The key to successful remote evacuations

Travel assistance requires rapid response

ITIJ also spoke with Jonathan Brown, Risk Team Manager, Charles Taylor Assistance, who said that the combination of urgency and remoteness is what makes these types of rescues so challenging. “By definition, any emergency requires a rapid response, but when the patient is somewhere difficult to reach physically – and often difficult to communicate with too – all of the ‘normal’ complications become that much harder to resolve,” he said. “Timing is always important, but when you need to reach an official for a flight permit at night or on their day off, and the patient isn’t yet somewhere they can be stabilised, every minute counts.”

For Rowland Raikes, Director of Medical Rescue International, which works on behalf of ship owners and their Protection and Indemnity Associations (marine liability insurers) specialising in the care and repatriation of merchant seafarers, there are a number of key challenges, which he shared with ITIJ: “Our main challenges are: accurate preliminary diagnosis, often by radio, email or satellite telephone so that we may advise whether immediate repatriation is indicated or whether the patient needs to spend some time in a local medical facility, if available; making contact with reliable agents in the port of disembarkation; liaison with local medical facilities, if there are any, as translation difficulties may be encountered; finding a route out of the remote port by sea, land or air; possible lack of availability of local transportation assets, such as helicopter and fixed-wing air ambulance to respond in good time; and if medical escorts and scheduled air travel is indicated, finding the nearest major airport, gaining access to the country for our escorts, and transporting the patient to it.”

There is no denying that challenges are numerous when it comes to the execution of remote evacuations, so how can global assistance providers set themselves up to offer an effective service to clients? Establishing and maintaining local service provider networks is crucial, as Dodge confirms: “Maintaining a global network is key,” he said. “The assistance providers that Arch RoamRight partners with are continually monitoring and updating all of the resources in their network. It has a team of people who are dedicated to travelling around the world and assessing each medical facility, air ambulance, and security partner they use. This way, when an event occurs, they know exactly who to call for help.” Brown also emphasised the importance of a strong network and stated that preparation, due diligence, openness and communication are equally important. “An effective local emergency response relies upon a good network of tried and tested providers. Experience and strong relationships built up over time will see you through difficult cases,” he said.

Dr Morgan agrees that a solid network is paramount and also highlighted other elements that need to be in place in order for a global assistance provider to provide a remote evacuation service, including an experienced team and effective risk evaluation. “Firstly, the assistance provider must have a team of experienced co-ordinators and medical professionals capable of understanding the difficult local logistics and with the confidence to make clear medical decisions,” he stated. “Secondly, global assistance providers must maintain a network of relationships with local assistance agents in each country around the world. When required, these agents can, in turn, leverage their local expertise and relationships to activate local transport solutions for remote rescues. Finally, global assistance companies must work with their clients to understand their patterns of risk. These allow the details of remote rescues to be planned in advance, including the identification of appropriate local providers. This can significantly speed up evacuation response times and give the client insight into what to expect should a medical emergency occur.”

For Raikes, an important asset is having reliable and knowledgeable local representation. “We are lucky in some ways in that the shipping industry has a huge network of agents in every port in the world who have to deal with all the different requirements that a ship may have including medical emergencies,” he told ITIJ. “In addition, the maritime insurers have people they call correspondents who are represented in all countries and often also in individual ports. Good local providers will be involved with translation, ground ambulance transportation, visits to hospital (if available) and provision of funds for local assistance, where cash may be needed rather than more sophisticated methods of payment.”

Facilitating the remote rescue process

The advent of new and improved technologies has significantly benefited remote evacuations in different ways, including enhanced communication and mapping. “The most important advances have been in satellite and mobile phone telephony to enable communication to and from many remote locations. This assists accurate diagnosis, swifter provision of first aid, remote medical advice and faster provision of initial transportation out of the area,” said Raikes. Dodge agrees: “Communication has become easier with expanding cell phone networks. When verbal communication can’t get through, text messages may suffice. We can also use cell phone tracking technology to pinpoint the location of an individual if it is needed,” he told ITIJ. Dodge also said that co-ordinating with booking technology is helpful. “If we know ahead of time that we have a group of travellers going to a remote area, we can proactively pull a list of nearby resources to have on hand in case of an emergency,” he explained.

