Repatriating a cruise ship passenger from Australia to Europe
The mission involved close collaboration and effective communication.
Prime Nursing Care CEO Franziska Hollenstein and Medical Director Dr Michael Dudnick recount a mission that involved close cooperation between an air ambulance team and a commercial airline medical escort team to ensure the safe repatriation of a cruise ship employee from Brisbane, Australia, to Palma de Mallorca, Spain.
The patient had a history of renal cell carcinoma with a nephrectomy some five years earlier. He developed progressively worsening back pain, weakness, ataxia, and painful tingling in his extremities. He experienced some pain relief with steroids and Ketorolac injections administered aboard the ship. However, he was referred to a hospital in Brisbane for further evaluation due to persistent ataxia and weakness.
Radiologic imaging demonstrated a spinal mass at T3 with cord compression. There were innumerable lesions throughout the lung parenchyma and solid lesions in the remaining kidney.
The patient had emergent surgery to relieve the spinal cord compression, including placing T2-T5 pedicle screw fixators.
Postoperatively, the patient developed Klebsiella urosepsis and was treated with antibiotics. He also underwent initial radiation therapy.
After the patient stabilised, the insurance company, in conjunction with the hospital staff and the patient, decided to repatriate him home for continued treatment.
Unfortunately, the patient's sitting tolerance was only 1–1.5 hours, and he had ambulatory dysfunction. His weight was 110kg, and he had developed an early sacral base decubitus. Collectively, these issues presented several challenges for the repatriation.
Prime Nursing Care reviewed the medical records, followed by lengthy conversations with the patient, his spouse, the insurance company's medical department, the hospital case social worker, and Prime Nursing Care's medical team to determine the safest and quickest way to repatriate the patient.
It was clear from the outset that this patient could not tolerate a lengthy commercial airline repatriation in a business-class seat; instead, he would require a stretcher aboard the aircraft.
Commercial stretcher flights were available from Singapore to Frankfurt and from Frankfurt to Palma de Mallorca, Spain.
Prime Nursing Care submitted the MEDIF for airline clearance. Their medical department requested additional imaging studies before they could approve this mission.
Thinking outside the box, Prime coordinated with an air ambulance team to pick up the patient at the hospital in Brisbane. The team fl ew the patient via air ambulance from Brisbane to Darwin (2,128 miles), continuing from Darwin to Singapore (2,081 miles).
The air ambulance team handed the patient over to Prime's medical team, a flight physician, and a flight nurse. Prime's team completed the commercial stretcher flight to Frankfurt, Germany (6,372 miles), and the final leg to Palma De Mallorca, Spain (777 miles).
The air ambulance and commercial airline medical escort teams coordinated medical care en route. They coordinated logistics, including immigration, and were in constant communication to ensure a seamless transfer of care.
The patient arrived safely in Spain, and the mission was a success. The total miles flown was more than 11,300 miles.
This mission demonstrates that a blended repatriation model is safe, effective, and can accomplish a lengthy transport quickly to the benefit of the patient