In the July issue of ITIJ, we reviewed the recent ITIC APAC conference in Singapore. Below are the case studies from this year’s ‘Industry insights’ session.
The Industry insight sessions at ITIC events provide a window on real-life medical assistance cases. Air ambulance and assistance providers took to the stage in Singapore to share their insights into logistically and medically complex cases, so that attendees might learn from their experiencesInjured child in Fiji Islands
Left: Annabel Toogood, Managing director, New Zealand Air Ambulance Service Right: Angela Coward, Senior flight nurse / clinical coordinator, New Zealand Air Ambulance Service
Angela and Annabel presented a moving account of a tragic accident involving a four-year-old boy on holiday with his parents in Fiji. While at the resort swimming pool the youngster sat on the pool filter pump with a missing protective cover and had his lower bowel sucked from his body. The traumatic injury required urgent air ambulance evacuation from the remote island to Auckland, New Zealand. In the meantime a laparotomy and bowel resection had to be performed at the local Lautoka Hospital in order to stop the bleeding and save the boy’s life. The infection also had to be treated with triple antibiotics.
The logistics of the emergency team included flight planning, team composition, and communication with NZAAS and Starship Hospital to establish treatment capabilities. Pre-departure clinical considerations included the urgent availability of a paediatric surgeon and paediatric anaesthetist, as well as preparations for possible interventions, obtaining blood for possible transfusion and for ongoing blood loss, and much more.
Upon arrival, 24 hours after the incident took place, the team had to meet the understandably distressed family and staff, communicate with the local doctors for a patient handover and assessment, and try to stabilise the boy for an air evacuation. During the flight there needed to be ICU management, updated mission coordination, support for family, and arrangements made for an ambulance to Starship PICU, followed by patient handover.
Despite the severity of the injuries and the remote location, thanks to a speedy response and a skilled medical team, the boy survived and made a recovery.Mental health complicates cruise evac in Shanghai
Radmila Sarkisyan, Project manager, development & co-operation worldwide, AP Companies
Radmila’s case study recounted an incident on a cruise ship near Shanghai, China. A 70-year-old lady slipped onboard the ship and broke both of her hands. She was accompanied by her 50-year-old son who turned out to have a mental illness that relapsed into an acute condition when his mother became injured. The son was extremely distressed and delusional, saying he couldn’t leave the ship because he was halfway through his mission to concrete over the sea.
However, it was necessary to ensure that the lady and her son disembarked and were evacuated back home to Almaty, Kazakhstan, as soon as possible. This raised several challenges, including the quick disembarkation of the passengers due to an unplanned port call. Both the elderly lady and her son were unable to care for themselves without specialised assistance and required urgent hospital admission. They also needed visa support and medical escorts. Additionally, there was the complication of getting medical clearance for a traveller with a mental illness to board a standard flight.
Despite the challenges, the evacuation was a success due to an extensive network of medical providers in port areas, including ground and air ambulance companies, transport providers, marine and general hospitals, and private doctors. Radmila said there was close coordination with port agents and a 24/7 call centre with a Chinese-speaking person. There was also communication with medical teams with valid visas at local offices, and contracts with airline carriers. As a result, both patients were successfully evacuated to Kazakhstan on a regular flight within three days of disembarkation in Shanghai. The lady was accompanied by a female nurse who cared for her during the whole journey and the gentleman was escorted by a male nurse.Italian tourist bus crash in Laos
Alexandre Besson, Operations director, Poe-ma Assistance & Services
Alexandre’s case study focused on a bus crash in rural Laos involving 15 Italian tourists insured by Filo Diretto Insurance. Their minibus crashed into an oncoming tour bus on a mountainous road 223 kilometres north of the capital, Vientiane. All of the injured were brought to Vientiane by local medical services. Alexandre said that the the initial notification did not indicate anything about the gravity of the situation or the exact number of persons involved.
The groundwork required finding out where the travellers involved in the accident had been taken. Once they were located it was necessary to get a medical assessment and appropriate advice regarding any further actions that needed to be undertaken. A red notice was then issued and contact made with a ground operations team in Laos for immediate intervention. The Poe-ma Assistant Operations Manager in Laos sent a coordinator to hospital and it was established that four patients were in a very serious condition, one of which had already had his arm amputated. Having assessed the situation, the Operations Coordinator immediately advised that the two patients in the most critical condition should be evacuated to the nearest centre of medical excellence in Udon Thani, Thailand.
Alexandre said that the situation was complicated by the fact that it was night time, and the local medical team was totally overwhelmed by the gravity of the situation and the number of patients requiring treatment. The medical team also wanted to proceed with an amputation on a second patient and the Poe-ma staff had to stay at the patient’s bedside to make sure she was not brought to the operating theatre.
Despite a green light for transferring all patients to Thailand, the Vientiane hospital refused transportation in ambulances that were not theirs and also tripled medical charges. In the end, Poe-ma managed to get exceptional authorisation to take all patients directly to the hospital in Thailand. The patient that was scheduled for an amputation by the Lao medical team had her limb saved by the hospital in Thailand. This was due to the correct evaluation of the medical situation by the Poe-ma coordinator who, under enormous pressure from the local medical team, managed to avoid the surgery. Alexandra warned that the attitude of the Lao hospital, demanding the use of their own ambulances and inflated prices, although unethical, was not uncommon in Laos.
For the full conference review, please follow this link