Dr Morgan also notes that modern technology has helped with communication and mapping. “Although it remains the case that many remote locations are beyond cellular networks, that is by no means always the case. Indeed, cellular technology is surprisingly widespread even in some of the world’s most resource-poor countries,” he stated. “Provided with the patient’s location from a smartphone or GPS tracker, our co-ordinators can now use computer desktop mapping software to precisely assess the local geographical considerations. The detail available on these applications gets progressively better year after year.” For Brown, improvements in mapping, access to information and communication facilitate preparations. “Smartphones make the sharing of medical information easier, for example a photo of a wound. Travel tracking and geolocation services can save valuable time that would otherwise be spent by rescuers trying to find the patient – and can even be used to trigger alarms and alert colleagues,” he told ITIJ.

Lessons learned and experience earned

When it comes to the most important lessons learned over the years, Dodge has learned that flexibility is paramount. “The most important lesson is to be flexible. Even when you think you have everything planned out, something can happen and quickly and easily force you to change plans,” he said and shared an example of this with ITIJ: “In a security evacuation from Haiti, we had planned to evacuate a group through the airport, but when the road to the airport became unsafe, we had to use a helicopter to evacuate instead.”

For Dr Morgan, the most vital lesson learned is finessing communication with clients. “In preparing for remote rescue possibilities, it pays to work closely with the client to understand as much as possible about the travel they intend to undertake. This includes gaining a detailed understanding of where they are going and what they will be doing, as well as carrying out a thorough consideration of what would happen in the event of a medical emergency,” he told ITIJ. Examples of important considerations, Dr Morgan says, are which communication devices travellers intend to carry, whether they will have a medical kit with them, if any member of the party is medically trained, who among the party will be in charge should a medical emergency occur, and whether anyone in the group has any notable pre-existing medical conditions. Brown is also a proponent of good communication: “Communications – during any incident, including alternative ways of making and staying in contact, knowing who to include in the loop and what information will be needed – remain as important as ever,” he said. Another lesson noted by Brown is the importance of thorough research and preparation ahead of time. “This includes considering a wide range of fall-back options and involves making the most of strong connections with local partners,” he explained.

When looking ahead and taking stock of lessons learned, in which ways will the industry be moving forward and are there any gaps that need filling? Raikes believes that the industry would benefit from a database of information about remote locations on a worldwide and country-by-country basis. “This would collate information from government and non-government sources, accurately describing facilities and situations. This would only be of any use if continuously kept up to date,” he said. For Brown, pre-travel screening and travel advice services are underused. “The widespread availability of specialist yet simple-to-use apps offers ways to make all this much more convenient for travellers. It may be that as we become used to using our phones to navigate Covid-19 regulations, there will be more interest in travel and risk management apps, as international travel more generally, and journeys to remote locations, become more frequent,” he told ITIJ.

Onwards and upwards

Adaptability and flexibility are inextricably linked to effective remote evacuations. “Adaptability comes from good planning, communications and experience, helped by effective working with clients and providers you trust,” Brown highlights. With so many components to the remote rescue process, which also possesses an intrinsic unpredictability, and with the speedy motion of the moving parts, flexibility is pivotal. Plans and circumstances can change in an instant and quick thinking is required. Other key components involved in executing a swift and efficient remote rescue are effective communication with clients and strong relationships with a solid network of providers and thorough preparation. Preparation is heralded as key in many situations, and that is certainly the case here and includes risk evaluation and improving understanding of patterns of risk. While technological advances have helped to facilitate remote rescues, it seems that this references improvements to existing technologies that have helped propel remote rescues forward. “Most technological improvements result in positive evolution rather than revolution,” summarised Brown. “In other words, new technologies help with many of the fundamentals, which have always been important.” Ultimately, remote rescues are, at their very core, challenging and are therefore never going to be deemed ‘easy’ but the key components are known and, with an already skilled and efficient industry striving to do better and better, it is a case of onwards and upwards. As Brown astutely concludes: “There is no silver bullet that can make remote rescues easy. Evacuations from remote locations test an assistance company’s capabilities like no other, but the foundations of success are not a mystery. The constant striving for quality and improvement, investment in good teams, technology and processes and strong relationships with partners, providers and clients are all mutually reinforcing. Prepare and share. There are no shortcuts.”