical cases inside one aircraft, where no external aid is possible.

Air medical training builds resilience

Covid-19 had put the patients into extremely critical states, with sudden changes that the staff had to deal with and make decisions upon. However, taking the risk to bring those patients into an aircraft with such a lethal risk due to ARDS will always give a better chance of recovery than leaving the patients abroad, where necessary care and equipment are lacking. Only experienced and well-trained staff can anticipate, make rapid decisions, and deal with this degree of stress.

This kind of mission requires a complete human preparation, but also a logistic one, insofar as the equipment is duplicated to cope with two patients: the oxygen cylinders, ICU devices and personal protective equipment for the crew. We are happy to declare that both patients are doing well now.