Overcoming challenges in a longdistance ICU repatriation

European Air Ambulance (EAA) recently received a request from its trusted partner MedResQ for a challenging air ambulance flight from Madeira Island, Portugal, to Iloilo, in the Philippines for a young Filipino citizen who had fallen critically ill during his stay on a cruise ship.

From a medical perspective, the initial medical clearing was already performed by MedResQ in close collaboration with the local hospital in Madeira. After the go-ahead from the Medical Department of EAA, the planning for the repatriation of the ICU patient was performed.

The mission

The total journey time for the patient from the hospital in Madeira to the hospital in the Philippines was estimated at around 23 hours, a long journey for the ICU patient. The mission planning posed significant challenges; a unique aspect of this operation was the combination of two aircraft types, the Learjet 45XR and the Challenger 605, resulting in a wingto-wing transfer within EAA’s own fleet at its home base in Luxembourg.

Despite the many challenges faced during the mission, the patient’s medical condition remained stable throughout the long air ambulance transfer

Given the patient’s stable but still ICUdependent condition and the extended total journey time, EAA’s Operations and Medical Department decided to split the flight crew and the medical crew into three separate teams. This ensured reasonable working hours for the three involved crews, allowing for optimal patient care while mitigating the risks of fatigue among the medical staff and respecting the legal working hours for the entire team.

Hence, Team A was planned to pick up the patient from the hospital in Madeira and fly him to Luxembourg on the Learjet 45XR, where Team B was waiting to transfer him to the long-range Challenger 605. Team C was pre-positioned to Dubai, via commercial airline; where they took over from Team B and completed the final leg to the Philippines. This meticulous planning ensured a seamless transfer, prioritising both patient safety and crew efficiency throughout the mission. Clear and effective communication between EAA and MedResQ was kept throughout all planning stages.

Weather challenges

However, it turned out that the weather forecast for Madeira Island would severely impact the start of the mission. Rain, thunderstorms and wind gusts of over 100km/h made it impossible for EAA’s Learjet 45XR to land safely. In close coordination with MedResQ, the entire mission was postponed for 24 hours to ensure a safe transfer. Once the storm had passed, operations could resume. Following a final medical clearing between all involved teams, the Learjet 45XR departed for Madeira and returned a few hours later to Luxembourg with the ICU patient on board.

The wing-to-wing transfer was smoothly executed inside EAA’s hangar, where the Challenger 605 was already prepared for departure. After a seamless handover between the medical crews, the Challenger 605 took off towards the Philippines, with a scheduled fuel stop and crew change in Dubai (UAE) and another fuel stop in Hyderabad (India).

A total flight time of 18 hours and 31 minutes was finally logged from Madeira airport to Iloilo airport. Despite the many challenges faced during the mission, the patient’s medical condition remained stable throughout the long air ambulance transfer under the supervision of EAA’s medical teams. Upon arrival in Iloilo, the patient was handed over to the local medical team and transferred to the hospital for further ICU therapy to support his recovery surrounded by his family and friends, in a familiar environment, not far from home.

Despite the challenges faced during both the planning and execution of these air ambulance missions, the importance of effective teamwork between the client and the operator cannot be overstated. While each party encounters its own difficulties, close collaboration, honesty, transparency, and efficient communication are key to ensuring successful execution and complete satisfaction for all involved.