Repatriating an elderly patient with severe cancer
Bluedot explains how it oversaw the transport of a 74-year-old man with advanced prostate carcinoma and multi-organ metastases home to Bangladesh
A 74-year-old male from Dhaka, Bangladesh, diagnosed with carcinoma prostate with lung and skeletal metastases, was undergoing treatment at a metropolitan city hospital in India.
The patient, who was on non-invasive ventilation (NIV) support for respiratory distress, experienced impending respiratory failure. The family decided to discontinue treatment after the treating doctor provided a clear explanation of the prognosis.
A need for intubation and mechanical ventilation
Following a direct assessment by the Bluedot medical team, in coordination with the treating hospital’s critical care team, it was concluded that endotracheal intubation and mechanical ventilation were required to ensure a safe transfer. With informed consent from the family, the patient was successfully intubated and stabilised.
Over the next 12 hours, the patient’s condition was closely monitored including serial arterial blood gas (ABG) analyses to assess respiratory and metabolic stability. Once he was deemed fit to fly, despite being on triple inotropic support, the air ambulance mission was activated.
The journey home
The patient was transferred via advanced life support (ALS) ground ambulance to a dedicated, fully equipped air ambulance jet. The aircraft carried essential lifesaving equipment, including two ventilators, a defibrillator monitor, and multiple syringe and infusion pumps, ensuring comprehensive critical care capabilities in-flight.
The onboard medical team, comprising an experienced flight physician and an air paramedic trained in aeromedical critical care, provided continuous monitoring, timely interventions, and stabilisation throughout the 3.5-hour flight. Upon arrival, a pre-arranged ground ambulance was waiting at the destination airport, ensuring seamless transfer to a super-specialty hospital, where the patient received prompt critical care.
Conclusions
This case highlights the vital role of coordinated ground and air medical services in ensuring the safe and efficient transfer of critically ill patients, particularly those requiring complex interventions during transport. The need for a primary direct evaluation and elective intubation prior to transport significantly facilitated a smooth and controlled repatriation, ensuring patient stability throughout the journey.
Dr Rahul Krishnadas MBBS, MEM, FCCM, Lead Medical Services and Flight Physician, Bluedot
Dr Krishnadas is a seasoned Critical Care Specialist and Intensivist with an extensive 11 years of practice in critical care units. He is an adept Flight Physician with a commendable track record of safely transporting over 100 international patients. His medical acumen is fortified with an MBBS, a Master’s in Emergency Medicine (MEM), and a Fellowship in Critical Care Medicine (FCCM) from Apollo Hospitals.Dr Krishnadas is certified in Advanced Cardiovascular Life Support (ACLS) and Basic Life Support (BLS) through the American Heart Association.
April 2025
Issue
In this issue we focus on how AI is transforming claims management; how assistance firms navigate the unique challenges of working in Africa; and what the potential legal risks are when conducting a medical transfer.
Editorial Team
The Editorial Team updates the ITIJ website daily, and works on features for the print edition. With expert industry knowledge and years of experience in writing about complex travel insurance issues, the Editorial Team is ready to investigate and report on the topics that matter most to ITIJ's readers.
