Interview: Dr Gene Delaune discusses both medical and military frontline experience
Dr Gene Delaune tells Megan Gaen about how his first-hand experiences of the emergency room and the warzone have aided his career in medical assistance and evacuation
Why did you choose a career in healthcare?
In school, I could never imagine myself in a job sitting behind a desk. I wanted to make a real, tangible difference and see the immediate results of my efforts. I was fascinated by science, especially biology and physiology, and in learning how the complex human body works. Halfway through university I realised I really wanted to continue my education – medical school seemed an obvious choice.
You are the Chief Medical Officer at SentinelMED. What does your role entail?
As Chief Medical Officer (CMO), I have oversight and policy responsibilities for all medical operations. We have two main products. On the case-management side, we function as the outsourced medical department and decision-makers for travel assistance companies, insurance companies, and hospitals with international patients. There is a team of physicians and professionals who review medical information and patient records, and we interact with both travel insurance companies and treating physicians with the goal of making sure patients who are away from home are getting the best possible care and are transported home when it is safe to do so. As the CMO, I oversee this team of clinicians and serve as a resource when they have medical or logistical questions.
Our second product is conducting medical transports for these travel assistance and insurance companies, as well as for individuals and hospitals. It is my responsibility to make sure that our medical escorts are appropriately credentialed and trained, and that the patients transported are medically stable. I have oversight of the medications and equipment they use to care for patients during transports and I am also involved in establishing relationships with the airline medical departments and clearance authorities to ensure patients have the smoothest possible experience when transported in commercial planes.
What is the role of medical assistance companies like yours?
Because SentinelMED is purely a medical company, we concentrate on what is medically best for a patient. Usually, when travellers need medical care, the doctors who are treating them have no training in aerospace physiology and the unique situation of a patient being transported while ill, so we help guide them. We consider factors such as expansion of gases, difference in partial pressure of oxygen at altitudes, and inaccessibility of immediate care while a patient is on a long flight, whereas a travel insurer also must think about underwriting, premiums and sales. By outsourcing their medical decision-making to a medical assistance company, they can separate business and financial considerations from medical decisions, ensuring patients are having medically appropriate decisions made regarding their care and transportation.
Over the past 20 years we have seen more travel insurance and assistance companies outsourcing medical management to specialised travel assistance doctors, who have both clinical expertise and aeromedical training to provide the best possible service. Because it is essential that travel assistance doctors continue their clinical practice to remain medically relevant, being employed full-time by a travel insurance company makes it difficult for providers to maintain a clinical practice. Part of our success is our ability to combine thorough knowledge of travel insurance and aeromedical medicine with the clinical expertise that providers maintain through their continued practice of clinical medicine in emergency and critical care medicine.
During your time at SentinelMED, what changes have you seen in medical assistance and evacuation?
I have seen a decreasing need for acute evacuations of patients over the past 20 years. The availability of good medical care is more widespread and now available in regions of the world where in the past we would have evacuated patients on day one. Also, because of huge advances in communication – the ability to quickly transmit photos, documents and to speak to treating medical providers and patients – we can get information early on about patients, even in very remote locations. We are often more comfortable with patients being stabilised locally before initiating evacuation or repatriation.
I have also seen less of a need for assistance companies to have their own credentialed network of vetted providers available. There are now many open source resources for patients and assistance companies to find medical facilities and research their capabilities and accreditations without visiting these facilities in person.
Additionally, because of the more widespread use of electronic payment options, the need for having direct pay agreements pre-arranged with providers has become less important.
What was the toughest medical evacuation situation you have been involved in?
One especially memorable experience was the week I spent in Thailand after the 2004 Boxing Day tsunami. I was deployed there in my role as CMO with Europ Assistance USA and had to locate and organise the evacuation of over 100 patients serviced by Europ Assistance. This involved visiting hospitals throughout the region, trying to find patients who had not been identified prior to their initial evacuation out of the disaster zone.
Additionally, it involved going to sites where unidentified bodies were stored to help identify insureds who had not survived. By the end of the week we had accounted for all of our patients and organised two medically staffed 737s to transport patients back to Europe.
Previously you were an active-duty US Air Force flight surgeon. How did that role prepare you for your current one?
I attended Tulane University School of Medicine on a United States Air Force scholarship, and afterwards was trained by the Air Force to be a flight surgeon. I was specifically trained to identify and care for critically-ill and wounded patients in remote locations and to determine when and how to safely fly these patients to a tertiary medical centre.
I trained in aerospace physiology, learning about the unique stressors that flight and altitude place on the human body. I was deployed to war zones several times and gained invaluable ‘boots-on-theground’ experience.
In 2003 I was stationed at a medical staging facility at Baghdad International Airport in the initial days of the conflict. I had to determine which patients could be evacuated to nearby Kuwait and which needed to be stabilised locally before transport. When Baghdad airfield was more secure and there were more options for stabilising patients in-theatre, it became possible to fly patients to Germany. This translated into longer flights, so patients needed to be stabilised to a point where they would be cared for during extended transport.
I also received training as a critical care air transport team physician. I would fly with the patients, caring for up to five critical care patients at a time during evacuations out of war zones, to receive lifesaving care in better equipped military facilities.
Now, as a travel assistance physician in the civilian sector, the training and experience I received in the Air Force are invaluable and have thoroughly prepared me to make appropriate decisions on when and how to evacuate even the sickest patients in the safest manner possible.
You also practise emergency medicine. What is it like working as a doctor in the emergency room?
I work approximately 100 hours each month as an emergency medicine doctor in busy, urban emergency rooms. I believe it is vital for me to continue this clinical work to best serve my patients in the travel assistance world.
As an emergency physician, I must remain knowledgeable about the latest medical practices and standards. During every shift I am interacting with other physicians from every specialty.
By working clinically, I have the confidence, expertise, and real-world experience to determine appropriate care for patients who find themselves ill or injured while away from home. Similar to travel assistance, working in emergency rooms puts me in a position where I never know what is going to walk through the door next. I must be able to think on my feet and figure out how to make sense of extremely complicated situations, while remaining calm and in control. And, back to my original reason for going into medicine, as an emergency physician, I can see the immediate results of my interventions.
What has been the highlight of your career?
The time I spent in Baghdad; it was a very humbling experience. Every night, the incredibly talented and dedicated team of airmen from the West Virginia Air National Guard, who I worked with, would receive between 50 and 100 severely injured soldiers via helicopter from the entire warzone. They would work tirelessly to stabilise these patients and load them onto aircraft in the dead of night when it was safe to move around the airfield. We saw hundreds of severely injured soldiers, who are some of the bravest, kindest, and most selfless people I have ever encountered. The injuries I treated, the soldiers I encountered, and the dedicated professionals I worked with will inspire and stay with me for the rest of my life.
What does the future of medical assistance and evacuation look like to you?
As people travel more, and more accommodations are made for people with underlying medical conditions, I believe there will be a bigger role for travel assistance companies. Similar to the way 9/11 highlighted the importance of having security measures, I believe because of Covid-19, people are more aware of the need for medical travel insurance and provisions for getting care when away from home. As sicker people are travelling, there is going to be a greater need for travel assistance professionals to make sure these patients are receiving the best care and being transported home when safe.