Seamless coordination across borders

Introduction

In July 2023, a devastating gas explosion in a Punta Cana apartment left a family of three with life-threatening injuries. The father, mother, and their infant all sustained extensive burns ranging from 45% to 82% of total body surface area, along with severe inhalation damage and traumarelated complications.

AeroAmbulance was activated to deliver an urgent aeromedical response. What followed was a multi-phase operation involving simultaneous helicopter and fixed-wing missions, critical care ground transport units (CCTUs), and eventual international evacuation to hospitals in Miami, Florida, US.

The challenge

The complexity of this mission lay in the sheer scale and urgency:

• Three critical patients with advanced airway compromise, all requiring ventilatory support

• Severe burns affecting between 45% and 82% of body surface area

• Parallel missions using both rotary and fixed-wing aircraft

• Infrastructure disruption when lightning temporarily closed Punta Cana airport

• International logistics barriers, including a shortage of ambulances in Miami during early morning hours.

This high-pressure environment demanded split-second decision-making and a robust chain of coordination among hospitals, aviation authorities, and international partners.

The response

Domestic transfers were the first priority. A one-year-old infant was airlifted on a domestic ambulance flight by helicopter from Punta Cana to Santiago, Dominican Republic, to a regional pediatric hospital specialising in pediatric burns.

The parents were stabilised and transported separately on fixed-wing aircraft to Santo Domingo’s Trauma Hospital with burn unit capabilities.

At every phase, the CCTUs ensured continuity between hospitals and airports, maintaining invasive ventilation and haemodynamic stability during transfers.

Once stabilised in national centres, the patients were prepared for the longer international leg. Ventilator settings, fluid management, and haemodynamic monitoring were carefully optimised and communicated to the receiving teams.

International evacuation required flawless coordination with hospitals in Miami. ICU availability was secured in advance, receiving physicians were identified, and real-time clinical updates – including ventilator parameters – were relayed to guarantee seamless continuity of care.

When Punta Cana airport was closed by a lightning strike, the operation was swiftly diverted to Las Américas International irport. Despite the disruption, critical care physicians maintained patient stability without clinical deterioration.

Ground logistics in Florida posed another challenge. At 04:00 hrs, ambulance capacity in Miami was unavailable. AeroAmbulance’s medical controllers negotiated alternatives, finally securing ALS units for 08:00 hrs. In the meantime, crews remained bedside with the patients in the Dominican Republic until transport was available, ensuring no break in critical care delivery.

The operation highlighted the value of integrated air and ground medical resources

The outcome

All three patients were successfully handed over to burn units in Miami in stable conditions. The operation highlighted the value of integrated air and ground medical resources and the adaptability of specialised crews when faced with evolving challenges.

Conclusion

This mission underscored the importance of resilience, adaptability, and seamless coordination in aeromedical operations. By integrating helicopters, fixed-wing aircraft, and critical care ground units, AeroAmbulance ensured uninterrupted care across multiple borders and facilities. Key lessons emerged: redundancy in resources allowed simultaneous missions without compromising safety; proactive communication with receiving hospitals guaranteed ICU readiness and ventilator continuity; and international partnerships proved vital when local capacity was limited. Precision and real-time coordination built trust with families, providers, and partners alike. Ultimately, this operation demonstrated that when every minute counts, operational excellence and collaboration can be the difference between tragedy and survival.