Transfer of a complex tetraplegic patient via commercial airline
This case illustrates Prime Nursing Care’s comprehensive process for the medical repatriation of a complex tetraplegic patient from Bern, Switzerland, to Boston in the US, via a commercial airline medical stretcher
The patient
A 34-year-old male with no prior medical history sustained severe cervical trauma while skiing in Switzerland. He developed tetraplegia and was airlifted with haemodynamic instability and bradycardia, requiring resuscitation during transport.
Upon arrival at the hospital in Bern, a CT scan of the cervical spine revealed vertical burst fractures of C4-C6 and dislocation of C5. The CT scan of the head revealed a subarachnoid haemorrhage.
He underwent the first stabilisation with decompression surgery the same day. The follow-up MRI showed severe myelin injury.
He underwent the second stabilisation surgery three days later and was cleared for commercial airline medical repatriation to the US 12 days after surgery.
The medical intake
A medical intake was completed, and the patient was assigned a high-risk score, prompting escalation to the Clinical Care Team for review and recommendations.
A 34-year-old male with no prior medical history sustained severe cervical trauma while skiing in Switzerland
Prime Nursing Care’s Clinical Care Team
The Prime Nursing Care Clinical Care Team has more than 150 years of combined expertise in critical care air medical transport. The team comprises the Medical Director, the Chief Medical Consultant, the CEO, the Director of Quality Assurance, and the Chief Flight Nurses.
The Prime Nursing Care Clinical Care Team has more than 150 years of combined expertise in critical care air medical transport
The case evaluation included discussions of the patient’s needs during the mission and of risk mitigation strategies to address potential complications.
The following equipment was recommended: a cardiac monitor, ACLS medications, advanced airway equipment, battery-powered suction, intravenous fluids, and a portable oxygen concentrator with enough batteries for the flight.
The Medical Director gave provisional approval for a stretcher flight mission staffed by a critical care physician and a critical care nurse. Final approval would be granted after the Clinical Care Team reviewed the findings of the initial assessment.
The mission
The air medical staff were briefed and flew to Switzerland the day before the repatriation to assess the patient and to plan the mission with the hospital’s treating team.
The total mission time from pickup in Switzerland to transfer in the US was 16.5 hours
A thorough exam assessed his clinical status, including current challenges related to impaired thermoregulation. They ensured that his central venous catheter and bladder catheter were patent and secured for transport. They reviewed his medications, including dosages and administration timing during the flight. The cervical collar would remain in place during the mission. Finally, the entire repatriation plan was explained to the patient and the travel companion. The Clinical Care Team reviewed the above findings, and the Medical Director gave final approval for the mission to proceed as planned.
On the day of repatriation, the patient was found to be hypotensive and showed signs of mild dehydration. Fluids were administered, and the vital signs improved. He was transferred to the ambulance stretcher, and the trip to Zurich airport took two hours.
Once at the airport, check-in procedures were completed, and the patient was transferred from the ambulance to the aircraft stretcher. The team added a mattress to the stretcher to prevent pressure-related skin breakdown.
After transfer to the plane, the patient’s temperature was 39.6°C. The team consulted with the Clinical Care Team to discuss the rapid increase in core temperature. The patient’s temperature normalised with intervention.
The flight was 8.5 hours. His vital signs were monitored; he received supplemental oxygen and IV fluids; he was rotated every two hours; and he received his medications as scheduled. Communication with the Clinical Care Team remained open throughout the transatlantic flight.
Upon landing, passport control was conducted on board the plane. The patient was then transferred to an ambulance and transported for two hours to the receiving hospital.
The foundation of an effective process delivers a successful outcome with patient safety at the forefront
The patient was transferred to the hospital in Boston without any change in his clinical condition. The total mission time from pickup in Switzerland to transfer in the US was 16.5 hours. The foundation of an effective process delivers a successful outcome with patient safety at the forefront.
Effectiveness of the process
The Clinical Care Team's review and recommendations, the air medical staff’s skills, and communications with our flight coordinators and the insurance company were all essential to a successful repatriation.
This complex case demonstrates the effectiveness of the process Prime Nursing Care has established for reviewing all elevated-risk transfers and shows that these patients can be safely transported by commercial aircraft.
Franziska Hollenstein
Founder, Prime Nursing Care
Franziska founded Prime Nursing Care in 2004, offering specialised commercial medical escort services worldwide, including air, sea, and ground repatriations, as well as critical care medical escort flights. Headquartered in Hollywood, Florida, with a European base in Switzerland, the company is recognised as a EURAMI-accredited advanced care provider for commercial airline medical escorts. She has personally completed over 2,700 commercial and air ambulance repatriations throughout her career.
Franziska’s passion for safe patient transport, including all the logistical components, is palpable. As an accomplished and dedicated flight nurse, she strongly champions staffing wellbeing as a fundamental pillar of onboard safety, recognising that a healthy, supported team is essential to delivering high-quality patient care on every mission.
She has been advancing industry standards and doesn’t shy away from challenges. Franziska’s vision is to align repatriation requests with the patient’s needs, comfort, and safety.
About Prime Nursing Care
Prime Nursing Care was founded in 2004. Prime has successfully repatriated over 4,300 patients. Every team member has extensive experience in critical care/air ambulance patient transports. Prime is an industry leader, recognised for safely repatriating complex patients. With staff strategically positioned worldwide, patients can be transferred on short notice, ensuring they reach the next level of care cost-effectively
June 2026
Issue
Welcome to your June issue! In this month’s magazine we look at medical escorts – a critical part of patient transport, with direct implications for patient safety, clinical outcomes, operational efficiency and cost. We also examine the interplay between governments and private business when responding to a disaster.
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.
