A successful repatriation from Greece to the UK

Irena Dimitrijevic (ID): Markus, what was the diagnosis for the patient?

Markus Lehner (ML): The patient had suffered a stumbling fall while on Rhodes. She took three doses of 400mg ibuprofen throughout the day without success. A doctor administered two medications intramuscularly, but no documentation was provided and no reduction in pain was achieved. At the hospital, a stable lateral fracture of the third lumbar vertebral body was found. Additionally, there were slight disc bulges at the L1/L2, L2/L3, and L3/L4 levels, as well as a complete disc prolapse at L4/L5.

ID: What treatment did you administer during the repatriation, and did any complications occur?

ML: At the hospital, the patient’s IV access was removed. After informing the patient and obtaining her consent, I established a new IV line before the flight. A 20G cannula was inserted without complications on the back of her left hand, and an infusion solution was connected to maintain the cannula’s patency. During the flight, as the pain in her left leg intensified (seven out of ten), I administered 5mg of piritramide intravenously. After a few minutes, there was a significant reduction in pain and the patient fell asleep. Later in the flight, due to rising pain again, about 30 minutes before landing, an additional 3mg of piritramide were given.

Dr Hubert Reichle (HR): We applied our Pre-Transport Risk Assessment System as we do for every mission. I analysed all the relevant vital parameters and findings from the hospital. Since there were no pre-existing conditions, nothing stood in the way of carrying out the repatriation by Markus himself, who had extensive experience in emercency medicine, anaesthesia and in clinical settings, which is why I had no concerns. We always apply a pointsystem to determine which medical crew configuration is required for each mission.

ID: Did you feel safe during the flight, or did you have any concerns?

ML: No, no concerns at all. It was an uncomplicated mission, like those performed many times daily on ground transports in Germany. However, the aviation sector is highly regulated. As the fracture was stable, I did not expect any problems.

ID: Would you do it the same way again, or would you feel safer with a doctor or an additional paramedic on board?

ML: In the case of an unstable fracture, I would bring along a second person. Additional support is necessary, especially if the patient needs to be moved or repositioned. It may be too difficult for one person on their own.

HR: Two people are generally always better than one, if only for mutual support. But in the end, it is also a financial decision by the client. The second person does not necessarily have to be a highly qualified emergency paramedic – a rescue assistant or a nurse can also be sufficient. This approach is already common practice in the US and Great Britain for example.

ID: Did you have prior support from the medical director?

ML: Yes, of course, Dr Reichle is always available on the phone, even during handovers at the pick-up destination or during fuel stops.

HR: The concept was of course approved by the client and the feedback was that the patient was handed over at the destination pain-free, stable, and content. Her accompanied husband was very pleased with the outcome of the repatriation.