Tight timings

Recently HAC Medical received a medical air evacuation call late in the afternoon at 15:57 hrs to evacuate an urgent trauma case, a male patient who had suffered a boating incident, from Mozambique to South Africa. The patient was in the local hospital in Praia de Bilene, a small town on the Mozambique coast around 950 kilometres from Harare, Zimbabwe, HAC’s air base. No other information was received.

The availability and level of medical care outside of major cities in Africa is extremely variable, and additionally the quality of runways and availability of after-dark operations is limited. We therefore knew that getting enough information to complete flight planning, activate the flight, and obtain clearances to land at night was critical in this instance.

Our flight planning process picked up that although Praia de Bilene has a registered airport, it was out of service and closed. The nearest serviceable airfield, at Xai-Xai, a town some 80 kilometres to the north, confirmed that they were open, but would close at 5pm.

We were activated by the assistance company at 16:44 hrs, just 16 minutes before the Xai-Xai airport closing time, but luckily we managed to request them to remain open, and they agreed, but for a fee of US$125/hour. Any attempt to contact them after 5pm would have failed, resulting in no possibility of flying in until morning. Our team were dispatched and ready to depart Harare by 17:26 hrs. We also immediately applied for flight clearance into Mozambique from Zimbabwe, which was granted at 18:24 hrs, taking 1 hour 40 minutes. South Africa, our drop-off destination, require Port Health clearance, including a medical report with the diagnosis, the reason for the transfer, and a letter from the receiving doctor and hospital in South Africa before flight clearance is granted. These clearances were finally granted at 18:46 hrs and engines started at 18:55 hrs with arrival in Xai-Xai at 21:07 hrs, four hours after their closing time.

In the meantime, the patient’s father had transported him from Praia de Beline to the hospital in Xai-Xai in his private vehicle. He was also able to send photographs of the injuries and pictures of the X-rays from there.

The patient was transported from hospital to the airport by ground ambulance, arriving as our aircraft landed. However, there was a further 30-minute delay as the airport authorities initially refused to allow the ground ambulance onto the apron. During this delay, our flight doctor and nurse had the first opportunity to undertake a full assessment of the patient’s injuries. He was a 17-yearold male who had been injured 10 hours earlier by the propeller of a motor boat that capsized. His injury was to his right lower limb, where he had sustained a Gustilo Anderson IIIB compound fracture of his tibia with a floating patella as a result of a traumatic rupture of his quadriceps insertion and his ligamentum patellae. There were no neurovascular injuries. Seawater contamination of grade IIIB compound fractures are renowned for the increased risk of infection, and the longer the time to initial surgery, the higher the risk.

The flight to Johannesburg, South Africa, was uneventful, the patient arriving stable at the destination hospital at 1:00 hrs. However, if we had been activated just 16 minutes later, after XaiXai airport had closed, there would have been a further 13 hours’ delay before the airport reopened, raising the high infection risk considerably, and possibly a very different outcome.