Connecting worlds: ICATT USA

It was July 2022. There was a call from Portland, US, for a patient transfer to Chennai, India. The call was answered by ICATT’s command centre at Bangalore. A 72-year-old elderly patient with multi-organ failure was to be brought to Chennai for further management.

A challenging distance

Apart from being the longest distance aeromedical transfer of a critical patient that ICATT had ever done, it was also one of the first cases where a critical patient was being airlifted to India from America for escalation of care.

Within hours, ICATT’s operations team set up a line of communication with the treating physicians at Portland where a detailed clinical summary was provided. Simultaneously the aviation team worked out the air logistics.

The receiving hospital at Chennai was aligned and a joint video call was arranged between all the stakeholders involved as well as the family. Soon after, ICATT’s medical team was dispatched to the US to reach Portland by commercial airlines so that they would have enough time to assess and pre-optimise the patient prior to transfer.

This aeromedical airlift was conducted with military precision, taking 26 hours of flying time in a Challenger 605 flying ICU

This aeromedical airlift was conducted with military precision, taking 26 hours of flying time in a Challenger 605 flying ICU. It received global media coverage, including on the BBC, as the longest aeromedical airlift.

A professional operation

This transfer highlighted how ICATT conducts its operations – including the swiftness of its aeromedical logistics and its capability with handling ultra-critical patients. Aeromedical logistics not only includes the aircraft getting mobilised, but also, and most importantly, the medical team being mobilised prior to the aviation positioning.

ICATT’s medical team was transported by commercial airlines with a complete set of mobile ICU equipment. The team reached the referring hospital and then did a thorough bedside assessment and embarked on pre-optimising the patient before the scheduled airlift.

Medically, this pre-optimisation phase harnesses the physiological reserve of a critical patient, which is very important in a long-distance air transfer. It also gives enough time to delay or cancel the aircraft arrival if the patient is non-salvageable, saving the resources of the insurance company and also the family.

At ICATT, the number of patients airlifted from the US, Canada, the UK, Australia and Africa has significantly risen since this transfer from Portland in 2022. ICATT Air Ambulance service, the largest in South Asia, is now increasing its medical strength from 25 aeromedical doctors to 45. All go through a structured training programme: FAM – Fellowship in Aero-Medical Sciences – a joint collaboration between ICATT and UK air ambulance services.

Overseen by two critical-care specialist doctors trained in the NHS, UK, Dr Rahul Singh Sardar and Dr Shalini Nalwad, ICATT is now operating out of three bases in India plus one in the Maldives and two in the Middle East. ICATT is the only organisation using fixed-wing jets, turboprops, helicopters and sea planes, as well as commercial airline stretchers for its operations.

It has multiple business-to-business and business-to-government contracts within India, the Maldives and the Middle East. With a process-driven operations system, it is working on the ethos of clinical governance, where standard operating procedures are adhered to and audited, providing standardisation of care and assured quality.

The uniqueness of the style in which it works is to take each case as a critical-care challenge, and each case is discussed by a panel. Every case ends in a debrief so that systems change for the better.