Commercial repatriation of a high-risk patient while containing costs

This article illustrates how a comprehensive, multidisciplinary team approach enabled the successful repatriation of a high-risk patient requiring noninvasive ventilation aboard a commercial aircraft in business class, while containing costs for the family.

History

The patient was a 61-year-old female diagnosed with amyotrophic lateral sclerosis (ALS) in June 2025. She travelled from her home country to the US for a three-day clinical trial evaluation.

During her return flight home, the patient developed respiratory distress with a choking sensation. The aircraft was diverted and returned to the US. Upon arrival at the emergency department, she was diagnosed with severe hypercapnic respiratory failure secondary to ALS-related neuromuscular weakness and hypotension.

The patient was treated with vasopressors and steroids. She elected to establish Do Not Resuscitate/Do Not Intubate (DNR/DNI) status but agreed to noninvasive ventilation.

Once stabilised, the patient wanted to return to her home country as soon as possible. She did not have travel insurance, leaving her responsible for all medical transportation expenses and creating significant financial constraints. Although the treating physician recommended air ambulance transport, the family quickly determined that the cost was prohibitive and contacted Prime Nursing Care for assistance.

Prime Nursing Care’s actions

Prime Nursing Care worked closely with the patient and family to develop a medically appropriate and financially feasible repatriation plan.

The team coordinated ground ambulance transport at both the sending and receiving locations and helped the family secure admission to a receiving hospital in the destination country. Throughout the process, Prime Nursing Care also provided the patient and family with ongoing emotional support and guidance.

Prime Nursing Care reviewed the medical records. We held extensive discussions with the treating physician and hospital care team to ensure a safe, seamless transport for the patient. The treating physician agreed to provide a fit-to-fly for commercial travel in business class, provided the patient was accompanied by a Registered Nurse and a Registered Respiratory Therapist and had access to a ventilator capable of delivering noninvasive ventilation throughout the flight.

Prime Nursing Care’s Clinical Care Team

The Prime Nursing Care Clinical Care Team brings more than 150 years of combined experience in critical care and air medical transport.

The Clinical Care Team conducted a comprehensive review of the medical records, the medical intake, and ongoing clinical updates from the treating team. Following the review, the Medical Director classified the case as high risk and approved the transport plan.

The transport team consisted of a Critical Care Nurse and a Registered Respiratory Therapist. Transport equipment included:

• Hamilton-T1 ventilator

• Liberty2 POC

• Portable suction

• Cardiac monitor

• ACLS medications.

The mission

On the day of transport, the team completed a final evaluation and deemed her fit to fly. The patient reaffirmed her desire to maintain DNR/DNI status.

She successfully completed a noninvasive ventilation trial on the Hamilton-T1 ventilator, and the patient and team departed for the airport. They travelled in business class, with the patient remaining on noninvasive ventilation throughout the flight. The transport was uneventful.

She successfully completed a noninvasive ventilation trial on the Hamilton-T1 ventilator, and the patient and team departed for the airport. They travelled in business class, with the patient remaining on noninvasive ventilation throughout the flight. The transport was uneventful.

Conclusions

This mission demonstrates Prime Nursing Care’s ability to manage complex, high-risk international repatriations requiring advanced respiratory support, while offering a cost-effective alternative to traditional air ambulance transport.

Several factors contributed to the successful outcome, including a comprehensive Clinical Care Team review, close coordination with the treating team, critical care Air Medical Staff, and specialised equipment. Through careful planning and execution, Prime Nursing Care safely transported the patient home while significantly reducing transportation costs for the family.