Navigating complexity
A challenging air ambulance mission from Mombasa to Munich, for the Malteser Aeromedical team.
In the field of aeromedical transports, the need for rapid and efficient medical decision-making becomes paramount when dealing with complex medical cases. This case study sheds light on a challenging mission conducted by Malteser Aeromedical, involving the transportation of a male patient from Mombasa, Kenya, to Munich, Germany. The patient presented a myriad of severe health issues, including Chronic Obstructive Pulmonary Disease (COPD), severe apnea, known HIV infection, and oedema in his feet in addition to proving to be challenging to convince him of allowing necessary preparations to bring him home.
The patient, a winter visitor in Mombasa, experienced a sudden deterioration in health when out on a walk, necessitating immediate medical attention. The local hospital diagnosed him with COPD, severe apnea, and oedema in his feet. Despite recommendations for a chest drain procedure to alleviate his respiratory distress, the patient adamantly refused the intervention – a requirement for safe aeromedical transport back to Germany.
Upon receiving the request for air ambulance transport, Malteser Aeromedical initiated a comprehensive pre-flight assessment. The medical team, consisting of highly skilled and experienced professionals, collaborated closely with local medical authorities in Mombasa to gather vital information about the patient's medical history and current condition. Working constantly to assure a swift repatriation process, the team also liaised with the patient's family on-site to ensure a thorough understanding of his complex health issues and to inform the patient and his loved ones about the necessary treatment and crucial decision to have a chest drain placed before departure.
A Learjet 45 was prepared for the mission and Malteser’s Aeromedical team made its way to Mombasa. Upon arriving in Kenya, the team made its way to the hospital to meet up with the patient and evaluate the situation and necessary next steps.
Upon closer examination, the Malteser Aeromedical team encountered additional complications. The patient exhibited a severe dyspnea and poor oxygen saturation. The breathing rate was only 35, and the oxygen saturation dropped to 88mm Hg, even with five litres of oxygen supplementation. X-rays of the lungs revealed complete shading of the right lung with a pronounced pleural effusion. The effusion had significantly increased in the past few days.
The team had initially proposed a thoracic drainage procedure to alleviate the situation, but the patient refused, expressing a preference for the procedure upon return to Germany. A collective decision was made that the patient was not suitable for air ambulance transport in this condition at that point of time. It was agreed that onsite thoracic drainage was necessary, followed by another X-ray. The patient's eligibility for ambulance transport would be reassessed based on improvements in the lung situation the next day.
Recognising the importance of stabilising the patient for a safe flight, the team contacted the headquarter of Malteser Aeromedical in Cologne to confirm that the transport would be delayed by one day to allow for the necessary treatment to take place and to convince the patient of the necessity of placing a chest drain.
In this case, the challenge was not only medical but also psychological, as the team needed to gain the patient's trust and cooperation. Through empathetic communication and personalised care, the team succeeded in convincing the patient of the necessity of the interventions for a safe flight. Having stabilised overnight and with a chest tube now in-situ, the team arrived back at the hospital on the next day. To further stabilise the patient, the same was intubated and the team was able to load the patient into the waiting ambulance and air ambulance at the airport in Mombasa. After an uneventful flight, the patient was handed to the local treating hospital in Munich for further examination and recovery.
In the face of unexpected challenges and a notably intricate patient situation, Malteser Aeromedical demonstrated remarkable adaptability, expertise, and unwavering dedication to patient care. The organisation's adept handling of the complexities arising from the patient's declining health showcased its commitment to delivering exceptional air ambulance services all around the world.
By successfully navigating through the patient’s concerns and explaining its medical necessity, the team at Malteser Aeromedical reinforced its pledge to prioritise the safety and wellbeing of all its patients, however complex the situation might be. This case stands as a true testament to the resilience and extensive capabilities of Malteser Aeromedical in managing challenging medical missions