Paediatric escalation and operational readiness for aeromedical evacuations from resource-limited locations
Sunisa Dissayasriroj of Medical Wings reveals how over-preparation and decisive bedside escalation helped stabilise a critically ill infant for safe aeromedical evacuation
Aeromedical evacuation of critically ill paediatric patients from resource-constrained settings poses severe risks due to information asymmetry and pre-flight communication blackouts. This case highlights a sevenmonth-old infant transported via fixedwing air ambulance who experienced critical clinical decompensation despite reports of minimal pre-flight oxygen needs. Through operational readiness, clinical advocacy, and immediate escalation to high-flow nasal cannula (HFNC), the transport team successfully stabilised the patient – demonstrating the necessity of an ‘over-preparation strategy’.
1. Pre-flight challenges and strategy
• Context: retrieving paediatric patients from hospitals in Asia outside the major metropolitan areas is frequently characterised by prolonged admissions, limited diagnostics, and difficulties in achieving direct consultation with sending physicians
• Clinical history: 17-day admission for right-sided pneumonic consolidation and septicaemia. Failed CPAP deescalation with persistent hypercapnia and hypoxemia (PaC02 57.8mmHg, Pa02 35mmHg)
• The over-preparation strategy: unable to rely on unconfirmed and static admission summaries, the flight team brought their full PICU payload (transport ventilators, non-invasive interfaces, and HFNC) directly to the bedside.
2. Poor correlation between reported condition and bedside assessment
Local coordinators reported minimal oxygen requirements (2L/min) and advised leaving heavy equipment behind. Driven by a strong safety culture, the team maintained their full equipment footprint.
Bedside findings:
• Neurological/physical: severe lethargy, hypoactivity, and faint crying – indicating impending respiratory muscle exhaustion rather than true stability
• Respiratory/vitals: a single nasal prong loosely in one nostril; HR 151bpm, Sp02 96%, scalp IV access
• Key insight: in infants, the lack of overt distress often masks terminal fatigue.
3. Bedside escalation prior to flight and outcomes
• Respiratory support: initiated HFNC with heated, humidified oxygen (18– 20L/min, Fi02 0.25–0.40), significantly reducing work of breathing
• Therapy and thermal care: administered IV Meropenem; managed fever spikes (up to 38.8°C) via antipyretics and tepid sponging
• Recovery milestone: as ventilation improved and fever abated, the infant regained neuromuscular strength, actively grasping the flight nurse’s hand. This small act marked improved cerebral perfusion and a positive response to critical interventions.
4. Key takeaways
1. Beware of ‘false stability’: minimal oxygen flow in low-resource settings often reflects equipment scarcity, not clinical recovery
2. Imperative of over-preparation: compromising equipment based on limited and often unreliable reports risks losing critical capabilities (e.g. HFNC) needed to prevent emergency in-flight intubation
3. Closing the information gap: direct bedside clinical assessment by specialised flight crew remains the gold standard for determining in-flight care strategies.
Sunisa Dissayasriroj, M.Sc., BSN, is the Medical Standards and Flight Nurse Manager at Medical Wings, Siam Land Flying. With 12 years in aviation medicine and 27 years in nursing, Sunisa leads quality assurance, driving operational compliance to secure and maintain CAMTS Global and EURAMI accreditations. Established in 1999, Medical Wings operated by Siam Land Flying is accredited by CAMTS and EURAMI to provide bed-to-bed air ambulance transfer for patients with the most critical medical needs. Operating throughout Asia and beyond, on a 24/7 basis, Medical Wings is fully equipped to care for the patient’s requirements.
September 2026
Issue
This issue we focus on the problems that rising costs are having on the industry. Air ambulance providers are facing costs across fuel, aircraft maintenance, staffing, insurance, regulatory compliance, and specialist medical equipment. As if that wasn’t enough, delayed payments from insurers are adding further financial pressure. Despite these challenges, providers agree that patient safety and clinical quality must not be compromised.
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